Dissecting Digital Transformation: Opportunities & Challenges in Digitally-Enabled Medtech & Care Delivery | LSI Europe '23

Transcription 

Vaughn Schouten  0:04  
I have the privilege of working with most of our summit customers, which at Salesforce is fortune 100 medical device companies across the globe. We have a fantastic panel here that I want to introduce you to. We've got Dr. Desai. He's a advisory partner to Nina capital, and also a 25 year practicing physician. We've got Yosef, which is the founder and CEO of hepatech. And if you want to learn more about their organization later today, they have a presentation. We'll go into the details this afternoon. And then we've got Carlos who is the President of International for TelaDoc health. So with that, no one wants to hear from me, I'm going to turn it over to our panelists to let them introduce a little bit more of themselves. And our first question to them is, what is their definition of digital transfer transformation? So I will start it off with I just spent a week at what Salesforce dubs the biggest AI conference in the world, we had 50,000 people in San Francisco. Everyone has a different definition of digital transformation, depending on your position, depending on your organization, what is it? Where in the process, are you? So I'm excited to hear from our panelists today from three different kinds of vantage points as to digital transformation, how they're thinking about it, integrating it and preparing for the future. So let's just go down the line, gentlemen, and Yossef will kick it off to you.

Yosef Safi Harb  1:38  
Thanks, Ron. Well, I think digital digital transformation is a journey from a to b, where a an institution or organization wasn't working with any digital tools, and then implements those tools, learns how to work with them, and then is able to transform the organization to work ideally in a more effective and more cost effective way to reach a certain goal. This is more or less on a high level. Awesome.

Vaughn Schouten  2:06  
Over to you, Carlos, this is kind of your world in the telemedicine world.

Carlos Nueno  2:12  
Right. Thank you, Vaughn. So yeah, I would say that you're right, telehealth, we started as a digitally transformed company already back in early 2000s. Very earlier than COVID. And of course, we started to cover all the different states in the US covering finally 50 states, then became a public company in 2015. And then started to grow internationally. And in 2018 19, when COVID started, we already covered pretty much of the world. So we saw COVID. Starting in China, where we have operations, we saw it going from the east, from the from the east, to the west, and coming into Europe, hitting some of South European countries like Spain or Italy, and then going to Canada and then going to Latin American states. So we saw it and suffered from an operational point of view, as we multiply our demand 10 times within days. And so for us, that was a transformation on a digital company. So I guess transformation depends on how mature or transform you already are. We were born as a mobile, first virtual first company. But that was a transformation for us. And we implemented lots of different mechanisms to provide more efficiency to be able to grow our operations, our physician network, today, we have more than 10,000 physicians, physicians working for us, more than 50,000 specialists. And maybe the the the outcome of all of these is that it allows you to provide more efficient care to patients. So I think transformation has to be always related to the patient, you need to put the patient in the front. And then from that angle, how can you improve access? How can you improve efficiency? And how can you crease quality of care? I think these are the three components. Fantastic.

Vaughn Schouten  4:21  
We will definitely dig into the customized medicine and the efficiency piece. Before we do, Dr. Desai, why don't you give us your viewpoint, and you have a unique viewpoint, right? You're a clinician actively in practice a primary care physician, but also an advisor and partner on the venture capitalist firm with some funds. So why don't you give us your perspective on digital transformation as a clinician, how does that look and feel and then also companies that you've invested in or looking to invest in?

Dr. Hemal Desai  4:55  
Sure, thanks for so I guess I have those two parts. vectors. But I also have a payer perspective as well, I spent last 10 years working for two global insurers. And I guess how I would crystallize digital transformation is that you're, you're making a change, you're making a substantial change that brings quite significantly more value. And the value that that change brings, is really on the perspective of all the different types of stakeholders. So I think Carlos, you touched on it, you know, if I'm looking at as a clinician, and looking at from a patient point of view, I want digital transformation to improve health outcomes. That's my primary goal. If I look at it from a payer perspective, I think there's a key goal in trying to make care more affordable, or make care more affordable for more people, through a payer perspective, whether that's whichever system you're working with, I work in the NHS, and that's making care more affordable for a universal health care system in the US or in insured populations is how do we make care affordable for them all across the world? So I think that's my payer perspective. And I guess, from an investor side, I think all of those perspectives and many more matter, because you're looking at, well, how is this company going to be successful? And really, it's around how they're going to create value. And so that's digital transformation within the company, if they're at a certain stage, and now they need to improve, either to gain more customers or to look at their operations. But how are they ultimately going to create value for the health system that they're looking to support? And, and therefore, us as an investor? How do we look at look at the, I guess, the opportunity that so

Vaughn Schouten  6:51  
let's stick with that payer perspective for a minute. And I've had the opportunity in my role. In our industry advisory team, we have med tech pharma, and then on the healthcare side, we have payer and provider and across the globe, the vast majority of them are our customers at Salesforce. So a unique use case that I was a part of that I got to kind of see bits and pieces of this digital transformation was what UnitedHealthcare did in the diabetes, disease, state space with Dexcom. Both UnitedHealthcare and Dexcom, are customers of ours. So they looked to us to kind of help them with integration. And we worked with them individually and collectively as they put this together. But I think that's a unique use case. So from a payers perspective, when you think about the industry and how it's changing what our payers looking for, when it comes to digital transformation, like those types of relationships when it comes to maybe Health Tech, or, you know, if you're Yosef, in cardiac monitoring. So what matters to the payer?

Dr. Hemal Desai  8:09  
So I guess there are very nuanced ways of answering that question. But ultimately, ultimately, you know, a payer is, is managing the funds to manage the population have to manage the health care of a population. And so if you look at health care systems, and what in whatever payer guys, you have, there's a finite resource there, in terms of in terms of cash, and there's a population that needs to be served. And all of the health health outcomes for that population need to be managed for today, and for tomorrow. And so digital transformation really has to support those goals. And when I mean, support those goals, really, you're talking about, you know, how do you get better insights into a particular population and their healthcare burden today, and the healthcare burden tomorrow? How do you manage the risks associated with the healthcare burden of tomorrow? How do you treat people more effectively now? So it reduces the risk of healthcare consumption in the future? And then how do you work more immediately around, you know, some of the other aspects that are coming? That, you know, there's a huge plethora of technologies of medications of new devices that are going to come and impact the health care for, for positive reasons. And so how to how to pay as look at that and say, how do we try and create the right environment, so that we can open up our members to receive some of those care elements, but in an affordable way and in a sustainable way, because you may have the best solution out there to transform somebody's outcome. But it's got to be affordable because if it's not a full Trouble, it won't gain the traction that it deserves. And so when you're thinking about it as a, as a company, you've got to think about all of those different aspects and make the solution meaningful, not only for the patient for ultimately for the payer as well.

Vaughn Schouten  10:18  
Fantastic. So some very interesting perspective and viewpoints there. So let's go back to what you mentioned, Carlos, as far as efficiency and personalized medicine, and you've been running TelaDoc. internationally for five years now, you've seen this massive uptick of virtual care. And I probably have one viewpoint of that, but you you have many more the last statistic that I saw, and it would be interesting to take a poll the audience, but I can't even see him, because these lights are so bright, so we won't do that. But the last statistic I saw is 87% of patients that had had a virtual health care visit, preferred it, and you may have some other data and statistics, which is probably more real time and more accurate. But why don't you talk to us about what you've seen, you know, maybe five years ago, and then COVID hits. And, you know, I would argue personally from my seat that it probably doesn't ever make a lot of sense to put all the sick people in the same place. But talk to us about telehealth, Tella doc, and this uptick that you've seen with COVID, and how it's affecting how it's making, creating additional efficiencies. And maybe from your perspective, you know, running the business with TelaDoc, how it's affecting clinicians, and even more importantly, the end user patients.

Carlos Nueno  11:55  
Yeah, so and also tying this to what Emma was saying, we work with many providers, and also with many payers around the world. And, and probably, there's this, this has been the biggest transformation in that space over the last five years. To your point, of course, COVID-19 created a immediate need, and many patients that have maybe not thought about their toil as a as an option, then had any other option as providers were closing physically. And so then the biggest question we are receiving nowadays is, is it is Verto care going back. And the truth of the matter is, of course, we don't have the volumes that we used to have during COVID. Because paid basically everywhere everyone was using the auto care, but the rates of growth are double digit constantly, year after year, we completed 60 million virtual visits, just some months ago, and 21 million were done last year alone. So there's a huge increase on on patients adopting virtual care as the standard way of accessing health care. Now, I think we are just scratching the surface in that sense, because there are a lot of many other growth opportunities, one of which is chronic care management. When you analyze the trends around the world, not just us, not only is that the satisfaction is very high, the adoption is high. But also we are in a world where we are seeing life expectancy increase, we are seeing chronic disease increase proportionally and we are in Europe. So it's about I think 1/3 of adults in Europe have one chronic disease. And when you look at above 60, it's about two thirds that have chronic diseases. And so the chronic disease is going to require a lot of investments on primary care. Now, primary care in general and health care, public health care in general tends to be under stress. And so that's creating a lot of opportunities for digital transformation and companies like Tella doc that can offer services that can increase efficiency, maintain or increase satisfaction. And chronic care is the one area that can avoid a lot of unnecessary hospitalizations. And just to keep in mind 50% of visits to hospital are related to chronic care and 70% of hospital hospitalizations are related to chronic heart disease. So what we are doing here is a little bit of combining the medtech industry how you can get the data out of the med tech out of the devices. How can you integrate this with virtual care? And, and how can you provide these as a service to consumers, whether it is through the payers, through the providers, or even in a direct to consumer way, which is another chapter, I would love to, to expand later on. But to your point, I think we are seeing great demand, we are going to see even greater demand on the chronic care space. And of course, there are specialties that have gone even beyond that mental health would be one. So we have, unfortunately, experienced a huge demand of mental health globally. And that's continues to grow. And that's probably what the one specialty that we've seen almost 90% or 100% transformation, people preferring virtual care, as opposed to physical care. So yeah, happy to continue the discussion.

Vaughn Schouten  15:48  
Fantastic. Thank you. So Yosef, let's go to kind of the provider and patient perspective. And I think from your seat. Earlier today, we met and I was learning a little bit more about the technology. And I was able to sit there for 60 seconds and make sure I wasn't dying. And I didn't have afib. So tell us a little bit more about habitat. But as you think about your organization, and what you're trying to do, and how that fits into this whole digital transformation, wave and empowering clinicians, providers, and the end user as far as the patient, because the convenience aspect of what we did out in the hallway over there, versus the alternative, the old way, right, kind of have this old school versus new school. But talk to us a little bit about your organization and what you see today as far as adoption, and then futuristically, when it comes to patient monitoring and the technology that your organization has.

Yosef Safi Harb  16:57  
Yeah, of course. So we're called Happy tech. And what we solve is that detecting heart problems can be like finding a needle in the haystack, patients often receive devices for 24 hours up to 30 days. But episodes can happen outside of the time of monitoring. And so many patients fall through the cracks about 30%, leading to hospitalizations. Unfortunately, that's an high annual cost. And devices are expensive. They're not always available. So we started looking as like, how could we solve this problem with something that 86% of the world already has a smartphone. So we spent six years in clinical studies, to be able and regulatory approvals to be able to detect heart problems just using your phone. So by placing your finger up for a small period of time, you can detect this. And that's all nice and great, because you have a great technology that patients love. But that doesn't mean it gets implemented only when the physician is really empowered and wanting to use it. That's when you're able really to create the digital transformation. So most of our work actually goes on to the clinician side is an onboarding the clinicians because clinicians be the NHS, they're so busy, and why you're you're disturbing their day to day operations, and why would they start using new technology. And every single day, there is some new kind of technology. And I think doctors are here, we're good. You know, we're so busy, so overwhelmed. So how can you make life more easy? So whatever you're bringing is not about the tech, it's about which patient pathway are you providing with? And how can you make my life more easy. So that includes the basic things like interoperability, just make sure that data gets into our EHR, includes things in like, Don't make us crazy with 100 alerts, because devices now have the ability to generate millions of data points, but nobody cares about that. Just tell me the one actionable item I need to know and make my life easier, please. And we sometimes forget that. And we you know, it took us also a long time and experimenting. Our first deployment was just five patients, you know, a few years ago, and now we're close to 12,000 patients. And it's like really step by step. And what's really helped are the Pioneer clinicians that are saying, You know what, we'll accept an imperfect situation, and let's get it better and better and better. And once they get it better, they convince their other colleagues and other hospitals to join in. But without the clinician, we wouldn't have seen the success that we've seen today. Because they understand their day to day like no other. And the tech is there just to support. So we have a very humble part in this. But the digital transformation is when you are able really to work together very closely empower each other. And then through that the patient will be empowered as well.

Vaughn Schouten  19:46  
Fantastic. So let's go back to the clinician side of the house, we'll play ping pong here. So when you think about maybe your day job as a clinician, and historically how Are you as a provider, and your organization as a hospital, reacting to this massive wave of digital transformation in the industry? How does that look and feel? And maybe if you have an example, right, like, has there been something that your facility has implemented, as far as digital transformation that meets those criteria that you talked about? Right? May or may not be the cheapest thing on the market, but affordable, you know, it needs to be affordable. So talk to us about the hospital and clinician perspective and how digital transformation has affected you. Yeah.

Dr. Hemal Desai  20:42  
So, you know, you were very kind about clinicians, I've managed many clinicians, and I've always, and I have been one for almost 25 years. So we're difficult people generally. But when we think that something is a good idea, we will pursue it. Or if it has a very good evidence base, that is going to improve the lives of our patients, we will adopt it. But we have to be convinced. And and there's a big step there. And so if I look at it, from a clinician point of view, what am I worried about, you know, when something new, and there are lots and lots of new things out there, there are lots and lots of things that we get approached. And if you look at just this conference, there are so many exciting technologies that are out there. And each one is, you know, I met probably 10 to 15 founders yesterday, just walking around the poolside. And every single one had a great idea. And I could see the application of that. But that's not the road to success, the road to success starts in at a very early stage. And from a clinicians perspective, you know, firstly, we're driven by safety, is this technology safe? If you can overcome that hurdle? Will it make the patient's life better? Will it drive outcomes? Is it effective? Then we get into? Okay, so if I'm in a position where both of those things are, are taped? Can I use it? Does it have regulatory clearance? Am I safe to use it? Has it been sanctioned by somebody has been approved from my jurisdiction? Has it been approved for reimbursement? Can I actually get this reimbursed if I was to suggest it, and then can I convince my peers in my department or in other hospitals to adopt this, because I may adopt it, but then many others might not. So there are a number of different steps. And even when you get to things like FDA approval and regulatory approval, that's really just the beginning of the journey. And as a clinician, you know, there are lots and lots of technology. So I mean, we're in our hospitals still very far back, and we're just adopting another EHR system. And, and the change is significant. And if I just look at it from my own shifts this weekend, just learning a new system, and just documenting my history. And my findings in the new system is a big challenge. Now, when you add on layers of other things that I need to do, it makes it makes seeing a patient even more difficult. So it has to be within my workflow. And it has to work. Otherwise, it's just another thing to do. And even if it's a great idea, I will find it difficult to adopt. But just just to add one other point, as an investor, one of the things that Nina you know, we invest in pre seed and seed levels are very early on. And one of the things that we're looking for is very similar to that is, Yep, absolutely great technology, whether it's in health tech, or med tech, but how likely is this to succeed? And how like, and when successful, you know, how likely is it to be adopted? And how can we, as a VC firm, support the companies that we've invested in to make them successful, and that's what sort of differentiates us so we're very much into a very niche space of, of Health Tech with a data layer. And and the advisory partners that Nina has has built together is really to try and facilitate the success of each of the portfolio companies that we have.

Vaughn Schouten  24:31  
So I'm going to put you on the spot and then we're gonna flip it back over to Carlos for some insight, but through COVID, and in your time as a primary care physician, what would you say how much of your practice has gone to virtual versus in person? And are you seeing trends with certain demographics, patient populations or particular disease states? Give us some insight So,

Dr. Hemal Desai  25:00  
so a lot. So across the NHS, in the UK, everything went virtual for a period of time. And that was a significant change. Even now, so far down the line, if we look at outpatient care, in certain specialties, still about 30% of outpatient care is still is still virtual, even in surgical specialties, post op care, a lot of that is managed virtually, in medical specialties, specialties, a lot of consults are still done virtually in NHS hospitals in primary care, many primary care practices have now adopted Digital First, in terms of triage in terms of consult, and then if somebody needs to come in, then they will be given an appointment for a face to face. So there's been some very long term sustainable changes to digital care in the UK particularly

Vaughn Schouten  26:04  
perfect. So, Carlos, from your perspective with the international market and TelaDoc. And this virtual care sounds like it's here to stay. You mentioned chronic disease management. I was talking there. So you mentioned mental health. at Salesforce, we have helped several organizations in the mental health space create these customer portals and it's almost all virtual, right? Like just in time, if someone's in crisis mode, they grab their smartphone 86% of the world has them. So what what's next when it comes to, you know, telemedicine? And are you seeing trends internationally with certain patient populations? Are there other people that are resistant or have resisted and continue to resist kind of telemedicine versus, you know, the patient population that says, you know, what, why would I get in my car, go get on the road, and go to a doctor's office to wait for my primary care physician who's running at least 30 minutes behind? Right? Why would I take two hours in my day, to go have a checkup on a disease that is well managed versus tapping on my smartphone and doing a 10 minute virtual care visit? So what are you seeing trends, you know, internationally with certain patient populations and demographics, maybe even country? Specific? Yeah,

Carlos Nueno  27:37  
and, and you're right, and also tying to what was discussed before, I think COVID was at a time where a lot of providers were forced to adopt their token. And when you are forced, you probably don't do it, as you should. Right. So it's more of a forced decision. I think, in general, everybody has had an experience somehow, with virtual care, probably not everybody's as happy as we were saying before, especially during COVID, when you are forced to do things, because there's now no additional option, I think, that probably is not the best. Now post COVID, I think we have a chance to redefine, and that's what we are doing with many providers and health systems is redefine how healthcare should be from the beginning. So again, it's about putting the patient first and designing how care should should work. And of course, you should get care wherever you are, whenever you need it. And we have not discussed about regulations and challenges and all of that. But there are many regulations internationally that prohibit access to care or make it so difficult. And so that is one of the challenges. And it's not only international, it's also us right so you have state regulations, which during COVID were lifted and access to care was easier. Now, we went back to having state licensed physicians and that makes companies like us be more difficult to provide care and access to care. And, and that exact same situation happens in every single country around the world. So you may not be able to provide care in a country if the doctor is not licensed in that country and imagine how complex it is to manage a digital company with more than 200 different regulations which are changing in some countries in Europe, you may be able to prescribe in some other countries you may not be able to prescribe, or in some countries you may be able or in the City of London you may be able to deliver medication at home. In many other places like in this country, you are not allowed to deliver medication at home. So there's still a lot of barriers that make X is super complicated. We have the technology, we have the mobile technology that everybody uses around the world. We have, as I was saying, demand is increasing. It's not a lack of demand, we have huge amount, unfortunately. But there's still regulations that make things very, very difficult. And so we also see the positive side of this. So we see many countries and states that are regulating in favor of access. And there are great examples in Europe, for example, in Germany or in France. Also, in terms of reimbursement, we're talking about physician adoption. Well, most of the physician adoption is related to reimbursement, do I get paid for virtual care as if it is a face to face? In many, many countries, this is not the case still. And so, again, we are improving. But if we don't pay physicians and clinicians according to what the value that they are providing, then of course, we limit the adoption of virtual care. So I would say that most of it comes from these challenges and barriers that we still need to go through globally.

Vaughn Schouten  31:09  
Thank you for that insight. So, Henry, we have some new sessions that have come out of this session, I think we got a session on health equity, right? access, affordability. We've also in let's wrap with this because we only have a few minutes left. So let's start with you as a health tech slash med tech organization and patient, patient centric, right, you're creating efficiencies, but you're also battling organizationally, some of these regulatory and compliance challenges. So let's wrap with that, when you think about digital transformation, you think about the legal and regulatory landscape that exists now today for a med tech company versus a telemedicine company, you know, versus a clinician side of the house. But also from the investment standpoint, what recommendations are what pearls would you give? And how have you navigated any of those challenges, right? Because Carlos is exactly right. With this new technology, especially in the healthcare space, a fun statistic, you can right home to your kids, about 30% of the data in the marketplace comes from healthcare. Right? When you think about the amount of data 30% of it, globally, is in the healthcare space. So you also from your seat, your organization, any best practices, tips or tricks or insight from a legal regulatory? Have you guys been able to work your way around data privacy, right? Some of this HIPAA stuff as you're looking at, you know, globally, but in the United States, you know, it was interesting. So as an end user, I got a letter in the mail last week that HCA had a data breach. And in their database, my entire family, my wife, and my three daughters, all of our protected health information had potential risk, right? So when you start thinking about this digital transformation, and AI, generative AI being layered on top of this, predictive AI, right, what is the next best step? If someone has afib? So what now? What are we going to do with it? What's the clinician? What's the patient going to do? Where does the data go? How does that trigger the next next action? So let's go down the line start with you Yossef, legal regulatory landscape, as a med tech organization, how have you navigated that best practices? What does digital transformation, you know, create? What barriers and challenges does this new technology create in the marketplace? Yeah,

Yosef Safi Harb  33:58  
maybe to tie a few things. Also, what you guys said, is that you need a few things for a country to have to be fertile ground, to be able to actually initiate you know, digital transformation. And obviously, having reimbursement is very important, the openness to innovate maybe how big you're penalized if you you know, have a data breach. So what we've started saying is, look, we're just going to focus on that countries that are ready for it. Because as a small organizations, we don't have the power. I think even the huge tech are still you know, having difficulty changing policies and regulators, regulations, it's just a matter of time. And, you know, we see Netherlands as an incredibly forward thinking country with great reimbursement right now. Nice adoption. So we're fully focusing on that. We are looking at the NHS as because they have introduced a lot of virtual wards. And obviously us is also very interesting for us we keep an eye on the other country Is, which are in discussion. So France and Germany want to introduce new new ways of reimbursing digital health or working with digital health. But personally, I don't feel they're, they're there yet. So it's kind of looking at the market, which country is, is ready for, for new technologies that we are in. And then maybe to address the legal and the GDPR, or HIPAA. The beauty I would say about our company is we work together with all the remote patient monitoring companies in Europe, almost all we don't work for you guys yet is that we integrate into platforms that are already GP, GDPR, or compliant to the countries that are working in. So we work with, you know, US based companies, but also Dutch based companies. And they have all the regulatory approvals in check, to be able to fulfill the needs and demands. So that makes the market access easier. Because it would be really hard to customize your solution to you know, 50 countries, which is what you are you are doing as per country. Fantastic.

Vaughn Schouten  36:07  
And that's a whole nother session that probably is occurring here. I doubt there's anyone in this room that doesn't have some form of wearable, right, and when you start thinking about the data that's being collected from that, so Carlos, from your seat TelaDoc, barriers, challenges, and any tips or tricks for some of these early stage organizations when it comes to legal regulatory compliance? You know, yes, everyone has this new technology, it's more efficient, it's going to create, you know, it's, it's better for the patient, the payers are on board. But when you start talking about protected information, and data and all these different things, what have you seen? Because I imagine you're probably still caught up in some of these battles across the globe, but tips or tricks legal, regulatory wise?

Carlos Nueno  37:00  
Yeah, well, of course, this is very relevant and very important for any healthcare organization. And you need to do it very well, from the from the start. And I agree, a way to start is focusing on specific markets that have the right framework and regulation, where you can test the concepts and grow from there, at the end of the day, most of Western countries would have similar regulations, and they would want to protect data in the same way. And nothing really that is impossible to achieve. And I would say there are some countries that are more mature in the type of regulations that they have. I think that the NHS in the UK with a CQC may be a good example that because they have a very good framework to assess, you know, quality, efficiency, etc. But that, but um, yeah, I think our experience is, at the end of the day, you have to build something that has scale, and is sustainable. And this is healthier, why you need to be sustainable, to be able to continue to deliver your services at the best quality possible at the end of the day, you're managing healthcare and patient care is all one matters. So we are seeing examples of companies that during the pandemic started to grow. And now they are suffering the consequences of maybe not doing these in the proper way, or rushing or going too fast to expand internationally, or not investing appropriately based on the scale that they have. And I think healthcare is a very long term industry that you need to invest now, and you'll need to have a return in the following years. Unless you are focused in that way, it won't work. If you are opportunistic, it won't work. And that requires, if you want to do an international expansion that requires good financing position as a company, you need to be ready to sustain those investments. And even more so today, because it's becoming very, very complicated with cyber protection, as you say, or data privacy, complying with all these regulations that we discussed. Finding the right business model at the end of the day is key. And we've seen a move towards value based in the US we are seeing this globally. I would say whether you focus on healthcare or technology, where you're going to license your technology or both, you're going to provide technology and the healthcare service behind of it. And therefore you become a healthcare entity that it's much more difficult to to comply with all the regulations. So these are very Important decisions that you have to take at the beginning, and then grow with them. And I think I'll leave it here. Great.

Vaughn Schouten  40:08  
Last but not least doc, and we're out of time. So we'll, we'll stick to efficiency but hurdles that you faced in implementing digital transformation as a clinician, or as a system, because you're part of a massive system, but maybe also, you know, from the investor side of the house. So

Dr. Hemal Desai  40:25  
I think the first thing to say for for companies is, you know, do your work around this, you know, if you're holding data, then, you know, it's very important, it's seen as one of those bits that can be put lower down in the list to look at. But it's incredibly important. And it's incredibly important from all the aspects. So as an investor, you may not have all the answers as a company, but it should be on your list of things that you know, you've thought about, and depending upon which stage you're at, you've actually have a solution in place to protect the data that you have. Because it could it could jeopardize your business and your ability to grow. So I think that's, that's really important around healthcare data. But as a clinician, as well, it's one of the things that, you know, you will be worried about, if you're holding the data of patients, you know, I'd want some comfort as a clinician, that the people that I'm working with, I can trust to look after the data. And so there's a regulatory police around that. But there's also an organizational piece that sits within the organization and making sure that the right standards are in place, because that gives comfort, and and then how do you deal with things when they go wrong? This is because inevitably, healthcare is a complicated space. And there may be mishaps that happen, and how do you deal as an organization and cope with that, so all of those things come on the journey. As a clinician, they can worry me, as an investor, they can worry me. But I think if you've got the right support around you, and the right care, and actually investors can really help in that the ones that are that have the knowledge and expertise to support organizations can really help the companies through that journey, because you won't have all the answers. And generally, founders in the early stage of development, you know, are purpose driven. And so they're really focused on on the mission of what they're trying to create. And sometimes some of these things you need people around you to help explain and to find you the right source of help. And so choose your investors wisely. Fantastic.

Vaughn Schouten  42:40  
So we'll wrap with this digital transformation. And you said it multiple times. It's a journey, right? crawl before you walk, walk before you run. There's an international strategy, but have a data strategy management, have a legal regulatory manage digital transformation plan. And I want to thank each one of the panelists for their insights. And thank you for being here today. Appreciate it.

Yosef Safi Harb  43:04  
Can I can ask you one thing, probably one thing that I'm wondering maybe others, what is what are you what is Salesforce doing in medtech? Because when?

Vaughn Schouten  43:14  
Fantastic question, so I'll give you a very efficient answer. So we're in I'll throw out a few organizations Johnson and Johnson Hologic, Stryker Smith and Nephew Arthrex. In the payer, world, united, Aetna, you start thinking about these organizations, you you think about the data that exists, right, I would love if there's anyone in the room like people think of Salesforce as a CRM, right? So much more than that, right? When you start thinking about all the data that's created in healthcare, so I run our med tech, and yes, it starts in Salesforce is known for CRM, but with what's on the verge, futuristically, with AI, with the payers with clinicians, you know, most telemedicine, you know, organizations are our customers, everyone has to find a way to manage their data. And for those organizations that have people out there commercially, what is the next best step? Right? Territory planning operations, right, at the end of the day, a medical device company is a highly regulated manufacturer. So when you start thinking about, you know, legal, regulatory and compliance or recall management, right, we've created a way, you know, we help organizations that typically would have to go hire 2030 People FTAs to manage, you know, a warning letter, or God forbid, a recall. Unfortunately, I've lived through five of those historically. So we play in the data space, but the nice thing is your data is not our business. And so it's an open platform, we have over 200 partners, so that's a as efficient of an answer as I can give it for why am I sitting here and why it sells source in the med tech space thanks thanks thanks everyone we're out of time appreciate it