RX Podcast_Rishi Verma: Audio automatically transcribed by Sonix

RX Podcast_Rishi Verma: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

John Shufeldt:
Hello everybody and welcome to another edition of Entrepreneur Rx, where we help health care professionals own their future.

John Shufeldt:
Hello everybody. Thank you for tuning in to Entrepreneur Rx. Joining me this week is Dr. Rishi Verma. Rishi is known to be an aerospace engineer turned medical doctor. He's also an entrepreneur and co-founded a company called Stethy, which is near and dear to my heart because it's an A.I. machine learning company that provides really diagnostic aid to physicians in their clinics. So, Rishi, welcome to the program.

Rishi Verma:
My pleasure, John. Thanks for having me on board.

John Shufeldt:
Of course. This will be a fun discussion because you do a lot of things that I love. And so let's start. Give us a little bit of your background because it's about as interesting as a person can get.

Rishi Verma:
Yeah. Look, I've had a bit of a varied background lookout. Before doing medicine I was actually working as an aerospace engineer locally here, and I was involved in designing thrusters for spacecraft. So one of my projects was actually developing an ion thruster for these small types of spacecraft called nano spacecraft. And yeah, we developed this ion thruster that actually could get a spacecraft to Mars within 30 days. So that was quite an interesting experience. That's what's my background before medicine involved in. During sort of engineering, my engineering days, I took a few biomedical units and I had a very good mentor who sort of guide me through my engineering days. And he said, look Rishi, you should probably take up medicine, I think you'll enjoy it a lot, I think you can bring your skills in engineering and medicine and combine them, and so that's how I pursued my medical degree. I sat in the exam and somehow I got in, and here we are.

John Shufeldt:
So ok, so you did four years of aerospace engineering?

Rishi Verma:
Yeah, that's right. It's a four-year degree back in Australia, so undergraduate degree. And then I did four years postgraduate of medicine.

John Shufeldt:
Wow! Ok. And then you spent some time in NASA while an undergrad, right?

Rishi Verma:
I did a small little internship there. I had a small internship, sort of secured that through winning my, so there was a thesis prize that they were organizing, and part of that prize was like an experience at NASA. So I won that prize as I designed this thruster, I was talking about. And yeah, it was quite a good experience, actually.

John Shufeldt:
That's very cool. So then you what? Did you take any time off between undergrad and medical school?

Rishi Verma:
I had a year off, so I did a bit of research. I was doing a bit of research regarding the thruster I designed, and were trying to commercialize it. And we ended up patenting the design and it's still in the commercialization process, as you would notice, it's quite a long, protracted process of getting approvals and testing and getting the final product. So in the meantime, I sort of got into this and pursued medicine as well.

John Shufeldt:
Now, does Australia have, we're verging off here a little bit, but does Australia have a aerospace program?

Rishi Verma:
It's a very, very small one. It's a very good question. I mean, we don't have a huge program compared to the States or for example, Europe or even Asia. It's a very tiny program. We only recently opened the space agency a few years ago, the Australian Apace Agency. Before that, we didn't have anyone who is sort of controlling our space agency here. So it's a very, very niche program. So I think they accept about 10-11 people a year in that particular program. So it's a very small niche program.

John Shufeldt:
Sure. Ok, so then you had four years of medical school and then how long is ophthalmology in Australia?

Rishi Verma:
Ophthalmology is four to five years, depending on whether you want to further do a fellowship in a particular field, or you can just do general ophthalmology for four years. So, yeah, it's quite a long and protracted .... But of course they're, yeah. It is kind of similar in the States, I guess, you know, in medicine, it's a postgraduate degree here, most of the universities only offer postgraduate medicine, so that means you have to have done an undergraduate degree prior to doing medicine. The only difference is in Australia, you don't actually get on to a residency program straight after medical school, so you have a two years of a general, general sort of stream. So you do one year of an internship and one year of what we call a residency, which is just a second year of your internship and then you apply for each college to get on the specialist program. So it is a little bit different here. It's a long, drawn out process.

John Shufeldt:
Yeah, it sounds like it is. And so did you know, when did you know that you have this entrepreneurial bent to you? Was it in undergrad?

Rishi Verma:
So look, growing up ... I always had a bit of an entrepreneurial spirit in me, like I was selling pens out in the hallways at school and hustling all the time, making a quick buck here and there. So I always had a bit of spark in me, but it was during my internship just right after I finished medical school, I noticed so many inefficiencies in how health care was delivered here, particularly in Australia and also within the Asia Pacific region that I had a few ideas that I wanted to pursue, and that's how I came on Stethy. So we launched Stethy during my internship, and it's been going strong ever since then.

John Shufeldt:
No kidding. So how long has it been going on for?

Rishi Verma:
It's been going on for approximately three and a half-four years so far.

John Shufeldt:
That's excellent. Can you give people an idea of what, because I've done my research obviously but people have no idea what Stethy does.

Rishi Verma:
Yeah. So as you mentioned, it is an AI platform, but look, in terms of what we do exactly, so we enable life science companies to help promote their therapeutics to doctors. So here, as in everywhere, there's a big problem with education in terms of providing education to doctors about upcoming therapeutics or medical devices. You know, when I was practicing medicines, I hardly knew about, you know, the upcoming therapeutics that were out on the market. So what we did is we created a platform for the life sciences industry to create on demand digital content in order to promote their therapeutics. I'm not sure if you've heard of the company called Canva. It's like a design online design studio. So we're basically the Canva for healthcare. So we enable this rich form of digital content that gets sent out to doctors so they can be educated about therapeutics or medical devices or products in the medical field.

John Shufeldt:
That's Stethy or that's pre-Stethy?

Rishi Verma:
That is Stethy. So pre-Stethy we were experimenting with a bit of AI and we had some AI products, pre Stethy. But Stethy is actually a sort of education platform for doctors.

John Shufeldt:
Now, but does it also allow patients to input data? Because I was looking at your pricing plans, and it looks like you can, patients can input data, it auto-registers them and that comes up with an AI machine learning driven diagnosis.

Rishi Verma:
Yes. So we have multiple products and services, so that is another option we have. We have an AI triaging platform that's been used by clinics in and around Australia as well as the Asia-Pacific area. So essentially, it automatically triages patients based on their presentations and symptoms and gives doctors a pre-diagnosis based on what the patients have come up with. So it's essentially an efficiency tool, such as a workflow tool. So just to manage waiting rooms and make the whole triaging process more efficient. Here in Australia and as I imagine also in the States, it's quite an inefficient process. There's a lot of patients waiting out on the medic, you know, in the waiting room with, you know, minor illnesses and to quickly triage them and see them quickly I think is the way to go and reduce waiting times, that's what we did.

John Shufeldt:
That's awesome. I'm smiling because I love this concept. Years and years ago, and I kind of wrote these algorithms, we're not AI, it's just imagination, but the attempt to do the same thing it was, if this then that. So this is, yeah, this is near and dear to my heart. How did you, where did the AI come from? Did you use natural language processors to read peer reviewed journals?

Rishi Verma:
That's a very good question. So we essentially designed our database from scratch, an AI being designed from scratch. So I've worked with a very talented co-founder who I met through uni, one of my good mates in engineering. So we worked on this project together and essentially he coded all our algorithms whilst I spent about two or three years developing this database. As you can imagine, with AI, it's all about the data and the type of data you have. The better the data, the better the results. So our goal was to have the best data we can get in order to have the most accurate algorithm out there. So what I would do literally when I was studying medicine and doing my internship, I would go through textbooks and look at each disease and write down their symptoms. I would also then and write down associated word to that. You know how so in terms of layman terms, you know, help the patients they wouldn't necessarily talk about, you know, symptoms in terms of medical language, they would talk about layman's terms. So we'd sit there literally for hours on end and just reproduce layman terms about what patients would talk about. So that's how we came up with our database, essentially.

John Shufeldt:
Wow. Ok, so you didn't really use peer reviewed journals. You actually vetted the medical literature and then tied the symptoms, tied the complaints to the symptoms, put that in your database, now, so when the patient comes in now and it says, I walk into the clinic, I give a list of symptoms and Stethy says, I think this person has X. Does it give you three diagnoses and does it rank order them by probability?

Rishi Verma:
Yeah, that's a good question. Look, it does. It ranks each pre-diagnosis, as we call it, based on the probability likelihood of that happening. So usually we offer the top five diagnosis based on the symptoms. The whole system is very clear, configurable. You can have 10 sort of pre-diagnosis, but obviously the lower down you go, the least accurate it gets. So we sort of constrained to five diagnoses and that's been working well for us.

John Shufeldt:
Now, does it auto order test based upon the diagnosis? In other words, so the way I tried to build this was, if this, then that, and it would say, OK, we think this is going to be a UTI and if it's a woman between whatever it gets, urinalysis, urine, pregnancy test. Does it auto order a test?

Rishi Verma:
Yeah, look, it doesn't at the moment, so our whole ethos is not to essentially replace the autonomy of the doctor at the end of the day. We essentially want to augment the functions, so make them more efficient in terms of their practices and their clinical diagnosis. So we've only been, you know, been giving them pre diagnosis. What we also do is we sort of summarize clinical notes. So if a patient comes into the presentation, we sort of summarize our presentation and then place that into their clinical notes. So that's read in front of them waiting for them before the patient's being seen.

John Shufeldt:
What's the interoperability like amongst different electronic health records? You know, there's, you know, you have Athena and you have all the e-clinical works everything in Australia?

Rishi Verma:
We have Cerner here so which is a time.

John Shufeldt:
I know Cerner.

Rishi Verma:
Yeah, yeah, exactly. So the funny thing here is it's not standardized in Australia. So every clinic, every hospital has a different form of EMR or electronic medical record. And the tricky thing is developing a framework where we can actually integrate at the back end. So like an API, for example. So that's what we've been doing. You know, each set of software has their own API, and integrating with their own API is a bit of a pain, to be honest. So we're trying to do an API for each sort of medical software out there at the moment.

John Shufeldt:
I'm involved with an AI company now and I think the thing that to integrate with seven different ones and then you're right.

Rishi Verma:
Yeah, yeah.

John Shufeldt:
And they're not individual Cerner, actually, but it's got to be incredibly challenging to map. You know what your guys or what you have in Stethy, and then try to map it into the variety of EHRs that are out there, that's got to be daunting. So I taught, I mentor some of these kids who are in college or medical school, and one of things I always tell them is it's probably going to be important to look for specialties that you cannot be displaced by AI. So the easy ones are pathology, radiology, of course. But I think even internal medicine, possibly in neurology, the real intellectual specialties, you wonder if the need for us is going to be less because AI has to supplant a lot of the time we spend with patients. What do you think?

Rishi Verma:
Well, I agree with you, John. Look, especially in the diagnostic heavy specialties, you know, even in ophthalmology. So I think it's a real revolution happening at the moment in medicine and that AI is taking over the diagnostics area of each specialty and where the doctors are fitting into that picture is sort of the clinical management side of things. So you'll have AI essentially giving you a diagnosis and you're then going ahead and managing each or looking at the likelihood that this diagnosis is right and then managing the disease. So I think it's heading towards that direction, that's what I've seen, and speaking with a lot of colleges and specialties, particularly in radiology, in ophthalmology. You know, in ophthalmology, you've got Google doing the retinal scanning and coming up with you know, diabetic retinopathy.

John Shufeldt:
Yeah, yeah.

Rishi Verma:
Yeah. So that's been huge. And at the end of the day, I think it's the right direction to go down towards because it all boils down to patients actually at the end of the day. If AI can, you know, come up with diagnoses accurately and we can then go ahead and manage those diagnoses accurately, then I think it's a win-win for everyone.

John Shufeldt:
Yes. What sort of in Australia, what sort of registration do you have to do? For example, in the US, if you have a device, you have to register with the ADA, with the FDA? And AI is a little tricky because at the end of the day, at least the companies I'm familiar with, the AI is suggesting diagnoses and the physician is the one who picks them. So all of the physicians still has the brunt of the responsibility. They can't say, not me, blame the computer. Is it the same in Australia?

Rishi Verma:
That's the same. It's same here. So we have a similar system in place where we ultimately give autonomy to the doctors in doing the diagnosis. The AI serves as just an assistant or a bit of a tool that's used to help the diagnostic process but ultimately the signing off is done by the doctor at the end of the day here as well.

John Shufeldt:
Have you managed to put Stethy outside of Australia yet?

Rishi Verma:
We have. So we've been partnering with a few life science companies overseas, particularly, so we've got a few of the top 10 pharma companies on board using our software. So that's been quite good to say. I mean, we've always wanted to go down that route because of the scalability. We just feel that, you know, life science companies are getting a hold of our AI and our products can actually scale quite well and we can see results quite quickly with them as well because obviously they serve thousands of doctors and patients. So that's why we went down that route.

John Shufeldt:
Yeah, I think that's genius. Is Australia a single payer system or is there multiple insurance plans there?

Rishi Verma:
That's a good question. It's a bit of a hybrid model, so most of our health care is covered under Medicare so it's government funded. You know, most of the elective surgeries like, you know, your cataract replacements and joint replacements are mostly private. So there's multiple players out there in the market that do that at the moment. So it's a bit of a hybrid model. So it's not quite like the US system at the moment.

John Shufeldt:
Are emergency departments there overcrowded? In other words, people use emergency departments? So that's the same?

Rishi Verma:
Yeah, it's the same here. I mean, it's been particularly with the COVID crisis happening at the moment, everyone's been in lockdown here and 80 departments have been overflowing with patients. I mean, there just aren't enough hospitals here at the moment. Our population is growing rapidly and the doctors here are just struggling to manage that. So I guess that's another thing with healthcare at the moment is just the efficiency crisis that's going on across the world.

John Shufeldt:
So, you know, I've been thinking through this model in the past, so tell me what you think of this, if you use Stethy, I always call it air traffic controls, the fly sort of, you know, aviation. So Stethy became air traffic control. So let's say I'm a patient in Australia, I log on and I go through the Stethy process and Stethy at the end of the day says, look, you don't need to go to the emergency department, you're going to be fine in the clinic or you'll be fine with telemedicine. And if I'm someone in the emergency department that's fine, but now I'm paying for it because now it's truly elective. Do you think there's a model there where you could place Stethy as this basically a virtual air traffic control, trying to basically guide patients where to go based upon the symptoms?

Rishi Verma:
There definitely is. The only issue with that is you introduce a lot of legal problems into that sort of model as well. I mean, if you direct them to the wrong place, for example, and it's incorrect and the patient has sort of a downturn, then it all comes back to you. But I think the way around is always having a person or a qualified individual overseeing the whole process. And I think that's what we're doing at the moment. We always have someone who's sort of monitoring the algorithm and seeing the correct outputs are given, essentially. So that's probably the way to go, to be honest.

John Shufeldt:
Now, so you would be described as as a technical founder, where would you tell our listeners to find someone like you out there? I think a lot of people, not a lot, but some people have, you know, pretty interesting ideas, but they don't have your engineering background. I'm sure you have a computer science background. Where do people find someone like you?

Rishi Verma:
Well, I mean, I guess the answer to that is just universities, deciding if you study medicine, look, obviously, I mean, there's so many people out there in the universities that you can just approach. There are societies that you can join, you see, computer science society, engineering societies or robotic societies. So you can just go in and join and speak up and work with people. So that's how I've met my co-founders and I've met my business partners before, just through these societies and events. The other important thing I would recommend listeners to do is just go to open days. I mean, you'll have these AI open days that we have in Australia where these big companies organize these meetups. You know, for example, Microsoft recently organized an AI meet up in Australia, and that's a really good way to meet new people, network and discover new things. So just going out there, putting yourself out there and networking is the way to go.

John Shufeldt:
Certainly. What's been your biggest challenge as you scale your business?

Rishi Verma:
Yeah. I think the biggest challenge for us is about human capital. Here in Australia, it's, I think, you know, finding the right developers and machine learning engineers is, it's hard to come by, and that's been a real difficulty for us, finding the right person to join our team. And that's why we've been looking, you know, in the overseas market, particularly in the US, because there's so many great individuals out there that have that amount of experience that we're looking for. And this whole work-from-home scenario has been really beneficial for us because, you know, we can just hire people overseas and they can join our team and work, you know, work from overseas. So I think that the lack of talent at the end of the day is what we're trying to overcome so that, that's our biggest challenge at the moment, just finding the right person.

John Shufeldt:
Man, how about your sales organization? So how have you gone out there and promoted it?

Rishi Verma:
That's a good question. Look, so we've been hiring a lot of pharmaceutical reps, medical device reps who understand this industry, who understand the health care industry quite well, and we found that, you know, these top individuals serve quite well for us in terms of understanding the technical knowledge needed to sell this product. So, you know, I mean, pharmaceutical reps or medical device reps ultimately sell to doctors at the end of the day. And that's what we're doing. We're selling to doctors at the end of the day as well. So there's a real common skill set out there that that's been really beneficial to us.

John Shufeldt:
What do you think? What, as an entrepreneur, what was your biggest aha moment?

Rishi Verma:
Oh, yeah! That's that's a good question. Look, I've probably had a couple, but the biggest aha moment for me was when I spoke with the head of Novartis, the ACMA head of Novartis who covers Asia, Africa and America. So and he was talking about, you know, this whole scenario that they were having with reps not being able to reach out to doctors efficiently, and that's when I had a light bulb moment struck me, that, you know, we can use Stethy to sort of reach out to doctors in terms of educating them about therapeutics through our platform. So that was probably my biggest aha moment. And that's how we've grown quite rapidly, a small help from that.

John Shufeldt:
It's interesting. So, you know, there's another obviously revenue, revenue model with your platform, which is collecting data and selling that data back. Have you gotten on that path yet?

Rishi Verma:
Well, we're not actually selling our data. What we're doing is providing a platform for these life sciences companies to input the data in, into the platform so they can educate the doctors. So I'll give you an example. So, for example, say you've got Pfizer launching a new type of drug out there in the market. There's this major problem at the moment, particularly with COVID .... that how would you reach doctors at the moment? You know, there's a finite amount of reps out there. There's thousands of doctors that you've got to reach to and how would you do that? So what they've been doing is they've been using our platform to essentially create on demand content about that particular drug and then distribute that content digitally to the doctors so they can have that content on their phone or iPad or laptops and go through that. So that's how we've been overcoming that program, through educating doctors at scale.

John Shufeldt:
What do you think your exit is?

Rishi Verma:
Look, that's another good question, because I think our exit would be probably partnering up with a big pharmaceutical company or even your CRM providers like Veeva Systems, for example, that they have a real need to reach out to doctors. So that's something that we're looking at, and I think we're heading down towards that route as well.

John Shufeldt:
But it seems like you can bifurcate your business because there are very different models obviously. You have the Stethy version, the AI version of Stethy, which is helping the providers act as a virtual triage or assistant. And then you have the digital side of it, which is educating physicians, it seems like you can splits, from that crack you can split the kind of different businesses.

Rishi Verma:
They are different products. I wouldn't say that different businesses. So they're, they essentially function on the same back end on the same platform. So essentially just a different offering based on our customer.

John Shufeldt:
Could you sell to the pharma companies and say, look, if you want to get your message in front of providers, pay for their AI, pay for the AI system for them, because that way you'll be embedded in their clinic because you're paying for it. If you think that's a model that would make sense?

Rishi Verma:
I definitely do think that makes sense. That is a good way to go down towards but there's a lot of regulatory hurdles as well that we've got to overcome in that area. So there's a lot of challenges that we're facing with that, about asking that.

John Shufeldt:
Well, so you can probably tell I'm excited about things like this. Well, Rishi, where can people get a hold of you? Where can people learn more about you.

Rishi Verma:
Yes. So you can go on our website, Stethy.co, or you can contact me on Rishi@stethy.co. More than happy to answer any questions that you might have on that.

John Shufeldt:
Thank you. Well, let me hear one final question. What advice, because there are many people listening to this and say that dude is really cool. Plus, you have a cool accent.

Rishi Verma:
Yeah, you're right!

John Shufeldt:
But other than the accent, like what advice would you give to people in medical school and people who are premeds and say, look, I want to go down this path, I want to save the world. I want to be this guy. What advice would you give them?

Rishi Verma:
Look, the number one advice I could give you is, you know, start now. I mean, there's no better time to start than now. I mean, if you have an idea, if you have it constantly in mind, don't delay. Start experimenting. Start speaking with people, start networking, get your idea out there and start building something, you know, if you can't code yourself, get someone who can code for you and start experimenting. And that's the way to go. It's all about the experimentation process and achieving product market fit, and in order to do that, you have to start now.

John Shufeldt:
Yeah. Very good. Did you have a hard time? I keep asking questions. How did you do the minimum viable product with how to be AI-driven? Because there seems like there really isn't that MVP in this world because you can't make a mistake and the MVP can't be, we're only doing, you know, sinusitis, it's, you know, that's our MVP. How did you pull that off?

Rishi Verma:
Look, it's a good question, and it's constantly evolving. So what we had, we had, I think, a set of 300 or 400, 350 diseases that we started off with. And then we started adding on more and more diseases as we went along. So we had an MVP product, but we then started ... each by each disease. So we keep building on. I mean, it's not like we've stopped. We just keep, we keep building on.

John Shufeldt:
Sure. So there's a screen that said, I have no idea what the hell is wrong with you, have a nice day.

Rishi Verma:
Well, kind of. Well, you kind of say, look, see your doctor. So we didn't really say that, but I kind of did at the end of the day, to be honest.

John Shufeldt:
You're an enigma, have a nice day. Well, listen, this has been great. Thank you very much for being on this program.

Rishi Verma:
My pleasure, John. I enjoyed it thoroughly. Thanks so much for having me.

John Shufeldt:
Pleasure.

John Shufeldt:
Thanks for listening to another great edition of Entrepreneur Rx. To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. Thanks for listening.

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