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The Voice of Healthcare - Episode 6

Co-hosts: Dr. Matt Cybulsky (Principal, Ionia) and Bradley Metrock (CEO, Score Publishing)

Guest: Nate Treloar, President & Chief Operating Officer of Orbita

Duration: 29 minutes, 17 seconds

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Bradley Metrock: [00:00:15] Hi, and welcome back to The Voice of Healthcare Episode 6, for Wednesday October 18, 2017. My name is Bradley Metrock. I'm the CEO of a company called Score Publishing based here in Nashville, Tennessee. My co-host for The Voice of Healthcare is Dr. Matt Cybulsky. Matt, say hello.


Matt Cybulsky: [00:00:36] Hey everybody. Good to be back, Bradley.


Bradley Metrock: [00:00:38] Good to be back with you, Matt. We skipped September, it seems. But it's great to be back with you exploring healthcare. This is a fun show. Thank you for setting this time aside. Our guest today is Nate Treloar. Nate, say hello.


Nate Treloar: [00:00:56] Hi guys, Matt, Bradley, it's good to be on the show with you.


Nate Treloar: [00:01:00] Thank you very much for joining us, Nate. And Nate's the president and COO of Orbita. Do I have that right?


Nate Treloar: [00:01:10] You got that right. You might also add in co-founder.


Bradley Metrock: [00:01:13] OK, excellent. And co-founder as well. So give us the elevator pitch on what Orbita is and does.


Nate Treloar: [00:01:21] Yeah, sure thing. Orbita is a software company. We're based here in Boston. We're not quite three years old. We started in early 2015. We're focused on the challenge of remote patient engagement, particularly for individuals that do not or cannot, for one reason or another, use the traditional smartphones, tablets, and other connected digital technologies that are becoming more common for improving patient care in remote settings. Our whole position on this is that with the rise of things like intelligent voice assistants, with the Amazon Echo being an example, we're seeing a transformation in how we can engage patients in remote care in this new digital world. But what we're seeing is that most health care organizations, home care organizations, and other similar organizations in the industry don't have the skills, tools or the ability, or even access to the tools to create and manage these applications in a way that makes sure that they're secure and robust and most importantly, in line with the goals of improving patient care and interfacing with existing systems.


Nate Treloar: [00:02:31] Our flagship offering is something we call Orbita Voice, and it's the first's sort of a buzz phrase, but I'll explain what enterprise-grade means in a second....enterprise-grade platform for creating and managing voice assistants and healthcare applications. So healthcare systems, care management service providers, and other organizations that we work with were seeking to improve remote patient engagement and education through these kinds of voice applications, and they use our technology to improve the way patients engage through the power of voice. A very simple example is being able to track through assessment surveys how an individual who might be under chronic care or care for a chronic ailment at home is progressing. And what we offer, and I have a number of examples, are application technologies, where the patient can interface with something like an Amazon Echo, and answer basic questions in the case of a patient, say with chronic rheumatoid arthritis, they might be asked questions like, "How easy is it for you to walk 500 steps on a scale of 1 to 10?" "How easy was it for you to dress today?" Asking basic questions and doing it through a voice interface so that they can actually gather that data or input that data without having to manipulate a smartphone.


Nate Treloar: [00:04:00] And then the other examples might be obvious, but patients who have vision impairment and cannot use traditional digital technologies like a smartphone or a tablet, voice is a great alternative to delivering them that same sort of experience with a hands-free type of environment.


Bradley Metrock: [00:04:21] So for somebody who's got a chronic condition, or one of the examples I believe you had on the web is somebody dealing with substance abuse who needs reinforcement, who needs nudging, this can step in and be something that really helps. I was struck looking at your site on really the humanity of what you managed to put together. The combination of the voice-first usages as well as some of the stuff you do that appears to be more mobile app driven, like the way that a patient or a user of Orbita Engage can lay out tasks that they need help with, "I need someone to bring dinner over" and "I need someone to take me to the doctor's office" .. and you've got all this stuff really integrated in a way that I think is really, really well put together. Can you talk to us a little bit about how you approach making sure the humanity of the patient stays at the front of what you're offering?


Nate Treloar: [00:05:30] Yeah, well, I'll tell you it's something that we've taken quite seriously, and the background of the team at Orbita....our technology guys, first and foremost, are trying to be aware of the problem and fall in love with the problem to before they fall in love with the solution and technology ... it's a challenge for people who are like us and hammered with technology. But we've really worked hard to understand what is the experience, and emphasize the word experience. That's going to be conducive to truly engaging a patient in their own care and empowering their friends and family and professional caregivers and ultimately informing their clinical care providers.


Nate Treloar: [00:06:17] Those are the three personalities or personas that we care about. The patient, their care team, and their circle care team around them, which can be their children or loved ones, and then the professional caregivers who are motivated to ensure that patient is getting the best possible care in any setting. We designed our whole platform around those concepts, and around the idea of optimizing the needs of each of those different stakeholders. And I think what you see in our material and the way are our technology comes forward, is an awareness of the needs of each of those individuals. We're not trying to put technology out there for technology's sake. While it's true that a lot of our technology is fairly general and can be applied across a variety of different use cases, what we want to do is make sure that we've identified the templates and patterns that represent the real value and important things that those different stakeholders care about.


Nate Treloar: [00:07:22] There are plenty of companies that have care management and home care monitoring solutions, and they're geared towards different ways of collecting data from the patient, like using a tablet or a smartphone like I said before, and increasingly these smart devices that are connected, like weight scales, or oximeters, or blood pressure monitors. And those are great ways of collecting very objective data about the wellness of the patient. But what they don't always do is take into consideration the patient's motivations and emotions for being a participant in their own care. That's how we like these voice assistant technologies, because they're not medical devices. They're lifestyle devices. So in addition to reporting your wellness through a device like an Amazon Echo, you can also play some music, listen to some Willie Nelson, check the weather, and find out who the Patriots beat this past week. And yeah, that was for you.


Bradley Metrock: [00:08:25] Yeah. Yeah, I got that.


Nate Treloar: [00:08:29] And I generally have an experience that's more whole health, not just around a particular kind of care need. Not to say that those other devices don't play a role in a connected health care experience but what we want to do is make sure that what we are putting forth to our customers, which is really enabling technology because to be clear we're not building the complete, last-mile solution. It's not a complete solution until the patients are onboarded, and it's hooked into a care plan and all the other things. We provide sort of the skeleton, the framework, for doing that. And our customers and healthcare systems and care management companies are building out the complete solution. So we're enabling technology in that ecosystem, but it doesn't mean that we're kind of removed from thinking about these things, so I'm glad to hear you point that out.


Bradley Metrock: [00:09:25] And so today, I'm just looking through your site, y'all released a press release full of a lot of different new enhancements that you brought to Orbita Voice, specifically sort of with the healthcare sector in mind. You want to share some of that with us?


Nate Treloar: [00:09:41] Yeah, that probably went out an hour ago.


Bradley Metrock: [00:09:45] Okay.


Nate Treloar: [00:09:46] Yeah. What you're referring to just went out today. We're getting ready for a release of our next version of Orbita Voice. We're informally referring to it as the enterprise release and what it includes in it are a number of capabilities that our customers have come to us and said, "These are of value to us, and if you can double down on these things..." They include, among other things, the ability to create these conversational health care applications in a way that allows you to publish them to different types of application frameworks.... I mentioned Amazon Alexa, which is Amazon's smart speaker. That's one platform. Google has their own as well, as does Microsoft. And there are bunch of other ones coming on the market. There are also telephone systems. People are familiar with these voice assistants you can call up and get these automated responses that ask you questions, and you say yes or no. Our new release will support what we call omni-channel publishing, so you can create these experiences, and they'll run across any of these different platforms.


Nate Treloar: So for our customers that want to create a voice application for Amazon Alexa or Google Home, they can create it using our platform and basically have access to all of these different types of devices and experiences, even text messaging so you can interact with a smart health care agent recorder your health assessments through text messaging, through a smart speaker, through the telephone interface. And that's one of them. The other things that we've introduced is more enterprise-class management technology, which allows non-technical people to manage that voice experience, and the content that, for example, might go into on a daily assessment survey, without having to be a programmer. And it might seem like, "Why isn't this already common?" The challenge of these new voice technologies is that they're quite new, and so the tooling for being able to manage content as easily as you can manage content on a Web site or in other digital's not quite there yet. So for our customers who want to manage, say, an assessment service, and say, "Hey! For this population of patients, this is the assessment survey I want them to be doing. And for this other population of patients, this is the assessment survey I want them to be doing." With a click of a button, they can change the experience delivered through these voice-first applications.


Bradley Metrock: [00:12:19] And just to be clear, your product, Orbita Voice, is primarily with healthcare in mind. But you'll let anyone use it or it's only for health care or . ...Who can and cannot use Orbita Voice?


Nate Treloar: [00:12:34] Well, we're a startup company, Bradley, so we were a little opportunistic in general. But we are hyper-focused on health care, and health care use cases. We do reference other industries, and some of our material, and even on our website. Anybody can come to us and get a sandbox environment for Orbita Voice and start developing voice-first conversational applications for really any use case, but our business is really focused on health care. That's why the application that's called Orbita Engage referenced on our Web site is very, very healthcare focused, because to your point earlier, we want to make sure we're not disconnected from sort of the humanity of what these applications are ultimately trying to deliver.


Matt Cybulsky: [00:13:22] I tend to agree with you completely, Nathan, that this is really going to be a harbinger of change when it comes to dealing with patients, especially because most patients, not all, but a large majority of patients know how to talk, and because of that reason, we can interact with them. But the question I have for you is, in the design of what you guys are building, or even in your consultations, with particular clients that use something like Orbita Voice - how are you building an engagement into that tool? Or how do you advise them into creating an engagement process when somebody might have a lot of other lifestyle toys and tools at home, including some noise built into their smartphone that's with them all the time?


Nate Treloar: [00:14:10] Yeah, there's no one answer to any of the breadth of different applications that we might experience or go after. There's a couple different ways of answering that question, Matt. The first one would be, what are the best practices for designing a voice or conversational interface for somebody in a chair setting, or who's at home, maybe doing their dishes and needs to take their assessment survey, or wants to send the message to a care team member. What we're doing through the process of our projects and developing our platform, is cataloging best practices, and template-izing best practices and interactions. And that includes knowing, for's a very simple example. People don't have a lot of patience in a conversational interface to listen to the voice assistant talk for two minutes. Right? And so somebody asks a question about....I'll give you a concrete example, we did a first aid application with a health care system out of the Midwest for Amazon Alexa, and a common question might be, "How do I treat a sunburn?" If they took the content that they might have on their website and just put that into a voice application - it's not going to be a good experience, because it's the two or three paragraphed, clinically vetted response to how to treat a sunburn. More typically, if you're in a conversation with a nurse and asking that question, he or she might come back and say, "Well, most sunburns are mild. But if you see a blister, this is how you should respond to treating a sunburn that starts to blister." And they will ask the question back, "Are you seeing blisters on your sunburn?" They don't know up front. So it becomes much more interactive and conversational, and the content needs to reflect that change. So that's the best practice answer.


Nate Treloar: There's also technical realities of these technologies that also need to be addressed. Noise in the room, the type of device itself that the user might be interacting with....a lot of people have smartphones and you can interact with these voice assistants over your smartphone. They don't have the same quality of microphones that you see in some of these newer devices like the Amazon Echo. Anybody who's worked with something like Siri will know that you have to be right up front and close to your microphone when you're talking to Siri. We expect these technologies to continue to improve. In the meantime, there's just simple realities. And what we're seeing, which is sort of interesting, is that the technology is starting to train us, even with voice. And people are learning to to wake up their voice assistant by saying her name, Alexa. And that training is even happening with older populations, who might otherwise be techno-phobic and not willing to use smartphones and tablets. It's kind of like when we first got smartphones, and you had to learn to use the touch screen, to swipe around. Eventually, most people eventually learned how to interact with their smartphone through this new interface. So we're seeing a little bit of give and take when it comes to working with these new voice assistants.


Matt Cybulsky: [00:17:40] Now that brings up a good point. I watched a video recently with a young person, I think a four or five year old. And they were handed a Gameboy. (And I think I'm dating myself by saying getting a Gameboy for my grandfather was, like, this amazing gift.) The video showed this child hitting the screen and then looking up at the parent confused, like, "Why doesn't my finger do the thing?" I'm used to seeing this thing...


Nate Treloar: [00:18:09] My favorite story was somebody that....I don't know if this is an apocryphal story, but some kid holding a newspaper and trying to touch it to interact with that.


Matt Cybulsky: [00:18:21] I love that. Now the same analogy can be true, regarding these voice technologies. I love that point that we're being trained. I notice that when I'm using my Alexa to communicate, many times I have to make some repetitions or change the way I ask something to get the right answer. But it seems to me that as the technology advances, there's going to be this more natural language kind of speech, that we're able to tie into - maybe it is the processing of the sound itself, maybe it's something else we don't even know.


Matt Cybulsky: [00:18:56] But something that you mentioned in an article I read about you, was this advent of moving away from using wake words into some other realm. Do you have any indication about how that might evolve, and what that might change as far as my interaction?


Nate Treloar: [00:19:13] Yeah. It's probably best to speak to you in the context of a very specific example. One that's coming up in residential care facilities that we're seeing is, what they want to have happen with these smart devices and the smart speakers. When Donna, it's my mom's name, comes into the room, it says, "Good morning, Donna. It's nine-thirty. Don't forget to take your 10 milligrams of Coumadin. And today is Wednesday, and at 11 o'clock, you have a physical therapy appointment. Sarah will be coming in for half an hour. And have a great day. So basically, it triggers some interaction to some other input, and in that case, it might be just a motion detector that knows she stepped into the room, or the "big-brother" type of example would be a camera with a facial recognition detection that knows that not only did somebody come in the room, but through facial recognition, you know it's Madonna. We know what to say to her. So that's one of the more common requests that we get. Right now, not all of the smart speaker devices support that direct automated and programmatic pushing of interaction like that. You have to wake them up. But we're starting to see interest in that. And there are very specific use cases where that voice-ation is a little more proactive. It's stepping in and saying something right away.


Matt Cybulsky: [00:20:59] Yeah, that's really exciting actually. We're definitely at the very early stages of all of this, and one thing that I wish that Alexa would do is....I have a wife at home and every once in a while, maybe it could whisper back an answer to me, like when's our anniversary and have I bought a gift yet?


Nate Treloar: [00:21:20] I think you can do that. I don't know it will whisper it, but you can set reminders. One of the things that Amazon did recently which was pretty interesting for the home care market, a couple things, both Amazon and Google, is they can make phone calls over your device, as long as your contact list is accessible to the Alexa app. Anybody on your contact list, you can place a phone call to.  Just by know, I do it all the time, I say, "Call Mom." And it will make a direct call to their landline. It works great. It's a voice over IP telephone call, but it works great. So you can turn that around, and my parents who live in kind of an elder care facility, they have a Google Home, and they can call me. They can just say, "Hey Google, call Nate." And it will place a call to my cellphone. So it works in that direction. You can also do device-to-device calls, which has a dependency. You have to both have that device. But the other thing that Amazon did, which is sort of interesting from a home care point of view is, they've got this thing called Drop-In and the way it works is...


Matt Cybulsky: [00:22:36] I love that thing. I play with that all the time. In fact, my friends and I go bonkers with that.


Nate Treloar: [00:22:41] Yes. For listeners, the way Drop-In works is, if somebody that you know has an Echo, and they grant you the right to do this ... you can use your Alexa app on your smartphone and drop in on them, basically open up a connection to their device and say, "Hey Bradley, how's it going? When are you coming over?" And if you're within earshot of that device, you can respond. It has a little bit of that Big Brother feeling too, as well, but as long as you granted the right for somebody to drop in like that on you, it's pretty powerful.


Matt Cybulsky: [00:23:17] Very powerful.


Nate Treloar: [00:23:18] If you have a loved one, or you're running a residential care setting, and you want to check in on of your residents or patients, you can just use your app and just directly reach out like an intercom.


Matt Cybulsky: [00:23:31] One of the things we're developing on the IONIA world is some work with depression and anxiety. You mentioned earlier about connecting patients to loved ones through Orbita Voice, or at least having that option to do so. A tool like Drop-In for someone who might be in addiction recovery, for example, or struggling with depression and anxiety is huge. In the pandemic of loneliness that we have in this country because of technology, I see this as a feature that starts to break down that wall a little bit, and allows for some emotional integration. Whether it's psychiatric mental illness, or if it's physical, it has shown to accelerate the healing processes.


Nate Treloar: [00:24:20] There's a real medical benefit. Another one somewhat related is individuals with Alzheimer's. It's not uncommon for somebody with dementia to ask their spouse the same question over and over again. What day is today? What's on my schedule? What time is it? And if you are the spouse of that individual, then you could be a saint. But eventually, getting that same question every five minutes over the course of the day can wear you down. And the worst thing you could do to that person is remind them that they asked you the same question 30 seconds ago. It's not good for them, and their anxiety level goes up. It's actually physically bad. But guess what? Alexa never gets tired of that question. So strangely enough, individuals with dementia can respond well to these voice assistants because these assistants have no ego. And in some cases, they refer to them Alexa as their friend.


Bradley Metrock: [00:25:15] This whole conversation really resonates with me personally, and I think we all will have to make a decision on what level of intrusion....I mean, intrusion is the word although normally it's said negatively, but in this case it shouldn't be viewed like that....intrusion that these devices are allowed to have into our lives because the thing I think about is cancer detection. So I am a melanoma survivor, and I have a distinct memory of wasn't too long ago that I read an article about how people who have....for lack of a better term, meaningful relationships, people who are married, or people who have a significant other, who are in positive and healthy relationships. And when they are diagnosed with cancer, the diagnosis is normally standard deviations earlier than it is if they don't have those sorts of relationships, and they don't have nudging to go to the doctor and stuff like that.


Bradley Metrock: And for me, personally, it was my wife who insisted that I go to the doctor to get this spot on my arm checked out. And fortunately, she did that. And so it was diagnosed at Stage 1b, as opposed to stage 4. And so it's interesting to hear, first of all, it's interesting to see Orbita and its offering. And here, y'all talk about this because it's very easy to understand the value of different ways that voice assistants and intelligent technology can complement the human experience and provide a, as I mentioned earlier, humanity where there needs to be humanity injected. People having reminders and prodding who may not have all of the network and support somebody else has.


Matt Cybulsky: [00:27:24] I think that....and this is a laudatory. But I'm really very impressed with the subject, and the content of what you all are producing, especially as a vehicle to accelerate these tools for patients, healthcare entities, and other providers. Well done, and I'm looking forward to seeing what you guys do in the future.


Nate Treloar: [00:27:48] Thanks. I appreciate it. Next week, we will be in Boston with the Connected Health Conference. And like you mentioned earlier, we will be showcasing our next generation of our platform. We're also participating on a panel related to Alexa in health care. We're expecting this....we know it will take off. We're certainly in early days, and we're learning applications and use cases of this technology every day. Every conversation I have creates other potential for how we can bring these kind of solutions to the market.


Bradley Metrock: [00:28:30] We certainly appreciate you setting the time aside and sharing about Orbita with us and sharing your insight and expertise with us, Nate. Thank you very much.


Nate Treloar: [00:28:40] Thank you, Bradley. I appreciate it.


Bradley Metrock: [00:28:43] For the Voice of Healthcare, Wednesday, October 18, 2017. Thank you for listening. And until next time.

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