The MATTER Health Podcast

Getting Under Your Skin: Addressing the Burden of Skin Cancer thru Technology

August 04, 2022 Season 2 Episode 8
The MATTER Health Podcast
Getting Under Your Skin: Addressing the Burden of Skin Cancer thru Technology
Show Notes Transcript
According to the American Academy of Dermatology, skin cancer is the most common form of cancer, with one in every five Americans estimated to develop it in their lifetime. With the prevalence of skin cancer continuing to increase among adults and children, advancements in technology may be the key to prevention.

Traci Dunn, chief human resources officer and head of diversity, equity and inclusion at VillageMD, lead us through a conversation with Scott Barrows, director of the OSF Innovation Design Lab, Kyoko Crawford, co-founder and CEO of SkinIO and Sam Glassenberg, founder and CEO of Level Ex, where they will explore the burden of skin cancer across various communities, the importance of early detection and screening for prevention and how the development of inclusive and accessible technologies are key to assisting providers and health systems with supporting patients.

Speaker 1 (00:11):

Hello, and welcome to matters. Advancing health equity series. I'm Steven Collens. I'm the CEO of MATTER. We're a healthcare technology incubator in an innovation hub with a mission to accelerate the pace of change of healthcare. We do three things in service of our mission. First, we incubate startups since we launched seven years ago, we've worked with more than 700 companies ranging from very early to growth stage startups. And we have a suite of services to help them at every stage of development. Second, we work with large organizations, such as health systems and life sciences companies and payers to help them strengthen their innovation capacity. We help them find value in emerging technology solutions, empower internal innovators to unlock the value of their ideas and create a more human-centered healthcare experience through system level collaborations. Third we're in nexus for people who are passionate about healthcare innovation.

Speaker 1 (01:08):

We bring people together to be inspired and learn and connect with each other. We produce a lot of programs, including large scale events for the broader community, as well as small forums that are exclusively for our members. Last year, we launched a series on advancing health equity designed to explore the issue through a lens of innovation and technology in today's program focuses on skin cancer. So the most common type of cancer will affect about 20% of the us population. And while black people are less likely to get skin cancer, their outcomes once diagnosed are like so many other conditions, worse than white individuals. So we'll explore the implications in our discussion today and address the importance of early detection and screening and the development of inclusive and accessible technologies. We have four people joining us today for this conversation. Kyoko Crawford is co-founder and CEO of SkinIO.

Speaker 1 (02:05):

It's a smartphone based skin cancer screening system. She's a Harvard graduate who started her own technology design and development firm before launching SkinIO in 2014. Scott Barrows is director of OSF healthcare's innovation design lab. Scott is also a medical artist and a professor of medicine engineering design, and biomedical visualization at both the university of Illinois and Bradley university. Sam Glassenberg is the founder and CEO of Level Ex, which makes medical simulations using advanced video gaming technology. And it has helped train more than 750,000 medical professionals to date. He was previously the CEO of the leading independent game publisher in Hollywood. Traci Dunn will lead the conversation with Kyoko Scott and Sam. Traci is chief human resources, officer and head of diversity equity and inclusion at VillageMD. She has held a number of senior roles in large and medium sized companies, including previously Accenture and McKesson. Tracyi, Scott, Sam and Kyoko, thank you so much for joining us. I'm looking forward to the conversation and Traci, I will turn it over to you.

Speaker 2 (03:23):

Thank you so much, Steven. I'm very excited to be with you all today and, and having the pleasure of moderating this discussion, you know, skin is the largest human organ. And while at the surface of every person, you know, it's often a neglected component of our overall health. So I wanna start off by asking our panel about current challenges, with caring for skin, both from a preventative health perspective, as well as diagnosis for conditions like skin cancer. So KK, I'm gonna start with you. Can you share with us some of the most common concerns when it comes to skin health?

Speaker 3 (04:05):

Sure. No, thank you, Tracy. And, and hello everybody. Thank you for having me today on the panel. So when we talk about skin, I think it, it's very, it's very important to note, again, it is our most external organ of our bodies. It's our largest one, but somewhat ironically, it tends to be quite invisible to us. And so when we think about some of the common conditions, I think there are some blockbusters out there. A lot of it is also amplified by a lot of the commercials and, and treatments that are being pushed to us as well. But you, you have kind of the common ones, right? Like acne, everyone kind of goes through that in their teenage years. It's, it's a Rite of passage and it ha and, you know, for a subset, it, it continues to persist psoriasis, eczema rosacea, a lot of those tend to also take up a lot of mind share when we, when it comes to common skin conditions. And, and of course there is skin cancer. As Steve, as Steven mentioned, you know, one out out of five Americans is going to get it by the age of 70. It is tremendously prevalent. So all of those tend to be the skin conditions that, you know, we are aware of, but not aware enough of to often act in ways that can lead to better outcomes.

Speaker 2 (05:28):

Awesome. That is fantastic. Thank you so, so much, you know, next, I wanna dive a little, you know, into the additional challenges that, that skin cancer prevention and screening pose to various communities, you know, what are you all seeing in providing equitable care? So, Sam, I'm gonna turn to you next. So level X has taken a unique approach to clinical dermatological diagnosis diagnostics. Oh my gosh. I cannot talk <laugh>, you know, particularly with toddler. So can you discuss the importance of technology behind early detection and screening for prevention?

Speaker 4 (06:10):

Sure. So look, I, I think actually in, in, in some cases, what we see is technology is actually making the problem worse. Hmm. And I think a lot of the examples we hear about on the news is, you know, oh, there's a new pulse oximeter that, you know, works with this, you know, with light in an interesting way, but, oh, they just, when they tested it, they didn't test it on people with darker skin tones and it doesn't work or AI algorithms to diagnose and treat disease. But the AI algorithms are all trained on Caucasian skin and therefore it doesn't work to try to detect the disease on skin of color. So this is a, a, a, this is exacerbating. What is a pretty, you know a known problem in healthcare in general, specifically in dermatology, which is with skin cancer. And in other areas, people of color just are not getting the same outcomes.

Speaker 4 (06:59):

Steven talked about, this are not getting the same outcomes when they go to the dermatologist and it's not out of malice. Right. It's simply because just like the, you know, that it's simply because the, that dermatologist has not had the opportunity to train their brain and see your skin disease at your severity on your skin tone, nearly as much as they had for the other 90% of their patients that are Caucasian. Right. and you would think that, you know, education would be able to solve this problem, but I think in many ways, it's only, again exacerbated. I like this example. I just literally just went on Amazon and, oh, I like myself a little bit smaller here. And just pulled a you know, just like sort of, I just started flipping through, you know, Fitzpatrick's call like one of the, one of the major, you know, major you know, example dermatology textbook.

Speaker 4 (07:50):

You see the pattern, right? If you actually look at the literature, 90 some percent of the content is all on Caucasian skin. So one of the things we were doing at level X was, you know, we building, we build games for doctors and we wanted build a game for dermatologists. And so we were asking, what are the challenges that you face and skin, you know, and diagnostic and treatment on skin of color is one of those, one of those issues that they highlighted. As Steven mentioned, my background's actually in the video games industry at, you know, I used to work at places like Microsoft and Lucas film and in games, we've actually gotten really good over the last few decades at rendering ultra realistic characters with ultra realistic skin. I like to, you know, pick the example of, you know, call of duty.

Speaker 4 (08:34):

You can literally, you know, have a dozen soldiers on screen and zoom into the face of one of the characters and, you know, this is what it looks like. And so what we've been doing at level X is building on top of that game technology to create a system that allows us to basically generate any skin disease at any severity on skin of any color and on any part of the body. So none of these images that are behind me are real. All of these are just emergent from a video game engine that is basically simulating light, bouncing around pigment and different elements of tissue to recreate skin disease on different skin tones. It's all amazing. It's, it's all, it's all video game. It's all, it's all not real. But then what we're able to do is use this to train dermatologists, to recognize based on imagery, to train their brain, how to recognize those diseases, because the reference material simply doesn't exist. Mm-Hmm <affirmative> so we need to create it. And we end up doing this a lot in melanoma and other areas like, you know, as Steven mentioned, because the dermatologists simply just don't know how to recognize it.

Speaker 2 (09:42):

That's so powerful. And and I think is, you know, truly gonna going to make a difference, because like you said, if you, if you haven't been trained on that, you don't know what to look for. You know, something that you see and diagnosed every day may look different, you know, on a, on a person, a person of color. So very, very excited about the work that you're, you're doing there at level X. Scott, let's bring you into this discussion, you know, based on your work with OSF design lab, what are some of the gaps that you're seeing and in the challenges about skin cancer?

Speaker 5 (10:16):

Well, the, the biggest gap we're seeing is access. We deal with communities not only in an urban setting, but in a rural setting and in take Illinois, for instance, in rural Illinois, central Illinois is, has the highest rates of melanoma in the state. However, there are fewer dermatologists per population in central Illinois. The agricultural focus is very big. The lack of sunscreen sometimes, and, and preventative factors, that's really essential. So we have high melanoma rates in urban settings. As Sam mentioned, you know, the underserved communities with there's, there's a history of health and equity, mm-hmm <affirmative> skin tone differences. I'll talk a little bit about some of the solutions we've looked at but it it's a huge problem. If, if especially melanoma, if it's not caught early, then it ha it has devastating outcomes. And then there are, are elements we look at that are related to both urban and rural and suburban to some degree besides screening and prevention, awareness, and education, we always try to address the social determinants of health needs, the needs of people in different communities.

Speaker 5 (11:49):

Health literacy is also something that's very important. And I think with both our, our other guests, you know, they do a fantastic job of adding to how can we better understand and integrate into, you know, the need of health or our skin cancer. And finally as Sam also mentioned, dermatology education in medical schools is often shortchange. There's just too much information. And that led to the development of an app. That, again, I'll, I'll talk about a little bit later, but it's screening access and getting risk factors cross and getting people wear sunscreen and not go to tanning beds.

Speaker 2 (12:38):

Mm absolutely. GI skin IO has made skin texture, skin cancer detection, seamless, you know, for your end users, you know, has enhancing the patient experience. How, how do, how do you see accessible technologies assisting providers in health systems with supporting their patients? What do you see?

Speaker 3 (13:02):

Yes. Yeah. So I think one of the big issues, and I think both Sam and Scott have touched on this, you know, there are kind of systemic level issues that surround this entire topic. Mm-Hmm <affirmative>. But one, one of the kind of pure numbers ones is that there just aren't that many dermatologists. Right. And, and I think you're looking at the 10,000 or so in this country and with that few number of dermatologists, <laugh>, it's no surprise. They aren't equally distributed geographically across the country either. Right. And so you have huge, you know, macro deserts, dermatology deserts, as well as micro ones like Scott describes within the state. We're all in right now. And so because of that, this is where, when we look at technologies such as skin IO, so, you know, with skin IO, what we've done is we've distilled this total body photography, kind of a proxy for the full body skin exam that dermatologist performs on a patient.

Speaker 3 (14:06):

We've put that onto a mobile app, very accessible medium one that can be used by anybody anywhere. Right. And, and that anybody and be anywhere is very important because that ultimately opens up access to this mm-hmm <affirmative> because a lot of it is the providers. I mean, most patients aren't reaching these specialists right there aren't enough of them. You, you ha you try to get in, sometimes you're waiting a year to get in. And if you have something like melanoma, much as Scott's point, you don't have that time necessarily. So you know, our technology by nature of being a mobile app on a commodity device allows us to reach communities and populations who may not otherwise even know to go into a dermatologist office. Right. Mm-hmm <affirmative>, and that could take the, that could take the form of events. It can take the form of community outreach.

Speaker 3 (15:01):

It can be your workplace. It can be, you know, your school. It can be a lot of things like that. The other part of it with skin cancer in particular is it's not just a one time thing. It's not just getting lucky that one time and catching, right. It is about tracking your skin over time. It's the changes that matter. As much as that anomaly, you catch that one time you happen to be in front of a doctor. And that's another area where technologies and platforms that are able to, you know, store this data and, and make sure it persists helps in that mission. Mm-Hmm, <affirmative>, you know, once you screen with a platform like skin IO, you now have a digital record of your skin, that's your best baseline to compare and monitor your skin over time. And so both those components matter when they're just simply aren't enough specialists on the back end to take care of you in person.

Speaker 2 (15:55):

Absolutely. You know, one thing that I'm hearing in, in all of Y's responses is just the importance of kind of proactive prevention and then also education, you know say I throw a question to you, but one of the things I wanted to, to add to that, I, I just got back from Disney last week, that little guy behind me, that six year old wave were down in Florida, and it was hot, really, really hot every day. And we did three parts. It was insane. But one thing that was interesting was, you know, every day I'm slathering the kid with just all kinds of sunscreen had extra in my bag and, you know, all throughout the time that we were there. And one of my cousins was like, you know, isn't that a little overboard, Tracy, you know, we've got melanin, you know, we're, we don't get skin cancer. And so clearly, I mean, obviously the blacks don't get it at the same rate as, as our white counterparts, but, you know, as was mentioned earlier, when, when we do it's really bad. And so I wanted you Sam to talk a little bit about, you know, how clinicians can be as proactive as possible, you know, with diagnosis and treatment across communities, but also with just education and awareness and, and just, you know, I think that could make a, a huge difference as well.

Speaker 4 (17:24):

Great question. I mean, look, first, the other thing is it's, we all often think of this almost in terms of like two skin tones, but it's not, <affirmative>, there's, you know, people of, there are, there are many people of color in many different groups and, you know, many there's all sorts of spectrums of skin tones. And so, you know, it's very important to not that, like the first step is making sure that you're sort of have that broader exposure Pacific Islander and not like, you know, every there, there, these diseases manifest in different ways, you know, in a wide range of communities of color mm-hmm <affirmative> in terms of education, I mean, you know, in the United States, you know, both primary care physicians, as well as dermatologists, they need to, you know, they need to earn a certain amount of continuing medical education credit every year toward renewing their medical license.

Speaker 4 (18:08):

So, I mean, obviously if they want to, they can play top D and earn CME credit from learning about this on you know, from learning about skin diseases on skin of color. We're, we're not, you know, you don't have to just play a video game. There are societies out there, like the skin of color society that put out content that is specific to how to not only diagnose, but also treat patients of color. And there are societies that are focusing on it, not just from a dermatological perspective, but in all sorts of, you know, different whether it's, you know, managing heart disease, diabetes you know, in different way, you know, genetic diseases in the way they manifest in different, in different communities. So there's just tons of, of educational material out there. And, you know, physicians typically have to do the, you know, they have to do some amount of continuing education anyway. So, you know, the opportunity that becomes to pursue those avenues that are providing education, not necessarily just focused on one one group, but giving you that, that greater breadth.

Speaker 2 (19:09):

Yeah. Oh, absolutely. Fantastic. I I'd like to flip back over to you, Scott. I apologize here having some issues with my screen. So Scott, for, for you, as you continue to do your research on, on this topic, what are some of the future trends that, that we should be aware of?

Speaker 5 (19:38):

Well, what we're talking about today right now is a future trend, but at least in, in my day to day activity and, and research that we're working on one is the expansion of community health workers. And that's both in, again, rural and urban areas. These are members of the community you're neighbors that receive training and can help build the trust in the community and give good like links to who to go to and who to talk to, and even finding a dermatologist or a doctor or reinforcing, you know, some concerns a neighbor might have. So ch H w expansion is really important. It's going on very well in some areas, not so well in others. Another is access, as I mentioned, and mobile devices certainly have changed everything. But as Sam mentioned, it's not the, you know, the cure all for everything.

Speaker 5 (20:45):

Some of the things we've been working on is we, we look at those most vulnerable and like homeless people. They might not have a mobile device, so we're putting iPads in kiosks and homeless shelters and giving them all the links they can. So they can access social determinants of health community health workers, providers, nurses how to get assistance. So telehealth is, is really a big trend that just has exploded. And I, I have to stress, you know, the human touch will never be replaced. That is essential and being a partner with people in the community cuz there is a lack of trust. So that's, that's essential. And the partnership in the community is very, very important. And that's not just with, you know, going to local neighborhoods, it could be churches, it could be barber shops, it could be organizations, community, health organizations, libraries mm-hmm <affirmative> and then partnering in education.

Speaker 5 (21:55):

I is really a, a critical piece of this not only grade school but with universities and colleges I, I will mention that we have several grants that with the university of Illinois, both Urbana and Chicago, one of them again, it aligns with what Sam was talking about, but it try, it addresses the shortage of dermatology education and with some of the similar components. So though not, not as beautiful as what level X is created. We've created an app prototype that uses an elastamer with tactile lesions on it and it's put over an iPad or an iPhone so that people, a lot of times dermatology is DNO diagnosed by touch or by tactile, you know sensations. So this will show crus and ulcerations and all sorts of different kinds of tactile manifestations. And because it's over like an iPad or an iPhone, the light comes through and building into this Laster and, and this education we've been working on an augmented reality portion of the app that is, can we look under the surface of the skin for like melanoma or basal, so carcinoma and even isolate out, you know, the tumor or the lesion and look at it, how deep did it go and educating people mostly medical students, but what does this, what does this do?

Speaker 5 (23:36):

It's interactive and it builds a library too, as pictures are taken. One other app that graduate students at the university of Illinois, Chicago created for a class is an app for variations in skin tone. It has sliders that you can adjust because melanoma basal cell carcinoma will look very different in someone of Mediterranean African American someone from Scandinavia. So it's a really great app and getting young people involved and engaged mm-hmm <affirmative> and getting it into the schools is, is really important. So that's, those are trends and I think can all be linked with these great resources that are being created and do such a wonderful job. So those are just some of the, the trends.

Speaker 2 (24:30):

Yeah, no, that's, it's great because, you know, I think the, the point you're making, you gotta meet people where they are. And and when you talk about, you know, I think about now there's so many of those apps and, and other aspects of life that folks are used to having that ability. I mean, something like super simple as I was looking for a new nail Polish and I was able to on the app be able to scroll over to darker skin tone and like, Ooh, yeah, that bright yellow doesn't look as good as I thought it was gonna look on me. But being able to, to meet folks where they, where they are and giving them some of the tools that they're used to in other aspects of their lives, I think can, can be really powerful for us. I wanna remind the group as well listeners that we do have the chat there at the bottom. It looks like we've got a, a question in here. And so I encourage others to do the same. One question here is as a melanoma survivor, do you promote doing research in families with you know, family history of melanoma, many people with melanoma did not get it, you know, from too much sun exposure, I'll open that up to, to anyone to to respond.

Speaker 5 (25:46):

That's a very good question. And I, my sister was a melanoma survivor and that was asked, I am not a dermatologist, so I cannot give a firm answer on that. But I know there are other other factors besides

Speaker 3 (26:07):

Yeah. And, and caveat, I am not a dermatologist as well. Either my co-founder is, but no, that's a really good question. And I think that just highlights that there are a variety of factors that, that go into kind of your general risk profile. And, and I, you know, part of this, when we talk about education awareness, I know it's a, a big part of this discussion. I mean, a lot of people are not aware or not entirely sure mm-hmm <affirmative> of their risk. Right. And, and yes, sun exposure is a big part of this for the skin cancers, you know, sunburns are directly linked to melanoma, sun exposure. All of that stuff would be for squamous and basil as well, but, you know, you can get melanoma in your eye, you can get it in, in places where the sun don't shine either.

Speaker 3 (26:55):

Right. And so there are genetic factors as well, family history does matter. And because we are aware of just how, you know, how just UN unaware or, or uninformed certain populations or certain subgroups can be mm-hmm <affirmative> from a screening perspective, it is a softer landing. It's a way to bring somebody into that journey of knowing more. Yeah. And we also, you know, as part of our programs have intake questions that specifically ask, and they're not onerous, they're just asking if you know, your personal history, if you know your family history, where did you grow up? Because all of those things contribute. You know, if you grew up in Florida versus growing up in Michigan, you know, there, there's just different cumulative exposure that you've had over your lifetime, regardless of your skin type. And so there, there are a lot of factors that all matter.

Speaker 3 (27:49):

And part of this is being able to have better data around this that's diverse. That is multidimensional mm-hmm <affirmative> because you know, skin cancers are, there are a lot of them and they, they are a lot more complex than just linked to one thing or the other. Right. And, and better understanding that landscape across the board and even for physicians, right? Like this should play all the way up in, you know, through that education process. Yeah. All of that can only make this better so that the entire system can serve more of the population more effectively.

Speaker 4 (28:25):

Yeah. I think it's, it's an, it's an excellent question. We often assume that diagnosis is something that's done visually. It's not well, at least in a lot of cases, it isn't. And so, you know, one of the areas, this is a big area of focus for us in dermatology and just about every major specialty, which is basically how do you capture the challenge of diagnosis, whether it's visual or whether it's, you know, looking at test results or asking for example about things like family history. So we spend a lot, you know, our, our, our designers spend a lot of time figuring out how do we capture the puzzle of diagnosis? How do you train a doctor, not just to be able to a medical professional, not just to be able to recognize, you know, a visual of skin disease, but how do you get them to think about, you know, for example, we have games like this, where you're literally, like, we're not rewarding you for guessing the right answer.

Speaker 4 (29:22):

You have to order the right tests, ask the right questions, look at things like family history in order to not only identify what the patient has, but eliminate the differential diagnoses. And so when you think about training medical professionals to be diagnosticians, really what you're training is a, you know, cognitive reductive and deductive reasoning skills that are based on lots of knowledge. And you know, doing this in effect in an effective way can be very tricky. But if you technology can really help here in the absence of technology, they're inevitably gonna learn it by practicing on live patients.

Speaker 2 (29:56):

Yeah, yeah, no, absolutely. You know, the innovation definitely is going to, to play such a, a great role in addressing some of these challenges. You know, one of the things I was noticing as well is I was looking through the questions that we've got several participants who have joined from Nigeria. And so thinking about innovation and access and especially technology being able to, you know, have an impact on these challenges on a global scale. So as, as we think about innovation, I would love for you all to, to just talk a little bit about how some of the things that your respective companies are doing can, can have an impact globally. So Sam, while I still see you big on my screen, I'm gonna toss that one to you first <laugh> to just talk about, you know, just the impact of some of these, you know, innovative solutions and how they can you know, drive progress and, and help to address some of these challenges on a global scale.

Speaker 4 (30:57):

So I mean that, that's the beauty of digital, and I think yoga already called it out, right? Like we, we all CR we're creating mobile apps that are available for free worldwide. Mm-Hmm <affirmative>. So what that means is, you know, you know, in order to train on things like you no longer need a, you know, 50 million simulation center and a major, you know, academic medical institution, you have everything you need in, in your pocket. Right. I think so that, that goes to, you know, that gets a lot of global reach, but I think it even goes beyond that. So, you know, Scott was, you, you were mentioning the sort of meet people where they are. And Scott was talking about examples of, you know, actually having to like, you know, the, the value of the personal connection, like being on a phone by yourself and learning is one thing. But like, there are also, you know, one, a big area of focus for us has been creating technologies that allow people to collaboratively train mm-hmm <affirmative> on how to treat and diagnose virtual patients. Here actually, I wasn't planning on demoing this, but maybe I will Kyoko or Scott. I'm just gonna, I'm just gonna paste a little link in the post chat. You wanna go ahead and click that and we'll, we'll, we'll show a little something under yourselves though. I'll show you what I'm talking about.

Speaker 4 (32:13):

Perfect. Okay, great. So all right. So both of you see on your computers, this knee, right? Perfect. Okay, great.

Speaker 3 (32:26):

No.

Speaker 4 (32:27):

Oh, you don't. What about you, Scott? Hold on. I do. Hold on. Sorry. Great. So Scott, you're out in. Oh,

Speaker 3 (32:32):

Now I see it now. I see it. Okay.

Speaker 4 (32:33):

Sorry. Okay. So you can see, basically I'm doing, I'm here on my computer doing surgery on this virtual patient, so I can control the elasticity of the skin. I can open this patient up here on the left. Scott. I want you to open up the patient on the right. Yeah, really? Yeah. You gotta pull it. They give it a good tug all. Wait, full drag. Good. All right. Excellent. Oh, here, keep popping. There you go. You got it. Excellent. So you're in Peoria. I'm in Chicago and the two of us are doing surgery together on a virtual patient simulated in the cloud. And so this is an example, we're, you're in Peoria, I'm in Chicago. That's not impressive. We actually use this technology worldwide, where you can have a doctor at Stanford training. Let's say a doctor in Nigeria, collaboratively over zoom or Ms. Teams. and so, you know, these are just examples. This is actually, this is repurposed cloud gaming technology. It's the same tech behind PlayStation. Now only you can reuse this to, for example, train, you know, a, a healthcare worker in, you know, you know, in, in Africa or Asia, anywhere in the world, how to do a procedure, how to diagnose a patient and we're just interacting with it collaboratively. So like there are a lot of opportunities to sort of take that telehealth analogy, but actually make it work for remote medical training.

Speaker 2 (33:49):

That's fantastic. Great. Thank you so much for sharing that and demonstrating that as well. The impact that, that technology and that globally Kik, I wanna switch to you to just talk a little bit again about innovation and, and how that addresses some of these challenges. So what effect have you seen that your solution has had on the, the detection of skin cancer? And there was another question that came in, I'm gonna package these together. What are some of the key barriers to adoption of some of the things that, that your company is driving from both a provider and patient perspective?

Speaker 3 (34:28):

Sure. Yeah. No, those are excellent questions. So from, from an innovation standpoint and, and kinda the effect and the impact that we've seen a big one is access. You know, what we've done in terms of, you know, going into the market has been really, it, it so happens. We've been able to really open this up to communities and populations who don't traditionally have access. You know, a lot of our clients tend to be, they can be, you know, responsible for blue collar workers. They can be a, or they can be in Sunbelt belt areas, right, where they're just geographically at, at a lot of risk and the opportunity to leverage technology like ours in the form factor that it is where we can easily come on site. We can go to a railroad, we can go to a warehouse, we can go on site with popup tents and screen people who wouldn't and, and anecdotally going there, you know, we can hear stories of most people have never seen a dermatologist.

Speaker 3 (35:36):

Many may not even know they have to mm-hmm <affirmative>, we've caught melanomas in individuals on their arms who had never seen a dermatologist, barely knew what a dermatologist was. So the opportunity to really meet people where they are is huge. And the impact of that is both clinically early detection, but also expanded education awareness. Mm-Hmm <affirmative>. And it, it, it goes hand in hand because at the same time, we're also on our end, you know, accumulating a database of this multi-layered view of the skin. That's also longitudinal that provides that educational content for the physicians who end up seeing some of these patients to better understand the communities that they're serving. And on the flip side for the system itself, it's creating a more efficient pre-qualified filtered pipeline of patients who need to be seen by those specialists, not just the people who happen to get in for an appointment because they made it a year ago, but the people who actually need to be seen, right.

Speaker 3 (36:39):

So it's creating the efficiencies and that delivery model as well. So that's really, you know, that's been a really impactful side of our, our business now, you know, in terms of challenges, it's, it's the challenges of all of us being human, right. And, and the various inertia that we hold. And that's true for providers as much as it is for patients. You know, for a big part of it on the patient side is awareness. It is, you know, a third of Americans don't even wear sunscreen. They don't know anything about skin cancer, right? Like there's a huge awareness gap, educational gap. But you know, another is, is inertia in general, right? Not, not, we don't necessarily always do things we should do. We, we do things we want to do, which don't tend to overlap often with things we should do.

Speaker 3 (37:32):

Right. <laugh> so there there's that. But you can offset a lot of that by meeting people where it's convenient, just because something is accessible, just because something's an app. And that means it's, it's accessible, doesn't necessarily mean it's always convenient for you. Sure. On the provider side, it's also the inertia of their profession, right. And, and their, the result of that training and just the cumulative I, I think cumulative tissue that, that results from that training and, and I think with, with dermatologists in particular, you know, they don't lack for patients. They, you know, they are, they're so scarce it's, they don't lack for patients. They they're doing business just fine. But the opportunity to break through and say, these are the patients you, you need to be seeing, you know, these are the patients who wouldn't otherwise access the system that you should be seeing. These are the patients you should draw into your system at multiple levels, even at the primary care level, those are kind of what is what we're finding to be ways to really start to shift the mindset and make that access across the system a lot more equitable for more, more of the population.

Speaker 2 (38:42):

Mm-Hmm <affirmative> no, that's, that's fantastic. Sam, I think, you know, kind of building on what you were demonstrating and sharing with us a little little bit ago there are discussions centered around kind of the role of gaming and video games and improving health outcomes. How did you even come up with the concept to, to use video games as a platform to really drive that education and awareness and provider learning in it?

Speaker 4 (39:10):

Oh, how did level X get started? Yeah. Oh, okay. I would love to say that it was some grand idea I had but it wasn't, this company was founded entirely by accident. And parental Gill, Alice Moore. All right. It's a very Chicago story. All right. So, so I, all right, hold on. Let's just, I have my, my artist drew pictures of the whole thing, so alright. So I, like I said, I spent my career in games. This my successful career in the games business has basically made me the disgrace of my family because I come from a long line of doctors. My grandfather was a famous doctor. My parents are both doctors. My wife, aunts, uncles, I'm the idiot who never went to medical school to show you how bad it got in 2006. I accepted a technical Emmy on behalf of my team at Microsoft for pushing the cutting edge of interactive entertainment.

Speaker 4 (40:05):

It's not the Emmy. They show on TV. It's the one they do before, but it it's the same statute. And so I call my parents to be like, Hey dad, I'm gonna accept an Emmy. And he's an anes. He was an anesthesiologist here at Northwestern. He goes, all right, Sam he didn't realize this was coming, cuz nothing had been announced. And he goes, he answers the phone. Mm-Hmm <affirmative> mm-hmm <affirmative> all right, Sam, that's very nice. But in this family, we only recognize Nobel prizes. He goes, you're not yet 30 years old. You can still go to medical school. I'll pay for it. This is, this is the world I come from. There's medicine and there's everything else. So in 2012, my dad gives up and he says, all right, you're too old to go to med school. So it at least put all this gaming nonsense to good use and make me a game to train my colleagues, to do a fiber optic intubation.

Speaker 4 (40:53):

It's a difficult procedure. We only do it on, you know difficult presenting patients. So it can be a struggle. So just please make me a game again meet people where they are. He said, make me a game. They can play on their phones. I don't wanna have to drag anybody to the simulation center. So out of guilt, I'm running a Hollywood game company. I'm busy out of guilt. I sit down for three weekends and I throw together a crappy little game for my father, but I upload to the app store. And I don't think about it again here, dad, here's the link. Your friends can download it. Leave me alone. I've got a company to run two years later in 2014, he calls me, he goes, Hey Sam, how many people downloaded the app? Dad? I don't know how many of your friends downloaded your game.

Speaker 4 (41:35):

I'll check for you. I went and I looked, we had a hundred thousand whoa, doctors, nurses, and airway specialists. Who'd been playing this thing. Mm-Hmm <affirmative> is again like, was talking about it's like, this is the power of mobile. So I Google it. Like, why is this happening? What, what have I, what happened? I discover unbeknownst to me, they've been doing efficacy studies on this crappy game I made for my father that chose it's drastically improving physician performance. And they're doing these studies at medical schools all over the world. And so that was the Mo that was the moment where I realized, all right, there's something here mm-hmm <affirmative>. And that was a motivation for starting level X. So what if, you know, instead of just Sam in his spare time, we took, you know, the top game designers, artists, engineers from around the industry, teamed him up with hundreds of physician advisors and contributors from around the world and put them on the challenge of capturing the practice of medicine using video games. We actually incubated it matter. OSF was actually one of our early investors. So yeah, but again, all not, no, no grand idea. It was all just accidental and parental Guild.

Speaker 2 (42:46):

That is fantastic. And the visuals to explain the story that I love it

Speaker 4 (42:51):

Game artists are very talented, a lot of fun.

Speaker 2 (42:55):

Fantastic. this, this conversation has been been amazing. I wanna move to one other section before we run outta time. Just really thinking about how inovation, you know, move forward in, in this space and for some of the innovators that are in the audience, I'm sure that we have several that are, that are listening today. You know, let's talk a little bit about some of the approaches that, that they might consider at this time. So I'll start with you Scott, you know, and, and all, all of you can, can answer this question, but you know, how do health systems co-create and collaborate with non-traditional partners like startups and and conversely for those startups to be better informed about how, you know, solutions are, are deployed, you know, in, in the case of level X you had, you had your dad and his friends and, and then a hundred thousand others that we're able to, to support in that. But, you know, just wanna talk a little bit about collaboration and, and how some of the innovators in the audience can and should collaborate with, with others to reduce the gaps in accessibility of cancer screening and, and just development across multiple communities. So Scott, I'll turn to you first. What, any thoughts you had on that?

Speaker 5 (44:14):

Well, before I, I address that, I do want to mention to our friends from Nigeria, that the medical school here in Peoria has a program where our medical students go to Africa and work in several different areas with remote access. And it helps we're not all that different, you know, in large rural parts of the United States the same access issues exist, but also getting to know how different cultures, how we can work better. That's really important. So I did, did want to throw that in there, cuz that's really important. Mm-Hmm <affirmative> from OS F's perspective, as Sam mentioned, we do have OSF ventures that would support it it's a process of application and review, but that is one, one venue mm-hmm <affirmative>. The one that I'm most involved with is our collaboration with universities. We do have research grant mechanisms set up with the university of Illinois, Urbana, Chicago.

Speaker 5 (45:22):

And we're also entering some new agreements with like Bradley university and, and others. But these grants are, are innovation grants where they're not huge, but we can explore along with external partners and partners at, at, in engineering and medicine and social work, whatever makes the best fit. That is a solution. Another one that, that is we're, we're working a lot with is the Illinois innovation network. It's funded out of the university of Illinois system. But we have a grant right now with Illinois state university to increase pediatric vaccination in central Illinois. So the IEN networks and innovation networks, we have a really great lab in Peoria called distillery lab. And it, it it's set up exactly for this purpose. People with a, an idea, it could be a single person business or small business or someone with an idea it's putting those together and incubating those. And you know, the, it, it's all part of, I think, a, a larger system. I, I, I guess we'll close with the thing that's most important for health equity is to listen. So our partnerships are also with the communities that we serve and want to serve and serve better. So listening and having people at the table is, is really an important part of a partnership for us.

Speaker 2 (47:04):

Absolutely. Absolutely. Kioko just from innovators, you know, side there as well. Talk a little bit about, you know, that question of just, you know, some of the ways in which we can increase the collaboration to find solutions.

Speaker 3 (47:20):

Yeah. I think, well, a big part of it is recognizing that too. I think there, there tends to be an inclination from a technology perspective that it, it can, it can solve everything it can disrupt and solve and you know, change the world all alone. And I think with healthcare it's, it's you know, it it's most imperative that we work within the ecosystem, that's there feel about it, how you do, and you know, it it's fragmented and it's broken. There are a lot of aspects about it, but one of the things that, you know, at least we've found at S is that, you know, it is a point of pride that we aren't a selfer app. We're not out there disrupting and clogging up we're, you know, stopping up how people get care, we're trying to make it better.

Speaker 3 (48:10):

And that requires partners that requires collaborating, that requires connecting to the ecosystem in which we ultimately do connect and access care. And so, you know, I think having, and that in of itself is a mindset, right? Like in, and sometimes it's not one that comes naturally when you're trying to be innovative when you're trying to be revolutionary when you're trying to change things for the better, and you're trying to do it alone as a startup, you know, out there. And so, and, and on the flip side, you know, these larger systems and, and provider networks plans, all of those can seem large mm-hmm and difficult to work with, but finding kind of those avenues. And I think, you know, increasingly with innovation labs and innovation programs and ways for, I think a lot of these systems are making their efforts to reach out to communities and recognizing that that collaborative effort is what makes that impact ultimately. Yeah. Is a huge part of it.

Speaker 2 (49:13):

Yeah. No, absolutely. So I wanna pose a question to you that came from our, our audience, you know, to comment on the potential blend of using the gamification strategy as motivation to overcome, you know, the inertia to move, you know, patients that providers to action with regard to preventative or further monitoring rehabs.

Speaker 4 (49:36):

Excellent question. So we so at, at level X, we do, you know, we, we we build content for providers. Mm-Hmm <affirmative> so actually medical professionals a lot of doctors don't like the term provider, but so we, we, we do for medical professionals and there we're using, you know, basically the, the neuroscience of play to help them, you know, to help them under, you know, do everything from like, you know, example we use the diagnosis example, right? Doctors are far more likely to recognize a disease they've seen recently, right. We can use the neuroscience of games to actually trigger recency bias. So you're more likely to see recognize the disease that you've seen recently, even if it's on a virtual patient. Mm-Hmm <affirmative> I think that using these same techniques for to use these same techniques for for patients, we're not actively doing that, but although we're starting to explore it, but there that, that is actually also very interesting mm-hmm <affirmative> and you see already, there are companies that create things like digital therapeutics, which is using the neuroscience of games to treat things like ADHD and PTSD and things like that.

Speaker 4 (50:53):

Mm-Hmm <affirmative>, but the same neuroscience behind video games can also be used to just drive positive user behavior. Right. The example, like the example I like to that comes to mind is I remember, you know, the Obama administration spent several billion over, you know, over eight years to try to stem the obesity epidemic. At one point, their focus was like, how do we get, you know, literally how do we get overweight Americans to just get up and go for a walk mm-hmm <affirmative>. And then I remember, you know, in the sec, their, during their second term in the white house, a, all of the meritorious efforts were eclipse by a single video game that got 40 million Americans up and walking for miles. And that was Pokemon go

Speaker 2 (51:31):

Mm-Hmm

Speaker 4 (51:32):

<Affirmative> right. We're literally like, you know, it just, I don't know, downtown Chicago was a zombie apocalypse for three years, right? Chicago, general kids in downtown Chicago. But what this demonstrates is the ability of games to drive behavior change. And actually every game is doing what Pokemon go is doing. It's not, they're not trying to get you to walk around in strange neighborhoods or go for, you know, and what they're trying to do though, is they're getting you to come back every day, invite your friends, engage with sponsored content. Yeah. Like these are the things that games are doing through, you know reward loops and, you know, hitting the right balance of reward and frustration and challenge and skill and all the techniques that we employ. But these are very effective at driving user behavior, including as we've seen in the real world. So there's a lot of opportunity to do that. And you know, eager to see some of the, you know, talent from the games industry, put their skills towards solving some of these behavioral challenges.

Speaker 2 (52:29):

That's fantastic. All right. So as we wrap up here, I wanna pose one last question to each of you, what more needs to be done. You're all doing amazing things in your respective areas to really just Chan change landscape and you know, in this, this journey around skin cancer, but, but what more needs to be done? There's, you know, tons of folks here, here, listening that are innovators or in places where, where they can have an impact. If I could just hear from each of you Scott what, what more can be done?

Speaker 5 (53:02):

Well, certainly the first thing that comes to mind is money <laugh>, but you know, what we're looking at are, are ways of connecting people and connecting dots and and making a difference with, especially those who are most vulnerable and and really anybody that that's, that has a health condition or that might be facing it. So I it's really to continue the involvement and working together. I, I think there's a, too many silos that still exist even in the state of Illinois, but working together and, and working with the community and partners and those who need us the most

Speaker 2 (53:51):

Mm-Hmm <affirmative> mm-hmm <affirmative> totally agree. Sam, what more, what more can we be doing?

Speaker 4 (53:57):

Oh, my good we're we're all. I mean, look, when it comes to the application of video game technology for all this, we're all just scratching the surface. Mm-Hmm, <affirmative>, there's still a, you know, 20 year gap between what's happening in the entertainment industry from a, you know, technology and neuroscience perspective and what we see in, in medical training. So there's a huge gap to close and it's going to take, you know, lots of initiatives to do that across every specialty in medicine. But I, I want to, you know, echo what Scott said. I think that, you know, that kind of, you know, cross-disciplinary collaboration is crucial. I think you kind of see some of the best examples here. I mean, matter is a tremendous showcase for that. You know, OSF is a great showcase for that. I mean, showing off all the cool self level X is doing like these things would not have been possible. They, or at least they would not have happened without the, the network at matter, and, you know, funding from OSF ventures. So you know, there there's a lot more to be done.

Speaker 2 (54:54):

Yeah, absolutely. Absolutely. Go ahead.

Speaker 3 (55:00):

Oh, no, I, I mean, I, I was just gonna say, I think the more is it's not one directional it's multidirectional throughout the entire system. I think, you know, there's obviously more that can be done on the technology front to be able to make it more accessible, more easy to use more accurate, more precise, more, you know, widespread all of that, but also on, on the system level too, there, you know, more needs to be done to better educate the, you know, the future generations of physicians, different ways to educate them different access to the data that's available to do so and different ways to do that. There should be more done on the reimbursement side of things, right? The entire economics of our healthcare system, when, when God talks about the money, right. You know, like prevention, is it, is it especially difficult area because our system generally is more reactive than it is proactive. And so to be able to recognize the economics of how that, how that all goes up, the more has to be across all of those different levers in order to really move the needle here.

Speaker 2 (56:04):

Absolutely. Thank you all for that, Steven, over to you to close us out.

Speaker 1 (56:08):

Thank you. So much thanks to all of you. Thanks Tracy for moderating and leading the conversation and Yoko and Scott and Sam for your insights. And and, and Sam, thank you for your digital pyrotechnics that are particularly impressive. I love it. And thanks to all of you for joining. If you enjoyed the conversation you might be interested in some of our upcoming programs. We have one on August 23rd focused on the future of aging. We have one on August 30th on the future of dementia and Alzheimer's care, and you can at matter that health, you can learn about all of our upcoming programs and I hope you all enjoy the rest of your day.