Healthcare professionals today face mounting pressures to deliver care that is efficient and accurate. Emerging technologies such as AI-driven documentation tools and Ambient intelligence are transforming the way clinicians work, reshaping workflows, and reducing administrative burdens. These innovations not only help minimize cognitive load but also create opportunities for more meaningful patient interactions. By thoughtfully integrating technology into care delivery, healthcare teams can strike the right balance between automation and human connection, thus ensuring that progress enhances, rather than replaces.
On today’s episode of In Network's Designing for Health podcast, Nordic Chief Medical Officer Craig Joseph, MD, talks with Anna Schoenbaum, DNP, Vice President and Chief Digital Application Officer at Penn Medicine and Srinath Adusumalli, MD, Vice President and Chief Health Information Officer at Penn Medicine. They discuss the intersection of informatics and care delivery, exploring how informatics and health IT drive quality and safety, and why multidisciplinary collaboration is essential for success. They also discuss the strengths and limitations of utilizing AI tools in healthcare and how these tools can assist in integrating patient data, decision support, and even revenue cycle processes.
Listen here:
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Want to learn more from Dr. Joseph? Order a copy of his book, Designing for Health.
Show Notes:
[00:00] Intros
[01:22] Informatics and technology in care delivery
[02:39] Defining the problem first
[10:04] Strengths and challenges for AI
[13:54] Nursing and AI tools
[18:07] The future of AI in healthcare
[27:07] Anna and Sri’s favorite well-designed things
[34:02] Outros
Transcript:
Dr. Craig Joseph: Anna and Sri. Welcome to the podcast. How are you all today?
Dr. Anna Schoenbaum: Doing great.
Dr. Srinath Adusumalli: I'm great. Craig. Thanks for having us.
Dr. Craig Joseph: Well, it's my pleasure to have you back. At least Sri, you have come back and Anna? First time. Where do we find you? Where are you hanging out today? As we record.
Dr. Anna Schoenbaum: So, I am... Sri and I, I think we're both in the same building, but we are in Philadelphia on the Penn Medicine campus, and that's the University of Pennsylvania Health System.
Dr. Craig Joseph: Why don't you give us, like, a little bit about your background and how you ended up at Penn Med?
Dr. Anna Schoenbaum: I'm the vice president and the digital application officer, the chief digital application officer at Penn Medicine. I've been here for over five and a half years and came along here based on just an upgraded opportunity to be part of a great health system. And, I've been in health care for 30 years, and I started out as a pediatric intensive care nurse. So similar to your background? Whoop, whoop. Yeah. And, just really along the journey of nursing and patient care always gravitated toward digital transformation, and, just really wanting to flip over to doing more for the greater good. And that's how I started in health 83.
Dr. Craig Joseph: Sri, why don’t you give us a quick summary of your background?
Dr. Srinath Adusumalli: My name is Srinath Adusumalli. I'm Penn Medicine’s chief health information officer, cardiologist by training and current practice. I did my medical training all over the East Coast in Virginia, then at Boston, and then landed here at Penn Medicine in 2014, where I started off as a cardiology fellow. And over the years, I ultimately went on to become a faculty member here. Grew an interest due to the phenomenal mentorship here at Penn Medicine in Quality, Safety, and Informatics in the nexus of those three. And, had built a career that sort of centers at the application of informatics and health information technology to clinical care delivery, did that at Penn Medicine for several years, and then went on to work in industry at CVS Health for several years, doing many of the similar activities and have been back at Penn Medicine since January of 2025.
I currently lead a team of health informatics across disciplines. We focus our time and energy on ensuring all types of technologies are developed in collaboration with Anna and other teams to best suit our clinical and business needs for the organization. And I continue to practice across the inpatient and outpatient spectrum. I do imaging as well as some very simple procedures.
Dr. Craig Joseph: Well, we're going to talk about a lot today. We're going to talk about AI and automation. But let's take a 30,000ft view and talk about technology. Both of you are clinicians who are dealing with technology day in and day out. But one of the hardest questions when you're trying to apply technology to a problem is do you need to even do that? And so, Anna, why don't we start with you? How do you decide if, hey, we have a problem? And b, if that problem is amenable to a technological solution versus something else.
Dr. Anna Schoenbaum: Yeah, but you bring up a good point. I agree that you really need to listen to understand the problem, because not all problems have a technological solution. But I think you start by listening. We try to understand what are they? You know, what are we trying to solve? What are the pain points? Is it just sometimes, is it more than that? And if you can take just an hour to look at the problem, I think that is really worthwhile. Because instead of just shooting from the hip of trying to come up with solutions, you're just really thoughtful and understanding. Is it training? Is it practice? Is it workflow, or is it truly a technology that can help with the problem and address the issues at hand?
Dr. Craig Joseph: And Sri, have you ever come across a technological solution that was looking for a problem to solve?
Dr. Srinath Adusumalli: No, I mean I couldn't agree more with and I mean, I think the way that we're trying to work with our clinical and business teams, as a technology organization is to really help them again, focus on the problem, help our colleagues really sort of deeply understand what do we think our qualitative and quantitative senses of the set of problems to be solved, for them to understand and then to help us understand and where I think the role of informatics in particular, is to help translate what the problem space is into potentially technology or, and in many cases, non-technology solution. I think too often we jump straight with the solution in mind. And Craig because I know you talk about a lot as we talk about particularly within the confines across our organization and in places like our Center for Health Care Transformation, Innovation, it's really about a problem and not trying to come with the solution, at least at first in mind.
I think particularly in the AI and the automation space, particularly automation, we don't want to automate bad processes to start with. So even before we jump to the new fancy shiny tech, a lot of the work that I think has to be done is really around deeply understanding the problem and process and are there aspects at a very basic level that can be optimized, reimagined, even, as we like to talk about, a lot around these days? Reimagining the process before we apply any technology to it.
Dr. Craig Joseph: I think I told you this story. Sorry, but for Anna and others, I, for years have been upset when I had the CMO hat on when folks came to me and said, I need this order sad, or I need this doc flow sheet row. And I'm like, hey, what you need to do is actually come to me with a problem and not a solution. Tell me what the problem is. And maybe you do need an order set, but maybe there's other technologies out there that you don't need. And I just couldn't understand how people didn't see the benefit of coming with, with a problem and not a solution until I went to a dietitian, because my cardiologist, who happens not to be you, but, someone else told me that I needed to be on this certain kind of diet.
And, and I met with the dietitian, said, hey, I need to be on this diet. And she said it would be much better if you came to me with a problem instead of a solution. So why do you think you need to be on this diet? And I just was like, oh my, the shoe is on the other foot now. So yes, I get it. Anna, you recently coauthored a JAMA Network Open study that evaluated Ambient scribe tools. And at least in the outpatient area, what did you find? What are some of the key takeaways from that study?
Dr. Anna Schoenbaum: Yeah, we you know, we had, so much new findings from this, launch. And we started early on. We began our small pilot in 2023. And in early adopter of a product. And we just did it with 15 licenses. Just do a little sniff test in primary care and see if the technology had any merit. And we quickly found out that people really enjoyed using it. You know, people started using the word this is a game changer. This has been really helpful in my workflow. So, we decided to expand it to 50 providers. And that's what the study was about. This was 50 providers across two Epic platforms, primarily in the ambulatory primary care space and specialty. And, we studied over 50 providers. Just looked to see you know, how it made a difference. It was the 17th specialty. And I believe our work was one of the first work of Ambient that showed statistically significant improvement in how they use the tools. We did it. AI tools did more than generate notes. What we heard from our providers is reduction, cognitive load, helping clinicians stay focused and be in the moment with their patient.
We also looked at just documentation quality on the reverse. We did say that the documentation may be a little bit longer, but does that mean it has better quality that something else? We're searching time in the EHR with less, and then we're looking at clinician satisfaction and burnout. One of the things that we did find is that the time in the note dropped by 20% after hours, what we call pajama time fell about 30%. And then the same note, same day. No completion improved by 9%. So, providers were closing their note and completing their day.
Dr. Craig Joseph: So, a lot of good things there. Sri, have you heard similar things? Outside of this study from some of your docs
Dr. Srinath Adusumalli: Yeah. I mean, I think that that is, we've heard those themes throughout, not just locally, but I think nationally, the evidence space is sort of this is supporting some of those, those early findings we had talked about in JAMA Network Open, but generally speaking, that folks are able to return or be able to experience, some of the joy that they entered, medicine to experience in terms of connecting with their patients. And I think it's on both ends right? It's on, clinician end, but it's also on the patient end in terms of the experience and the connection and the conversation, and the relationship that can be built by being able to focus your attention through the course of the visit directly back in a patient. I know I'm personally a user of the technologies, and I feel that way I can turn my gaze from the computer screen back directly into the patient's eyes and have a conversation. And I think that's really the potential of, when we think about potential of AI technologies in general my, as our hope and aspiration is that is that we help to continue to sort of imbue our practice with that, that the AI will help us even increase the humanity, and the human element of the care that we deliver.
Dr. Craig Joseph: And of the, for this particular study, you found that the Net Promoter score was neutral, meaning the 50 doctors or 50 providers that were in your study basically gave a score of average, not high, not low. But that doesn't seem to go along with, the kind of the, cosmic energy that we hear about with, Ambient scribing. What do you think was going on there?
Dr. Anna Schoenbaum: You know, this is because we were early adopters of early technology. We got to dip our toes, thankfully, to be able to test the waters. And I think that's probably the biggest disconnect this face is evolving so rapidly from what we implemented. What we did was it wasn't necessarily the first time around. It wasn't necessarily integrated with the effort. So, I think it was a copy and paste, but now it's integrated in Epic and now you can generate orders. Now you can do a lot more things that I think it is evolving so fast that with each release that you get a little bit more of this technology. So, I bet if we circle back that that the Net Promoter Score will go higher.
Dr. Srinath Adusumalli: I think that as many I think now like to say this is the sort of worst this technology will be at this point. And it's another important point not only to speak about here, but also with expectations with regards to all of the users of the technology that we're all sort of working together to help to improve it. It's improving rapidly, whether it's from an integration standpoint, whether it's from an underlying model standpoint, whether it's from the product development on top of the models, the space is moving so quickly. And I think one of the other things that are clinicians get the benefit of with any of these technologies is being able to see that rapid cycle improvement right, as they're using the technology. And that sort of rapid cycle feedback is another sort of newer aspect, perhaps to some of the technologies that folks are using it work.
Dr. Craig Joseph: Yeah, that's actually a point I've never really thought of before. Usually it takes years. Sri, you mentioned you're a user of this technology. Can you describe where it works great and where it's not awesome?
Dr. Srinath Adusumalli: Yeah, that's a great question, Craig. And I think that is generally back to whether to Ambient or other technology is what we're finding is there is tremendously heterogenous uptake, for a whole variety of reasons. I think that's the case with any new technologies. I think that is also the case for these technologies. And, in particular, although the pace of uptake of Ambient is certainly more than, particularly among the provider community, more than, most any other technologies. And I think there are parts of, for example, documentation that that most will agree that these tools are doing quite well in and also are quite burdensome are the pebbles in folks shoes. This is step sitting there, for example, writing a complex history of present illness. The tools do generally quite well. And taking sort of a conversation and then summarizing the story and putting that into a history that might otherwise take quite a long time of pajama time. And trying to write that, I think particularly in spaces like primary care, we see these tools performing very well when we start to get into some of the specialty and subspecialty spaces there, there is room for improvement.
But we're already seeing that improvement as time has gone on. I think that these tools will continue to improve in the specialty spaces, as you go on to other parts of the note, like the assessment and plan, for example, where those become generally more sophisticated and also require some context. I think context is key and being able to incorporate the context of the patient, other context from the record of prior visits, for example, into the note itself and into the creation of the assessment and plan will sort of take that to the next level. But as it stands right now, it's a good starting point. And then we'll continue to improve both for primary care and then and then for specialists. But there is some differences there in, in sort of how the tools perform according to the, to the sections of the notes. And there are use case differences as well. I think there are some visits, for example, that that can be quite highly templated and probably documented in an order of minutes if it's not single digit minutes and so those may actually just be quicker to be done using, for example, templated tools that come along with our electronic health record and may even take longer to go through the process of using the tool. And then there are others that certainly using the Hebbian tool is faster. So, it's not only sort of, heterogeneity at us at a primary care specialist/subspecialists level. It's also even within those spaces and in particular use cases or even visit types that there are differences.
And then we're also finding, I think there are differences among individuals in terms of in terms of the approach to notes and documentation. And I think there are those that are much more particular, and there might be more personalized elements of the note itself. And right now, I think the current state of the technology is again, still room for improvement around personalizing to individual-to-individual preferences. And those who are where those preferences are more important may find a bit less value. From Ambient tools versus those who maybe hold particular aspects of the way the note is, a little bit differently. So, I think one of the next frontiers is along that line along the lines of, personalizing the way the structure and the content of the notes itself.
Dr. Craig Joseph: Well, Anna, you're a nurse executive. Your background again started as a PICU nurse. How do nurses use AI or Ambient scribing differently?
Dr. Anna Schoenbaum: Well, nursing is just starting to dabble with the Ambient, listening tools or Ambient intelligence tools here. You got to try different workflows in different settings. And so here at Penn Medicine, we have done that. We right now have Ambient intelligence technology in the ambulatory space, in the workflow, a nurse trio. So that is, I think, we have one of the first in the country to dabble in that. And the reason was, is that we implemented nurse triage. And at the point it was the same time we were implementing for the provider and we just said, well, why don't we just try it for the nurses. And we gave it out to, I think, just a handful. And they said, well, even though it's clunky because it was kind of our prototype, they said it really makes a difference. And they didn't want to go back. And we lost. Something happened to one of the licenses, and a nurse can't use it one day. And she was just so upset. And so we knew we had something.
And so now, we have it deployed for nurse triage. We have this tool for to 80 nurses, and then we are just about to begin on the inpatient side in the in the next few months here for the next few weeks I should say. So we're very excited, very interested in seeing how nurses can leverage this tool and will learn about the workflows, how we might do the design, the training simulation labs, because it's very different to be able to talk out loud. I think as a pediatric nurse, I always talk to my patient, but not I'm not sure if you do that with adult patients as much. I know when my dad was in the hospital and because I was in the room, they always talk to me and they always talk to my dad. But that's not necessarily a comfort zone, for many of the nurses. So we're going to have to kind of flip the culture of being able to talk to our patients more loudly and just maybe talk to them about their assessment and ask them again, understand what kind of pain they feel on a pain scale and make sure it gets documented. So there's a lot of work by colleagues across the country in this space, and we look forward to learning from them, and also to be able to contribute to this, field of innovation.
Dr. Craig Joseph: I'm fascinated by what differences we're going to find between how nurses and physicians use the tools differently, or nurses who, like you, have doctoral degrees. Which way are you going to go if there really is a difference or maybe there won't be, I don't know. It seems to me like there will be key differences. Even in the same conversation at least for the way the documentation appears or the way that the questions are posed. Am I wrong, Ana? What do you think? Where will we be in four years?
Dr. Anna Schoenbaum: So, I you know, right now because our EHR has low sheets, is developed by Flow Sheet and we have medication records. But I think maybe we might look at flow sheets just for trending eventually. And maybe it's more the narrative, like our providers. And it will generate the note for us. It may be more advisory as well. And I think it's really going to change. And we're just at this past at what three mentioned that this is probably the technology is the worst will the will continue to improve and then we'll be able to adapt it to our workflow as we help develop these solutions with our vendor.
Dr. Srinath Adusumalli: Yeah, I think there are some parallels with regards to sort of shifting the interaction. In even in the provider space. I think in particular for example, many are not used to including myself for not used to verbalizing our physical exam in a way that that that physical exam could get picked up and sort of documented, as is in the know that requires the shift. And it wasn't easy to start with. So it'll be interesting. I think we'll learn a lot. You know, as Anna mentioned from the pilot, I think the other aspect, as one of our clinical leaders sort of astutely pointed out, is that thus far and we've pointed out to our Ambient partners as well, is that thus far, at least up until this point, I know it's is changing as we speak, much of the documentation that we capture through Ambient tools is free form and free text, whereas their use case will be capturing discrete documentation. And that could offer some learning too as we also strive to do the same out of some of the Ambient documentation that comes on the provider side as well, for example, capturing problems in a discrete way.
Dr. Craig Joseph: Do you describe your cardiac exam to the patient when you're using Ambient listening so that tool can pick it up? I hear an S1 and a split S2, and then that's what this means. Is that how you kind of do it?
Dr. Srinath Adusumalli: I can say I can continue to practice that. But I do think that that does help to build for example, when oftentimes this cardiologist will look at individuals’ necks and we're looking for something called the jugular venous pressure. At times it's not the easiest physical exam finding to locate. And we're pairing a bunch of us are staring at someone's neck and they're wondering, why are we looking at their neck so deeply? And so we explain what we're looking for. I think that this form of documentation sort of extends that to the rest of the physical exam, as well, is it sort of the vehicle for us to have more of a discussion around sort of what are we doing during the course of visit and partner on that with the patient? So, I think that's another good sort of outcome. That being said, there are also, I think, are there ways, whether you're someone who wants to do that or adapting or, adapting the note, for example, to keep portions of Ambient documentation and portions of structured documentation within the EHR, those are both options that we've surfaced for clinicians as well.
Dr. Craig Joseph: So, Anna, did you find that there were physicians? I'm kind of looking at internists, specifically who said, hey, I'm kind of lost here because I usually use the time that I'm creating the note to kind of gel all of the findings and all of my thoughts. And sometimes I figure stuff out as I'm writing notes. And if you take away my note writing ability because now I don't need to do it, I'm afraid I might. I might miss the big picture. Did you get any of that feedback during the study or subsequently?
Dr. Anna Schoenbaum: We did get some of the feedback. I mean, many of our providers have perfected their template, right? And they're very quick at it. And they felt that if they went to ambient, they would miss those steps. So, I think it's what workflow works well for, what physician with what setting needs to be factored into. But also at the beginning is they may want to use it just for a portion of their work. Last year we just mention and then maybe use their template for the rest. So, I think eventually you will have some clinical decision support if you want to do it one way versus other. And they'll say you make a peer with some nudges and say you miss these components and or did you want to document these? So, you may have some nudges that may come forward as this technology evolves.
Dr. Craig Joseph: Well, that leads me to my next question, which is where do you think we're going to be either in the near future? So now what else? How else are we leveraging AI in in new ways? And then where are we going to be five years from now?
Dr. Anna Schoenbaum: So I would say regarding foundation, if you use Ambient to provide your technology, whether it's asynchronous or with the patient, but also, with other data factored in, I do believe we are collecting data from our vital sewing machines or hemodynamic or wearables, and then we'll have labs and we have imaging results is what kind of documentation is truly needed. We have asked nurses and other clinicians to document extensively, but we have all this information now. Could we just provide a summarization report. And that's how you, with the addition of the documentation and encounter with the patient or going into the patient and getting some other information. And so, I feel that it will be more proactive type, documentation and suggestions and also the data visualization will differ based on your need.
And maybe it is based on how you ask or how you think or maybe set up on your profile. So I think that's just kind of the beginning. The next couple of years we'll see this. Maybe I see in the future that there's some surveillance and that we are, again, be able to detect patient deterioration way ahead. And maybe that is by the information in the patient record, but also some of the other tools that may be within a smart room, because there may be things too, that may detect us, maybe changes in gait. But I think the road ahead is very promising.
Dr. Srinath Adusumalli: The world is very, very promising. I agree 100% with Anna. I go back, actually, Craig, to the prior question. You know, there are various purposes of documentation and, and one of those purposes particularly depending on the type of visit that you're delivering, is to help us. And the process of documentation is also the process of cognition as we write and as we think that documenting how that helps us sort of reason and think through a patient case. Oftentimes we'll do that. You know, oftentimes that that will be contained within the within the pajama time. There's friction there, but it's almost a positive kind of friction in the same way. You might write a research paper. The process of doing that research is also helping you internalize and sort of think about whatever that research question is.
And so I think that that that doesn't mean that the process of documentation has to stay the way it is in order to achieve, to support our process of thinking about the patient. But we do need to design, to your point, design intentionally. How do we design the structure around Ambient documentation to be able to preserve and enhance our ability to think about and reason around the cases that we interact with? And I think that that'll be to now answered the second part of your question. That'll be part of what I think the next phases of Ambient are. And I think the Ambient, it becomes much more of a platform, an Ambient intelligence platform, and not just about the documentation. And I think we're seeing this already, right, that platform extends. If you look at even the ambulatory setting extends across the arc of the starting all the way up potentially upstream, in terms of pre visit perhaps working with a patient to collect information. That then could be to the next version of privacy questionnaires, information that then could be incorporated within not only the note but into a visit agenda that then could help support the clinician in terms of what to, address within conversations.
So, conversation decision support that then informs the ultimate note that's written. That then is a note that's written to be able to support, sort of all the other downstream processes, particularly in the revenue cycle space, like coding and, and the submission and payment, around claims. So, I think that whole arc or life cycle, the visit maybe and beyond will be supported in some ways by these Ambient intelligent platforms. The next step that we're seeing, and we're actively thinking about in addition to the documentation, is particularly the coding and revenue cycle space and the opportunities that might be there.
Dr. Craig Joseph: You're doing your history and asking and interacting with the patient and then doing an exam. And typically you'll come to some conclusions about, hey, I think this is what's going on. I think this is what we should do next and put some orders in and some referrals in. And that's all well and good. But then afterwards you might go to the, the AI and say, hey, what did you think? And, I could fully imagine the AI saying, well, what if you didn't really address this issue? Or how come you didn't think about this syndrome? If we think that that's not great, at least I don't think that's very helpful after the patient is gone. But I don't know how to incorporate that during the time that we're there without kind of making it look like, we all have a computer overlord that's, looking over us and making suggestions that may or may not be appropriate for the patient.
Dr. Srinath Adusumalli: Well, I think that's where... and I don't know if I have a great, great answer off the bat in terms of what that design should look like. But I think that's where I'm incredibly excited about sort of the work ahead for us in terms of the incorporate the implementation of AI into clinical care. You know, we focused appropriately on, over the years on sort of underlying models that the products themselves. But there's a lot more work to be done on that model of human and computer teaming. You know, you might call it augmented intelligence, you might call it collaborative intelligence. It's that interaction work. And I know there's a lot of there's science here in terms of human factors and, and others behavioral science, for example, might be able to help support. But there's a lot work we have to do in terms of figuring out what is that most productive interaction that we should create. What is the UI? What is the user interface look like? I think those suggestions, ideally these would be forms of conversation, decision support and implicit support. How you tee it up without overwhelming either the patient or the clinician while one is still trying to have, positive interaction. I think it can be done, but it'll require a lot of work and iteration between us and between our partners.
Dr. Craig Joseph: Anna, any thoughts in this difficult question?
Dr. Anna Schoenbaum: Yeah, I think you will see throughout the phases of a patient's journey, you'll see information prior to the patient visit, before you walk into the patient's room, during the patient and then after. So you can imagine using Ambient intelligence technology as you prepare for the visit with the get Up lab. Or maybe the patient reported something through their portal, any kind of care gaps. And don't forget we have genomic data potentially to and social determinants of health. And as during that visit you can pull in that information and that conversation. It will summarize. If you talk about medications it could say whether you need a new prescription to see if there was an allergic reaction in the past. But then also I think you use the connection, if you need more information from third party resources, whether it's internal or external, you could have that connection and get evidence right there while you're seeing the patients.
Tee it up or say, hey, do you want to look at this latest research after the visit? It could also generate an auto referral, referral scheduling. It could be about drug adherence and close contact the patient and then maybe some close the care get low. And then as we mentioned regarding maybe on the inpatient setting is to connect this to the smart rooms or in the ambulatory setting in the practice. Exam rooms. But you're going to see, I think this intelligence, not just in that patient conversation, but it could be during ship rounds and dogs. So, I think there'll be a better, deeper understanding of how this technology works. Wherever the patient is in the journey.
Dr. Craig Joseph: Yeah. Love it. Well, I'm excited. I think the next thing is flying cars. But I'm not going to ask either of you about flying cars today. Well, we'll talk about that maybe the next time, we're running out of time. So, I'm going to ask you one more question. What is something in your life that's so well designed it brings you joy every time you use it? And Anna why don't I... why don't we start with you?
Dr. Anna Schoenbaum: I'm sorry. Can I do two?
Dr. Craig Joseph: Absolutely can do two.
Dr. Anna Schoenbaum: I am somebody that loves to capture moments, meaningful moments. And I will say the photo to the camera on the iPhone. It's so dear to my heart because I take lots of pictures. But then I put them to videos and we had a family reunion this weekend, and I know those events are not going to be forever, and so I'd love to capture those moments.
And then the last one is just earbuds, just so I can run and listen to my music, and it helps me get through. I'm a runner and I just love to have some joy as I run, and I think those are the best technology for me.
Dr. Craig Joseph: All right Sri. You've done this before. You can't repeat.
Dr. Srinath Adusumalli: I didn't think about that. I won't repeat the couple I mentioned last time, although they still are some of my favorite technologies. I actually think one picked up since then is drive an electric car. And as you might if with regards to electric vehicles, they tend to have some of the newer technologies or at least redesigned sort of UI and user sort of experiences within the vehicle. And I think the design of this one in particular does bring me joy every time I use it because, it's the details, the details have been very much thought through to the experience of a steering wheel, to the surfaces, to even the air. And then the technology, of course, the technology experiences, which are also quite personalized or personalized.
But even the technologies I mentioned last time in this one, it's that attention to detail and the little details that are what sparked the sort of joy and delight. And I think that's also what we want to be able to bring. I think just to tie that back to our conversation here is that whether it's the platform itself that we use or these new technologies that we're incorporating either within or around the EHR, that's the kind of joy and delight that we would strive to bring. And I think in doing that, that's where the details that we've talked about here and other as well, will be important, and we'll help to drive that.
Dr. Craig Joseph: Yeah. It's hard to imagine joy when dealing with the electronic health record, but I feel like we're almost there. We are almost there.
Dr. Srinath Adusumalli: We might not have said that five years ago, per se.
Dr. Craig Joseph: Yeah, you could always make it less bad. Like, that's what everything every year was. We're trying to make it less bad. Just because people don't generally associate joy with record keeping. And that's essentially what it is. I look forward to seeing where you all go and the progress that you make. Anna, Sri, thank you so much. This was a great conversation. Thank you. Look forward to reading the flying car paper.
READ THE TRANSCRIPT
Show Notes:
[00:00] Intros
[00:09] Marina’s background and her book: The Vagina Business
[01:29] Gender data gaps
[02:52] The emergence of Femtech
[04:00] Innovation and obstacles in birth care
[05:30] Title controversy and pushback
[13:02] Femtech vs. Scamtech
[14:09] The pink tax in healthcare and global innovations
[27:03] Marina’s favorite well-designed thing
[28:52] Outros
Transcript:
Dr. Craig Joseph: Marina Gerner. Welcome to the podcast. Where do we find you today?
Marina Gerner: Thank you so much for having me. I'm sitting on my chair in London in the UK.
Dr. Craig Joseph: We are talking today because someone connected us about your book. And so, you put out a book recently, The Vagina Business.
Marina Gerner: That's right. And the subtitle is The Innovative Breakthroughs that Could Change Everything in Women's Health.
Dr. Craig Joseph: So, give us the backstory. Why don't you kind of give us a little introduction as to how you got to where you are and how you got to write a book that's called The Vagina Business.
Marina Gerner: My background is that I'm a journalist, and I also have a side hustle as an adjunct professor at the NYU Stern School of Business, and I've always been interested in the stories of women, whether that's in, you know, technology or health or business. So that's been my focus for a while. And then a few years ago, I learned that if you ask most people to imagine a person who's having a heart attack, most people tend to picture an old white man and the symptoms they think of is pressure on the chest and then pain radiating down the left-hand side.
And I learned that those symptoms are typical for men, but they're not typical for women. And I thought that was so shocking. You know, and as a result of that, women are 50% more likely to be misdiagnosed after having a heart attack. We also wait longer to seek help. Our symptoms are considered atypical. They're more likely to include things like jaw pain and long-term fatigue, for instance.
And women also experience that pain and the pressure on the chest but were more likely to describe it as discomfort. And so, I learned there was this issue. And I also met the founder of a company called Bloomer Tech, and the founder is called Alicia Chong Rodriguez. And what her company has created is what I thought is the coolest thing. It's a smart bra that can help women who are at risk monitor their heart health. And I thought, this is wonderful. You know, not only is there this huge problem, but there are also people who are creating new things that might be part of the solution, and that might help us fill that particular gender data gap. And I approached her about an interview.
I messaged all of my editors about this story of the smart bras, and then I kept looking at my inbox and there was just tumbleweed. Nobody was interested. And there it was this. Yeah, it was really surprising because I've written for lots of different places. You know, I've been a journalist for 15 years, and there was the sense that the topic was a bit niche. That made me wonder, how can something that could potentially help over 50% of the population, how can that be considered niche? And then I held on to this story. Even though I didn't manage to place it. The story stayed with me, which doesn't happen with many other stories in journalism, you know. But this story stayed with me. And then the pandemic happened. And I think that changed a few things, because power dynamics shifted between the doctor's office and the patient's home, because we trusted people to test themselves for Covid. And, initially, when you think back to the start of Covid, men had worse symptoms than women. So, if you wanted to be cynical, you could say we started to pay attention to sex differences in health because men were more affected by Covid.
And that's when I finally managed to place the story. But the smart bras came out in the Guardian. It did really well, and I was invited as a result of that, to chair a panel at one of the first ever conferences focused on Femtech, which is female technology. So that's technology focused on female bodies. And I was completely blown away by this conference. I was drawn into this space. I was in my early 30s at the time. I'm in my mid-30s now and I have a child now, but at the time I knew that I wanted to have children soon. So, I was preparing for this, and I knew that the vast majority of first-time mothers experienced birth injuries, unfortunately.
So, I wanted to prevent that. And I was looking for solutions. And I found a company in California called Maternal Medical that's creating a preventative device for birth injuries. And I thought that was so fascinating. I spoke to the CEO, Tracy McNeil, and she told me that the last big innovation in the standard of care at birth, mostly epidural, which was popularized in the 1950s, and that was that just blew my mind because I was thinking, there's no other area of society or technology where we bring something out from the 1950s and we say to people, hey, look, this is the best we got. Look at this cutting-edge floppy disk over here. But in birth, that's exactly what we do. And I thought that was shocking. And the more I looked into the space of what I describe as vagina-centric innovation, the more I realized that one of the biggest or perhaps the biggest obstacle is that most investors are male, and they don't want to invest in these companies because there's so much stigma around these topics.
And I have a quote from one investor who says in the book, “I don't want to talk about vaginas at my Monday morning partner meeting.” And that's the kind of attitude that stands in the way of innovation focused on female bodies. And that just made me so angry. Yeah, I wrote an article called “We Need to Talk about Investors Problem with Vaginas”, and that went viral, came out in Wired magazine. And then I took this as my what they call a proof of concept in the business world, to then write a book and look at this movement and, you know, tell the story of the Femtech movement.
Dr. Craig Joseph: So, I love everything about that. What I wonder about is what is the right response to that. That partner who said, I don't want to talk about vaginas at my Monday morning partners meeting, right? It would seem to me in hindsight, the best response is, you know, would you like to talk about money?
Marina Gerner: Yes. Would you like to talk about the unmet need? Would you like to talk about the total addressable market? Would you like to talk about why these matters? And you know, if you don't want to talk about vaginas, maybe all the others also don't want to talk about vaginas. So, wouldn't you have an advantage if you were the odd one out?
Dr. Craig Joseph: Yeah, that makes sense. Is that message being received now because of some of these conversations, because of some of the female founders that you're referencing?
Marina Gerner: I sure hope so. I mean, my goal with the book is to change that conversation and to normalize that conversation, and that's why it was so important for me to have the word vagina on the cover, because I could have called this book lots of other things. And I actually, you know, faced lots of obstacles with that particular title, and I had to come up with 16 alternative titles at one point. All of those titles were tested on a target audience in A/B testing by my publisher. And then The Vagina Business won. So ultimately, this title won in the market research. But there's been a lot of resistance to it. But the point of the book is to destigmatize the conversation. So, I figured if I put the word vagina right next to the word business, you know, and the book can sometimes be found in the business section, sometimes it's in the social sciences section. It depends on the bookstore, but it stands out wherever it is.
Dr. Craig Joseph: I love it. And did you get pushbacks from someone other than the publisher?
Marina Gerner: Oh, yes. Yeah. So, the publisher also had feedback from independent bookstores who said that they wouldn't display it, and they wouldn't promote it. I had pushbacks from when I was reaching out to other authors to write endorsements for the book. One author said to me the title is too much for her, so she wouldn't write me a blurb. I had a venue turn me down when I wanted to have a book launch there, just purely based on the title. Some people who've written reviews for the book on Amazon have used the word vagina in the review, and then that was flagged as violating community guidelines. So, they've sent me screenshots of their reviews being censored. And I think there's a lot of censorship that happens behind the scenes where people wouldn't necessarily tell me, you know, nah, I think your book titles are too much for us, but they simply don't reply.
Dr. Craig Joseph: Wow. I'm just honestly shocked.
Marina Gerner: Yeah. No, this book was published a few months ago and it continues to be an obstacle. So, the book has already won two awards, which is amazing. And one of them was supposed to be announced in Dubai. So that didn't happen because they couldn't have mentioned the title on the stage of this big conference. And you know, that continues to be back. It keeps happening and it is shocking, but it's not too surprising because all of the founders I've interviewed in this space, whether that's menopause-related, UTI-focused, sex education, all these companies and nonprofits experienced censorship online. All of them.
Dr. Craig Joseph: Wow. I'm at a loss for words, and that's not typical for me. So.
Marina Gerner: I can believe that. Yeah.
Dr. Craig Joseph: It's just I get it in certain areas of the world maybe or but boy, widespread.
Marina Gerner: Yeah. Including things like lactation cookies, you know really things where you just wouldn't expect it.
Dr. Craig Joseph: You said that you were a professor at Stern as well. How did that come about?
Marina Gerner: So, I have these, some people call it what, my multi-hyphenate or, you know, portfolio career. I have these two tracks in my career. I've been a journalist from the age of 19, I think that is when I published my first article in a vague newspaper, and I also did a PhD in my early 20s. And so, I just continued doing those two things at the same time. I left academia for about five years to be in journalism full time as a staff writer. I returned to academia with this. It's an adjunct professor role, so it's part time. Yeah. It's wonderful. I teach a course called Commerce and Culture, which is very unusual because it combines, you know, business and society, business and culture.
And it's also what I'm doing with the book because I think women's health innovation is the perfect case study for that, because if you only looked at it from a business perspective, you'd think, hang on. This is our $1 trillion market opportunity, you know? Yeah. And you wouldn't understand the stigma and the cultural side of things if you only looked at it from the cultural side of things. You wouldn't understand the financial underpinning of everything. So, I think with a topic like that, my very idiosyncratic choice of subjects has come together in a way that's really helpful.
Dr. Craig Joseph: Some of the female founders that you talked about in the Femtech area, they all seem to be female.
Marina Gerner: Not all of them aren't.
Dr. Craig Joseph: Yeah. I was going to say, tell me about that.
Marina Gerner: About 80% are estimated to be female. But then there's a, you know, a fair amount of both founders and researchers and investors who are men. And I've included plenty of them in the book as well, because I think everybody needs to be on board with this subject. And it's an opportunity for everyone, really. Where it gets a bit complicated is when you look at the data on how much money different teams raise and unfortunately, most money, even in the Femtech space, is raised by all male teams. And that's where it becomes a structural issue because there's a company over here called Flo Health, which is a period tracker, and they've become the first European Femtech unicorn. And they were founded by a group of men. And so, when they became a unicorn, people were asking, you know, is it what do you make of it?
Is it a problem that it was set up by guys or is it a victory for all of us because they've raised all this money and they've achieved this unicorn status? And it's complicated in and of itself as a case study or as a one-off example. It is a good thing for the Femtech industry to have such an example, such an example of success. But if you look at the structural side of things and you realize, well, if it was led by a group of women, they wouldn't have raised that money. And so that's where it becomes difficult.
Dr. Craig Joseph: Tell me about that. We like to talk about design. The stat part of the part of the podcast designing and healthcare. And so Femtech design, are there any kind of overarching concepts that people just generally get wrong when designing for Femtech from? Not just the product itself necessarily, but maybe the, the, the conceptualizing of it and marketing of it and financing of it. Are there design flaws that you've seen that are common?
Marina Gerner: Yes. Let me just pull up a certain chapter in my book. What I do is I distinguish between Femtech and scam tech, and so Femtech is technology focused on female bodies, everything from periods to menopause, but also going beyond like cardiovascular health and bone health. And then you have scam tech, which is technology that monetizes insecurities and that, you know, mis-sells things. And so that's where we get to the insidious side of things. So, for instance, vagina steaming devices, you know, are harmful devices and those still exist. They're not banned. But we know that they can lead to all sorts of damage. There's also a range of intimate wash products that are potentially quite harmful. And then I've also found that there is a new version of the pink tax in health care.
So, you know, when we think of the pink tax, traditionally we would think of razors. And so pink razors that are marketed to women are more expensive than blue razors that are sold to men. And in healthcare we have generic drugs like ibuprofen being repackaged, put into pink packaging, and they're being called feminine acts or Midol. And those are then sold at a premium or period pain relief. So those are three categories. Kind of the actively damaging, the useless, potentially damaging and a new version, of the pink tax. And so, the questions I recommend asking are, does this product monetize shame in any way? So, does it imply that your body is dirty? Does it sell?
But is it painful? You know that that old idea? Does it provide a full sense of safety? Is it under regulate it for what it is? What data does it collect? You know, what claims does it make? What's the evidence and what emotions does it trigger? Because in the fertility space we sort of messaging that sounds, like you're running out of eggs, you know, quick, quick, quick. You're running out of eggs. You're almost 35. Your fertility is about to fall off a cliff. And so, whenever you have something that triggers your emotions so strongly, it's kind of worth pausing and asking, you know, what? Am I being sold here?
Dr. Craig Joseph: I'd say I've never heard of the pink tax, but it totally resonates.
Marina Gerner: Yeah, it applies. So, I usually use the example of razors. But you could also look at haircuts. You know, haircuts for women are so much more expensive or rain jacket all sorts of things. Once you start looking into them, you'll see the pink tax in them.
Dr. Craig Joseph: That is fascinating. How do you draw attention? You know, you've said some of the media of which you are somewhat a part of the media is not helping, right? Sometimes even in trying to advertise your or market your book.
Marina Gerner: Yeah, absolutely.
Dr. Craig Joseph: How do we get the folks in the media to be more comfortable, or is it just part of the overall culture of the area that they live in?
Marina Gerner: I think it's about shifting the conversation, and not just by making people more comfortable with certain terms, but also by just using certain terms, without using euphemisms, for example, because, you know, if people don't want to use vagina at a doctor's office and there are some surveys that show that I don't remember the exact percentage, but a really large percentage of young women don't want to use the word vagina at the doctor's office, and that has really terrible consequences further down the line.
How do we get people to use those words, and how do we get people to use words like perimenopause or endometriosis? And I think because if you don't know that something might happen to you or your friends or your family members, how are you supposed to address it? And there are still lots of people who think, okay, menopause is when your period stops one day and they're not really aware of perimenopause and the various symptoms, the 34 odd symptoms that can come with that. And the same goes for endometriosis. 10% of women are estimated to have endometriosis, but historically we've normalized female pain. Right? So, women were always told, oh, you've got period pain. Extreme period pain. Well, that's normal. And in reality, there could be an underlying issue there like endometriosis.
Dr. Craig Joseph: You're going back to your first example of heart attacks with women too. This has real world implications as you know, even if the signs of a certain disease are slightly different, it's on the healthcare side of being able to think about some of these things. And yeah, you're right. The average female having a heart attack doesn't have the same symptoms as the average man. And yet we only assume all heart, we kind of, most of us assume all heart attacks are, you know, chest pain feels like an elephant standing on my chest, that sort of thing. And that shows in the morbidity and mortality results of cardiac problems in women. Let me pivot a little to the concept of Femtech that term.
Some folks have a problem with that in saying that. Well, why does it? Why is it Femtech? Isn't it just tech?
Marina Gerner: Yeah.
Dr. Craig Joseph: Femtech, why does it need its own category?
Marina Gerner: I have lots of thoughts on this. I think the first funny thing is with term Femtech is whenever you use it, people hear fintech, financial technology. So, you know, oftentimes people think you talk about online banking when obviously that's not what we're talking about here. The term was coined by Ida Tin, the founder of CLU, in 2016, to bring together all these different kinds of companies that are innovating in women's health.
And so, what's special about it is that 80% of founders are female, and it's estimated to be a $1 trillion market opportunity. Obviously, I hope that Femtech will only be called tech one day, just like health tech, but will simply be health, right? Because tech will be a normal component of health care. And I think with Femtech, some people prefer to use the term women's health innovation. But I think the success of the movement does not really depend on what term we use exactly. And I think the term might evolve in the future as well. But right now, it's really helpful because people find each other by using that term as a hashtag on LinkedIn, on Instagram, there are conferences that are organized that are specifically called Femtech conferences, Femtech webinars, Femtech accelerators.
So, it's a term that has energized people and that has brought people together. And I think for that, it's really helpful. And a parallel example is, you know, feminism, you could say, well, isn't it simply equality or human rights? But we still have feminism for a certain reason, and hopefully we won't need feminism one day. And the same way I would say, hopefully we won't need the term Femtech one day it will all be tech because tech will serve us all equally.
Dr. Craig Joseph: So, are there any good examples or particularly interesting founders or companies that you've encountered in the writing of the book that you think deserve highlighting?
Marina Gerner: Absolutely. I could give you so many examples. It really depends on what part of women's health you're interested in. But there's for instance, in Copenhagen, there's a new form of contraception that's being developed called V, and it looks like a laundry capsule. It's transparent. And so, it's something you dissolve in the vagina, and it works together with the cervical mucus to keep sperm out. So, it's a non-hormonal form of contraception. And I think in the future we will have more non-hormonal choices. There's also contour line, which is a long-term contraceptive for men. It's a reversible vasectomy that uses hydrogel and that's being developed at the moment. So, I think there's a lot that will happen in the non-hormonal contraceptive space. Then there's also a device that's just come to the market in Ireland, which is a smart nipple shield.
So, you know, nipple shields are usually used when you're breastfeeding to either help with a latch of the baby or to protect the nipple. And historically, they've been made out of lots of different materials, like glass and pewter and plants even. I think this one is different because it has a sensor in it that can measure the amount of milk a baby is getting. And that could potentially be really helpful if you have babies with a low birth weight or, you know, if you have mothers who would like to breastfeed, but they're too worried about how much milk the baby's getting, you can also then use that information for research purposes. And that's the case with a lot of Femtech companies, is that they collect so much data we've never had before, that if you partner with researchers, you can get some incredible insights into how somebody's milk supply correlates with other aspects of their health.
Dr. Craig Joseph: That's amazing. As a pediatrician, all we could do was measure the number of minutes the baby was nursing and then the output. Right. We you could never really know what the baby was getting. So that would be incredibly helpful, especially for kids who are somewhat sick. And we really need to know about their fluid intake.
Marina Gerner: So that one's called the Coro. That device. Yeah.
Dr. Craig Joseph: That's awesome. So those are just a few of the kind of examples that are.
Marina Gerner: Yeah, I've interviewed over 100 people in the book. So, you'll find many, many, many more examples there. And I've interviewed people across 15 different countries because I wanted to show people the range of innovation there is.
Dr. Craig Joseph: If you could wave a magic wand and change just one thing about women's health care, how it's designed, how it's delivered, what would that be?
Marina Gerner: Oh, yes. I think there's something really universal, which is the normalization of female pain. I think if we reverse that, that would be a huge and revolutionary thing to do, because right now we still say to women, you know, extreme period pain, oh, that's normal pain with breastfeeding. That's normal. Oh, you're giving birth. Well, there's no birth without pain. IUD insertion. Well, you can't possibly expect pain relief, although that's slowly changing. But I think if we completely reverse that attitude across the world, that would be revolutionary.
Dr. Craig Joseph: Is there any specific advice that you'd give to aspiring entrepreneurs who are looking to break into Femtech? What can they learn? Besides reading the book for sure, what can they learn, to either avoid or make sure that they do?
Marina Gerner: Well, of course I was also going to say, read the book. All of my wisdom, all my treasures, contained in the book. And, you know, I'm giving them to the world. I think it's really important to if you're not a researcher, if you're not a medical professional, to assemble a team that you know, includes medical professionals, that includes researchers, and to make sure that whatever you're doing is evidence based. I think we see a lot of snake oil. Unfortunately, there are a lot of things that are not evidence based, especially in the area of supplements or apps or, you know, things that aren't regulated to a high standard. Always make sure that what you're doing addresses an actual problem, because I see companies that are addressing issues that aren't actually issues as well.
So, I've seen apps that will analyze your menstrual cycle and tell you if you're supposed to have a meeting or if you're particularly creative on that day. And that's just reductive. And it's just unhelpful. It's not constructive. So, make sure that you're addressing an actual problem that you find a, you know, solid unmet need. Make sure that there's a business model for your venture, that it can exist in a commercial frame, because not everything can exist in a commercial frame, even if it's a good idea, even if it addresses an unmet need. Put together a good team and think about how it will get funded. And you know, venture capital is not right for every company. And in fact, I think we need many, many other sources of funding in women's health.
Dr. Craig Joseph: Excellent. Well, we always like to end with the same question and the of all of the folks that we interview. And the question is this, is there something in your life that is so well designed that it brings you joy whenever you interact with it?
Marina Gerner: I would say my hands free and smart breast pump. So, I have a baby. I'm breastfeeding, and I also launched a book at the end of last year. So, I've had speaking engagements all over the world, and I always travel for the shortest possible amount of time. You know, a day and a half, maybe two days and one night. And I'm traveling with this breast pump that is quite small that I've used on the plane that you simply pop into your bra, and it doesn't have any wires that are, you know, attached to anything. It's relatively quiet. It's convenient. And on these trips, I always find myself thinking, wow, I'm so dependent on this device because, you know, without it I would risk having a clogged milk duct.
I could risk having mastitis, I could risk my milk supply going down and so on. But with this device, I've got the freedom to be away for a day or so. I used a breast pump on the plane, and I asked the flight attendant on the way back from San Francisco, I said to them, have you ever seen anyone else using a breast pump on the plane? And they said to me, oh yeah, actually, there was a woman there on Friday who used a breast pump. And I said, yep, that was me, because I was flying on the same schedule as the flight attendants. So, it's still quite rare, I guess. And there are certain suggestions I have on how they could improve that design. But I think compared to all the breast pumps, it's a much more convenient tool right now.
Dr. Craig Joseph: That's amazing. Doctor Marina Gerner, thank you so much for educating us about Femtech. And I would encourage everyone to check out your book, The Vagina Business, and to prominently display it in their front window.
Marina Gerner: Yes, that would be great. And please post about it on LinkedIn or on Instagram and feel free to tag me and I will reshare your posts.
Dr. Craig Joseph: Excellent. Well thank you again. I really appreciated the conversation.
Marina Gerner: Thank you so much for having me. It was great talking to you.