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2020 MIT Platform Strategy Summit
July 8, 2020, Cambridge, USA
2020 MIT Platform Strategy Summit
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2020 MIT Platform Strategy Summit - Fireside Chat: John Halamka, Mayo Clinic Platform
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About the talk

About speakers

John Halamka
President at Mayo Clinic Platform
Geoff Parker
Professor at Dartmouth College

I am a professor of engineering in the Thayer School at Dartmouth College where I also serve as Director of the Master of Engineering Management Program. In addition, I am a visiting scholar and research fellow at the MIT Sloan School’s Initiative for the Digital Economy where I lead platform industry research studies and co-chair the annual MIT Platform Strategy Summit. I work to understand the economics and strategy of network "platform" industries. I co-developed the theory of “two sided networks” which provides a mechanism to explain pricing in network markets. I work with numerous organizations to help them understand and craft their platform strategies. WW Norton published our book "Platform Revolution" in 2016 - this is our attempt to make the research accessible to a wide audience. It's now in 10 languages and we're gratified to hear that people are using it to help inform their platform strategies.

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It's my distinct pleasure to be able to introduce. Dr. John halamka, and he and I are going to have a fireside chat for about the next half-hour. John is president of the Mayo Clinic platform, but that's a relatively recent role and we'll get into that. But prior to joining Mayo Clinic, John was executive director of the healthcare neurology center for the bi Beth Israel. Boston and was formerly Chief Information officer at Beth Israel. And was also a professor at Harvard Medical School, a little bit to

this role of organization that at Beth Israel, John oversaw, the Essential Health relationships with industry Academia and government worldwide and With his government rules served in both active and other than both the bush and the Obama Administration and governments around the world. In addition was responsible at the eye for clinical Financial administrative and academic high tea. And I think that is really important because it goes to not only the going thing. That the

HR System has relatively new to Mayo Clinic, but if you, if you saw Peter's talk earlier in the start of hot for platforms,, but I think he represents exactly the type of experience higher, but you were expecting company organizations. I'm to start to seek as they try to figure out people who can kind of span these boundaries and manage all of these external relationships. A surprising fact, is that in addition to what you would be, was at least one or two

full-time jobs. Downtown is also a practicing Emergency Physician and I believe see something on the order of 9 patients per year. At least the last time we spoke. I'm so, so, John. Thank you so much for joining us here. Welcome to the unity Farm Library where I am really distancing but on Zoom, 16 hours a day. You, you and me both, but try to figure out how we can be even busier in this time of lockdown. It seems, maybe there was a lot of downtime in the traveling in the moving around with now, just filled and plugged in the

whole time. So we met about a month ago, give or take, the world has obviously changed a great deal in the, in the car 6 months. So I have a series of things that I want to explore around platforms. But before we get to that, maybe just tell us a little bit about your role in the covid response because I think that's ended up, really spending some pretty interesting ground. Will certainly add. So as you say, I join Mayo Clinic in January and was charged with bringing together a variety of digital businesses

storage and compute and alliances and all the rats and then what would happen if you asked the question, imagine it has five stages isolation. We're at we're wearing wearing masks that are home zooming with me then get into more of a always tried to go out. We need testing and we need to contact tracing figuring out who you touched and who, you know, got infected and isolation there. And then you're going to have this return to work. Will will call pre-vaccine. And then maybe the return-to-work post vaccine. On The New Normal, As if you look at those 5-day

just think about all the organizations needed to provide all the platform Services across those five elements, right. PPE is all about supply chain platforms or ventilators, coordinating manufacturing or cures figuring out what drugs work and not at all the data on efficacy. Write this drug work or not. I would vaccine which vaccine when are they safe and efficacious? So did you do that? You really a cooler. And so is about 12 weeks ago. It seemed that there were a variety private-sector companies. That isn't

Google Microsoft, Amazon apple. Right many companies coming together and see how do we help if we're going to provide all the platform Services across these five stages and we formed a completely nonprofit completely selfless. No one is a piano in a steering roll. Hear a coalition called the covid-19 Health Care Coalition. You'll find out on the web at c-19 hcc.org. Covid-19 Healthcare coalition.org everyday. We po708 assets and you'll see it's situational awareness

for when should you open or not? And how is it county-level friend going in the United States? What masks work and don't how many ventilators are going to need next week? Right? And all of this is a set of platform tools cloud-hosted and provision to buy all these Federated organizations working together and maybe one last thing to say. And then, of course, there have been many coalitions found it as you probably see. So we formed a coalition of coalitions, do all the platforms could be together and you'll find a website called the

fight is in us.org. Where are we got The Rock? Dwayne Johnson Samuel, L, Jackson, Helen Mirren and variety of other celebrity who are the voice of this. Coalition of coalitions. All running a plasma bomb, platform, encouraging donations and trying to get the cures as fast as we can all using a platform approach. So I love that Coalition of coalitions description. And actually I'd suggest that we're likely to see that in a lot of context. So, you know from an industry. We saw that

from Zumiez close morning and then dr. The bushes presentation. So it doesn't love the metaphor. You turn your volume down slightly because people so the things that I've heard repeatedly when I speak with was company is especially over the last couple of months. And the pandemic is this notion that we've had five years of change in other five weeks or or in a couple of months or five or ten years of change, and you just described this Coalition of Partners on technology companies and you're working with governments. Would you say that the pandemic has made those

relationships sort of easier to pursue? I am just out of necessity and you think that those changes are likely to endure or once this passes wall. Can I go into our separate corners and then wall wall ourselves off from one another. Well, what a great question. I have turn my volume down so hopefully less feedback. So I've been in the industry for almost 40 years and never was at all. You know, we're going to get to this. Virtual connected patients are going to be using their phones to contact their doctors and upload their

data for wearable. It'll all be wonderful. And of course we should end by 2030. Will have this, will guess what? From January through about March of 2028. We made that transition simply because we were no longer able to have these on premise visits. We had to go through virtual care delivery. And that spanned everything from asynchronous store in for two pictures that you tag to Virtual consultations to Acute Care in the home yesterday, Mayo Clinic went live with

hospital at home. We're treating patients. Now is our Florida campus with COPD and congestive heart failure. Kidney failure in their home with remote patient monitoring and teleconsultation and nursing, there is no longer a need for John Whose license in Massachusetts to have a license in Florida. No problem. I can do my teleconsultation anywhere reimbursement, change theirs. Now, parody between what I used to get for an office visit and what I get for a phone call. And there's every

single day all these restrictions on credentialing and who can do what? And what side of service is appropriate in a paramedic actually, come and work in your home as opposed to taking you to a hospital. So I'll change. And so, what is going to happen to your question, but I'll talk to see a mess. I've talked to Jess FDA and they all say the same thing. Don't roll back. This virtual care and the platforms associated with it, is The New Normal? So, I love that answer and, and I

hope that actually maintain send and I imagine that there will be some forces trying to trying to return. Probably take some Georgians to pull off on any kind of mention all the things that I was expecting on the regulatory changes. And just as a sidebar with you mentioned people and the coalition's of companies that rapidly produced that equipment on got waivers from antitrust, authorities to be allowed to cooperate and end so similar, they were able to get some pretty quick, things happening. I hadn't really

thought about the reimbursement issue. But of course, it makes perfect sense that if you can get parities in, you can make people much more willing on the provider side to do these innovative solutions. Where do you think you're giving up? Quality. If you will, I mean you you said you you're able to do some pretty interesting interventions remotely. And on the flip side, where do you think things might actually have been proved in our ability to do the remote consultations and interactions with as a caregiver and

with patience Carter? What's imagine the customer experience Ryan? They were talking and we're a mighty platform strategy. So I'm at where everybody's aux and customer experience expert. Let's see your in Massachusetts, right? Okay. So I imagine you from your location, had to drive to Boston and non covid time. How long would it take longer to answer? The answer is, let's say your usual experience that you're going to go see your doctor for 15 minutes. You can drive 2 hours.

You're going to pay $40 for parking. You're going to sit in the waiting room with Coughing on you, and then you can have a 15-minute encounter. And then you're going to go on a 2-hour on the road. Hit rush-hour nightmare will match and I could deliver the exact same experience with the exact same outcome in real time with no travel at lower cost. Okay. So we're finding is the number of sensors that are evolving in the market is so significant that, of course,

we can measure pulse and blood pressure pulse oximetry, but their new company developing remote urinalysis, diagnostic sensors for the hall or one that I was chatting with you yesterday as the developer will call it up like a heart EKG, but it's for your abdomen and I imagine you have ulcerative colitis or Crohn's disease. There's some issue the abdomen affect you. Sensor on your abdomen and it does an electrical signal analysis in real-time of your gut motility. Like, okay, we'll start a Sears other question, like what

if we measure remotely in a consumer's location at low-cost admittedly physical examination, you do is harder at a distance. But again, I'm going to push back on that. So I went to medical school in the 1980s. And, you know, papers published instead of suggested that the sensitivity and specificity of the physical exam is just not so good. So if I can get real-time digital Telemetry, I may not be given up much and maybe the last thing I'll say is kind of cultural question for you, which is my mom is just about 80. And of course, she for her whole life has gone to see a human

and it's been a very tactical experience. And so the question is, what does she feel like she's lost something like empathy because you don't have a human who's there in a room to hug you or touch you or reassure you? Okay? I think that's probably true, but my daughter has 27 Has never had an expectation of a knot digital experience and it's completely cool with Quality Care. Delivered instantaneously at a distance. So we'll answer quality question. Why buy it kind

of depends a bit on your expectations, but in terms of being able to do remote diagnosis and treatment, I don't think we're giving up anything. That one, I think we could probe and and I have to agree with you a lot. And I love the sensor question. And then, as a sort of this Internet of Things gets cheaper, and cheaper than we can instrument more and more. Imagine. My Imaging colleagues would say I do. But wait, what about the new clear sort of Imaging machines in the x-rays and say, well, you know, we're getting there, maybe ultrasound units are starting to get a little

cheaper. So, I asked a question earlier. So it's it's been around for a long time and the pace of change was already rapid, just as a result of some friends. And so maybe talk a little bit knowing that you're new to the organization. But how are you seeing their adaptation to this? You have a kind of a complex machine? Has a lot of routines and a lot of moving Parts, really stressed, not just by covered, but really, but the changes in the in the whole

Healthcare and Technology landscape writ large. Wilshire. So if you read the history of Mayo Clinic and really quick, when you become a Mayo, Clinic employee, you are given the history of Mayo Clinic which describes exactly what Mayo did to be. An innovator over the last 150 years and that includes invented, the medical record as we know it. Here's the problem. Of course, it's 1880. And you have to have a cloud or what are you going to do? Well, of course, Henry Plummer invented and affect the Mayo Clinic Cloud by creating a network of

pneumatic, tubes, and conveyor belts. So that any patient going to any destination to see any provider when instantaneously have all their information available to them. And this was a innovation Evolution because problem is every doctor used to have a notebook and used to write the patient data and it would be silent. So we've been doing Exploud and distribution of data for a hundred fifty years. All we did was go from analog to digital and I think the major adaption it is just Mayo get a partnership agreement with

Google. Can you wear Google? I'm at work together. I'm very large-scale storage compute. A I factory data ingestion and orchestration using a whole variety of collaborators and add to what you've seen is you do a transformation like that. You need a Visionary CEO. And the CEO male who's been there one year, longer than me and Rico farrugia was hired because you said, we're going to be a platform based organization. And that what we're going to do is think about how we're going to buy

20-30 was his notion deliver large-scale data analytics today. I democratize to the world remote care in a qt care. And, and this is going to be a series of components that we build and buy and assemble into various platforms business 2030 Gold Member. I said, things have happened over the last 12 weeks to slightly accelerate that we're already live with a whole bunch of this stop and the Mayo Clinic organization, culturally has embraced it and a comments. They're making in delivering High Acuity care in a patient's home. Using a remote patient monitoring and virtual visits. Is no

question the future evolution of what we've done for a hundred fifty years. So I actually see this is just continuing what we've already done. It isn't necessarily a seat on a little over a year ago to get to meet John Rico and then give a talk at Mayo and and he told me that there was this ten-year plan because we're going to talk about platforms for the next 10 years and what you told me, 10 years turned into 10 months, perhaps then,, we first started about Recruitment and

let me just comment on that cuz we're in a platform talk to you. He's a regional leader for this platform adventure. And so they are a job description. I don't know if you seen it. Must be a physician a mighty course. Six trained engineer with 30 years of digital transformation experience International. Travel, an extensive communication skill course, the phenotype of this particular job description was wand. Right answer? They were kind of brilliant because here I wasn't endowed Harvard chair,

right? And why would you leave an endowed Harvard chair? Position of the answer is quite simple, which is, they created a platform concept, where the CEO and the board of directors said, we're going to change Healthcare in the world by bringing together all these digital capabilities. All we need is somebody who will have the engineering and medical expertise to help us on that jury. So I had more more recruits to your point are going to be moving into or a platform base positions. It

just as required slightly, esoteric experience. Well, and I think for the first movers in particular incumbents, they're able to kind of Define who it is that they want, and then offer the new Smith's, it'll be interesting to see how firms as Peter said earlier. I grow their own Talent internally when those aren't necessarily available and end, it actually has two complimentary question. What do you wish that your colleagues at Nao knew about it about ehrs about Ian Mars? That would help you be more effective in executing sort of

this platform. Vision the emerging Well, I'm not sure there's anything that I would regret or anything that I feel is a negative, but I will tell you this, when we put platform strategic plan together. We said we're going to an 80% failure rate. Right. And it's like completely novel to Mayo Clinic. What we're going to fail and I should look, we don't know what the platform in health care is going to look like in 5 years. Maybe we don't even know what it is in six quarters. So, but we got to try

it. So we have to deal with. How can we do remote diagnosis from your Apple? Watch know maybe. Yes, maybe. No, try it, you know, can we develop a warehouse of algorithms that the world would connect to? So, I didn't use male patient, right? Anyone maybe. Just try it. Right? And so, with the board and the Mayo Clinic staff, agreed, is that the only way we could try to be a category of what he is, by testing out so many speculative things, taking risks,

and be a given the free. To fail and that is entirely novel to Mayo Clinic. It's a thing that you just highlighted would be a failure at numerous companies where they want a detailed plan. So I'm going to take off my glasses and these are the Amazon Alexa glasses, prototype part of their day Zero program, they expected to fail. But their notion is probably, we will want wearable Computing of some kind. So let's try something and let's see how it works. Right? So I now have a full Alexa implementation on my face.

And that means, I turns out at my farm. I've a hundred and three Internet of Things devices and I can now control all of them with my glasses, right? But I can change the temperature. Turn on and off Lights. Theater unlock doors. Whatever. Do you want it? Is there a market? I don't know. But boy, it's worth a try. What some of the shift because while we were talking quite a few questions have come in from the audience. So I want to make this participative. So please keep adding questions, but one one

really resonates sure, which is how do you think about training and educating patients and family caregivers to be better at this sort of co-production if you will of Health Care and telemedicine at home because presumably you're that shift more and more of the responsibility onto the patient home environment. Restaurants in a couple of ways. So first, it's really important while we're on the topic to talk about the digital divide and talk about equity and talk about ensuring that we are meeting a patient, their level of technological comfort. So

when I can take a platforms, I don't assume everyone's going to have an iPhone 11, right? Everyone's going to buy an Apple Watch, right? You can't write. You have to ask yourself. What do your patients expect and they're going to be those with Nokia flip phones and you got to respect and support them and those who are wearing Alexa on their face and okay, right? So meet the patient's where they are with a spectrum of end-user customer experience. But as well, I think that's so much of our remote care is going to depend upon not just objective data. The sensors,

we talked about but subjective date. What is your pain, score your son. Something. I can't measure so easily. How do you feel today? And so we are thinking about as we develop these platforms, is the nature of the data will ingest will take many participatory contributions from patients and their families and I mean even things like social determinants of Health. Hard to actually get that in a 5-minute encounter with the registration clerk. But if you're asking a patient family to interact and a participatory fashion with the record in their experience and provide you more detail,

you can better tailor care to their needs. There's no question. Patient data contributed data and meeting the page that their level of comfort or two key focuses. So I love the technology. I want to push a little bit harder on that because the number of questions have come in around 2 class system. So you talked about digital divide, but we don't necessarily have a solution. Are there ways through this platform, Serta group of Partners. There might be, for example, centers that you could go to that have good

conductivity and technology. So you can drive within 5 or 10 miles is opposed to the to our drop down to Boston that you described earlier. Yes, a couple of ideas here. So it was that go hunting at Harvard who has been a close friend for many years to study some years ago. Looking at the capacity of Medicaid patients to receive a text right after that actually 80% of Medicaid patients and their families to receive a text. See you say, haha, you know, requiring everybody to have, you know iPhone 11. No, but if you engineered to say, if you have that fine,

but A text will support a whole lot of people I know you don't even have an internet connection or a phone plan. That's okay. You could imagine that there are as you say, it's the library. It's sure it's a workplace. It's a it's a place. You could go for an intermediate, they have connection to your health caregiver, but I imagine is going to be a little strange that we're going to end up with a new class, a medical provider. A care Navigator or call it a care traffic controller and my mom when I told her, oh, you know, there are

fire enabled, apis that enable you to download your full day to set and manage it on your phone. She said it like, I don't have a clue what you're saying, but I'm more than happy to delegate to you to be my care Navigator. So I think your points well-taken. It's less engineer to appropriate levels of comfort. But let's also think about the necessary Personnel who might be an intermediary, an interpreter and navigator for those who have no digital access of the intermediary, because, of course, that helps with reducing friction, and

an improving access and people's willingness to participate in these systems on one thing that I am actually going to ask the final two questions. One is, is this issue of enter Opera? Body of data types, and I know that you've got a big Tech partnership with Google. But so to talk about that a little bit and how you beating down some of these silos. And then the second question is, What you're doing here in the u.s.? How would you see that as going global? Maybe answer the second one first? Because these are both spend a

lot of time in sub-Saharan Africa and India. And so, it turns out, I mean, write, their issues and each location. So it looks like India, did you print out the per capita income in the town's I work in like and I'm Bihar State, and pot, not pepper capita incomes a dollar a day, but yet everyone has a 4G Android phone and a SIM card enables them to get a fair amount of data, right? So, okay. Can you deliver a telemedicine experience? Even in a place that doesn't necessarily have access to clinical care. The answer is yes, to the Gates

Foundation has funded quite a lot of this telemedicine delivery to resource-poor areas. Connecticut to sub-Saharan Africa and they don't have a lot of bandwidth. It was expensive and they're often community healthcare workers, who have a phone, and you have to go to the store and board mechanism because they don't necessarily have phone connectivity while they're going to Village. And so, your engineer again to the start of cultural and technological capabilities of a region, but none the less this notion of a cloud with hosted services that are accessed by someone. Whether it's torn

forward to direct connect as Work World. What ability. So remember their two rules have been finalized by HHS onc, the interoperability rule, the information blocking rule. Basically what it says is every provider organization must make available an API for every patient to access a set of common data elements, and you cannot say no. So some of this was technology, some of it was policy. And now for the last bit, some of its Psychiatry people who just don't want to share.

It's now a federal law. I think that's a great place to close on John. I feel like we just got going and I could talk with you for another hour. However, we're at the top of the hour and I would just like to. Thank you so much for sharing a little bit of your time and your experience. Hopefully, we can continue the conversation because I suspect that you're going to have a wild ride over the next 12 months. Thanks so much. You have a great afternoon.

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