Things & Thinks Half & Half Ed. 4
Through this monthly dialog series, I have been in dialog with leaders who have walked differing paths towards innovations in healthcare. From traditional large organizations to new-age start-ups, each of the sessions so far has brought fascinating insights into the healthcare innovation process and its impact in the real world.
This month’s guest gives us a very special and different perspective- Jennifer Goldsack is the Executive Director of Digital Medicine Society (DiMe). DiMe is the professional organization for experts from all disciplines comprising the diverse field of digital medicine. Together, we drive scientific progress and broad acceptance of digital medicine to enhance public health. I have been part the DiMe community for over a year now and so I can personally vouch for the terrific work we are doing here!
T&T: Hi Jen, so happy to have you as a guest here on Things & Thinks! Let’s begin with your backstory?
JG: I am trained as a chemist, going for my masters to Oxford University, England. Then I moved to the US, was a rower on the US Olympics team in 2008. After the Olympics in Beijing, I decided to stay in the US. In hindsight, I was lucky to make a smooth transition from training at the elite level to my next endeavors. I knew I did not want to continue in the labs as a chemist. I knew I didn’t want to continue in the lab as a chemist and ended up using my research skills in Health Services Research at the University of Pennsylvania, first in the Department of Surgery, and then in the Department of Medicine and it was tremendous; Health Reforms was passed in the US and so there was a lot of opportunity for great research. It felt like approaches to healthcare were changing a little bit. It was very jarring to be coming from Britain with their National Health Service to the US and seeing how different it was. So being part of the research charged during Health reform was really inspiring. After that, I was a co-founder of a pragmatic Research Institute at a community health care system in Delaware.
From there, we had to relocate because of my husband’s work and I ended up working for a public private partnership, co-founded by the US FDA and Duke University called the Clinical Trials Transformation Initiative (CTTI) and it was actually at CTTI that I first started getting into the digital piece. Actually, my first suite of projects was when the US FDA had come to CTTI and said we want to understand why no one’s using mobile technologies (a broad term indeed that was used then) in drug development. So it was very opportune and I was able to run an entire program of projects on ‘digital’, of leading experts around the world including with regulators to sort of explore those challenges and at the end of completing several years there, it was very clear to me that the promise of digital technologies to improve not only clinical research, but also health care and public health and health promotion was absolutely enormous.
There were also a number of challenges to ensure that we achieve the full promise of digital technology to improve lives. It was clearly going to take the kind of collaboration that had really not been seen in any other industry before and that was really the impetus for founding DiMe. In the absence of having everyone at the table from citizen scientists and cybersecurity experts all the way through, you know, every flavor of engineers, data scientists and clinical experts to regulators, payers, investors, funders, policymakers and patients, this field isn’t going to work and being very intentional about creating a better future- not a future world where we don’t do precision medicine but instead we double down on the surveillance product, where we don’t use these tools to ameliorate health disparities, but we actually make them worse- it’s going to require a lot of intentionality. And so that was what led to the founding DiMe.
T&T: And how has the experience been setting up and leading the DiMe Community?
JG: So we’re still very new. We only launched in May 2019! Yet our impact has been absolutely extraordinary. We’ve got over 30 published manuscripts, with many more in the pipeline. We have this extraordinary community of several thousand experts from around the world who are absolutely committed to our mission of advancing safe, effective, ethical and equitable use of technologies to improve people’s lives. We have a relationship with our US FDA colleagues through our participation in their network of experts. We have partnered with the health innovation hub for the German Federal Ministry of Health. We enjoy a really strong partnership with our colleagues at the American Telemedicine Association. And I think that allows us to do an awful lot of work, not only in our areas of focus which is sort of research, education, and community building, but they focus on policy. So through a partnership, we are able to allow the needs of our community and the research we do to get funnelled into policy through a strong relationship, not by trying to do everything ourselves. We are also now collaborating with the VA, the Veterans Administration, the largest healthcare system in the US. And I think this spirit of collaboration is really important. So, we’ve always led with collaboration, we’ve always led with the need to establish digital health as an evidence-based field. We have led with the needs of our community first, driven by the patient’s we serve as our North Star and it’s been very successful.
It’s really interesting to reflect on the fact that DiMe was founded before anyone even knew what Covid-19 was. Yet we recognized that the need to bring these different disciplinary experts together was absolutely mission critical to the success of the field; that we were already successful prior to the pandemic, because I think that our colleagues and industry recognized that the future of healthcare in the digital era is not just coming, it’s here, that the benefits are enormous. But that the changes in the way we need to approach our thinking, this skillsets of the field, the best practices of the field have not caught up with I think the promise of the field and so we were doing great work, but for the pandemic and I think that the pandemic has strengthened the resolve of healthcare professionals, of healthcare administrators and policymakers of medical product developers to make the transition, to a digitized approach to improve patient care.
The mantra we have at DiMe that I’m very proud of is ‘Clinical Quality Work on a Tech Timeline’
and I think that’s really important for us. I am really frustrated — as I think everyone in the field is — by this false dichotomy, that it can either be high quality and method and rigorous or it can be fast; and I don’t think the two things are at odds and when you think about what DiMe has achieved in the 21 months, I think we’ve proven that it’s possible. I think that we’re not just telling people it’s possible we’re showing people but with a real commitment and collaboration, you can do things quickly and with the highest quality and that’s how we want to define the field and we’re leading by example at DiMe.
T&T: I can vouch for this Quality-Speed balance through my work on our ongoing Tour of Duty for The Playbook!
JG: It’s a whole new way of working for our field, isn’t it? And I think people appreciate that; I know how much we have asked of people and I know how busy people are and yet after just a few months in The Playbook Tour of Duty, we’ve been able to show such tangible progress, I think people are excited. So for me, that’s the way we work; it would be unacceptable for us to have asked you to work this hard if we couldn’t serve up the quality of output, but I think what you can see as you have worked hard and we’ve done work that will change the field. Because everyone has come to the table with these different viewpoints and backgrounds and have the hard conversations and done the work, we have these powerful, evidence-based, pragmatic tools that solve the actual problems the field is facing. All of the resources from The Playbook are open access and available at playbook.dimesociety.org.
T&T: Is there something you learned in college that’s proved almost wrong?
JG: You know, I don’t think I’ve come up against anything that feels particularly ‘wrong’. Actually I think I’ve been very lucky because everything I did in this sidebar career, around being an athlete, around bringing people with very different personalities and different approaches to the table and showing how successful you can be, you respect the other people on the team, when you work hard and when you have the same goal regardless of how different you are… and I think we can see that immediate translation into Digital Health. Some people are here because they are investors and they want their ROI, other folks are here because they’re technical experts and they’re excited to help patients using their technical expertise; other people have spent their entire life devoted to making good policy or have a vocation for patient care. Yet everyone comes together and I think that what we’ve achieved in the community at DiMe, is a community where folks recognize that to have success at digital health, you can’t just have one viewpoint dominating we have to have the skills and the knowledge and the participation of all of these other experts.
T&T: You are an athlete and I assume you are no stranger to routine practice; how has that experience helped you what you are doing now?
JG: I have two, no, three things! First, recognizing you don’t do anything alone; Even in an individual sport, you have a coach and you have mentors, you have all these other people and in a team sport you understand how to come together as more than the sum of the parts. So I think that’s one piece.
The second piece is being ‘comfortable being uncomfortable’. This work is really really hard. And some people shy away from the biggest issues. And if you look at the projects that we do at DiMe, it’s projects that everyone thinks we should do and no one else is doing! So our thoughts are always-this is going to be very hard and very uncomfortable and we will be fine and we will just work hard and we will get it done. So this ‘comfortable being uncomfortable’ bit is helpful.
Now the third piece- I was in a funny sport- I was rowing- which is a ‘strength’ sport and an ‘endurance’ sport and a ‘technical’ sport! So you have all of these things that you’re trying to achieve at the same time and when I was training full-time practicing for six hours a day six days a week. But at that point you physically can’t do any more because at some point the fatigue is so bad, you have diminishing returns. So I remember asking myself all the time- whether it was training, sleeping, eating, and so on- will this make me faster? You have to work smart and hard. I see similarities in the choices we make every day in the field of digital health and digital medicine. There is so much work to do, so many needs, and so many people every serve. The hardest decisions we make are about what projects to pursue and which ones not to prioritize. We’re really being disciplined to think about our priorities and portfolio of work at DiMe in the same way as I used to as an athlete -will this make the field better? There are plenty of things we could do for a variety of different reasons. Picking those challenges where we can uniquely use the expertise of our community, the passion of our community, using the limited time and resources to do work that makes the most difference. This has been part of our success. There’s plenty of good work that happens that doesn’t really change the field and I’m really proud that the work we do at DiMe is changing the field and I think it comes back to the question I used to ask myself will this make me faster and it dime it will this make the field better and it helps that constant decision making.
T&T: As an aside, let me guess your position in rowing? Were you at the ‘Stroke’ position?
JG: I was! I was only in a two person boat but yes I was in a stroke seat! I didn’t just get a chance to go to the Olympics and picked up a best friend along the way- she’s a formidable woman. She’s a very very accomplished lawyer. She runs her own immigration law practice. It’s really interesting to think that I took all of my feistiness from training and put it in healthcare and she’s just as this amazing work in immigration law for individuals and also immigration law policy. And yeah, definitely we like hard problems. We like big challenging problems!
T&T: What’s something new you’ve learnt about yourself in the past 3–6 months?
JG: One of the things I’ve learned about myself is the ability to keep moving forward under what feels like a lot of pressure and strategies to do that. I always think I’ve been quite good at it, but it’s been pretty extraordinary, you know, just because we’re a non-profit. It doesn’t mean we haven’t faced the same challenges as other startups.
We’re 21 months old. Babies! But we’ve done so much in this time: We’ve built a community, while doing good science. We’ve tried to be the conduit for different areas of this field while building an internal team of incredible staff who are able to do that forging meaningful relationships with our community making sure that work we did actually had impact. It has been — as it has been for everyone in our field — a real roller coaster of the year; and I think that for me learning about myself the ability to make good decisions and still be present for the community even under a lot of pressure is something I’m really proud of.
I tell you all the things that make it not even easy, the things that make it possible and the fact that the work is so good. I know we are going to make a difference which is always motivating but also the folks I’ve opted into being part of DiMe are pretty extraordinary. Think about everyone you work with on the Playbook. Everyone’s amazing. Everyone’s doing the work and so that’s a bit that’s made it feasible because that’s the crazy thing! It’s doing the work, doing the science and then doing the communications part and then trying to build the operational structure of DiMe to support the growing field-it’s been a challenge and it if that’s been the big learning, I think for me personally, is that even my own ideas of ridiculous goals have been have been achieved! So yeah, it’s probably not a sustainable state of affairs, but we’ve done some really good work. And we have built a platform to do a lot more.
T&T: This has set up a good Baseline for us. I keep thinking about what we would work on next at DiMe?
JG: It’s a high bar, isn’t it?
I’m already thinking about what’s the next Playbook. How do we think about translating this into a low-resource setting? How do we take the deep dive into some of the most challenging issues and take them further like need for integration? Well, what do we do about that? Nothing is ever done. We’ve done a tremendous amount of work and the next question is what’s next!
T&T: That’s a great segue for us to talk about Healthcare; what do you think about our current healthcare ecosystem?
JG: Let’s look at this from the way last year has gone, the fact that later today, I’m getting my vaccine. That’s unbelievable. The fact that not only were we able to put the science together, that the population was willing to enrol in clinical trials, that there was sufficient funding that we are able to get the supply chain up and running….. I mean every success requires that level of coordination and intentionality and collaboration and I think there’s a lot we can learn there. I can’t think not just an invention- invention is brilliant and inspired- but it becomes an innovation when it’s broadly accepted, when it becomes part of the fabric of everyday life and I don’t think you go from problems to solution for innovation without a team.
SS: I absolutely agree; I feel many healthcare inventions stop at the brilliant ideas but not many of these see the light of the day!
JG: It’s true and it’s challenging and I don’t know the right answer yet; but I think about it all the time; Let’s focus on the US right at the second and then we’ll think about the world. So in the US, the size of the healthcare market (even though it’s ridiculous to think that) is over three trillion dollars, that’s bigger than the GDP of France! And then think that someone thinking- my one piece of software is going to change the lives of everyone in France, not only healthcare, but transportation, commerce, communication! So I get confused that we’re taking this patchwork of invention approach; We have to be very careful that we don’t stifle innovation, but I think the gap is between one mountaintop full of great inventions and the other mountaintop where it’s systemic change and it’s getting across that that valley in between. There is no shortage of brilliant innovators, great scientists; the science is here. The patients are ready.
But how do we get from ‘The Mountaintop of Invention’ to the ‘Mountaintop of System Level Re-imagination of Patient Care’? and that’s only in the US, the global Health Care economy is over twelve trillion dollars!
So again, this should remind us of the need for a coordinated approach, to be able to weave those inventions together to change the lives of the patients, that we are all ultimately trying to serve
SS: Yes so we need people on both mountaintops.
JG: You know, it’s a ‘Yes And…’-we want the dreamers taking the moon-shot… and then we need to bring everyone else with us.
T&T: So out of all these different things, what will be the biggest challenge for healthcare in the next decade?
JG: The challenge is that none of the challenges are new-we still have highly variable quality at very high costs. We still have enormous health inequity and disparities in access and outcomes. We still have conditions and diseases like Alzheimer’s with absolutely no disease-modifying treatments and this isn’t new, this was a problem 10 years ago. This was a problem 20 years ago. And this was a problem 30 years ago. So I think one of the big challenges is that the challenges aren’t new.
Let’s look at COVID-19? It has been devastating for our clinical colleagues. It’s been devastating for patients and people, the economy and what did covid tell us? That all our clinicians are overworked-we knew that already; It told us that there are health disparities- we knew that already; that the infrastructure was inadequate we knew that already!
If all we do is shoehorn a few bits of technology and a few algorithms into existing clinical workflows, we really might as well not bother.
So I think the biggest challenge in the next 10 years is overcoming the activation energy (You can always tell I am a chemist because I say things like activation energy!). There’s a lot of activation energy that’s required to not just add a diffuse bits of software and add a few widgets but really transform to a digital era that should be powered on high quality data and information and where the focus shouldn’t be the hospital- There’s a lot of incentives that have to be overcome. And so I think the biggest challenge is around overcoming that activation energy to actually make system level changes.
T&T: Can you give an example of what can be the possible way out of this Déjà vu?
JG: So one of the projects that we’re doing at DiMe that I think is really interesting is the IMPACT collaborative that we’ve launched with our colleagues at ATA and that’s focused on supporting virtual first Care so care that doesn’t originate with clinicians in a clinic. In fact as much of the care happens virtually until it can’t, until there’s a procedure required or imaging required that makes it necessary to go to the hospital. So I think there’s a huge promise with virtual first. First of all, I don’t think all healthcare should be virtual in the future. But I think we need to get really really comfortable with virtual first as part of the spectrum of options.
Here is another analogy-if we look at the history of manufacturing when we went from steam engines to electrical power, it took about 20 to 30 years to get any benefits. Why? the original layout of the factory was built around the drive-train of the steam engine and then when they bought electricity, they just replaced the drivetrain with an electrical socket. So it wasn’t the old factories that led to improvement. It was new factories being built that pioneered the idea of a production line because they didn’t need to build around a drivetrain.
And so I think virtual first it’s going to do for healthcare what couldn’t be done in manufacturing. They’re going to be a forcing function-they’re going to think about without having to re-engineer existing workflows because they are brand new organizations that are not built around a clinic, they are coming of age when the digital technologies are mature, they’re coming of age as patients and frankly clinicians want to use these modalities, they can reimagine what good health care looks like without having to do the re-engineering of existing workflows. They can use all of the tools to build around the patients, meeting the patient’s needs, keeping the providers happy and that I think becomes the forcing function to accelerate the pace of innovation within the more traditional places. Ultimately it’s all a spectrum and we’re going to meet in the middle somewhere and I think we’re going to meet in a vastly improved middle much more quickly based on the pressure that a successful and thriving virtual first industry would place on the rest of healthcare.
T&T: If you are asked to bet on something about healthcare in future, what will that be?
JG: We are definitely going to see the increased use of digital technologies like sensors, decision algorithms. We are definitely going to see The increased use of technology. Definitely. What I am uncertain about is whether it’s going to make things any better and I think that’s the crossways we are standing at and I think that’s why organizations like DiMe and the work we’re doing is so important. There is no doubt in my mind that decision makers are committed to advancing technology.
Electronic Health Records in the story of Meaningful Use in the US is a good example. They invested billions of dollars There Were Ten Years of hard work by the healthcare system to introduce electronic health records that met the needs of meaning for use. Well as it turns out meaningful use doesn’t actually allow particularly good access to data. It doesn’t make physicians happy- it did exactly what they wanted them to do, but it didn’t really have the transformative power they hoped for. That my best -there is definitely going to be more technology. The open question is to what effect and that’s why we need to do the work. We need to come up with approaches and supportive mechanisms and the shared mindset about what good looks like and be intentional and not have a blind spot that leads to failure.
T&T: and conversely, is there something that you would bet against?
JG: I would like to bet against clinicians having a less important role than they do today. Despite all of the technology that we are bringing to bear, we are facing clinician shortage and innovation whether it’s with molecules, biologics, vaccines, is going to be clinician-led. There is never going to be a time where you’re an in-patient and you are not thankful for your wonderful nurse. There is never going to be a time where healthcare works without a doctor but, I think that their roles may change… hopefully for the better. In the US physicians spend 30 to 40 percent of their time in administrative tasks. Hopefully we can make some of that nonsense go away. Hopefully we can make it easier for every person regardless of demographic background or geographic location to access one of the doctors that they need or one of the physical therapist or occupational therapists or nutritionists and we take that 30 or 40 percent of time spent in admin and repurpose that time to focus on reaching patients we haven’t been able to reach before.
T&T: What’s the best piece of advice you could give to someone starting their first healthcare job now?
JG: It is pretty straight forward-
We care about making lives better for patients. Come on in, the water is warm and there’s a lot of work to do!
I had no healthcare background, but you know, we’re trained as scientists. And so I knew what evidence look like. I had all my team sport background. I liked hard problems and I got my first job in healthcare just days I’ll perform was passing in the US and I was inspired and so I think particularly in a new era of healthcare that isn’t constrained by the walls of the hospital, that more than ever is focused on not just the patient but people, that requires expertise from clinical experts from you know, biomedical experts all the way to cybersecurity researchers, to data scientists highly empathetic humans to actually go out and be community health workers right there is unfortunately just like all of the Innovation the world is getting sicker. Anyone who is interested and using whatever expertise, whatever passion, whatever work ethic they have in service of the cause. There is so much work to do.
And I think that there are gaps in terms of skill sets across the board; clinicians who maybe have an undergrad degree in computer science would be powerful assets. Someone who was pre-med and then decided they didn’t want to go to medical school and now wants to go to coding bootcamp! There is no one right way in and most importantly we have to have a healthcare workforce that better reflects the patient population that we’re here to serve. We have to have a workforce that better reflects the patient’s we serve, they need to come from all walks of life. They need to have all manner of experience to draw on and for those of us already in the industry.
T&T: Jen, this has been an awesome discussion! Thank you so much for your time and sharing your thoughts!
