Today we're diving into a conversation with Sabrina Erlhoff and Dr. Elena Tsoy, two of the leaders of a new Alzheimer's diagnostic tool coming out of the memory and aging Center at the University of California, San Francisco, we talked about the challenges of developing healthcare technology within an academic setting, some of the clinical breakthroughs that have enabled products like this to be built, and how product leaders can incorporate the large variety of stakeholders necessary to build a clinically effective piece of technology.
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Chris Hoyd 0:07
Welcome back to Product in Healthtech, a community for health tech product leaders by product leaders. I'm Chris Hoyd, the head of product at Vynyl. Today we're diving into a conversation with Sabrina Erlhoff and Dr. Elena Tsoy, two of the leaders of a new Alzheimer's diagnostic tool coming out of the memory and aging Center at the University of California, San Francisco, we talked about the challenges of developing healthcare technology within an academic setting, some of the clinical breakthroughs that have enabled products like this to be built, and how product leaders can incorporate the large variety of stakeholders necessary to build a clinically effective piece of technology. But let's jump into that discussion. I am joined today by Dr. Tsoy and Sabrina Erlhoff from the University of California San Francisco's Memory and Aging clinic. And we're here to talk about a really cool product that they have built over the last several years called Tabcat. And Sabrina and Dr. So I think we maybe can start by having you guys introduce yourselves and talk a little bit about your role in this product. And maybe Sabrina as the technical project manager on this, I'll kick it to you first to start.
Sabrina Erlhoff 1:20
Thank you. And thank you for having us this space dedicated to product and health tech is such an important one. And we're really honored to be part of the discussion today. So I'm Sabrina Erlhoff, I'm a technical project manager working under Dr. Kate Possin, who developed Tabcat, I actually started working at the memory and aging Center at UCSF as a clinical research coordinator. So I've kind of seen the full gamut from from start to finish with this product. I'm moving more into the product management space for tab cat. Now, I work directly with our software developers at Vynyl with the clinicians who guide our work with the patients, we do the testing on and sort of synthesize all of the vision that we have for the product together and make sure that the product moves along.
Chris Hoyd 2:14
So definition of product management, synthesize the vision and make sure it comes along. Thank you. Okay, and Dr. Tsoy started. Go ahead.
Dr Elena Tsoy 2:22
Of course. And of course, thank you. Yeah, thank you so much for having us. I'm super excited to be here, I this is the first time I'm taking part in this type of an event. I'm super excited. And I hope more people will be involved in this with my background. So I'm a clinical neuropsychologist and an Assistant Professor of Neurology at the UCSF memory and ageing center, I work very closely with the Tabcat team. And my role is sort of a little bit more on the scientific side where I'm primarily responsible for overlooking data collection, you know, making sure the analysis look right. And ultimately making sure that the product that we have developed is actually valid and usable. But then specific settings that it is intended for. However, at the same time, we do want to say that I am super excited to learn and I kind of had to learn through my involvement about all the technical pieces, which are extremely important. And I think as clinicians who are working in this sort of very digital era of healthcare, we all need to be able to understand what are some of the features? And what are some of the specific logistics that are related to developing products and healthcare so that they are as user friendly and as clinically useful as they can be. So I'm super excited to be taking part in this.
Chris Hoyd 3:37
Excellent, thank you so much. We're very grateful to have you both here today and very excited about about this product, which is called Tabcat. And maybe we can kick off by summarizing what this product is and what its goals are and what outcomes you're hoping to achieve from it. And maybe Sabrina again, I'll start with you.
Sabrina Erlhoff 3:56
Sure. So Tabcat stands for tablet based cognitive assessment tools. It's a software platform, again, developed by Dr. Kate Possin seen here at UCSF for both research and clinical use. At its most basic, it's a tablet based application that houses a variety of tests and questionnaires used to assess cognition. But it does go beyond that in its offerings of HIPAA compliant data storage, robust scoring based on a well characterized sample of research participants at the memory and ageing center and beyond automated reporting that can be integrated into the electronic medical, medical record, access to resources, portability, what am I missing Elena?
Dr Elena Tsoy 4:49
I think you got it all. Very attractive user interface.
Unknown Speaker 4:55
So yeah, and our most popular set of tests. On Tabcat is called the tab cat brain health assessment. We have widely studied the brain health assessment and its detection of neurodegenerative disorders, like mild cognitive impairment and dementia. And maybe Elena, you can talk more about our studies on the brain health assessment.
Dr Elena Tsoy 5:18
Yeah, definitely think one of the interesting things about Tabcat, which is, I think, why a lot of the team members that are involved in this work and sort of seeing the outside because, you know, we go to scientific conferences, we see there's a lot of products out there that are sort of meant to measure cognitive health. I think one of the unique features of Tabcat is the fact that it was first of all developed not by company, but by a group of very excited neuropsychologist who recognize the need for digitalizing cognitive assessment. And I think one of the most exciting developments in the field of Neuropsychology or cognitive health in general is the fact that we can now use machines to measure certain things that a human cannot measure, you know, things like reaction time, are absolutely impossible to capture by a human examiner. And at the same time, those metrics tend to be the most sensitive or you know, the most useful for clinical conceptualization. So Sabrina mentioned, we developed batteries that are not just sort of, you know, scientifically robust and have really good results, but are also very efficient for implementation. In very, very busy clinical practices, we primarily work with our partners in primary care, where as most people know, the time is so limited and every minute counts. So we're developing a tool that doesn't require to be administered by a very busy doctor and can be done easily by medical staff like a medical assistant. And at the same time, does this require all of that, you know, kind of manual scoring and sort of trying to make sure that you're doing things right and automatically scores everything, and just shows you the results in electronic medical records, I think has been a game changer for us, as well as to our partners who we consistently hear luckily for us positive feedback.
Unknown Speaker 7:11
Very cool. That is super exciting to hear about. And you touched on something, Dr. Tsoy that I want to kind of double click on, you sort of contrasted the setting in which you're you guys are building tab cat with maybe some of the other alternatives in the market, right? That might be maybe they're funded by venture capital, maybe they're coming from more of a sort of the 'move fast and break things' ethos, you guys are in more of a kind of an academic and research setting, can you maybe talk a little bit about, you know, maybe the pros and the cons of that distinction,
Dr Elena Tsoy 7:42
When we were starting to develop Tabcat, I don't think even our team fully realize the extent to which we will be sort of spending a lot of, you know, dollars, but also our own team's efforts, as well as you know, a lot of kind of supportive, supportive infrastructure for maintenance of a certain platform, I think this is something that we definitely had to learn. And this is something that a lot of academic settings, for example, not used to because I don't know if you're aware, but you know, if you work in a sort of grant supportive program, you kind of work from a grant to grant and so you kind of have this, you know, continuation of support, but at the same time, you always have to be coming up with innovation. And I think, as you're thinking about something like a platform that you want to have longevity, as well as continuous application, you really, really have to think deeply about how do you justify those costs. And so I think a part of what we have been doing is sort of, you know, brainstorming different solutions in terms of making sure that we are supporting as many studies as possible and supporting as many providers as possible, at the same time making sure that we kind of balance out that ability to provide that high quality support, both technically and scientifically. So that's kind of the biggest con, I think that I see. But in terms of pros, I think there's so many pros, the fact that Tabcat can be used in both research and clinical care allows for multitude of opportunities, you know, to look at data longitudinally, we have all of these data sources that can be easily combined. And then you know, can be turned into research questions, which can in turn be turned into policy and actually, you know, making sure that people are making decisions about health care recognize the importance, as well as the added value of doing something like this in primary care. So I think, you know, there, there are tons of pros, including by no means it's not the smallest, smallest Pro, but I think the ability for a lot of healthcare providers who might otherwise not be comfortable doing cognitive assessment, you know, because a lot of cognitive assessment tools, even the most basic ones, require extensive training and require a lot of sort of interpretability you know, there's a lot of that ambiguity in terms of understanding is this a normal response or abnormal, you know, which puts a lot of strain on many healthcare teams. So I think the fact that this can all be digitized and you know, data can be collected in a highly high quality and high volume, sort of fashion is extremely helpful.
Chris Hoyd 10:16
So the academic setting is, and the nature of the funding and whatnot is maybe just a little more conducive, comfortable even for someone with a with a very clinical focus to make sure that all those things fall into place. And there's not maybe an undue pressure to get something out the door before it's really ready for the audience. Interesting.
Dr Elena Tsoy 10:38
I think we can spend all the time in the world to make sure that our tool is as good as it can be i
Unknown Speaker 10:45
Which is Yeah, which is appropriate in this case. That's awesome. And Sabrina I'm sure it's someone who's, you know, close to the developers close to the designers, you probably have a slightly different perspective on it.
Unknown Speaker 10:57
Yeah, and, and to add to what Dr. Tsoy said about, you know, finding business partners who share our values in scientific rigor and understand our limitations, as they were, you know, relate to time and are willing to kind of guide us through what we believe is ethical and meaningful commercialization, I think has been, it's been a challenge for us. You know, I think there's so many people out there that we can partner with and finding somebody who fits exactly like a glove and exactly what we would want and can honor our product as as much as we honor it, it has been a challenge, I would say. And, you know, in the academic setting, like any other product, we have to practice, you know, perspective taking on a daily basis, right, we juggle the needs of researchers, primary care providers, the medical staff who administer our tests, the patients, the caregivers, and if so many people, and what I think is really fascinating about our specialty is that our patients are not only elderly, on the most part, which gives us a certain, you know, set of challenges and UI and UX design. But they also may present with unique symptoms of neurocognitive disorders that can cause confusion, memory loss, difficulty understanding language, difficulty staying focused, the academic setting that we're in is, is very conducive to learning about these perspectives, because we have such direct access to specialists in the field. And you know, the firsthand experience with our wonderful, generous research participants that give their time to us. And I think it is a really critical and a big advantage in the space that we have is that we have access to this wonderful cohort of research participants to really inform our UI and UX design. And while we may not be very formal about that UX research, we have plenty of anecdotal and firsthand experience to work with
Unknown Speaker 13:07
Maybe with that as the backdrop, I'm curious if we can, you know, circle back to like, where the product is, in its lifecycle? And what is taken to get it this far, you know, I think several years of clinical support is, you know, kind of a little anomalous in the world of tech, to really take the time to establish that, that foundation, so can you just describe what it looked like to get it to where it is now, and, and you know, what you think is sort of ahead of the product.
Unknown Speaker 13:37
Let's see, we started building Tobcat, I believe in 2013. And didn't start contracting with software developers until 2015, I believe. So from that period, we were really just like, you know, taking shots in the dark, I think, with how we wanted to design these tests, but we were working hard to, as Elena mentioned, you know, bring together this vision of having a brief assessment to detect cognitive impairment. And then we started designing these novel tests during that time. Once we program them into a cohesive software platform, we probably started collecting data specifically on these tests and their efficacy and in detecting and diagnosing cognitive impairment for at least three years, maybe four years. And it wasn't until 2018 that we published our very first validation study showing that these novel tests that we created, were reliable and valid at detecting and diagnosing neurocognitive disorders. So on the on the question of timelines, we do have a very slowly in the research field, but that first validation paper was absolutely critical to getting our foot in the door and showing pride marry care providers potential partners, how valuable our tool could be. From there, we've done tons of focus groups. We've organized people from all different nations and backgrounds to inform and iterate on these tests on the user experience of the platform itself. And of course, work also in the space of integrating into the electronic medical record. And this has been another crucial step in in making the our product really usable in primary care practice, I think we probably are all familiar with the limitations of primary care practice and integrating products into their workflow and having one single set of results or report integrated directly into the EMR was was totally crucial in our, in our development. From there, we're working on implementing an even more primary care practices outside of UCSF, and doing some big research studies in implementation there and hopefully looking at time and cost analyses as well, to measure the real life impact that our tests can have on primary care, and of course care guidance, following
Unknown Speaker 16:21
Incredibly methodical, rigorous, I would say, very empathetic for an extended period to all the various stakeholders that need to be listened to and accounted for. I think it's kind of it's pretty incredible effort. Has it felt slow to doctors, lawyers that feel like about right?
Unknown Speaker 16:40
No, I think it's, you know, I actually think it's going pretty fast compared to other academic research usually takes us on average, about 10 years to answer a single question. No, I think it's Sabrina mentioned that one of the things that has been sort of very eye opening for us is kind of seeing the real world impact of this product. So soon, I think it's very rare in our field, where, you know, we tend to answer these sorts of, you know, difficult deep scientific questions, and then, you know, it takes years to collect data to answer them. And then it takes even more years to then try and make sense of what this means. And how does this actually change healthcare, I think, with Tobcat, at least in my experience, the fact that we sort of went from you know, the sort of the idea, that dream of having something so quick and simple. And, you know, there were all of these, like EMR integration wasn't even on the table early on, because, you know, we didn't even think that we would get there. And the fact that we did, I think in the, again, forgive my academic timeline, but in a relatively short period of time, I think is very exciting, because we can see the real world impact. And we see patients who have gone undergone this assessment in our own clinic. And it's just I think it's really fascinating to see that we we are making a difference in real in real time.
Chris Hoyd 17:58
And that is a perfect segue to my next question. I'm curious, those moments where you are kind of realizing that it's, it's making a difference that this might be the thing that moves the needle for a lot of people, maybe can you just share some anecdotes, or just some of those moments over the last few years where you've just felt, you know, maybe proud or excited about what this thing has become and what it could be?
Dr Elena Tsoy 18:25
You know, I think, oh, I can I can think of a very recent development that I think, is something that we again, probably couldn't imagine. So in, in Alzheimer's disease research world, there's this huge consortium called the NACC, National Alzheimer's Coordinating Center. And it's an NIH funded program that coordinates these, you know, 30 plus Alzheimer's research centers, which are the biggest centers for Alzheimer's disease and related diseases, nationally. And so as part of this consortium, you know, we all conduct neuropsychological assessment, meaning that we collect information according to health using different types of tests. And so usually, and, again, talk about slow research. These tests are paper and pencil tests, you know, their standard sort of, you know, assessments that are done by an examiner. And then, most recently, we actually have been contacted by the team by the leadership of this huge consortium that took note of all of the developments that were happening in the digital world. And they were very excited about Tabcat and the tests that it offers. And, you know, they would like to make it potentially a part of the new sort of revised version of this protocol. I think the fact that we are getting to the point where, you know, a nationally recognized research program that serves 1000s of patients and families with Alzheimer's disease is interested in sort of recognizing the potential I think it's exceptionally excited and exciting and again, something that we could not imagine I would say and I that's on the research side. And I think at the same time, like, every single day that I see a patient in clinic who has, you know, taken Tobcat as a part of their primary care visit, and and now they are in a telling me that I knew something was wrong, and I am so glad that I'm here. I'm glad that he got the referral, I'm glad that I'm seeing a specialist now, you know, when I'm still able to make the decisions when I'm concerned, you know, and whatever the reason, I think the fact that people are able to get that access to care, you know, access to specialist access to neuropsychologist access to laboratory studies that are so important for their health, I think is critical for me. So, you know, clinically, I see the benefits every single day.
Chris Hoyd 20:39
Very cool. And what about you, Sabrina?
Sabrina Erlhoff 20:41
Yeah, I think you brought up a great point. I actually think for me, it would be kind of smaller moments maybe along the way, rather than, you know, one big exciting moment that we've had, when I started working with this project in 2016, it was two years of work before I saw a publication come out of Tabcat. And since then, four years later, well, a real testament to Dr. Tsoy, paper writing, skills and timeline, she's a paper writing machine. Since then, we've had tons dozens of publications written and not only out of studies done at the memory and ageing center, but studies done all over the world, using our tests, and seeing that kind of ever increasing number of publications coming out being a testament to how much data we've collected, how far we've come, how many people have picked up our product and decided this is really exciting. And I want to do research on it and see if it, you know, works with my population of patients. Those moments along the way have just been mind blowing to me to see, especially with this, the slower pace that we started at and where we were when I when I started working on the project. So for me, it's really been the little little steps along the way, that have just been totally exciting and have kept me going.
Dr Elena Tsoy 22:11
Yeah, I'll mention one more thing that I think was extremely exciting to me, and I just I like couldn't stop talking about it is that I just came back from this huge conference, the biggest Alzheimer's disease conference internationally, it's all going to organize by the Alzheimer's Association. And, you know, typically, when you go to this conference, there are these big talks right by leaders in the field that cover most important topics. And one of the topics was actually on sort of diagnosis of Alzheimer's disease and primary care and the critical role that primary care really plays. Because the unfortunate reality is that there simply aren't enough specialists in this country or particularly in the world, to diagnose everyone and to be able to see every patient who is likely at risk for some sort of a disease. And I was sitting there in the talk, hoping to, you know, learn other people's perspectives outside of UCSF, and I saw this huge researcher, you know, giving a talk about primary cares, perspectives. And out of nowhere, he just brought our tack hat and said, you know, there are these amazing tools available. And it was just such an amazing moment for me, I took a picture, sent it to Sabrina send it to our team that you know what, we don't have to promote anything, people are apparently finding us somehow. So I think it's just it's really exciting to be recognized at this level. Because I think all of the work that we put in obviously, we don't necessarily expect it again, we're not a company and I think are kind of our currency, so to speak, our publications, and we're doing okay on that. And but at the same time, we think the fact that people are excited about our product, is what gets really gets us going.
Chris Hoyd 23:49
That's all incredibly exciting to hear. All right, so maybe my next question, kind of a product question for the product leader on this one. Sabrina, can you talk a little bit about your approach to product management for this where you've got so many voices, so many stakeholders? So many, you know, you've got kind of the political perspective, you've got developers you've got to account for you've got a roadmap, you've got to make sure you've got funding for each phase. How do you manage all that?
Sabrina Erlhoff 24:17
I somehow I have, when you put it that way. It makes it sound kind of overwhelming. But yeah, you know, I personally am someone who thrives with a big to do list, right? I don't think I would do well being bored every day. And so being in this role where I do have to juggle the needs of so many diverse stakeholders. Is is good for me. Personally, I think for for me, what drives me the most is the mission behind our work. I am just so proud of the the patients that we serve the mission behind it. And, you know, the scientific rigor that we are committed to, and maybe even obsessed with, I find that all very moving, and it drives me every single day. You know, in day to day, nitty gritty work, I think the most important things that I bring to the table are being extremely organized in everything that I do, you know, making sure that I'm really listening to what all of these key stakeholders are, are needing from us. And then also, you know, making sure that I'm thinking through every single detail, every single outcome, and, and running any idea that I might have by the appropriate people. So I think really knowing the ins and outs of who you're speaking with, knowing the ins and outs of the patient behavior that you're dealing with, with the medical practice needs that you're trying to integrate into, and the scientific rigor that we value so much, knowing the ins and outs of every single one of those aspects, bringing it to the table is really important, and critical to the job. So that was probably just as messy of an answer as the actual job itself. But, um, yeah, it's really something that I've come to love. And I am just so excited to keep learning more from everybody in the field. Especially as we, you know, maybe bring this product into a more commercial world. I think having that knowledge of the ins and out of the business practice side of things is, you know, something that we're going to have to address at some point. And probably what we're, we're we might be missing right now.
Chris Hoyd 27:00
Like, literally sounds like you two are the perfect people to have brought this thing to life. It's really incredible.
Sabrina Erlhoff 27:07
We Yeah, probably like half of my strategy is just bugging Elena on Slack every day. And asking her questions about, you know, how we should design things and what she thinks and you know, getting her clinical perspective, and having such great access to it is amazing.
Dr Elena Tsoy 27:25
Sabrina is being overly humble, trust me, I think one other one thing that I know that she didn't mention, as a part of her job description, and product management is I think, a big part of what Sabrina really unique is uniquely positioned to bring to the team is optimization, whether it's optimization of, you know, our timeline, whether it's optimization of our data output, you know, because I think one of the things that frequently happens in research is that we are truly any researcher you would need, but always say, more is more, right? Give me all the data, you know, whatever it is that you are collecting every item level data, all of the metrics, so you're getting this huge data outputs, you're not sure which ones you're going to use, but get them all right. So I think what puts Tabcat apart is that, of course, we're collecting all of this sort of item level data in our back end. But at the same time, I think it's that optimization and making sure that both the platform itself sort of the application itself, but also the data output, and all of the actual metrics that are important to either our researchers or clinical users are, you know, presented to them in a way that is not by any means overwhelming, or concerning or unclear. This is ultimately Sabrina's job and she's doing a fantastic job at it.
Chris Hoyd 28:43
Yeah, it sounds that way to me, and I think, you know, slipped into that answer was the the nature of the collaboration between you two, it sounds like a very, sort of high bandwidth you guys were very communicative about about this. And I think that's rare in my experience, especially, you know, someone from a clinical background like yourself, doctor Tsoy, like being encouraging of that, and open to that and understanding why that's so important. Like, that accelerates everything. So that's really cool. So that's, you know, a lot of positivity, we're at a great place. Right? This has gone largely very well, I think over the last several years. But let's talk about some challenges. There's some some of the low point are there any points where you guys maybe weren't sure if this was, like actually going to be clinically effective, or you weren't sure if it was gonna get funded for the next version, or, you know, any frustrations or, or worries along those lines over the years?
Sabrina Erlhoff 29:36
To have real impact, you have to nudge your way into a clinical workflow, and there's tons of stuff there that gets in the way. I think one of the things on the tech side that we deal with the most or the the limitations of the electronic medical records themselves, there are, I don't know maybe 15 to 20 different vendors of electronic medical records, within that you may have a hospital that's using more than one for each department that they work in. And on top of that each, each hospital or clinical space will be using their own specific instance of electronic medical records. So any integration work is really done like on a case by case basis, unless you really get picked up by the vendor itself and you know, are integrating directly with the vendor. So, so the scale ability of EMR integration for us has been a real challenge, I would say, I think the technical aspects, the the actual pieces of poking the EMR up to Tabcat is, is not that difficult. But finding the champions who can provide the technical expertise at the clinic or the hospital that we're working with is very challenging. We may be working with one provider who's so excited to use Tabcat and really wants it to be a part of the medical record, but they have no idea who to turn to, to get that technical skill set in there to actually integrate Tabcat. And so that kind of scalability is is, is a pretty big challenge, I would say moving forward and thinking bigger picture about the future of tab cat, just off the top of my head to that may be a doctor. So I can touch on besides the primary care integration as maybe our work in being inclusive towards patients from diverse backgrounds. It's not so much of a technical problem. But we do run into issues of UI and UX design, and our analysis of data and thinking about patients from different cultural backgrounds, different levels of socioeconomic status, you name it. So that has been a really interesting discovery along the way. One example I can think of is, in some cultures, we've learned that thoroughness and accuracy can be is valued over speed. And so in our tests of executive function, where speed is really the primary performance metric, we have real differences in how we need to approach the instructions for the tests that are given to the patient, the analysis of their performance. And so you know, these these big dreams that we have of having big scale EMR and, you know, tests that are widely used by anybody on the planet, these big dreams lead to big problems. And we're lucky and fortunate to have tons of international partners thinking about this with us. But it is it is a big challenge that we face.
Dr Elena Tsoy 32:49
Totally agree, I think the only thing I could mention is if I had to like sort of put all of the potential difficulties that we run into in terms of developing this project, and making sure that it works again, and intending clinical settings is this balance between how much guideline or directive we provide versus how much flexibility we allow, you know, it has a lot to do with, you know, with what Sabrina was talking about with electronic medical records. But I think at the same time, I think it applies to any healthcare product you develop, you don't just develop a product, you have to develop a whole pipeline, the entire workflow in which you want this product to work, you know, so just an example of Tabcat, you know, we had to think about who would be actually administering it, if we want to save the primary doctors, primary care physicians time, then who would it be? Would it be a nurse? Would it be a social worker? Would it be a medical assistant, you know, every different every clinic has their own set of sort of this medical staff? You know, so you have to think about who that is going to be? Do we want those people to be bilingual? And if we are, what languages would they be supporting? You know, and if this has to be done, it has to be done in a separate room? Or does it can the caregiver be present or not, you know, all of these different aspects, I think of kind of figuring out the logistics so that when you actually partner with someone, again, you were able to provide this high quality support to ensure that you're not just giving them the tool and letting them run with it, you know, kind of which they eventually will run into a wall with. So you want to make sure that you provide them with all of these considerations and guidelines and directives, which again, have to be almost tailored to every single healthcare system and setting in which we're working.
Sabrina Erlhoff 34:32
You kind of touched on this a little bit. But providers, they really lack support and resources, they need to actually deliver care following a diagnosis so we can tell the provider your patient has a high likelihood of cognitive impairment. But what happens next, you know, and I think our mission is is to really impact not only the provider actions, but the care of the patient and the caregiver. And so we really work hard to provide kind of turn key recommendations that can be integrated and given to the patient and their families, you know, following diagnosis, and this has to be done in a way that is informative, but not alarming to the patient. So being very thorough in the resources that we give these resources need to be, you know, specific to the area, specific to the culture, the language spoken, it is just unbelievable how much you know, we want to give and how difficult it can be. So it really is totally essential to look beyond that final step of diagnosis. And think about the care that follows
Chris Hoyd 35:49
So nuanced. So complex, so thoughtful, it's really cool to hear all this. And I think as we're coming up on time here, maybe we can close by talking about, you know, sort of what's your focus over the the near to mid term? And what's your, your sort of dream for this? What's the ideal state, you know, maybe in a handful years down the road? Maybe I'll start with you, Sabrina?
Sabrina Erlhoff 36:13
Sure, yeah. So we are really diving into the space of self administered cognitive tests, which, if you talk to any clinician, it almost feels like an oxymoron. Sometimes, there are just a whole host of challenges in actually creating a self administered cognitive test. This would be a test that the patient can complete fully on their own without the examiner to lead or proctor them. You can imagine a simple questionnaire like is your how's your memory doing today, you have an unreliable narrator. So these, these self administered cognitive tests are very difficult to develop with the kind of scientific rigor that we we hope to have the standardization of testing that we hope to have. So there are several, you know, challenges ahead of us in this space. But with a few years of solid research and iteration on our test design, we, we do hope that this would close the gap in the provider time issues that we have, allowing the patient to be assessed in a quiet space, like a waiting room, or a mobile testing unit that visits their neighborhood. And, and allows that the results to really be delivered straight to the care providers, the primary care provider, skipping there need to, you know, spend time assessing the patient. So we are diving into that space, we hope to expand our research of social determinants of health with which Dr. Tsoy is an expert on fostering patients or fostering relationships with international partners, low to middle income countries. And of course, we're hoping to expand our implementation in primary care settings, we have some really exciting collaborations in our future with primary care providers in California. And we're just hoping to keep learning as much as we can from it and really take that experience and run with it.
Dr Elena Tsoy 38:21
Yeah, I think my vision is a is very much in line with everything Sabrina was saying, because we are, you know, two peas in a pod. But I think ideally, if I were to dream big, I would, I would want every single older adult in any country in the world to come to their primary care physician. And as a part of their workup, you know, the same way that we are getting our blood pressure checked, our height, our weight, all of the indicators that we know are critical for health, to have their brain health checked, right, using this very brief, highly culturally tailored and ultimately easy to administer and easy to implement tools. So in my ideal world, every single patient gets Tabcat once they turn 50. And it provides for easy data monitoring, it allows physicians to not have to rely on specialists, particularly internationally, as Sabrina was saying a lot of our work happens outside of the US in countries where there is a single neuropsychologist on for the entire population, you know, and they're overwhelmed, and they're primarily seeing patients who are not in that age group. And so we think it's that ability to facilitate access. And I think ultimately living in an aging world, I think, you know, with this like impending dementia burden that I think every single person who who works in this space experiences, you know, the world is aging, and we're not doing anything to prevent it. And so, I think a lot of the things that we do is just facilitating that high quality healthcare, and also kind of redefining what it means to be aging. gracefully in a way that you know can only be facilitated through a primary care setting that again, with given the right tools would be able to promote it. So that's the, I think my big dream.
Chris Hoyd 40:12
That is a beautiful, beautiful vision. Really cool work. You guys are doing incredible to hear kind of the nuance and rigor that you guys are bringing to it. Yeah, this was a huge privilege for me. So thank you both for your your time. And yeah, really appreciate contributing to the product and health tech community. Thank you very much. Thanks. Talk to you. Thank you so much for joining us. Connect with us on LinkedIn, YouTube, or on our website at productinhealth tech.com. If you have ideas or suggestions on what you'd like to hear in a future episode, or if you are interested in being a guest, please shoot us an email at info@productinhealthtech.com Thanks