The Convergence of Medtech, Biotech, & Digital, & What it Means for the Future of the Industry | LSI Europe '23

Speakers

Joe Mullings

Joe Mullings

Chairman & CEO, The Mullings Group
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Ashley Seehusen

Ashley Seehusen

Venture Partner, Santé Ventures
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David Zakariaie

David Zakariaie

CEO & Founder, Senseye
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Bill Hunter

Bill Hunter

President & CEO, Canary Medical
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Shobha Parthasarathi

Shobha Parthasarathi

Advisor, Xontogeny
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During this insightful panel, industry experts explore the obstacles obstructing the aggregation of patient and EHR data, despite its potential to drive innovation and personalize healthcare.

 

Transcription

 

Joe Mullings  0:05  
Thank you so much. And I really appreciate everybody's attendance here today. And just about last night, you can't get a show like that at JP Morgan. I'm just saying, if you attended the extravaganza that was really special. So let's jump into it right away if my panelists would each introduce themselves and that will help with their perspective as we share our thoughts.

Ashley Seehusen  0:25  
Ashley Seehusen, I'd say ventures, I'm a venture partner there. sante is a early stage Life Science investment company. We invest in healthtech, medtech and biotech.

David Zakariaie  0:37  
I'm David Zakariaie. I'm the CEO and founder of Senseye. At Senseye we are doing the first diagnostics and severity monitoring platform for behavioral health, and our initial focus is on PTSD, anxiety and depression. 

Bill Hunter  0:54  
I'm Bill Hunter, I'm the CEO of Canary Medical, we put sensing implants inside other medical devices to connect them to the internet. Our lead product is the Persona IQ, smart knee made by Zimmer Biomet.

Shobha Parthasarathi  1:09  
I'm sure I've had something. I'm an advisor with Xontogeny, it is a Boston based life sciences accelerator. And we are associated with a venture fund and a hedge fund. And the Venture Fund has called Perceptives Xontogeny venture fund. And we invest in pretty much everything, seed and series A B stage companies developing either therapeutics diagnostics, medical devices, research tools, and digital health as well, except not just pure software.

Joe Mullings  1:37  
So since this is a digital focus, we had to pick a small sector. And the sector, I think, that we could have the most impact on is the management of chronic disease, we may fray out on that a little bit. But I really want to focus on that today. Because I think that's where digital really has its best opportunity to enter in an actionable way to med tech, for those of us that have been involved in digital companies to date. They're fantastic sounding, but nobody's really figured out how to get paid for them yet. We've introduced them the last couple of years, and a large majority of them have not figured out who's going to pay that bill. Therefore, the adoption is tough. But when we think about chronic disease, 18% of our GDP is spent on that managing that in this country, and 80% of that 18% is the management of chronic disease. So as we look at this, that patient and consumer monitoring comes to mind, yet, what I want to discuss tonight or today is who's going to own that, ultimately, the convergence of the data, the consumer patient, and they're two different things, the pharmaceutical company, the biotech company, or the device company, because it's up for grabs right now. And is it going to fall under the control of one of those entities? Or is there going to be a new agency that will be developed, that will hold that data that will have the trust of the consumer that will give full access and be able to make that actionable data? I want to open up with with a quote that Bill had to get us started. So he wrote an article after a little over a decade of participating in the field of digital health. I've reached the conclusion that successful companies follow a predictable pathway based upon the growing number of patients they have under management, digital health companies begin as patient monitoring companies, become diagnostic companies and evolve into patient management companies. Though I don't know when you wrote that, but the is still believe that to be true.

Bill Hunter  3:35  
Yeah, I do. I think you start collecting data. And you're not always sure what it means. And the first thing you can do with that data is patient monitoring. And then people say that's great, but who cares? What are you going to do with it that's clinically meaningful. And so the next thing you do is try to do predictive analytics to figure out what it means and try and get out in front of whatever it is that you're monitoring. And then you do that, and people say, that's great, but how do I change patient outcomes? And then you have to evolve into using that data to manage the patient and actually change, you know, whatever parameter it is you're looking at, and you kind of go through that evolution, because at the end of the day, you get paid for outcomes. And data is not outcomes. It's applied data. That's outcomes. And that's kind of the route you go through to get there. 

Joe Mullings  4:31  
Are we getting paid for outcomes? Are we still a fee for service environment and health care? Ash?

Ashley Seehusen  4:41  
I think we're somewhere in the middle. I feel like we are evolving. As we get more devices are connected and we have more data. We're figuring out what to do with it. Some of it is pay for service. You know, again, we're trying out some of those models. I think we're trying out some of the models where we just give patience, unlimited data. I mean, a lot of us have this, I have lots of functionality on this, it tells me the time. And that's about it. So, you know, data is only important to the person that matters to who can interpret it, and is willing to pay for it. And I think that is the biggest thing is willing to pay for

Joe Mullings  5:18  
Sure, but so this massive data build shared a stat when we were just waiting for what was the number you had to date? Right now with your implant? 

Bill Hunter  5:29  
We have about a billion data points. So we now have a millennium of postoperative patient data.

Joe Mullings  5:35  
Yeah, that's a substantial number yet, who is going to own that get actionable information out of it? And does that need to be an agency at large? Or will it be owned by big pharma or big device?

Shobha Parthasarathi  5:52  
It really depends on the utility of that data, right? Who's gonna use that data and for what purpose. So sitting where I sit, which is early stage startups, right, that we invest in. So it's really two different worlds right now that we live in. So you've got the traditional, the pharma, the American medical device companies, and the data science companies. And then you've got the biotechs, what's really impressive to see is that the new biotechs that are coming out, doesn't matter whether it's therapeutic diagnostic, they are much more integrated, right from the start in their thinking, as they're developing the therapeutic, they are thinking about, what's the device they can use to deliver, they're thinking about what data they're going to integrate into their regulatory pathway, what they need, from the FDA purposes who's going to pay, I mean, they're thinking it in a much more wholesome way than we did in the past, which is very product driven. Right. Now, I think everybody's aware that the patient is really a customer, a very engaged customer, the patient is no longer at the receiving end of the treatment, but wants to actively be engaged in their treatment, actively monitor themselves be monitored on the other side, as well. And that whole thing is I think changing the way things are developed, things are monitored. And I think Big Pharma, big medical device companies are doing it more sort of retro actively. They're looking at the data after having brought the product out. Whereas these guys, which is the space that I live in, I see them kind of all happening in parallel. So who's going to own it? I, to me, it all depends on a lot of things. AI companies are taking data from public sources, generating their own combining it all. Ownership, I think is still up for grabs.

Joe Mullings  7:40  
Right. But data from the public is public data, personal healthcare data is highly protected. 

Shobha Parthasarathi  7:47  
Correct. 

Joe Mullings  7:48  
Right. And so David, I want to jump to you because people generally don't put mental health and chronic health care, we usually use heart disease, hypertension, diabetes, pain management, but mental health sits in one of the largest categories in chronic health care. 

David Zakariaie  8:06  
Yeah, it does. And so I think what's interesting is the way that we think about the the issue to the mental health industry today, and kind of what we're trying to do, we think, like, the large reason why mental health can become a chronic issue is that we don't have diagnostics. And we don't have really any way of any way of monitoring and managing a patient other than basically asking them, you know, some sort of qualitative question every day. And most people know, like, if you asked, you know, most people don't want to tell a random clinician how they're actually doing and feeling. And so that just doesn't really work. And so the way we're kind of thinking about it is, you know, the most interesting statistic I ever learned, for a lot of traditionally chronic mental health conditions, though, the largest of which, which is PTSD, the difference between PTSD, PTSD being something chronic that a patient is stuck with for the rest of their lives. And something that can effectively be treated in about 16 weeks of evidence based psychotherapy is if you diagnose it within two years of the traumatic events occurring, and if you are able to actually do the right modality of psychotherapy. And so that's a situation where being able to diagnose accurately but also being able to being able to monitor the patient and the severity of the patient to ensure the treatment they're receiving is, you know, that will make a very large impact on the quality of life for that patient for the rest of their lives. And so, you know, in our situation, we own a lot of the data because there aren't really public sets of data for what we're doing. It's all kind of being generated on our own studies, but exactly what we're able to, to who to to to do with all that data, I think it's still kind of an open ended question.

Joe Mullings  10:09  
So I want to start at the top here with who's going to own this data? Can it be a pharmaceutical company, and pharmaceutical companies have owned some of the largest class action lawsuits this country's ever seen? So is there trust there for the data? Bill, your your giggling. Device is an episodic moment in time of care. So they really haven't managed the lifetime customer. Pharmaceutical has, though in vitro diagnostic companies possibility, or is there an entity and you've got to pick one of the doors here? Or is there an entity that yet has been established, that is either government owned, or independent, like our credit card company, who they get us we trust them, they deal with the merchant, they deal with the bank. And all they are is sitting in the middle protecting your data, and you trust them or American Express, Visa, MasterCard, Diners Club, whatever it is. 

Ashley Seehusen  11:13  
I think you just touched on something really important is the data should belong to the patient, right? It's their condition, their thing to manage, and having a say in who and how they sell, give, manage that data is going to be really important. I think patient patients aren't brought up enough in this and thinking really about their ownership. You know, a lot of companies are benefiting off their data and granted the, you know, the individual dollars associated with that are pretty small, but really thinking about where does the patient fit in? And how do we advocate for them to own their own data within this larger structure. And you're right, like maybe there is a place to bank it, or a company that manages more data. And again, I see a lot of really early startups that have some great wearable, they're collecting a lot of great information. But then when their business plan starts to fall apart, is how they what do they do with that information? You know, physicians are bombarded with information and data and really being able to do something actionable. And using that in a productive way doesn't always happen. And I'd say with companies that you have a service, etc, like sure there's more there. And then there's giving it to the patient themselves and letting them decide, are you giving them anything actionable? Are you just telling them, Hey, this is happening? And so I think we need to think through all of those things and putting that patient really at the center of it.

Joe Mullings  12:41  
Well, your thoughts on that is no, so I before you answer. So I take a DNA test, I take a 23andme tests, I see what I'm predisposed for, I then have some monitoring going on me, I'm a consumer, I'm not even chronic chronic disease state, even though 60% of the population has one of the chronic diseases. And I monitor that data with control limits. But all of a sudden, I start to infringe upon the control limits when I'm predisposed for subclinical science come up. Who manages that as we move forward with all these consumer driven devices, and also those that the device companies are making?

Bill Hunter  13:17  
You know, I'd never really thought about what you said until you said, I'd never thought about some separate entity. Being responsible for that. I started my career as a doc. And so my belief is exactly the same. The patient owns the data. I believe that philosophically and legally, The reality though, is that, you know, you press one, click on your acceptance, and now that data's into the ether. And so the patient doesn't tend to be a very good custodian of that data. So the concept of having a centralized custodian is actually an intriguing idea, and not one that I've ever thought of. I know from a practical point of view, in the real world, everybody seems to think down that the hospital owns the data, the doctor owns the data, the payer owns the data. And, you know, we could waste the rest of our panel talking about the legal wranglings in between all the shows. So I don't think there is an answer. I think there's a philosophical answer. I don't think there's a practical answer.

Joe Mullings  14:28  
And show me your response. So I think I've counted 147 patient monitoring companies that are in process right now, sort of as sublime is many robotic companies, there's only going to be a couple one when the dust settles. And so with those, they're building the proximity to the patient, but that's probably the most and least important part of the proposition. So where are we going with these small little islands of data? nobody's aggregating them to put actionable information together and venture capital loves SaaS loves subscription prescription models. And you guys have to have your eyes on that.

Shobha Parthasarathi  15:14  
True. I mean, going from small to big scale. I mean, if the individual does hold on to the data, it's really of no use to society as a whole, right? The data actually becomes useful when it's looked at it in a global sense, right? Whether it's for patient segregation, for I mean, for patient for clinical trials, right? All of that for grouping of patients, you need to have one large entity that can access that data. So at the individual level, yes, it's mine, but then it doesn't serve anybody else, but just me. So that's a philosophical thing. Right? Do I want to be paid for releasing my data? Probably not. But people can hold on to it. So, yes, there's these islands of data. And as I know, as we see, I guess we don't think beyond that, right? We're just looking at that one investment, and the data that comes out of that, but we're not looking at a more continuity to that. So I have to kind of think you're right. I mean, you need like an Amazon. Right, a one stop shop for all, that'd be ideal, but I don't know if it's practical.

Joe Mullings  16:32  
Well, practicality is one thing and today's model, perhaps but we've got, you know, misaligned incentives across the entire healthcare continuum. Right. But we do have organizations like the IRS that have more data on us than anybody else. We have credit card companies who can predict exactly what we're going to do and how we're going to do it. Yet we have not formed an organization like that for the management of our healthcare, which is the single highest expenditure that is crippling this this country. So David, in your business model, is the data just go between the patient and the doc? And then is there a higher responsibility to find a lake to put that in, to learn from and to make actionable?

David Zakariaie  17:13  
Yeah, it's a good question. In terms of, is there a higher responsibility? If the answer is yes, but that's not somewhere that we're at yet. So there so. Right, so as the way the product works right now, and it's primarily deployed, and it's currently deployed in clinical trials, until we secure our regulatory approval, the the data is owned by the patient. A fully anonymized version of it is always saved on our server, which we're using for kind of the continuous training of the model, because we don't need anything. We don't need anything identifiable for that. And the actual, like, the actual diagnosis, the severity, and kind of the full report that we generate, is saved in the patient's it saved in the patient's electronic health care record. So as far as like our product is concerned, the data is, is I guess, effectively owned by whoever owns the rest of their healthcare data. So yeah, how, where else it could be saved? I don't know. I think the idea of like, a Visa, MasterCard or something is interesting. But I like I don't know how that unless it's the government, how that entity gets set up without then using that data for some other commercial purpose. Like, like, even your credit card company that knows everything you're gonna spend, sells advertisers to then target you 20% off whatever, because they know you're gonna go shop at that place, hopefully. So how we avoid that from happening? I'm not sure unless the government opens the entity but for for us, and where we're at, like, as a startup, like, this is not an area that we can really innovate in. It's just more of like, we have to save it on the EHR, because if not, we won't get paid. 

Joe Mullings  19:04  
But this is a Device Centric meeting, and there's all Device Centric people here. Are we just going to be settling in on saying, fine, we'll make the device for you to track whatever it is whether you're a consumer or a patient with chronic health issues, but somebody else will worry about how that actually adds value, because otherwise, remote patient monitoring never gets to really have an impact. Certainly pharmaceuticals making a run on Roche website reads doing that what patients need next. Eli Lilly's website is moving away from pure pharmaceutical, broadening our impact. Our team develops life changing medicines, but we don't stop there. We're continuing pursuit of something larger. And so I think that pharma is hinting towards that. And is device going to bungle away the opportunity to have that mass of market is where that actually becomes a therapeutic unlock. If you can sub clinically find signals that can impact a catastrophic event as you enter that chronic care disease state. That is probably the largest market we've all ever seen. Well, we chase stents and structural heart. So Bill, thoughts on that area?

Bill Hunter  20:25  
Um, I think that's true, I think prediction is the key. When you're started with the preamble, you know, once you have the data, people say, Well, that's great. But given me the data after the fact, is not as meaningful clinically, as giving me you know, an inclination ahead of time, right? A few days notice on an evolving infection can be the difference between a catastrophic redo and of course of antibiotics, right, there's all kinds of situations where, you know, early intervention makes all the difference in the world, I, you know, kind of tying the themes together, I don't think Big Pharma or big medtech will be aggregators of data. I don't think they're set up to do that, you know, remember, we were doing when the internet was was being, you know, we're laying fiber all over the world. And they said, The Last Mile was the most expensive into the home, right? The we're not set up for the last mile, we're not set up to go into each and every home, that's the domain of the hospitals. That's the domain of the payers, and the lake. So I think the vision that you're talking about will involve companies doing what you say, which is getting enough data on their own expertise on their own molecules, their own devices, whatever the case may be, to provide predictive analytics. But ultimately, we will be data providers will be integrators, we'll put that into a bigger system, whether that's in the hospital, or whether that's, you know, in the payer, where that is then further refined and mushed together to provide the greater insights beyond that, right. I think a lot of big companies went in thinking they were going to be aggregators. And I, you know, I don't think that's going to be a reality. I don't think any company is big enough to have that kind of scope. And it's going to have to happen at the provider level

Joe Mullings  22:13  
That exists today. And again, that's the challenge that I have at this panel here is we reflexively go back to that doesn't exist today. And we've got to look beyond that with our ability to gather this data, converge this data and make it actionable, Shobha, your deep and thought down there, 

Bill Hunter  22:33  
Well you have to separate product from from data.

Shobha Parthasarathi  22:36  
Now I think of it as a continuum, right screening of patients discovery, then the treatment of patient the follow up of patient and then monitoring of patients, whether irrespective the setting, whether it's in a hospital care, setting, acute care, home, chronic care doesn't matter. They're all interconnected. And for me, I see it as digital coming into play then device coming into play them the drug coming into play, the monitoring coming into play, they just interplay with each other at different points in the journey of the patient. The thing is, right now we're all siloed in our thinking, it's not integrated. And that entire journey end to end needs to be integrated, right? You just have a menu list, okay? Patient A comes this is the patient is big background, and then how you connect blah, blah, blah, blah, blah, all of that. Right, back to the patient. So I think piece that's missing is the linking and the integrating of these individual things. But otherwise, I mean, we're all still that's because we're still thinking in silos.

Joe Mullings  23:31  
And actually, medicine hasn't changed much about 90% of it's still analog by nature, right? We haven't even really, you know, the step that Bill gave earlier is in scope. Do you see an environment where pharma device biotech gather data, and then again, it goes up to another entity, and that provides advisement to a care decider and I purposely didn't use the word doctor there. Right? So So if I've got that 23andme test, I've got my genetic predisposition. I've got a terrible lifestyle. My sleep habits are terrible. I am talking about me. 

Ashley Seehusen  24:21  
Me too.

Joe Mullings  24:21  
And now the care deliver person or entity says this device with this drug, and that pharmaceutical or biotech cocktail. That's what we should be using. And we become more precisely prescriptive with this data lake that we could mine. 

Ashley Seehusen  24:44  
Yeah, definitely. I mean, I think integration is the key right of for certain chronic conditions like diabetes, etc, sure that your pharma company could own that and effectively manage it. But when you kind of go beyond that, and you look at whole person health, it's going to be a higher entity. I think it has to be. And some of the most exciting wearables I've seen are those that have some tack, but then have really thought through the back end systems. That's the stuff that's getting me excited. How do you plug other things in? How do you make this actually useful in managing your COPD, etc? So I think there'll be a higher entity, I'm not sure it can be one, one specific pharma company, medical device, company, etc. But if they can feed into that, if we can integrate, we can start thinking about whole person health. And as you say, identify, you know, you would benefit from this treatment and you know, because medical device company has given you information, they might also get customers from you as well, with those alarms, those kind of decision points that happen.

Joe Mullings  25:54  
Bill, you mentioned the last mile, the last mile does exist. So you were talking about fiber, the challenge, there was actual physicality of fiber, but nearly every person who walks the earth today has at least one mobile device. Yes. So that solves the last mile. Yep. From that connectivity side. But David, your, your product, especially it's critical that last mile, and it's by the choice of the consumer, typically, isn't it or the patient, not prescribed to them by the doctor? Is your as a proactive approach? So therefore, is it a consumer seeking health? Or is it somebody who's got to prescribe by a clinician?

David Zakariaie  26:33  
So it's, it's both long term, but in the short term, it's, it's the, it's the latter first. So because because there's no mental health diagnostics out there today, the first iteration of what we're building is a Class II medical device. So it has to be prescribed by the clinician, it's a lot, it's a much easier thing to diagnose and process to go through than the way things are done today. But it does still require a clinician in the loop, the way we've defined a clinician is kind of a nurse practitioner up. So it's not just the doctor. But it does require a it does require a as a clinician, in terms of, of the Last Mile aspect, though, because what we've built a software, you know that a large part of our strategy is, you know, it's not to build it as a standalone, but to build it as a software development kit, and to essentially directly integrate it into as many of a telehealth platform as we possibly can. And so while it is possible to, you know, to have the product be used in a physical setting, I think, to us it makes a lot of sense to kind of administer it, you know, in that, you know, in a much more efficient and scalable manner, which for us is it's through all the telehealth platforms.

Joe Mullings  28:00  
Bill, you and I were discussing some MEMS technology earlier, where that proactively is going to start getting embedded into devices, even from edge imaging modalities. Where do you see that accelerating to on the data side? And how does it potentially become an unlock for device players and former players as well?

Bill Hunter  28:21  
Well, you know, when I first started the company, which was 11 years ago, we talked about putting sensors inside medical devices. Most people said, why? And I don't need that. But, you know, the world has changed so much in the last decade. And we live in a world where everything is connected. You know, when your refrigerators connected to the internet, it's pretty hard to believe that life saving devices aren't going to be connected. So I think the first step is connectivity. You know, we put an amazing amount of hardware into human beings. And then we walk them to the front door of the hospital and say, best of luck, come see me in two weeks. And they have no indication of what's going on. So I think connectivity is number one. I think what we're seeing just in the evolution, not in medicine, but you know, your phone knows where it is on the planet, it knows where it is in 3d space, it can do all kinds of different things. That same technology should be SOP for, you know, life saving devices. So I think we'll go connectivity, and then we'll go diagnostics, the device providing some sort of feedback, right? Right now we put things in and then the only thing we can do is go back and do an MRI or an x ray or something and figure out what's going on, you know, it would be nice to have from the source data. So I wouldn't be surprised if we had the same panel, you know, five or 10 years from now that almost every device provided some sort of feedback of all kinds of different natures

Joe Mullings  29:53  
Wouldn't device be motivated to do that because they then go from that episodic point of care and to a sort of subscription model of the ongoing monitor of that implant? And why what's what's been the holdup there? Because the technology does exist in mining and all kinds of technology bases other than medtech?

Bill Hunter  30:13  
I'll give you a quick answer on on both sides, right? I mean, on the first side, on the negative sides, there are companies that don't want to know how their device functions. They don't want to know what their failure rates are. I won't single one particular group out, but, you know, if they find out that their failure rate is 'X', and their competitors haven't done the same studies, they're worried that that will work against them. Right. On the other hand, I think everybody recognizes that, you know, being connected has a benefit. Medical devices traditionally have been a single sale entity, you know, so we make total knees, that's a 20 year patient commitment. But historically, Zimmer has been paid on day one, for doing that, but they had a relationship with the patient for 20 years, it might be better to make less over 20 years than to make the entire payment on day one. Plus, you know, the payers are saying prove to me that you're giving me 20 years of value that you're asking me to pay for on day one. So I think, you know, in terms of that, you know, using that as a way to extend the payment model or change the payment model. I think that's real. And I think they all recognize that, that that's where it's going,

Joe Mullings  31:29  
Thanks for calling out is what my outcomes were in a clinical trial trial are often entirely different than when you take a take a true distribution across the human race. So So tell me why the argument keeps coming up about shared data, and we can't figure it out, because of the protection of EHR. Who is standing that up? And why are they standing that up? And we can't possibly get around that? Who is the entity that benefits by keeping that farcical argument on the table?

Shobha Parthasarathi  32:09  
I'm not quite sure I understand what exactly you're trying to get it.

Joe Mullings  32:13  
We keep coming back to it's the it's the patient's record. It's the consumers record. And we've got to protect that, therefore, we can't share it.

Shobha Parthasarathi  32:22  
You're talking about individual companies saying that? The ones who have access to patient data.

Joe Mullings  32:26  
Yes. Yeah, there's walls all around that statement, that don't allow us to share this data for the greater being of the patients in the consumer. So who's benefiting by that being in place and take the patient out, because there's a easy way to anonymize that and bring that to a sort of constructive convergence of helping make better decisions in healthcare?

Shobha Parthasarathi  32:52  
I think if we get around, you know, I mean, it's value, right? It's if you could talk money, and you could talk, security of that data, right. So as long as we can balance those two out, because I mean, that patient data is has value, monetary value. And so as long as you can come up with a resolution on on how to deal with that monetary piece of it, because sometimes, that's only the only value there is, right. And so it has to be monetized. Which is why people hold on to it. And as far as security, if if you can get more confidence that it would be secure, which is not right now, that is not the case. It is being shared and it is being breached. So which is another reason why we hold on to it. So if we can get past that we might be in a better place.

Joe Mullings  33:45  
But your social security card, social security numbers, breach, your credit cards have breached, I have to turn mine in every month. So I just I just always a poking at that argument, Bill.

Bill Hunter  33:58  
I, you know, I think the real problem we touched on a little earlier is that everybody, I think every board of directors sits down and says our data is really valuable. And you say, but I don't know how. So since I don't know how it's going to be valuable. And I can't predict how it's going to be valuable in the future. We have to hold on to it. And and that's the approach that everybody takes. We have to do a lot of hospital contracts. And it can take us a year to negotiate the data transfer and privacy in those hospital contracts. Why? Because the hospitals know that their aggregated data is going to have real value at some point and they don't want to give that away that they don't really know and how or why or when. And so I think it comes to we're still at an early stage, and everybody's paranoid that they're gonna give away the goose that laid the golden egg but they don't really know where the assets are and which one's going to be the winner. And so everybody's hanging on to everything. And it's clogging the whole system. And it's happening at multiple levels. It's not just at the company level or the patient level, it's actually not happening at the patient level, that's happening at the hospital level, the payer level government level, you know, just about everywhere.

Joe Mullings  35:14  
David, your thoughts on that?

David Zakariaie  35:18  
I don't think I can come up with a more refined answer than Bill. Like, I do think that I do think that's what's going on. But I think the other I don't know, I think the other side of it. The only other reason why I could think that at a board or corporate level folks wouldn't want to do it is, you know, in lack of clear regulations, in terms of what we're allowed to do with that data, I think there's a lot of liability issues that people just don't want to take. And so it's, I think it's kind of perceived as unnecessary risk. Especially, you know, especially the world we live in today, where the FTC will come after you 5 10 15 years after like, you know, some sort of trade transaction is already closed. And so yeah, I think it's, it's somewhere between the combination of those two things, but I'm not. I don't really know who's winning. I think it's just clear who's losing.

Joe Mullings  36:10  
Ashley as an investor, how do you look at this?

Ashley Seehusen  36:14  
I think that it's actually the hospitals that are holding on to the egg. This isn't an investor take this is just an industry take, I think it's the hospitals are holding on to that data. You know, EHRs are notoriously messy. They're, you know, if you started mining that for mistakes and complications, I think you'd find all sorts of stuff and

Joe Mullings  36:36  
Isn't EHR just a way to build though?

Ashley Seehusen  36:38  
It is, it is.

Joe Mullings  36:40  
That's why it was created.

Ashley Seehusen  36:40  
I'm sure. You're clear on that. But there's still you can see that how patient was treated, what drugs they were given what device they had, what their follow up care was, whether they went to PT or not, and you I mean, there, it would be a rich database for a lot of the things are going wrong in healthcare today, and how can we make those things better? And we know that putting a better eye on some of those things actually helps and helps outcomes for patients? I think hospitals are terrified.

Joe Mullings  37:13  
Closing question, I will start from the side with you, Ashley, who is eventually going to own the broken down silos of data on patient monitoring, personal monitoring, consumer monitoring. Is it one of the device, pharma, biotech companies? or not, or was it an entity or is it the government?

Ashley Seehusen  37:36  
I think it's a third party entity. I don't know if it's the government or not, I feel like a lot of us would have a hard time handing over our data to the government to manage. But it could be could be and it might be. It might happen in countries where there's less personal choice to start with, and it might work well. And we'll see where it goes from there. I think in the interim, it might be Big Pharma, med device to some degree, but ultimately, it's going to have to filter up somewhere else.

David Zakariaie  38:06  
I think in the short term in the next 5 10 years, it's gonna be the device companies. At some point someone adds at some point. There'll be enough, there'll be enough of a critical mass where we'll want to aggregate all that data that some sort of third party entity will form. I also don't think it's the government just because, yeah, just because it's the government. But I do think a third party, private entity will form for that aggregation.

Bill Hunter  38:34  
If the patient owns the data, he who owns the patient wins. And so I think it will be different in different parts of the world. So I practiced in socialized medicine. So we'll be the government and socialized medicine countries. In the US, it's going to be the payers because ultimately, payers on the patient. 

Joe Mullings  38:51  
Sho

Shobha Parthasarathi  38:53  
I think like we're following the tech industry in so many ways, right? Whether it's miniaturization, personalization integration, think about the big companies today, the tech companies that hold all the data, same thing could happen to healthcare to healthcare data.

Joe Mullings  39:05  
Thank you. I'd like to thank my panel. I'd like to thank all that participated in listening to the session. Hope you appreciate it. And thank you for supporting LSI for sure. Thank you

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