In this episode of 4x4 Health, we continue our new series Working in Healthcare with series co-host Geeta Nayyar, M.D., M.B.A. Chief Medical Officer for Greenway Health. Our guest this week is Vincent Keunen, Founder and CEO of Andaman7 a startup dedicated to improving healthcare by providing innovative software technology. A cancer survivor, software engineer and entrepreneur with 20 years of experience in the health IT sector, Vincent has developed numerous systems in Belgium. In 2011, Vincent was recognized as national CIO of the year.
Dr. Dave Levin: Welcome to 4 x 4 Health sponsored by Datica. Datica, bringing healthcare to the cloud. Check them out at www.datica.com. I'm your host, Dr. Dave Levin.
Dr. Geeta Nayyar: And I'm your cohost, Dr Geeta Nayyar. Healthcare is one of the largest sectors of the US economy and one of the most intensely personal aspects of our lives. But few of us have insights into what it's really like behind the scenes. Who are the people who make healthcare tick? What do they do and why? What observations and advice do these insiders have?
Dr. Dave Levin: In this special 4 x 4 Health series working in healthcare, Geeta and I talk with doctors, nurses, administrators, IT professionals, and others to get insights into their personal journey and the wisdom they've acquired a long ago. Today we're talking with Vincent Keunen, founder and CEO of Andaman7, a startup dedicated to improving healthcare by providing innovative software technology. Vincent is a self-described cancer survivor, software engineer and entrepreneur with 20 years of experience in the health IT sector. He's developed numerous systems in Belgium. In 2011 Vincent was recognized as national CIO of the year. Welcome to 4 x 4 Health, Vincent.
Vincent Keunen: Thank you for having me.
Dr. Dave Levin: Alright Geeta, why don't you get us started here.
Dr. Geeta Nayyar: So Vincent, thanks so much for coming on the program. You've got such an amazing background. I think one of the best stories are the ones that come from personal healthcare story. So, you know, you being a cancer survivor is just phenomenal in itself. Can you tell us a little bit about yourself, your organization and your journey?
Vincent Keunen: So, I'm a software engineer by training and I’ve been an entrepreneur for most of my career. As Dave said just earlier, I’ve been building systems that are used by a large number of hospitals in Belgium, like 90% of them are still using some sort of software that I’ve built previously. And then on a personal level, I was diagnosed with leukemia, blood cancer, that was in 2007 and fortunately I'm on a very efficient treatment, which is called Gleevec. And that's a very efficient treatment because for me, the cancer is, it's like a simple flu or it's really minor. Three months after me and my son who was 10 years old, was diagnosed with bone cancer. And for him the difference was a very, very, significant treatment lasted almost two years. Hard chemotherapy, radiotherapy, then he once had the bone marrow transplant and then he was amputated from his right leg. So today he's still alive more than 10 years after that, but he's still working with a prosthetic. So, the difference in experience between those two cancers in the same family are just huge. And the difference, those very efficient treatments that are coming out now for cancer. So, this is why I decided to create Andaman for two main reasons. One is to contribute to research and find a targeted treatment like mine for other types of diseases. And the second goal is also to empower patients and allow them to collect the health data on their smartphone. Cause during that difficult experience, we as parents, we realize that we don't have a lot of information about our children, about ourselves and so on.
Dr. Geeta Nayyar: Vincent, thanks so much for sharing such a personal story. One of the things that struck me is you kept using the word efficient when you were talking about your treatment as opposed to your sons. Can you maybe explain what you mean by efficient and why that was so valuable to you?
Vincent Keunen: Well, the fact that Gleevec was there made a huge difference for patients like me. Before we like was there when you were diagnosed with LMC. So, the leukemia that I have, you would have a few months to two years life expectancy. So, it was really a death sentence. And with the medication you have the normal life expectancy, it's restored back to normal and there's almost no side effects. So, for me, I'm taking that pill once per day for the rest of my life apparently. And that makes a huge difference for me. And for my son. I told you what he went through. So, this is why even though there are treatments for bone cancer, like you got chemotherapy and so on, it was still very, very tough treatment. So, the difference there as you said, that's what I mean by efficient. I'm not sure it's the right term though. I'm a French native, so please excuse me.
Dr. Geeta Nayyar: I think it is, we talk so much about the value of money, but there's nothing like the value of time, especially when it relates to our health. So now I think you're spot on.
Dr. Dave Levin: Yeah, I think it's a really interesting word as well. And would add to that efficiency and the efficacy of it and presumably fewer side effects to your treatments required and the like. So, the story that you've told about a personal life experience that led you into a focus on healthcare is a fairly common one I hear on this podcast. Tell us a little bit more about your thinking and the motivation and the passion around those decisions.
Vincent Keunen: So, I’ve been working in the health sector for most of my career, so I know the sector and I’ve contributed to a number of projects, but when I got significantly sick and my son too, then I realized that there is so much more to do. And also, like technologies were evolving so fast and bringing so many benefits in many sectors of our societies. And I had the feeling that the health sector was really lagging behind. It was adopting new technologies much slower than others. That was my impression. And there were also a lot of old ways of behaving like paternalism. How do you say that in English?
Dr. Dave Levin: Paternalism, Yes.
Vincent Keunen: Yes. Okay. That's a bit too hard for French speaker, not sharing data and excessive concerns about privacy. Privacy is obviously important, but it's the patient's choice, right? It's not the hospital to decide about privacy and so on. So, I realized there were many, many shortcomings and things that needed to change for the benefit of patients mainly. Doctors are there for patients and pharma companies also are therefore patients. It's their customers somehow, right? So, everybody should be focused on what the patient's needs and what the patients need is first access to their data when there is a problem or has problem. This is very critical of course, you wouldn't imaging not having access to your financial data, for example. You know how much on your bank account. There's no data restriction there, but there isn't the health sector, which is just weird. It shouldn't happen. It should change. So that's one thing. And the second thing about why I'm passionate about this is that for research, research keeps saying we need data, we need more data and quality data. When you look at studies about patients willing to share the data for specific purposes with very specific conditions, 85% percent of patients agree to share their health data. So, there's really a problem there. People need data. Some others had the data and are ready to share it and it doesn't happen. So, this is why I created Andaman to both serve the patients directly by having their health data with them and then enable, some kind of data collection, but with strict privacy and always with the consent of the patient. So, if you dig deeper in Andaman, you will see that there are a number of important choices that we made to both serve the patients and their privacy and then still be able to collect data and contribute to research.
Dr. Dave Levin: I want to come back to this whole issue of patients contributing data, because it is a really fascinating topic. But also want to clarify something, your description of the experience in the health system, are you referring to your experience in Belgium because it sure sounded a lot like the same sorts of challenges that we face in the United States.
Vincent Keunen: From my experience, I know many Europe and the US and probably South America, I don't know Asia that well and Africa. But yes, our countries progress with different speeds. But still I think there is a big technological problem about interoperability in exchanging data and also some kind of problem about fears of exchanging medical data with patients or restrictions to do it. And also fears about privacy, which are completely legitimate. But there are solutions for that. And the preview is that we build such a solution with Andaman. So just to give you an example, with Andaman, there is no health data in the cloud. Everything is stored on your smartphone. So, this is already a big choice. It makes it more difficult of course to build such a system because it's distributed in nature. But it also means that there is no single place where there are lots of health records, right? So, for hackers it's a lot less interesting to hack a phone and just take one health record. So, by design there is already some security building and there is some privacy also by default, GDPR says privacy by default and situated by design, it's a bit, one of the famous sentences of GDPR, which is effective here in Europe. Privacy by default means that no data is shared unless the patient takes some action, some initiative and decides to share the data. So, I think with this in place, most patients are comfortable with that. They are in control and then they can share the data for specific purposes like for this clinical trial for example, for this quality of life study and so on. So I think that when you reach the right balance between the two, the needs for data and the privacy, then everything becomes a lot more fluid and a thing that is evolving or more or less in the same way in the US and in Europe at this point.
Dr. Geeta Nayyar: So Vince, you clearly have a passion for this. You've clearly navigated the healthcare system abroad and it sounds like domestically as well. You mentioned that the issue is a technology problem. And I'm wondering if you mean it’s more of a process problem. We're seeing a lot of the same data silos happening that we did before the digital age and now we see them in the digital age. Can you comment on that? As far as the system abroad versus domestically.
Vincent Keunen: For the last, I would say two years, there's been a lot of change in the US in a very good direction. So, from what I know from your history, I would say I think that it started with Obama and Obamacare pushing for meaningful use three and meaningful use three includes some elements about interoperability and patient access to their data and so on. And apparently this has worked so well that now I would say most of the software vendors, the companies that sell software to hospitals like ethics Cerner, Allscripts, and those, they all have a standard API that uses the FHIR standards. And so suddenly in the last couple months and or last year, a number of companies including startups have been able to directly connect to hospitals in the US to get the data. And for example, Andaman is already compatible with a very large portion of the US hospitals and family doctors too. And so, the patient's installing Andaman can connect to the hospital with a login password that the hospital has given them and then download all of their health data on their smartphone. So, this is a huge step forward. There are still silos, there are still interoperability problems. That is a huge step forward. And in Europe, unfortunately we are not moving as fast because the market is a lot more fragmented. So, there are no very larger software vendor that is selling software in multiple countries. It's really the German software comes from Germany, the French software come from France and so on. So, the market is a lot more fragmented and all of those actors are not really strongly motivated to send an API like the US vendors have now. So unfortunately, in the last two years we didn't move a lot in Europe while the US has made huge progress. So, I hope that Europe will move faster. And for that for example, Andaman is part of two European funded projects. So, the European commission is funding projects for that to improve interoperability in Europe.
Dr. Dave Levin: It has also taken, so given significant effort on the part of the federal government, the United States, a combination of the office of national coordinator and the centers for Medicare and Medicaid to essentially mandate that there will be a use of the FHIR API or a reasonable successor and a definition of a core dataset that particularly these EHR vendors and others need to expose through that API. So, it's taken a lot of folks working together and both the public and the private sector, I think in the United States to push this forward. Some of us would like to see it go faster. But it's definitely progress. I want to go a little deeper on what you're doing with Andaman and what you've clearly described as the ability of a patient to load your application and connected and get their own data. What about the patient reporting back? Adding data back or sharing data back with the provider? Is that part of Andaman as well?
Vincent Keunen: Well, yes, it's part of Andaman, because what you should know is that Andaman is allowing you to collect data from various sources like hospitals, lab and so on. Also, from connected devices and other apps on your phone. But you can also enter data yourself. And what is a very advanced feature of Andaman is that every data element, like suppose your weight is associated with the timestamp to know when the data was valid and source. So, I know very exactly what for example, 10 measures of my weight. I know that this one comes from my hospital and it was measured by the doctor. This one's come from me because I entered it manually. And then this one comes from within scale for example, that automatically send the data to my smartphone. So, we have that very fine traceability system, which is absolutely necessary when you build like it is our case distributed collaborative health record. So, with Andaman anybody can enter data about the same patient at any point. So, me about myself, my wife, about me, my doctor, about me, anybody can enter data and we will never have conflicts and all the data will be exchanged between those various people. That's what we call the circle of trust. So this is a very different approach from a system in the hospital where it's centralized and usually the hospital systems have been built for doctors, nurses and the hospital staff, not for external people, usually even family doctors that are not part of the hospital have a hard time having access to the data and especially modifying it. Patients, it's even more difficult. So, Andaman has that capability and for example, if we get data from a hospital, we are also able to send data back to the hospital. For example, data coming from a device or from a user input, patient input. But most of the systems today are not ready to accept data. That's true for US and Europe. The problem there is that those systems need to improve on being able to know the source of the data, which is not always very well fine grain. So that a doctor that sees data, they know if it's coming from the patient or from a colleague doctor because there's going to be less trust maybe on those types of data. If the data comes from a medical grade device or consumer grade device, that's also different. So, for all of these reasons and others, there's a big need for being able to get data from external systems, having a high traceability and then showing that to the doctor. And most of the systems today are not ready for that yet. I know there are smart phone FHIR and other initiatives like that to try to do this, but it's still work in progress.
Dr. Dave Levin: I think you've described a lot of the problems that I’ve seen, the challenges of, so the provenance of the data, the reliability of it, the technical infrastructure that simply allows it to be exchanged. The other thing that I hear from providers is that they need some intelligence behind this as well. So, a lot of data streaming in. How does that get filtered and really turned into something actionable? So, to be blunt about it, I may have 3,000 diabetics in my practice. I don't want to see and have to respond to every single blood sugar that they report. What I really want is the ability to identify the ones that really need my intervention or at least some sort of assistance.
Vincent Keunen: Correct. That's a new problem due to the large quantity of data that we are able to collect. And yeah, that's very true. So, it's even true if you have a patient that is a thing, two, three days in the hospital and as a way to be monitored like every two minutes for their heart rhythm. There need to be a system that filters out the data to show the alerts when there is a problem. And that's even true the same problem with patients collecting a lot of data with their watches or with other devices. So yes, we have made huge progress by collecting a lot more data and now we have an internal problem, which is how do we process the data efficiently and assist the doctor, because it must be some kind of artificial system, like automated system software. But it has to be, you have to trust the system. If you don't want the system to miss alerts or to have too many false alerts. So, it's a whole new problem and there's room therefore for improvement, innovations and software to process those large amounts of data. Completely agree.
Dr. Geeta Nayyar: I wish instead of big data, it was meaningful data. Every time I just had a patient last week that said, Oh, I’ve got my heart rate. I've got it right here on my watch. Do you want to see it for the past six months? And I was like, no, I don't. I don’t need that. I just need to know the trend. I need to know what happens when you feel symptomatic of shortness of breath, etc. But it's so hard to explain because the average consumer thinks, well, more data must be good. Big must be better. So, it's interesting in healthcare, like life, there's so many of the same challenges and then you run into, what's the malpractice sort of angle to that or what's the safety issue? And my, doctor doesn't want my data. Which not the case. We want the meaningful data; we want the relevant data. And so how do we get where we are in the ecosystem to help us as docs with those tools.
Dr. Dave Levin: Yeah, I mean we've talked about some of the challenges. The promise is so enormous though. I mean, beyond the obvious, which you've described really well, Vincent. I'm able to collect and sort of curate a more complete health data set for myself. So much of what we've done in traditional healthcare is we advise people, we write a prescription, off they go back into the real world and we don't really know what happens after that. We don't know, were they willing, able, interested in following those directions. What kind of reaction did they have to the medication or other prescribed treatment? So even this very basic outcomes reporting to be able to close the loop, not to mention the possibilities for expanded research into new therapies, new drug therapies and the like. And I presume that's part of the, the animating vision of the work you're doing as well.
Vincent Keunen: Yeah. What you described is for me almost a new kind of mixing that, I don't know, we could call it real time mixing, something like that. Because when it happens, then the data is generated and if there's some kind of software system that is controlling that, it could be an immediate alert, like recent example with the Apple watch, for example, detecting heart problems. So yeah, we're going in that direction and that's another kind of medicine, it's not a medicine e where the patient feels bad and he waits a bit to see if it's improving. And then after some time he goes to the doctor and the doctors measures a number of parameters just at that moment. And it lasts for half an hour or even less. So, the doctors currently in today's meeting that are very narrow a window into the life of the patients. And with those new systems, it's going to improve a lot. That's true. But yeah, there's the challenges of big data and who is responsible, and all of these that needs to be put in place.
Dr. Dave Levin: Yeah. That's a really terrific point too. It's not just that this is data we didn't get before, but the cycle time, the ability to report it in near real time is also a new capability. And I certainly subscribe to the general belief in healthcare that the more you can shorten cycle times, the better the outcomes are going to be. And that seems to be a general principle of pathophysiology and treatment and then healthcare in general.
Dr. Geeta Nayyar: That's why I liked efficient. I love that Vincent, earlier you said efficient. I thought God, he nailed that one word. We don't use it enough, but it's about being efficient and effective. I love that.
Dr. Dave Levin: Well said. If you've just joined us, you're listening to 4 x 4 health and we're talking with Vincent Keunen, founder and CEO of Andaman7. So, Vincent, what's a typical day in the life like for you?
Vincent Keunen: Oh, I get up in the morning.
Dr. Geeta Nayyar: You have Belgian waffles every day.
Dr. Dave Levin: Waffles and freit in the afternoon.
Dr. Geeta Nayyar: Besides that, what do you do?
Vincent Keunen: Belgium fries, right? Not French fries, like everybody believes, it’s a historical mistake. Usually I get up in the morning, I go to work. I have usually quite a number of meetings including video meetings with my colleagues in the US or with potential customers. And then I occasionally have internal meetings with the developer teams to know where they are on the roadmap and to see if our HR processes is progressing. And then I am often invited also to testimony like here you invited me, and I was also invited by Rush for example, for the annual meeting. And then I have a number of calls with, for example, I was elected one of the Hymns influencers this year. So that requires some contacts with the team there to prepare communications. I travel to the US almost twice per year and to various European cities maybe once per month. That's for a few days. When I go to the US, I try to stay two or three weeks, either the East coast or California usually. For the moment, I'm also spending a lot of my time on the process where we want to, we believe we have a great technology in Andaman and to scale it fast. We would like to join forces with a larger actor for example. So, we are trying to find a strategic partner or strategic investor, some also spending time on this. Because when you're a startup you have to take care of everything. The patients or the customers and then the technology you build and the marketing and sales and the financing of the company so that there's a lot to do in a small company to do all of this.
Dr. Dave Levin: You've touched on something that's of personal interest to me. I'm somewhat involved in the venture community here in the United States. And I'm curious about specifically how you funded your company. Tell us a little bit about the capital journey, if you will, for a startup in your situation.
Vincent Keunen: So, I realized over the years that there's a huge difference between US and Europe first and the difference is I would say two faults. If you get 1 million of funding in Europe with a same effort, you get 10 million in US. It's almost timestamp. And I'm not, it's not me saying that, I saw it and I had confirmation from many European or US actors or people moving from one area to the other. That's one difference. And the second difference is the risk taking. I think the risk taking is much bigger in the US. There's a funny thing there. You call it the venture capital, right? So, it's a venture, but in Europe it's called risk capital. I think even the word says, it's clearly that there is a, for here it's considered a risk a lot more than in the US. So that's one big difference. Still I was pretty lucky with Andaman7, maybe because I'm more senior than other entrepreneurs, but I could put the first raise, I was targeting 500K, so half a million and I’ve got 1.3 million. So, it was unusually high for a European startup. And then we got two extra funding rounds. And for the moment we raised 3 million, but we figured that to go to the next step, we would need to raise five, ideally 10 million. And I have the feeling that in Europe, it’s going to be very difficult to find those investors. Even though we have an ambitious project, even though we have a global solution for, I don't know, I mean say probably, that Andaman is available in 20 languages. So that's European and American languages plus Chinese, Japanese, Russian, Arabic. So, it's pretty, I think our ambition is clear. But still I think it's going to be difficult for to find European investors. So, I need to go to the US to find investors and being based in Europe, it's an extra complication too. And I'm not well known, as well known in the U S as I am in Europe. So this is, what I'm telling you is the European entrepreneur view of capital raising and I know some of my competitors or smaller companies like us doing similar things and I see them raising 3 million for the first round and then 17 million for the second round and they're still building the product. Here we build the product with 3 million and we have a hard time finding the next rounds to grow and to scale the business and to the sales teams and so on.
Dr. Dave Levin: I have a feeling you and I could have a very long conversation about this, but that our listeners might not be particularly interested, but I got to do at least one more follow up. So, I believe what you described was private venture. And I'm curious about the opportunities in Europe around public venture. So federal government and then also institutional investors.
Vincent Keunen: Yeah. So, yes, we do have public investors. So, most of the countries have their national or regional investment groups that try to help the startups. And one of the goals is to develop the economy and the employment in the area and so on. So, we do have those, in our case, they represent, and they take equity. And those for us it's representing, I believe, 10% of our capital. So, it's there, it's good. I'm thankful for them, but it's not very significant. And usually the public investors on a given round, they limit the contribution to the amount that the private investor will put. So, it's a 50, 50 maximum, and it's usually lower. So that's one thing. But on the other hand, we also have grants, two types of grants. First grants were, the money is given to the company without any equity. And without anything back. And there are advances, so very low interest or zero interest lending of money. If the company goes bankrupt, then it's lost. But if the company grows, then you are supposed to reimburse when you will be successful. So, we have those systems in place. And in our case, for example, we've been very lucky because we got a lot of those subsidies or grants, almost 2 million. And they come from either a lower region, which is the Southern part of Belgium or it comes from Europe. For example, we are part of two European projects. Each project is around 7 million euros, so close to $7 million. And we get, for example, half a million because there are 15 partners in the project. So, this is also a funding that we get, that helps us. And in the second case here, it doesn't take, it doesn't require you giving away equity. So that's pretty interesting.
Dr. Dave Levin: Thanks for sharing that.
Dr. Geeta Nayyar: Vince, you've got such an awesome perspective as a patient and entrepreneur, an entrepreneur in Europe. You clearly have a really good 360 view of the healthcare landscape. We'd like to just ask you on a personal level, if there was just one thing in the world that you know you'd like to advise someone to know about their healthcare, what would your advice be? What would that one thing be that you would tell someone, that might be going through something today?
Vincent Keunen: Yeah. I would say, take control of your health. Meaning if you believe that health is like, I don't know, you drive your car to the station, ask the people there to fix your car and then you come back, when it's fixed, it's not going to work. So, if you go to the doctor and say, okay, fix the problem. It's not going to work. You need to take control of your health. You need to have access to your data, and you need to understand as much as you can. Of course, we really as a patient, never understand as much as a doctor who studied many years for that. But still, for that's very narrow condition that you have probably then you can learn quite a lot and then change your lifestyle and understand and maybe ask for second advice and spend the time that is needed because all doctors have a lot of work and not overwhelmed by my work. So, it's very difficult for them to spend hours with each patient. It's almost impossible. But the patient, if they have a problem, they can do it. So, invest in your health, I would say. And in preventive health, that would be even better. So, nutrition, exercise and mental health also, relaxing and managing your thoughts, like medications and all of meditation, sorry. All of these are important. And if you're in a serious condition, like we have been twice in my family, then put all your energy there and don't hesitate to ask. Ask the second doctor or your family for example, we asked for first again for a second oncologist and my family doctors said, yeah, that's a good idea to do that. But tell your oncologist that you want a second advice. And I did that, and I talked, that was a lady oncologist and she's had a very good idea. I would be reassured if you get a second advice because this sickness is so rare that we don't have that much experience on that one. So, she was very open, and we got a second advise from Paris hospital and with a second advice in the same given the same diagnosis she could go full speed in the treatment, which is important when you have cancer for example. If you lose three weeks by testing another treatment or not the right one, then you lose three weeks. So, it's important to be fast on those occasions.
Dr. Geeta Nayyar: That's right. I love that Vincent, thank you so much for sharing that. That was wonderful.
Dr. Dave Levin: Yeah, and I agree there. I think the best doctors welcome that kind of partnership with their patients and good doctors welcome a second opinion. They're not threatened by that. So, I think your advice to arm yourself with information and be proactive and be engaged as much as you can is really spot on. At least it really sings to this primary care physician’s heart and I'm sure it does take to Geeta as well.
Dr. Geeta Nayyar: Absolutely. And I love the word advice cause at the end of the day it's advice and you can either drive the car home or not, but I can only give you the advice. I think that one as well.
Dr. Dave Levin: We've been talking with Vincent Keunen, founder and CEO of Andaman7. Vincent, thanks for joining us today.
Vincent Keunen: Thank you for inviting me.
Dr. Dave Levin: You've been listening to 4 x 4 Health sponsored by Datica. Datica, bringing healthcare to the cloud. Check them out at www.datica.com. I hope you'll join us next time for another 4 x 4 discussion with healthcare innovators. Until then I'm your host, Dr. Dave Levin.
Dr. Geeta Nayyar: And I'm your cohost, Dr. Geeta Nayyar, thanks for listening.