The Maker Movement in Healthcare — Susannah Fox, HHS — Full

Susannah Fox, CTO at the U.S. Department of Health and Human Services, discusses the Invent Health initiative and the potential she sees in the creation of new tools in and around improving innovation in health care.

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Key takeaways from this episode of StartUp Health NOW can be found here.

[00:00] Chime

[00:05] Intro Music

[00:43] Steven Krein: It’s my honor to introduce Susannah and Unity for our next chat. And, a little bit of context, and I think it’s important, we have a real place in our heart for the Chief Technology Officer of the Department of Health and Human Services because I think Susannah’s the third one taking over from Bryan Sivak and before that the incredible Todd Park.

[1:08] Steve: No easy shoes to fill. But it was really Todd and Aman Bhandari back in 2011 that gave StartUp Health the platform to launch at the annual Datapalooza event in Washington which is where we met Susannah five years ago.

[1:24] Steve: And we were spending time about a month ago or two months ago in our StartUp Health Village in New York City talking about the festival and Susannah and really jumped at the opportunity to really, what we offered was give her the platform now to launch something very exciting.

[1:38] Steve: So without further ado my partner Unity Stoakes and Susannah Fox, the Chief Technology Officer of Department Health and Human Services.

[1:46] Unity Stoakes: Thank you so much Steve and Susannah. It’s so wonderful to be here with you today. So, thank you. So, I thought just to kick off the conversation, just wanna learn a little bit about you. How did you get involved in healthcare?

[2:01] Susannah: Great question. I was assigned to study healthcare when I was at the Pew Research Center. And, what we were looking for was where are the spaces in terms of the social impact of the internet? That change needed to happen, should happen, and we wanted to study the aspect that was making such an impact on people, and that is healthcare.

[2:25] Susannah: So, the year 2000 was the first time that I started looking at the impact of technology on healthcare. And, there was really, people were looking at the business impact, but nobody was looking at the social impact. What effect it was having on patients and caregivers. And, I fell in love with it.

[2:42] Unity: So, you’re really an anthropologist in many ways which I think is a unique background for a CTO. And a CTO of HHS. So, you have some big news to share. Which I’m very excited to talk about. What is that?

[2:59] Susannah: So, we are launching today publically a new initiative from the HHS IDEA Lab and that’s called Invent Health. And, what I want to do is open the aperture of technology at HHS to include not just software, and IT, and electronic health records which is important. And data. But to really look at devices. And the hardware of healthcare.

[3:24] Susannah: In my field work I started noticing this about 5 years ago. A lot of what I did prior to taking this role was follow the alpha geeks of healthcare. And they were the people who showed me 15 years ago about crowdsourcing towards a diagnosis. They were the ones who were already using data. Back when it was still sort of list serves and Excel spreadsheets.

[3:46] Susannah: Patients were using data. And, about 5 years ago they started showing me devices that they’d created to solve a problem in their own lives. And I realized that a lot of people aren’t necessarily paying attention especially in government.

[4:00] Unity: These were just individuals? Or companies?

[4:02] Susannah: Yeah. These were individuals and companies. And, realizing that we have so much to learn from people who are solving their own problems, and how might we lower the barriers to entry?

[4:15] Susannah: And then coming to government I saw that there are pockets of people all around HHS who want to lower the barriers to entry for innovation and hardware. For example, there’s not a lot of Americans who know the difference between a class 1, class 2, class 3 device at the FDA. And the FDA knows that there’s great innovators out there who could bring this unexpected resource of their vision, their ideas, but they just don’t even know how to approach the regulations.

[4:45] Susannah: We want to make it easier for people to understand what the regulations are so that they can come in to us and we can lower those barriers to entry for innovation and hardware.

[4:55] Unity: So, that’s very extraordinary really that HHS is focusing on this. I remember back when Todd Park launched the data liberation movement and it really started with data, and then Bryan Sivak focused on a lot of the infrastructure. So, sounds, this seems a very practical approach to this wave of creation that’s coming in to healthcare. Is this part of a strategy that’s aligned with the health consumerism movement that’s happening, or how did this come about?

[5:27] Susannah: So, part of it is the idea that we all need to be part of an innovation nation. And we all need to be part of solving our own problems in healthcare. And what I really believe is that we need to prepare for the maker movement. We in healthcare need to prepare for the moment when there’s 3D printers everywhere. And people start to create these things.

[5:49] Susannah: These devices, these medical devices, assistive devices. I would say, very gently, that the government was caught somewhat flat footed when the internet came along. And when big data came along. And we’re catching up, and a lot of what Todd Park did was come into the role of the CTO and say, “This is important. We have all of this health data that we need to liberate and give to people so that we can really measure the healthcare system.”

[6:17] Susannah: What I’m looking out at the landscape and seeing is, that the next wave to come towards us is the maker movement. And additive printing, and all the ways that manufacturing costs are dropping. And ideas are swelling up from patients and caregivers.

[6:35] Susannah: And we need to meet that. And the reason why I’m here and wanted to announce it here, is that I see such an opportunity for investors and startup companies. I would love to see the investor community and the startup community create a platform where people can trade ideas. We really don’t have that in healthcare in terms of hardware and devices.

[6:57] Unity: So like an ETSY for healthcare?

[7:00] Susannah: Yeah exactly. There’s this great partnership between ETSY and Nordstrom. Where Nordstrom understands that they have sort of lost track of the edges of what’s cool. And, ETSY has that. And so, ETSY brings these ideas to Nordstrom and Nordstrom can say to a crafter for example, “Ok you’re making 100 of these things and it’s blowing up. Can we support you? Can we help you get to 1000 units? Can we help you get to 10,000 units”?

[7:26] Susannah: And we don’t have something like that in healthcare, sort of an early warning system for what is really coming up in terms of devices.

[7:34] Unity: So, what are some of the things that you think are possible from this initiative or this concept, as more, makers, creators, inventors start participating in the creation of health?

[7:45] Susannah: Well, so one that I’m inspired by is the VA for example, is now starting to co design and co create better prosthetics for our wounded warriors who are coming home. And that is symbolic of how we could cro create and co design all kinds of devices to better serve people.

[8:04] Susannah: And the idea that these tools are going to become more democratized. So that’s one way. Another way, in the global health space, other colleagues in government, the USAID Global Development Lab, are working with people in country so that they can create solutions to problems in a low resource area that’s right for that group of people.

[8:27] Susannah: What I love, is in sort of walking around the federal government and meeting other people who are interested in this, I met with folks at NASA and realized that we share an interest in the development of medical devices for low resource settings. Because space is a low resource setting. As is a rural health clinic in India.

[8:51] Unity: It’s amazing how many innovations have come from NASA that have been applied in other industries. Do you foresee a time in the the near future then where it’s not just entrepreneurs, but it’s consumers that are essentially making their own healthcare devices?

[9:07] Susannah: And they already are. And essentially where we are now is that people are are tweaking these things, they’re making these things. Sometimes it’s kind of a duct tape, coat hanger, MacGyver situation. But it’s a great idea. And, how might we move things over from “I’ve solved this problem for myself, for my kid, or for my older loved one. And how might we bring that into the healthcare system?

[9:32] Susannah: And again in the retail space, I think of something like Spanx. So, Spanx was this great idea. Where someone, just, this woman, cut off the legs of her control top pantyhose. And, she had trouble finding somebody to invest in this and had trouble finding a maker for this. But she went for it and now he’s got this billion dollar company.

[9:52] Susannah: And, it was a really simple innovation that solved a problem she had. How many people have a problem like that in healthcare? How many people have a device that just doesn’t work for them?

[10:02] Susannah: How many, how many people are, for example, and, we’re sort of facing an Apollo 13 moment in our country in terms of an aging population. We’re gonna have more and more people with low vision. We’re gonna have more and more people with low dexterity. We’re gonna have more and more people with hearing issues. How might we leverage American ingenuity to benefit everyone in the world who’s going to be dealing with this new wave of older adults? How might we help them to live with greater dignity and in better health?

[10:32] Unity: What sort of challenges arise with this? You mentioned of a lot of folks don’t know the difference between class 1, class 2, class 3. How does regulation maybe impact this? And then how does this initiative perhaps address some of these, these challenges when everyone’s now going to be creating their own healthcare solutions?

[10:55] Susannah: What I want to do is learn to my colleagues in the federal government. We’re sort of launching this in beta to learn from the startup community, to learn from the makers who are already out there, and to learn from my colleagues.

[11:07] Susannah: And again, in walking around HHS and walking around the federal government I found out that there are public labs that are available to citizens who want to use them. There are resources that people might not know about that are held by the federal government that we could advertise, that we could make sure the people know about.

[11:24] Unity: These at libraries, or where do people get access?

[11:27] Susannah: So, public labs that are part of the NIH. So, people can get access to these industrial strength tools. And, get access to the expertise. Another thing that we know about in government is where are the hot spots. And as entrepreneur’s that’s what you need to know and that’s what data can tell you.

[11:51] Susannah: So, how do we direct the beam of entrepreneurial spirit and investment to the problems that really need to be solved in healthcare. And so, we’re pairing up our data initiative with his new “Invent Health” initiative.

[12:05] Unity: So exciting. So, what does success look like, in maybe the near and long term from from this initiative?

[12:14] Susannah: So, we’re in the last year of this administration, which is, it can be a really unsettled time in the federal government to be in the last year of an administration.

[12:22] Susannah: And so, what I really want is for my colleagues in HHS to look at this and say this is important. This is something that I need to understand and be ready for. So they can say to the next administration, we need to do this.

[12:40] Susannah: So, I see this is as sort of a gift, hopefully, to the next set of leaders to come into HHS. That again, we needed to prepare for the internet and didn’t necessarily. We needed to prepare for big data. We need to prepare for the maker movement.

[12:56] Unity: So, since you brought it up, what happens a year from now when there is a change? Obviously it’s uncertain what that change will be. What do you think will happen? To the legacy that’s been the last 3 CTO’s.

[13:11] Susannah: So, the idea of a Chief Technology Officer at the agency level and at the White House level is really something that the Obama administration created. I have hope and confidence that Republicans, Democrats, anyone recognizes that technology is important to the success of our country and to the success of healthcare.

[13:34] Susannah: And so I really believe that no matter whether it’s a Republican or Democrat in the White House that they will continue to have this focus towards the future that the Chief Technology Officer has always brought to HHS.

[13:48] Unity: So, there’s a lot of entrepreneurs here, a lot of investors. How can they get involved with “Invent Health”? What would you ask to them be to support this initiative?

[13:59] Susannah: We’re going to a platform where it’s kind of an intake valve. And one of the issues with the federal government is that sometimes it’s kind of hard for us to have a relationship with entrepreneurs and investors.

[14:14] Susannah: And that’s sort of the role that that I play as an ambassador between these two worlds. And so we’re going to create a place where people from the FDA, people from the CDC, people from the NIH can talk with startup founders and investors about devices where people can ask each other questions. And create this community where we can all learn together about what’s coming.

[14:37] Unity: So, one of the things I also wanted to ask you is about your experience serving in the government. And, maybe, advice, or wisdom, or what that experience has been like, that you might share with others who have thought about that. And would you recommend that to others?

[14:56] Susannah: I absolutely recommend it. You guys probably know this, that one in three American healthcare dollars is controlled by the US government. So, whether you’re trying to sell into the government, or be a customer, or have any relationship to U.S. healthcare, the best thing to do is to understand the government.

[15:13] Susannah: And, what we offer is tours of duty. Where people can come in as an entrepreneur in residence and attack a specific problem and try and solve that problem. We’re currently recruiting for data scientists, if anybody wants to come in.

[15:31] Unity: And is that a one year term?

[15:33] Susannah: Yeah, it’s a one year term. And, it’s such an honor to serve. To, you know, to come in and know that you are actually trying to move this huge 90,000 person agency in a slightly different direction.

[15:51] Susannah: At first I kind of railed against the bureaucracy. But now I have respect for it. Because it’s like any big company. That if you want to change something you need to use the bureaucracy. And so, a victory can seem really small, but if you just are able to shift the thinking of the bureaucracy a little bit, or solve this one problem, it’s an example of hope. And it’s an example that things can change.

[16:18] Unity: Oh, that’s wonderful. Last question. How do you stay healthy, how do you take care of your your health and wellness?

[16:25] Susannah: I had a doctor a few years ago who looked at me and said, looked at my numbers, I wasn’t a really data driven person. But he looked at my numbers and he said, “Are you satisfied with only living into your sixties?” And it changed my life.

[16:43] Susannah: None of my cholesterol tests had really, you know, affected me. Because I was always of a normal weight. And he said I want to put you on Lipitor. And I said give me a chance. I eat Ben and Jerry’s every night and I don’t exercise. I stopped eating Ben and Jerry’s and I started walking to work and now I’m a runner. But I always tell that story to say you never know what’s going to change someone. Or one thing that somebody says to you is going to change you. And that is what changed it for me.

[17:13] Unity: Well, fantastic. Well, thank you so much for your service. Thank you for being here. Thank you for “Invent Health” and we look forward to being a part of that, so thank you.

[17:22] Susannah: Thank you.

[17:23] Unity: Thank you. [applause].

[17:29] Chime

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