During our time at CES 2018 in Las Vegas, we noted that large firms, previously known for their consumer products and services, are jumping into the healthcare space. Samsung may be the best example of this, as over the past few years it has expanded its offerings to include even high-end ultrasound machines.
We had a chance to sit down with Dr. David Rhew, Chief Medical Officer and Head of Healthcare and Fitness at Samsung Electronics America, and ask him a bunch of questions about how contemporary technology can improve medical care, help individuals monitor their health, and improve clinical outcomes while lowering overall costs.
Medgadget: Thank you for having us. When did Samsung create the Chief Medical Officer (CMO) position?
I started really in the provider space looking at something which today is now known as clinical decision support but back then in 1990s, no one really knew what CDSS was. It was just about alerts, medication alerts, but what we realized was that there was a huge opportunity to build this into the electronic health record. I really started spending a lot of time.
I have a computer science background. I do a lot of programming and artificial intelligence and essentially created a startup that was owned by Cedars-Sinai. That startup started doing pretty well, started integrating to the EHRs. I should say we started doing well outside of the EHRs and then Cedars acquired us. Next thing I knew I’m in the whole health IT space and really building these technology solutions that are well integrated into the clinician workflow.
As you know healthcare is really moving outside of the hospital and so much of what we’re seeing today is the need to engage patients and consumers’ families, so the opportunity to apply that same approach, providing the right information at the right time, we need to have a different type of infrastructure. It’s not about an EHR or even the patient portal, it’s about use of technologies that patients and consumers and families would use every single day. Smartphone, wearable, TV, home appliance, sensors around the home, newer things, things that are embedded in you, all that. That is a really exciting new area and Samsung was very interested. Obviously it has a very strong footprint in the consumer space and they had been looking for quite some time to really help understand this a little better. I’d say over the past five years we’ve been looking at how a lot of the Samsung technologies could be used to really address and improve these outcomes.
We were looking at it in two fronts. One was from a pure consumer perspective. If we launch a new product, how can consumers readily use this and take advantage of the benefits? But also on the enterprise side, which is where I sit, which is looking at how can enterprise organizations like hospitals, health systems, payers, medical device companies use these to deliver on their specific business objectives, which in many cases are the exact same things. It is improving the quality, reducing cost, but at the same time growing the business around it.
We work with both groups. We have solutions that I have really been spending a lot of time looking to make sure they’re vetted because we really want to make sure these are validated and things that work well. We look to launch them and we launch them with small, medium, and large-size companies.
Medgadget: Have you acquired any start ups that help you in this?
David: There has been some M&A activity. We have I would say for the most part a bit been doing more partnerships and I would say we’ve also been doing a lot internal development, so there’s a lot of innovation that occurs on the device itself. As we look at wearable, we have talked quite acceptedly about what are the features on the wearable that need to be improved upon to make this a much more marketable device not just for the broader consumer, but also for healthcare. If we look at the phone and what are the features on that, what are the capabilities and how does one address security in all of this?
It’s interesting because a lot of the same things that we see in other industries, the same challenges, are really the same challenges we have in healthcare, a special issue with to deploy it. Is this device secure? Can you do mobile device management around it? Can you customize the user experience on this? How do you rapidly deploy it? Things like that so we’ve been thinking a bit about enterprise and then specifically around healthcare.
Medgadget: You mentioned security but also there is a regulatory process. Do you have any concerns about the FDA regulatory process in terms of … I remember 10 years ago, there was concern among companies who were developing for example software for a cell phone to process glucometry readings. There was no clear guidance from the FDA at the time, whether it falls under their jurisdiction or not and what the regulatory requirements are. Are you working with FDA?
David: Absolutely. In fact, I just met with Bakul Patel who leads the digital health component of the FDA yesterday. We engage with the FDA regularly on several initiatives. I’m not sure if you heard that there was a program that was launched. It’s a pre-certification program with start-up companies we selected. I have a pool of [unintelligible] that we’re looking to basically do sort of a TSA Precheck, where you go and get this vetting and then all of the solutions that we launch are fast-tracked through the FDA.
We really want to find ways to work with the FDA to be able to bring some of these really highly innovative solutions to market. I think the FDA has also signaled in many different ways their eagerness to be able to do that as well.
Medgadget: Are you working with other big tech companies on strategy?
David: Absolutely, yes. It’s funny again, just yesterday, I’ve had meetings with some of the big-time tech players as well as small, medium, and large. We have found that a lot of innovation occurs in players that are a little more niche specific, so if you want a specific type of solution that will address readmissions in the home, there’s a great solution provider named Vivify Health. Vivify Health has a very broad market share in terms of that and they’ve created a wonderful opportunity to be able to use that. We work with large payers, United Health Group. We just launched a major initiative using our wearables within their corporate wellness program. Across the board, we work with different size companies and different partners.
Medgadget: What are the areas you see the most growth in in terms of just the tech itself and then also in the EHR healthcare clinical side?
David: If you look at the industry as a whole, there’s been a lot of innovation that’s occurring on the sensor side for whether it’s the phone, the wearable, or even other types of devices. We’re going to continue to see a lot of really interesting things come out there and some of which blend over into some of what we call the medical space, so a lot of these medical devices that are classically FDA certified devices. We’re already seeing today that you can show the data but where we’re actually heading, this is a large part of what we think a lot about, is how could you actually change the entire consumer experience or the patient experience so that it’s not just watching it on it but actually managing it on your smartphone or your watch? That’s going to be really transformative when you really have the ability to control all the things in your body, outside your body, and around your environment with your smartphone or with your smartwatch. I think we’re getting there.
One of the reasons why this has been top of mind to a lot of folks at Samsung as well as the device companies ties into security, because right now security is not adequately addressed in many industries. In healthcare, if you look at the number of cyber attacks that occur, 84% of them are occurring at the app layer, so it’s not about having a device that you can brick which is the current solution. It’s about being able to have that protective layer. It’s almost like a super antivirus that protects the applications as they’re functioning.
What we have recognized is that if you’re going to do that, you’re going to need to create a hardware-software protective layer called Knox, which is what we call it, I should say. `We’ve created one and it enables the data to be secured both at rest and in transit. It’s been rated by Gartner over the past two years as the most secure enterprise platform. It’s being used by government agencies extensively and it’s also being used by the financial organizations, the large, big ones… JP Morgan, Goldman Sachs.
What we recognize is that this security platform is on a Samsung device so most people historically have figured Android has got a lot of vulnerabilities, this has actually turned that weakness into one of our greatest strengths because now we actually have something that is vibrated by Gartner, even more secure than BlackBerry devices which is pretty remarkable when you think about how we have evolved in terms of our thoughts, in terms of what these devices can do. At the same time as we think about where healthcare is going, a lot of as you start integrating some medical devices and the data on there, that has to be secured.
Whether it’s on the watch, whether it’s on the phone and so we’ve leveraged the Knox platform with all our Galaxy phones, our wearables, tablets and we continue to push that. That’s the reason why for us we think that there’s a great opportunity to be able to leverage some of the things that we’ve got here on the Samsung side.
Medgadget: In terms of the wearables, is there anything large that you guys are working on? I read about this Simband a couple years ago in 2014, that’s kind of died down and the rumors that is coming back is that because of the sensor functionality.
David: Yes it never died. That’s good news. The funny thing is as we look to build this out and we actually had fully functional models that were working. It worked great, the only problem was it was just too darn expensive.
There was a non-market viable solution. What we realized is we’re going to really have to think not just through the sensors but what makes sense in terms of putting it onto a device and how do you position or market that device because, as you all know, there’s a balance, there’s a trade-off between all the great things that you can do on a SmartWatch and the battery. It drains the battery, the more you do all these different things and so we’ve really been thinking about target specific use cases for which things and how do we leverage that. You’ll see either components or sets of components from the Simband and other types of things that we’ve been working on being brought into our product roadmap as we launch new products.
The quick answer is “yes” there’s a lot of some really exciting stuff, probably stuff that were related to Simband and other things because we’ve been thinking a lot about sensor technology. We will probably start seeing that come out in some of the later version things of the different wearables.
Medgadget: How about the data that you collect from the sensors and stuff? Do you have a system similar to some of the studies going on like the Baseline study with Google and then NIH has also has one where they’re trying to collect all the patient data and Samsung trying to partner with one of those?
David: Yes we’ve been talking to healthcare organizations. We talked pretty extensively to a lot of organizations that are interested in this from data collection, population health management of assessing trends, assessing a detection of unusual activity, arrhythmias and things like that. A lot of interest in and all of that because we think that there’s really great potential for that, and I would say that is one path that we’re looking at. The other path that we’re looking at is how can you use a wearable, like consumer grade wearable to improve the health of a specific individual.
This isn’t just about, oh you help me diagnose Afib or whatever and I didn’t know. I’m talking about I just had a heart attack, I’m in the hospital, I’ve been asked to undergo cardiac rehabilitation. Cardiac rehabilitation is a six to eight week program. The doctor is telling me that I have to come in three times a week, spend 30 to 45 minutes there. I’ve got kids, I’ve got a job, I live far away, I live in cold weather, it’s icy. How am I going to be able to make this and what we see traditionally is that people will start off because this has been recommended, and then they’ll just drop off. The completion rates for these programs are really low. I mean 10-40% or so nationwide.
We digitized that whole cardiac rehab program on the smartwatch and we tested this at clinical facility and we’ve actually had incredible results. We doubled, we went from 40% to over 80%. We nearly double that. When we asked the cardiologist what that meant, the clinicians that were involved they said according to the systematic reviews and med analysis on cardiac rehab, for every four patients that complete this program, one, you’re saving a life.
We’re recognizing that the opportunity is real in terms of true clinical practice. You can virtualize care on a smartwatch, put it into a program, deploy it, and have tremendous help, improvements in care and obviously in terms of quality and cost as well.
Medgadget: I think wearables have been around long enough now that there’s a wearable fatigue and things like that. When you put a smartwatch on someone they might be compliant for the amount of time it takes to do this study but after that do you have any methods that you’re trying to push for it?
David: Yes that’s the big challenge today. I think if you look at wearables, there’s a certain group of people that will take wearables and readily use them and get good health benefits from it, but the majority of folks will either not use it or they’ll use it very briefly and then give up. For those you really do need a mechanism to incentivize them and to keep them well supported. We’ve been looking at both angles. United Health Group incentivizes their employees to use this through the fit program, which they basically get paid to achieve certain activity goals both in terms of frequency, the intensity, and the total number of steps they do.
When they achieve those they get more money. I mean it’s a great program, but it is one that obviously is tied into the financial incentive. There is also an element around support and social support, and we see this and this ties into that cardiac rehab program I talked about. A large part of the reason why that works, no one was getting paid for it, the reason they’re doing is because on the back end you’ve got the clinician, you got the groups basically saying, “Hey I noticed that you’re really not tracking your activity today.” Give them a phone call and they know that there’s somebody there supporting them, or in other cases somebody needs help and then you push your button and then you guide a back end.
You’ll be hearing today, if you’re able to attend, we launched a new product with mobile health, it is a wearable that is specifically designed for seniors. What we wanted to do was, back to the earlier point about wearables and adoption, if you take a wearable and give it to a senior and you say that this is your new purse device. It’s got 4G connectivity, well they’ll be like it’s got so many apps, they’re so small, what do I do? So you have to simplify it. We made it real simple, there’s a big button there that says help.
And the other thing that we learned is that when somebody calls, when you answer it you have to go and swipe it, that’s another step. We reconfigured the watch so that when the emergency call comes in it automatically answers after this sequence of help because that’s a sequence that we know you do not need to have them answer. We had to reconfigure using Knox and a variety of other tools for the device to be able to do that. That’s the commitment that we’re making and we have great consumer devices that can be used for a lot of fun and exciting things, but if you’re going to look at specific conditions in certain scenarios we’re going to need to think about the security, the customization, the mobile device management, all of this and that’s the type of stuff that we spend a lot of time working on.
Medgadget: Do you think Samsung will be moving into implantables one day?
David: We are working very closely with medical device companies that are doing implantables. So through partnerships, the answer will be yes. Whether we ourselves do that I guess that’s TBD. I would say for the time being much of our focus is on focusing on specifically how we can change the consumer experience outside of the implantable, whether it’s a continuous glucose monitoring or neuromodulation, all of those things today require a certain amount of FDA approval to go through as well as surgery and all the other things.
There are many groups that do that very, very well. It’s not our goal to be able to change that but at the same time as we think about how that experience extends outside of the body, we’re kind of now when we tie to the hip to create a solution that works well. I think it’s not just about sending it to a smartwatch and watching it. It’s really now about the entire work flow so that’s the reason why we spend a lot of time thinking about it. It’s more than just simply viewing the data.
Medgadget: We know that Samsung is a big company in terms of semiconductors. Do you know how to improve some of the implantables from that perspective, their functionalities from inside?
David: It could be. It’s not an area that we’ve been spending too much time looking at. Mostly through partnerships, we’re relying very heavily on the established medical device companies. They could be medium or large sized ones, they don’t necessarily have to be all the big ones.
Medgadget: How does Samsung as such a large company manage all these things. Do you have incubation teams or a lot of different teams focusing on different targeted areas of healthcare and fitness?
David: Yes, we do. I would say there’s really two groups that are spending time thinking a lot about healthcare. I manage the group that is the Samsung Electronics America. We’re more of a commercial arm. We look at solutions that are already vetted or need to be vetted. And we figure out ways that we can work together and make those adjustments to make this a market viable solution. We go to market and plan that.
On the other side, there is a large number of, again, R&D labs. We’re constantly doing innovation with other partners, we’re learning more about what needs to be done and we’re trying to think of what’s the next great innovation? You’re going to probably hear more about this in the coming months because there’s been a lot of-exciting stuff being done.
I would say, the third, which is really becoming a big area of focus for us is around the overall platform that allows us to be able to capture consumer/patient health data that will then allow the patient or consumer to share that with certain individuals to do virtual care. Samsung Health, aka S-health, is an application that used to be just on smart phones and that would allow you to be able to track your own fitness. We added it to the watch, its about you taking care of yourself. Then you could share it with your family, then you could share it with your physician.
What we realised is that if we go to the point where we actually want this to be meaningful, we had to go beyond simply just creating a little portal where people can send it. We had to create a way that the physician could help provide the guidance of what needs to be done. That initial consultation should be done through that platform as well. We partnered with American Well to essentially create that first opportunity for interaction, whether it’s urgent care visit or it’s part of a chronic disease management or a specialty care. As part of that we started to define these programs through this platform, Samsung Health, so that consumers can capture data and then share it with a third party which could be your healthcare provider, it could be maybe a yoga specialist, it could be someone who really provides this.
It’s exciting because right now we have about 240 million users globally with Samsung Health. In the United States, it’s much lower like tens of millions, so what we found is that we have really some work to do here in the United States to be able to help create a marketplace and a platform that allows the people to be able to access it.
We’re also getting good traction, like New York Presbyterian, we have a clinic, Anthem… they’ve all been eager and are signing up. We’re starting to create opportunities for the consumers to be able to access the care and other services.
Medgadget: I guess the final question, you are a clinician and now you are working in business, basically. I see a lot of clinicians interested in start ups or being involved in business. Do you have any recommendations for them, or ideas, how they can contribute too?
David: Yes, One, I’m excited to see that there are more clinicians that are getting more involved in this because we absolutely do need the clinical input. Many folks have said that that’s the missing ingredient because we have a lot of technology, but it’s not done in the context of how it fits into our existing work flow. Specifically the clinical work flow. I’m excited to see that. I think that many of the folks- it’s rather unfortunate, by the time they realize they want to do this, they’ve already down a path so far along, that they have to go back and do some retraining or they literally start from scratch.
I would really like to see this starting earlier where people in college, or even high school start thinking about this as a career path. In order to do that, you’re going to have to think about a few things. It’s not just about the clinical side, there’s obviously a technology piece to it. There’s also a business side to it and that’s where I think a lot of folks have- especially if you’re looking to be an entrepreneur and start that, they don’t have as much experience and knowledge around how that works.
I was rather fortunate because when I started out, I was able to experiment in the time in which I was still under faculty. I was able to do things. Nowadays, it’s a little risky. You’re basically dropping out and doing all the stuff and doing it on your own. You’re placing the big bet. I know it’s a little challenging nowadays, but if you want to do something that’s really rewarding you sometimes need to take that leap of faith. Don’t be afraid to do what you feel is really the thing that you see your passion. If you love it, do it, but make sure that you not only think about the clinical side, which I know most of them aren’t really strong. I know people are thinking about the tech, and also think about the business side. How would you actually build a company? What’s the business model? Who’s going to pay for it? Prove it. Start with a reference client, build that, and continue to grow it. From there, depending on a lot of factors, you might get the next great company or product.
A lot of people think that the digital health opportunity is so large that it is going to transform the way that we think about healthcare because it will be about all of the stuff we’re seeing here at CES, and all the different things that people could be doing at home. Wearing things that’s going to help a lot of them self manage it but support it through clinical care. Virtual care will be a big part of it. I’m excited. I think that there are a lot of things that Samsung can do to contribute to it and hopefully, we can get more young recruits, a lot of good talent, especially on the clinical side, into this space.
This interview was conducted by Medgadget’s Dr. Michael Ostrovsky and Dr. Alice Ferng.