Latest / The Clinical Realist / The Number That Should Stop You: Building Continuity Before Big Tech Does, with Amy Andrade

Transcript

The Number That Should Stop You: Building Continuity Before Big Tech Does, with Amy Andrade · The Clinical Realist

• 0:01
  SPEAKER_00: So here's a number that should stop you.
• 0:03
  SPEAKER_00: People whose care is scattered across multiple providers with no single person or system holding them with the whole picture have been found to have more than double the risk of dying.
• 0:12
  SPEAKER_00: And that's even after you account for how sick they already are.
• 0:14
  SPEAKER_00: And it's not because the medicine got worse, it's because nobody was holding the whole story.
• 0:19
  SPEAKER_00: So my guest today has spent her career on exactly that gap.
• 0:22
  SPEAKER_00: So Amy Andrade is a biomedical data science researcher getting her PhD at McHarry Medical College.
• 0:28
  SPEAKER_00: And she's studying what happens when a health record gets scattered across every clinic, every hospital, every system a person has ever touched.
• 0:35
  SPEAKER_00: And that research led her to co-found Alfinity, where she's chief product officer building infrastructure to rebuild the record around the person instead of the institution.
• 0:44
  SPEAKER_00: And the ambition doesn't stop in health.
• 0:46
  SPEAKER_00: So Alfinity is building continuity across not just health, but financial and legacy data too for a person's whole life, not just their term.
• 0:53
  SPEAKER_00: So I've been fortunate enough to have a front row seat to this bill because Alfinity has been an advisory client of mine for a couple months now.
• 1:00
  SPEAKER_00: So today I get to flip the mic and ask Amy what continuity actually looks like from the inside and why some large competitors just got signaled that they want the same category.
• 1:11
  SPEAKER_00: So, Amy, welcome to the Clinical Realist.
• 1:13
  SPEAKER_00: Great.
• 1:14
  SPEAKER_00: Thanks for having me on.
• 1:15
  SPEAKER_00: I appreciate it.
• 1:16
  SPEAKER_00: Of course.
• 1:17
  SPEAKER_00: Well, I opened with that mortality number because I think it's the whole case in one sentence.
• 1:22
  SPEAKER_00: So I want you to make it real.
• 1:24
  SPEAKER_00: Walk me through what fragmented care actually looks like for a real person and not the abstraction, like the actual moment where nobody has the whole picture and it costs them.
• 1:34
  SPEAKER_01: Yes.
• 1:34
  SPEAKER_01: And it doesn't only cost them possibly life, mortality, but also money and time and then the caregiving.
• 1:43
  SPEAKER_01: A lot of this happens under duress when you enter into the emergency room and there is no clear-cut record of information about you and your health.
• 1:53
  SPEAKER_01: We'll just focus on health.
• 1:55
  SPEAKER_01: Or it happens when it's time to move your parent.
• 1:58
  SPEAKER_01: I've personally experienced this, and time to move them in long-term care, memory care, especially.
• 2:04
  SPEAKER_01: And even though I've been in healthcare now for 20 plus years, it was so stressful.
• 2:09
  SPEAKER_01: I was organized, but I was like the thumb drive with a stack of paper because my mom's records were at different institutions for different reasons.
• 2:18
  SPEAKER_01: And so the person who we need the whole story for, or even um drug dependency for rehab, mental health rehab, those are three, four areas, those are the three top areas where care coordination can cost a person's life, actually, um, because the whole picture isn't in view of the of the providers providing the care for the person.
• 2:40
  SPEAKER_00: So I know you've said before that the record should be built around the person and not just the institution.
• 2:46
  SPEAKER_00: And we know the patient's the only one present for their entire history.
• 2:50
  SPEAKER_00: So what does that mean as an actual product?
• 2:52
  SPEAKER_00: Like what does Alfinity build that a hospital's EHR or a patient portal doesn't?
• 2:56
  SPEAKER_01: Yes.
• 2:57
  SPEAKER_01: And so, and we're not here to replace, we need those electronic health records to collect um the data and care when you go in and actually receive in care by your primary care or your dermatologist or your specialist on those pieces.
• 3:13
  SPEAKER_01: And some of those are within, they're all in buildings, though we live outside buildings, so we'll come back to that.
• 3:19
  SPEAKER_01: But they're that data, each building that you go into, each organization has a different system.
• 3:25
  SPEAKER_01: And those different systems do not talk to each other.
• 3:29
  SPEAKER_01: So you, if you think of yourself with little stickies all around you, your record is fragmented with these um post-it notes that are around all of your body, and each one represents a piece, that fragmentation of your medical record.
• 3:43
  SPEAKER_01: Um, and each of these pieces, the other person, the other institution cannot um connect to and cannot get your whole picture.
• 3:51
  SPEAKER_01: That's what it looks like.
• 3:53
  SPEAKER_00: So I know as a provider, as a board member, as a patient, dealing with the limitations of interoperability and with data silos has been a career-long struggle.
• 4:03
  SPEAKER_00: Um but when I think about how folks are trying to approach this today, what's the hardest technical or trust problem in making this a reality?
• 4:13
  SPEAKER_00: It's actually not technical.
• 4:14
  SPEAKER_01: We actually, you know, it's been about 20 years.
• 4:16
  SPEAKER_01: I started my career, I know you as well, when we were going from paper to um to electronic health records.
• 4:23
  SPEAKER_01: Uh, early 2000s, um, there was a push from the federal government um to get on those medical uh systems, uh electronic systems, and we have, we've got the data, but the data sits there, and we've tried uh building pipes, if you will, to move that data around, but it's always been optional.
• 4:40
  SPEAKER_01: So not every provider or every network has joined into those pipes in that building.
• 4:45
  SPEAKER_01: But today the technology and the policies that the federal government has put out has allowed technology to grab your data by your consent at all those different places where you've um seen the providers at.
• 4:58
  SPEAKER_01: So remember those sticky notes.
• 5:00
  SPEAKER_01: And so you can actually, the technology can go and grab by your consent your data at all those different places.
• 5:07
  SPEAKER_01: Apple has done it, Apple Health, if you know that, they do it.
• 5:10
  SPEAKER_01: Um, it sits there, and we're seeing some other places do it as well.
• 5:14
  SPEAKER_01: But they're not, or they're only using the data for a particular reason.
• 5:18
  SPEAKER_01: They're not putting it all together in what we would call a personal health record or a longitudinal record so that we can see the actual time sequences of events and that it's accessible by other providers.
• 5:30
  SPEAKER_01: And the technology is there.
• 5:32
  SPEAKER_01: Now it's a trust issue.
• 5:33
  SPEAKER_01: Um, and getting um to work with the institutions um to allow us to get in there, um, not get in there, but allow you to download your data and it's on your phone or your tablet or your computer.
• 5:45
  SPEAKER_01: So it's really a trust issue, not a technology issue.
• 5:48
  SPEAKER_00: I believe that it's usually not the tech itself.
• 5:50
  SPEAKER_00: Um, when we think about the medical records, I think everyone is well aware of what's in medical records, what usually is being regulatorily um asked to be shared as an example.
• 6:00
  SPEAKER_00: But I know you folks are trying to span health, wealth, and legacy.
• 6:05
  SPEAKER_00: That's right.
• 6:05
  SPEAKER_00: Why why go that wide?
• 6:07
  SPEAKER_00: How does the financial or legacy data even you know impact our medical data or our health data?
• 6:13
  SPEAKER_01: Actually, so yes, that's a great question.
• 6:15
  SPEAKER_01: And what we thought is when we thought about Alfinity, we thought of a life management system, and we thought through, and my research back in 2015, um, when I was working at Maharry Medical College for those 10 years, brought me to the point of, oh wow, we're just sticky notes of data all around us.
• 6:33
  SPEAKER_01: And that data is so valuable.
• 6:34
  SPEAKER_01: And one of the things is that our health were present in all of those doctor visits, um, but our health actually takes place 80% of the time outside those walls where we live, work, and play.
• 6:47
  SPEAKER_01: And so that's the important part of it.
• 6:49
  SPEAKER_01: And so when we think about that, and and in public health, it's a long standing where your wealth goes, your health is.
• 6:56
  SPEAKER_01: So if wealth is a is a you've got good um being able to have provision for eating, there's no desert food zones and those kinds of things, then health and wealth go hand in hand.
• 7:08
  SPEAKER_01: But as we know and as we learned through COVID um 19, that many of our um more discriminated or I should say underrepresentative people groups don't have food always available, don't have the things that we have available, and those are the ones that we saw fell most first with the COVID-19.
• 7:26
  SPEAKER_01: And so we felt like we could bring this all together, let health be the trigger, and send out an event alert over to possibly your financial advisor, um, that you would be able, that it would not have your medical record, but that it would alert them to say, whoa, Mr.
• 7:43
  SPEAKER_01: Smith's in the hospital, he's had a heart attack.
• 7:46
  SPEAKER_01: Um, you know, I we need to re-look at his um finances.
• 7:50
  SPEAKER_01: He's 50 years old.
• 7:51
  SPEAKER_01: We've prepared for him to retire at 70 years old, but now that he's had this major heart attack, maybe we need to re-look at what his financial portfolio looks like to keep him um wealth health as well as his health as well as well.
• 8:06
  SPEAKER_01: So that's why we put the two of those together for longevity on that piece of it.
• 8:11
  SPEAKER_01: And then if you take that to the next, and there's a big transition right now in the next 20 years, as the boomers are the youngest boomers are now 65 and handing over their wealth.
• 8:21
  SPEAKER_01: And then in the next 20 years, it's about$84 trillion that will transfer hands twice.
• 8:27
  SPEAKER_01: And so that's another reason to keep health and wealth together.
• 8:31
  SPEAKER_01: Um, and we thought if we could get the record, let it be the trigger in the event, then the other things would be able to fall in line much easier.
• 8:40
  SPEAKER_00: So, one of my concerns when I hear about this is that the people who probably need the most health and help are probably the ones with the least wealth.
• 8:48
  SPEAKER_00: Yeah.
• 8:48
  SPEAKER_00: So if you don't have a lot of wealth, you may not have a financial advisor.
• 8:52
  SPEAKER_00: You may not actually have a lot of things planned out.
• 8:55
  SPEAKER_00: So when we think a bit about how those people then are again the ones who need the most assistance, the ones who may not have, again, financial pieces all lined up with an advisor, et cetera.
• 9:08
  SPEAKER_00: How are we going to actually help them?
• 9:11
  SPEAKER_00: Because I know that if we, you know, continue to push public health and things like that, we're working on assisting folks from a healthcare perspective for various zip codes, making sure lead paint is taken care of, things like that.
• 9:23
  SPEAKER_00: But when we think about this wealth component, I have concerns that maybe we're not going to actually serve that population that needs it.
• 9:31
  SPEAKER_01: Yes, and that's true.
• 9:33
  SPEAKER_01: And and the majority don't have financial advisors.
• 9:35
  SPEAKER_01: And even um many middle income, if you will, need a financial advisor.
• 9:40
  SPEAKER_01: But there is that stigma of I don't make enough money.
• 9:42
  SPEAKER_01: And so, you know, they don't go.
• 9:43
  SPEAKER_01: But on that piece of it is that within alfinity, we've built tools for the individual for education.
• 9:50
  SPEAKER_01: So education around simple um things around um, we don't balance checkbooks, but wealth education, how we handle our money, the amount of money coming in, the amount of money going out.
• 10:01
  SPEAKER_01: But that's just a piece of alfinity of that educational piece.
• 10:04
  SPEAKER_01: If if no utilization on the wealth or the legacy side, that's fine because it's all around the health.
• 10:10
  SPEAKER_01: And that's what they need most is that record to be able to have that full, because most of those um that are the the least in conditions of having a financial advisor are also the ones that have the high uh comorbidities with chronic diseases, so more than one.
• 10:26
  SPEAKER_01: Um blood pressure, diabetes, and those comorbidities.
• 10:30
  SPEAKER_01: And so focusing just on health piece of that will will allow them.
• 10:36
  SPEAKER_01: Our thesis is that it will prove out that the fragmentation of care will close and that they will be saved missing data, and so that the full treatment plan could be looked at so there's not over um over medication with um antibiotics, I think.
• 10:52
  SPEAKER_01: So there's not a crossover if you have too many antibiotics, right?
• 10:55
  SPEAKER_01: You're on them for eight or 12 weeks.
• 10:56
  SPEAKER_01: That's not good.
• 10:57
  SPEAKER_01: So the doctors are able to know that piece of it.
• 11:00
  SPEAKER_01: And then as we get them healthier, then there's the financial tools to be able to do the education, very simple education that the whole family could take um take advantage of.
• 11:09
  SPEAKER_00: Now it seems like this would be an interesting tool for patients, but also an interesting tool for hospital systems or employers, things like that.
• 11:17
  SPEAKER_00: How do you think you folks will go to market when you consider how to get this into people's hands, especially after discussing how to get into the right people's hands so that the people who need it most can have it?
• 11:28
  SPEAKER_01: Right.
• 11:28
  SPEAKER_01: The first thing that we thought about was employee benefits.
• 11:31
  SPEAKER_01: Employee benefits in the sense of going to um small businesses under 50 um employees or even to the larger businesses to um go through a broker channel.
• 11:42
  SPEAKER_01: So we working with an employee broker that works um that sells benefits or prepares benefits and then um open enrollment um at the end of the year, usually, and being able to sign up that the employer would provide this as an employee benefit.
• 11:56
  SPEAKER_01: And that's the way that we see that we can get adoption and to help the most people at once.
• 12:01
  SPEAKER_01: At the same time, running in parallel is being able to go to the um health care organizations where the people need it the most, and that's starting with long-term care, that's starting with behavior health, both mental and addiction.
• 12:13
  SPEAKER_01: Um, that's where the coordination of care um drops, and then also for um the memory care, long-term memory care.
• 12:20
  SPEAKER_01: And actually, that's where we're getting most of our traction of potential clients and working with us.
• 12:26
  SPEAKER_01: It's harder in the larger institutions because they think, you know, they want to keep, you know, they don't understand, they don't understand and have the concept of person-centric health data.
• 12:36
  SPEAKER_01: We've had a no-go in some large health community health systems, which are the ones that need it the most.
• 12:41
  SPEAKER_01: And so we have swung and going to start with the ground up on the smaller ones.
• 12:45
  SPEAKER_01: So we're starting where the the pain is the most, um, and the family and or friends that are supporting those um persons in the long-term care behavioral health um areas um need it the most because it's being able to get the records not only to the provider to help them through that crisis, if you will, on the behavior health and addiction pieces of it, but when they walk out, I've actually seen a folder that was this thick coming out of all of the tests and things.
• 13:13
  SPEAKER_01: Um it was it was uh a family member.
• 13:16
  SPEAKER_01: Um, it was huge, you know.
• 13:18
  SPEAKER_01: They should have at least had a thumb drive, you know, with that information, but it was all actual paper.
• 13:24
  SPEAKER_01: And so it's not a paper problem, you know, it's a problem that we're able to track electronically and give you, it's there, it's in the system, that's how the paper was printed.
• 13:34
  SPEAKER_01: Um, but being able to make sure that the person has the information and their um point person uh that's supporting them.
• 13:41
  SPEAKER_00: Now I'm sure you're using some components of rules-based engines or AI tools to assist with the fragmentation.
• 13:47
  SPEAKER_00: And again, you know, there's a lot of mistrust right now on the clinician side, on the patient side.
• 13:54
  SPEAKER_00: You know, there's just a lot of misinformation in both directions.
• 13:57
  SPEAKER_00: And I think, again, like we mentioned before, there's definitely concerns about failing silently through the AI where some of the people who are already falling through the cracks might continue to be those under-resourced ones.
• 14:10
  SPEAKER_00: So when we think about the failure modes of what you folks are doing, how does Alpha New do it differently to catch that instead of hiding it?
• 14:18
  SPEAKER_00: How are you making sure that you have responsible and transparent AI?
• 14:22
  SPEAKER_00: Absolutely.
• 14:23
  SPEAKER_01: Um, the first thing is where AI fails um, and it's usually the ones that we're talking about that have the most changing of different places with care coordination, they fail them twice.
• 14:33
  SPEAKER_01: They fail them because they don't have the whole record together, and then they fail them on the AI silently.
• 14:38
  SPEAKER_01: And that's been proven out in research and the data.
• 14:41
  SPEAKER_01: And what happens is that AI is only as good, our fiddle, our artificial intelligence is only as good as the data.
• 14:49
  SPEAKER_01: So bad data in or incomplete data gives you incomplete results.
• 14:54
  SPEAKER_01: So that's what you know, there's this push for AI, and it's wonderful, and it needs to be responsible, and I'll talk about that in a minute, but you have to have the whole picture.
• 15:02
  SPEAKER_01: If you don't have the whole picture, then you're not able to, then it's only it's blinded.
• 15:08
  SPEAKER_01: It's like a blind study.
• 15:09
  SPEAKER_01: You only see a piece of the whole pie and not the whole person.
• 15:12
  SPEAKER_01: And so that needs to be raised more.
• 15:14
  SPEAKER_01: Um, it can only um predict or give you information and summarize information on what it has.
• 15:21
  SPEAKER_01: With the what we're doing different is we're not using that AI of doing the description, descriptive analysis or predictive and trying to see trending happen, um, chronic disease predictive models and seeing the trending happen before you they're at for per before persons are actually diagnosed.
• 15:38
  SPEAKER_01: And so that's what we're doing different is that we're doing the actual AI on the end with analytics on the whole person data.
• 15:46
  SPEAKER_01: Um, we're verifying that um, and you have to do different tests, statistical tests, to make sure that we're not um subconscious subconsciously biased.
• 15:55
  SPEAKER_01: If you program it with those subconscious biases and we all have them, and we're not checking for them um programmatically, then we will be blindsided and it will be silent.
• 16:04
  SPEAKER_01: And so you have to test ourselves.
• 16:06
  SPEAKER_01: You can't just let the AI um do its thing, if you will.
• 16:09
  SPEAKER_01: So it needs to be and it needs to be transparent, and our AI is uh is is transparent and and how those algorithms are developed.
• 16:17
  SPEAKER_00: So I'm sure that all of us have had fragmented electronic medical records, fragmented care in lots of places.
• 16:23
  SPEAKER_00: If you've lived in more than one state, you're pretty much stuck.
• 16:26
  SPEAKER_00: Um I'm pretty sure anyone who's listening to this, if I asked them to get their whole medical record, they'd probably just laugh because there's just no way we could actually accomplish it.
• 16:34
  SPEAKER_00: So when we think about continuity, what does that look like for someone who's never actually had it?
• 16:40
  SPEAKER_01: You know, it's interesting.
• 16:42
  SPEAKER_01: We finally made a move.
• 16:42
  SPEAKER_01: So personally, we made a move from my hometown, Nashville, Tennessee.
• 16:46
  SPEAKER_01: We're in Atlanta now, and uh my husband, I'm allowed to share it, he said it was fine, um, has comorbidities.
• 16:52
  SPEAKER_01: He has diabetes and the high blood pressure and those kinds of things, well maintained.
• 16:56
  SPEAKER_01: But I had to start probably four months before we were actually moving, make the appointment on the other end in Atlanta, and then get that appointment.
• 17:06
  SPEAKER_01: So then I could call um the hospital um in Nashville, his where he has his care, and say, okay, I need all of these records now transferred over to this place in uh Atlanta.
• 17:20
  SPEAKER_01: And so you have to be um fortuitous to be able and logistics oriented to actually move that data.
• 17:26
  SPEAKER_01: So I had to physically make a phone call, two phone calls, and then fill out a form.
• 17:31
  SPEAKER_01: And sometimes the the the organization may charge you um a fee for processing that um and they may not.
• 17:38
  SPEAKER_01: So it's six dollars and fifty cents.
• 17:40
  SPEAKER_01: So that could be an inhibitor to some people, right?
• 17:42
  SPEAKER_01: For getting that uh record transferred.
• 17:44
  SPEAKER_01: Um, I could not get them by paper.
• 17:46
  SPEAKER_01: I said I'll come down and get them.
• 17:47
  SPEAKER_01: Nope, can't get them by paper.
• 17:49
  SPEAKER_01: And so I had to pay the$6.50.
• 17:52
  SPEAKER_01: So what does that look like when we've never had that?
• 17:54
  SPEAKER_01: I think that's a good example.
• 17:56
  SPEAKER_01: Um, you know, if you live in the same town and you do everything under one provider network, then life is easy from that perspective.
• 18:04
  SPEAKER_01: But that's the amount of work to move so that all the records are now together in Atlanta, but it still doesn't give him a complete one medical record.
• 18:15
  SPEAKER_01: So any data or uh analytics that are now happening via AI in Atlanta at this hospital network, it's not picking up the stuff from Nashville because they just scanned it in and it goes in as an attachment.
• 18:29
  SPEAKER_01: It's not actually putting the data together to make it all viewable via AI to get the data.
• 18:36
  SPEAKER_01: And that's what's different.
• 18:37
  SPEAKER_01: And that's what's different about Alfinity is that we are asking you, the person, why don't you just keep up with your record?
• 18:45
  SPEAKER_01: It's not hard.
• 18:45
  SPEAKER_01: All you have to do is consent.
• 18:47
  SPEAKER_01: You go through, you pick out all your providers, we do all the back work on the back end.
• 18:52
  SPEAKER_01: Um, it's all, you know, uh secure and doing all of the things that we need to do to be secure, and it continuously updates.
• 19:00
  SPEAKER_01: So you never have to touch it again.
• 19:02
  SPEAKER_01: All you have to do is then you go to a new place, you move to a different town, or you're just taking the summer and going someplace else.
• 19:08
  SPEAKER_01: You can just consent to that new um provider and it all goes electronically over to them.
• 19:13
  SPEAKER_01: And no, it won't cost you$6.50 on that piece of it.
• 19:17
  SPEAKER_01: So for that record.
• 19:18
  SPEAKER_01: So that's what it looks different via Alfinity.
• 19:21
  SPEAKER_01: Um, but don't be fooled, even though we've got records and you've got them uh a particular portal that you go through, not all of your records are together, even if you've combined them via paper.
• 19:31
  SPEAKER_00: So I'm gonna put you on the spot for this one.
• 19:35
  SPEAKER_00: So, you know, we have Meta's VP of Health Tech.
• 19:37
  SPEAKER_00: I think they just co-published a call for kind of the same patient-centric continuum.
• 19:43
  SPEAKER_00: Um you talked about Apple Helm.
• 19:44
  SPEAKER_00: Google presumably is not far behind.
• 19:47
  SPEAKER_00: Um, I was at Oracle, you were at Oracle too.
• 19:50
  SPEAKER_00: And so I'm sure Sterner is working on things.
• 19:53
  SPEAKER_00: I'm sure Epic is too.
• 19:55
  SPEAKER_00: Why does Alfinity have a snowball's chance?
• 20:00
  SPEAKER_00: Why does a company of your size have something better?
• 20:04
  SPEAKER_00: Are you differentiated in some way?
• 20:05
  SPEAKER_00: Are you just faster than all these other big tech companies?
• 20:10
  SPEAKER_01: I would say we're faster because we keep it simple.
• 20:13
  SPEAKER_01: You know, there's a real um principle that I've always lived by for the in my work career, KISS.
• 20:19
  SPEAKER_01: Keep it simple, stupid, and I'm the stupid.
• 20:22
  SPEAKER_01: And so it's always keeping it simple.
• 20:24
  SPEAKER_01: And I think um you have to go outside the walls of the organization, and nobody's looked at it differently.
• 20:33
  SPEAKER_01: Apple's been the closest, they just haven't done anything with it.
• 20:36
  SPEAKER_01: They have the record there.
• 20:37
  SPEAKER_01: I've got my Apple Health record from five years ago, but there's nothing's happening with it, it's just kind of collecting stuff.
• 20:43
  SPEAKER_01: Um, Fitbit and all of those different things and um different ways of collecting information.
• 20:49
  SPEAKER_01: It's sitting there, but I think lean and nimble and relying on the person.
• 20:54
  SPEAKER_01: So none of those are allowing the person to hold their health record, the entirety of the health record.
• 21:01
  SPEAKER_01: The person is still not in focus out of all of those solutions.
• 21:05
  SPEAKER_01: And I think that's the difference between Alfinity and the bigger organizations that are huge, is that they're still working through the organizations.
• 21:14
  SPEAKER_01: They're not working through the person.
• 21:16
  SPEAKER_01: And the person needs to go, the person is the data and should follow them wherever they go.
• 21:22
  SPEAKER_01: And I think that's the differentiator because the I don't see the other ones looking at the person.
• 21:27
  SPEAKER_01: The only one I did see was Meta published a paper probably back in February and talked about, you know, we live, work, and play in all these places.
• 21:35
  SPEAKER_01: But what they're doing is they're using the Google glasses.
• 21:38
  SPEAKER_01: So they're using the Google glasses that you can see and they're collecting all of that data.
• 21:42
  SPEAKER_01: They've got, they're gonna have, you know, is it a fall on the stairs when they pause, or is it that they just stop to talk to somebody?
• 21:51
  SPEAKER_01: You know, so they're that's just an example of some of the stuff they're gonna have to weed out.
• 21:55
  SPEAKER_01: So it it will be cool, but it will take a long time.
• 21:58
  SPEAKER_01: We just wanna keep it simple.
• 22:00
  SPEAKER_01: The person needs to have their record with them and consent it.
• 22:04
  SPEAKER_01: And nobody should tell them no.
• 22:05
  SPEAKER_01: And the laws provide that.
• 22:07
  SPEAKER_01: You're allowed to get your record, all of your record in electronic format.
• 22:11
  SPEAKER_01: And that includes your labs, your medicines, and your um visits and all of your diagnoses and those kinds of things.
• 22:18
  SPEAKER_01: So I think we're it's almost as if we're being an advocate, a patient advocate, to say you're allowed to have this.
• 22:27
  SPEAKER_01: They cannot tell you no.
• 22:29
  SPEAKER_01: And we're given a simple tool to be able to do that.
• 22:33
  SPEAKER_00: So if we think about kind of data continuity as a new generation of middlemen, you know, the PMBs of health data, are you folks extracting value or are you creating it?
• 22:45
  SPEAKER_00: So where is that critique fair and where does it miss what you're actually building?
• 22:50
  SPEAKER_01: I would say that we would be able to others would be able to leverage that data.
• 22:55
  SPEAKER_01: When you think about in as we go and we get all of the longitudinal record, that whole history of a person's data, as long as the person has consented, we'll be able to, it's anonymized, meaning we take all of the personal health information out so that you couldn't be identified.
• 23:14
  SPEAKER_01: And then more research could be done.
• 23:16
  SPEAKER_01: Right now, the only um actual database, if you will, or set of data that has a longitudinal record on it is um, and the goal was 10 years ago was to get a million um people to sign up and and to do this, and it's called All of Us.
• 23:31
  SPEAKER_01: And it um who manages that is out of Nashville um at Vanderbilt um University Medical Center there, and because Maharis in Nashville is a partner with them because Maharry represents um underrepresented populations um in Nashville and also in Memphis with their new clinics, and so that's they've got about 800,000 patients now, and that does have a longitudinal record there if you had signed up for it.
• 23:56
  SPEAKER_01: So if you think about only eight a million records when there's 300 million people, you know, babies all the way to our older generations, 300 million a million is just a drop in the bucket, right, for research.
• 24:09
  SPEAKER_01: But if you think about what um alfinity could provide to the research community to be able to have real-world data is what they call that, then that would be extraordinary.
• 24:20
  SPEAKER_01: Because right now, real world data really sits in Europe, the United Kingdom, and those places in Europe that have a unified health system where they have one number and everything is kept together by that.
• 24:31
  SPEAKER_01: But we don't have that in the American health system because what drives our system is um by the providers and who's paying the bills, and that's where the data sits.
• 24:40
  SPEAKER_00: So I know we talked briefly before about how the tech is the easy part, and you've heard me say that again and again.
• 24:46
  SPEAKER_00: With health and financial and legacy data all in one place, that trust bar is going to be really high.
• 24:52
  SPEAKER_00: So, how do you earn the right to hold that for one person?
• 24:55
  SPEAKER_00: What's the moment that a user actually decides they're gonna trust you with all of that data?
• 24:59
  SPEAKER_00: What have you found so far?
• 25:01
  SPEAKER_01: So I think when we've explained um the security and demonstrated the security, it's the same as your banking system, right?
• 25:08
  SPEAKER_01: Our banking system was the first to go online and be able to use our ATM cards.
• 25:12
  SPEAKER_01: I can remember um traveling in Europe in 1991 and going, This is so cool.
• 25:16
  SPEAKER_01: Mom deposits money and I can withdraw it within seconds.
• 25:19
  SPEAKER_01: It was the most, you know, all the way um in Europe.
• 25:22
  SPEAKER_01: And so we have a trust now, right?
• 25:24
  SPEAKER_01: We trust our financial institutions.
• 25:26
  SPEAKER_01: We don't have that yet.
• 25:27
  SPEAKER_01: I don't think we're getting that level with healthcare, but then to have it all together, yes, you're right.
• 25:32
  SPEAKER_01: Um, but it's uh for the health we're we're holding um that information, but it's encrypted and it's military grade encryption.
• 25:40
  SPEAKER_01: So explaining that piece and being able to get people comfortable with with that piece of it.
• 25:45
  SPEAKER_01: It's also um you have you can put any of your, we have the secure vault, we call it a health or a wellness vault, where you can put your power of attorney documents in there.
• 25:55
  SPEAKER_01: You can set up who can roll, God forbid, if something happened and um you passed away in a car accident.
• 26:00
  SPEAKER_01: There are certain things that you set up that things automatically happen.
• 26:04
  SPEAKER_01: And what we are able to demonstrate is that your family won't be left in alert, you know.
• 26:09
  SPEAKER_01: Right now, I think um before Alfinity came along, um, I had a briefcase with all of the papers in.
• 26:16
  SPEAKER_01: My mom was still alive at the time, and I didn't want them to get packed in the pods.
• 26:20
  SPEAKER_01: I was like, do not pack these papers, you know, because I had everything, even though I had it electronic, I kind of had it scattered on my my Google Drive.
• 26:27
  SPEAKER_01: And so everything was there.
• 26:28
  SPEAKER_01: But when we show them how easy now that it's secure, it's in the vault, they set up, they're in control, and there's no access to it unless they have set it up that way.
• 26:38
  SPEAKER_01: And so we've even now developed a card, um, almost like a like a health card, if you will, but an emergency card, almost if you're diabetic or have allergic allergies to certain things, latex, and you carry an emergency uh like bracelet or thing like that on you.
• 26:53
  SPEAKER_01: Um, the ER doc can see that they have a code and it's like break the glass, they can get in and they can get the information that's needed.
• 27:01
  SPEAKER_01: And so um we've been um testing that as well because that's where you need it in those emergency, you know, times.
• 27:08
  SPEAKER_01: And it's better for the family.
• 27:10
  SPEAKER_01: There's less stress on the family of having to try to figure out where everything is.
• 27:14
  SPEAKER_01: And when once we explain that and have that, it's a longer sell, if you will, you know, on that piece of it, but it's so crucial that it makes sense in our world of electronics and busy, busy, busy, things are scattered and everywhere.
• 27:28
  SPEAKER_01: And I'm I am definitely a person in case.
• 27:30
  SPEAKER_01: And so I've been setting up my affinity account and getting everything in place, and I know now that um I'm the keeper of the passwords, and now I know that they're there and that if anything happened to me, that they would be able to get to them.
• 27:42
  SPEAKER_01: Um, and even the kids if something happened to my husband and I together.
• 27:45
  SPEAKER_01: So there brings a sense of security when you think about your loved ones.
• 27:49
  SPEAKER_01: We work hard because of our loved ones, our kids or or whoever, you know, friends or or causes that we want things to go to.
• 27:56
  SPEAKER_01: And I think that's where we win the trust because it's really to make their life easier on that piece of it.
• 28:03
  SPEAKER_00: I like it.
• 28:04
  SPEAKER_00: So let's think to the future.
• 28:06
  SPEAKER_00: Say Alfinity just kills it.
• 28:08
  SPEAKER_00: You get, you know, acquired by whomever someday.
• 28:11
  SPEAKER_00: But what would it look like if everyone had a health, wealth, and legacy longitudinal record?
• 28:17
  SPEAKER_00: What would that world look like to you?
• 28:19
  SPEAKER_01: I think it would be a it would be, it will level the playing field, in my opinion, especially on the health record.
• 28:27
  SPEAKER_01: I, you know, your book, The Borderless, you know, society and those borderless communities.
• 28:32
  SPEAKER_01: Um, actually, the borderless communities, and we talk about rural communities or communities that are less representative, they are the ones that have the mobile phone because they don't know where they're going to be sleeping, if you will.
• 28:44
  SPEAKER_01: Sometimes they don't know if they're gonna be in the car or if they're gonna be in a housing unit or moving the next time around.
• 28:50
  SPEAKER_01: So they have a they have a cell phone.
• 28:52
  SPEAKER_01: And even across the world, I've seen it in Brazil, I've seen it um in India where they have the cell phone.
• 28:57
  SPEAKER_01: That is the one thing that everybody has.
• 29:00
  SPEAKER_01: So that's all you need to have that data.
• 29:02
  SPEAKER_01: So the world would look like um they have they have their own information that is about them, and they can make their decisions, and the people around them, if they need assistance on that, can make a better decision for them.
• 29:16
  SPEAKER_01: And so we minimize the mortality rate, we minimize the cost.
• 29:20
  SPEAKER_01: I think the average cost now is$4,500 of the data that I've recently pulled of what not have of having fragmented data cost an individual.
• 29:30
  SPEAKER_01: And right now it's I$600 billion to a trillion dollars of what it cost on stress and stress and unpaid, uncompensated care by those that care for our um older generation or those that you know have disabilities.
• 29:46
  SPEAKER_01: Um, that that's a lot, you know.
• 29:48
  SPEAKER_01: And so, you know, just taking it's pressure enough to manage in that situation.
• 29:53
  SPEAKER_01: I felt it.
• 29:54
  SPEAKER_01: Um, I'm in healthcare, I knew the system, knew how to work through it, but I just want it to be a daughter and not have to deal with working through the system because you got to jump through the hoops, you know.
• 30:05
  SPEAKER_01: How much more for those that one don't have that capability are clueless on that piece of it as I'm coaching my young adult children.
• 30:14
  SPEAKER_01: Um, don't pay the bill, wait for all the claims to get paid, you know, you don't own any money yet.
• 30:19
  SPEAKER_01: But that's to me, it's a world where it's more, it's it's fairer.
• 30:23
  SPEAKER_01: Um, and that we see people getting the the what they need quicker and they have a voice.
• 30:28
  SPEAKER_01: You know, I'm gonna go back to that speak for those who can't speak for themselves.
• 30:32
  SPEAKER_01: And that's what um the founder, Jeannie and I um are motivated by is that it's doing the right thing um for the right people at the right time, and that's why we're doing it.
• 30:42
  SPEAKER_01: It'd be, you know, we have a we'd love to go to um international places, third world and developing countries, because they do have um satellite, they do have phones, and we really probably will get quicker traction there because they don't have the infrastructure already laid and they already see it because they have their phones with them every day.
• 31:01
  SPEAKER_01: And so yeah, and the organizations see it.
• 31:04
  SPEAKER_01: It's not the people we're having trouble with trust, yes.
• 31:07
  SPEAKER_01: Um, organizations, why would I why would I trust that?
• 31:10
  SPEAKER_01: I was like, that's the law, you know, um, and it's there.
• 31:14
  SPEAKER_01: So it's just been kind of an interesting conversation as we've been out speaking with CEOs.
• 31:19
  SPEAKER_00: Like that.
• 31:19
  SPEAKER_00: Well, at the end of every um podcast, I ask two questions.
• 31:23
  SPEAKER_00: I'm gonna ask you these last two questions and ask everybody.
• 31:25
  SPEAKER_00: Okay.
• 31:26
  SPEAKER_00: So, what's the clinical reality, or in your case, the data reality that most people in health tech get completely wrong?
• 31:36
  SPEAKER_01: The data reality that most health tech people get wrong.
• 31:40
  SPEAKER_01: Doing this, trying to solve the same problem the same way.
• 31:45
  SPEAKER_01: You've got to solve it a different way.
• 31:47
  SPEAKER_01: You've got to shift your paradigm, you've got to look at it.
• 31:50
  SPEAKER_01: So instead of looking at the base of flowers forward, right?
• 31:53
  SPEAKER_01: You're looking at those beautiful flowers somebody sent you and they're gorgeous.
• 31:57
  SPEAKER_01: Well, what does it look like looking at it different?
• 31:59
  SPEAKER_01: Stand on a chair and look down.
• 32:01
  SPEAKER_01: So we have a painting that my husband did as a student artist, and he stood on his chair and he painted the picture from down.
• 32:08
  SPEAKER_01: It's a whole different perspective.
• 32:10
  SPEAKER_01: Or if it's a glass table, crawl underneath and see what it looks like.
• 32:14
  SPEAKER_01: So I use that as an example of shift your paradigm, shift the way you're looking at things, and shift how you want how you could solve the problem.
• 32:22
  SPEAKER_01: And I think that's the biggest thing they get wrong.
• 32:23
  SPEAKER_01: They keep doing it the same way over and over and over.
• 32:27
  SPEAKER_00: I like that.
• 32:28
  SPEAKER_00: I like that.
• 32:29
  SPEAKER_00: And then the next one is when's the last time you changed your mind about something in this industry?
• 32:36
  SPEAKER_01: Ooh.
• 32:37
  SPEAKER_01: Um, I would say since 2020, um, after the pandemic, um, I had 18 months where I ended up working for myself.
• 32:46
  SPEAKER_01: My contract ended at Maharry, fair enough.
• 32:49
  SPEAKER_01: Um, and they were fighting the fire, you know, so they weren't hiring, nobody was doing special projects, and that's you know, my career, that's what I do.
• 32:55
  SPEAKER_01: So I was doing some consultant advising, and I think coming back, my first job back was at Oracle, um, and then moved on um to this job here in Atlanta, and it was just different, you know.
• 33:08
  SPEAKER_01: I really thought, gosh, do I really want to do this anymore?
• 33:11
  SPEAKER_01: Because we've just have shifted in the way that we deal with people, work with people, you know, all that that pandemic brought about.
• 33:19
  SPEAKER_01: Um, and when you walk into hospitals and doctors' offices to be kind, be nice, zero tolerance, and you know, treating the healthcare workers, it just really makes you think about wow, do I want to be a part of that, you know, anymore?
• 33:31
  SPEAKER_01: Um, so I decided to um pursue my uh biomedicals data science PhD um at Maharry because they now have that program.
• 33:39
  SPEAKER_01: So that way I'm always connected to Maharry.
• 33:41
  SPEAKER_01: Um and the fact that I believe so much in the mission and vision of what they've been called to for 150 years, and that's to serve those that are underserved as the vision and to continue to reach out to make it a better place for them, and therefore it becomes a better place for all of us.
• 33:59
  SPEAKER_01: And so I think there was a time after the pandemic I really thought, oh blow it, I'm just gonna go do something else, you know.
• 34:05
  SPEAKER_01: Um, but now having uh worked with Gene on this, he had a Lego piece of the legacy part.
• 34:12
  SPEAKER_01: The story goes, I added my legacy piece of this light cont life continuity infrastructure, and it just makes me get up in the morning um with a mission and a vision um to make it better, you know.
• 34:23
  SPEAKER_01: And I think we can reach a lot of people, um not just here in the States, but um overseas, that it will help people, it will help the providers, um, and it will make it better.
• 34:33
  SPEAKER_01: Um, it's just data people and the data people in person.
• 34:37
  SPEAKER_00: So well, thank you so much, Amy.
• 34:39
  SPEAKER_00: This is exactly the conversation I was hoping for.
• 34:42
  SPEAKER_00: So that number that we started with should stop us all, and then what it actually takes to build the fix.
• 34:47
  SPEAKER_00: We've heard a lot about that today.
• 34:48
  SPEAKER_00: So thank you for the time and for having this wonderful discussion.
• 34:51
  SPEAKER_00: Before we go, tell everyone where to find you in alfinity.
• 34:54
  SPEAKER_01: Sure.
• 34:55
  SPEAKER_01: So it's easy, I think.
• 34:56
  SPEAKER_01: Um www.alfinity a-l-p-h-i-i I-n-it-i.com.
• 35:04
  SPEAKER_01: I have to do that, alfinity.com.
• 35:06
  SPEAKER_01: Um, and it means the um beginning and the end and into infinite infinite infinity.
• 35:11
  SPEAKER_01: Um if you think of uh Buzz Lightyear.
• 35:13
  SPEAKER_01: So alfinity.com.
• 35:15
  SPEAKER_01: So we're easy to find.
• 35:16
  SPEAKER_01: Drop us an email, you'll see the website, you can reach out to us, and we'll be um able to respond pretty quickly.
• 35:22
  SPEAKER_00: All right.
• 35:23
  SPEAKER_00: Well, for everyone listening, if that number landed for you, the doubled mortality risk when nobody's holding your whole story.
• 35:28
  SPEAKER_00: Go find Alfinity's work, subscribe to the clinical realist wherever you get your podcasts.
• 35:32
  SPEAKER_00: And if you're working through a live data continuity or clinical AI governance question inside your own organization, not a theoretical one, a real woman, um, the link to Alfinity will be in the show notes.
• 35:42
  SPEAKER_00: And I'm always available.
• 35:43
  SPEAKER_00: So I'm Dr.
• 35:44
  SPEAKER_00: Sarah Mann, and this is the clinical realist.
• 35:46
  SPEAKER_00: We'll see you next time.
• 35:46
  SPEAKER_00: All right, thanks.