Welcome to the latest episode of Digital Health Interviews! We are thrilled to present today’s special guest: Austin Lee Chiang. In our conversation, we will delve into the intricacies of the US healthcare system and explore his firsthand experiences with implementing cutting-edge technologies in the field of gastrointestinal medicine.
Austin Lee Chiang: “I’m a gastroenterologist, and I’ve been practicing for a few years, but about a year and a half ago I also stepped into the role of Chief Medical Officer for the gastrointestinal business at Medtronic, which is a big medical device maker. So now I juggle two roles: I practice part-time at an academic center in Philadelphia and then I’m full-time at Medtronic. And then on top of all of this, I also play around with social media and am active on all different platforms as well.”
Often the chief medical officers have a lot of clinical experience and they’re retiring from their clinical jobs, but Austin is a little bit closer to the trainees, to a young faculty, and brings a little bit of a different perspective, especially with the social media piece.
Austin Lee Chiang: “You know I’m very aware of what the customers and patients are thinking about and how to get the messaging out to them. A lot of what I do is not about just medical devices: it’s also about the disease states and thinking about how to get a message out about the different conditions, how those conditions affect not only older people oftentimes but also younger ones and how we raise brand awareness among that segment of the population. So a lot of it is just a matter of who I am, and my experiences.”
Speaking about the American healthcare system, Austin doesn’t think that it’s entirely broken and not salvageable. But he thinks there’s a lot of perks to it. Our guest lived part of his life in Taiwan where there’s a single-payer health system, so he’s able to compare and contrast as a clinician what it feels to work there.
Austin Lee Chiang: “There are benefits and disadvantages to both systems. We have a lot of challenges here in the U.S. The pandemic was a huge example of all the challenges we face with the public health response and the culture here; misinformation is everywhere. How complex the systems are here and the bureaucracy we have to deal with! So I agree to a certain extent that it’s broken but that’s where we have to get creative and try to think of ways to improve it.”
Then Austin names his list of the top problems of the US healthcare system. As for a consumer, there’s a lot of misinformation — that’s a huge challenge. The pandemic was a big example of how people are very individualistic and it’s harder to rally around authority and a common piece of knowledge.
Austin Lee Chiang: “I think one common challenge for both consumers and practitioners is navigating insurance companies. As a clinician, I share the feelings of a lot of my colleagues that a lot of decision-making is out of the hands. We’re taught one thing in medical school — and then when we’re practicing we’re told: “No, you can’t do this because this is what the policies say.” How do we change that? Another challenge is that a lot of us feel helpless in understanding how we can advocate and change this process. Educating the clinicians on how to change that, how to advocate, how to understand how these policies are put in place, and how guidelines are formed. I think a lot of doctors out there aren’t taught that through medical school. Understanding everything around science is important. Medical school, medical education at this point, or training, in general, is very focused on understanding medicine and science. That’s very important but understanding the political piece of it, the business side of things like everything outside of just patient care is equally important, I think we’re beginning to realize that.”
Technologies have an important role here: there’s an opportunity for them to make the lives of both patients and medicians more efficient and easier.
Concerning innovations and breakthroughs in HealthTech or MedTech, there are so many different things on the device front that have been transformed tremendously.
Austin Lee Chiang: “There are also changes in how technology has affected just our understanding of healthcare: the impact of social media is a big example of that. It’s not necessarily a healthcare innovation but has positively impacted how we practice healthcare and how people perceive it and it’s another thing we have to care about now.”
Let’s talk more about the gastrointestinal department at Medtronics where Austin is a Chief Medical Officer. He thinks the culture has been great: the people there are bright, open, and inclusive, and the company pays a lot of attention to that. Everyone has a very specific distinct kind of responsibility. When Austin came in, he was the first Chief Medical Officer for the business, so he was given a blank slate with what his role should look like.
Capsule endoscopy. Here in the U.S., it’s pretty standard of care. It’s built into the guidelines and the algorithms when specialists are looking for certain things after endoscopy, so it’s quite well adopted here.
Austin Lee Chiang: “There’s 20 feet of small intestine that we usually can’t see and that’s where capsule can be really helpful. It’s a very arduous process like reading these studies: it takes a lot of time and not all capsule endoscopy systems are created equal. Some of them have different frame rates, and some of them are programmed in a way that takes pictures more in detail during certain segments of the bowel. We have capabilities now where we’re able to read the study that doesn’t necessarily have to be on-prem but can be like remotely or through the cloud. These sorts of innovations sound simple in theory but when you apply them in healthcare it can be challenging: operating within this complex healthcare system, dealing with cybersecurity issues can be like a whole other level of challenges.”
GI Genius is the first kind of AI-powered polyp detection device. It’s to help doctors spot polyps which are pre-cancerous growths during screening colonoscopy and to potentially prevent colorectal cancer. When doing colonoscopies, it’s impossible to be able to see everything at once, so this will help prevent missing those polyps.
Austin Lee Chiang: “It was first introduced in mid-2021. We’ve already had three software upgrades that have since incorporated more images to refine the algorithm. We also announced a partnership with Nvidia earlier this year. We were inviting external developers to develop algorithms for other disease states and things like that and potentially we can host those algorithms on our hardware.”
The main focus in GI right now is definitely in the AI space. Robotics for Medtronic is also a big priority.
Since our main audience of the channel is startup founders in digital health and MedTech, here are some recommendations to them from Austin to create valuable and life-saving products.
Austin Lee Chiang: “I always encourage people to involve the target kind of audience whether it’s physicians or patients. I feel like we don’t do that enough. Maybe the solution that’s been created hasn’t found the right problem to fix or isn’t adequately addressing something, so I think having those voices early on is important. I think a part of my initial goal of being on social media is raising greater awareness about GI disease states. I’ve thought about how that can potentially drive the use of some of these devices because of the disease states that we’re trying to address. And that’s important not just for medical devices and HealthTech but also just medicine in general. There isn’t enough attention on prevention and social determinants of health and all the things that affect people’s health and livelihood. I feel that’s going to be the next phase of where we should be focusing on.”
And here’s a special note for doctors to pay more attention to new technologies and not to be afraid of adopting them: “I think we often complain why things aren’t better in healthcare, but it’s really up to us to adopt new technologies and try it out. I don’t think there are a lot of doctors out there who probably realize that. We need to use the new technologies for the whole field to move forward and I’m not sure why there’s that sort of resistance. Maybe it’s just like a cultural thing, maybe it’s built into how we’re educated about medicine to always question things and be skeptical. It’s always good to have a healthy dose of skepticism. I think it’s a great opportunity for a lot of physicians who want to become leaders in their field. If they’re early adopters of the technologies it’s an opportunity for them to help develop the next phase of a new technology. I’ve seen examples within my field where people have become big names in the field because they are super users of certain technologies. So early adoption can make a difference.”
Our previous episode was with Kevin M. Baumlin: The US Healthcare System Overview
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