A Data-Centric Perspective: Reframing the Global Health Care Conversation

December 03, 2021

Data is reframing the global conversation regarding advancements in health care. In this episode of TechTalk, health care innovator and advanced technology expert Radhika Iyengar joins EisnerAmper’s West Coast Technology and Life Sciences Practice Leader Amar Bhatkhande to discuss how blockchain and artificial intelligence are transforming the health care industry—and its future.


Transcript

Amar Bhatkhande: Hello, and welcome to TechTalk. I'm your host today, Amar Bhatkhande, Technology and Life Sciences West Coast Practice Leader at EisnerAmper. And with me today is my friend and a special guest, Radhika Iyengar, a blockchain in healthcare expert. Where should I start, Radhika? She's a TEDx speaker, Silicon Valley Woman of Influence, a CEO, author, board member, advanced technology expert, and healthcare innovator. Wow, that's a mouthful.

Today, you will get to hear first hand from Radhika on the topic of healthcare from a data perspective. What you hear today may give you a different perspective and influence your next business decision. Welcome to the show, Radhika. Thanks for joining me today. Please tell our listeners a little bit about yourself.
Radhika Iyengar: That was a pretty great introduction. Thanks so much, Amar, it's such a pleasure to be here today with you and to talk all things data around healthcare. It's definitely a topic that I'm very passionate about. As far as my background or a lot of what I'm doing in terms of next generation in healthcare, is really framed by data.

It's fueled by a vision that we can actually do some things that are fundamentally different to give us better quality of healthcare worldwide. So that's something that really propels me forward. And in terms of my background, we can get into that, but it's very much of a global conversation. I'll just say, leave it at that.

AB: Perfect. So I understand you were born in Bangalore, raised in Morocco, you speak multiple European languages. How have your personal experience influenced your approach to your work and life's passion?
RI: Great question. When I grew up in Morocco, and to be clear, I was at the northwestern most tip of Africa in Tangier, which is about 14 kilometers away from the coast of Europe. It was a really unique place to grow up. Obviously, my cultural home is India. My mother tongue, so on and my cultural traditions are all Indian, but I think my experiences growing up in a place like Tangier in Morocco, it was really a part of gateway culture, I would say. North and south, east and west, and it's where all of those confluence of multiple cultures and traditions.

So when I look at the world, I think it really has shaped my view of the world as a one world perspective. We are all more similar than we know. And so when I look at any of the things that I'm working on, even from a technology perspective, that's the thing that excites me most is that how can we develop the most impactful solutions globally to what we have going on in the world? It's not about our immediate backyard or immediate ecosystem. It's about a global conversation. So for me, I think growing up in a place that was as diverse and multicultural as Morocco is, and Tangier is, a lot of that mindset is embedded in what I do today.
AB: I can just say wow, I think that journey is so fascinating. Well, I'm going to shift the gears a little bit and let's talk about data and healthcare. So I've heard you talk about data-centric approach to healthcare. How does it reframe the conversation regarding the advancement in healthcare?
RI: Another great question. Let me just set the context for what it means to have data in healthcare. I think when people think about healthcare, they may not always just think about the data perspective, but if you think about who we are as individuals and over the course of our lifetime, many of us, like me, born in one place, raised in another, have traveled around, lived in multiple spots. And every place we've gone from birth until throughout our lifetimes, we have a piece of us residing as far as a health record or a data record that is sprinkled in all of these different places. What we lack still today is a contiguous, holistic sort of record that it contextualizes everything about who we are. We have pieces of who we are residing in multiple areas with different providers or clinics, or even the data that we ourselves generate daily, for example, with a fitness tracker or other things that we use.

So the entire data conversation is something that really jumped out at me because I was involved in healthcare early on as a pre-med student a long time ago. And I did not choose the clinical path of pursuit of medicine, so to speak. But that passion for doing things in healthcare has always stayed with me throughout my life. And then nearly 10 years ago, when I got involved with digital health and looking at the advent of technologies and how these technologies can really help us do things better in the delivery of healthcare, the one thing that did jump out at me is what do we do with all of this data? It's still incredibly fragmented and siloed and indeed, the vision that we had when people were working on electronic health records and so on, and although we have a huge adoption of health records today as EHRs, the conversation still is fragmented.

It's still siloed and it's very difficult to share from one to another. And so the entire conversation in terms of a contextualized discussion around who we are as individuals, is still something that is to be desired. And so I think what I'm doing today is really solving those fundamental and foundational kinds of challenges that we have around a data centric discussion around who we are in as individuals and the kind of healthcare journeys that we have. If you look at the holy grail of healthcare, you ask anybody that's involved in healthcare, they will tell you that personalized medicine and personalized healthcare is a big dream. We'd all love to have healthcare tailored to who we are as individuals, much like we have anything else that is tailored to our preferences, to our lifestyles, to just our beings.

So if you look at all of the other advancements that we have in other aspects of our lives, where things are far more personalized than they were ever before, it's tailored to who we are as individuals. It makes it much more meaningful and definitely much more engaging to us as individuals. So I look at how do we achieve that big lofty goal of personalized medicine or personalized healthcare, and that is really a dream to go after. We still find, no matter how many advancements we've had in digital health and in telemedicine these days and so on, it's still that one size fits all approach. And so it's the next generation of what we're supposed to see from a data centric perspective is really what's going to be driven by a new approach and a new conversation around data.
AB: So let me, in continuation of that. So who do you think are some of the players looking at healthcare from an advanced technology perspective?
RI: I think there are a lot more players, I would say, looking at healthcare from the AI side of things. These days we're seeing huge leaps and bounds of advancements with AI on the diagnostic side, for example, on the clinical trial side, for example, in healthcare. But that's really where a lot of that new innovation and action has been. And of course there are digital tools available to us, including digital therapeutics, for example, for mental health and so on. But when you look at who's really looking at solving foundational challenges in healthcare data, I'll say that a lot of the blockchain based solutions that are coming up and have been deploying in the last few years have really started to think about the entire discussion around data structures. You have companies, for example, mostly today, looking at the non PHI or non-protected health information side of healthcare, which is to say revenue cycle management, for example, which is where the clinical side, administrative side, and financial side of healthcare converge.

So if we look at billing systems and the health record system and the administration systems, and all of those can combine in something like revenue cycle management, that's one example of people like Change Healthcare, for example, that are doing important things in changing that conversation, which are based on blockchain based systems and very scalable systems, by the way. So Change Healthcare for example, is currently at about 50 million transactions per day. So that's a highly scalable system that has been developed on that side. Ultimately, one has to think about why blockchain. I'm talking a lot about blockchain as one of the big elements. If you look at the ethos of blockchain, it's really that single source of truth. Trust and integrity around data are really the cornerstones of what we think about from a data-centric perspective, and who are the players who are working with this. For example, there is a consortium, and this is unique again to blockchain where you have consortia. The consortium that I'm referring to is Avaneer Health.

You've got big names in the business. You've got Aetna, Anthem, IBM and several insurance companies like HCSC. You've got a number of different players that are involved both on the insurance side, the payer side, i.e.. you've got a bank, the PNC bank, for example, that's an interesting scenario where you've got a bank involved. And again, all of these mean that these are different stakeholders at the table, looking at how you solve the conversation around data, as it pertains to I would say more of the revenue cycle management side of things. Certainly that is a foundation in a way in discussing what data really means for healthcare, because if you look at a health record, you've got different aspects of it. You've got the medical record itself, but then you've got a financial record, a legal record. There are multiple aspects that come around that health record.

And so these are the aspects that many have been focused on. They've also been focused on how do you credential providers and such. And so there are many use case on the administrative side of things, relieving burdens that have been existing for many, many years. If you look at the delivery of healthcare, now it's an entirely different conversation because now you're having to deal with patient IDs. So there's a lot of regulatory push right now through the House of Representatives, and also in the US Senate, to talk about what does it mean to have a unique patient ID? So I think in the future, when we have blockchain based systems or decentralized technologies that are underpinning what a unique patient ID truly means, it shifts the conversation not just from a provider and a payer perspective, or even a financial perspective, but the patient perspective as well.

So we are as much of an important stakeholder in our own journeys and in our own healthcare records as anyone else at the table. And so these unique models of who's doing what with healthcare, that's where I will make a plug for the company that I'm a CEO of, which is Barlea Corporation. We are a trusted backbone of data for all data. And when I say all data, we're talking about data that's not only in motion, it's moved from one place to another, but it's also data at rest. And so if you think about how data has to be conceived of, number one, it has to be secure and trusted. Number two, it has to be private. Because this is back to our unique patient ID side of the conversation. And then it also has to be authentic.

The integrity of data has to be preserved end to end. The visibility and transparency, not of the data itself, but of the record of transactions on that data, meaning who's touched this record, who's seen it, who's handled it, who's shared, who's viewed it, all of the aspects that we're thinking about, who's interacting with the data, those records of transactions also have to be kept intact. And when you think about the difference between Web 2.0 models, where you have single owners that own that data repository, there's a lot of, unfortunately, a lot of manipulation that can happen in that data. And so with blockchain and Web 3.0 technologies, we find a much different construct around data and how we're treating the conversation around data.

So Barlea as a platform is that trusted data backbone for many different stakeholders in the ecosystem to come together and be assured that all of the data that is traceable and visible on that platform, you are recording every transaction that pertains to that record. You're not going to see the actual record because again, that is private. And so this comes back to that unique patient ID kind of model that I was talking about that the government is so passionately now advocating basically as the next generation of what we have to have. So I'll just say that Barlea Corporation is one of those companies that is really reframing the entire conversation around data, particularly what is security, what is privacy, what is trust around data. So we are a cybersecurity platform, in essence, that is establishing the zero trust sort of model around data and providing maximum visibility into end to end transactions around a patient's health record. So these are some examples that I'm throwing out there in terms of various entities, both consortia, as well as individual companies that are working on changing that and reframing that discussion around data and trust.
AB: Perfect. So I think you brought up a good point of blockchain. So let me ask you this. How are we as a society making advancements in healthcare and how are the technologies like blockchain, AI leading the way?
RI: Pretty voluminous question there. When you think about what the implications of these technologies are, I'll just say this. From my own interaction and participation as a member of the select task force, it's the California Blockchain Working Group. We are a select task force that's been working to advise California state legislature, and Governor Newsom on the implications and applications of this technology for California. We came out with our report July of last year, 2020, Rick recommending certain areas that the state of California could view, start interacting with this technology and exploring public private sort of partnerships and how we could redo certain systems, essentially using blockchain as one of the foundational technologies. The reason I mention that is if we're thinking about the future and what this means for a society, what this means for a community, what this means for the world, it's where technology and policy come together.

And it's also where public and private sectors can come together to reframe that conversation. When I look at the future of what healthcare means, first of all, it's personalized. We've got to get away from this one size fits all mentality in healthcare, once and for all. It's been a dream for many, many, many years, probably decades, I think, but it has to come to fruition. It can be a reality with using technologies like blockchain and AI. If we think about privacy and trust, what does that mean? And for us to have full privacy and trust around our data, we are going to have to be empowered in that journey. So it is about a different model where people like you and me have the right to grant and revoke access to our own records. This is the generation that's coming.

This is not about others taking control of that. It's about us taking ownership and control of that process. So there's a lot of things that HIPAA laws for example, were designed to protect privacy, but they only went so far. So we are at the cusp of that next threshold, something that I outline in my book. It's really the internet of identity. So there's the internet of trust. There's the internet of value. There's also the internet of identity. And so identity is one of those big things that I think there's some tremendous advancements and promises that are being made, and they're all based, a lot of the decentralized technologies underpinning that future of what it means to have identity and digital identity that you can own and operate and administer yourself.

It's really a game changer, I would say. And particularly when it comes to healthcare, what I see as the future is that which is going to enable us to become true drivers of our healthcare journeys. It really is a healthcare journey. Who we are today may not be what we are tomorrow, and we have to take ownership and control of that journey. But that means also taking ownership and control of everything that pertains to us from the data perspective.
AB: That's a very powerful message that you're giving to the community. Earlier in this conversation, you did mention about your book. Can you tell us a little bit more about your book?
RI: Sure. My book is called Enterprise Blockchain Has Arrived. It was published in 2019. My co-author and I published it to, once again, democratize access to information around a very important technology in our lifetime called blockchain, and decentralized technologies in general, the power of this technology and the real value and real deployments that we can see happening across the board in many different sectors. So the book not only talks about why this technology, how have we gotten here, who are the players, who are the different platforms that are doing important things in this technology. But then also the different use cases, so we explore financial services and banking, we explore supply chain and logistics, healthcare, and life sciences, the power and energy sector, blockchain for social good, for example. So there are many areas and also the nexus of different technologies like blockchain, AI, and IOT.

What we were impressed most with this technology was not the hype. It was not about the hype of crypto or any of that, although crypto is very exciting, and there are many different use cases that are coming out of that. It's really more so of the foundations of what we're solving for the next generation and beyond. This is about a generational lasting sort of impact, like I said. So the book has been written with that view of how do we create impact with this technology? What are the opportunities that anyone can explore, whether you're an entrepreneur, whether you're an investor that wants to look at the next big opportunities for investment, whether you are any other company like an EisnerAmper, looking at what the potentials are in the various sectors. This is the reason why we wrote our book.

I would say in general, that the most important thing that I can leave the audience with is that to think about web 3.0 technologies and particularly blockchain as being the next foundation for the future. The internet has been a great ride. We've had an incredible ride with the internet over the last couple of three decades or so. And we've enjoyed the open communication capabilities, because if you look at it from protocol perspective, that's really what that was about. TCPIP was always about open communication, but it was not designed for privacy and security. So I look at the next generation of systems foundationally and my colleague and I wrote this book to look at where the next transformations are going to happen using this technology.

But it is split into different sectors. We have interviews with many world leaders represented in the book as well. So it's our thesis, as well as these conversations. And we are also working on a second edition. Much of the content is being updated because this is about a moving technology. Obviously it's not static, it's a dynamic environment. So we are working on the second edition at this moment, and we hope that people will take the time to read it because we feel like it is the most comprehensive review on the technology, not only from the application, but from the implication perspective.
AB: Perfect. So no discussion will be ever complete unless I ask you to state your vision for the future of the healthcare industry. So would you mind doing that in a few words?
RI: I'll give it to you in a nutshell. I talked about the integrity of data and trust around data, the privacy of data, the security of data. To me, and this is where Barlea's dream comes in and vision comes in, is about redefining cybersecurity for healthcare, because what we're looking at is increased ransomware attack. They're so insidious and the ramifications so voluminous that we need to change the entire discussion from a foundational perspective. As I say, we don't have time anymore for band aid solutions to deep tissue problems. So what we're doing is rethinking how this is constructed from a data perspective so that we can have trusted, private, secure, authentic data processes end to end. And that entire integrity of data is really what I see as the future of healthcare. What it delivers is personalized healthcare and personalized medicine going far beyond just the sophisticated processes that perhaps AI gives you.

AI is amazing. AI is sophisticated. It can do marvelous things, but you know what they say, garbage in garbage out. So you've got garbage data coming in and you're running AI on top of it, your result is still going to be flawed. So I think for me, it's really looking at that entire data continuum and really defining what does that future of healthcare mean from a data perspective. And in now more than ever before, when you see a third of global hospitals attacked by ransomware, I feel like this is a real calling for me, and this is why I took on the CEO position at Barlea Corporation, to really bring about a new generation of healthcare cybersecurity that is hopefully going to now provide greater trust between a person and their provider, and to really empower the person to get more engaged with their own personal health journeys and deliver a more personalized care in health.
AB: Radhika, thank you for taking time to have conversations with me today, and thanks to our listeners for tuning in to TechTalk. Subscribe to EisnerAmper podcast to join us for our next podcast episode, or visit eisneramper.com for more tech news you can use.

About Amar Bhatkhande

Amar Bhatkhandé is an Audit Partner and a leader in the Life Sciences and Technology Services Group for the firm's West Coast practice, with over 25 years of experience in public accounting and 2 years in private.


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