468: DiME with Jennifer Goldsack

Jennifer Goldsack is CEO of Digital Medicine Society (DiMe), the professional home for digital medicine. It is a global nonprofit with a mission to advance the ethical, effective, equitable, and safe use of digital technology to redefine healthcare and improve lives.

Victoria talks to Jennifer about using new products and solutions to solve some of the most pressing and persistent challenges in healthcare, measuring success by how well they are caring for people every day and not by how good their products or how many they use on any given day, and how DiME can improve the way that we identify, manage, cure, and support people in a lifetime journey of health and disease.

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Transcript:

VICTORIA: This is the Giant Robots Smashing Into Other Giant Robots Podcast, where we explore the design, development, and business of great products. I'm your host, Victoria Guido. And with me today is Jennifer Goldsack, CEO of Digital Medicine Society, the professional home for digital medicine. Jennifer, thank you for joining me.

JENNIFER: Thank you so much for having me; excited for our conversation today.

VICTORIA: Wonderful, me too. And we have our Program Manager for DEI Geronda with us today. Hello.

GERONDA: Hey, how's it going? I'm super excited to be on here as well.

VICTORIA: Yes, me too. It's going to be a great conversation. So, Jennifer, why don't you just tell me a little bit more about the Digital Medicine Society?

JENNIFER: Happy to, one of my favorite topics, Victoria. So the Digital Medicine Society, or as we affectionately refer to it as DiMe, is a global nonprofit, and our mission is to advance the ethical, effective, equitable, and safe use of digital technology to redefine healthcare and improve lives.

And I think one point I'd like to make right off the bat is while we are tech and digital enthusiasts here at DiMe, we are not tech determinists. What we think about is how can we harness the promise of these new digital tools in the toolbox, these new products, these new solutions, and how can we use them to solve some of the most pressing and persistent challenges in healthcare, an industry that exists to care for people? That's what we think about all day. That's our measure of success: how well are we caring for people every day, not how good are our products or how many products can we use on any given day.

VICTORIA: Right. So what did you see in the digital health space that led you to believe that something like DiMe needed to exist in the world?

JENNIFER: So it's interesting. When we take a step back and think about all the experts that need to be at the table to ensure that we build a field of digital health that is worthy of our trust, in our opinion here at DiMe, we think this is the most interdisciplinary field you can imagine, and that's a bold claim. But let me play it out for you. And maybe we can think about some other interdisciplinary fields during the course of our discussion.

For digital medicine to work, we need citizen scientists and cyber security experts. We need physicists, engineers, product folks, data scientists, clinical scientists, clinical care providers, healthcare executives, regulators, payors, investors, funders all to sit at the table together, all to speak a common unifying language, all to have a shared idea of what our North Star is. What are we trying to do here as we digitize healthcare, and what does good look like and for whom as we do it?

And so that's the gap that the Digital Medicine Society was introduced to fill. That water cooler, if you like, where the leaders in our field can share their expertise and where we can very intentionally build a much better future for healthcare using the new digital tools in our toolbox.

VICTORIA: Interesting. And I like how you pointed out for whom. [laughs] And I see digital equity is a big topic that you're focused on with the organization. Can you tell me a little bit more about that?

JENNIFER: I'm happy to, and in our opinion here at DiMe, equity has to be front and center of everything we do. I think too many times we look across and considerations around diversity, equity, and inclusion; they're part of a rubric. They're a vertical. That's not what we think here at DiMe. We have to think about diversity, equity, and inclusion in everything that we do as we work to digitize healthcare. We know that there are pressing, persistent, and absolutely inexcusable inequities that exist across the burden of disease, across access to care, across the quality of care you're able to access, the care that you can afford. We know that all of those things introduce a long-standing history of inequities in health and healthcare.

As we digitize the healthcare industry, it's unacceptable for us just to be thinking about, hey, as long as we don't make things worse, that's not acceptable to us. We are thinking at every turn about how can we improve the way that we identify disease, the way that we manage disease, the way we cure disease, the way that we support people in a lifetime journey of health and disease? And how can we make sure that we do that for everyone in a way we've never been able to before?

So while I could talk about some of the projects that we've done that exclusively focus on advancing health equity through the use of digital tools, it's actually something we keep front and center in everything we do, in everything we talk about here at DiMe and something that we try and compel every single person in the field to think about to make sure that we seize this opportunity.

GERONDA: I think that's fantastic. And something that you hit on that it's really important for us at thoughtbot is continuous improvement. And that intentionality is incredibly important when it comes to DEI efforts. And so one thing that we do have at thoughtbot is we have trainings, and we try to work toward a shared language. But we do understand that everyone is at a different point in a different journey towards DEI to be able to build and design the best products and provide businesses to our clientele.

So I'd love to hear more about how your organization does consider that continuous improvement for all employees across the organization in terms of ensuring that you're enforcing shared language across the organization to be able to continue to have really great care for your people.

JENNIFER: Geronda, I love this. And I think that you've touched on something that's really important, which is while we can be collectively frustrated, perhaps even angry, about the health inequity that we see on a daily basis and that we frankly have not addressed as an industry for decades and decades...and quite frankly, I think we should be frustrated; we should be angry. Not taking the time to meet people where they are as they make a commitment to designing, developing, and thinking about the business incentives that they need in order to do this work well and to be intentional is actually incredibly counterproductive. So we always start with that shared language.

When we talk about inclusion in digital health, we need to not just think about all of the different vectors of inclusion and domains of diversity that we've developed as a healthcare industry, but we need to think about those vectors and domains at the intersection between healthcare and digital. And if we do nothing else beyond educate the field on what those domains and vectors are so they can be intentional, is they think about, gosh, what's the healthcare problem I want to solve for, for whom? How do I need to consider the needs of our intended users as I do that? That in and of itself is going to take us so much further than we are today.

But I'd also love to learn from you guys. I love the three-part way you describe your work, that you think about designing, and then developing, and then getting the business of great product development right. How do you guys think about it? I'd love to be able to learn from you too.

VICTORIA: One thing I know, speaking specifically to the intentionality that you mentioned, so if you're building an AI product and you're not intentionally thinking about DEI, you can actually build bias and problems into the code itself. So for us, and, Geronda, I want to hear your perspective here too, consulting with experts in the field, especially in DEI early and making a culture where we do have a program manager of DEI. So I've really pinged Geronda several times already this year about, like, I have this question about this. And I think having access to an expert and having access to knowledge that you should go back and check yourself is part of it. But do you have anything you want to add there, Geronda?

GERONDA: I definitely agree with everything that you had said, Victoria. And also what I'll add too is that it is really thinking about in everything that we do, how do we bring DEI at the forefront? And recognizing, as I mentioned before, that everyone's in a different place. So it's not to say that if you mess up or if you didn't consider something that, you can't continuously improve. And we have this culture where I'm not going to come in as the DEI police to say, "How come you didn't consider that?" Or "Why didn't you think of that earlier?" It's more to say, "Oh, okay, well, here's how we can approach this differently."

And everyone's pretty open to the feedback and the learning. And so one example that I'll give is that our website, thoughtbot.com, we're right now working towards accessibility for our website so that we can offer it more to those with disabilities, or those that are visually impaired, or hard of hearing, and offer it to be more accessible for anyone who goes to our website. And it's a learning curve for quite a few of our folks.

But the learning library that's offered in there to say, okay, I may not know everything about how things impact those that may be visually impaired, but let me educate and help to develop this website in a way that's going to support them. So to Victoria's point, it's infusing DEI in every way that we can. And what I love as well is that we do have a DEI Council, and we do have a shared platform to bring about issues or have those discussions and ask the questions so that you can continuously improve yourself to make sure that you're developing and infusing DEI across the work that you do.

So great question and I really feel like it's, of course, a work in progress. But we're in a really good place where we can continue to have that continuous improvement through education, and learning, and feedback to correct ourselves.

VICTORIA: Yeah, I love that. I think that having the culture at least puts you in a good starting place. [laughs] I'd love to hear more about what projects you've worked on in that space, specifically, Jennifer.

JENNIFER: So, first of all, I love how you talk about this idea of you need to have a culture in place that allows us to assess opportunities, that allows us to identify the kind of work we need to do based on where we are today. And then once we've assessed those opportunities, once we've identified potential pathways, we actually then have the support and the right environment to be able to implement these best practices.

And there are two things that I'd love to highlight. The first is actually education resources and specifically education resources on applied digital health ethics. I think creating this culture of ethics which is absolutely inextricable from a culture of equity, is critically important. You need to have those folks on staff just like you guys do. You need to be able to go to potential end users and communities and have line items in your budget to reimburse them for their time and their expertise.

You need to be able to have goals and performance metrics that actually reflect the success you're having or where you're struggling when we think about building a more inclusive environment. So that's a lot of what we try and fuel through our applied digital health ethics education. That's something that's a direct-to-learner option for folks; we're very proud of. We've had fantastic reviews and testimonials. We had tremendous faculty help us with that curriculum, and it's been really well received. And we are confident in the change that that education resource is driving in the field.

The second is actually a suite of resources that we launched more recently, and this is where I can start to get really tangible. So as an organization, we convened a broad and diverse group of experts to really tackle the issue of diversity, equity, and inclusion in digitized clinical trials. And I use action-oriented words like tackle very intentionally. Unfortunately, what we see an awful lot of the time is people admiring the problem, for want of a better expression, that we'll see endless panels at conferences and op-eds, and these sorts of things being written about the current state.

But what we were determined to do is own the fact that there is nothing technically prohibiting us today from deploying these digital tools and resources in the service of advancing diversity, equity, and inclusion while simultaneously addressing some of the long-standing clinical issues, while simultaneously addressing some of the regulatory science issues, while promoting access, while making sure we generate better data for better clinical decision making.

This is not an either-or. This is not a trade-off. We are not limited by the technology; we are powered by the technology. It requires our intent and our commitment to actually doing this work. So I'm going to pause there to see if Geronda or Victoria you have questions on any of that. And then I can certainly go into more detail about those tools if that's interesting.

GERONDA: It's super interesting. And I do have a question. But I'll kind of recap and understand that by having those different broadened expertise, you're having multiple people come together with this expertise so that you can ensure you're providing the best data to help you make those equitable decisions. Does that sound about right?

JENNIFER: That's exactly right. I think that as fantastic and expert as our team are, we are merely representative of a broader community that is doing this excellent work out every single day, trying to improve the way we care for people, representing different communities, building tools. And unless we bring not only those innovators from different backgrounds to the table but also representatives of the communities we're actually working hard to serve to the table, our efforts will be inadequate. And that's why we're so committed to this multidisciplinary, pre-competitive, and collaborative work as we build our tools and resources here at DiMe.

GERONDA: Yeah, and that's amazing. The question that I have for you, the follow-up question to that, is we try to look across...our company is global. We do have employees in many different countries across the globe. So trying to ensure that we have an understanding of the needs on a global scale can sometimes be challenging. Can you speak more to this multidisciplinary broadened expertise and how they might bring in perspective that can help shape your technologies or even clinical trial project in a way that supports different ethnicities across the globe and how they identify and even intersectionality of folks as well, so not just race but also LGBTQ or other races as well like socioeconomic status?

JENNIFER: It's such a good question, and it's so important. And I think one of the things that I have frankly learned an enormous amount and really taken to heart are these many different domains and these many different vectors of inclusion. Now, first of all, if we start saying, look, we have to consider these 50 (I'm being facetious, intentionally so.) different considerations, then we're going to become so overwhelmed so quickly that we become absolutely ineffectual as we try and think about serving all of these different individuals.

But, Geronda, you gave fantastic examples around the hard work that you've been doing even in your own website environment to make sure people who are differently abled...they might have certain vision or hearing impairments or whatever that might look like, and they can access your resources. They can interact with your team just as easily as anyone else. So I'll give you an example of something that had never occurred to me until we actually started working with a member of a community who represented this particular part of the workforce.

We were talking about actually how we can use a variety of different tools to monitor respiratory illnesses and diseases. You can think about things like asthma. You can think about things like cough was an important symptom of COVID, for example. How can we use the microphones that you might find in your smartwatch or your smartphone? How might we use these to be able to monitor, predict and track disease?

We'd gone through how does different socioeconomic status, how does place, how does race, or ethnicity perhaps play into your access to these different tools, your tech literacy, your trust in these different tools and products? What had not occurred to me at all...and I'm so embarrassed to say this, but you think about you can have a tool where you do all of the work around inclusive design. You can think about all of the different needs to earn the trust of the communities that you're asking to use these tools. But we hadn't contemplated how you might use these tools if someone, for example, worked in a work environment where it was incredibly loud.

If you're on a building site, if you're in a warehouse, if you're working on a checkout, it doesn't matter how good the sensor is in your smartwatch that you may have been provided with because that work environment is going to absolutely drown out any signal from that stream of data. And so we need to think about all of the different ways that someone's life, and career, and their background, and social determinants affect our ability to develop and deploy tools that really can help them manage their health, improve their health, have better health outcomes.

GERONDA: That's amazing.

VICTORIA: That's amazing. And I wonder if you've encountered too an issue with if you're designing these applications...like I know when I was living in Washington, D.C., there were 3,000 people who don't have internet at home, don't have a computer, don't have a phone. So how would your team approach that kind of problem?

JENNIFER: [laughs] I think this is the theme of our conversation.

VICTORIA: [laughs]

JENNIFER: With intentionality, which is, is the goal here simply to provision tools and technologies, or is our goal here to be more thoughtful about the tools that exist, that we can use? Is our goal here to think about digital infrastructure and how we should be thinking about that not just to power healthcare but also perhaps access to education, access to safe and secure bank accounts, all of these different sorts of things?

We cannot assume that every single person has top-of-the-range technology, unlimited data plans; we are foolish to do so. But the first thing we need to do is actually ask and understand what access to technology looks like and not just assume it's an affordability issue. Maybe it's a trust issue. You have to understand the root cause before you can work to solve something.

I'd also offer up some other data that I always find compelling and important as we have these conversations. While we know there are large portions of the population who don't have access to what some of us, unfortunately, when we're moving quickly, just assume that everyone has, there are also horribly underrepresented populations, represented populations that do have access to these technologies. Some recent data actually showed that one-third of homeless individuals in California do have a smartphone. Let's actually just pause and think about that for a moment.

You can't get access to benefits or brick-and-mortar healthcare because you have to go and fill in all of your information if you don't have a home. But if you have a smartphone, which presumably many of these folks have realized that even at some of the hardest times in their life, they actually need that to stay connected in today's digital economy, that this is actually a way and a vector for us to reach them, for us to capture information and data about what it is they need, not just to improve their healthcare but to get supported into a more safe and sustainable environment with more security where we can actually support their health in a much more holistic way.

It also can connect them with care, whether that's mental healthcare or whatever their needs are in any given moment, that if we were relying on the traditional brick and mortar system, we'd be unable to capture. So this goes back to two things. First of all, don't assume. Don't assume that people do or don't have technology, and if they don't, don't assume you understand what the root cause actually is. The second point is don't think about these digital tools as limiting factors; think about the ways that we can use them to overcome so many of the challenges that we've faced in the way we care for people for decades and decades.

VICTORIA: I love that you bring that point up. I volunteered for many years with an application called HopeOneSource, which is a mobile app for people who are experiencing homelessness to get access to services that they need. And I know it might have changed over time, but it was like 80% of people who are experiencing homelessness do have a cell phone. And partly in the United States, there is a subsidy. If you're under a certain income level, you can get a free cell phone.

But it's very easy to have your cell phone stolen or to get lost. And the impermanency of the device is also an issue. So I think it's actually, like you said, you don't want to make assumptions about what people have and what they don't. And you do want to bring the intention and understand what it's really like because that will change how you build in things like security and two-factor authentication and things like that. So...

JENNIFER: That's exactly right. And also, what are some of the infrastructure things we can do? You mentioned the subsidies for folks who are low-income. But then we want people to start transmitting confidential and private information about their health in order to access the highest quality care possible. Are we creating environments where there is access to secure connection environment? So they're not using public Wi-Fi where they actually might be more susceptible to harm due to sort of misuse of that data if it falls into the hands of the wrong folks.

These are all of the different things we need to be thinking about. That's not to slow us down or to dampen our enthusiasm for the opportunities that digitization provides to improve the way we care for people. But again, it comes back to...I think what's emerging is almost a theme of our discussion, which is the need to be intentional.

GERONDA: I love what you said about not making assumptions because I'm a DEI practitioner, but I always tell people I'm not perfect. [laughs] And so my bias comes in sometimes. I sometimes will assume that I might know the answer to something or what somebody may be experiencing because I may be incredibly passionate about the LGBTQ+ community, which I'm a part of. And it's reminding myself that I can't assume or let my own biases or own feelings towards certain things to steer my decision-making.

I really have to be super open and objective to what the facts are telling and get those other experiences from other people. So I continuously check my bias, and I continuously try not to make those assumptions which can be hard at times. And while I know everyone at thoughtbot thinks I'm perfect, I'm the best, [laughter] it's just not true.

VICTORIA: I think it is true. [laughter]

GERONDA: There you go.

JENNIFER: Geronda, I so appreciate you sharing that, and I think it probably is giving everyone listening the same experience that I am having right now, which is you owning that and being willing to share that. Immediately cascading through my mind...and now all of the assumptions that I come to the table with, and all of the ways that I think about things and those hot topics that are unique to me and my lived experience, and what I've been exposed to. And on the one hand, we should never dismiss that. On the other hand, the definition of being inclusive is to go out to folks with those different viewpoints.

And one of the things I see increasingly featuring in these sorts of domains of diversity is political views. And you think, gosh, how has this even become a thing in the way that we consider caring for people? But it's so divisive. And I come to the table with all of my thoughts about these kinds of things. But what's serving us about our lived experience and about the passions that drive us all to try and create better products and a better and more inclusive future, and what's not? And how can we humbly acknowledge that and really listen and hear what others are telling us?

GERONDA: Right. Exactly, exactly.

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VICTORIA: If I'm a clinical researcher and I'm about to design an experiment, let's say, how can I use the resources at DiMe to help inform my opinion and help bring in that inclusivity, which I want?

JENNIFER: So, Victoria, great question. [laughter] I'm teed up to answer this one. So I think the first thing is, and, Geronda, this is something that you mentioned earlier, which is you don't do a 45-minute brainstorm before you get going, check a box, and say you did it. It's a continual process, and it's a process of continual improvement. So when we describe this, we would discuss the entire clinical trials lifecycle. So, first of all, there are DEI considerations, even in the kind of question you want to answer.

If you are doing clinical research because you want to develop a new molecule, a new pill, or something, for example, what community will you be serving? What's the problem we're trying to solve for? Are we trying to add a me-too drug to a population that's already well-served? Or are we actually thinking about, gosh, there's this underrepresented population? There's a disease state where we've struggled to break through. We believe that we can deploy these digital tools in order to really effect change here. So it starts as early as what is the problem you're trying to solve for? What is your research question?

Then each stage as you think about, gosh, what are the tools that I might want to use in order to answer this question? Who are the people that we could possibly serve through the development of this new drug, for example? Great, then we take seriously our responsibility of making sure that every single individual who participates in our trial reflects and represents that broader population, that we are going to take inclusivity seriously so that when we have an answer to our research question, we know that what we know about the safety of a new drug and what we know about the effectiveness of a new drug applies equally well to every member of the population.

At that point, we're asking ourselves questions about as we think about parts of the clinical protocol, so the different steps that we work through in order to safely administer a new therapy that's part of the trial, as we think about capturing the information we need in order to determine whether it's safe and effective, are we setting that up to be as safe as effective for everyone? Are we able to design the trial in such a way that the burden of participation isn't a barrier for certain members of the community?

If we're picking digital tools to do things like remote patient monitoring...so imagine for anyone who has a smartwatch the green light on the back of your watch that's measuring your heart rate. Unfortunately, some of those products work differently across different skin tones. Have you done the work to make sure that you're selecting a tool that is going to give you equally trustworthy information for every single person? These are all of the things step by step that you should think about as you are developing a clinical trial.

We have tool after resource after checklist to help you do this in a really accessible way. We organize them so you can find them really easily based on either what stage am I at and what can I do today to be more diverse, and more equitable, and more inclusive in the way that I'm developing new medicines? We also allow you to find these tools and resources based on a particular digital product.

So if, for example, you think that you might be able to use, and we haven't said the words yet, so it's probably time, AI or machine learning to better identify a more diverse patient population that you could enroll into your trial, how are you thinking about catching potential bias that might take your good intentions and actually render them almost useless because you didn't identify bias in the algorithm, for example? So all of those tools and resources, and there are over 60 of them available, are open access. They're free to download, use them, interactive checklists, considerations documents, tools, and resources that help you act today as soon as you make a decision about doing clinical research that benefits all people.

GERONDA: And it almost sounds like, in a way, that this resource could be helpful for many other industries as well because although it's tied to clinical trials, the considerations and process that you're taking to start to think through those DEI elements that checklist can be helpful across many different disciplines. Would you say that's correct?

JENNIFER: I would. Now, Geronda, our superpower, is getting the digitization of healthcare right. And that's a big enough task that while there are other pressing areas, we will not stray into those. But I think you've hit the nail on the head. When we think about getting access to education, for example, or access to safe housing, or any other kinds of benefits, and we can think about how some of these digital tools can overcome many of the different barriers to access that different communities face. Absolutely, all of these different principles can apply. And in fact, we actually think that's really important.

We talk a lot about harmonization in the work that we do. There are folks who have product portfolios that span different industries. When we think about really trying to hammer home the need to be intentional, to make sure that as we digitize the healthcare industry, we are bringing everyone with us, we should avoid, wherever possible, having unique or special considerations. Ultimately, these are all the same humans that we serve in other industries. We are trying more than ever to meet people where they are than insisting they come to us or come to the clinic, for example.

All of these principles apply equally well. And if we do that harmonization well...and this comes back to the idea of culture that we were talking about. This just gets embedded into the culture of developing products for every single person, regardless of whether that's an educational product, or a healthcare product, or a financial product. We should be thinking about these things regardless of how we're striving to help and support people.

GERONDA: I love that.

VICTORIA: I love that. And I wonder, when you were developing these products for clinicians or for healthcare providers, was there anything surprising in your initial research and discovery when building these things?

JENNIFER: Yes. And I would say that technology is no longer the barrier. There is nothing that we need a product to do, whether that's the way we account for, right? You're not always going to eliminate it. But the way that we account for, for example, bias in the way that we capture and process data, if you acknowledge it, you can do the necessary statistical interpretation. And then you can actually be well-informed in your decision-making.

There's nothing either about the data, about the form factors, about battery life, about the performance of these tools that is stopping us from building and deploying solutions that work for everyone starting today, starting immediately. So then, what is the barrier? The barrier is a knowledge gap, a skills gap, an incentives gap. And that's really what we've been hammering to address.

And if you do look at our DEI resources, especially for digitized clinical trials, we try and think about all of those gaps and support people, whether it's through, here, let us educate you on actually where some of the risks are, some of the new vectors of inclusion or domains of diversity, especially at the intersection of digital and health. Let us support you with tools and resources, and guides for how to do this.

And then let us give you data and let us give you things like a market opportunity calculator, which is something else that we've created that will actually give you the business case to be more inclusive in the way that you develop digital products for use in clinical trials and the way you deploy them to support better research. That's really what we're focused on.

And so the surprise almost is that the tech isn't limiting us in any way. The flip side of that being we are not going to tech our way out of this. It comes down to humans and our decisions and how we develop and deploy these tools in the service of better health.

VICTORIA: That makes sense to me, and it makes me think about there's like a moral obligation or value that you can apply to DEI, but there's also a financial aspect. [laughs] And if you put a lot of effort into building an app, for example, and don't think about inclusivity, and you get to the end and think, oh, now I have to go back and make it accessible, that can be a lot of rework. It can be a lot of cost, if not even a legal liability and financial liability, I would imagine, in the healthtech sector.

JENNIFER: That's exactly right. I couldn't have said any better, Victoria. [laughs]

VICTORIA: [laughs] It's like, you are morally and legally obligated in many cases to include people. And it's better to just start from the beginning and start from the beginning and knowing what we're trying to do.

JENNIFER: 100%. And I was trying not to pile on because I think the statement just stands alone. We are morally obligated. In some cases, we are legally obligated. There are emerging regulations certainly in the clinical trials environment about having more representative samples in order for you to get regulatory approval, for example. One of those regulations is moving slowly, which is always frustrating and disappointing. But given the moral imperative, given the emerging regulations, given that finally, this is more at the forefront of conversations, you've got to think about the gymnastics that are happening to continue to avoid doing this. And that's a little bit of the pressure that we want to apply.

And so when we talk about the fact that there's no technological reason for not doing this, and when we have tried to provide the tools and resources to actually put these tools into practice, the only remaining question is, are you going to do it? And that's a big question. And as a field, we've not been terribly good at leaning into that previously. We'll talk about it all day. We'll admire the problem of inequity all day. We haven't been good enough at acting. And I'm hoping we're at a tipping point.

VICTORIA: Great. And it sounds like now with DiMe, there's no excuse. All the information is there for you. [laughter]

JENNIFER: That was exactly what we tried to do. That was the challenge that we gave ourselves and this extraordinary team. And the different individuals and organizations that came to the table to do this they set the standard high. And I'm so proud of their sort of possession, of their courage, and their tenacity in saying, "We are going to serve up absolutely everything that's needed. We're going to present it in a way that it's almost impossible not to find what you need for every person who's coming with this question." We set the standard high, and I'm incredibly proud of how well we delivered on that.

VICTORIA: What does success look like for DiMe in the next six months or in the next five years?

JENNIFER: What is it? Is it a Bill Gates quote? Is it...you sort of overestimate what you can do in 6 months and underestimate what you'll do in 10 years, something along those lines. And the intention is there, though. Anyone who knows me well will probably say I've never underestimated anything in my life. I'm always pushing for the next thing. Let's come back to this notion that the tech is not the limiting factor. And we're facing a really interesting moment in healthcare where the current environment is simply not sustainable. There are not enough clinicians to provide care or conduct research. We've had an expensive healthcare system for a long time.

But the prices are not sustainable when you think about how much health insurance is going up relative to inflation, when you think about the out-of-pocket costs that people are facing when you think about the fact that there's not a single healthcare executive who's sleeping well at night because they can't staff their units, and their supply chain costs are incredibly high. And they're worried about the sustainability of their hospital, especially in rural and underserved areas. Business, as usual, is not an option.

So in the next six months, I think we're going to keep pushing along. But in that five-year window, I think we are going to see a fundamentally different way that we care for people in the healthcare environment and that we conduct clinical trials. No longer is healthcare going to be built around the clinic. That's not to say they're going to go away. There are, of course, going to be times where you need to see a clinician in person, where you need to have a procedure, where you need to have some lab work or imaging done.

But so much of this can be translated into the home, can use tools to extend the knowledge and expertise of clinicians so that we can better care for people, all people, by meeting them where they are. I think we're going to see a fundamentally different kind of healthcare, different kinds of clinical research built around the patient, not the clinic. And part of that is going to be redefining what good healthcare even is. Currently, good healthcare is once you turn up at the clinic already sick, sometimes really sick, facing a catastrophic and likely very expensive outcome, we do our best. That's good healthcare.

I really think we're going to drive towards a future where these new flows of data and these new technologies are going to actually allow us to try and mitigate disease earlier, to intervene earlier, to catch all people who are at risk earlier in their health journey. And the great thing about that is it offers the opportunity to define healthcare differently. All of a sudden, good healthcare isn't; how good are we at intervening when you're sick? But how good are we at keeping you well and keeping you out of the healthcare system?

I also feel strongly that it is no longer going to be enough to just raise the top end of healthcare and provide the best care to the people who are able to afford it, that we are going to start to embed metrics around equity into our evaluation of good healthcare. And the sooner we do that, the better because every time we look at those numbers now, they are astonishingly bad.

VICTORIA: Yeah. And it's making me think about, you know, in five years, if we continue with the trend of global warming, they're also predicting more pandemics, more disease. And it seems like we are going to have to reimagine how we do healthcare because the current path isn't sustainable.

JENNIFER: Exactly right. Exactly right. And the sad thing about all of this is that the burden of things like climate change, the burden of pandemics falls on those communities and those individuals who have been underrepresented and underserved in healthcare for the longest. It increases the burden of disease and health stress on folks who have consistently carried the highest burden of disease, been part of the highest risk categories. Not only do we have to get better at delivering care to all people reducing the burden of disease, we have to do it where actually those challenges through all of those external pressures, Victoria, are going to be becoming worse.

VICTORIA: And it reminds me of another term I've heard for underrepresented, which is historically excluded, which I think really applies here. So that's fascinating.

JENNIFER: Because it is what it is.

VICTORIA: Yeah, right? Like, that's what it is. So I think it's wonderful that's what you're working on. And let's see if you could go back in time to when you first started DiMe Society; what advice would you give yourself now that it's been three years and you've come a long way?

JENNIFER: [laughs] Sleep more. [laughter] I don't know, when I look in the mirror these days, there's an old lady that I'm sure wasn't there at the beginning of all this. But I think that's not the spirit of the question you were asking, Victoria. I wish we'd been bolder sooner. And we've never shied away from tackling the hardest problems. We started with this bold mission and vision.

People would ask us when we launched DiMe, you know, "Gosh, are you really focused across individual health promotion, across healthcare delivery, across public health, and across clinical research?" And we said, "Absolutely," because if we don't tackle it all together, we're simply going to create new silos in the digital era. And we're never going to move towards this reimagined healthcare system, a new healthcare system, one that cares for everyone and where access to research is even harder than access to care.

With these new flows of data in the digital era, we want to do it together. So it's not that we weren't bold, but the way now we make strong statements that we've always believed and that we've always been proud of around the imperative to be inclusive around the demand for high-quality evidence to drive trust around the fact that none of this is a tech issue. It's a human issue. I wish we had gone there sooner. I think it is serving us well.

I think that the professionals that we work with across industry respond to it. They want to be part of this journey. They want to build a better healthcare system. And so, while we've always been, I think, bold and courageous in the vision that we've held and the work we've done, giving voice to it in a way that really reflects our vision and our passion has been so well received by our community. And they have stepped up to do this work incredibly well. I just wish we'd gone there sooner. That's the only thing I would have done differently.

VICTORIA: I think that's great advice, especially for founders who are starting out in a space like this, to really stand by their convictions and be bold about it. [chuckles] Like, this is what you believe in, and other people will connect to it if it's right, so I love that. And we're getting towards the end of our time here too. So I want to make sure I can pass it to Geronda if you have any other final questions for our guest here today.

GERONDA: More a comment in that I think that learning more about your organization and perusing some of the tools that you offer and the checklist that you offer...and it's such great work. And in some ways...and I'm trying to get the best way to say this. But in some ways, it's so clear of, like, this is what you can consider. This is what you should do. Although the work is not easy to do, it's really a helpful guideline for how you can start to think differently.

I really appreciate the thoughtfulness that was put into a lot of these resources that you're giving out and just where you are in your trajectory as well because DEI work is not easy work. And you sometimes...it can impact you emotionally. It can impact you mentally sometimes. But when you're continuing to go after what you know is needed and the intentionality of things, it really is super helpful.

So although I said I didn't have a question, and I just had a comment, I lied. I do have a question. [laughter] My question to you is, in doing a lot of this work, ensuring that DEI is infused in healthtech, all the work that you do and that your team does, how do you just navigate and manage your well-being, your mental health, your emotional health as you continue to do all this work?

JENNIFER: It's such a great question. And when you said, Geronda, that this can sometimes be really emotional, I heard a statistic actually from a colleague of mine, Ricki Fairley, who's the CEO of Touch, Breast Cancer, and she was telling me that cancer affecting women under 35, Black women under 35 are diagnosed with cancer at a rate twice that of White women and die at a rate three times higher than White women. And, I mean, you hear that statistic, and it just takes the wind out of you. And it would be really easy to hide from that because it's hard to hear, sometimes too hard.

The way that we handle sort of all of this as a team is we square up to these data, and then we celebrate one another. We celebrate our community when we are able to make positive change, even if it's incremental change. Even if sometimes you have those moments where you really move the needle, you have those other days or those other initiatives where you feel like you're crawling on your hands and knees to gain inches.

But to celebrate that every moment and to remind ourselves the work is returning value to those people that we all get up every morning to try and serve, that it might be hard, but we're making progress. And that is, I think, the way that, as a team, we stay positive, we stay productive, and that we're able to balance, frankly, the exposure to the reality of some of these issues.

GERONDA: I think that's great, having a community even within the workplace. It's so crucial because you spend most of your time at work, as we all know. [laughs] And there's a lot that just goes on across the world all the time, and being able to just talk it out. We have employee resource groups for people to come together with common identities and just talk through things that are impacting them. And so I really think that's great that you're able to just be honest with how you're feeling but also celebrating those important positive moments because sometimes we can focus a lot on the negative. So I really love that you bring the positive aspects of that as well.

VICTORIA: Yes, thank you for sharing, and it comes back to the intention. Like, we're all on the same page. We all have this intention of solving this problem. So we're in it together in a way. So, Jennifer, are there any final thoughts or takeaways you want to leave our listeners with today?

JENNIFER: No, this was a fantastic conversation. I think we've drawn out this theme of intentionality that will serve all of us very well. Geronda, I love the final question about how do we keep our own sort of emotional state and mental health solid as we do this hard work? It's the perfect note to end on. So Victoria, Geronda, thank you so much for having me on. This has been just a wonderful conversation. I've really enjoyed it.

VICTORIA: Wonderful. Thank you so much for joining and spending time with us today.

JENNIFER: Yes, I very much appreciate it. This was an awesome conversation.

VICTORIA: All right. And you can subscribe to the show and find notes along with a complete transcript for this episode at giantrobots.fm. If you have questions or comments, you can email us at hosts@giantrobots.fm. And you can find me on Twitter @victori_ousg.

This podcast is brought to you by thoughtbot and produced and edited by Mandy Moore. Thank you for listening. See you next time.

ANNOUNCER: This podcast is brought to you by thoughtbot, your expert strategy, design, development, and product management partner. We bring digital products from idea to success and teach you how because we care. Learn more at thoughtbot.com.

Special Guest: Jennifer Goldsack.

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