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“In many ways, internet of things (IoT) is a double-edged sword: connected devices are capturing huge volumes and varieties of data that can be mined for everything from potentially life-saving health care information to guidance toward peak athletic performance, but it is incredibly difficult to convert that raw data into truly meaningful and actionable insights.”

Frank Fornari is a scientist and chairman and founder, BioMech.

He shares his story and discusses his KevinMD article, “The focus of the internet of things (IoT) must pivot to achieve health care potential.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show, we have Frank Fornari. He is a scientist and health care entrepreneur. His KevinMD article is titled “The focus of the internet of things (IoT) must pivot to achieve health care potential.” Frank, welcome to the show.

Frank Fornari: Thanks, Kevin.

Kevin Pho: We’ll get into the article in a little bit, but first off, briefly share your story and journey to where you are today.

Frank Fornari: Sure. So, you know, my background has been in science and medicine. I spent probably more years in school than I needed to. My training is in neurophysiology. I spent some time in medical school, and my doctoral work is in molecular genetics and pharmacology, with advanced training in structural biology and organic chemistry. So I set myself up to be the person who tries to unravel the mechanism of action of pharmaceutical agents, find targets across pathological processes, and design drugs to do that.

So the first company that we had was a pharmaceutical venture, and then we moved on to a national medical laboratory that helped clinicians understand how to prescribe drugs better, by bringing testing that we do during clinical trials to the masses, giving physicians access to the same tools as we would have in a clinical drug trial. And then this company: The technology goes back to, probably to date myself, 1984, when we started working on this. It’s mathematical biology, developing motion analytics systems that help understand how people move, how to assess treatment, and how to diagnose injuries, that sort of thing, using functional motion as an endpoint or a biomarker, much like any other laboratory test. So that’s my background in a nutshell.

Kevin Pho: I talk to a lot of physicians who are interested in going into the entrepreneur space. They have a kernel of an idea, or they have the entrepreneur’s spirit. So you’ve been in this space for a while now. What are some of the challenges to breaking into the health care entrepreneur space?

Frank Fornari: It’s as bad as it sounds. You know, the idea and the product you developed tend to be the least important thing in the business world once you get out there. And I’ve got lots of acquaintances, physicians and scientists, who have lots of great ideas, and most of the time they may work in a laboratory or on a small scale, but to make them practically useful in the health care space, they’re not designed to do that. So when I develop something, I always start first with why. Why would somebody need it? The how, where, and when are operational; they’re not easy, but they’re easier than why. So if you can’t figure out why something is to be made, then you should just stop there.

And then the second thing is that health care is overloaded. People are overworked in this industry. We don’t have enough people to deliver it, and access is very limited. So this has to be easy for the patient and the practitioner. It also has to be economical for the payer as well. So the product really needs to be, and the big one is, accessible. We’ve got a major problem that we’re trying to fix in health care: A lot of people just don’t have access to it. And technological products, no matter what they are, should be designed so everybody can get them, not just people in the middle of a big urban area or people that can afford to get them. And so we’ve kind of veered off in some bad directions in health care over the past 20 or 30 years, and hopefully the crisis that we’re in is going to help to remedy that.

So if you want to develop something and commercialize it, first you have to understand that 90 percent of it is going to be business process: understanding how to build a distribution channel, understanding how to get something reimbursed, understanding how to make it part of the everyday flow in a hospital or a clinician’s office, understanding your end user, your customer. Most inventors either just don’t have that skill, or they kind of see it as something that is not interesting to them, like somebody else will do that. So a lot of things just die on the vine because the inventor doesn’t have the wherewithal to actually push it, or brute-force it out into the system.

Kevin Pho: How does one go about finding that business information? Because like you said, it takes more than an idea. Do you go out and get an MBA, or find mentorship? How does one go about getting that training?

Frank Fornari: Well, Kevin, you know, I haven’t taken one business class in my life. I took accounting, which is incredibly valuable, by the way, probably the best course in business you could take. I never had the time to get an MBA, and I’m not saying an MBA wouldn’t have been a good thing. Had I had the time, I probably would have maybe learned some things that I’ve made mistakes on. But I will tell you, when you go into business, you have to not be afraid to make mistakes. I’ve made every mistake you can possibly make in business, but I’ve only tried to make them once. That’s the key. So you do something, it doesn’t work, don’t try it again. It’s not going to get better just because it’s a different month. Move on to some other way to solve the problem.

So even if you don’t have hardcore business education or experience, it’s really common sense. It’s understanding how to develop a relationship with your people in your company, how to help them optimize what they do, how to work together, and how to get your product out in a way that the customer understands why they need it, how it helps them, and how that moves their needle, and then servicing that customer. And those are things that we should all do in any relationship we have, regardless of whether it’s a business relationship or any other one. So a lot of it is just common sense, not thinking of yourself as the center of the universe. You’re there to help everybody else. That’s your job, not to be recognized or to help yourself.

Kevin Pho: All right, you wrote this KevinMD article earlier in the fall, “The focus of the internet of things (IoT) must pivot to achieve health care potential.” How did this article come together?

Frank Fornari: Well, you know, a number of years ago, somehow the world got together and decided that if we just took every piece of data that we can generate and put it in a barrel, somehow we could dig out the answer, right? And that’s sort of what’s called in chemistry a combinatorial approach. You put things in a barrel, you test something, you pull something out. If it still makes the result, you pull it out, until you’re left with the one thing that actually is causing that. So the issue with that is, in order to get a quality answer, you’ve got to understand the nature of the data that go into the barrel. You just can’t throw everything in there and somehow the answer is going to pop out magically, because the possible interactions between things are enormous, and we as humans, even with computers, can’t possibly determine all the relationships.

I’ll give you, for instance, you and I. There’s two of us here, OK? So the possible interactions with us are two factorial. It’s two times one, so we can have two interactions. Bring another person in, and it’s three times two times one; now it’s six. If you put in a thousand things, it’s a thousand times 999 times 998. You get the picture: That number goes from here to the moon. So it’s really an impossible task to dig out a lot of meaningful things from that many interactions. So IoT is a great concept, but it needs to be fine-tuned. If we’re going to move health care forward, we need to drag it kicking and screaming into the data realm.

So with health care, when I was a kid, you know, we had a local hospital, and the local hospital was where we accessed our health care. So that hospital had to have an X-ray machine and had to have a whole bunch of different clinical specialties in there, and the local hospital was burdened by the carrying costs of all that, and they didn’t have enough patients to drive the profitability. So back in the day, when I was a kid, and I’m 64, 64 was ancient. Most people didn’t make it to 64. So Medicare didn’t have a problem, because most of the people that went past 65 would die. Now, in today’s world, people are living to 70, 80, 90, 100. So they’re living 35 or 40 years past the retirement age, and they’re accessing health care because they’re the sickest part of the population. So these hospitals are strapped. They don’t have the resources.

And as you know, we’re losing physicians and other health care folks; they’re just not going into health care like they used to. It’s expensive to become a health care professional. You come out, you have a lot of debt, and the only way you can manage to pay it off is if you go to work in an urban setting where you can make a lot of money. So, you know, the majority of people in America live in rural America, and they just don’t have access to health care. So one of the ways to bridge the gap, the chasm between the health care delivery device and people accessing it, is using technology. And we now live in an age where, with products like the ones we make at BioMech, and all these other innovative products that are coming out, we now have the ability to give people access to data from wherever they are.

So I’ll tell people, like, “Kevin, what’s the most said word in the last two and a half years on the planet?” OK. “You know what the second most said word was?” Test. Test, OK? Yeah. So tests are an incredibly important part of medicine. Greater than 70 or 80 percent of all medical decisions are made with laboratory results. So the more we can use laboratory results to drive health care, the earlier we’ll diagnose you, the more accurate the diagnosis, and the better the ability to track your progress through the treatment and make adjustments to that treatment. That’s the way the system works. So by taking technology out of the laboratory and the hospital and making it available to everybody, as we push people away from the hospitals and out into their homes, or to getting treated at local stations, you know, I like the way this is going.

From a necessity standpoint, health care needs to move away from these central buildings we call hospitals. They just can’t manage under the weight of their own expenditures. So we’ve got to diversify that health care, because I always tell people, you know, health happens everywhere. It happens everywhere, all the time. So if I’m sitting out in rural North Dakota, my cancer’s every bit as serious as someone who gets it in Midtown Manhattan. So that person should be able to get quality data, get treated properly, get diagnosed, and those sorts of things, and technology can do that.

So back to IoT: If we sit down as an industry and take a look at the requirements, or the metrics that move the needle for physicians to use numbers and technology and laboratory tests to diagnose people, we can then start to put together the health care IoT. And using AI technology, which we do every day at BioMech, we can have good technology that’s going to become predictive and preventative, right? So that’s, I think, where this needs to go, and that’s kind of the message I put in the article. And it’s moving that way. It’s moving that way, but slowly.

Kevin Pho: So I’m a primary care physician. Give me a case study, story, or example of how this more focused IoT can affect my workflow and affect how I care for patients.

Frank Fornari: Sure. So fundamentally, primary care docs are the first line of defense, right? I mean, you guys are generally the first place someone goes and says, “Hey, I’ve got an ache here, a pain here, blah, blah, blah.” You guys see these patients often; they become like a family member. So the more you can use technology to assess them when they come in for their yearly physical, the earlier you guys can identify things, and then either treat them there or refer them on before they become catastrophic. Because as you know, when they become catastrophic, the outcome’s not so good, but the cost of it just skyrockets.

So I’ll just give you an example of what we do at BioMech. We have some tools that really assess balance and fall risk. Literally in minutes, we can assess somebody’s balance and their fall risk, whether they’re in front of you in your office or they’re in their living room. So you, as a primary care guy, once a year, or every time you change a prescription med that may cause dizziness or, you know, you get my picture, can now have this patient get that data to you, to see if you need to intervene. And right now, you can’t do that. If I walk in, you look at me, you can’t tell if I’m a fall risk. Maybe you walk and observe me, or ask me some questions, but with patient self-reporting and clinician observation, there’s too much pressure on that, and it doesn’t get you where you need to be.

It’s like, you know, I worked in oncology in my first life. If you had leukemia, I would never ask you, “Hey, Kevin, how’s your white cell count today? What do you think, good or bad?” I mean, you’d sue me. I would just take a blood sample and test it and count the white blood cells. It’s the same way with “Are you a fall risk?” I want to measure your balance and see what number you are, so you can make an accurate diagnosis, a decision on what to do with me. So there are a million ways that technology can really help every piece of health care.

But you bring up a good point. Primary care is a major place that we need to do better. We don’t have a lot of folks going into it anymore, because they’re one of the least reimbursed and lowest-paid parts of the clinician system. So kids are coming out of school, and even if they want to go back to the town of their upbringing, they simply can’t afford it, and they don’t do it. So we’re kind of stuck with little access to guys like you, and so we need to fix that. So if we can fix it by getting you data, without you having to be there, that you can look at in real time, then we start to close that gap, and we’re able to treat pathology the way we should.

Kevin Pho: So one thing I hear from physicians is the concept of data overload, right? Because a lot of patients now have all these devices that can send us whatever data, their EKG, blood pressure, heart rate, and all that. And you did mention AI to kind of help make sense of that data, so talk more about that. How can we make sense of all this data that’s really coming to us? Because as you know, primary care physicians, we’re strapped for time. Sometimes the last thing we need is more information. So how can we sift through that and make sense of it?

Frank Fornari: Yeah, and that goes back to the original conversation a few minutes ago. It’s the quality of the data, and the data that are meaningful, that we need to focus on. And again, with IoT, the concept was to just grab all the data and throw it in there, and Kevin’s going to sit there at night and try to sort through all of it. Well, you don’t have the time to do that, and even if you tried to, it would be a daunting task. Then you’ve got to ask yourself: Is the data, is this test, a quality test? Is it precise, accurate, reproducible, or is it junk data coming in from some sort of toy out there? There are a lot of toys out in health care that aren’t medical grade or laboratory grade that people use, and their error rates are huge, so you can’t really use them.

So the way this should really work is we sit down with guys like you and say, “All right, Kevin, what do you need to see? What’s important to you that will move the needle for you? So pick. There are 14 things we can measure; how many of these are important?” If you say six, then we take those six and we start to put them into an AI algorithm that’s going to then be able to take a look: If you’ve got three of these things, you have a 65 percent chance of having this. So we can build those models retrospectively, because we know the outcome. Now, we would take current patients that have outcomes, we would go back and pull that data out, let the AI engine weight those metrics, and hopefully we’ll come up with logical thinking the same way that you think as a physician.

So I tell people AI is nothing more than taking what’s in your head and putting it in a computer algorithm. The computer isn’t getting smart; we’re telling it what to look at, what makes sense, and what doesn’t. So here’s something that I always tell people that they laugh at: There’s low-intelligence AI, or dumb AI, like people, and smart AI. It’s intelligence. So the smarter the AI is, driven by more information that you can give us to build into this algorithm, the better we’re going to make it. And again, it’s filtering out from the massive amount of stuff out there and picking the highest-quality data that’s going to make a difference for you and your patient.

Kevin Pho: So tell us the immediate next step. If you were in charge of everything, tell us what exactly has to happen next to get from where we are now to where you want to be.

Frank Fornari: The biggest thing we would do is we need to restructure how health care is reimbursed and paid for. It is the most complicated piece of this. It’s one of the only commercial systems where you don’t buy it directly; you pay someone else, who then pays somebody else to do what you want them to do. And it’s not a 30-day receivable business. The insurance industry isn’t always engaged with what makes sense medically. They’re driven by profit, and they’re driven by business decisions, not necessarily things that make sense medically. And I don’t mean that they’re purposely trying to harm people; it’s just the nature of insurance. This is how the insurance world works. We have a coding system called CPT that is woefully outdated and moves like a glacier, so it prevents technology and innovation from coming in and getting implemented.

So there are pieces of this system that the average person has never heard about, like the fact that most of us who work in the system are paid 50 cents on the dollar. We get denied a ton for what we do, and then on top of that, you’ve got a massive amount of people who have no health care, and we have to treat them regardless. So we do all this work for free, basically, and we’re strapped because we have so many resources as clinical people. Hospitals are strapped because they’ve got to expend a ton of money and energy to treat a lot of folks who just don’t have health care. And it all starts with, everybody should, we should find a way to deliver health care in an affordable manner. Right now, no one’s been able to do that. That’s where we need to start.

The health care system itself is full of wonderfully talented people, dedicated people who treat sickness and take care of everybody from cradle to grave, every single day. They work tirelessly out there. It’s still too burdened by paper. It’s incredibly inefficient. I mean, you guys are tired. The average doc is working 13, 14, or 15 hours a day, six or seven days a week. They’re tired. I will tell you, health care is burned out, and a lot of my friends who I went to school with, they’re all leaving. They just can’t do it anymore. So it needs to change, and I think it needs to start with relooking at how the business model is. And you can start to see the evolution of pay for performance, of cash for health care, like, “I’m just going to pay you here, Kevin. I need this drug; I’ll give you 40 bucks for it.” And maybe the answer is somewhere in the middle, but we need to really take a look at this thing. We’ve got thousands and thousands of payers out there, and plans, and it’s incredibly complicated. And after 35 years in it, I still don’t understand it. So the whole thing needs an overhaul.

Kevin Pho: We’re talking to Dr. Frank Fornari. He’s a scientist and health care entrepreneur. His KevinMD article is titled “The focus of the internet of things (IoT) must pivot to achieve health care potential.” Frank, tell us some take-home messages that you want to leave with the KevinMD audience.

Frank Fornari: I would encourage people to get tested often out there. From a consumer standpoint, from a patient’s standpoint, the more you know about what’s going on with your body, which is an incredibly complicated piece of machinery, by the way. If people could really understand how complex genetics and biochemistry, all of this, is. Your body is very fragile, so try not to do things to it that are going to cause pathology, because we can’t always fix it. We can’t. I mean, you have to be part of the process of taking care of yourself. The burden of responsibility for health rests with all of us first. And I think the more knowledge we have, proper knowledge about how to evaluate risk, how to take things that are proper for us, and how to take better care of ourselves, is a good way to start to help the health care system heal itself. If we have fewer people coming to it with big problems, it’s going to alleviate a lot of the issues we have.

Second of all, do not be afraid to ask your physician things. Ask these guys; talk to them. They will give you very good advice. They’ll tell you how to stay healthy, they’ll tell you how to eat properly, and they’ll tell you things not to do. And when they tell you this, here’s the big one: Listen to them. Listen to them. Patient adherence is probably 30 percent across every disease, which is just terrible. People just think they don’t have to listen. Physicians are highly trained; they’re experts. They see wellness and death every day. They know what works and what doesn’t. Take advantage of it, because you’re paying for it. Every time you write that check to Blue Cross, use them. And just be very careful about trying to figure things out yourself.

The internet’s full of stuff. The wonderful thing about the internet is I can get information out there in a second, and when I was a kid, we had three TV stations. I didn’t know what was going on anywhere in the world; everybody was isolated on their own. Now I can find anything out immediately, but the problem with it is I can also get bad information really quickly. So don’t trust everything you read out there about health and wellness on the internet. Everybody is throwing something up because they have an angle; they want something from you. So just be very careful and use common sense, but at the end of the day, trust the clinical delivery system. Trust your nurses, your clinicians, your ancillary health people. They’re educated, they know what they’re doing, and use them.

Kevin Pho: Frank, thank you so much for sharing your time and insight, and thanks again for being on the show.

Frank Fornari: Thanks, Kevin.