Podcast Transcript: Patient-Reported Data and AI in Healthcare

By Sacha Heppell - August 06, 2020

 
 
Sacha Heppell

Welcome to Who Would Have Thought my name is Sacha Heppell, Chief Marketing Officer of SmartTab. The vision of the future is that SmartTab's drug delivery platform will be used in AI systems and the Internet of Medical Things. The patient's experience drives our mission to build out that future right now. Every day, in our world class Center for Innovation. I'm hosting This podcast with Robert Niichel, our founder and CEO, Robert's 15 plus years of experience in leadership and management of pharmaceutical research and development led to the founding of SmartTab in 2016 to combine wireless technology with pharmaceutical drug delivery. I'll pass it over to Robert to introduce our guest today, who's building out an extraordinary Patient-centered AI platform.

Robert Niichel

Thank you Sacha, we want to welcome Mehmet Kazgan, Founder and CEO cliexa, also known as Clinical Excellence Algorithms, a digital health company and chronic disease tracking platform that is reinventing the way medical conditions are managed. The cliexa platform connects patients, physicians and payers to better manage the most serious and expensive conditions in the United States. Building a health system with an innovative approach centered on underserved patients with health care services that they deserve. Hello Mehmet, and welcome to the show today. Thank you for joining us. Let's just jump right into it. Can you tell us your background story and what inspired you to start your company cliexa?

Mehmet Kazgan

Sure. So my background is actually software development side worked about almost 20 years in software development in big companies, including Microsoft, Kodak, PayPal, Visa, and Seagate, stars even. And then until six, seven years ago, I met my doctor friends and we basically became friends and started to focus about healthcare. Then I realized healthcare has a big challenge on technology side, it's not actually following through. And I started working for Aetna about until 2016. And I left at Aetna in 2016 May to start my own company to basically focus on patient-centered care.

Robert Niichel

Yeah, that's really exciting. Congratulations on stepping away from the corporate world and starting your own company. And then maybe you could, you know, just tell us a little bit more about your company's platform and how it works.

Mehmet Kazgan

Absolutely. So think about the thing about cliexa is an enablement platform for patients and doctors. So we actually provide the solutions for doctors and providers, clinics and health systems to monitor their patients, either by before the visit, they come to the clinic or during the visit or in between visits. So the idea is, how can I paint a picture for the doctors, it's a chronic condition, I want to see the patient's picture, whatever condition subspecialty agnostic condition that we're providing them a picture off, connected to us claims data, their background, family history. So instead of asking these questions over and over fill in forms, we we understand what the picture they want to see. We paint that picture by giving the patient a mobile application customized to their needs, and the answer to questions and here's the picture for the doctor to see not only first time but also during the treatments. That's what we do.

Robert Niichel

Yeah, very nice. Very nice. And, you know, kind of moving on more specifically, you know, one of the common commitments is we're both of our companies are looking forward to patients serving patients with Crohn's disease. And your company recently participated in the Denver, take steps walk with the Crohn's and colitis foundation. Congratulations to your company raised significant money for that. And then really, specifically with Crohn's and IBD, how can his platform be used to help the patients and physicians when they're focusing on a chronic disease like Crohn's or IBD?

Mehmet Kazgan

Absolutely. So thanks again, and cause disease in IBD are one of the conditions that we actually have a platform to monitor. So again, for one of these patients having Crohn's disease or IBD. Their typical visit is like around between two to six months, maybe once a year to see their doctors and the doctors are monitoring the treatment. And again, you cannot cure the disease. You just basically manage the condition with, you know, injections and prescriptions. So how can I collect information from the patient to provide the best treatment and that kind of follow up would be their bowel movements, their physical condition, their energy, their their basically activities, and we just basically call it bills in between visits within six months to a year and provide indicators for providers or doctors to even schedule an early visit to kind of like fix something beforehand before it becomes a bigger problem. So for IBD and Crohn's disease, it's actually a challenge because you don't see your doctor in a month every month. It's not it's like six months to a year. So monitoring patients on a mobile platform is actually much more easier in their doctor's opinion and perspective. And we're making it easier for patients to automatically respond to the alerts, notifications and even send connected device data.

Robert Niichel

Very nice, very nice. And then going one step further with the IBD. We had a question Crohn's advocate Natalie Hayden on on an earlier podcast, and she was explaining what you just touched upon how it's important for physicians to see the day to day symptoms, the day to day feedback from the patient's themselves. And then you're looking at your system, which you know, is basically more, I believe a more of a patient-centered platform versus a lot of the other apps out there. They're just a tool for physicians. So maybe you explain a little bit more how your application your software really enhances patient experience, and you know, the ease of use and how that really provides a focus on the patient care.

Mehmet Kazgan

Absolutely. So going back to that painting picture analogy, every patient for a same condition would have a different persona one is your patient historical profile that makes their genetic profile their family history, and of course, like what medications you have been on or allergies or milestone surgeries, that's your patient profile, and the other one is called diagnostic profile and diagnostic profile also is basically telling the doctor what kind of treatments you're on what the responses have been. And basically what we do with the patient-centered cares and Natalie's example, Natalie is one of the millions of patients but she fits on a certain persona. For example, if she's a female, she's 40 years old. She has a family history of Crohn's disease or IBD before, doctor treats that with a different risk factor. So we basically structured different personas for patients, you know, based on that information, and that information is actually referenced by the diagnostic profile and see how the treatment actually changes that persona in time. It's different than any other platform out there rather than tracking the information, making it a good picture and then get the provider paid with the claims. It's more like we know how Natalie's background and treatment is actually affecting her condition her prescriptions in time and we keep updating that picture. frequently with different data buckets. Very nice, very nice. And then moving on to another topic we saw were you joined the StartUp Health family. So congratulations, and welcome to the StartUp Health family. And then maybe just tell us a little bit more about StartUp Health working with them what it means with your company, how it will help propel your company forward in conjunction with the assistance of StartUp Health as well maybe just talk about that a little bit. Absolutely. Any other startups, I think we're trying to build a market presence. Any other startup, we're trying to show that our product market is there and with the resources to build a company and scale you need partners, and those partners are the ones that build A. network that you can actually work with and learn from B. they're going to have a network business network that you can build clients with and startup helped over 370 companies in their portfolio. I think we are also part of different other partners, but they really help with their network to learn from other startups with their mistakes, their successes, but also it's opening up doors to different network of businesses that we get a lot of market presence from them. So since we started, we already have been approached by venture capitalists approached by business leaders, we build a lot of interest, even with the last two to three months already, their profile got a lot of presence already. So it has been working and like paying off already with that partnership. And I believe it's going to actually build a bigger network as we go.

Robert Niichel

You're also in the Denver, the catalyst health tech innovation center as we are as well. So the question is, what do you see for the future of Denver as an innovation hub as we build out digital healthcare platforms?

Mehmet Kazgan

I think as a start, we became right away as part of the Boomtown accelerator program. The first time I started the company and I started to see how Denver and Boulder and Colorado is a great hub. And it's actually I think I heard Denver Startup Week has been the largest kind of like in kind in the nation that has been doing a lot of activities. So I've seen a lot of support from different startups, different groups to build your company even improve your case, your product. So catalyst was a good example, because it was a hub of lots of different other companies. It scales from smaller companies all the way to largest health systems. So events and gatherings and kind of like information exchange really helped us to learn and look at the picture from different perspectives. And we're seeing that a lot of companies have been thriving with that small ecosystem, while actually size wise it's large. But locally, it's a small ecosystem that we can communicate much faster than any other state, as far as I can tell from my knowledge. So catalyst has been a good catalyzer in that word, to transact that information quickly with other founders, other executives, other business leaders. We're lucky to be here.

Robert Niichel

Yeah. Well, thank you. I will turn it over to Sacha for some additional questions.

Sacha Heppell

Yeah, yeah. As health systems advance, how do you see the platform could potential integrate with digital medicine like drug delivery systems that we're developing at SmartTab.

Mehmet Kazgan

Sure. So what drug delivery systems are trying to understand how the outcomes from the patients are driven. So basically, you're going to understand how the treatment is working for the patients. There are two aspects work. One is the quality of life aspect, how the patient functions instead of one to 10. What's your pain? The answer you get is I can actually put my socks on easily today. That's what the message you will get from the patient and you need to transcribe that information into a clinical outcome. That's what we do is cliexa that and then that clinical outcome by asking the patient How hard was it for you to get out of the bed today, with the injections you're on with the insulin that you're taking with the dose today? How hard was it for you to prepare breakfast with your family this morning and put it into your AGP report says your insulin levels and X or Y. So we're kind of like that translation system in between, with that, the drive delivery comes with, okay, The outcomes are telling us things are working or things aren't working, and it changes every day. So the way it changes with the new drugs coming up, that things are changing with the new genetic, things are changing with COVID symptoms, things are changing with the pandemic. So those are kind of like dynamic variables to deliver like a treatment method to a patient, and you got to be like on it all the time. And you cannot just go tell and ask the patient all the time, 1 to 10 What's your pain? Because that scale doesn't mean anything. So functional scale, translated into clinical outcomes is what is going to make the direct delivery systems more successful. And we want to be the complimentary application or platform that will follow this with new medical devices, new pandemics, new vaccines with COVID it new challenges. We want to build that relationship and make that communication like seamless to show the drug delivery companies and systems, the outcome s as quick as possible. So they can provide the best treatment methods as the time goes by.

Sacha Heppell

Hmm, Wow, that's great. So how does the platform communicate a patient's pain more effectively than the traditional way to ask, What is your pain?

Mehmet Kazgan

Yeah, absolutely. So great questions. So I think that will also make us a little bit different than any other platform out there. So you want to tell a doctor what that pain means for that doctor to put a treatment in there. So traditional methods are saying, Give me 1 to 10 smiley face, you know, crying face, show me what your pain is. Well, pain is multi dimensional. It might be mental, it might be coming from another condition that the doctor is treating you that might be completely caused by your drugs, your divorce you're getting with your wife or your husband that it's causing your pain in your head. So it is really multi dimensional to get a clinical value when you ask the question to pain. So depending on the subspecialty, not only we're interacting with the patient, so they can go to the application and say, this is the parts of my body hurting either in a scale of high intensity, low intensity, but also the duration of the pain like is it go away? Is it acute, like we kind of give the visual interaction so they can interact with the body on the screen and say, these are areas that I'm hurting as they give that we also asked questions like custom questions or clinical assessment based questions to get different assessment score. So when we get that outcome, not only we just get that outcome, we apply that into policies to that treatment of that clinic to the doctor to the health system, saying that if the pain is in this between this threshold, or we're going to order XYZ labs urine analysis, or we're going to increase the medication, x, y and z, now you've got that but also we apply those initial guidelines on what they also suggest. So now there's their treatment, their calculated model that they think is going to work for the patient. We have the national guidelines, we're partners with American College of Cardiology, for example, we will follow their guidelines. And after that, you look in time how those outcomes are actually correlating with each other. Now we're giving a better decision support platform for the doctor to see the pictures of okay, instead of from 1 to 10, pain is five, we know the patient's functional scale, the depression scale, their mood, their energy, how they actually interact with other people's and social and emotional scales are in this threshold. So we can fix this by that. So if you see the depression and anxiety skills are higher and pain is not that much, you can actually treat the patient with natural therapy, for example, that will take care of pain instead of drugging the patient. So that's kind of like how we draw that picture for pain which is different than traditional systems.

Sacha Heppell

And, when we were talking to the IBD, patient advocate Natalie Hayden, she was saying that it was difficult for her to get pain meds due to the opioid crisis, even asking her doctor for a month's worth of pain medication to manage her chronic pain for the year, you know, when she knows it's not a flare up and she doesn't want to go to the hospital, that the doctor was not giving her pain medication. So how do you think this might help with situations like that?

Mehmet Kazgan

That's a great example that I can explain that to you. So doctors are limited with restrictions, and that's called pdmp, which is a prescription drug monitoring program. So you cannot actually prescribe Natalie because she has been already on certain medication and that's something called morphine equivalency. So that number should be in a certain threshold so they can actually prescribe again to Natalie either with a virtual health visit or in person visit even though you go tell patients, I mean, doctor that I am in extreme pain, not all the time and certain times. That's not enough justification for Doctor with today's restrictions and guidelines that he or she can actually prescribe medication. However, the way it works, it's the best way to do it is, the clinical systems health systems build their own policy, they're seeing if the functional scale, clinical assessment scale is in between this threshold. If the patient is responding to this clinically validated assessment in this threshold, our policy says they're in low medium high pain or risk. That way our policy is going to be able to write medication. However, prescription drug monitoring program MME values also should be kind of correlated to it. In today's time, you know, you need to be going into the PDMP login, look at the PDMP values, calculate the MME's and get the questions answered, type your notes. It's not working really well. The way you can make it really work is like have patient respond to the custom questionnaires, it often includes assessment values, correlate with the PDMP data and say, okay, you're in between these thresholds so you can actually prescribe this certain medication that way not only you have a quick and efficient way to apply a treatment but also justify the patient team that you're a self advocate of your care. Here's you're outcomes here and this is my restrictions and our policies requiring that well, that's kinda takes care of the justification part and compliance but the sole Natalie's problem on the chronic basis, you're also giving Natalie a case to say that, look at my numbers in a clinical scale. And my outcomes are showing it's not actually improving. So I need to get medication so you build a case for both sides patient and provider to justify how opiods can be written or prescribed. Now also, you need to be watching what you're also prescribing because you don't want to overdose the patient with with certain medication too. So it's a pretty like critical area, you got to be in between the patient care and quality of life as well as compliance at the same time.

Sacha Heppell

So when the patient's actually communicating that pain through the cliexa platform, what does that actually look like?

Mehmet Kazgan
 
So when they come into a clinic, or they're actually in between visits, so think about a new or an established follow up patient. Not only you can do this at home with your phone, they are automatically wired to the template medical records. So doctors and clinics say this is what we need to collect on an administrative basis, clinical basis, ask those questions, qualify the patients for certain clinical assessments as they respond yes or no. Once that's done, you push that information directly to the EMR, with the risk methodologies, national guidelines, and it pops up in patient charts. So we're not offering providers another tool, we're actually integrating that information in what format they want either discrete, in a report, or in a PDF or progress notes basis, we kind of draw that picture in that format and put it into their system they're currently using, that's how it works.

Sacha Heppell

Awesome, awesome. And often we talk about the future of digital health and digital technologies, revolutionizing healthcare. Most people have yet to experience what that looks like. How is cliexa created that Future right now, And what impact is it having at this moment?

Mehmet Kazgan

Sure. So I think the 4th Industrial Revolution as we know it is data, right? And data that we built AI on it, or we talk about AI all the time, AI is based on the data you provide, which is input, throughput and output. AI learns from it and starts to basically predict what the output is going to be by looking at the set of data. So if you look at the in the clinical industry, clinical arena, healthcare, that data constantly changes the way we look at today, like think about COVID and the pandemic, we're walking around masks, our life expectancy completely changed. We know like over people over 70 years old are in high risk now, which wasn't the case before pandemic hit right. So things changed a lot in health care, new bacteria, they adapt, they evolve, we're going to see second term variables in other codes coming up. We don't know yet. But what happens is, if you have a way to learn from data, well, you need to have a way to collect in a way that you can collect and see the outcomes of it. But across time you got to see that picture how it actually correlates. Healthcare data is different than financial data. You can look at stock data exchange and see what the trends are. You can play, you can see how good you are, healthcare data is not that predictive model based or you can say, I think we can do this sort of patient. That's what you can do. We're not there yet. You can, you can be there. And that's what we're actually striving for. We are collecting really valid significant clinical data, drives outcomes, but also systems can learn how it changes in time. I'll give you an example. A patient with a chronic condition is more at risk with COVID than any other patient. There are other indicators, your age, I don't know if you have an autoimmune disease, a Crohn's disease, patients are more vulnerable to an epidemic like COVID as well, okay, we know that, we take a risk assessment and we say, okay, this patient should be in an emergency room or staying at home, we make a decision. But do we know what the outcome of that decision yet? Well, we tried to learn this in clinics by implementing monitoring systems in check in and as well as in more patient monitoring. So you can see across time, even with COVID outcomes, you can see how this patient outcomes are changing in time. Now AI is going to work with that data and it's going to make some predictions. When you have a second or third wave or another pandemic hitting, you know, the vulnerability because you have seen in the past, looking at the patient outcomes, now you can build more decision on it. This is where we see the future, cliexa is going to be the platform, cliexa is going to be basically the Salesforce of that digital healthcare enabling that information for any other platforms. So complementary to the ORs complimentary to the AI systems. So we want To be the middleman to collect the right information and how people will process it, we can do it themselves, but we're giving them a chance to process that data as we collect them. Amazing.

Sacha Heppell

That's great. Thank you. Yeah. What are we not seeing now about the benefits of this technology? And over time, like you're saying in the future, what do we have yet to discover about the benefits of this technology?

Mehmet Kazgan

I'll give you a very simple example Sacha. So you go to a clinic today. Traditionally you sign bunch of forms, you fill your family history, which you do five times, in different subspecialty visit, you do during the day, and it may ask the very same questions medical assistant and you sit in the exam room with your doctor, even though you fill the form doctor will ask the same question to you. Right. And now we provided, you have the medication and your gone. Imagine this. You sit in a clinic waiting room you get a tablet, you respond to the questions, you hit the submit button, the moment you step into the clinic, cliexa system will be telling you, Sacha with the age of 25 male with a Crohn's disease and a past of family history of X, Y, and Z. Cliexa system actually says that there's an 82% chance from the other patients treatments and outcomes that you can actually SVR or treat this patient in three months providing this totals of medication, you will just get that picture in front of you. Well, that's very impressive and really innovative. But here's the next layer of it. So let's say your high risk and system tells me your higher risk. That's very innovative, but I'm going to change that and I want to see you next month. Well, I did something that worked well. With many patients not only Sacha or didn't work well with Sacha, systems still will be monitoring that information to find the most optimal treatment value in time it will keep learning from it. So you're going to learn every time and improve it without moving your finger providing the latest outcomes from different systems. That is not there yet, because we don't have enough data yet. But if cliexa would have billions of data points that's coming in and AI is learning from it. We're not talking about a single condition. We're talking about multiple diseases that we're monitoring yet. And if you add the whole pandemic information on it will open a different door for for clinical decision support AI, and you name it. So everyone is after the same thing, but we're trying to solve a simple problem. How can we collect the correct data in the correct form and track outcomes. That's what we're after.

Sacha Heppell

Awesome. And how many years do you think it'll take for us to get to that point where we have that data?

Mehmet Kazgan

Well, I will speak on behalf of cliexa, I think we are going to be there within maybe three to five years, we're going to have an extreme accurate outcomes we have seen from a AI platform predicting 97% accuracy on opioid risk compared to a calculated risk in a clinic that that pain password will be guessing already.

So if you put it in a scale, I would guess three to five years. But this is just a wild guess, as I speak as many other innovators out there.

Sacha Heppell

Pretty promising. I'm really impressed and inspired by you and the team and your authentic commitment to really understand the world of the patient and the physician and connect those worlds and support them through these digital technologies to transform our healthcare system and improve the outcomes of patients. Thank you.  So how can health care providers and potential partners contact you?

Mehmet Kazgan

Well, they can go to our website, which is www.cliexa.com, or they can reach us via email info@cliexa.com, we're happy to help and become partners in this journey.

Sacha Heppell
Awesome. Thanks so much for spending the time with us and we look forward to staying up to date on your progress and all the great work you're up to, thank you.

Mehmet Kazgan

Thank you so much for giving me the chance.

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