The Future of Healthcare & How We Get There

What kinds of possibilities exist in the future for healthcare? How can medical devices reach across different fields of medicine and provide a holistic patient experience in collaboration with each other? These are some of the ideas you’ll hear about in today’s conversation with Daniel Kraft about the future of healthcare. 

Daniel Kraft is a Stanford and Harvard-trained Physician-Scientist innovator and investor with over 25 years of clinical, research, biotechnology, and entrepreneurial experience. He’s the Chair of Medicine at Singularity University and the founder and chair of Exponential Medicine. Daniel is Board Certified in Internal Medicine & Pediatrics and completed fellowships in hematology/oncology & bone marrow transplantation at Stanford. He’s also Faculty Chair of Medicine at Singularity University and Founder, and Chair of Exponential Medicine, a unique cross-disciplinary program that explores how rapidly advancing, convergent technologies can shape the future of healthcare. Advisor to several leading biomedical & digital health startups. He’s given six TEDx & TEDMED talks.

Listen to the episode to learn more about how Daniel sees the need to start integrating across platforms to give doctors a more holistic view of the patient, the transition from “sick care” to healthcare, and what actions he thinks will help shape the future of healthcare.

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Some of the highlights of this episode include:

• Advice for developers on creating devices with a symbiotic relationship with other devices in the field

• What the future looks like for physicians when patients can do their own self-assessments

• Whether physicians are too hands-off and removing physical touch because of digital devices

• How to achieve cross-pollination among specialists in different medical fields

• Positive outcomes in digital health due to COVID

• How Daniel keeps tabs on a variety of different fields

• Finding unmet needs in the market

• New ways to engage with patients

• Actions to take for the future

Links:

Daniel Kraft's Website

Daniel Kraft LinkedIn

Daniel Kraft Twitter

NextMed.Health Event

Data Donor

MedTech Devices

Daniel Kraft's Venture Fund

Digital.Health

https://www.xprize.org/home

Etienne Nichols LinkedIn

MedTech Excellence Community

Greenlight Guru Academy

Greenlight Guru

Memorable quotes from Daniel Kraft:

“Most every medical device can have some sort of digital layer to it.”

“The future’s already here, just not evenly distributed.”

“Lateral thinking means also just… trying new things and staying curious, but also sharing that with others.”

“You don’t want a separate device or app for every medical condition, you kind of want one ring to rule them all and to make holistic sense out of this.”

Transcript

Announcer: Welcome to the Global Medical Device Podcast, where today's brightest minds in the medical device industry go to get their most useful and actionable insider knowledge direct from some of the world's leading medical device experts and companies.

Etienne Nichols: Hey, everyone, welcome back to the podcast. My name is Etienne Nichols. I'm the host of today's episode. In today's episode, we speak with Daniel Kraft on the topic of the future of healthcare. We covered a lot of ground. We talk about things like the possibilities within medtech, health tech, and the need to start integrating across platforms to really allow doctors a holistic view of unique patient data so that we as an industry can transition from sick care to healthcare. We also talked about how to become a digital donor, what that even means, and where you can go to learn about all the wearable technology as it relates to your field or discipline of medicine or the discipline of your device itself, and much more. Daniel Kraft is a Stanford- and Harvard- trained physician, scientist, innovator and investor, with over 25 years of clinical research, biotechnology and entrepreneurial experience. He's the chair of medicine at Singularity University, and founder and chair of exponential medicine. I could go on and on about Daniel Kraft. He's really impressive. He's given six TED and TEDMED Talks. He's the inventor of the FDA- approved MarrowMiner, and founder of Region Med Systems, a clinical stage medical device company developing tools to enable regenerative medicine. This was also interesting to me, he was a military officer who served for 14 years as a flight surgeon, practicing aerospace medicine in the California and Massachusetts Air National Guard with F- 15 and F- 16 fighter quadrants. So he's also the host of Healthy Conversations, a podcast with CVS Health. And he's been featured on CNN for his idea, bringing a 3D printed pill to the market. I heard him talk at a conference, and I loved his talk. I chased him down, and he was just trying to get into his Uber, and I convinced him to get on the podcast with me. So this was a conversation I've really been looking forward to. So I hope you enjoy this episode with Daniel Kraft on the future of healthcare. Hey, everyone, welcome back to the Global Medical Device Podcast. This is Etienne Nichols, host of the show. Super excited to be speaking with Daniel Kraft today. How are you doing, Daniel?

Daniel Kraft: I'm great. Good to be with you.

Etienne Nichols: Yeah, good to be with you as well. So was talking to a few different people you know about you recently; Torrey Smith, CEO of Endiatx, he called you the Grand Master of Digital Health. And I wondered if you could maybe tell us a little bit how you got to be such an iconic figure in digital health?

Daniel Kraft: Boy, I'm not sure I would ascribe that term to myself, or that I'm iconic in the field. First of all, I mean, digital health, like anything else, it's a bit of a buzzword. I mean, what does it really mean? I think of the word digital health, mobile health, connected health, and let's just call it health. The sort of emerging ability to connect the dots between medical devices, data, omics, public health, and then to take that sort of data feed, whether it's from your wearable or your implant or your connected home or your sewage water, and make that relevant to a patient, a consumer, a clinician, a healthcare system. And so it's a pretty broad space. And some people think about it in the realm of wearables or apps, and I think more about digital health as sort of this interconnectivity layer to make healthcare smarter, more intelligent, a learning engine, and much more tuneable and personalized on the user interface, UI, UX, and to sort of enable us, big picture, to start to crowdsource some of the data and insights to really move the needle in improving prevention, diagnostics, therapy, to mental health and beyond. So how I sort of got here, wherever that might be... because I was a gadget guy. I think I had all those Hammacher Schlemmer, all those magazines that have gone away, where you get all the gadgets. I was one of their early users. I've always in medicine, since I trained as a traditional physician scientist, always like to look at things through the lens of, " Why are we doing it this way? How might we do it better?" And that happens not in any one silo or bucket, but at the interface of fields, from sensors and omics, to now blockchain and VR and drones and psychedelics. And so it's at the interface where things get interesting. And so I've had an interesting journey over the last maybe 12 or so years, having done the traditional medical academic research lab, and startup and investment world as well, becoming a bit of an accidental futurist. I've served as the chair of medicine for Singularity University since it started. And I built and run a program called Exponential Medicine, which is on exponential technologies and how they're reshaping healthcare. And I've been involved in XPRIZE and coming up with XPRIZEs. So I like things at the X, at the cross point, and I think digital health, broadly at that sort of space where it often connects the dots between med devices and pharma and robotics and hospital to home and all those sort of emerging areas that have been catalyzed during the pandemic as well.

Etienne Nichols: I love that you actually have the medical device background as well. So I mean, even going through the traditional and then having worked with medical devices, now, at least it seems, just having talked with you in the past, you have a more of a panoramic view of a lot of the digital things that are going on, whether it's wearables or all these different things. Since our audience is a very primarily medical device, I'm curious, as people are developing these devices, is there any kind of advice you could give them as far as how can you make that a symbiotic relationship with all the other things that are in the field so that when you join that internet of medical things... what kind of advice do you have for those developers?

Daniel Kraft: Well, I think as you're looking at the problem you're trying to solve and the audience and the regulatory and reimbursement and other landscapes, obviously you want to always solve for a key pain point. Actually, I got my sort of medical device start as a bone marrow transplant fellow at Stanford. I was part of the very first cohort at Stanford Biodesign, which is a well- known platform, very focused on med devices. And the pain point I was trying to solve for as a transplant fellow was harvesting bone marrow doing 100- plus punctures in an hour in the operating room. And I came up with a medical device called the MarrowMiner. There's a little part of it, the rotating flexible sort of shaft, kind of like a Roto- Rooter for harvesting bone marrow. And that device doesn't need a lot of connectivity on the digital side, but at least got me in the space of being able to build something physical and think about getting it through all the regulatory paths, which it now is through trials, and is a way to get better, faster, cheaper, easier stem cells out of patients for bone marrow transplant or beyond. Now, that sort of device probably doesn't have a lot of digital layers to it, except for maybe tracking and the fact that you can do earlier, easier prototyping with digital tools. But I would say when I would be talking to a device entrepreneur, think about, what are the cross points? You want to be looking at everything from how the product is being used, and that could be a sensored device... We're now using non- sensored elements. Cameras now can pick up movements and other elements, if you're trying to see how it's used in the real world. A lot of now of course device meets software, meets sensors, meets data, meets insights. How might you embed some sort of sensing technology that gives you insights in terms of how it's being used or outcomes other measures? Even surgical devices from hip implant to knees can have sensing elements. That may not be required for the end stage product, but could be useful in development. And then how might you take some of the data from that software meets medical device, meets hardware, and glean not just data from, let's say, an implanted defibrillator? The data is the oil, but you want the insights and the actionable insights. How do you translate data to insights that are actionable by the clinician, by the patient, by the healthcare system? And bigger picture, now that medical devices fit into the larger ecosystem, how do you get them sourced? And how does the clinician have them in their formulary, and maybe be able to personalize and adapt them? So those are a few high level pieces. I think most every medical device can have some sort of digital layer to it, and gives a bit of a new lens, particularly when you start to blend the sort of software layer with AI, with big data, which machine learning. It means some old school things can be repurposed or cross- fertilized.

Etienne Nichols: You make me think of something that you mentioned earlier about being a futurist, when you talk about... I'm going to borrow a phrase that I've heard you say before. Intermittent sick care is where we are or maybe have been. We're moving towards continuous healthcare with a lot of the different data and the ability to utilize all of that data in a good way. So I'm curious, going back to the futurist thing, what do you think the future is going to be like? If I'm able to wear my Oura Ring, my WHOOP Strap, and do my own self- assessment, what does that look like for the physicians? And what's that interaction looking like?

Daniel Kraft: I think I'm more of a nowist than a futurist. A lot of this technology, that famous ... " The future's already here, just not evenly distributed." And a lot of it is already here, just maybe isn't always cross- connected and leveraged with incentives and payment models. And we're still stuck, for God's sakes, using fax machines and DVDs to communicate in many medical facilities. But I would say, to sort of reboot your point, we do practice more secure. That's where the incentives lie. It is still today very much based on intermittent data that's usually only collected in the four walls of the hospital or the ER or the ICU or when you go in for your annual visit. And that leads to our reactive mindset. We tend to wait for the problems to land in our emergency room, the heart attack, the stroke, the late stage cancer. And big picture, especially device and sensor and data- driven now, is this era of continuous sensing. It could be from your wearable, from your ring, your watch, your underwearable. It's increasingly coming from our smart- connected homes, cameras; voice as a biomarker. Wifi- connected homes can now pick up everything from behaviors to sleep patterns to falls to your smart- connected speaker. So now we have continuous digital exhaust that can be collected whether we like it or not. Even we're talking through the magic of Zoom, there's a camera on both of us; that could be picking up our vital signs. It could be looking at changes in our voice compared to our baseline. So I think where we're going to end up going, whether we like it or not, is being able to collect our digital exhaust and make sense of it in context and, say, for Etienne or Daniel, our base lines might be quite different. And what's most interesting is not what my blood pressure is now and my heart rate and my weight on today's date, but what is that in context of my past and where I might be compared to others? Has is it changed in some remarkable way that might show there's a predilection to some medical issue happening downstream? And can we pick that up early and do something about it? So that shift to early notification, the synthesis of having your own personal check engine light like a car has, from 500- plus sensors that's using software to tell you when the light goes on, that hopefully drives you to action, right? If you keep ignoring your check engine light and you blow your gasket or you haven't replaced your tire, then you'll end up... might be paying the price heavily. And I think we're going to enter this new era we're starting to see already emerge where our connected devices and that smart insights can be hyper- personalized, not just to give you that flashing check engine light, but to communicate that to you in a way that really makes you take action. It might be micro- actions over long periods of time for proactive health span and longevity, all the way to, " Yeah, get to the emergency room right now."

Etienne Nichols: Yeah, I think that's a good answer. That makes sense. I can see that already in some of the things that I've experienced. I guess the flip side of that is the pendulum always swings one way or another. I've talked to a few different medical students, just some different physicians. And one of the complaints that I hear that they've told me that they hear some patients get is that maybe an increasingly common complaint is that the physician chooses not to touch the patient during a physical exam, for example. I'm curious what the pros and cons are, maybe even of physical touch. Are we removing that too much, or is it... I don't know, what are your thoughts on the other side of digital health?

Daniel Kraft: Well, we want to blend sort of the art of medicine, the beautiful human components, the touch, the eye contact, with the technological. Abraham Verghese is a well- known physician, educator at Stanford who has been making sure medical students there still know the art of how to do a proper physical exam, palpation, not relying on the pocket ultrasound or the AI- enhanced EKG or MRI machine to diagnose a neurologic condition. And there's something very therapeutic in the human physician or clinician experience, right? The art of the touch, the relationship often drives the word adherence or a compliance to taking the meds: " You're going to do that for Dr. Kraft, and he's going to really want to show how you're doing." I may as a clinician text my patient, even if it's not me, it's my chatbot doing it autonomously, that makes them feel more connected and more likely to stay on top of their blood pressure meds or statins, which they can't feel the effect of. So I think we need to make sure that these technologies enable better care, don't get in the way, but can be used in smart ways to augment the virtual physical exam. And we certainly have seen a big enablement of that, catalyzed by the pandemic and virtual visits, but to keep that human component. And arguably as we go to this now more virtualized or blended age, virtual visits will not be as boring as a Zoom call. They may end up in our holographic glasses or the Apple eyeglasses which are rumored to come out in 2023. So we're quickly entering not just the metaverse but the mediverse, M- E- D, mediverse, which will be-

Etienne Nichols: Oh, nice.

Daniel Kraft: Enabled with blockchain and NFTs to maybe give you points every time you walk your 10, 000 steps. So I think we need to get out of our bit of our old ways of thinking. But back to your key point, the human relationship part, the human touch piece can be super critical. And I think we need to make sure we still integrate that into medical education as well as start to educate clinicians of all types, from nurses, to pharmacists, to physicians, to physical therapists, how to leverage some of these new emerging digital health tools, technologies, devices. Because there's still a big gap between what we have now and what's being actively utilized in the outpatient world and the virtual world.

Etienne Nichols: That's a really good point. Two things; I guess I can see both sides of it. I don't even know if I should bring this up. But when I was younger, living in Oklahoma, I went bull riding and I wound up in a hospital, and the doctor... They all thought I should have a certain operation, where I had stuff all over my chest, something with my heart. And I was just going to take it off and I was going to get out of there. And the doctor, this older guy came in. And he started rubbing my feet, talking to me. And just for some reason I calmed down, I said, " Okay, whatever you need to do." I don't know what happened there. That's one side of it. But the other side of it is I work remotely now. I'm connected to my team in these different ways. And I still, just a drop in a chat or whatever... like you said, it's absolutely true. I can connect with my team that way. So that's really cool.

Daniel Kraft: But you have a relationship with your team, probably some of you've met in person. And there's probably that optimization. Sometimes it's fun to meet people you've been talking for a year on Zoom and you finally meet: " You're taller, shorter, fatter, wider than I expected you to be." But often the best combination, and that's back to this future of work element now, is how many days in the office do you need; with the blended virtual optimizes that? And I think for medical care, I think hopefully having that relationship with your real, human, physical, let's say doctor, enables the virtual elements to be much stronger and to make those ties more capable and impactful.

Etienne Nichols: Well, I know you have an event where you bring people together as far as digital health and different things. I wonder if you could speak to that, just talk a little bit about what you're working on now.

Daniel Kraft: Well, in my sort of role as an accidental futurist, it was always fun to... I'm trained in internal medicine and pediatrics and hematology, oncology, bone marrow transplant. So I've been to lots of specialty conferences, whether it's general pediatrics, to the cutting edge of oncology, or now there's obviously medical device conferences and cardiology. And every field has its own element, which is important. But I find the most interesting things happen at the interface of what's happening and where it meets technology and accelerating technologies, AI, robotics, 3D printing, nanotech, blockchain, CRISPR, to chatbots, to drones and beyond. All of those are up and moving very, very quickly. So for 10 years I built and curated and ran a conference called Exponential Medicine, with the theme of understanding the pace of change. Sometimes things come faster than we might expect, sometimes slower. But arguably the world is accelerating in many ways. And many folks in healthcare practice incremental medicine. And things happen slower than they could. COVID has been a catalyst to accelerate us bit of this health age. That being said, it was pretty magical to bring 800 people from 43 countries, I think last time we met pre- pandemic, to cross- fertilize. And you learn from what's happening at NHS, to what folks are doing in Australia. You see the next generation wearables or we had, for example, the founder of Moderna there in 2015, before anyone heard of mRNA, or founders of Livongo earlier, or folks doing cutting edge stuff with virtual reality for training folks on medical devices or doing social connection. So that being said, that event is now growing post- pandemic. It's going to be called NextMed Health. Nextmed. health is the website. It'll be March 13th through the 16th at the iconic Hotel del Coronado in San Diego, where we've run our prior events. The magic is you get to cross- fertilize with mavericks and instigators and clinicians and investors and patients and a whole mix of folks, from insurance companies and beyond. And that's really where the magic happens, both the mixing of people, fields and ideas, and being exposed to what's cutting- edge and what's likely to be here in the next 2, 5, 10, 15 years. And so we encourage anyone in your orbit to come check us out at nextmed. health, and join us there. We also bring in and select about 50 startups from small in- the- garage versions to larger ones, do a hands- on innovation lab. And we have a small startup competition as well. But a lot of things have been sparked at our prior versions. So I would hope to see some of your folks there. And that brings in some of the elements of Greenlight Guru and regulatory reimbursement. We had for several years the leadership from the FDA's digital team, Bakul Patel, when he was there, from coming to that experience and seeing some of what's next, helped them design software as a medical device, the pre- check program, and now build that whole center for digital health excellence at the FDA. So often, it's about bringing the right people together and helping spark the art of the possible. And the final point I'll make is that that means we want to drive to more health globalization and health equity. And it's well beyond the tech part. How do we build the art and the science and the cross- connections and the community that will be able to collaborate across the traditional silos to bring us a better future for healthcare around the planet?

Etienne Nichols: That's actually the point that I really was curious about. Before I get away from that, I'll include in the show notes a link to that NextMed Health event. Definitely check that out. We'll put the link in the show notes, and you can go check that out. When you talk about those silos... Because most physicians will call themselves one or the other. They're a cardiologist, they're an oncologist, they're this, they're that, they're specialists in that field. How do you get that cross- pollinization beside from events, a one- time thing? I know and I've experienced the power of that cross- pollination, but how do you make that a continuous improvement practice where you really affect healthcare across the industry?

Daniel Kraft: Part of it is by showing examples of what's coming next. That often is at that interface. Obviously, a lot of the medical device world is now blending, as we talked about earlier, data, big data, natural language processing, to glean insights, whether it's about how to better market and communicate, all the way to the performance of devices that are crowdsourced insights from around the world. I think one of the things I love to do is open people's eyes to the aha moment, like, " I had no idea this is here or it's already happening." And that sparks not just the creativity but sometimes the inspiration that, " Wow, we could uplevel our team or our product." And also, it's often a bit of a mindset shift. We often have large hospital systems join us, big payers, others that are often slower to move. There's this old quote that I love to share, that the challenge isn't the new ideas, but it's often escaping from the old ones. And human nature, we often don't like to move the cheese, especially if it's your cheese. So how do you get people to escape from their old mindsets that we still do use fax machines, and HIPAA is the best thing ever, and med devices should be done this way? I mean, now we have digital manufacturing, now we have augmented reality. How do you take a medical device that some of your colleagues may have built, and leverage augmented reality to train people up faster, or to use new forms of digital manufacturing to blend a device with pharma, or building a new company called Intellimedicine, Intellimedicine. com, where I've been evolving the concept of digital manufacturing or personalization of... I call them 3D- printed personalized polypills and telemeds, where you want to be able to build the right pill with the right combination of doses for that patient, and be able to print it on their kitchen counter in real time. So patients got polypharmacy, because they're on three hypertensive meds and a statin and an antidepressant and something for the diabetes. People don't take those meds and don't often dose them appropriately. What if you could print that in one pill? So that's a bit of a combination of the future of printing a combination pill. But it has to tie back to now using genomic information and wearable information to measure someone's blood pressure from their wrist and tweak their dosing, or have a home- based lab that checks their INR for how thin their blood might be and enable them to print a new dose of Coumadin or other blood thinner. So sometimes it's you show an example of that and go, "Oh wow, we have three things that we could do that could help that," or have something analogous. So it's about the art of the possible and the human spirit. And we're also at the beach in San Diego and bonfires, and even chocolate shaman ceremonies-

Etienne Nichols: How could you not be more creative? Yeah, absolutely.

Daniel Kraft: But it's also like things that are completely out of people's normal wheelhouse. We had Paul Stamets there for a couple sessions, who's the guru of mushrooms meets medicine on some of the work that started out psychedelic'60s, but now MDMA and other old school compounds are now being going through clinical trials to show their impact on treating PTSD, to addictions and beyond. Really powerful shifts that are happening across different industries and where they intersect.

Etienne Nichols: Yeah, that's fantastic. I love your quote about escaping the old ideas, because you're absolutely right. I wonder if you have any specific examples from the pandemic. I think we all know the bad things that came from the pandemic and the COVID outbreaks and so forth, but there have been some silver linings. And speed to market in different situations, provided you're still providing quality and effective devices, is definitely an advantage. But I wonder what you've seen as far as any benefits that you've seen, especially on today's topic of digital health.

Daniel Kraft: Sure. I mean, on the medical device side, let's say especially early in the pandemic, there was a lot of energy around ventilators and the shortage and how many we might need. And you saw incredible amounts of innovation pour into, " Let's build rapid iterated, low cost, portable, anyone can use ventilators." And while we thankfully didn't need as many as we were feared to need, that is hopefully going to drive next generation, cheaper, more globally accessible, AI- enhanced things for ventilatory support, particularly maybe emerging markets. So that might be one example of that catalyzed. And we also saw a lot of folks 3D printing components. There was a couple stories out of Italy where they saved a whole CPAP modification. And they were missing parts, and they 3D printed them. And the company that they didn't ask for licensing permission was fine with it. So that's a bit of catalyzing new people into the space when there's a key need. So chief innovation officer's often been COVID in this challenging time. So that was one piece. I think another area that has emerged a big pain point still even is testing. Rapid testing, low- cost testing took a long time to get to our pockets or our homes. The pandemic especially, played a role sharing this XPRIZE Pandemic Alliance task force where we brought together 100- plus organizations to collaborate on addressing PPE, diagnostics, therapeutics, clinical trials, mental health and beyond. And one of the prizes that we ran, I did with Jeff Huber, who was a former VP at Google, went on to becoming the founding CEO of Grail, which is doing early cancer diagnostics. We did a XPRIZE for fast, frequent, cheap and easy COVID testing, particularly the first year. It would take you three days to get a result. And so to make a long story short, it was a 6 million XPRIZE. We had 707 teams from 77 countries enter, and ended up with like 200 finalists. We tested the testers, narrowed it down, and had nine pretty amazing winners, all medical device meets diagnostics, some of which were very out- of- the- box, including smell cards, that would be the tester smelling with an app and find an early problem. Others are using breath and other new versions of molecular diagnostics, some of which are already in markets, some are going through regulatory. Even if they aren't on the market yet, it catalyzed new ways of doing faster, cheaper, easier, home- based diagnostics for infectious disease, and I argue for non- infectious diseases. And now, almost everyone's done some home- based diagnostic test. That was unheard of pre- pandemic. And we can think of all the other diagnostics and devices that will now live in our homes as we go from hospital to home, or hospital to homespital, that are really going to shift how and where we do healthcare.

Etienne Nichols: The thing that blows me away every time that I hear you talk, Daniel, is your ability to lateral think. I mean, all these different industries, you're tying them in to, " Oh, well, what if we take that here and put this here?" I just don't even know how you have time to even understand or view all these other industries. I don't know if you have a secret, but...

Daniel Kraft: I mean, I think anybody could do this. It's just take your blinders off a little bit. Of course, everybody has to get their... often their special degree, their MD, their PhD, their master's. You need to know one field relatively well and do it well. But it's much more fun to find collaborators in aligned elements, or have a brown bag lunch at your pharma or med device company where you share your latest favorite medical gadget or app or something, bring in a new VR headset with a new health video game, like I spent 100 days early in the pandemic on my Oculus headset doing Supernatural, which is this pretty amazing, fun game where you're swatting balls on mountains and on beaches. And what was fun about that was it kept you engaged because you could compete with your friends. It would also track your heart rate on your medical device on your wrist. And it would gamify the whole process. And I could also, looking at my data from my wearable, show that having done that for three months, my resting heart rate went down by six points, some measurement of health. But that was cool for me. Maybe I'd want to show that to someone who wants to get engaged in working out or who wants to explore virtual reality or augmented reality or extended reality as a way to collaborate in the medical device space for sending 3D files and playing them around.

Etienne Nichols: Yeah

Daniel Kraft: Medical training, as companies like Osso VR have done, where now surgeons go on the VR headset and they pick up the medical devices, and they can train on a particular patient and learn a whole new set of skills. And now the data shows that those folks are faster to learn, maintain that better, and have better outcomes. Those are some of those shifts. So lateral thinking means also just trying new things and staying curious but also sharing that with others. And so you can get that from Twitter feeds, you can follow me @Daniel_Kraft. You can go to nextmed.health. You can come to my platform digital. health, which is a bit of a platform for exploring what's already here.

Etienne Nichols: I looked at digital. health, the platform. Can you talk to us a little bit about that, and maybe how we can use that to maybe collaborate a little bit?

Daniel Kraft: I think we zoomed back in the beginning. I think all of us in the medical device space or healthcare innovation in general, we want to solve problems, and sometimes big hairy problems. And it's always fun to see a problem in an unmet need and try and solve it. Sometimes it's device- related. In others words, my pain point was people would send me all sorts of new gadgets and wearables. I've got a stack of things in my drawer. I call it my digital doctor tag. But I often would see emerging technologies and think they were great, and I'd be surprised that no one else knew about them. So as a small example, yesterday I went to visit the headquarters of AliveCor. I know the founder, Dave Albert, who invented this... it's a small little EKG that would sync with your phone and show you could do a two- leading EKG and now a six-lead EKG. Started as a bit of a crazy idea, caught on. Now there are ads for it on CNN and the Superbowl. But still I meet people, cardiologists included, have never heard of that technology, who are still using old school stethoscopes, when now there are digital stethoscopes or$2, 000 pocket ultrasound devices like the ones from Butterfly or Echo. And so there's so much out there, including thousands of apps. So I was lucky to get the website domain digital. health. It's easy to remember. I've been building that out as a platform to understand the digital health landscape, mostly for clinicians to start, from the regulatory elements, to funding, to journals, and evidence. But a core component is a database of now over 1600 digital health companies and their solutions. So you could put in atrial fibrillation and find AliveCor and look at their versions of the devices and how people might have ranked them, and videos, and link to the site and put it in your own personal digital health formulary; or as a clinician, prescribe that to your patient who might have A- fib or other cardiac issues. You might have put in depression and find apps like Headspace or others that are very specific to leveraging digital mental health, for everything from PTSD to ADHD. It could be elements around everything, from wound care to how do you run an operating room or manage your staff? So there's just a ton of solutions out there in the digital health landscape. Some of them are diagnostic, some of them are therapeutics, some of them are practice management, some of them are clinical trials- based. And so we're building that as a bit of a home to help folks discover those and hopefully leverage them and start to integrate them into their workflow and patient care and healthcare in general.

Etienne Nichols: That's great. And I don't know if this is a misuse of your core, but if it's primarily clinicians, if I could talk today, if it's primary clinicians, I can almost see the benefit of going in there, because there is a community aspect of that, the ability to talk to each other as well, find out missing needs or unmet needs, I suppose, in the market too, so that's... Yeah.

Daniel Kraft: Well, I mean, clinicians are a broad subset, everything from pharmacist to a physical therapist. But also, it's a resource for anybody. Probably more than half of the things in our current database are a medical device component. It is a wearable with the app or some sort of other sensor, or something that integrates with digital manufacturing. So it's pretty, I would say, medical device- heavy, actually. There's not as many apps as pure apps as things that are blending software, device, AI, et cetera. So please check it out. And by the way, if you have your company and a solution that might match, you can enter it into the database yourself. You submit your company, then you add the solution sets that you have, and people can find it. And so it's still a very early project, so would love any feedback or ideas or potential partners or collaborations.

Etienne Nichols: We'll put a link in the show notes as well so that people can find that, www.digital.health. It's not too hard. That was great. Man, how did you do that?

Daniel Kraft: By the way, we should collaborate on meddevice.digitalhealth, or any other version. We can build out sub stacks around cardiology.digitalhealth or any other realm. So there's lots of ways to hyper- personalize this, depending on who you are as a user. And the end goal is that when I prescribe that connected medical device, let's say something as common as hypertension, right, we're still... It's so hard to manage hypertension. There are connected blood pressure cuffs that have been out for a while. What if I could go to digital.health and prescribe that to my patient, shows up in the mail the next day? It automatically then syncs with my clinical workflow, my EMR. I don't want to see every blood pressure from you, but if you're running 20 points too high or 20 points too low, I would like to get a little ping, and maybe it instigates me or my medical staff to call the patient and tweak their blood pressure meds or adjust their 3D telemedicine printer to print the right combination of beta blockers, calcium channel blockers. That's where these things should merge. A lot of devices, apps, et cetera, are very siloed and fragmented. I think we're going to see a lot more consolidation in the next few years, right, because all these point solutions can't exist separately. You don't want a separate device or app for every medical condition. We want the one ring to rule them all to make more holistic sense of this.

Etienne Nichols: You mentioned the futures here. I guess that one ring to rule them all at the moment might be our iPhone. I don't know what that looks like in the future. Do you have any thoughts on what the future looks like? I mean, you already mentioned the future's here and you've talked a lot about the different possibilities, but-

Daniel Kraft: Well, we all want to have personalized medicine, precision medicine. Let's call it precision health and wellness as well. That's a whole other emerging market, to keep people healthy and then longer healthier health spans, not just lifespans. And we know that a lot of our bad healthcare outcomes driven by our bad behaviors, and now we can start to measure those in different ways. And we don't want to be a big brother and have everybody always tracked, though people definitely engage with that. I think a lot of these digital health type solutions today are still somewhat one- size- fits- all. The user interface doesn't change much based on age, culture, language, incentives. And I would say in the next five or 10 years, we'll each have the opportunity to have our own personal health coach and bubble. It might be driven from our smart watch or our smart home, our smart speakers, things that can follow us. It might not have to be living on any one physical type device, but it'll be integrating elements from our virtual meetings to our voices as a biomarker, to the labs that we can do, to our connected toilets, to our diets. Your fridge will cheat on you and tell you when you that ice cream at 2: 00 in the morning. But then it's not just going to collect all that data, because we already know we're supposed to exercise more and eat less. It might present that to you in a way that's very contextual to you. It might be your version of your digital mother, if that's who you respond to. It might be Einstein, it might be your personal doctor, it might be an avatar, it might be the right kind of voice. It will show you that information in the context that you're going to respond to; not the information, but the insights. Because a lot of the devices today show you your sleep patterns, but you often want that score, or I like to think about more as your synthesized sort of FICO score for your health. It integrates your vitals, your labs, your financial health, your sexual health, your sexual connection, your social connections; maybe your sexual connections, that has a role... the local environment, your exposome, all those things. Health is complex. And I think the ability not to make that hyper-personalized in how we connect with that, not just when we're in the sick care modality, can make a big difference.

Etienne Nichols: Yeah, I've seen the example used too where you're trying to present that in such a way, maybe even looking at a mirror, and it'll show you an aged version of yourself, for example, or something like that. I mean, there's so many different ways it can be done.

Daniel Kraft: Future you. I mean, and for the med device folks out there, everyone makes these great little animations of the stent and the thing going in there. But now there's the opportunity to take that device or a medical issue and show that in the context of the same patient. You can show them an augmented reality future, and what's happening with hypertension impacting their kidneys or their brain. That might make folks much more engaged in their care going forward when they get a picture of that. So I think we will have this future you element emerge and that's going to help drive a lot of engagement, because the new drug is the empowered, engaged individual who doesn't feel like they have to wait to go to Dr. Wellme for their care, but they're part of their care team as well. And they have a responsibility to be on top of not just their data, but even sharing that data. So one little pivot point here, which is part of this future of medicine I think, is that most of our care today is driven by 10- year- old, double- blind placebo- controlled trials, Framingham data around managing everything from cardiovascular risk to using aspirin or statins. That's driven by a pretty small cohort of mostly European, Caucasian, often nurses in Western Massachusetts, in Framingham. Now, we're in an era of much more diversity or an opportunity to pull data and insights from much more heterogeneous populations. There's the All of Us trial, allofus. nih. gov, where you can sign up to be a data donor, share your medical records, your genomics, your wearable data. Bottom line, we are starting to crowdsource a lot more of health information. And that can really drive us to this era of much more individualized care. I want to know patients like me or patients like mine when I'm seeing them in front of me in the clinic or on the screen, that I'm not just going back to some double- blind, placebo- controlled trial on some very narrow subset with no comorbidities. But I can see thousands of other patients who have inflammatory bowel disease, who failed first line therapy, who also have type 2 diabetes; and managing someone with some skin condition, and I can learn from others like them with similar genotypes who might respond to drug X or therapy Y or a digital therapeutic, and get much more real- time insight. So I like to think of that more as the Google Maps or Waze of healthcare, where we're sharing our insights in privacy- protected ways, but we can build better hyper- personalized local maps for your healthcare journey that will also help inform others.

Etienne Nichols: Man, that's fantastic. And we'll put links in the show notes as well of that. Was it allofus.gov?

Daniel Kraft: Allofus.nih.gov, I believe. Double- check it.

Etienne Nichols: Yeah, I'll check it out.

Daniel Kraft: Another company that's interesting that's doing that, it was actually founded by one of the founding team members of Waze, is a company called stuffthatworks. health. And they're now to like 4 million- plus people sharing what's working and not working, from everything from plantar fasciitis, to cardiac issues, to long COVID, to cancer, and building a bit of an insight map that is going to be, I think, an example of what will really help drive the future of healthcare. So that we're going to get just- in- time, updated information from others that you can use as a clinician or a device developer to truly build solutions and therapies that match right time, right person, right place, right dose, all those sort of ways to optimize and match care to the individual.

Etienne Nichols: Man, that's fantastic. I mean, I feel like I have so many ideas already after talking to you, it's kind of like walking through the woods, you look at a log and you're like, "Oh, there's nothing there." And then Daniel Kraft comes and flips it over like, " Wow, there's so much life here, so many different opportunities." What is one thing that the different developers and the different people listening can do? Maybe it's the data donor, I don't know, but what's the one thing you recommend or could give advice to say, " This is an action that we can take just to improve the future as well"?

Daniel Kraft: Well, part of it is don't wait for the future to arrive. I mean, it is that you can go on digital. health and many other places and find solutions that might match a need that you have, or a family member or a community member. And some of them may not be through all the regulatory groups yet or been fully baked, but you can sometimes buy those as a Kickstarter. It might be lots of examples, but you might have hypertension and maybe you should just go out and buy that$ 30 connected blood pressure cuff at Best Buy or on Amazon and try and get that data to your doctor, who might be reticent to see it. But if you start to say, " Well, this is available, why are you not using it as a clinician," that might help catalyze, again, more uptake in utility.

Etienne Nichols: Own your health, yeah.

Daniel Kraft: Own your own health, but also be a little bit of an early adopter. Nothing's going to be perfect, everything's going to emerge. So I think that's one way to help bring the future faster. And then inside your own companies, maybe have once- a- month brown bag lunch where you bring in folks from outside the industry. We can learn from folks who are doing video games. Actually, I just invested in a company. I have a new venture, small seed stage venture fund called Continuum Health Ventures. We've invested in a company called Deep Well, built by some of the icons of the video game world with, a guy from the medical device world. And they're building video games for mental health, sneaking into mental health on these massive games. So that's video games and healthcare and devices. Now we have Akili Health, which just had their IPO this fall. That is the first FDA- cleared video game for treating ADHD. And there'll be other examples of that. So it can be from the game... and how to game people to stick with their medical regimens. Bring in someone who is doing design thinking. Obviously a lot of folks doing design in medical device, but could you bring someone from a different industry, from automotive... or I'm a pilot, I love aviation. I served as a flight surgeon in the International Guard, flying in fighter jets. What lessons can we take from aviation, which is a great example and already been overused, I think, in healthcare: checklists, flight simulators, to medical simulators? But how do you bring in other thinking and individuals and mindsets into your own organization, into your orbit, that help spark those cross- connections as opposed to, " This is how we've done it for 20 years, and that's why we're going to keep doing it"?

Etienne Nichols: That's fantastic. Well, I feel like that's a mic drop right there. You gave a lot of good insights, a lot of good advice. Where can people find you? I think you already mentioned your Twitter account. Is that the best place?

Daniel Kraft: Easy place, go to DanielKraftmd.net, and you can sign up for my newsletter. About once a week, I try and put together a little like, " Here's the cutting- edge of what I'm seeing in health and medicine across the continuum." And a lot of this relate to medical devices and beyond. Check out nextmed. health, and come join us in March. And we'll also have virtual events. It's not going to be just a once- a- year conference. It's being built as an innovation platform to keep people cross- connecting and learning, and hopefully catalyzing and reimagining the future of health and biomedicine. So this will be two places. And we'd love your partnership on digital. health and the other endeavors that are, again, at the interface of health, medicine, technology, people and ideas.

Etienne Nichols: Great. Well, that's good. We'll put links in the show notes for everybody. Those of you who've been listening, you've been listening to the Global Medical Device Podcast. Really appreciate it. Hope to see everybody in March. And we will see you all next time. Take care, everybody. Thank you so much for listening. Just a few of the points I took away from the conversation. Number one, the human side of medicine is never going away, but we're nearing the mediverse, the mediverse. And it's important to pursue education on how those devices can improve patient outcome. When I say" education," understanding what's out there so that the device that you are working on, knowing how it can integrate with other devices and work together to improve overall patient outcomes. And number two, while the potential is still great, the future is here. We need to be owning our health, going to websites such as that I've put in the show notes, to learn what your options are for preventive medicine. We're living through the transition from sick care to healthcare, but it's only going to happen for you if you take ownership. And I think as a medtech professional, it's really interesting to be able to see very easily all the different types of technology that is out there, and to understand how ours fits in. One of my favorite tidbits was when Daniel was talking about the lateral thinking and how you can achieve so much more breadth of knowledge if you start having those brown bag lunches with other departments and other companies, other industries. So good. If you enjoyed this episode, reach out to Daniel on LinkedIn and let him know. Also, I'd personally love to hear from you via email. What future topics would you like to hear about? Shoot me an email, etienne.nichols@greenlight.guru, or look me up on LinkedIn. You can learn all about what we do, if you head over to www.greenlight.guru. Not only do we have an award- winning software solution for the medtech industry, we've built a community and an academy where you can go to join the conversation or learn more about the things we discuss on the podcast. You can find those at community.greenlight.guru or academy.greenlight.guru. Finally, if you enjoyed this show, please consider leaving us a review on iTunes. It helps others find us. It also lets us know how we're doing. Really appreciate it. Thanks, everybody. Have a great week.

About the Global Medical Device Podcast:

The Global Medical Device Podcast powered by Greenlight Guru is where today's brightest minds in the medical device industry go to get their most useful and actionable insider knowledge, direct from some of the world's leading medical device experts and companies.

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