In this episode of the IoT Unicorn Podcast, Dr. David Rhew, Chief Medical Officer & VP of Healthcare, Worldwide Commercial Business, from Microsoft, shares his experience navigating through today’s pandemic and the digital transformation of healthcare.

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00:00 Pete: Okay, well, we're here with Dr. David Rhew from Microsoft. David, really appreciate your time. We have a lot of things to talk about today, we're gonna try to squeeze it into the allotted time period, but thanks again for joining us.

00:14 Dr. David Rhew: Thanks, Pete, it's a real pleasure to be here.

00:16 Pete: Good, good. Yeah, and full transparency, something happened in the first conversation I had with David where it didn't record properly, so we're actually going through this one again. So it should be nice and well-practiced. So live and die by Teams, I guess. But anyway, David, so we, as I mentioned, chatted a couple times now, and you're actually fairly new to Microsoft. I think before we get into a lot of really interesting topics I think listeners wanna hear about around digital transformation of healthcare and what's going on with COVID-19 and Microsoft, maybe you can give us a little run-up to how did you end up here at Microsoft, and you've been here almost exactly a year now, so you can give us a little bit of background on yourself and your journey to Microsoft.

01:07 DR: Sure. Well, first of all, I'm a physician, I'm a healthcare researcher, and also a technologist. And really the combination of those three have evolved rather organically throughout my career. It's been remarkable how those three have converged to allow us to be able to start thinking about how healthcare can be used to improve health outcomes, or I should say how technology can be used to improve health outcomes, and really excited to be a part of that program here at Microsoft as we start launching technologies, predominantly cloud-based solutions with artificial intelligence to drive that.

01:45 DR: My story, I guess, begins when I was in college. I was thinking quite a bit about different types of ways that I could help people, and I guess my initial thought was helping people would probably be best served if I went to medical school, so did a curriculum, a pre-medical curriculum. And as part of that program, I think I gained a lot of the basic skills needed to be a doctor, but one of the things that I did also was I was curious about other types of activities and other types of skills. Technology was always a fascination. This was around... In the 1980s, and video games were pretty popular then. These are the arcade video games, not the ones that we typically use...

02:28 Pete: Yeah, the good ones.

02:29 DR: The classics, the Space Invaders, the Pac-Man, Mario, and I was fascinated by that. I just felt, what an incredible way for us to be able to start thinking about how we can not only spend our time, but also how we could use technology to create new experiences. And I started doing a lot of programming, in fact, I became a computer science major as well as a cellular and molecular biologist. And then I went to med school, and in med school there's not a whole lot of opportunity to use computers apart from a word processor, so I felt in many ways that that part of my career journey was put on hold. And it was on hold for a while because what I ended up doing is after I graduated from medical school, I went down a path of exploration in healthcare, specifically looking at ways that we could reduce variation and improve access to care and improve the overall quality of care. And it was done predominantly through what we referred to as guidelines. Turns out that if you were to go to a doctor in... Probably your local doctor, and you were to go to maybe survey the same type of... Ask another doctor across the country or even the globe how they would treat the same type of condition, you'll get a lot of different responses.

03:54 DR: And in fact, when they've done analyses, they've found that variation in care is pretty dramatic, even for things that have been proven to be beneficial. And what we learned in some of the investigations that I was a part of and others have been actively looking at is that a lot of that has to do with just the fact that we don't have mechanisms to remind clinicians to provide that right information at the right time. And I started building basically programs that would provide that right information at the right time. It was very manual. In many cases we had nurses and other clinicians run around the hospital, identifying patients, giving pieces of paper to doctors, saying, "Oh, by the way, your patient fulfils low-risk criteria, you could switch him from an IV antibiotic to an oral antibiotic and send them home," when traditionally, they might have stayed for another few days or maybe even longer. And we ran these programs, we found that it was highly effective. And not only did it reduce the length of stay and reduce total cost, but when we followed up with these patients, they actually did quite well and they were quite satisfied, so... The less time you can spend in a hospital's always good.

05:05 Pete: Yeah, for sure.

05:06 DR: People were having a good time just finding that, hey, you know what, this is something that provided value to just the patient, the health system. And that really got me thinking about how do I start scaling this, because you can't have a person run around the hospital with every piece of information. It really has to be automated. So working with some colleagues, we put together some software that ultimately became a company, and this company got acquired by Cerner, which is a large healthcare information technology company, and next thing I know, I'm in the middle of implementing EHRs across the country and even the globe. And so seeing patients half the time and working with technology was my life work for quite a bit of the early part of my career. And I learned a lot, I learned a lot about how technology is an enabler. It really helps us to be able to achieve some of the goals. But it was really predominantly focused on the inpatient and in-clinic experience. And so I started thinking about, what about outside of the hospital? Could we actually start engaging patients and family members in a more effective manner than simply just sending them a text reminder or giving them access to the patient portal?

06:30 DR: And so what we started thinking about as an industry was this whole category called digital health and connected care. And there were many consumer companies that were looking to get into the space, Apple would be a good one, but also Samsung. And I had an opportunity to talk to folks at Samsung, shared a bit about what I was interested, in terms of where I wanted to take technology, and they shared a similar vision, so it was kind of a great match, and they asked me to be their chief medical officer. For six years I was Chief Medical Officer at Samsung. And during those time periods of working at Cerner and the electronic health world and also working at Samsung I kinda got a chance to experience both ends of the spectrum in terms of what clinicians experience and what patients do. And that bridge was something that I was looking to find a way to make it more seamless, more ubiquitous, which really brought me to Microsoft because of the fact that with its enterprise cloud infrastructure ability for us to be able to have those communications, data communicating also now more freely within the electronic health records space into using HO7 fire standards into a common platform. We could do a lot more than what we were currently doing, and that really is the opportunity for all of us to start thinking about how technology can help us achieve some of the outcomes.

07:51 Pete: Yeah, it's fascinating. I think it's... You can imagine healthcare is one of the great data science challenges we have, there's such a massive amount of information and knowledge base, and like you were saying, the knowledge and the way people are treated and the treatment plans kind of vary, and having access to all of the knowledge collectively and having all the data analyzed. I'm a big Fitbit Versa fan myself, and the measure itself is a pretty key part of my regimen. And especially in people that are not doing too well being able to have all of that data accessible from edge devices and being able to basically get to the right outcomes and treatment plans is pretty, pretty critical stuff. You can't think of too many more purpose-driven business outcomes than that. So that's amazing. It must be... And you're... I know when I joined Microsoft, the first two years, people said it takes two years to find the bathroom at Microsoft, 'cause it... There's so much going on.

08:54 Pete: So you're a year into it, and of course, and we'll talk about the obvious elephant in the room here, you've been in the middle of helping us steer through this pandemic, probably halfway through your first year. So that must have been quite a challenge to sort of come on board and then sort of this all happened, right? Can you give us a little insight as to what was that like, how did that sort of ramp up for you?

09:22 DR: Yeah when I joined Microsoft, I guess there are two chapters or two parts to my time at Microsoft. The first six months were essentially spent working very closely with our partners, our clients, implementing the technologies, the cloud-based technologies to help them achieve some of their business goals, and then when COVID hit and it really started in... For us in January, I know December was probably one of the first times we started hearing about this in China, but we have colleagues, we have Microsoft folks that work in China, and we were very concerned about their health and what was going on. And then when it continued to spread throughout the country and then to other parts of South East Asia, we realized that this was something that was gonna require a pretty coordinated effort within Microsoft around this. Turns out that my background as a physician is in infectious disease. I was actually an AIDS physician during the time, during the AIDS epidemic, and I was seeing patients that were fairly young, healthy individuals that would deteriorate in a rather short time period, and then succumb to the illness. Today there are so many parallels, you're seeing this affect so many young, as well as older individuals, we're seeing a need for public health and also a need for us to be able to accelerate the time to research to vaccine and treatments.

11:00 DR: We never developed a vaccine for AIDS, but we did come up with a treatment that in many ways has allowed us to be able to better control that. And so with that as sort of a backdrop, I was asked to serve as the international coordinator for Microsoft's COVID-19 response, and that was an incredible opportunity to understand really all the different groups within Microsoft that touch the different countries that interface with the governments and the non-government agencies, and what we as a large technology company can do to lean in. That involves providing software cloud services, AI skills and resources, and in many ways, that was our first response to how we could address the pandemic. When the pandemic hit, or I should say when the infections started appearing in the States, particularly in the Kirkland area, near Seattle, that really hit home for many of us in the Microsoft family, because that's where our offices are, our main headquarters are. So yeah. You remember very well.

12:08 DR: And that, during that time, we were recognizing that we needed to do more than just simply provide our technologies, we needed to innovate, we needed to solve some of these problems. So in working with organizations like Providence Health System, we customized our chatbots and made them COVID-19 specific screening and triage tools. We tied it directly to portals that could allow for virtual care assessments, and then tied it into lab testing, we built out mechanisms to provide food services and other types of critical supplies to people that were quarantined at home. We started investigating how we could work through collaboratives to better enable exchange of data and promote the development of a variety of different types of solutions, or I should say ways for us to be able to procure critical supplies such as personal protective equipment.

13:05 DR: And so that process was an extraordinary time. We partnered with companies like GE Healthcare to create virtual ICUs to enable multiple patients to be managed by a single trained clinician. And we started spending a lot of time thinking about treatment. We were thinking about how AI and a variety of other tools can be used to help accelerate the pace of discovery both from a scientific R&D perspective as well as clinical trial recruitment. And so, this has been an incredible journey for us.

13:36 Pete: Yeah, I think, I was looking at the recent Inspire conference and some of the talks there going on and Satya was saying that we've sort of advanced... In two months, we sort of advanced about two years worth of innovation in the time of great crisis. Throughout history, it's sort of a potential real accelerant for a lot of historic inevitables, so we were on the certain trajectory. A separate topic, but online learning and other things, that was sort of a thing that was nascent to be experimented with, and then all of a sudden, it was sort of like, we're all gonna do it now at the same time.

14:14 DR: Yup.

14:14 Pete: Same with a lot of the, obviously, remote collaboration that we're doing. So I can imagine in the healthcare space, you had been working for a long time on the whole digital transformation of healthcare. And now because of the pandemic, we've had to really accelerate a lot of that stuff and really bring to bear a lot of the technologies we were kind of trying out and really sort of making them much more mainstream a lot more quickly. And I know before this particular chat, I was mentioning to you about where... We've been involved recently in how do we take some of the techniques we've done for retail in terms of supply chain management in a typical store, and how do we apply that to healthcare facilities so they can understand their supply of PPE and other things and how can we automate that using a lot of the edge AI as well as cloud capabilities that we would have in a typical grocery store.

15:09 Pete: And so, we're seeing all of this stuff just sort of happen, and obviously, because of the pandemic, there's obviously an underlying urgency that we need to cooperate and innovate as fast as possible. So that must be... I can imagine, I always ask people when they say like, "You come in the morning, you have a cup of coffee. And then what happens?" I can imagine in your job, you have a cup of coffee and then there's probably about 2000 emails in your inbox.

15:38 DR: A lot of times these emails are things that have a direct relevance to what we're seeing and living today. So for instance, much of what I've been focusing on recently have been things that just return to work and return to school. These are topics that we know are of high importance to many individuals, technology can play an important role. But in the setting of a pandemic, almost everything has to be done with health and public safety and mechanisms that will allow us to be able to suppress and/or make sure that the infection doesn't get out of control. So there's just an interesting... I guess, a collision course between how healthcare has now touched every single vertical, whether it's retail like you're describing, whether it's manufacturing.

16:28 Pete: Yeah, hospitality.

16:29 DR: And now education, hospitality. And it's been, I think, a learning experience for all of us 'cause we're now starting to realize that this pandemic isn't gonna go away simply by providing some of the existing technology. We're gonna have to sort of out-think it, build the strategies to get faster delivery of or the maturation of our R&D so we learn what works. A great example would be convalescent plasma. We knew that this work for other types of conditions, but to enable this to be something that we could use more widely, there are two factors, and it all boiled down to one, really. We need more convalescent plasma. We need more donors. More donors for the studies and more donors for the actual... I guess, the convalescent plasma that could potentially be delivered and transfused into patients. And that has gotten us refocused on what can technology do to help clinical trial recruitment or donor recruitment.

17:39 DR: It's funny, because I don't think that in the past, if I would have thought, what is it that will accelerate the research and the ability, that I would have landed on that being sort of one of the critical pieces, but it is. And that's one of the things that we're starting to recognize that sometimes, we're surprised in what is actually the critical piece.

18:00 Pete: Yeah. And one of the other interesting by-products, I think, of this, and I know when we sit down at dinner every night with my teenage kids, we talk about the news of the day and this is inevitably is a topic. And at least one of the things I think that's been, I guess, positive out of this is we're not only innovating like crazy to out-think this, as you said, but we're also becoming a lot more educated around data science. And people are now able to talk about numbers and analyze data and talk about our values and really be a lot more analytical in understanding data. And I think that's just good, that's just good for everything moving forward. And again, sort of accelerating that trend where now, everyone has to become pretty fluent in understanding statistics and data and be able to talk about it in a rational way, regardless of whether you're a high school student or a technology professional. So I think it'll be fascinating to see down the road how much of the accelerations stick, some of the new habits and practices and skills that we're building and things that we're doing together stick as more permanent. So yeah, it's fascinating.

19:18 DR: Yeah, absolutely.

19:19 Pete: I saw Bill Gates on CNN last night. It's always great to see Bill G., as we like to call him around here, talking about vaccines, hot topic, and I think it's going to be... It's gonna become kind of the next chapter of the story at some point as we get into that phase. And there's a couple of factors there, obviously, there is the development and the new techniques to develop vaccines that are being pioneered right now. Obviously then the logistics of manufacture and distribution, right? Which is gonna be interesting. And I think the last time we talked, when we didn't record, but it was fascinating, 'cause you were talking about the paradox of supply and demand with vaccines, right? Like how to make sure we make enough. Make sure there's enough demand to take the vaccine, but also make sure we have enough supply to get it out.

20:14 DR: Well, one of the strange things that we've realized is that, and it ties into what your earlier statement around how we're becoming far more educated, but at the same time, we're also recognizing that not everyone believes the facts. And because of that, education and our ability for us to engage people to help them understand their concerns and to be able to then create greater awareness programs, adoption programs is so critical. So with regards to vaccines, it's very possible that we may have folks that need it that will refuse it. And what we wanna do is we wanna get ahead of that, we know that there's certain groups that this would be of highest importance, these are age groups, demographics such as ethnicity, comorbidities, those are individuals for whom this should be in all likelihood, be prioritized first. Just given the fact that they're the ones who actually probably will need it the most to prevent the biggest... To have the biggest impact, which is death. At the same time they may be the ones least likely to respond to it.

21:24 DR: So we're kind of like in this... It's always a double-edged sword. We're kinda recognizing who needs it, but they may not want it, they may not respond to it, we may need to actually do a second booster, how do we actually do proper and fair allocation of this? Many of these things, hopefully, it'll be a problem that we can address soon because to have a vaccine would be so important, but again, with every step along the way, we're realizing that there's some challenges.

21:56 Pete: Yeah. Yeah. I recall actually, when I was very young, we had the swine flu vaccines and we had to... I don't know how old I was, but I do remember going with my family and a big, big crowd, I don't know, it was big gymnasiums or something like that, and there was a huge long line. And we all lined up for our swine flu vaccines in the arm. And yeah, I mean, there's obviously a double-edged sword of the information distribution, which is fantastic, and everyone has the opportunity to be informed; at the same time with social media and other things, people have the opportunity to be misinformed, and so there's a lot of challenges out there. I'd heard some statistic, something like the seasonal flu vaccine only has about an uptake of about in the 40% range. Even though it's pretty well established that that is a really good way to prevent the flu and we've all had the flu. It's pretty nasty.

22:48 Pete: And for some people it can be deadly. So I think that'll be another thing is like how do we use technology to help people, like you said, kind of understand what's gonna be healthy for them and also help them feel comfortable taking that step forward to invest in their health, which ultimately is all of our healths, it's the kind of the fact that we all need to protect each other from this virus and getting people educated on that. So that'll be sort of the next wave and like you said, it can't come soon enough, I guess, as we see this thing unfolding.

23:25 DR: Absolutely, yeah. I think that's the one key lesson learned from this pandemic, is that this is not anything that one individual or one organization can solve, it's gonna require a coordinated community effort around this to both protect us as well as to get through it.

23:42 Pete: Yeah. Yeah. For sure. Definitely. Well, we always say IoT is a team sport, but in the case of the COVID-19, it kinda takes it to a whole other level. Right?

23:51 DR: Right. Absolutely.

23:53 Pete: Fantastic. Well, David, I don't wanna take up too much of your time, like I said, this is the second time we've had this conversation. So but I really appreciate... Any kind of final thoughts or things that our listeners should be aware of in terms of what you're working on here at Microsoft or what they should be doing to help themselves?

24:12 DR: Well, one of the things that I'm most proud about is that Microsoft is taking a very... I'd say a very important position of their role and responsibility in the community and the world. We look at us as responsible corporate citizens, we have to do what we can lean in to help address the COVID-19 crisis. Innovate as quickly as possible through partnerships, but also address other issues that we face today. This could be everything from racial injustice, societal issues, such as... And also environmental issues. And what we have found is that these are all interconnected, where healthcare used to be about just simply a medical condition and treating it, what we realized that the most significant factors in many cases, have to do with what we'll refer to as social determinants of health. Your income, your education, where you live, the foods that you eat, and your ability to afford those foods. The people that you are socializing with or not socializing with, these are all... It's an interconnected world, and healthcare is becoming interconnected in so many different ways, so as we think holistically about how we improve one's health and well-being, it'll probably touch on things that we never even envisioned in the past.

25:39 Pete: Yeah. Yeah. That's fascinating. You're right, it is a holistic approach that we need to take and we are much more connected probably than we ever imagined. So good. Good stuff. Well, David, again, thank you so much for your time, appreciate it. And I'll see you around.

25:55 DR: Thanks, Pete.

25:56 Pete: Okay, thanks.