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Embie has calculated 23 metrics for REI and clinic benchmarks for converting IVF Patients and we are making them available to you.
These metrics include;
Conversion Rate from Referral to REI Consult
Avg REI Appt Time for NP/ 1st Consult, Incl Prep and Notes
Avg REI Appt Time for F-U Appointments, Incl Prep and Notes
Total Appointment Time Per Year, Per REI
IVF Cycle Cancellation Rate
See the numbers for these metrics and 18 others to see how your clinic compares.
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Transcript
Dr. Cristina Hickman 00:00
If you want to think about the presence in the presence is the data is being captured automatically. So I'm using an electronic witnessing system, which is capturing the time that I started at the end of the procedure just by performing the procedure. So the doctor comes into his collection, he taps in his his cards onto the pump, the pump automatically knows that this particular doctor likes this particular brand of needle and preferably a single lumen needle, it automatically changes the pressure to match that single lumen needle. And now documents every time this doctor is pressing on the pedal to pump is documenting every tube that's being filled, and so on. This is now live recording of the data. It's not something that he did when he left it's recording as it's happening. So as a consequence of this, we can get live KPIs live and continuous KPIs.
Sponsor 00:53
This episode was brought to you by Embie. To see where your time is going visit embieclinic.com/report. That's embieclinic.com/report. Today's advertiser helped make the production and delivery of this episode possible for free to you. But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the advertiser, the advertiser does not have editorial control over the content of this episode. And the guests appearance is not an endorsement of the advertiser.
Griffin Jones 01:31
250 fertility clinics. How many clinics have you visited? That's how many today's guest has visited. Dr. Christina Hickman is an embryologist by trade. She has her PhD in embryology. She's the co founder and co owner of a clinic in central London called Aria, Aria? I don't know how to pronounce it. I didn't ask her how to pronounce it because she's involved in so many different companies and has been in the last several years, some that she's founded. Somewhere, she's served as Chief Scientific Officer or Chief Clinical Officer and somewhere she may serve as an advisor. And I like that background for really thinking about what the digitalization of fertility treatment looks like. Dr. Hickman makes the distinction between digitalization and digitization and a lot of you better listen closely because you're going to think your digitalizing but you're really just digitizing. So pay attention. She talks about the difference in digitalization versus digitization and everything from consents to prescription ordering and beyond including smart lab equipment, smart clinical equipment. I pressed her on, well, who's going to be the hub for all this because everybody wants to be the hub. Dr. Hickman proposes an alternative to the hub. She says there doesn't have to be a hub. Take a listen to that argument. Tell me if you think it holds water. I ask her why come we don't talk about blockchain no mo. Is it still a thing? Dr. Hickman talks about the route that the field took instead of blockchain and why she paints a picture of how the physical environment of the clinic and lab can merge with the digital environment so that it's one environment I liken it to a not Oscar worthy but better than airplane worthy movie from like 10 years ago that you can add to your watch list. You're welcome. Dr. Hickman paints a different picture than only vertical integration where one or three companies own everything, and she sees how community of different companies in different verticals can successfully integrate in an ecosystem and she shares some players that she thinks are doing really well in this area. Enjoy this conversation with Dr. Christina Hickman. Dr. Hickman. Christina, welcome to the Inside Reproductive Health podcast.
Dr. Cristina Hickman 03:29
Thank you very much for the invite. It's a pleasure to be here.
Griffin Jones 03:32
You were recommended to me by a few people, some which was the team at Embie but then some others. Everyone described you as forward thinking. So I thought that was interesting. I went to your LinkedIn profile. And then I saw a lot of X date to present, X date to present, X date to present. You got a lot going on right now. Tell us what are you up to?
Dr. Cristina Hickman 03:56
Yeah, so I'm a clinical embryologist. I've been a clinical embryologist for 20 years. And you know, as a lab manager, I have experienced myself as well as through my team, a lot of the challenges associated with providing care to patients. So I stepped out of the lab manager for brief periods where I traveled the world and visited 250 clinics around the world. And I did that through consultancy, supported by industry. So this allowed me to get a completely different perspective of how reproductive care is offered outside of the UK. So I got some insights into the US into Asia into you know, China and Japan as well as Australia and South America. And it was very interesting to see that the challenges that I was experiencing in my clinics in the UK, were very similar to the challenges in all the corners of the world. So from that point, I ended up joining some venture capital back to startups. This was my like tomorrow or fertility opportunity And each of these, we're trying to solve a part of the fertility journey. Together these, each of these companies kind of when you bring them together, you can now have the entire journey of the patient being able to be resolved. So the challenges we were experiencing were too big for a single company to resolve them. And this is why I'm involved with so many different companies, because each of them are the number one provider that supports that particular solution to a problem that I was experiencing for caring for my patients.
Griffin Jones 05:33
You mentioned that the challenges were surprisingly similar from what you were familiar with in the UK, when you would go to East Asia, Latin America, the United States, Australia, all corners of the globe. What were those challenges specifically?
Dr. Cristina Hickman 05:48
So for instance, doing consents of patients, right? So we historically we would do it with paper. So in the UK, we have a lot of consents that we have to go through which are regulatory required, we also have our own clinic consents to get through, and, you know, going, they're very complicated for the patients. So there have been digital solutions that have come into the market, you know, trying to provide you with PDFs, that our have made our life a lot easier. But the problem is that these consent platforms, although they are maybe integrated with your EMR as any deposits that PDF into your EMR, it's still like a separate digital solution to the rest of your digital ecosystem in your in your clinic. So one of the things that we've been working on is how can we get away from PDFs, you know, so PDFs is what we call digitization. But what we want to do is move towards digitalization, you know, those two extra letters, the A and the L provide a whole different leap into into efficiencies in the clinic, but also a different experience to the patients. So no longer do we have to deal with the patient having to complete the same consent three or four times, because he got one box incorrect. And therefore they have to do the whole form again. So we don't have to do, those inconveniences are automatically eliminated. And further to that, by taking away the PDF, you now you get a phone friendly version, because our patients are on their phones and not on a computer, they're on a phone. So now we can make it easier for them to to understand what it is there consenting for through convenience. And thirdly, because we're not in a PDF that's siloed. On the side, all this information now becomes business intelligence, because it's interconnected in the rest of your ecosystem, each individual fields that the patient has completed is part of the information that helps us better understand this patient. Now you take that just from consensus, or you evolve it now to every step of the process, every ultrasound scan you perform on the patient, you have that information directly from the source, every every time that a patient has an embryo on the embryos cultured in a time lapse incubator, that information, all of that is capturing that data automatically. And moreover, none of this is being captured by our staff spending time inputting information into the system. It's information that comes from the source of the information without administration. So the administrative tasks are completely removed. That's one of many examples, you know, that we could go through but every step of the journey that a patient is going through, there's a pain point for the patient and a pain point for the staff that's trying to support the health care of that patient.
Griffin Jones 08:34
So major difference between the two letters between digitalization in digitization, digitization, does that still include a DocuSign is just digitization because you're simply taking your existing consent, you have it in Docusign. And then staying on the example of consent at a platform level or at a software back end level. What does digitalization of that same consent look like? If it's not a PDF? That's being stored in a DocuSign signed via something like a DocuSign? What would the digitalization of that same consent look like?
Dr. Cristina Hickman 09:12
Let's say you're trying to fill in your your PDF form through your phone, you're gonna have to zoom in with your finger and you drag left and right you know, just to read the full sentence. But here everything is portrayed in fitting your your your your phone view, you're you're easily able to move from one page to the other, and your your your signatures and consents are connected with what you're permitted to do. You can enter if so, for instance, in the UK, historically, you couldn't put more than 10 years, you know, for for your consent period, or maybe your consent periods that you're putting for the storage of your embryos or eggs and storage is not aligned with your partners. Or you know, some clinics like to align it with with with their with their own conditions within their clinic. So all these things, you can provide a tool that educates the patient as they're going through, but not necessarily by them watching a video in advance, receiving the in the informational videos at the time they need it. But let's say this is not a visual patient, this patient doesn't like to learn through videos, because videos is not for everyone and she prefers to read, you can now choose the different forums of learning or educating yourself about the various decisions that you have to do throughout your treatment. And it's not just consents, you know, you can use this for instance, for embryo development. So you're able to see your embryo developing live as it's happening inside the time lapse incubator inside the clinic. So the patient is sitting at home. And they have that transparency of care to be able to see what the embryologist sees as well.
Griffin Jones 10:51
So Can these still exist as separate platforms? Is that even the right way to think of it in this move towards digitalization as opposed to digitization? I can't be the engage in engaged MD does it have to be an over encompassing EMR? It's you know, it's it's the it has to be the EMR in every function of the clinic and lab.
Dr. Cristina Hickman 11:14
So the challenge that we have with EMRs is that there's multiple reasons where I opted for building an EMR free clinic. So I need more for one thing is designed for a somewhere for you to put your information in there. Okay, so I've performed the procedure. And then I go in there, and I type in that I've started a procedure 8:00am, I finished at 8:30. And Christina did it together with Griffin who did the egg collection. Okay, so we, we've I spent, I did the procedure, and then I went out there and I documented that procedure. That's what an EMR is kind of designed for. And if I want to know about my KPIs, I will once a month, I will extract all the data, assuming that is an EMR that allows you to extract data, because not all of them do. I'll extract all the data, create my graphs, and then present this in a KPI meeting. Okay, so this is the old fashioned way of performing your, you're doing things from the past, okay? Now, if you want to think about the presence in the presence is the data is being captured automatically. So I'm using an electronic witnessing system, which is capturing the time that I started at the end of the procedure just by performing the procedure. So the doctor comes into his collection, he taps in his his cards onto the pump, the pump automatically knows that this particular doctor likes this particular brand of needle and preferably a single lumen needle, it automatically changes the pressure to match that single lumen needle. And now documents every time this doctor is pressing on the pedal to pump is documenting every tube that's being filled, and so on. The doctor just comes in performs the procedure and leaves only needs to document if there's anything out of the ordinary that that takes place. Otherwise, the documentation was just from him tapping his card onto the electronic witnessing system that includes the pump. So this is now live recording of the data. It's not something that he did when he left, it's recording as it's happening. So as a consequence of this, we can get live KPIs, live and continuous KPIs. So the moment that I put an embryo in a time lapse incubator, the AI comes in and automatically tells you when that egg has fertilized when it's degenerated when it's formed the blastocyst when it formed, the good quality blastocysts what was the pace of development, what was the score it was given. And all of these are automatic and continuous KPIs that allow us to monitor how our lab is performing a so we're now moving like beyond digitalization, where we're going now kind of towards a future where we're not just getting the data present. But we're getting the data for the future, we're getting it to predict and prevent what might happen next. So that we can take action before any non conformities have a chance to directly impact your success rates.
Griffin Jones 14:11
So are all of these different areas, whether it's the smart reporting from the electronic witnessing system, or the equipment ordering, or the informed consent, or all of these different tables within one master platform or these different platforms that somehow have to be integrated together?
Dr. Cristina Hickman 14:32
So a lot of when you're talking with the different companies, you know that the hardest thing to get this done is not the technological aspect, the technological aspect of integrating the different platforms is very easy. The issue is every company wants to be the hub or the central, you know, and and getting the negotiation of who's going to be the brain of the system is what makes it really hard to get the companies to collaborate with each other. Unfortunately, we are in a field which is run by humans. Humans are thinking on what's in it for me, right? If I want to collaborate with you, I want to get us to a point where we're thinking as a field, what's in it for the patients, if we really want to practice patient centered care, we need to be strategizing what's best for the patient, across companies, across clinics, and working in a in a way that creates this community of digital experiences that feels like a single one. And this is what we are creating. So the the two companies that that we built, one is called Avenues, which is clinic in the UK. And the other one is called Ovum Care, which is a new German entity, which is going to be opening the first clinic in Portugal later this year. These are now two companies that are coming together, to create together with Embie, and with many other digital suppliers, this, this neutral experience, where as a community, we can bring the digital tools together synergize without a single entity, a single hub, you know, nobody is the brain of the system. We're just interconnecting all of the solutions, so that they all get the best out for the patients to experience the best possible care. So it's a different form of thinking rather than going in what's in it for me, we're thinking that's now wipe out the all the options strategize with all these chess pieces we have available. How do we get it? What's best for the patient?
Griffin Jones 16:27
Am I understanding correctly, that there's an alternative to the hub? Because when you say everybody wants to be the hub, they sure do. And so to their venture capitalists and their private equity partners, and there's a whole lot of money at stake in in them being the hub. And many people do have the patient's interests at heart, but they're not going to say to their competitor or their potential competitors, as their vertical start to overlap. Oh, no, we all want the patient to be number one here. So why don't you go ahead and be the it's not a Canadian standoff with after you, you go ahead and be the, the the hub everybody, they want to be the hub, they've got a real vested interest in being that and so you're sitting? Well, you so you're saying it's possible to have a workaround to a hub?
Dr. Cristina Hickman 17:16
Yes, so there. So this is exactly what we've built. So we, in our clinic using Embie, using Fertility, using TMRW, okay, so all of these different companies and their we are able to solve, none of these companies are offering a solution that goes across the entire span, okay, but they are the best at what they do. If I want to store an embryo that was my personal embryo, I want that stored in a TMRW's robot, if I were to better understand how my embryos developing to get better strategies for my care, I want this to be assessed by a fertility AI tool. So what we do is we, through the care provision, we have a digital strategy of how we're going to approach this. And what we're what we have is now companies are willing to have these integrations across across the platform, what we what that's going to create as a next step is the ones who are outside the community ecosystem will wane away, okay, because they won't be relevant anymore. If you're not part of this digital pathway, then you're not going to if you're if you're, and I see a lot of EMRs being in that category, if you refuse to integrate, or if you charge too much to integrate, make it too expensive, which that expense will be passed on to the patient, then the companies will find alternative routes, which which which make it more relevant to the patient.
Griffin Jones 18:40
So I was going to ask about the EMRs, because many of them aren't in the digital pathway, or they'll say, sure, we'll integrate, but you're gonna pay us a good chunk for integrating. And we're the hub. It's, it's it's our data. And so we've been saying this for a while that the walled gardens will eventually, the walls of the walled gardens will come down, those that keep their walls up will be rendered irrelevant. It hasn't happened yet. So what is, what are we waiting for? Why are these companies that are not in the digital pathway, it seems like they still have a lot, if they have a number of fertility groups, large fertility groups, they've got their data, they're entrenched with them, it's very hard to switch EMRs. It seems to me that it could be a long time, to me it seems like the only thing that would get them out is those big legacy clients not renewing and switching out. And that's a long sales cycle. It seems to me like the only thing it would be switching out is is there any catalysts that would come forth to make those EMRs that aren't in the digital pathway render them irrelevant more quickly?
Dr. Cristina Hickman 19:55
Like there's a lot of clinics out there who you know, you go to a website and it says I am the lead in clinic, okay, or I offer a state of the art, okay? If you're if you're sending a stash of papers home with the patients and getting them to do the consents through paper, if you're if you don't have time lapse system, if you're not using electronic witnessing, if you're not creating a centralized data infrastructure so that you're having live and continuous KPIs, if you're not using AI for your assessments, whether it's for ultrasounds, whether it's for, then you're not state of the art. Okay, and I think that's, that's a big statement. And the same goes for the patients, if you're being treated by a clinic that gives you that experience, you are not being treated by a leading state of the art clinic. So I think it is the catalyst is going to come from two levels. One is the patient's noticing, because now there's going to be the alternative to go to the clinics that are using these technologies and are open to digitization. And who are who really are putting the work in to do that transition away from EMRs. I mean, we still have clinics out there that are completely paper based, okay, there's there's, there's some which are, you know, really far back, they need to move away from the paper, move towards the digitization, and start strategizing. How do I get to be better informed? How do I get better business intelligence, so that I can adapt to this changing world that we're going to be facing now in this in this next generation. So I'm here today to tell you that this is not talking about the future. There's nothing that I'm telling you today that is not available in the markets today. So there's no reason why we should be doing paper prescriptions, you know, we it should be electronic, there is no reason why we shouldn't be integrating with a wearable detail from the patient so we can better understand their how their behaviors are contributing towards a fertility success. So this, we've reached a new era, where now we're going to see the ones who are able to adapt to it. And then the clinics who won't, I think are gradually going to start disappearing.
Sponsor 22:04
Your clinic might be seeing 1000 new patients a year. Do you know how many REI hours per year you're spending on patients that don't convert to treatment? Over 700 according to the averages. That's over 700 hours wasted. There's finally a technology that scales access to care while allowing you to serve patients at the top of your license as an REI. Embie is that technology. Embie enables fertility clinics to treat more patients with their existing staff and infrastructure. By improving workflow and patient communication, Embie enables you to generate over $1 million in additional revenue per year. Embie saves REIs hours per converted patient. Embie saves over two and a half hours of nurse admin time per cycle. Embie enables you to see up to 20% more patients per year. How do we know? Embie has calculated 23 metrics for REI and clinic benchmarks. And we are making them available to you. To see where your time is going visit embieclinic.com/report. That's embieclinic.com/report.
Griffin Jones 23:12
For those EMRs that have been the walled gardens thus far, and I'm not picking on them. I understand they've got costs, they've built their businesses, they're trying to think of the future value of their companies and they're trying to win their races. For those that have been walled gardens, is it too late for them? Is it too late for them to go the route of entering the digital pathway?
Dr. Cristina Hickman 23:38
No, definitely not. But the strategy needs to change. So I think COVID, of all the bad things that COVID brought to us, the one thing it did that did very well was it created this this we've evolved 30 years in a space of two years when it comes to digitization in healthcare. Okay, and this is something that has allowed us to evolve away from that siloed What's In It For Me concepts to now the company is already thinking what are the strategic partnerships that we need to be making, so that we can provide better service to our clients who can then provide better care to the to the patience. So this, this philosophy is already there? I think we're going to be involved evolving to the next level up where we're going to be seeing not just one or two interconnections, but how do we how do we maintain our strategic positioning within this ecosystem? So we've gone through a process where everything was siloed, this has all been dismantled. Now, people are trying to find their place in this digital world. And those that adapt will continue to have this community approach. And this is what I think is different that it's not just about technology, it's about frame of mind. It's about a curiosity towards evolving into the next position. How do you position it? It's having this realization of What are the strengths that you as an individual you as a company bring to the to the fertility care world. So many examples out there of big groups of clinics who have spent half a million, a million building their own EMR systems or building their own digital AI digital solutions, only to be third grade or fourth generation below what is the standard of care from from companies that focused on just that one thing. So I do believe that the future of our field is going to be a community of companies working together as opposed to one big company only acquiring or the smaller ones. And then there's mantling it and then figuring out how they grow in an artificial manner. So I think we have a new opportunity here to grow a different aspect of our care.
Griffin Jones 25:51
Interesting, because I just recorded an interview with Lou Villalba, new the new CEO of TMRW, and we made that topic about vertical integration and some vertical integration is going to be inevitable, you're painting a picture where it's not where not everything is vertically integrated, where you have a community, and there still is a value in having separate companies doing what they do best. And not just one company owning every piece of the value chain. There's so people should listen to both episodes, because they're both they both paint different things that will happen in the future.
Dr. Cristina Hickman 26:26
I mean, what what what is different about the digital world and the digital technologies is the fact that the world moves very fast there, and things become obsolete very quickly. And therefore you need to have a very creative and innovative culture environment to be able to survive in that space. And this is why I do think there will always be space with smaller companies to kind of find find are treading because of the nature of the fast pace of digitization.
Griffin Jones 26:54
And the tension between innovation and efficiency. There's a book called The Innovators Dilemma, theory called The Innovators Dilemma, I've talked about it on the podcast a couple of times, and the incumbents often are disincentivizing from, are disincentivized from innovating, because they're trying to win the efficiency game. And you sure you a really good company will carve out a piece of budget time leadership focus to focus on future value. But inevitably, that tension is something that weighs on incumbents, and there's a space for new companies to win the innovation game. I want to jump on the digitalization versus digitization examples in other spaces within the space some more because I know that my some of my audience is not getting it there. They think they got it but they don't. And the example that you gave about the paper prescriptions, people will say, Oh no, no, we fill prescriptions, we just do that through the EMR or we do it through the pharmacies portal. We don't use paper, we use those but that's still digitization isn't it versus digitalization of having of having that that data in a place where it becomes business intelligence?
Dr. Cristina Hickman 28:11
Okay, so So let me explain the digitalization in terms of prescription. Okay, so how prescription is done in the past will be you, you put in the patient's history again. And then from that, you you create, maybe you have a template with so let's say you put in I want I want an antagonist cycle, I'll go with a low dose for this patient. And then you just kind of tweak what is the what you want. And then that generates an electronic hopefully, in many clinics are still paper and they still got assigned by ink. But let's say that generates an electronic. And then from that electronic concerns, the patient is able to take it over. In digitalization, we go a few steps further. So for instance, when you create all of these, the history of the patient, so So this is what I'm going to prescribe this patient, she's going to have an antagonist cycle, I want her to have the following egg options and sperm options and genetic options and so on when and she's going to be using donor eggs, or she's going to donor sperm or whatever, and you press enter, it then creates a template of all the appointments that this patient is going to have. So she's going, I'm a particular doctor that, I might prefer to have daily scans or maybe I just do two scans in a cycle, they maybe I'll do a baseline or maybe a day nine. So you kind of put in this is my template in terms of cycles. And from that you already get all the tasks that go to your your team members. For instance, I selected she's going to use donor sperm. So therefore all the donor sperm matching tasks get sent to the relevant team members. So all of these tasks are there, you can tweak it. So you have all the appointments and all the tasks are there. And with the click of a button, it then goes on to the prescription. And at this point you're not signing. What you're doing it is you're confirming it, and then you get a two step authentication onto your phone confirms that this was you because that's even safer than then signature nowadays. And then it gets sent over directly to the pharmacy so that this gets delivered maybe to the patient's home or with the ability to. So whilst you're doing this, that's it, the patient has a copy in their patients app, and the patients can see that prescription. And all you had to do was two clicks, one to confirm the appointments and the or under tasks going to the team members. And a second one to confirm the drugs. The prescription side, it goes a step further where you can use AI to suggest what would be the based on the BMI, based on the age, based on all the other patient demographics, and not just your template, but now using patients and tele data intelligence so that we can do true evidence based prescription. Okay, so this is digitalization. And then when you start thinking about prevention, and so on, let's say as you're doing your scans either side to up their their adults, it can automatically calculate saying, look, for this particular patient, she's only purchased or she was only prescribed a set amount of drugs, now that you increase your dosage, we need to make sure she's got enough stock. So it's preventing the patient running out of drugs before you even realize that she's going to run out of drugs. Okay, so this is the difference between digitization and digitalization.
Griffin Jones 31:24
So, we have proposed an alternative to the hub and that these different companies are capable of these business intelligence, they're capable of this automation, but when it overlaps, who does, who does the data go to like if it's if if donor sperm tasks are triggered by by something, maybe maybe a pharma order or something that happens in the clinic from smart hardware, then the next step when when the steps overlap? Who owns those business insights in a world where there isn't a hub? How does that, how is that workflow managed?
Dr. Cristina Hickman 32:07
I'll give you an example on the genetic side, for instance, okay, so I am doing an egg collection. And I know that this patient is going to be having egta. So the moment that I put the embryo in the time lapse incubator, the genetic lab can now see as early as like the second day of development, what is the chance of there being blastocyst for this particular patient. So the genetic lab is part of the care provision team. And it's already been allocated that this patient is going to this genetic lab. But now the genetic lab can see not just in this particular patient, but all the patients coming from that clinic, all the patients coming from all the clinics that are associated with this lab, they can see how many blastocyst am I going to be getting in the next three days, they can tell that in advance, which means they can now make a determination when's the right time that I should be putting my 96? Well, this for analysis, should I wait one more day, should I bring it down a day, because whether you're using the full 96 wells, or whether you're only running one patient is going to be the same cost. So you can better strategize, and therefore, just by having that insight of how the embryos are doing on the second day, and by the way, all of this happened without any human spending their time sending an email of I'm expected to send you blastocysts in three days time, all of that is completely unnecessary, because of this information. Now, the who holds what information and how that information flows, is determined through the regulations and the contracts between the different service providers. Okay, so for instance, in Europe, we have to comply with GDPR. So the patient's needs to be fully aware of who's handling your data, how is it being handled, and as an hfpa licensed clinic, it is our responsibility to ensure that everybody is being responsible with that data. So we have checklists that we go with each of the suppliers to make sure that they're complying with the quality of data handling that we expect them to be to be having.
Griffin Jones 34:04
How does the blockchain back all interface with this or or these platforms built on the blockchain?
Dr. Cristina Hickman 34:12
So at the moment, the particular projects are working on the moment, none of them are using blockchain. I have worked in blockchain before I came into the field through Apricity. So we did a collaboration with Okin, who is a specialist in blockchain. And we actually built a blockchain specifically for research so that we could bring data from different parts of the world. At the time, I was doing a lot of collaborations with China, a lot of collaborations with Russia, with Japan with the US. And each of these countries have very strict rules about data not leaving their particular country, especially healthcare data. So the blockchain is a fantastic solution, allowing the algorithms to learn in the different hubs without having to, without the data having to move. So what moves are the algorithms, not the hubs. So the technology exists politically, I wasn't able to get to that project to succeed. But the technology exists in allowing that that that to to work. But this was because the no money was involved. We're trying to do a and again, this, this reflects the whole What's In It For Me siloed data, this would be a project that would make perfect sense in a patient centric community. But when I was working on this five years ago, I think we just weren't ready for it, then.
Griffin Jones 35:30
Are we going to see more of the blockchain as the spine behind a lot of these platforms? Or is there a way of doing this without the blockchain over a sustained period of time? Because we seemed like we were only going to talk about the blockchain for about four and a half seconds. And then we started talking about AI. And we haven't talked about blockchain since though is is blockchain still an inevitability or now are there ways where we think that it's these types of platforms will exist for a meaningful period of time without it.
Dr. Cristina Hickman 36:05
So I tried to blockchain wrote, and for those who are willing to do the collaborations, they preferred to do it by protecting the data integrity through contracts and through regulation, and through through cybersecurity. So there are alternatives to blockchain, which is what's the field opted for even today, so not not just at the time, but even today, so the technology is there. But there are alternative ways of doing it using logic using legislation using legal contracts. And I'm in full compliance with the with the multiple regulation, it just means that we're not moving huge hubs of data. This is data being transitioned through care provision in a safe and secure manner. So for instance, Europe has, in their list of places they don't want their data to go to, is the US is one of the top places where if you're sending data to the US, because of the regulations around data handling in the US being different to those in the in, in Europe, it's one of the places they say, if you're going to do this, you need to ensure the safety of the data. So what we can do is create cloud environments which are in the US, but which are fully compliant with European standards geographically in the US, but they're not interconnected. They can they can, they can demonstrate its security accordingly. Okay. And on top of that, if you're going to be doing that we have to inform the patient, that we're going to be moving data to the US. So this is effectively contractual ways of kind of resolving that challenge.
Griffin Jones 37:38
How did you find yourself moving so far down the clinical end of the spectrum of the solutions, like by the time you get to consent, you know, it's for things that are done in the lab, but it's happening in the clinic, your background is, as an embryologist, how did you end up going beyond just lab solutions to broader clinic solutions?
Dr. Cristina Hickman 37:58
Mostly because I started owning clinics. So now I start looking at the clinic as a whole as opposed to just a lab. But also because my initial focus was on embryology based solutions. But I quickly became aware that so for instance, when I'm labeling my data, which embryos become a baby in which embryos don't become a baby, I now have the issue of Wait a minute. Was it a good embryo? It just happened to go to the wrong uterus? Or was it a good embryo that just happens to have a doctor that made a mistake during the transfer procedure. And so this is called mislabeling where, actually, the AI did get it right. But other things outside that data form. Because I'm only looking at the time lapse information, I'm only looking at the embryo, I am missing the rest of the fertility care. So my interest started spawning, actually in both directions post transfer and pre transfer. So we've done a lot of work on for instance, how we make stimulation decisions, how do we determine the type of trigger? How do we decide the right protocol for this patient, and so on. And what I discovered when I went into that, because it was around COVID times that I started getting to simulation, everybody had moved on to antagonists. And I started to appreciate how little diversity we actually have in the clinical side, compared to the embryology side, there's a lot less options to choose from a lot less opportunities. But when you think about it, that's not because there's less options is because the technology for data capture wasn't there. So now we have AI solutions that tap into your ultrasound and capture a wealth of data in the same way that you have AI solutions and embryology capturing a wealth of data from the timelapse. So I think we're going to be seeing a lot more focus on the clinical side as well. Because on the embryology side, it's all about not making any mistakes. Once I get my eggs and my sperm, it's all about do no harm and try to not you know, as long as I keep them safe, they will hopefully have the viability that they were there seems to have it's all opportunities for error rather than ways to improve the egg. Whilst in the clinical side we have the opportunity to improve the egg, we have the opportunity to improve the quality of the sperm. And I kind of saw the pre embryology side as an opportunity of not just mitigating the risks, but actually increasing chances of success to patients.
Griffin Jones 40:24
Are you still fertilizing eggs you own clinics, you're involved in multiple ventures or starting ventures you're also the adviser to other ventures? Are you still in the lab fertilizing eggs?
Dr. Cristina Hickman 40:35
That's my that's my safe space. That's my that there's no better place than sitting down doing an exit doing a biopsy, doing a vitrification, you know so, so very much. Embryology is kind of like playing an instrument and you kind of need to keep playing it or you're going to lose your touch. So I have obviously I don't do it in the same volume that I did before. But I'm very much involved. I do workshops where I'm training embryologists as well on all these skills, but certainly yes, performing the procedures as well.
Griffin Jones 41:04
Just to keep this saw sharp. So sometimes you're going to be in the lab with a junior embryologist. And here you are owning the company and you're involved in all these other companies and there's some junior embryologist just out of university is their first real job and so that happens sometimes?
Dr. Cristina Hickman 41:20
No, definitely. I think there's many examples of embryologists who have gone out there to create they're out there to own their own clinics to wonder that they will actually to I saw today David Sable put an article in Forbes talking about how clinics should be owned by embryologists, which made me chuckle because obviously today being World Embryology Day, I thought that was quite quite timely. So I certainly think that we are seeing an era of empowerment of embryologist, whether it is because they own their own clinics because they are venturing into the the corporate space and I would really encourage many embryologist to go through this journey. For me it was it was a very insightful, both in terms of my own personality, my own characters and understanding myself, but also in acquiring new skills. So you know, now I'm involved in running, I'm running FDA trials together with fertility in the US, I am understanding how to how to get CE marking and FDA approval of products. I and this, you know, initially people say that you're venturing into the dark side, I have found it a very bright side into the corporate world. But obviously I never did a complete jump. I've always stayed clinical, I've always kept my hands on the clinical side. And I think this is kind of what has given me kind of a role in the field of creating communities, creating interconnection and creating a better understanding between both the corporate and clinical sides.
Griffin Jones 42:44
Well, being still in the clinic, is there a way that you see of balancing the physical space? Are there other changes that need to come with the physical space, not just the technologies being digitalized? But are there other ways that balance the physical space in the digital space? So there's sort of feels like one single environment?
Dr. Cristina Hickman 43:05
Yeah, so this is something that has been a big focus for us and ovum care. So when you're thinking about the branding, the marketing and the feel that your brand brings to the clinic, to not just the clinical but but to the to the patient to herself. It needs to feel like both the tech, the digital and the physical feel like one, there needs to be a consistency in your story in your look and feel. I think one of the things before as an embryologist, I never quite got the UX, UI and the look and feel. And I have a much greater appreciation now of how important that is to the patient and to their experience that they're going through. So what you want in your patient app is you want to have that ease that when you come in, you have all the information you have the transparency of your care, you have your own digital passport that follows you beyond the point in your journey where your care is complete, but you can always look back and it's they're accessible to you. There isn't a restriction on you accessing your own data, which is not just a legal requirement, I find it should be the ethical approach as well. But then you get that same feel when you walk into the clinic, where you have you walk in. So the way we've designed it, we didn't go the spa route. I found the spa route was too sedentary. I didn't want to go the big corporate route. It wasn't about walking in and feeling like Oh, I better dress up to come into this clinic. You know, so this has been some of the clinics I've done in the past. And when I did focus groups with patients, they said look, this place is beautiful. It looks like a five star hotel. But it's it, I don't feel comfortable in here, which kind of shocked us because you know, we had used the most expensive interior designer for this room. And turns out this is not what patients wanted. What a patient wants is to walk into a clinic and it feels like home. Okay, it looks and feel feels like they are in their own home. So for us, this meant that we use a lot of wood in the, in the decoration, we use a lot of a lot of texture. And we made the room, we have books around the place, we have lots of lots of plants, lots of trees, lots of making things look as natural as you can, and as far away from clinical and hospital feel as you possibly can get it. And definitely not going down the spa route. Because that's too relaxed, you want to get it to the point where they just feel comfortable in that environment. And this will reflect into their care. I didn't understand early on in my career, how important the space was, you know, so for instance, initially, the clinics I worked in had one office for the embryology team, one office for the nursing team and another one for the doctors. And this creates kind of competition between the teams, which is the opposite of what do you want to achieve. So open plan spaces, so similar to We Work offices. And do you have We Work in the US?
Griffin Jones 46:02
Did they go out of business? They were something happened with them? They were not. But yeah, they were they were a big rise. And then I think they weren't profitable for a while, maybe they're still around. But yes, we have them.
Dr. Cristina Hickman 46:14
But the idea is creating a space that's comfortable to work in. So what is the optimal environment that will allow me to achieve the best possible care to the to the patient? What is the type of ultrasound machine any to use the type of beds that the patient needs to be on? How do I hide the clinical field, and when I need to be compliant in terms of cleanliness, you know, for my CQC inspections, so there is we have spent a lot of efforts trying to find that right balance between feeling homely, not not feeling overly posh and feeling comfortable, yet compliance with healthcare requirements. And the way that we've approached this is by creating modular systems that will allow for clinic builds to be built up faster and therefore reducing the cost of care even further.
Griffin Jones 47:04
So as you started to talk more about the ultrasound machines that made sense of how that aesthetic translates to the digitalization in bridging the to the digital and the physical environment, but is that aesthetic that you chose? Is it a deliberate juxtaposition? Because otherwise the the digitalization just feels like you're in 2001 A Space Odyssey like I think of the movie Her? Did you ever watch that movie?
Dr. Cristina Hickman 47:30
Yes, yes, it did. Yeah.
Griffin Jones 47:32
For the audience that hasn't seen it, Jude Law, romance movie about he falls in love with artificial intelligence, it's really good. And one of the things that I enjoyed about the movie, it takes place in the semi near future, the undefined future where there's more advanced artificial intelligence. And in most movies where they do that, the aesthetic looks very futuristic. And they they counter position that with an older aesthetic, so it actually looked like the late 60s, early 70s in a in a kind of way, or at least that was that was marbled then throughout, and it it gave more credibility to the story in some ways, but it also made the aesthetic more realistic. Because it's not like I'm just in this like future pod like The Matrix, it felt like a proper balance.
Dr. Cristina Hickman 48:23
Yeah, and I think that's what, at Ovum our our tagline is where compassion meets technology, you know, and everybody associates technology with being cold. And I'm here to say that, you know, it doesn't have to be it's only cold if you use it in a cold manner. So how can we use technology to bring warmth to care. So for instance, whenever we're using the, our platform, we don't call the patient to tell them an update or fertilization we can face like, it's equivalent to FaceTime but directly inside the app through the security of the app. So we're able to see each other's face to face. And especially when you're giving bad news, you and you can read each other's face, and the patient can see the support from the facial expressions that you're giving to them. It's not just the tone of our voice, they can they can see us there, they have that option. And that provides that extra warmth, even though we're not physically together, you know, this, so so that approach of using technology to bring compassionate care has been also a big focus and has generated a lot of discussion of creating, for instance, different forms of communication that the patients can use. No more emails, okay, so everything. You can have email, like communications through the application. You can have WhatsApp like communications through the application. And the benefit and the nurses will love this is that at the end of sending the email, you don't need to then upload your email into your EMR. You just send it and it gets received by the patient. And now we have AI learning all the words that are being sent back and forth with the patients to try and identify things that we need to improve on. You know, do you have, are they complaining about there not being enough appointments available? If we start picking that up before the patient even gets a chance to realize as a negative. You know, there's, we try to fulfill that there's a Japanese feel words called Omotenashi. Do you know it?
Griffin Jones 50:18
Nope.
Dr. Cristina Hickman 50:19
It's about predicting what you're going to need before you realize you need it yourself. Okay, so what we are really using this as a true example of how technology can support compassion at a level where we can provide a care before the patient realizes their needs. By this point, it's already been fulfilled. And it's no longer a need.
Griffin Jones 50:41
Talk to me then in anticipating needs, how much is this technology? How much is artificial intelligence going to or should be, maybe not just treating infertility but maintaining reproductive health? And what's the difference in your view?
Dr. Cristina Hickman 50:59
Yeah, so I think that's a really important change in direction that we're going to be seeing, it's not there yet. We're seeing some early signs of it, but it's not quite there yet. So we are making that a core at both Ovum and Avenues. So in Ovum Care, it's not just about treating the infertility. So historically, we've seen infertility as a disease, we've made big points of getting the World Health Organization to recognize infertility as a disease. But I want to see if we can change that a bit. We're in a world now where we know our patterns of our sleep. Because of our wearables, we know we get beeped when we've been sitting too long. So go go take a walk, we know how many steps we've taken today, and what we've eaten today. So we're now at a stage where we know more about our bodies and our health than we've ever done before. Historically, what we associated with healthcare was going to a hospital, our children are going to associate healthcare with their smart ring or their smartwatch. Okay, so the perception of what healthcare is, is different. And because we are gaining a better understanding with tools that are available at home, we are we are have this expectation that we don't want to wait to be sick before we get treated, we want to see how we prevent the sickness and for infertility, that means not treating the patient when they have been trying for six months or 12 months, and then bring them into the clinic. I mean, can you imagine trying for 12 months and every month getting the, maybe next month, maybe next month, and trying again, and not being able to be treated by your National Health Service, because you don't fit the criteria, because you haven't been trying for 12 months. I mean, that's quite, quite tough. I had the blessing that I mean, I'm Brazilian, I had private care in Brazil. And as a consequence, I went to the gynecologist as a teenager, I understood my body from the age of 15. And I knew all my reproductive health issues early on, I planned my life. I had my children when I was 24 in my mid 20s, and I wouldn't have had I not known what was my reproductive situation. So in having this early in life, you go in, you understand your body, both the man and the woman, by the way, not just the woman, we understand, and we can do the appropriate plans. For me, the plan was just trying having babies early or earlier in life than I had originally anticipated. For others, this might mean freezing their eggs, or for others, it might be just coming to terms with the fact that okay, maybe babies are not for me. And this is something that if I ever want them, I'll go down the adoption route. But I know this early in my life, and therefore I can prevent the needs that I would have needed IVF I would have needed egg donation if I hadn't gone through that journey. So how many other patients right now are doing egg donation. And unfortunately, I don't have a time machine to give them to go back in time to tell them to change their reproductive plan. So this is the approach that we that we're taking, where we're not just treating infertile patients. We are combining infertility care with gynecology care with urological care. And we want to kind of see all of this throughout your lifespan even beyond in your menopause and andropause years so that we can have a better reproductive health not disease halfway.
Griffin Jones 54:27
How does something like Embie play into this and I'm picking on them because they hit me to you and you've mentioned them a couple of times but this is not a featured sponsor episode, they might do the brought to you by, but featured sponsor means the sponsor gets editorial control. They don't get editorial control. So you can say anything that you want about them we're not going to cut it that you can you can run him through the mud, you could say they're great. You could say that they're that they got a ways to go but what what what are how do they play into this dynamic?
Dr. Cristina Hickman 54:59
So Embie, I met Ravid, she's the founder, very impressive, anybody who has the opportunity to meet Ravid, this she's one of the stars in the fertility field. Her story is that she's had multiple IVF cycles, I can't remember the exact number. It's something like 10 or 12 cycles, something absurd. And she took that as a she learnt with her cycle that she went through initially being quite passive, and gradually being very data driven in her approach to the point where she eventually kind of told the doctor how she wanted to be treated based on the data she had collected. And she, what she learned from this is that she wished she had had this patient app to better understand her care at the time, so many other patients out there that she could support. So she's dedicated her life to create the solution to the patients. Now, before I met her, you know, she had this hugely successful app, you know, 1000s of patients data in there, patients are highly engaged with it, with her app. Her apps are beautiful, she she designs them, she has a marketing award winner, you know, she has an amazing background of skills, and she created the patient side. Now what was missing for me, I was like this poor patients are having to put things in manually every every time. Now, what was amazing about her data is that the patients that were using Embie app, compared to the patients that do not use Embie app around the same regions, you can compare that across geographies, across different demographics of patients, and so on. She founds that Embie app patients have reduced cancellation rates and increased live birth rates. So she presented this data at an estuary this year, you know that the numbers are astronomical, it's like they dropped from 8% cancellation rates are down to 1%. You know, so can't remember, like birth rates, I think it goes up from 46% to 61%. You know, these are these are we're talking about ends of like, 1000s of patients, you know, so so these are significant numbers, with significant improvements. And all that all that she's done, is empowered the patient with their information and provided them insights of similar patients to them, what's happened to them. You know, how powerful is that? You know, to be able, so the patient doesn't need to have a PhD in embryology and you know, I don't know how many fellowships in order to build the knowledge they need. All they need to know is that narrow information about them, to allow them to now participate and engage in the decision making. So this for me Embie app was very, very impressive as a tool. And we've been working together for for Ovum, as well as for Avenues. But this is the Ovum Care project. So we've been working together to create the clinical sites. And this is where all the things we've been discussing today. A lot of these are available within the Embie app. And this is the way that any other clinical they wanted to become an EMR free clinic. That would be the approach.
Griffin Jones 58:04
You've walked us through a number of solutions. You have explained to us the difference between digitalization and digitization. You have shared with us how the digital and the physical environments can blend you've also posited in alternative to having a hub in EMR free clinic would be an interesting follow up topic to bring you back for just a topic about that. But how would you like to conclude our discussion?
Dr. Cristina Hickman 58:32
I think I think we have reached a new a new world to embryology today is so different to what embryology was five years ago. The same goes to nursing and reproductive reproductive care as a whole digitization is the new buzz. You know, the investment in this in this area of fertility has skyrocketed, and the number of very innovative companies out there, they're here to stay. These are not digitized. It's not something that's going to come and go. And we can put the blinders on. And I think everybody who's who's listening in have a responsibility of really thinking through Am I really offering the best standard of care to my patients? Do I need to rethink how to modernize my care so that I can really put patient centered care as a reality in my particular practice.
Griffin Jones 59:23
Dr. Cristina Hickman, thank you very much for joining us on the Inside Reproductive Health podcast.
Dr. Cristina Hickman 59:28
Thank you. It's a pleasure to be here. Thank you.
Sponsor 59:31
This episode was brought to you by Embie. To discover where your time is going and how Embie can transform your clinics efficiency. Visit us at embieclinic.com/report. That's embieclinic.com/report. You've been listening to the Inside Reproductive Health podcast with Griffin Jones. If you are ready to take action to make sure that your practice thrives beyond the revolutionary change.