EntrepreneurRx_Matt Lashey: Audio automatically transcribed by Sonix

EntrepreneurRx_Matt Lashey: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

John Shufeldt:
Hello everybody, and welcome to another edition of Entrepreneur Rx, where we help healthcare professionals own their future.

John Shufeldt:
Hey everybody! And welcome to another episode of Entrepreneur Rx. I'm really excited to have Matt Lashey on the show. I've known Matt for a while now, because we've invested in his company called TTI. Matt, welcome.

Matt Lashey:
Good morning, thanks for having me today, John.

John Shufeldt:
Happy day after Thanksgiving.

Matt Lashey:
Yes, you as well, about 10 pounds heavier and hoping to shave that off before Christmas the next go-round.

John Shufeldt:
There you go. I totally, totally identify with this. So you give a little bit of background on yourself first and then we'll dive into TTI. How did you end up here?

Matt Lashey:
Yeah, so the experience of starting the company actually came out of a personal experience that I'll kind of get into later, but I started my career, graduated from Columbia Business School MBA, the first part of my career was focused on market research and data analysis, and so I was working primarily actually, for an innovation firm for financial institutions. And so I was working the 70 to 80-hour workweeks of a consultant. And my partner, while I was doing that, was diagnosed with non-Hodgkin's lymphoma. And companies had been paying me big money to identify opportunities and reduce risk using data, and so when my partner was diagnosed, I wanted to do as much as I could to help him. First thing I did was to go online and fly, as everyone does, and do the Googling, and with an MBA from Columbia University just sort of felt more debilitated the more I Googled. And I can really, you know, as I started this company and talked to several others who have been in my situation and my partner's situation, it's a common feeling. There's so much contradictory information, almost too much information, TMI, and you don't know what applies to you. And so that really, that experience was what led me to want to create something that would help patients, but then also empower caregivers to play an active role in a patient's care, and that really was sort of the impetus for everything that we're experiencing today.

John Shufeldt:
Yeah, it's funny, I get, I started that business ... decade, more than a decade ago. And my tagline initially was, you know, for people who don't have friends that are doctors, because if you're not in the healthcare space, no matter how really no matter how smart or connected you are, if you're not in the space or you don't have somebody that you're close to, that is, it is nearly impossible to navigate. And I mean, I know the back story, you guys, and you guys are both incredibly well connected. And despite that, it's got to be mind-numbing, and I've had a couple of medical things done, and I mean, even for me in the who's been in this three decades, you're like half time, you're like, what the hell? This has to be easier, and it isn't. So I applaud you for seeing the problem and going right to solution mode.

Matt Lashey:
Yeah, and you know what's interesting to, even those who are connected, when you're inexperienced like that, you're, you put your head down and you want to get through it and you're motivated and you don't want to be in a position, you don't want to feel dependent on others. So we were even reluctant to reach out to those connections and ask for help because we didn't want to be an imposition on those we love.

John Shufeldt:
Yeah, or taking advantage you know, take advantage of all the connections you have. So give a little background what is, what is TTI?

Matt Lashey:
Yeah, TTI started with an app, and just kind of going back to the story a little bit, when Rick was going through cancer, our doctor had advised us to keep a digital record of, to keep a record of what he was experiencing, a diary. And because I was a data guy, I wanted to do this in a way that we could, that I could analyze the data and maybe identify some of those opportunities or potential risks as we were going through it and make it useful for us. Because what happens a lot of times is when people keep records like this, it goes into a book and you might leave through it, but it's not, it doesn't add any value in the long run, and maybe you might refer to it when you're in a doctor's meeting or not, but I wanted to do this in a way that maybe we could actually leverage what we were doing in a useful way. And so, I can get into a little bit of the story of how that was valuable for us, because it really early on I identified that some of the symptoms that Rick was experiencing were tied specifically to some of the medications that he was taking, and with the help of our doctor, identified those connections. I identified that there was a relationship there and the first aha for us in that experience was that there are options. We didn't realize that there were 30 different, 30 plus different antiemetics that a patient could take. The one that Rick happened to be taking was causing him significant issues, and so when our doctor prescribed an alternative for him, that alleviated his major issue and we were able to sort of move on and through the treatment process, much better. But also as a caregiver, I was able to help him and motivate him with this data so that I could show him that he actually did feel better on the days that he was more active when he was going through treatment because he was tracking his water, he drank more water. So that system was so helpful for us, and mind you, when Rick was first diagnosed, I didn't only just do the Googling, I also went to the App Store and downloaded every app that mentioned cancer or non-Hodgkin's lymphoma or a chemotherapy. I paid for the ones that weren't free and nothing was really helpful. A lot of promises and none nothing was really delivering on the promises that they were reporting in this app store. So once Rick and I got through treatment and by the way, he's cancer-free today, so all is good on that front, but once we got through that, I had been advised that, hey, you know, you should, our doctor encouraged us, you should create an app, you should actually do this and create this for other patients that are going through your situation. And at the time people told me, Oh yeah, you can outsource the development, it'll cost about $60,000 and take about six months. Well, it cost a lot more money than that, and it took a lot more than six months. And it's like when I sort of look back, I wonder if I even would have endeavored to actually do this if I would have known how much work and effort would have taken. So I'm glad that I was given that information in the beginning, but about a year later and a lot more money later, we created what was chemoWave, which was an app for cancer patients. And this app, for the same way that I was tracking Rick's activities and experiences he was going through treatment, this app made it easy for patients to track what they were experiencing, and then our platform analyzed that data and identified for the patient if and when the things that they were doing were connected to their symptoms and experiences. That was the, that launched chemoWave. The app launched in 2017 and the same week that we launched, there was a study out of Memorial Sloan Kettering conducted by Dr. Ethan Bash that was a seven-year clinical trial that showed that when patients were engaged in this way, when they were playing an active role by keeping a digital record of what they were experiencing, and if their care providers had insight into what they were experiencing, that it improved their quality of life by 30% and extended their life by 21%. It reduced emergency room visits by 7%, and then all of the healthcare costs associated with those emergency room visits, with most of your listeners are in the medical profession, so they know that an emergency room visit is for a cancer patient is not just a quick 30-minute visit, but that it often results in a hospitalization and duplicative tests and just a lot of associated costs. So when that study was released, I thought there's a business here. So up to that point it was really more of a personal mission. I wanted to create something that could help patients in the same other patients in the same way that I was able to help Rick with my manual process, but with a significant reduction in healthcare costs, I realized, you know, there's a business here. So that was when we decided to create TTI, Treatment, Technologies & Insights, and it's been a snowball from there. You know, I didn't even know what patient-reported outcomes were before I started this company. I learned that term with the release of the Ethan Bash's study. So, you know, it's, you know, and then through that, as we then created a portal that provided insight for physicians to receive reports and the data on their patients, we've now also been working with specialty pharmacy to help patients and provide patients with educational content and reminders that would improve their adherence and identify when and if patients are likely to discontinue their treatment. So it's really been a snowball from there, and we're following the data essentially, which is what we've always been doing, but hopefully, that answers your question.

John Shufeldt:
Yeah, it does, that's a great answer, actually. So how have you gotten past the, you know, I have, but again, people call me all the time, Hey, John, I'm going through this and I just did this, and now I'm 100% worse, I'm 100% better. And I always have in the back of my mind say correlation does not mean causation. How do you, how have you gotten over that intellectual hump? Because a lot of patients and myself included, I'm sure if I was in their frame of mind, say, well, gosh, it worked. You know, I did this, now I'm 100% worse, but you don't really know if one is related to the other. You just again, it's just correlation.

Matt Lashey:
Yeah, so it is correlation. And we definitely are, we're very cognizant of the fact that we, the causation is, we have to, we're treading a fine line there. Our system identifies that there is a relationship and it's never even just one thing. So, you know, and when you think about Wave Health, which chemoWave then became Wave Health because there were hundreds of patients that weren't going through chemotherapy that were using chemoWave, and so we decided to expand the focus of our platform, so it wasn't just for chemotherapy. But, going back, so identifying if and how things are related then creates an opportunity for patients to ask their physicians about it. And in cancer treatment, when you go in to meet with your doctor, you have about 12 minutes every three weeks, every four weeks, sometimes the time timeframe is even longer, so that is a very important 12 to 15 minutes. When we're providing reports to our partners, that physician comes in basically with the discussion guide so the patient doesn't even have to bring it up themselves, but if the patient knows that the physician is seeing what they're tracking and they're seeing sort of our variables where we're saying, hey, there's a relationship here between Zofran and your constipation, that you are 30% more likely to experience constipation on the days you take Zofran. We highlight those relationships without making any recommendations. We're just sort of prioritizing to the top changes in a person's condition, if are they feeling better or worse, what symptoms are they experiencing, and what impact or what changes they're having on their mood. And then it's up to our partners, the doctors, to identify if and how they should discuss this with their patients. So basically sort of provides them with a discussion guide and they can go in, not starting with an exploratory conversation, but with a list of here's the relationships that Wave Health has identified, I'm going to ask them about point A, point C, and point D, and then we can spend the last 5 minutes of our time together talking about politics, God forbid, or something like that.

John Shufeldt:
God knows it all, we don't want to do that. Okay, so, once you collect enough data, it seems like you could have it algorithmic-based or have it AI-based with machine learning like, you know, 30% of patients with, who take Zofran for this chemotherapeutic agent get constipated. So now it's likely that there is a causative relationship. So yeah, on the physician's hands, I guess, is where I'm headed.

Matt Lashey:
That's something that we're very sensitive to. Number one is we, data is important and can be very useful, but it is data analysis, market research, it's an art and a science. So you have to kind of come to it with expertise and knowing how to look at it. So that's number one. And we never would ... to replace the doctor's role in those types of decisions or any sort of recommendations that we've made based on the data. It's a, data is meant to be a guide, not the answer. So that's number one. Number two, and it's something that we've really started diving in is we've now generated a large enough user base where we can look at groups of people versus just the patient in their own data. And the more patients with similar diagnostic and demographic profiles that we can start to analyze the commonalities of those experiences. And then just the Zofran example, we know that for a certain percent of the population, Zofran and doctors know this, it's not new, is that a certain percent of the population doesn't respond positively to zofran and experienced side effects. And what we're now doing with global insights when we analyze a patient population is we're identifying what characteristics would help to determine ahead of time if that patient has a predisposition to having those negative side effects. And because there are 30-plus options, I don't know what the number of options are today. If there's a risk, you can start with something that is less likely. There's no absolute but less likely to cause those side effects and maybe prevent the patient from experiencing that issue altogether.

John Shufeldt:
Yeah, prospectively do it. How many patients would you say have pharmacogenetic testing prior to them getting anything done? In other words, they get their diagnosis, then they go get pharmacogenetic testing to say, okay, because I've done it, so here's all the medications you can take, here's all the medications you can't take and add that data, add that level of data into it as well. Could you offer that?

Matt Lashey:
So I don't know how many patients do that, but I'm a huge proponent of pharmacogenomic testing. One of the things that Rick and I have done as a part of this, this process, he did not have pharmaco genomic testing done before he started treatment, but as a part of, as an exercise to sort of say, hey, what would have this, what would this have identified for him prior to his treatment? And we could afford it. So sometimes rarely does insurance cover this, but in the case of, in Rick's case, so it was, I didn't share, I don't think the experience that Rick has, but it was Zofran and it was constipation for him. And he I mean, it was a debilitating issue for him for several weeks before we then brought that to the doctor. And when the mindset of the patient is okay, when you're going through chemo, I just have to put my head down and get through treatment, a lot of patients don't understand that they have those types of options. And if Rick would have taken that pharmaco genomic test, it did indeed identify Zofran as a medication that he should avoid or that he had a propensity to have negative side effects for. It doesn't say it's an absolute, but if he would have taken that pharmacogenomic test, you know, you're going through chemotherapy, it's hard enough as it is, but then layer on top of that significant constipation, which he was taking Zofran to prevent his nausea, but his constipation was so bad that it was making him nauseous. So it was sort of this vicious cycle and he could have avoided that issue altogether if he would have taken that pharmacogenomic test. And sort of one thing that also just highlights an issue with us that I've learned as I've gone through this whole process is that oftentimes those types of tools pharmacogenetic testing, in our platform, patients oftentimes don't bring up the issues that they're experiencing with with their physician. So these are opportunities for to provide insight into what the patient is experiencing that may not come up in those crucial visits where there's so much to cover in such a short amount of time. Number one, that might be the reason that it doesn't come up. Two, patients oftentimes will only share what they're experiencing in that moment and not what they've experienced over the long time frame. And we've even seen patients that they want it's this, I don't want to bother my physician with this information. I know chemotherapy is going to be tough. Constipation is probably just one of those issues that I should be experiencing. So they don't bring it up or they even sort of downplay it. So these types of tools really help provide insight into sometimes the doctor-patient communication that wouldn't come up without them.

John Shufeldt:
Oh, you are totally right. I mean, I think patients like ..., all they want to hear is, are my counts better, is the cancer going away? Yes. Everything else is immaterial. And it just well, you know, I'm on chemo, so of course, I'm going to feel X, Y, Z. But you're right, maybe some of the, maybe the X and Y can be taken out, and yeah, you're stuck with the Z. Sorry, but the X and Y we can do something about. So you're dead on, and you're right as well, it's a 10 to 12-minute encounter. And look, I'm going to talk about the constipation, because if I do, I'm not going to get to the meat of the issue, which is, is this getting, am I getting better? Is this, so, yeah, that's a great insight. So right now, the system sends messages to the physician prospectively and say, hey, your patients, you know, basically here's our analysis of your patients', patient-reported symptoms and side effects.

Matt Lashey:
Yeah, so we have, our platform is available to the general public for free, so patients can download our platform, our app and use it and then pay for to receive the reports that we provide to our partners. If we're in a partnership with a hospital or with a specialty pharmacy, or in the context of a research project, those reports or that type of information is subsidized on behalf of the patient, but we, for patients that are using it for the general public, we do charge a nominal fee for them to receive the reports and they can print those reports out and bring them into their visits with physicians. But if we are in partnership with a hospital or with a specialty pharmacy, those reports and that data gets processed and synthesized for easy analysis and interpretation, because we know that doctors, pharmacists are all too busy to have to, do the analysis on their own. So we organize the data and process it so that it's sort of easy, like here's what we've identified. And in the same way that a pharmacogenomic test would sort of prioritize things based on efficacy or potential issues would rise to the top, we do that with anything that the patient is doing or recording through the platform.

John Shufeldt:
What's been the hardest part of all this? I mean, what was your aha moment?

Matt Lashey:
I, you know I, so data and the perception of data, especially in the healthcare community. Another thing that I sort of learned is that we're dealing with a lot of doctors who lived in a world pre-electronic health records. And I can see how the requirements around that governmental requirements and regulatory requirements where you're required to record certain things in the EHR system and how that has actually had a negative impact on the quality of that interaction, and that is data. And it's and it's sort of been a 20, 25-year time frame where doctors have been really frustrated with all of the requirements around data that's for claims or for legal, they have to get into the system and it takes away from their patient interaction. And so luckily, there is always in hospitals, one or two physicians that are huge fans of data, they understand the value and then they become sort of the advocates or the evangelists for how this data can be used. But I would say the biggest, the hardest hurdle to overcome is preconceived notions about data and its usefulness in patient care and in patient ongoing patient care today. I think that there's an understanding that, oh, I can analyze this data and it might help inform something in the future, but if I'm treating a patient today, I, how is this data going to improve the efficiency of this interaction or make me more effective at caring for this patient today?

John Shufeldt:
Yeah, it's funny, it seems like such a slam dunk from at least from my vantage. But you're right, there is a group of physicians probably around maybe my age and older who, if not embrace the changes, particularly in the EHR, because it is, as I just worked on the rez for five days and the EHR of most tribal hospitals use, NIHS uses, is probably 20 years antiquated, maybe 15.

Matt Lashey:
Yeah.

John Shufeldt:
It's nearly ... based. I was, I ordered so many morphine, it took me ten clicks to order morphine ... to order one drug. And you know, I was giving them five drugs and ordering a bunch of tests on the person. I remember thinking, Oh my God, there has to be an easier way.

Matt Lashey:
Technology and data. Technology and data is supposed to make things easier or make you better, make you more effective, and so it's unfortunate that that's been the case. And the other thing that I'll just sort of build on what you were saying in terms of the doctors that were there before and practicing pre-EHR system, those are the guys that are and gals that are in charge today. They're making the decisions, and so that's why I think it's been such a hurdle.

John Shufeldt:
Yeah, but, you know, like you said, I think the first time I met you guys, I was laughing because I thought if you come into the emergency department and you have a diagnosis of cancer that's relatively new, you know, you have to convince me not to admit you because you're going to be, you probably have leukopenia, low white blood cell count, you'll probably have X, Y, and Z going on. And I think for a lot of these patients, they probably, some of them they do okay at home with close follow-up, we can never really guarantee close follow-up. And our ... the path of least resistance is just admit you. So probably, drives a hospital is crazy but you know 70% of them are going to get admitted if they hit the emergency department or and the health plans have you know, I know they know that. So anything to keep patients out and prevent unnecessary admissions is a huge savings and better for the patient with less nosocomial infections and everything else.

Matt Lashey:
Absolutely, and you know, there's been lots of analysis on EHR data, and I'm recalling one that was done out of Fred Hutch up in Seattle. And I think that in that, I think it was done two years ago, they identified all of the emergency room visits amongst their cancer patients. And I think it was 85% of the emergency room visits they designated as preventable or avoidable. So if they would have, in those three week or four-week windows, received some sort of alert or notification that there was an escalating risk, that they could have done something about, change the medication, and who knows what that is, I mean, there's lots of issues that and things that a patient could be doing that could be leading to an escalating risk, but identifying that and intervening before it becomes a significant adverse event, think about the savings there. And, you know, if you have 100 patients, 1000 patients, one of the things that our platform aims to do is amongst a large patient group identifying specifically the patients that are experiencing escalating risk so that the nurse coordinator, so that the physician can focus on those one or two people, not because they have a profile that they're older or comorbid condition, but they are in the process of experiencing something that would potentially lead to emergency room visits, and that's where we sort of get the sweet spot.

John Shufeldt:
Yeah, no, that's perfect. So one of the biggest takeaways it sounds like, was just how difficult the implementation needs to be.

Matt Lashey:
Difficult, so in terms of so that actually has been another hurdle in terms of integrating with the EHR systems. Is that what you mean? Yeah, so and I think that just really mostly because there's not a standard, and every hospital and even within hospitals are different systems that don't talk to each other. And so everything is very siloed and every integration requires a separate effort, there's not sort of a one size fits all solution, which is changing today with data harmonization models. So creating guidelines and regulations so that data is formatted and structured in a way that it can be easily shared across different EHR systems, and then also tools that really sort of facilitate the interoperability to make that easier as well.

John Shufeldt:
... be brought up to you? This will sound heretical, but ... brought up in saying, look, if you're supplying us with this information that we may not have, but for you and we don't react to it, we now have liability.

Matt Lashey:
Yes.

John Shufeldt:
How do you answer?

Matt Lashey:
Yeah, there's a, yeah, so there is this concern about that, and the way to address that is by managing patient expectations. So in the context of a partnership, patients have to know that there is not someone watching their data 24 hours a day, seven days a week. So that's number one. We also have to let them know through automated push notifications that when they log, say, a body temperature above 100.5 degrees, there are certain things where it's like that patient should be going to the emergency room, right? And and so automating some of that, some of those notifications within our platform. But again, just sort of managing the patient expectations, the best way that we've seen it work is instead of creating a dynamic, so our data can get shared with our providers in real-time, but what we also do is we provide a weekly summary or a weekly report. And if patients know that once a week that their physician or their care team or a nurse navigator, it doesn't even have to be the physician, someone is going to be looking into the system, viewing their report, doing a check-in, and if they notice anything that would signify escalating risk, it would be on the physician to reach out to the patient. That model of once a week check in and even having a nurse coordinator or a designated person looking in and not even the physician, and then escalating that to the physician if necessary, that model has really worked well with most of our partners. But the legal concerns, there is, when we start conversations, those little legal concerns are definitely prevalent.

John Shufeldt:
Yeah, I can see somebody, a patient saying they took this medication, they noticed increased bruising. I'm going to, I'm totally making this up.

Matt Lashey:
Yeah.

John Shufeldt:
And then six months goes down the line, they have a head bleed. They go back, Wait a minute, this was right in front of you. They had the TTI, particularly, bruising, capillary fragility, what have you, and you should have known, Doctor, that this medication you have them on likely caused that. You had this you had the canary in the coal mine sort of warning six months earlier, and, but for you're not reacting to that now, this person's in a vegetative state. You know, there's this book out a long time ago called The House of God, and there was a medical student, and we probably all did it, and and one of the things that said is if you don't take a temperature, you can't find a fever. And, you know, everybody starts, you know, we all kind of laugh and then but there's some truth. There's some truism to that, like there's some stuff, like I don't even, patients tell ... I'm like, I don't even want to know that.

Matt Lashey:
Mhm, yeah, yeah, and I actually, we've actually, unfortunately, we live in such a litigious society and that is such a big concern that you will encounter physicians that are more concerned about that than the opportunities. It just seems this way than the opportunity of finding that canary because, because of all the legal potential, legal ramifications.

John Shufeldt:
I don't even like canaries for God's sakes. That is classy. You know, maybe as you use your system develops and iterates and you take that away from the nurse coordinator to, Wait a minute, this sounds like it may be something that's bruising or what have you, and this gets automatically alerted to the physician.

Matt Lashey:
Yeah, and this is actually something that, this is also something that we've been working on, too, is that with each partner, they tell us what they want to be notified about, so, and it's not a one size fits all solution either. And we're working now also to normalize the data, even on things like pain, to understand on a 0 to 10 point visual analog scale, what does a five mean for patient A and is that the same as a five for patient B? And with enough data and with profile details, diagnostic and even characteristic details, we can start to understand that in a much more discreet, significant way in the future.

John Shufeldt:
Yeah, that's awesome. Well, any final words of advice for aspiring entrepreneurs who want to be when they grow up?

Matt Lashey:
Yeah, I would say don't give up. I think, you know, that resilience, I think we're we were going around the Thanksgiving table and sort of mentioning things that we were thankful for, and I think that I've been lucky enough to have a support system that has been there to continue to encourage me through all of the ups and downs. And as I sort of look back, I mean, there were lots of times that I could have given up. Like I said, it cost a lot more than $60,000 and it took a lot longer than six months a year but, you know, as I look back, number one, I'm thankful for what I learned in those valleys or when things didn't go perfectly. And, you know, success is really just continuing to get, to continue to go despite a failure. So I just sort of think about, there were several times that I could have given up, and I just sort of shudder to think about if I wouldn't have continued on and not being where we are today, just sort of weird to think about.

John Shufeldt:
Yeah.

Matt Lashey:
Don't give up.

John Shufeldt:
It's resilience, it's the common denominator for success. So, Matt, this has been great. Everybody we'll have all the show notes and ways to reach out and contact Matt. And Matt, thank you very much for taking the time a day after Thanksgiving to do this. I really appreciate it.

Matt Lashey:
No, thanks, John. I enjoyed it.

John Shufeldt:
Appreciate it. Okay, folks, that's another wrap on Entrepreneur Rx. We'll see you soon.

John Shufeldt:
Thanks for listening to another great edition of Entrepreneur Rx. To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. Thanks for listening.

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