How Amazon throws a big bomb to the pharmaceutical industry in the U.S.? ---- An insight of PillPack, a medication delivery company in the U.S.
Writer: Christiane Zhao
It is an ordinary night like the other nights. I went to the Wholefood supermarket before I go back to my apartment. I was waiting on the line, and I keep seeing the former one scan a QR code and get a discount for her check.
"What is that?"
"Oh, it's an Amazon Prime membership."
Okay, so I assume the first thing to do is to get an Amazon Prime membership online. To get a supermarket discount and two free prime member shipping, I registered for the membership, eventually. It does take some courage to share your daily routine, your online shopping history, home address, and now, your supermarket glossary list and medical insurance or prescription to the company. I said that for a reason ---- A PillPack advertisement was sent to my mailbox within seconds.
"Our service is free,
you only pay for your medications.
PillPack could change the way America takes its medicine."
I am just one of the Prime members who got the message. It is still unclear how many people received email marketing or how Amazon targets its users, as approximately 100 million-plus members reported they did not receive any early messaging. It also remains unclear which individual is involved in Amazon's initial PillPack marketing wave. Not surprisingly, this mysterious body has chosen a semi-transparent pill bag as its eye-catching symbol.
I opened the hyperlink in my mail, what first comes into my eyes is ---- A human hand is holding a semi-transparent pill bag. A few big dark-blue words in Times-Roman font style written on the left-hand sides: "Your medication, delivered." A hyperlink provided below is expecting to direct you to an advertising video. Amazon is expected to explain the entire pharmaceutical services by 35 seconds. The scene is covered by a light-blue background, which seems to make their services trustworthy and transparent. For those like me, who had never heard about PillPack, it marked itself as a full-service pharmacy that fills prescriptions send ships drug package. Packages are in the pre-sorted dose and are placed in a dispenser.
This caught my eyes. Medication-delivery is already a mature concept, but it is still an unreachable dream for the majority of the population in the world, including New Zealand. This became an even more exciting mystery that I would like to explore to. The attractive side of this story is when you know how contradictory and complicated it can become; and how difficult it is to drive changes safely while dealing the traditional players. However, everything has simplified in the PillPack's website. Your prescription drugs or supplements will be on your door by a few clicks only ---- You can transfer your pharmacist and personal prescription by only eight steps only, and most of them supporting with auto-search. The zero shipping cost plus increased convenience is more than just a slogan since Amazon since it purchased PillPack, a drug delivery services company, in mid-2018 for $753 million.
Amazon is making a big push to the $3 trillion healthcare market. For PillPack, it is approaching a market with $500 billion per year and growing up 7% annually in the United States, and this number only includes prescription medication(IQVIA). While PillPack has mainly focused its eyes on chronic-conditions and multi-dose medications, we are having approximately 60% of American adults have at least one chronic illness, and 40% with two or more (Centers for Disease Control and Prevention). It is precisely just like what Bezos is expecting -- Big money return and acts as a strategic supporting point to grow its empire in the healthcare market.
Amazon is having this on-again-off-again interest in healthcare. It is not Jeff Bezos's first time of getting involved in this market. Back in 1999, the company bought a 40% stake in DrugStore.com, and he was one of the board members. Drugstore.com ended up bought by Walgreens for $429 million in 2011, which shut down five years later. Bezos emphasised in a Shareholder letter in April that the company is still a smaller player in the global retail, but he will not hold back from taking opportunities to grow. It seems to be true that Amazon is expected to draw customers, including its Prime members, away from the 64,500 retail pharmacies in the U.S..
Amazon has been quiet since the acquisition, but it is clear that a protracted battle has triggered between the old guard and the new. It won't be an easy battle for Amazon to win.
This e-commerce beast's entry does threaten the brick-and-mortar pharmacies. CVS, Rite Aid and Walgreens, which operates more than 20,000 stores in the U.S., collectively lost more than $11 billion in the stock market on the day of Amazon's announcement, said by Adam J. Fein, president of Drug Channels Institute. Those large, traditional retailers have long dominated the $413 billion annual U.S. market for filling prescriptions. PillPack is also a common enemy for the pharmacy benefit managers (PBMs), which always act as the industry middleman. PBMs earn up to 50% of its profit from distributing drugs to their patient directly, said by Roos Muken, the Evercore ISI analyst.
However, PillPack needs relationships with them. PillPack is dependent on PBMs to get paid by the patient's insurers. Those PBMs is not only PillPack's competitors but also the gatekeepers to control the access of patient data and insurance payment. Surescripts, which is owned by CVS Health Corp. and Express Script, is having a network connection to most of the U.S. pharmacies and PBMs. It also has the most comprehensive databases of prescriptions, including those written on papers.
In early August, Surescripts publicly accused PillPacks of fraudulently receiving patient data. The latter one is currently retrieving medical histories of its customers through Surescripts database via ReMy Health Inc.. In the United States, doctors and hospitals need to enter the government-issued National Patient Identifier to retrieve the data. However, ReMyHealth did not include PillPack's NPI when retrieving data from Surescripts database. Tom Skelton, CEO of Surescripts, claims that they do not allow pharmacies to access to patient's medical history. In response to that, PillPack spokeswoman Jacquelyn Miller denied any wrongdoing as the company receives patient authorisation online during the registration.
Back to 2016, Express Scripts accused PillPack of misrepresenting itself as a retail pharmacy and taking movements to block its members from using PillPack's services. It ended up being allowed to stay in the Express Scripts network as a mail-order pharmacy.
The story did not end. Based on an article published in early August, CVS and Walgreen are rejecting the prescriptions transfers request from them to PillPack. Two claimed PillPack did not receive proper consent from the patients. They did not intentionally decline the transaction, but they did not receive approval by calling the patients to confirm the transfer request. It is also reasonable to question the way that PillPack collects a patient's consent by a single click. Douglas Hoey, the CEO of the National Community Pharmacists Associations, also states that there are 20 to 30 pharmacists reported they receive a request from patients never authorise the transfer.
The local retailers are desperately looking forward to providing customers with new reasons to visit their store and pick up the prescriptions. Both CVS and Walgreens are remodelling hundreds of local retailers to targeted at the customer with chronic illness, and give the customer more reasons to visit them. Walgreen is considering to enable after-hour prescriptions pickups. Walgreens also established partnerships with numerous companies to monitor patient's health and behaviours in the past years. While nearly 90 % of all dispensed medication of generic, it does not make up high-profit margins. However, medication delivery can cut down local retail's traffics and sales dramatically. Based on an article published in the Wall Street Journal, customers use the pharmacy can have an average of 2.3 times visit a week to the store and spend $66 on groceries and $26 on prescriptions. However, for customers who don't use the pharmacy, only spend $24 weekly on groceries with less than one visit per week. CVS is also playing down the online threats by struck a deal with U.S. Postal Service for medication delivery. Customers will be charged $4.99 per delivery.
Not surprisingly, PillPack and Amazon are not fighting with empty hands. In contrast, there are plenty of reasons to clarify the threat on the traditional players. Amazon's PillPack has pharmacy licenses in 49 out of the 50 states. It also owns five distribution centres in New Hampshire, Austin, Texas and Miami, which means it can ship medication to almost every state. Its rich-in-assets and comprehensive team structure enable PillPack raised roughly $118 millions in private capital before its acquisition by Amazon. Despite the fact that Amazon has deep pockets and unlimited ambitions, Amazon's same-day delivery services plus PillPack's adherence packaging, the service became even more attractive than ever.
It is not possible to understand PillPack without looking at the team behind. T.J. Parker, who remains as the CEO of PillPack before and after the acquisition. Grown up in his father's pharmacy in Concord, New Hampshire, he worked in the pharmacy since 16. His dad later also became one of the first pharmacists of the company. During his time in college, he also met two other important men who settled the foundation of PillPack in next few years. He partners with Elliot Cohen, an MIT engineer and investor. In 2013, they won an MIT competition and got the first angel investment. Then the company also quickly gather several rounds of venture capitals. By July 2013, PillPack had already raised just over $4 million in funding. When its online pharmacy first launched in February 2014, the company only has 50 customers and nine employees. In the first few years, PillPack experiences difficulties. The cost and effort to file for license and the misinterpretation of Google and Facebook make the company became quite struggle in both maintaining a flow and marketing to expand the market. PillPack was faulty being labelled as a drug manufacturer. An investment changed that --- Kevin Colleran, an early member of Facebook's ad sales team, helps to clarify this misunderstanding. Facebook became an entry for PillPack to reach more customers than ever. Customers continuous to route over --- by the end of last year, it generated $299 million in the annual avenue.
PillPack is just a piece of Amazon's big move into the healthcare market. However, healthcare is not just delivery medicine in a timely manner. The well-structured pharmaceutical structure and isolated parties can also add up complexity and issues among the way. While PillPack is also facing pressure from other traditional players in the market, they are also experiencing pressure from other medication deliverers. There are the flip and downsides of PillPack integrated into Amazon. It is also true that PillPack will not be happy to have Amazon as an enemy, especially if they are burning quite a large amount of money to develop the new pharmacy operation system. Players like PillPack can also mean the changing of dynamic in the healthcare system, as well as patient behaviours and lifestyles.
"The pharmacy world is much more complex than just delivering certain pills or packages. I strongly believe that the role of the physical pharmacy will continue to be very, very important in the future."
---- Stefano Pessina, Walgreens CEO
* PillPack's official website design changed when I published this article. From a human hand holding a semi-transparent medicine bag to a medicine bag only.
*This article is a concluded analysis of PillPack based on the articles in trustworthy websites such as CNBC and WSJ.
The 8 Steps to register for PillPack's service:
*In Sep 2019
Investment in Health Tech project in New Zealand. -- Interview of Mitali Purohit, Network Manager at Icehouse Ventures
Writer: Christiane Zhao
Christiane: During the video interview, you had mentioned “International potential” in venture investment for several times, why you think it is so important from an investor’s perspective?
Mitali: Because for the angel investors or early-stage investors, they are looking at ten to thirty times on Return on Investment. If New Zealand’s technology harnesses the local market only, it is difficult to see the Returns on Investment due to its limitation in geographical spaces. Sometimes it is also hard if you are only limited to the New Zealand and Australian markets. So, given the healthcare technology, medical technology or even simply software development, it requires a lot of investment by locals and overseas, and it is natural to think their services and products should be geared towards an international market. Thus we can get the returns, and you can also have more users from overseas to validate your products.
Christiane: Of course, I strongly agree with your opinion. During our video interview, one of the questions I asked is “Do you think AI-health project has a future in the New Zealand investment market?” You say yes. I have also done some research about it, which makes me not very confident to give a yes to this question. Because we have a relatively low population density, and we also have a public healthcare system. So, do you think it is easier for us, as investors, to say no for an AI-health startup to balance out our risk and return?
Mitali: I agree that the New Zealand market is quite small, but we need a fair amount of data points to develop an AI model that is accurate and useful. You will need data to make sure the algorithm is accurate and working. That’s why we go back to what we said: Does this have global potential ? For instance, a company can partner with companies overseas to develop a product that is accurate, usable and investible. It enables the company to scale up internationally from there. So, when I say yes, I mean this is a market that is worth for investment. However, if it is too local, it is not seen as worth investment. In the case of AI-healthcare, we also got so many different categories. For example, a model can be used to improve hospital admission efficiency. However, in New Zealand, every hospital has different IT systems. So imagine if you develop a similar product for the New Zealand market, it will be hard to launch. As an angel investor, you would like to know if there is market demand for this product. But if every single user is different, you cannot guarantee the technology will be picked up quickly by the majority.
Another thing is the procurement system within each healthcare buyer (hospitals etc). There isn’t much funding/budget available to take up new technologies regularly within hospitals and clinica, and it takes a long time for the system to adopt a new product. In general, if you only look at the AI-healthcare market locally, it is not investible. But if you have something like, say, using Avatars ---- digital human to provide consultancy around mental Healthcare or digital nurses to triage hospital admission, those aspects are more comfortable to develop, as you can generate data quickly, and the product could be adopted globally. So, we shall break down the AI technology application into different segmentations, and then we invest in different areas based on its characteristics and performance. Therefore, it is not just a straightforward yes or no question.
Christiane: Could you please kindly explain the process of applying for funding? As you know, many students might not have many ideas about how it works.
Mitali: The best thing to do is to find the investment group and go over their websites. Look at their investment criteria and see whether it is suitable for your project before you approach them. The New Zealand investment community is very small, and the people are amiable. You can contact their managers of those investment groups or funds. All angel investment grounds in New Zealand are listed on Angel Association New Zealand’s website. In general, you will need an investment presentation which covers the product, its application, market potentials, targeted problems to solve, the approaches to solutions, and more. It will be helpful if you go and chat with those companies before you start your application. Once they have some interests, they will guide you with what they are looking for. Usually, a team is essential for a startup. For instance, there is a medical startup that came to us about nine months ago. The technology is excellent, and there are significant market needs for this. However, there are only professionals in medical science and sciences, but no entrepreneurs. Therefore, we advise them that they need someone commercial to run the business. They came back to us later, and we invested in them.
Christiane: You had mentioned, we got 11 angel investment groups in New Zealand during the video interview, but we do have any venture capital groups(VCs) in here. Could you please explain why?
Mitali: Because angel investment probably only have ten years of history in New Zealand. By now, we have enough deal flows of companies, which we invested in ten years ago, which are now starting to look for more massive amounts of money from VC funds. There are also a few VCs from overseas are planning to enter the New Zealand market soon. Besides, angel investment is different from VCs. Angel investors usually give support to startups at the initial moments, but VCs typically come in to support growth. It generally invests in a later stage with a more considerable amount of money invested. Given the maturity of the New Zealand market, we have more capacity for the VCs to get involved nowadays.
Christiane: Are there a lot of foreign investors at The Icehouse?
Mitali: We have many investors that are based overseas, especially those entrepreneurs who are growing their business in the States, Europe and Asia. They are willing to support the New Zealand startups now, as their journey as entrepreneurs could be entirely meaningful to them. We have connections to local and international investors, business mentors, and VCs. We also have investors from the significant funds which supports companies to grow internationally. It is also an advantage of partnering with The Icehouse Ventures because we can provide local investment as well as connections into overseas investment. Icehouse Ventures has a good brand and reputation overseas, so it makes it easier for us and our start-ups to reach out to international networks.
Christiane: From your perspective, what are the challenges for the Icehouse Ventures?
Mitali: The biggest challenge could be finding a suitable team and experienced entrepreneurs to make an idea became a reality in the international market. Sometimes we see a great company and its great founders, but we often do not see the complete team. In relation to Healthcare, we did not see enough. There is not enough funding going toward medical technology at an exit point, which is when the company is growing, and this idea is waiting to be sold. The biggest challenge is that we do not have enough investment opportunity in the healthcare sectors that have international scale.
Christiane: We saw a lot of small healthcare companies in New Zealand, and some struggled a lot after a few years since they got established. Do you think it is a prevalent case in New Zealand that we have a lot of healthcare and technology startups?
Mitali: A core part for the healthcare startups is about infrastructure integration -- can you develop a technology that can be quickly adopted and used by the current healthcare infrastructure. It is hard for a healthcare startup to scale big in New Zealand. For instance, Fisher & Paykel is one of the biggest healthcare-related companies locally, but it is only one-of-many large payers internationally. We do need the infrastructure and research funding to support these startups. Besides, we do not have a lot of large corporates to assist them to grow. Healthcare Technology requires a large amount of research funding to support, but we do not have enough funding to leverage it. Consider other areas, such as IT technologies, software and engineering. You only take a little bit of initial investment with a given market of users. It can further grow and request approximately $2-7 million worth of fundings, which support you the next stage. However, when you look at Healthcare, you might need at least $10 million at the initial step to be able to scale.
Christiane: So, when we look at places like China, Japan or the United States, sometimes we do see some new startups that can challenge the status quo or even the business models of the big, mature companies in the industry. Do you think that will ever happen to New Zealand?
Mitali: Well, it can only possibly happen with enough of R&D investment and private sector working well together to build a start-up and corproate ecosystem. If yes, then I think so. Israel, which is a similar size to New Zealand, has done this! But as you know, you need the money and people to do this research and go through the initial business stage in New Zealand. We need to provide enough support from research facilities, but there is still a gap between science and computer technology. There is more to do on this front.
Christiane: What about balancing the risk and return for the healthcare technology market? It is possible that we invested so much at the beginning, and it turned out to be nothing.
Mitali: Yes, but you can also receive higher returns in the medical and Healthcare market if the product works out. I think the critical point is to have more awareness of how the markets operated overseas. Who are your potential buyers of these startups for exit, so we can see returns flowing back to NZ to fund other start-ups in this area? If you get the profits, the multiples are higher than a software product (fingers crossed). To balance the risk and return for the health-tech sectors, you would need an in-depth understanding of the technology as well as the environment it is applied in. It really helps when you have an experienced entrepreneur who has taken a healthcare technology through to market in the team.
I also worked with a lot of female investors through ArcAngels. The general feedback is that the biotech market can be high risk, but the social impact of a company could be a necessary aspect to consider and add up the bonus. First, I am expecting to get my financial return, and second, I am also expecting that the investment subject is bringing an impact to the local community, national and international market. So, there are a lot of them who are taking risks. However, we have a limited pool of investors in New Zealand who understand biotechnology or healthcare technology. As we see more successful healthcare companies giving investors the return, the confidence will build.
Christiane: I am aware that you are interacting with a lot of female investors and entrepreneurs in New Zealand. Do you think there is still gender inequality in the investment industry?
Mitali: I would not say “gender inequality” in purpose, but we do not see many female investment managers, investors or entrepreneurs in the New Zealand market. The Angel Association New Zealand did a review last year, which states that there are only 18% of the investment are from female investors and 18% angel investment went to female founders. The quality of our women-led companies in NZ is exceptional. The concern is that we don’t have enough. The common theme we hear is, women founders who have great ideas don’t know where to start, or do not have mentors to support them through the start-up and fund raising journey. When we have more female investors and mentors in the community, we could see more women founders coming out and pitching. Internationally, we are starting to see more groups encouraging and empowering female investors and founders. We also know that women have a different way to target an unsolved problem. We also see that women investors have a greater understanding of the market reality since the female consumer is mainly contributing to product sales in the market. In regards to Healthcare, a female member could act an even more critical role. They are still the primary carer of both the family and in traditional healthcare settings, so they can assess these investment opportunities more thoroughly. Therefore, we will need more female researchers standing out and more female investors to help bridge this gap. It enables us to align the financial returns and long-term views.
This interview article is a follow-up Q&A session after the video interview. If you would like to watch the video, please visit www.vimeo.com/caretechdia
* All rights reserved by Christiane Zhao and the interviewee.
Hello, I am Christiane Zhao. It has been a while since we send out newsletters for you. Since the Women in Health IT Conference, our team are working efficiency to express this community’s thoughts to different industrials leaders and organisations during the past month. We always believe this is what organising and essence is all about.
Several interesting thing to share with you.
I attended the Health Tech Week 2019 in early July, and a lot of attention has been drawn to the Therapeutic Product Bills.The Therapeutic Products Bill would replace the Medicines Act 1981 and establish a new regulatory scheme for therapeutic products. During the conference, a consultation process has involved and several professionals has raised concerns and drawn confusion to the draft. For more information, please watch my Vlog 6 in CareTechdia(on Vimeo).
I visited Scott Arrol, the CEO of NZHIT, with Gabriella Laude, Sammy Choudary and Gabriel Siman. We are expected to generate a summer internship programme for both of our students and Health IT companies in Auckland. If you have any suggestions, please kindly send an email to me or my team. We are expected to launch the programme by the end of the year. This programme is expected to provide students opportunities to work in the health-tech industries and close the gap between students and the industries. We will also carefully control the gender ratio to ensure all genders receive equal benefits from this programme.
The Ministry of Health also invited me as the first guest speaker to talk at the Health Women’s Network. We mark this as an achievement for the committee team, as well as for you, as an active participant in our community. We are glad that our stories can inspire more professionals across all levels in the healthcare and technology industry, and we are expected to walk further and further by standing shoulders and shoulders with any single one of you.
Lastly, we are planning to host an orientation event on mid-August. We will release more information about this event very soon.
I deeply appreciate your participation in the Healthcare Technology Association NZ. As mentioned before, I am expected to fly to America to continue my Health-Tech journey in Boston by the end of August. During my time away, I will work with Gaberilla Laude, the co-president, in a distance. Please continue to support our committee team as always.
Here to the strong men and women: May we know them, may we be them and may we raise them.
Christiane and the HTA team
Christiane Zhao as the first guest speaker of the Health Women’s Network at the Ministry of Health, New Zealand
“Diversity is our constraint and unity is our power. If they don’t see there is a gap in the industry, we will break the silence and raise the hands.”
On 18th July 2019, Christiane Zhao had been invited as the first guest speaker of the Health Women’s Network at the Ministry of Health. She started with her personal journey of reducing inequality through establishing the Healthcare Technology Association NZ. She then shared her experience of hosting the first ever Women in Health IT Conference in New Zealand.
The Health Women’s Network is a place mainly for the female professionals at the Ministry of Health. It facilitates the sharing of information and experiences, and encourages and supports women’s participation in the health-related workforce. The invitation to provide the talk for both the Auckland and Wellington offices marks a fundamental turning point for both Christiane and the community she represented. It indicates that the public and the industry are drawing greater attention to the inequality gap between tertiary students and senior professionals, as well as the gap between male and female workers. Christiane believes the status quo within the industries should be carefully addressed, and the ability of accessing information or meetings should be based not on a young professional’s socioeconomic status but rather their skills and willingness to learn.
“When we were selecting the conference topic in February, we were especially surprised by the fact that we do not have any sort of conference or meeting specifically for the women in the Health-Tech industry,” Christiane said. “After we selected the topic, I visited several offices and spoke with a lot of people and, surprisingly, the complexity of this topic makes our work even more meaningful than ever.”
An issue arising from this topic is that some people assume it is creates a battleground for male and female professionals. The team is trying to avoid focusing too much on statistics and addressing gender equality, but rather to focus on the realistic and personal barriers for female professionals to release their potential and overcome challenges. Throughout the entire preparation process, Christiane also realised there is very little research or survey data to represent the gender inequalities in both the healthcare and technology industries in New Zealand. In addition, it is significantly difficult to invite either male speakers or male attendees to be involved in the conference. “Some told me there is no gender inequality in the industry as approximately 60-70% of healthcare workers are female.” Christiane states, “However, we do not have enough female-representation at the management level in both industries. We also face greater barriers due to the fact that female CEOs are doubted in the status quo.”
Christiane herself generated $4000 sponsorships and receives approximately $3000 from ticket sales. Half of the sponsorships are generated from Mercy Radiology and Vensa Health. She then collaborated with five supporters, made up of non-profit organisations, non-profit societies and companies. A team of 10 part-time students were formed in April to support the WiHIT Interview Series and the conference itself happened on 27th May. During the meeting, the majority of the attendees were inspired and surprised by Christiane’s initiatives and achievements.
During the talk, Christiane provided some solid data generated from the Women in Health IT Conference. The conference had more than 74 attendees and 14 guest speakers involved throughout the entire day. There was wide representation of staff from DHBs and companies like Orion Health and Deloitte. Approximately 18% of the attendees were managers, 13% attendees were CEOs/Directors. Its official website received more than 6043 visits within three months, which is an impressive record for New Zealand. “We received a lot of positive feedback from the surveys as well as other social platforms such as LinkedIn and Facebook.” Keeping a whole-day conference ticket as low as $43 for students and $87 for others is another step taken to fight against inequalities in the industry. Tertiary and Master students comprised 20% of the attendees.
On the 24th of June, the HTANZ committee team lead by Sammy Choudary and Gabriella Laude hosted an event about genomics and next generation sequencing at Grafton Campus, University of Auckland. Five guest speakers discussed various issues and projects regarding next generation sequencing, and an audience of diverse academic and professional backgrounds attended the event. The topics covered ranged from the challenges of managing and analysing large quantities of data from genomics, to finding ways to stop the infestation of the Varroa mite in beehives.
The first speaker: Dr. Justin O’Sullivan is a researcher at the Liggins Institute at the University of Auckland. This talk discussed the utilisation of genomics and next generation sequencing in the life of consumers and government agencies. Currently there are an unprecedented amount of direct consumer access to their genomes through wearable devices and electronic health records. A common example for direct consumer access to genomic technology are companies that trace ancestry from DNA samples. Another example includes the ability to analyse one’s gut microbiome to develop a personalised nutrition plan that suits the gut microbiome.
He also cited the use of genomic technology and next generation sequencing in law enforcement agencies where small samples of DNA can be sequenced and matched against any relatives in its database. In this case, this method was used to identify the Golden State Killer. New innovations in genomic technology allows the digital construction of one’s face using a DNA sample. In conclusion, Dr. O’Sullivan demonstrated how the future of genomic technology and next generation sequencing is not limited to scientific research, but also in our everyday lives.
Dr. Dan Jones is a researcher at Plant & Food Research where he talked on recent developments and challenges that are involved in the next generation sequencing of plants and crops. Whilst Plant & Food Research do not directly deal with human genomes, they are involved in the development of new plant and food cultivars that support or enhance human health attributes. Such developments include berries that have higher anthocyanin levels.
He then discussed the challenges facing next generation sequencing at Plant & Food Research where researchers are required to assemble genomes due to the extreme size of genome such as Pinus radiata. Furthermore, the difficulty of extracting plant DNA and the large variations of genome within the same crop species, known as polyploidy, poses additional challenges to next generation sequencing for plant and crop researchers. Dr. Jones conveyed how next generation sequencing in plant and crop sequencing faces different challenges than the study of human genomics.
Dr. Pablo German is the co-founder of Pheromite, where they aim to develop a parasiticide through the genome of the Varroa mite, a pest that infests beehives. He talks on the complex steps and developmental stages required to create the right chemical compounds that can target the mite. These complex stages involve the sequencing of the Varroa mite’s genome and “mining” for transcriptome sequences which allow potential protein target to be developed on a computer. These targets are used to develop chemical compounds which eventually leads to the parasiticide To finalise, Dr. German shows how the analysis of genomic sequences can lead to the development of new products, and that the same development cycle for Pheromite’s parasiticides can be applied to humans as well.
Dr. Stefan Bohlander is a professor at the University of Auckland where he discussed the impact of genomics and next generation sequencing in myeloid leukaemia. This disease has a great impact in cancer research as Leukaemia is the first disease that had its genetic alterations found. The method for the discovery of the gene alterations that lead to Leukaemia and analysis was the precursor to next generation sequencing. He then discussed the specifics and developments through genomics that have led to improved diagnostics of Leukaemia, and the ability to isolate the gene alteration, or the proportion for malignant cells in the patient for acute myeloid leukaemia. These advancements lead to more effective and accurate treatments such as bone marrow transplant. In conclusion, Prof. Bohlander demonstrated a specific case where genomic science is applied in the field of cancer.
Prof Crist Print is a professor at the University of Auckland, and he talked on the impact of genomics and next generation sequencing in the medical and clinical field both in New Zealand and abroad. Firstly, describing current projects in New Zealand that the audience who aspire to become bioinformaticians can be part of such as genomics Aotearoa, PROSPER and NETwork. Then he discussed collaborative genomic projects overseas, such as Genomics England, where research companies are linked to genomic data from the National Health Service with the consent of patients to develop improved therapy solutions. Similarly, genomic projects were initiated in Australia which resulted in large investments in the genomic industry in the country.
Considering these events in genomics, Prof. Print cited the need for genomics in healthcare, using Dame Sally Davies’s 2016 UK CMO report where she outlined the need to add members that have knowledge and experience with genomic science to the “clinical team”. This addition to the clinical team demonstrates the evolving nature of genomic science and its involvement in healthcare. He further demonstrates the increasing role of genomic science in healthcare through the review of the NHS on the future of its health workforce for a digital future where it states that “all staff will need digital and genomic literacy”. This calls for clinicians such as GPs to embrace genomic science to enhance care and diagnosis in the field of health.
Prof. Print then discussed the challenges facing genomics such as the need to develop artificial intelligence to handle vast quantities of data generated from genomic sequencing. The talk also discussed inequities that exists in genomic science, where certain ethnicities and population groups are underrepresented in genomic databases, that genomic databases are biased towards countries that have put greater investment into genomic technology. In conclusion, Prof. Print stated the immense potential that is still yet to be unleashed in the field of healthcare and that genomic technologies can play a big role in how societies can improve their health.
Overall the five speakers have enlightened us in the field of genomic science and we can see the importance of genomics and next generation sequencing in our everyday lives, in healthcare and in research, where advancements in technology has led to innovative products, diagnosis and therapy. We also looked at the unique challenges that stand in the way for further developments in this field. Hopefully anyone who attended the event and those who read this article can use the knowledge and insights passed from the speakers to embrace the wave of genomic science into our society.
A Report by Gabriel Siman,
Writer at HTANZ.
Written by: Anzel Singh
Reverberating within a room of the Iconic Sir Owen G Glenn Building at The University of Auckland Business school was a strong presence of intelligence, encouragement and unity as female powerhouses reunited with colleagues and widened their networks. Shaking hands with fellow female and male professionals at the forefront of ingenuity such as clinicians, data scientists and health informatics enthusiasts, 14 inspiring speakers further ignited everyone’s passion for change at New Zealand’s first Women in Health IT Conference.
The first speaker Alexis Stewart, Director of Strategic Programmes at Mercy Radiology walked us through digital radiology and their robot Matilda. Taking 6 weeks to train and working 24 hours a day in finance. Matilda uploads invoices and saves the company 35 hours per week allowing staff to spend their time value adding.
Dashboards were additionally mentioned it in terms of being able to look at why referrals may be falling as well as customer demographics.
Deep neural networks were discussed next, specifically, computers beginning to understand ideas such as concepts within videos and joint movement as a medical example. Gabe Rijpma, Beachhead Advisor and Senior Director for Health and Social Service in Microsoft Asia briefly highlights an era of computers we’ve never seen before.
Healthcare bots being one unique aid for healthcare professionals since these healthcare bots can be programmed without you having to be a programmer, yourself.
Clinicians can also anticipate documentation support such as Project EmpowerMD in which consultations of clinician-patient interaction are recorded and key points such as symptoms are transcribed. Although Rijpma points out we’re still 3-5 years away from this, it remains to be an exciting concept. Involving clinicians being able to conserve their energy and focus on excellent care rather than typing up each patient case.
Using machine learning to mimic GP consults for the greater good of increasing accessibility of mental healthcare, Angela Lim, CEO of Clearhead shares her perspective on Entrepreneurship within healthcare and how her company uses AI to turn 3 consultations into one via a wellbeing assistant.
Framed similarly to a messaging style type app, Clearhead offers the best way to cope with mental illness independently as well as allows appointment bookings with different specialists under your wellbeing portal.
Tom Varghese and Sarah Zub from Vensa tackle the importance of Grow Inclusive, the benefits that come with not only being diverse but more importantly building teams that are more inclusive and where everyone is felt that they are heard. Bias reducing recruitment systems being one of the many ways this can be ensured and your company can flourish.
A wearer of many important hats, Associate professor for the National Institute for Health Innovation at the University of Auckland and Clinical Director for Innovation at Waitemata district health board Dr Robyn Whittaker naturally covers Innovation.
Speaking on the ‘Leap Frog’ programme centred on rapidly delivering technological initiatives to benefit staff and patients. Whittaker discusses the journey of inviting Mobile technology into healthcare through mediums such as ipads to improve experience for all. She also speaks about New Zealand gaining a new hospital. Referring to the new surgical hospital planned for the north shore hospital campus. Therefore making Innovative decisions before and during its development is pivotal to the future of our healthcare, before it comes to life and is part of our ecosystem.
Women in New Zealand have a long history of being change makers and pioneers. Empowering those that contribute their knowledge of health and Information technology during this time of gender inequality and lack of acknowledgement continues to be vital when they are the backbone of our health industry and a huge part of what makes it great. The Women in Health IT conference is the start of many incredible efforts to shine a light on these heroes and will inevitably be a memorable experience that leaves you with hope for the future knowing you are part of making it better.
About the Writer ----Anzel Singh
Anzel Singh is a Writer with a Scientific background in Biological Sciences and Psychology holding a keen interest in Technological Advances within the Health Sector. Having Volunteered for the Auckland District Health Board as a Reablement Companion and Site Ambassador which ultimately contributed to his interest in helping people. He is currently participating in the Entrepreneurship Summer Lab at The University of Auckland which has allowed him to manifest his passions into a Virtual Reality project to help people with Autism practice Social Interaction. Working with a like-minded team eager to utilize Technology to improve Wellbeing. He is curious about the Future of Health and the Impact AI will make throughout its integration. Intending to witness all aspects of innovation within the industry from Genetic Engineering to Cognitive Prosthetics and Personalised Medicine, with the purpose of digesting that information into simpler content to share with the world.
Writer: Anzel Singh
CEO and Head of Digital Health at Mercy Radiology and Clinics, and Healthcare Holdings Limited, Dr Lloyd McCann provides a snapshot of New Zealand’s Healthcare system adapting to the era of technology. Speaking on the great potential benefits of embracing Artificial Intelligence, Machine learning and utilization of Cloud-based solutions that ensure services are deployed more rapidly than ever before. Transformation of the Healthcare Industry enabled by technology proves to be an exciting time as service delivery shifts towards patient-centred care which not only puts you in the driver seat of your healthcare experience, but also leads to a more sustainable system. Currently working at the forefront of these changes Dr McCann discusses what is beyond the horizon.
Q: When will Digital Health just be referred to as Health in terms of normalisation of AI and how fast is this transformation occurring?
Dr Lloyd McCann: One of the problems we have is that is referred to as digital health in the first place and not just health. We don’t talk about digital banking or digital travel we just refer to it as banking and travel. When is a hard question... I think we’ve entered a phase where we are accelerating towards digital delivery and digital services are becoming more embedded in healthcare. I think we’re still a few years away from it being integral to service delivery models, but I do think we’re starting to see this change speed up now.
I don’t think it’s just about machine learning and artificial intelligence. There are so many other technological approaches and solutions that we’ve just been very slow to adopt in health. Things like robotic process automation, cloud services, mobile solutions and so many other proven approaches that we are yet to adopt at scale.
Q: What disruptors on the horizon will be changing Healthcare and what should future Clinicians and Health IT specialists expect?
Dr Lloyd McCann: There’s some work being done by the medical futurist, Dr Bertalan Mesko that I follow closely. One of the first things he’s put out is that in health we shouldn’t be worried that AI and machine learning approaches will replace health professionals. What health professionals need to understand is that health professionals that embrace AI and approaches like machine learning will probably replace those that don't.
One of the reasons this is coming is because of the shift to a more consumer-centred model of care. Consumers expect convenience, rapid delivery of services and access at a time that makes sense for them. Consumers want information to be able to inform their decisions so the traditional model where we as medical professionals were the gatekeepers and custodians of that information is getting ripped apart and that’s a good thing for the consumer in my opinion.
In terms of some real disruptors, if I was going to pick two would be machine learning and AI because I think as these systems mature and as we get more confidence in systems that information asymmetry does get challenged and addressed.
The other big one for me is the increasing hybridisation of systems, biological systems meshing and being part of digital systems, whether that be a genomic sense or in a traditional clinical service delivery sense that mash-up between biological and digital systems creates some fascinating opportunities in terms of wearables and implantables so your ability to deliver care in different ways exponentially increases. A real world example is the digital therapeutics approach where we’re seeing entire treatment plans being delivered using a virtual model.
Omada health in the US are getting better outcomes from a virtual service delivery model than an in-person service delivery model for the treatment of diabetes and it’s more cost effective. For professionals that embrace these technologies and approaches there are lots of opportunities, but for those that don't, I believe they’ll become less relevant in the future.
Q: What potential do Integrated Practice Units have in revolutionising healthcare and what other specialities besides Head and Neck will follow this system?
Dr Lloyd McCann: Integrated Practice Units are not a new concept, it’s a concept that’s just been re-branded. Essentially we’re talking team-based care. Working in teams to get the best outcomes for patients is what it is all about. I think that is something that needs to be embraced in all areas of healthcare. Ultimately collaborative decision making means you’re making a more robust decision for the patient. I think all specialities need to embrace this approach.
It’s better for the consumer since you have a multidisciplinary or consensus decision being made for the best treatment pathway for that patient. The way we’re organized doesn’t exactly lend itself to that at the moment so we’ve got to reorganise our system but we know that the evidence suggests when you are practising team-based care the outcomes and cost-effectiveness of the system is markedly improved.
The head and neck example is where we took a 12 week pathway and compressed it down to a 45 minute appointment just by bringing the radiologist, the head and neck surgeon and pathologist together as an integrated practice unit.
The interesting thing is the clinicians that work in these team-based models of care get more job satisfaction so it’s better for the clinicians too because they’re working in a collegial environment where they get to operate at the top of their scope. Getting to make good decisions for their patients in real time as opposed to working in an isolated manner is just better!
Q: What role do Cloud-based solutions play in improving Clinician decision making and what’s currently happening in this space?
Dr Lloyd McCann: If you think about decision making or even just having the right information at the right time to make the right decision; using cloud-based solutions allows us to be more flexible, cost-effective, deploy services much more rapidly than the traditional on-premise model.
It also allows us to consume services in a much more flexible manner rather than needing to invest heavily in infrastructure or hardware upfront.
There’s a lot we could and should be using the cloud for. Several organisations in the US have moved most of their applications to the cloud and they’re seeing real benefits. Utilizing providers like Amazon, Microsoft and Google where cloud service delivery models are their bread-and-butter means we leverage all that expertise.
There are many different applications we could be leveraging and utilizing if we moved to more cloud-based services. We’ve just got to get more comfortable with that in health. And so you’re starting to see that progression in New Zealand, but we’re still taking baby steps.
Q: What are you most excited about in terms of future development in Health and what can we as patients/consumers look forward to?
Dr Lloyd McCann: I think there is a real opportunity of truly becoming a patient/consumer centred system. We’re still provider centred/lead and if you look at most other industries that’s not the way things work. Through utilizing digital tools, and more importantly changing the way we think and act to become consumer centred, we can have better outcomes for patients and the system. The evidence shows us that by delivering consumer centred models of care, we deliver better value - and it just makes sense. So that’s one of the things I’m most excited about. The opportunity to become truly consumer centred.
Author: Eloise Young
Since the 1990’s women in healthcare have increased in their numbers, allowing them and society to look towards an industry of equality. Many of these women have been taking on lending roles such as presidents and CEOs in companies and are the central voices and faces of healthcare, and healthcare IT initiatives.
Not only do women in health IT bring intuitive and differing minds to developing projects and systems within organizations- they bring hope and inspiration to women all around the globe who aspire to be a part of this growing industry. As dominate figures of companies in the healthcare sector, women are now strong influencers and guiders to new beneficial discoveries and technology breakthroughs in today’s healthcare. Through women obtaining primary roles within leading healthcare companies, they are showing how women are involved, driving ideas and leading the IT movements. It also shows that we as a global society are making steps to achieving gender balance in the dominating companies that strongly influence the public. Although the healthcare industry and the many various industries of our world are not quite there yet in terms of gender equality, there is still room for hope. This hope is due to the women taking on leading roles in both organizations and IT research groups. They represent to society that the world is not what it was before; the assigned roles of the past will remain in the past because of the confidence and empowerment that these women project.
By women working in health IT organization teams, it enables them to be a part of the production of healthcare and to have the opportunities to help develop the way healthcare technology works. The women in the teams, research groups and all the diverse roles within the health industry represent how women are now a part of the problem solving and development. This not only produces a better, well rounded research team, it allows women to put their diligence and skills to practice and be a part of the growth, discoveries and evolution of today’s health IT corporations.
With women in all the areas of healthcare technology it is opening up a bigger scope of thinking as it allows more minds, and more perspectives to analyze the problem and develop the solution. In the words of Alan Mulally “leadership is having a compelling vision, a comprehensive plan, relentless implementation, and talented people working together.” By both women and men working together in such an important and dominant global industry, it is allowing all kinds of various ways of thinking to solve problems and realize finer details that may have been overlooked with only limited perspectives. It is therefore crucial that equality is encouraged so that all possibilities can be brought to the drawing board. By doing so, it allows companies, organizations and greater industries as a whole to thrive and benefit everyone on our planet, for a better, more effective healthcare.
Though there is a lot more work needed to close the gap and prejudice on gender roles in healthcare, it is safe to say that the gap is closing. Although women in this industry and all industries still feel masculine dominance, they need to remember that the situation is changing, and take pride in the fact that it is because of them that equality is now obtainable in the near future.
It is our pleasure to announce that We're taking part in the Pink Ribbon Breakfast campaign this year to help support Breast Cancer Foundation NZ's vital work. Please come visit us at the Women in Health IT Conference on 27th May to support.
By taking part, you’ll be helping all those affected, as well as bringing us one step closer to our vision of zero deaths from breast cancer.
We think everyone deserves access to the latest and most effective treatments. We also want people to have all the support they need during their breast cancer journey and recovery, including rehabilitation, counselling, advice and access to a supportive online patient community.
The money raised will be used to fund research projects and medical grants to help improve survivorship, as well as support patients and their families during treatment and recovery.
Donate today to help make zero deaths from breast cancer a reality. You can either donate online or on the day of the conference. http://pinkribbonbreakfast.co.nz/page/healthcaretechnologyassociationnz
Author: Eloise Young
The Healthcare Technology Association (HTANZ) hosted an after hour event on Friday, 15th march which brought both students and health professionals together to educate, inspire and share the upcoming digitalisation processes in healthcare. The Decima Glenn Room at the University of Auckland Business School bustled with an eager audience to hear what the three health organization speakers had to say about the future of our healthcare system. But before the speakers could hit the spotlight the Healthcare Technology Association’s very own founder and president, Christiane Zhao warmly welcomed the room expressing what an honour it was to be there, and have all of us there to share this moment of her career, and the exciting news of health technology together.
First to present Orion Health’s developed technology in clinical information searching was their former clinical product specialist, Michael Hosking (who recently became the director of Clinnovation Limited). Hosking’s work of more efficient and accurate patient searching within the healthcare system he states, will give New Zealanders “more confidence in their healthcare professional having access to accurate information more quickly than currently exists.” This development, Hosking further explained in his presentation will not only improve time scheduling and workload for clinicians but will also save patients time and money. The underlying NLP technology behind Hosking’s work he claims has uses other than system efficiency, “some other uses could include: real-time bio-surveillance to improve national responses to infectious disease outbreaks; similarity analytics which supports scenarios for more individualistic care plans; and advanced clinical decision support informing disease prevention.” When I asked Michael what students should take away from this event, his answer was one directed towards those who wish to be a part of this growing industry and advice to current technology tasks, “clinical engagement and active ownership of the problem and solution is critical- ensure this early and often to improve the likelihood of success of any digital project.” Hosking’s future in health technology is something he looks at with an open mind as he expressed “I believe the opportunities are boundless. My passion lies in sustainable, data driven, healthcare system design and workforce development”, which reminds us all to keep our doors open, keep our passions close by and look forward to what lies ahead.
Next to bring laughter all around but also the incredibly futuristic world of healthcare was Vensa Health’s business strategist, Dr. Tom Varghese. Varghese’s presentation explored the technology of AI ‘communication’ with patients nationwide. The idea that patients can simply type their symptoms into a message-like forum and a computer will reply with a diagnosis. This of course lead me to ask Tom a question a vast majority of us were thinking, why should people trust a computer? Tom’s response was simple, “a human being comes with inherent errors and flaws, you forget, you say things you’re not meant to say, you’re not sometimes empathetic, a machine won’t do that.” It seemed understandable enough, and yet some of us were still sceptical so Tom further explained, “a machine is fed a bit of information and follows an algorithm, responds with data, reproduces that over and over again. So as a clinician, I would trust a machine because I’m able to get consistency, I cannot demand consistency from a human being.” Varghese’s answer truly connected the dots that in order to have easy access, affordability and convenience in healthcare we must put trust in the very thing society has had queries about for decades. In terms of patient information security Varghese commented, “My personal take is information is never 100% bulletproof, you could have the best encrypted data procedures and you could still get hacked into, but what we do with that is, we learn and reiterate and we get better.” Which is why of course Vensa Health’s project will keep all patient information in the cloud rather than in “a little box sitting under your doctor’s desk.” When I asked Dr. Tom Varghese my final question of why university students should take an interest in this area of the health industry, his reply I believe not only spoke out to those aspirating to be involved in health, but all of us aspiring to be involved in the future, Tom said, “You’re a digital generation, thinking differently is part of your DNA. Those people sitting there making those decisions, they probably don’t understand or comprehend it that well. Why should you be involved in it? Exactly that, because it is you inheriting this legacy.”
To wrap up the evening Dr. Lloyd McCann took centre stage to talk about the overall ambitions and obstacles of health technology and about digitalisation from a private company's perspective. McCann brought to light the problems the healthcare system will face when undergoing this digital transition. He stated, “with any change you create some friction, which is not necessarily a bad thing. I think there are ways we can change our thinking and the way we act that allows us to get better at doing it.” In foreseeing the digital health uptake McCann predicted, “we probably will reach that point, the tipping point theory, where there is suddenly a very sharp rise in uptakes and adoption in terms of digital approaches.”
Healthcare, as we all know is one of the pillars that hold up the world we live in today and what these three health technology professionals subconsciously projected through their presentations is that this pillar must not only be maintained, but also improved. With these new, exciting developments in health technology, we can all share in the life changing opportunities of this growing industry.