As part of the Future of Healthcare series, I’ve had the pleasure of interviewing with Shree Kalluri and John Krystal, MD. Inspired to create a company that makes a huge difference, Shree Kalluri founded Forte Research Systems, Inc. in 2000. Today, Shree continues to drive the company’s strategic direction and shape the culture that makes Forte a company that people and organizations seek out and stay with. Shree takes pride in the contribution that the company’s products make to the discovery of new cures through the work done at research organizations across the United States and beyond.
John Krystal, MD is a Chair of the Department of Psychiatry at Yale School of Medicine and the Co-director of Yale Center for Clinical Investigation. Dr. Krystal is a leading expert in the areas of alcoholism, post-traumatic stress disorder, schizophrenia, and depression. His work links psychopharmacology, neuroimaging, molecular genetics, and computational neuroscience to study the neurobiology and treatment of these disorders. He is best known for leading the discovery of the rapid antidepressant effects of ketamine in depressed patients. He is a member of the U.S. National Academy of Medicine. He also serves in a variety of advisory and review capacities for NIAAA, NIMH, Wellcome Trust, Brain and Behavior Research Foundation, the Broad Institute, and the Karolinska Institutet. Dr. Krystal previously served on the National Alcohol Abuse and Alcoholism Advisory Council (NIAAA), the Department of Defense Psychological Health Advisory Committee, and the NIMH Board of Scientific Counselors (chair, 2005–2007). He has led the American College of Neuropsychopharmacology (president, 2012), and International College of Neuropsychophamacology (president, 2016–2018). Currently, he is co-chair of the Neuroscience Forum (NeuroForum) of the National Academies of Sciences, Engineering, and Medicine, a member of the NIMH National Mental Health Advisory Council, and he edits the journal, Biological Psychiatry (impact factor: 11.982).
Thank you so much for joining us! Can you tell us a story about what brought you to this specific career path?
John: I spent the summer after my first year of college at the University of Chicago working in a methadone clinic affiliated with Harvard learning about opiate dependence. When I returned to college, I took a biochemistry class. Each week, the professor would cite a recent advance in biochemistry. I remember the day this professor told the class about the discovery of opiate-like peptides made by the body. I had the epiphany that the problem of addiction had its roots in these fundamental aspects of biochemistry and that I wanted to be a part of building these links. I went to Yale for my psychiatry residency and remained on the faculty because it was a place where I could link basic and clinical neuroscience research in trying to understand the biological bases of psychiatric disorders and to develop novel treatments based on these neuroscience insights. This plan succeeded to a far greater extent than I could have anticipated, as my colleagues and I discovered the rapid antidepressant effects of ketamine, the first rapid-acting antidepressant.
Can you share the most interesting story that happened to you since you began your leadership position at Yale?
John: I had the sense that our department needed to build our feeling of community in order to realize our potential for excellence. I appointed a deputy chair for diversity and created a departmental diversity task force with confidential paths for faculty and staff to share information with department leadership. In parallel, we had discussion groups and Town Hall Meetings over several years during which we identified obstacles to building our community.
The Department of Psychiatry is a large department with a proud tradition alleviating the burden of mental illness and addiction through its clinical, educational, and research missions. Since its inception in 1930, the department commissioned paintings of its chairs and hung these portraits in our main conference room. Time and again, the portraits of the prior chairs emerged as an obstacle. People felt that the paintings were not only a celebration of the past but also a statement about the sort of people who were perceived to be the most valued by the department, i.e., white males. Discussing the paintings became a vehicle for talking about many of the most difficult issues that we faced in our community. Collectively, we decided to put the paintings in storage, to take photographs that reflected the diversity of our department and to hang these new portraits in our halls. This process proved to be an important step forward in building our departmental community. This experience sensitized me to the ways that the environments that we create communicate our values.
Can you tell our readers a bit about why you are an authority in the healthcare field?
John: I have spent the past 30 years as a psychiatrist treating mental illness. During this period, I maintained active research programs and I have led research centers funded by the Department of Veterans Affairs and the National Institute on Alcohol Abuse and Alcoholism. For the past 10 years, I have chaired the Yale Department of Psychiatry and the Psychiatry Services of Yale New Haven Hospital.
What makes Yale’s research center and Forte’s technology stand out? Can you share a story?
John: The Yale Center for Clinical Investigation (YCCI) was established in 2006 to promote clinical and translational research and educate the next generation of clinician scientists. YCCI was one of the first 12 centers in the country to be funded by NIH Clinical and Translational Science Award. Early on, we realized that if we could harness technology we would be able to more quickly bring innovative treatments to patients. At that time Yale, like many institutions, implemented an electronic medical record system. At the same time, we were implementing OnCore, a clinical trial management system, to help manage and carry out research studies. We had the idea that if we could somehow get these two platforms to talk to each other, we could really speed up the research process. We worked with Forte, the company that makes OnCore, on an interface with our electronic medical record system that allows us to access information from patients’ electronic medical records that is relevant to the study they’re participating in. This was the first time this had been done and it has allowed us to more quickly get studies up and running safely and effectively so that researchers can spend more time actually doing the research.
Shree: Much like John mentioned, we’ve seen what embracing new technology can do to accelerate innovation and treatment in healthcare. I saw a bigger opportunity to leverage tech beyond just organizational mechanisms in healthcare, there was huge potential in applying tech to push the boundaries of what we thought we could do in clinical research. That’s the main focus of Forte: developing specialized software that’s purpose-built to collaborate with clinical research institutions, ensuring real value is built into all facets of research. Our goal is to support the community as a whole and encourage them to work together, providing tech-based ways to actually do that in a manner that is seamless, informative, and minimizes redundancy when problem-solving common issues. Interoperability is a known challenge in healthcare and we’re trying to fix that. The industry is complex — there is self-interest and competition on science, for example — but our community has determined that if they can all get better individually and widely share those experiences and best practices, that overall science and healthcare improves, making innovation with speed a reality.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
Shree: What we’ve been focusing on as of late is on building an ecosystem that makes secure data sharing a reality — what we’re calling Trial Data Exchange. So much of the data and science that clinical research is outputting can be leveraged across multiple studies and multiple research institutions. But when you’re dealing with healthcare data you have to be extremely careful about who has access to that data and how that data is being used. So, in addition to our focus on data sharing, we’re equally focused on data protection. Every step of the way, we ask ourselves, “How can we apply modern technology to our discipline in a way that encourages collaboration but is restrictive in the right places?”
It’s a big undertaking but the progress we’ve made so far is very encouraging. In part because we are building this ecosystem together with the likes of Yale and other top research sites; we’re not developing in a vacuum and that’s important. It’s the only way we’ll do this right, in my opinion.
For Forte, it’s zeroing in on the pain points of research institutions and alleviating them with technology; focusing on our energy on interoperability and collaboration in healthcare. The way the system works now is a bit disjointed and it’s negatively impacting patients and their care; creating a lot of patient risk. Using better technology allows researchers to focus on the science and not the operations of data organization and what-not.
Are you working on any exciting new projects now? How do you think that will help people?
John: I am working on new treatments for several psychiatric disorders. In one project, we hope to repurpose a failed cancer chemotherapy as a treatment for alcoholism. In another project, we are testing a rapid-acting antidepressant as a treatment for PTSD.
What are your “5 Things I Wish Someone Told Me Before I Started” and why?
- I wish that I had done a research fellowship instead of establishing my research momentum while on the faculty and leading a clinical program.
- I wish that someone had told me to get more training in math beyond calculus in college. My later interests in metabolic modeling and computational neuroscience would have been accelerated had I had a background in differential equations.
- I wish that someone had told me to negotiate for a start-up package before I joined the faculty. Had I not gotten grants in my senior residency year and at the end of my first year on the faculty, I might not have succeeded in establishing a research career.
- I’m glad that no one told me about how hard I would work in my career. I would not have understood that the rewards more than repay the effort.
- More than anything else, I’m glad that no one told me that I could not pursue my passion for research.
Shree: While John’s is very specific to his area of expertise, most of the lessons I’ve learned have centered on leadership and turning passion into progress. Here are a few of the most important things I take with me every day:
- Be Patient. Success — or even inspiration — doesn’t come overnight. Focus on progress versus perfection and everyday, every win no matter how large or small, will be significant.
- It can be easy to have a vision of great things when you surround yourself with a team that can execute your ideas. Build a strong team and, more importantly, trust them with the task.
- After you’ve built a great team, learn what motivates them — what gives them a sense of purpose? — and the leadership style they respond best to.
- Be a mission-driven organization. For us, it was and is all about the patients. We want to give our customers, like Yale, the tools they need to deliver the best care.
- Stay focused by constantly asking yourself, “what do I want to transform?” It’s easy to be distracted and going down every rabbit hole makes you your own worst enemy.
According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
John: In the mental health arena:
- We have a shortage of qualified mental health and addiction treatment providers
- There is a shortage of available services, so that access to care is limited.
- People are not screened for treatment; when referred for treatment they do not routinely follow up or adhere to treatment
- Our treatments are not sufficiently effective for many patients
Shree: I want to focus on two. I think most people would agree the US healthcare system is broken. Not enough people are getting the streamlined care they need, and not enough healthcare institutions are prioritizing patients. This is an ugly combination. From my perspective, two big steps that are fundamentally infrastructure-driven:
- Interoperability: Existing clinical research systems — and healthcare systems overall — are not built to work together. Community is so important in our industry so there are endless collaboration challenges but also endless opportunity to improve. We need to develop ecosystems that are designed to support the work we’re all doing — allowing connection where it makes sense and placing barriers where it doesn’t. Modern technology has come a long way and we’re only starting to really embrace that in healthcare so the future is promising.
- Healthcare has been driven more by billing than care: Unfortunately, in the United States, healthcare systems are optimized for greed, not for improved patient care. It’s why people are having to choose between taking care of their health and putting a roof over their family’s heads. It’s why basic access to healthcare continues to be such an important topic. This country should be reexamining its healthcare systems but from the viewpoint of humanity and dignity, not greed.
You are a “healthcare insider.” If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system?
John: We would measure the outcomes of mental health treatment and hold healthcare systems accountable for outcomes. All other needed steps would emerge eventually from this one.
Shree: John and I spoke a little about that above but I agree with John about prioritizing the need to reinvent a healthcare system that prioritizes people and holds healthcare providers/institutions accountable. What it boils down to for me, is the need to have a real, patient-centric approach to healthcare so that it’s less about making money and more about delivering great care. In general, that also means, listening better to the patients, making care more accessible, and giving healthcare providers the time and resources to build stronger relationships with their patients.
What are your favorite books, podcasts, or resources that inspire you to be a better health leader?
John: I listen to audiobooks as I drive to and from work each day. Lately, I have been reading books about leadership, including Good to Great by Jim Collins, Principles by Ray Dalio, and Leadership in Turbulent Times by Joyce Kearns Goodwin.
How can our readers follow you on social media?
John: You can follow us on Twitter. YCCI is @yalediscovers. The Department of Psychiatry is @YalePsych.
Shree: The best place to start is our website: https://forteresearch.com/; or on Twitter (@Forte) and LinkedIn (https://www.linkedin.com/company/forte-research-systems-inc-/)
Forte is the industry-leading provider of software and services in the critical areas of clinical trial management, clinical data management and research administration for cancer centers, academic medical centers and health systems. The company is dedicated to modernizing and standardizing the industry’s approach to clinical research management, execution, and analysis, transforming the way the world studies and treats healthcare.
With a strong belief in community, collaboration and standards-based development, Forte also facilitates the Onsemble Community, a customer-exclusive group for peer networking, best practices, and support. Twice a year at the Onsemble Conference, clinical research professionals meet in person, discuss the latest challenges and solutions in clinical research, and discover ways to collaborate to drive meaningful impact to those living with diseases and conditions in need of cures.
Forte continues to be a beacon of information and intelligence to research professionals across the globe, providing complimentary blog articles, eBooks, webinars and more to support continuous learning on industry topics. Learn more at https://forteresearch.com/ and connect with the team at Twitter, LinkedIn, and our resource center.
About The Yale Center for Clinical Investigation (YCCI): YCCI was launched in 2005 to promote clinical and translational research and to train the next generation of investigators to develop therapies that improve the lives of patients. YCCI was one of the first 12 centers to be funded by the National Institutes of Health Clinical and Translational Science Award (CTSA) as part of an initiative to bring medical research from the laboratory to patients. Thanks to support from the CTSA, Yale School of Medicine, Yale University, and Yale New Haven Hospital, YCCI has developed into an administrative home for the CTSA and a hub for clinical and translational research, vastly changing the clinical and translational research landscape at Yale and across the entire Yale New Haven Health System.