Olympian Jennifer Goldsack Spills the Tea on DiME’s New Seal for Trustworthy Digital Health

[00:00:04] Welcome to the High Tea with Grace podcast where we spill the tea on HIT. Today I'm honored to welcome Jennifer Goldsack, CEO of DiME. Thanks so much for joining us.

[00:00:14] Grace, it is a pleasure to be here with you this morning.

[00:00:17] Awesome. So tell me a little bit about the career path that brought you to DiME. We're thrilled to have you.

[00:00:23] A very non-traditional career path that brought me to DiME. So I'm actually a chemist by training. So that was my first foray into the world of science.

[00:00:33] And then did nothing sensible, Grace, for a few years. I was actually a full-time athlete. I competed at the Olympics in 2008.

[00:00:41] So that's actually how I ended up in the US. My mom's American. And I had the opportunity to be on the US Olympic team.

[00:00:48] So I moved over here the winter 2007-2008, competed in Beijing, which was just absolutely extraordinary.

[00:00:55] The privilege of being on the US Olympic team, competing, sort of being able to reach that pinnacle of my first career.

[00:01:04] And then coupling that with the ability to be in Beijing, in China. And you will remember those games.

[00:01:11] They were absolutely spectacular. So that was incredible.

[00:01:15] And then I retired. And Grace, the funny thing about this is, one, I always thought I'd go back to the UK and ended up staying.

[00:01:23] I do. I feel this week as we record this in particular, this is a tough week for America.

[00:01:27] But I am very proud to be American and wanted to stay after competing.

[00:01:33] But you may remember that the fall of 2008 was not a great time to be looking for a job.

[00:01:39] I'd always thought I was quite employable. I'm competitive. I work hard. I'm good in a team.

[00:01:45] I've got more education than you could possibly know what to do with.

[00:01:48] And that ended up then taking a position at the hospital at Penn.

[00:01:54] They were one of the few places in Philly, which is where I was living, that was actually hiring.

[00:01:58] And I met some fantastic women in senior leadership positions.

[00:02:03] They were confident that I could convert my research skills over to healthcare.

[00:02:08] And Grace, for a number of reasons, that really was a turning point for me.

[00:02:14] One of the things that you hear often when you speak to professional athletes who retire and then really struggle to make that transition.

[00:02:22] For me, it was so easy because of the importance of the work and the passion that I felt for the work.

[00:02:28] You spend all of these years as an athlete turning up with the privilege of sort of doing hard things while having fun with your best friends.

[00:02:37] But ultimately, you're trying to be the best in the world at something.

[00:02:40] And then you go into your second career and it doesn't feel like that.

[00:02:44] But for me, coming into the U.S. health system, which was so different to the health system that I grew up with,

[00:02:50] and then what started me on this trajectory was almost immediately after I started, there was the passage of the HITECH Act.

[00:02:56] And then the Affordable Care Act came down.

[00:02:58] And so I was fortunate enough, and it was nothing other than sheer luck,

[00:03:02] to be in the right place at the right time with extraordinary sort of bosses, mentors,

[00:03:06] to really come through at the leading edge of the digitization of healthcare from the very start.

[00:03:12] So I went from Penn down and then co-founded a pragmatic research institute at a large community healthcare system in Delaware,

[00:03:19] hired the first few data scientists.

[00:03:21] Everyone thought I was crazy.

[00:03:23] They're like, but we have statisticians.

[00:03:24] I was like, this is different.

[00:03:26] Grace, I'm going to tell you, I think I was onto something with the benefit of hindsight.

[00:03:30] And then my husband's actually in the military.

[00:03:32] So we'd been up in the sort of northeast and had to move down to Tampa, Florida.

[00:03:36] And I thought to myself, what on earth am I going to do on the west coast of Florida?

[00:03:39] I ended up working remotely for an organization called the Clinical Trial Transformation Initiative.

[00:03:45] And so, Grace, I've been really thinking about these new digitized data sets, new analytics techniques,

[00:03:51] how we work that into a learning health system, and then moved over to the clinical trial side of the house.

[00:03:56] And so then was thinking all about how do we use remote sensor technologies, real-world data, analytics,

[00:04:02] to develop new medical products.

[00:04:04] Had a sort of couple of years spent in startups.

[00:04:07] I wanted to see if I was the right fit for really putting all of this knowledge that I'd accumulated into a particular product.

[00:04:14] I really wanted to be driving sort of market-level change and was looking around to supplement the work I was doing

[00:04:23] through an organization that was really thinking intentionally about digitizing healthcare.

[00:04:27] It didn't exist.

[00:04:28] And that was the very long story for how we got to Dime.

[00:04:32] Wow.

[00:04:33] That is an amazing story.

[00:04:35] I'm so thrilled to have an Olympian and now somebody that is an Olympian at healthcare data in front of me.

[00:04:42] Let's talk about data.

[00:04:44] With over 300,000 consumer health apps, 30,000 targeted at healthcare professionals,

[00:04:51] how in the world do health systems go about selecting and trusting digital health solutions?

[00:04:57] And how are you thinking about this at Dime?

[00:05:00] And what challenges are they really facing in this process?

[00:05:03] It's such a good question.

[00:05:04] And those numbers really are extraordinary.

[00:05:07] First of all, just a little bit about Dime to give context to the answer to that question.

[00:05:11] The Digital Medicine Society, which we founded about five and a half years ago now, is a global nonprofit.

[00:05:17] Our mission is to advance the safe, effective, and equitable use of digital technologies

[00:05:22] to redefine healthcare and improve lives.

[00:05:26] And that's the mission that gets us up every day, that sort of binds our community.

[00:05:29] And Grace, it tells you nothing about what we actually do.

[00:05:32] So let me do that.

[00:05:33] And then I'm going to talk to you about how we use those superpowers to tackle, just as you said,

[00:05:37] this sort of proliferation of digital health software products

[00:05:40] and the burden of having to figure out what's going to work for me.

[00:05:42] We think about the sort of enormous ROI that's associated with the digitization of healthcare, right?

[00:05:50] It should be improving outcomes, access, equity, affordability, both for the individual and for society.

[00:05:57] There should also be commercial returns for those innovators and for those actors within the system

[00:06:04] who are actually taking some risks to drive forward.

[00:06:07] But what we see far too often at this stage of the digitization of healthcare

[00:06:12] is that there are some sort of issues and questions that need to be codified,

[00:06:16] either through new rulemaking out of government agencies or maybe even new legislative policy.

[00:06:21] We also see that there are some things that are business issues, right?

[00:06:25] Strategy implementation, how are you actually thinking about positioning your organization?

[00:06:29] But then there's this big gap in the middle, which is a single organization can't define

[00:06:34] good evidentiary standards all by themselves and then try and disseminate them across the whole

[00:06:38] or the whole $4.5 trillion domestic ecosystem, $10.5 trillion international sort of healthcare field.

[00:06:46] You can't think about even when the tools exist, sometimes we don't know what good implementation looks like, right?

[00:06:51] You can't one by one at every clinic around the world figure out how to do good implementation.

[00:06:57] We need to think about the skills gap that exists in our market.

[00:07:01] We need to think about where are the incentives misaligned?

[00:07:04] And we actually need to do sort of storytelling and we need to give case examples and demonstration projects

[00:07:09] to actually get people pointing in the right direction.

[00:07:11] So that's the work that we do at Dime, the work that's not an individual business problem,

[00:07:15] that's not a policy problem.

[00:07:17] We try and do really intentional sort of market creation for what we believe is the right pathway

[00:07:23] to capture all of the value that the digitization of healthcare offers the patients that we're here to serve.

[00:07:30] And then to take a long and winding path back to your questions about what the heck about all these digital health software products,

[00:07:37] one of the things that our extraordinary community, Grace, has been telling us over the last probably couple of years at this point,

[00:07:44] whether that's healthcare systems, whether that's our payer colleagues and whether it's individual patients,

[00:07:50] is they're overwhelmed by the number of digital health software products that exist.

[00:07:55] We have a fantastic patient in residence here at Dime who I know, Grace Cordovano,

[00:08:00] and she's giving me sort of example after example of a patient or a care partner whose child or who they themselves

[00:08:08] or who their spouse or their parent receives a diagnosis.

[00:08:12] And they're thinking there must be some apps to support information exchange or diet or all of these things.

[00:08:18] And then they go and they look and there's thousands of options.

[00:08:21] How do they know which ones are going to be actually effective that are going to be taking sort of respectful care

[00:08:27] with the appropriate permissions of their data?

[00:08:30] And then here's some sort of stats that will blow your mind even beyond the 300,000 plus apps

[00:08:36] and the 30,000 that are sort of clinician and system facing.

[00:08:40] We did a nationwide listening session a couple of months ago, Grace,

[00:08:44] with chief medical officers from health systems across all 50 states,

[00:08:49] different payer mixes, different settings.

[00:08:51] And then we did, we were asking them,

[00:08:54] how much time do you spend researching a digital health software product purchase?

[00:08:58] They said between 75 and 150 hours per product.

[00:09:03] What? That is unsustainable.

[00:09:06] Completely unsustainable.

[00:09:08] And then we said, how many critical purchases are you making a year at the moment?

[00:09:14] Roughly 20.

[00:09:15] So even if you do that multiplier, that's wild numbers.

[00:09:19] But then you think they're not just evaluating one product.

[00:09:21] And then you think about the fact that there's 6,000 health systems around the country

[00:09:25] and then there's freestanding clinics.

[00:09:26] And it's not just that's tens of millions of hours.

[00:09:30] It assumes that there are the sufficient skills in-house at every health system

[00:09:37] to actually de-risk that purchase decision.

[00:09:39] And if you are trying to improve your clinical workflows to improve the experience of caring for

[00:09:46] people for your clinical teams or for your administrative teams, it assumes that you can

[00:09:50] actually identify those products.

[00:09:52] It also assumes that you can successfully identify those products that are going to improve patient

[00:09:56] care, improve efficiency.

[00:09:58] And whilst the leading health systems certainly have those capabilities,

[00:10:02] the majority of healthcare systems, clinics, do not.

[00:10:06] And so then if that capability, if that burden of de-risking the decision sits exclusively with

[00:10:14] the end user or with large payer organizations thinking, what do we want to put into our wellness

[00:10:18] programs, into our sort of chronic disease management platforms?

[00:10:22] One, we're not making the best decisions.

[00:10:24] Two, the burden of making those decisions is going to inhibit the adoption of powerful solutions

[00:10:29] that should be fundamentally changing care.

[00:10:32] And the likelihood that a decision is the right one for a system and it's actually going to yield ROI

[00:10:38] when margins are so slim is really low.

[00:10:41] So that's the problem we set out to solve for.

[00:10:44] And interestingly, in doing it through the creation of the dime seal, we also really learned from our

[00:10:49] developer colleagues that they're delighted because they're really struggling when they make the

[00:10:53] investment to actually generate evidence in support of their claim, to think about good privacy and

[00:10:58] security practices, to think about being equitable, to think about high usability.

[00:11:02] It's really hard for them to be recognized in this incredibly crowded market.

[00:11:07] So that's what we've been working on.

[00:11:09] It took us about a year to develop the entire evaluation framework and a really nice,

[00:11:16] great user experience for developers coming through, making sure that we're reporting the

[00:11:20] right information to end users.

[00:11:21] But yeah, the dime seal is something we're really proud of and we think should have substantial

[00:11:27] impact on the efficiency of adoption and adoption of the right tools.

[00:11:32] That is very exciting to think about.

[00:11:34] And not only that it's being offered so that hospitals, health systems, payers, whoever needs

[00:11:39] to use those technologies can know what they're getting when they go into it.

[00:11:42] But also patients, we don't have that amount of time, right?

[00:11:46] When we're just trying to figure it out, we go on vague kind of user reviews, right?

[00:11:51] And then just say, okay, trigger happy.

[00:11:54] I guess we'll pick this one, right?

[00:11:55] We don't really have an understanding.

[00:11:57] So what are the different areas that go into that evaluation then?

[00:12:03] Is it cybersecurity?

[00:12:04] What are different things that you consider when you are going to give a company a seal of

[00:12:10] approval?

[00:12:11] Yes.

[00:12:12] A lot of work went into this.

[00:12:14] So Grace, we looked at thousands of scientific papers.

[00:12:16] We looked at, I think, nearly 50 different regulatory guidances that were pertinent to digital

[00:12:21] health software products, over 150 industry standards like ISO standards and all these

[00:12:25] different sorts of things.

[00:12:26] And most importantly, we spoke to hundreds of community members from patients themselves to

[00:12:33] help end users and sort of decision makers at health systems, payers, and then of course

[00:12:38] the developers.

[00:12:39] And the domains that the dime seal cover, and I'm going to be perhaps a little bit crass

[00:12:45] in describing them, but it gets to the point of the problem we're trying to solve for.

[00:12:49] That's what we love and that's what we want to know.

[00:12:51] So bring it to, give it to us.

[00:12:53] I'm like, this is why I love talking with you, Grace.

[00:12:57] We looked at evidence.

[00:12:58] Do you have evidence to support your claim?

[00:13:00] So your claim might be functional, right?

[00:13:02] You might be saying we can reduce time and documentation by 20%.

[00:13:06] Can you?

[00:13:07] Great.

[00:13:07] We'd like to see the receipts.

[00:13:08] You might be saying that we can correctly calculate sodium and potassium in this nutrition

[00:13:14] app that's patient-facing for people worried about potential kidney issues, right?

[00:13:17] Great.

[00:13:18] We'd like to see that data.

[00:13:20] And we'd like to be sure that it is pertinent for every single system or person who's using

[00:13:27] the tool.

[00:13:28] And the digital health software products that are evaluated by the seal cover, in some cases,

[00:13:33] a true medical device where you're making a clinical claim, but it might be a functional

[00:13:37] claim.

[00:13:39] Regardless, this is where I'm going to be crass.

[00:13:41] We want to know that you're not lying about that.

[00:13:42] And so that's what we are looking at.

[00:13:44] And what's interesting as we think about not just the evidence domain, but also privacy and

[00:13:49] security and usability, which I'll get to in a second, we have equity woven throughout.

[00:13:54] So one of the things, Grace, that drives me bonkers about what I see around conversations

[00:13:59] about equity when it comes to the digitization of healthcare is that it exists as a pillar.

[00:14:05] And I'm like, you can't just put it off on one side to be included or not included.

[00:14:09] It needs to be woven throughout.

[00:14:11] So when we're looking at the evidence, we want to not just say, do you have evidence to support

[00:14:15] the claim you're making?

[00:14:16] And does it work?

[00:14:17] And is that evidence collected from all of the settings where this could be deployed,

[00:14:21] all of the patient populations?

[00:14:22] And so that's where we see equity in our evidence pillar.

[00:14:26] The second pillar of the three, so we have evidence and then we have privacy and security.

[00:14:31] So Grace, this was the one that you immediately asked about.

[00:14:34] And because we feel really strongly that in the digital era of healthcare, that patient safety

[00:14:41] is part of, we have to contemplate sort of data rights.

[00:14:45] We have to think about security.

[00:14:46] So this is where we really dig into not just are you an acceptable product to be deployed

[00:14:54] with into a health system, if that's where you're at, if that's your context of use.

[00:14:59] But for things like patient facing apps, we're also thinking about not just do you have an

[00:15:05] appropriate sort of data policy, but is your privacy policy written at an eighth grade level,

[00:15:10] right?

[00:15:10] For anything that's patient facing, are you actually making it possible for patients to

[00:15:15] come in and make a good decision about whether this is an acceptable tool to them?

[00:15:19] So privacy and security is an integral part of this.

[00:15:22] And again, the equity is woven throughout by saying it's not just enough to do it.

[00:15:26] You have to actually do things like this at an eighth grade reading level, right?

[00:15:30] And then the third pillar, so we have evidence, we have privacy and security, and then we have

[00:15:34] usability.

[00:15:35] And this is really important, especially for those products that fall into that more sort

[00:15:40] of traditional medical device category.

[00:15:43] Because by definition, they have good evidence.

[00:15:46] They have to have looked at security.

[00:15:48] But we can have clinical decision support systems that are cleared by FDA that don't

[00:15:53] dock into an EHR work-like system.

[00:15:56] That is not, it is not reasonable to ask a provider to log into a different portal to do

[00:16:02] all of this work, right?

[00:16:04] We can have a cleared medical device, for example, might be a digital therapeutic, but they might

[00:16:10] have set up their security protocols in such a way that you can no longer access the text

[00:16:15] to voice function, which means that if anyone's vision impaired, that they can't participate.

[00:16:20] So we really have thought about the evidence.

[00:16:23] Do you have evidence to support your claim or are you lying?

[00:16:26] Privacy and security.

[00:16:28] Are you actually going to be safe when you're deployed in a system or on an individual's

[00:16:34] phone?

[00:16:35] And are you protecting data appropriately?

[00:16:37] And then usability.

[00:16:39] Do you actually work in a way that's friction-free that will allow any user of your product to

[00:16:44] actually benefit?

[00:16:45] So that's how we set it up.

[00:16:47] And I'm really proud almost of the simplicity of the framework because we could have piled

[00:16:52] anything onto it.

[00:16:54] But we really got down to what's at the core of whether you should be participating in this

[00:16:58] industry or not.

[00:16:59] What are table stakes for you to be developing digital health software products that are acceptable

[00:17:04] in our world?

[00:17:06] I am so excited, one, about this and everything that you're saying.

[00:17:12] It's so incredible to me that we've come to this point and haven't had clinical validation

[00:17:20] leading these different innovations.

[00:17:23] And it's been an afterthought.

[00:17:26] It's just shocking to me that this framework is as innovative as it is.

[00:17:31] It's a no-brainer.

[00:17:32] It seems to me like this should have always been the way, right?

[00:17:36] And so it's exciting to me that you're pushing this forward.

[00:17:40] I think what do you think the challenges have been historically to date that have kept companies

[00:17:45] from really prioritizing this or really seeing this as something important to really consider?

[00:17:50] So that's a really good question, Grace.

[00:17:54] I think there's probably two things, which is in a very early market, I think anything that

[00:18:01] is like a benchmark, whether that's a regulatory benchmark that you need to make or an industry

[00:18:05] standard feels like a burden.

[00:18:07] And I think as a sort of segment becomes more mature, the more sophisticated solution developers

[00:18:15] will actually identify that if we want to sustain this part of the market, we can't work around

[00:18:22] these benchmarks, these standards, these best practices.

[00:18:25] And we can actually differentiate ourselves by saying, yes, we do this.

[00:18:30] We deliver all of these things and that's going to return to you.

[00:18:33] So I think it's a little bit of natural evolution, to be honest with you.

[00:18:37] And a marker actually, Grace, that the digital health software product market is now quite

[00:18:41] mature.

[00:18:42] We're certainly not short of a number of products that are available.

[00:18:45] So I think that's one reason why now is the time.

[00:18:49] The second one I would say is it's interesting.

[00:18:53] Healthcare is defined because of the level of information asymmetry by third-party evaluation.

[00:18:58] So you can look at the work that ASTP ONC does.

[00:19:02] They certify EHRs, right?

[00:19:04] You can look at NCQA and the Joint Commission and they're looking, they magnet, right?

[00:19:09] They all give certification for different kinds of healthcare delivery or nursing excellence

[00:19:14] or whatever that is.

[00:19:15] FDA is the third party for medical devices.

[00:19:19] We always rely on that third party.

[00:19:21] And again, I think that there are definitely elements of the dying seal, like privacy and

[00:19:27] security, right?

[00:19:28] You could, there's SOC 1, 2, there's HITRUST.

[00:19:30] There's all of these different things that already exist.

[00:19:33] But what I am really proud that we've done with the dying seal that I think is both great

[00:19:38] for developers and most importantly, really good for end user decision makers is that we've

[00:19:43] bought it all together.

[00:19:44] So what we're saying is we're not asking for an end user to say, okay, now you have to rifle

[00:19:51] through all of the sort of publications and the clinical evidence that support claims.

[00:19:55] Now you need to be looking for all of these other certifications.

[00:19:58] ISO, HITRUST that look at privacy and security.

[00:20:01] You're not having to do implementation to actually see whether the product docks into your EHR.

[00:20:06] We've done that.

[00:20:07] We've done that as a one-stop shop.

[00:20:09] And the other thing, Grace, that I think is so important, and we don't see, I think, enough

[00:20:14] attention being paid to it at this point in the digitization of healthcare, which is we

[00:20:19] didn't come to the table as a Me Too and say, oh, Dime's so clever.

[00:20:24] Dime's figured this out.

[00:20:24] One, we work with the community.

[00:20:26] But if you have a 510k clearance and you are a developer and you come to the Dime Seal,

[00:20:32] you just upload that letter and you test out of evidence.

[00:20:35] You've done enough.

[00:20:36] You're done.

[00:20:36] We're not going to burden you.

[00:20:37] But if you don't have that because either you're too early or because you're not a medical

[00:20:41] device, we ask you a lot of other questions to show us your receipts to prove your evidence.

[00:20:45] The same way if you come to the privacy and security section and you've already got a HITRUST

[00:20:49] certification, great, upload it.

[00:20:51] You test out.

[00:20:52] So we are complementary and unifying.

[00:20:55] And I think that needs to be more of the ethos that we bring as a community to the table

[00:21:00] where we try and help.

[00:21:01] And I love that idea.

[00:21:03] It's not like a competitive seal of approval, right?

[00:21:05] This is just supposed to show others that you have these three areas really figured out.

[00:21:11] And I think that's fascinating.

[00:21:12] So what is the process for a company that's looking to potentially apply to get the seal?

[00:21:17] What's that process like for them?

[00:21:20] Fortunately, it's quite a delightful process.

[00:21:22] And I'm really proud of our developer team.

[00:21:24] And it's not grace.

[00:21:25] I'm actually proud of Dime.

[00:21:26] And I will sing the praises of our team all day.

[00:21:29] It's pretty unusual for a reasonably young nonprofit to be able to put together a tremendous

[00:21:34] piece of software that is actually a great user experience.

[00:21:37] So I feel like there's a little bit of we need to walk the walk on this.

[00:21:41] So it's not just that I think we have the right evaluation platforms.

[00:21:44] What a developer would do would be they would come to the sort of Dime seal on the Dime website

[00:21:49] and they would enter a platform where they're asked to enter just a little bit of information

[00:21:53] about their organization, a little bit of information about the product, not because it makes that

[00:21:58] much of a difference to how we evaluate it.

[00:21:59] But remember, the purpose of getting the seal is so that you're more visible to buyers and

[00:22:04] end users as a preferred product.

[00:22:06] So we need to actually create a really good searchable catalog and library.

[00:22:10] So we ask you some questions so you can be easily identified by the end user community.

[00:22:16] Then you essentially go through a series of sort of questions where you're either asked to make

[00:22:22] a self-attestation about your performance.

[00:22:23] We might ask you to do something like upload your privacy policy as well as prove that it meets

[00:22:29] a eighth grade reading level.

[00:22:30] So in some cases, we're literally asking for receipts.

[00:22:33] In other cases, it's a checkbox.

[00:22:34] In other cases, we might be looking at sort of an excerpt of a code set, for example.

[00:22:39] But remember, for those developers who come to the table and have that sort of de novo

[00:22:45] sort of decision or a 510K from FDA, you test out of evidence.

[00:22:49] If you have SOC 2 or if you have high trust, you test out of these different pieces.

[00:22:53] So the process takes anywhere between about two or three hours if you're testing out of most

[00:23:00] of it or about seven or eight over a few days if you are doing the comprehensive sort of

[00:23:06] bottom-up review.

[00:23:07] But we really have worked hard to make it user-friendly.

[00:23:11] And the most important part of it for Developers Grace is we've spent about six months already

[00:23:16] and we are investing a huge amount in making sure that the end users, the patient community,

[00:23:23] healthcare systems and payers are aware and have a deep understanding of the value of the

[00:23:28] dime seal so that going through the process is actually going to return to developers immediately

[00:23:34] because they will be able to differentiate themselves in the market, whether it's for

[00:23:38] investment or whether it's for adoption.

[00:23:41] And that piece, I think, is fundamental to success.

[00:23:44] And we've taken that part really seriously.

[00:23:47] We're silly and naive if we think it's going to self-disseminate, but we are doing the work.

[00:23:52] That is so encouraging and just fantastic.

[00:23:54] And I love the work that you're doing there.

[00:23:56] And I'm thrilled to be able to amplify that message even here.

[00:23:59] And listeners, if you are considering getting accreditation, be sure to look into this.

[00:24:05] Check out the Dime Society online and see if there's any way that you could get involved

[00:24:09] in this in some way.

[00:24:10] Or tell a friend if they're considering to use a digital health tool that maybe the Dime Society

[00:24:15] could help support their search.

[00:24:17] So I'm wondering, as we're looking 10 years, 20 years down the road, what do you hope will

[00:24:25] be innovative in this space and will be...

[00:24:31] Thinking in the future, what's your crystal ball in this space in terms of what you hope

[00:24:36] the future will hold here?

[00:24:38] So here's what I envisage.

[00:24:39] And we talk about this a lot at Dime as a team to keep our eyes focused on what we believe

[00:24:45] is the North Star.

[00:24:46] Currently, we have a healthcare system where we wait patiently in the clinic for people

[00:24:52] to arrive already with symptoms probably further along than they should be in order to seek

[00:24:57] care.

[00:24:58] As they do that, it's burdensome for them.

[00:25:01] It's costly, right?

[00:25:03] In addition to the cost of the visit, they've either got paid for transport or they've paid

[00:25:08] for parking.

[00:25:09] They've maybe got a babysitter.

[00:25:10] They've taken a half day off work.

[00:25:11] They've done all of this.

[00:25:12] And then the healthcare system that they are greeted with is one that's incredibly difficult

[00:25:17] to navigate.

[00:25:17] And it's one where we evaluate whether it's performing or not on how good we are at doing

[00:25:22] a patch-up job on a patient who's already sick.

[00:25:25] And I think that is the fundamentally flawed model.

[00:25:27] When I think about the digitization of healthcare, I think about the fact that data doesn't live

[00:25:32] in manila files in a file cabinet with only the practice manager with the key.

[00:25:37] We have these flows of data with permission.

[00:25:39] We have the ability to do enormous analytics on these datasets.

[00:25:44] We have the ability to capture data outside of the clinic through a variety of different

[00:25:48] sort of tools.

[00:25:49] We also have communications technologies that can overcome the maldistribution of clinicians

[00:25:56] and the patients who need them.

[00:25:57] So if in 10 years, Grace, we haven't got to a point where we have moved away from a sick

[00:26:03] care system and we've used all of these data and technologies to actually think about a healthcare

[00:26:08] system and we evaluate ourselves by how good are we at keeping you out of the clinic?

[00:26:13] Unless it's absolutely necessary.

[00:26:16] How good are we at meeting you where you are with the care you need when you need it?

[00:26:21] How good have we been at maintaining the human touch and empathy in the way we care for people

[00:26:28] while leveraging every single last drop of juice out of these technologies to improve the lives

[00:26:34] of clinicians and most importantly, to create affordable capacity and reach an access to healthcare?

[00:26:41] It is absolutely not beyond the realms of possibility that we can get there in 10 years, but we are

[00:26:46] going to have to be focused.

[00:26:48] We are going to have to be pulling together as an entire industry.

[00:26:52] And here's a big statement, Grace, but I honestly don't know what the future of healthcare is if

[00:26:57] we don't do this.

[00:26:58] I don't know how we maintain a sustainable industry when we don't have enough clinicians,

[00:27:05] where costs are unaffordable for individuals and society, where the burden of chronic disease

[00:27:10] and mental health is just so unacceptable.

[00:27:12] And when we still have these major diseases, cancer, Alzheimer's, Parkinson's, childhood

[00:27:19] diseases that we can't even wrap our arms around yet.

[00:27:21] What is the plan if we don't squeeze every juice out of digital?

[00:27:27] And that does not mean that healthcare stops being a clinician-led field.

[00:27:31] It does not mean that it's mechanized instead of empathetic.

[00:27:34] But I don't know what we do if we blow it right now.

[00:27:39] We blow our opportunity to take the level of investment, the technological capabilities,

[00:27:44] the pressing need, and bipartisan interest in really getting this right.

[00:27:48] We have to do it.

[00:27:50] Snaps to that.

[00:27:51] I think everybody here listening in is absolutely snapping, clapping, cheering.

[00:27:56] Like, you go, girl.

[00:27:58] You're so right about that.

[00:27:59] And thankfully, all of us are part of making that happen.

[00:28:03] And I appreciate you so much for the role that you're playing to really help move this

[00:28:09] forward in a trustworthy, reliable, equitable way.

[00:28:14] Our listeners always love to hear about trends in the space.

[00:28:17] But we also love to learn about you as a leader and things that drive you and help you work

[00:28:22] your best.

[00:28:24] Tell me, you've been doing so much work through the years you're an Olympian.

[00:28:29] Oh, my goodness.

[00:28:31] And creating this amazing society and amazing company.

[00:28:36] So what are things that you do in your personal life that help you work your best and make

[00:28:41] a difference?

[00:28:41] And I can't believe we're learning from an Olympian here.

[00:28:46] I still do try and work out most days.

[00:28:48] Though, honestly, Grace, I'm like 20 minutes.

[00:28:50] That's all I need.

[00:28:51] That's all I can commit to on a daily basis.

[00:28:53] I walk the dog and I do 20 minutes of workout.

[00:28:55] So that definitely helps me, I think, show up to be more pleasant for the team at the

[00:28:59] very least.

[00:29:00] That is good for me.

[00:29:01] I also...

[00:29:03] One of the things you learn as an athlete is to get really good at using your on-off switch.

[00:29:09] And what I mean by that is really going back now to student athlete or times where I was

[00:29:16] an athlete and working a job on the side.

[00:29:18] You have to be present with what you're doing, right?

[00:29:20] So you will burn out as an athlete if you were worried about training, the competition,

[00:29:25] injury, whatever it is that you're dealing with 24-7.

[00:29:28] You need to decide when you're showing up.

[00:29:30] You need to get there.

[00:29:31] You need to warm up.

[00:29:32] You need to be focused.

[00:29:33] You need to say, I am here for the next two hours for the first session of the day.

[00:29:37] I'm going to execute on it with my full focus.

[00:29:39] I'm then going to warm down.

[00:29:40] I'm going to do my nutrition.

[00:29:42] And then I'm going to go and switch off.

[00:29:43] And you come back and in Olympic year, you do that three times a day.

[00:29:46] So it's pretty intense.

[00:29:47] But you will burn out if you are then worrying about it when you're not there.

[00:29:52] Or if you're not fully focused when you are at practice, you will never be world-class.

[00:29:57] And so one of the things I think about, especially because I think, unfortunately,

[00:30:01] we all probably work quite a lot more than we should right now is when I'm at my desk,

[00:30:05] when I'm working, when I'm engaged in everything we're trying to drive forward with our community

[00:30:10] at the Digital Medicine Society, I'm focused, I'm on, I'm present.

[00:30:14] And when I'm not there, I'm not there.

[00:30:16] And I found that to be incredibly helpful.

[00:30:19] It is full presence.

[00:30:20] And then when you're with your family, when you're with your friends, when you're volunteering,

[00:30:26] whatever it is you're doing, be fully present in that.

[00:30:29] And that has been, I think, one of the most powerful things for me.

[00:30:31] It's you're there and you're all in or you're not there.

[00:30:34] And you are fully devoted to embracing the other parts of your life.

[00:30:38] I needed to hear that today.

[00:30:40] And I'm sure you're all feeling the same.

[00:30:42] Sometimes you feel guilty turning off.

[00:30:44] Am I even allowed to do this?

[00:30:46] And it's no, unless you turn off on the times where you are allowed to turn off,

[00:30:52] then you can't be your best on the times you have to be on.

[00:30:55] And the same rule applies to when you show up with your family.

[00:30:57] And the same rule applies when you try and show up and you try and be a friend.

[00:31:01] If you're sitting there worried about work, you're not authentically present.

[00:31:05] You're doing a crappy job.

[00:31:06] And for any of us who are goal-driven, ambitious, that feeling of doing many jobs badly is just

[00:31:14] about the worst feeling you can have.

[00:31:16] And so for me, it's you show up, you're present, you decide how you're going to allocate

[00:31:19] your time and then you stick to that decision.

[00:31:22] So true and so inspiring.

[00:31:24] And I know all of us are feeling that right now.

[00:31:27] Oh, I needed to hear that.

[00:31:29] She's so great to it.

[00:31:31] I'm glad you asked.

[00:31:32] It was good for me to hear it out loud as well.

[00:31:36] And there's a lot right now.

[00:31:37] I think that's the challenge of where we find ourselves.

[00:31:40] I think we all work within an industry that we are all passionate about that is struggling.

[00:31:46] You know, we are struggling to care for the people that our industry exists to serve.

[00:31:51] Everything going on geopolitically, our own domestic environment.

[00:31:54] And that's all on top of trying to show up as a human for the people in your life.

[00:31:58] It's a lot.

[00:31:59] It's an awful lot.

[00:32:00] And we can't do it all.

[00:32:01] No matter what people say, you just can't.

[00:32:04] You have to know what your limitations are.

[00:32:07] Exactly.

[00:32:07] You pick your priorities and then you execute.

[00:32:09] If we try and do all of the things, it's just too much.

[00:32:13] So I'm wondering if you could give advice to your younger self,

[00:32:17] looking back and you could give advice to your younger self,

[00:32:19] what would that be?

[00:32:20] And it could be career.

[00:32:21] It could be personal, whatever.

[00:32:23] However you want to take that question.

[00:32:25] The off the cuff is, don't be such an arsehole,

[00:32:28] is probably what I would say to my younger self.

[00:32:33] But in all seriousness, it actually reflects a question that I'm asked incredibly often

[00:32:40] by earlier career sort of colleagues and folks in our field,

[00:32:46] which is tell me how you got to where you did.

[00:32:48] Tell me what the plan was.

[00:32:49] And especially after I retired as an athlete, and at that point, I'm 26.

[00:32:54] And I feel like I'm behind in my career because, of course, life is an exercise.

[00:33:00] You know, I'm not doing enough.

[00:33:01] I need to do more.

[00:33:02] Where am I?

[00:33:02] And really trying to think about, gosh, what exactly is my career pathway here?

[00:33:07] What I am doing right now, I could not be happier.

[00:33:09] I could not be feeling more satisfied in my career than what I'm doing now.

[00:33:13] And it was never on the pathway.

[00:33:15] And so I think what I would have assured my younger self is that the decisions that

[00:33:20] by happenstance I was making anyway, but I was still questioning all the time,

[00:33:24] was do something you really care about.

[00:33:26] Do it well and do it with good people.

[00:33:29] And you will always be able to connect the dots through that career trajectory

[00:33:33] and map a pathway, even if it's not the one you're expecting.

[00:33:37] So that would be what I would say to myself.

[00:33:39] So encouraging.

[00:33:41] So now to finish this conversation off, where can our listeners find you online?

[00:33:47] So despite the fact I run an organization called the Digital Medicine Society,

[00:33:51] I do feel like I'm a bit like my dad when it comes to social media technology

[00:33:55] and all these sorts of things.

[00:33:57] LinkedIn is the place where I'm pretty active and where you can find me.

[00:34:01] The other thing as well is I would encourage everyone to access the Dime Slack environment.

[00:34:06] That is a tremendous community of individuals.

[00:34:09] You're always hearing first about the work that we're doing at Dime,

[00:34:12] opportunities to engage, new resources we're making available to you.

[00:34:16] You also get access to all of Team Dime and sort of thousands of members within our community.

[00:34:21] So that's another place to really get us at a little bit more of a personal level here at Dime.

[00:34:25] That's fantastic.

[00:34:26] We're already connected on LinkedIn, but I'm totally joining the Slack channel after this.

[00:34:30] So I'll see you all there.

[00:34:33] Fantastic.

[00:34:34] Fantastic.

[00:34:34] Now, before I forget, did you happen to bring tea with you today?

[00:34:39] So there's an interesting backdrop behind me today.

[00:34:42] Actually, I arrived very late last night in Hawaii for a conference this weekend, which is fantastic.

[00:34:47] But when I woke up this morning and knew I would be having this conversation,

[00:34:52] first of all, I needed coffee.

[00:34:54] So I've gone coffee this morning, not tea, despite being English.

[00:34:56] I feel like I'm bad for the brand right now.

[00:34:59] But I have a really tremendous cup of Hawaiian coffee here.

[00:35:03] And I actually went for a stroll this morning to pick it up.

[00:35:06] And it's a local...

[00:35:08] It's not just a local bean, but it's also locally roasted by a company called Paradise Coffee.

[00:35:14] And what's really cool about this is not only is it absolutely local to Oahu, which is where I am right now,

[00:35:21] but they do all of their roasting using exclusively solar power.

[00:35:26] So in terms of the environmental impact, there's no transport costs.

[00:35:31] They're only using energy that is renewable.

[00:35:34] And plus, it's really good, which I needed this morning.

[00:35:37] So it's perfect.

[00:35:38] That is so terrific.

[00:35:40] And we hope you have a great time in Hawaii and enjoy spending time with folks and brain sharing

[00:35:45] and brain trusting and getting the word out there about Dime.

[00:35:49] I thank you so much for taking the time out of your day to join us.

[00:35:52] We really appreciate learning from you.

[00:35:54] Grace, it's my pleasure as always.

[00:35:55] Thank you so much for having me.

[00:35:57] And thanks to you folks for joining us too.

[00:35:59] Check out the High Tea with Grace podcast for more interviews with great guests like Jen today.

[00:36:04] Cheers.

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