#5: Future of data in healthcare - the importance of patient centricity and ways of achieving it | Julian Ranger, Founder of Digi.me

Published on January 21, 2022

How to recognize that “the iceberg is melting”? Today's special guest, Julian Ranger, the founder of digi.me, talks about personal data, and patient centricity as the future of healthcare, a new privacy model, and how it relates to the Military Internet. You'll get information about the different geographic regulations of patient data, and how the 7 stages of the cultural change process relate to healthcare. Enjoy the listening!

In this episode, we will answer the following questions:

01:21 background story of Digi.me

03:34 primary value of using Digi.me - how users can share and control their data

09:13 patient data privacy

12:31 why companies don't have to think about HIPAA or GDPR while using this model

14:17 how the stored data works

18:11 main focus of Digi.me and why it is safe to use it

21:00 what is Military Internet and how it works

23:42 how Digi.me enables patient data security

26:48 geographic regulations of patient data and government compliance

34:16 how to change healthcare data to be patient-centric, and how culture change relates to this.

36:26 why is patient access to their medical records is a must

39:12 patient-centric model as the future primary focus of Digi.me

41:51 primary advice to other professionals who would like to develop or implement technology in healthcare

44:02 Rapid Fire Round (3 questions)



Digi.me website: https://digi.me/

Julian Ranger's Twitter: @rangerj

Julian Ranger's LinkedIn: https://www.linkedin.com/in/julianranger/

Digi.me Twitter: @digime


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Ivan Dunskiy: Hello everyone, and welcome to another episode of the HealthTech Beat podcast. The mission of our podcast is to show the real-life challenges of implementing technology in healthcare. The podcast is sponsored by Demigos, a company that develops IT solutions for healthcare startups and companies. You can check for more information on demigos.com.

My name is Ivan Dunskiy, your today's host, and I'm joined by an honored guest Julian Ranger, a founder at Digi.me. Digi.me is a company that returns data to the individual to enable individuals to share more embedded data about themselves, to enable services to provide more and better value. So, in healthcare Digi.me is the enabler of patient centricity, which is widely seen as the future of healthcare.

And that is something that we are going to discuss today. Julian, thank you for being here. How are you today? 

Julian Ranger: Pleasure. Very well, in London. So, one of my first times, it's been quite a few months because of COVID I used to be up every week and like everybody else. Now travel is not as regular. I am doing very well. Thank you. 

[01:21] The background story of Digi.me.

Ivan Dunskiy: Could you please give a brief background of what you do at Digi.me? 

Julian Ranger: Sure. I should sort of start off. I think perhaps in my wider background because it's somewhat relevant. So originally, I was an aerial engineer, and then I was lucky in the early eighties to be in the right time, the right place and got into the beginnings of what we call the military Internet.

And I founded a business that was all about managing the networks, data, and interoperability and built back to the worldwide business that I sold to Lockheed Martin. And that's relevant because did you meet these based partly on the experience of how do you manage data? How do you make it available? How can you use it?

And it was that experience that led to the founding of Digi.me, which is noticing what is it that is complicated about personal data, the data of where you and I is privacy security and consent. Yes, that's a big problem. But the bigger problem is the availability of data. How do you make it so that data is available to be reused for new purposes, especially in health, where data is often locked away in silence, and we can't even use it in the health infrastructure? And the answer is that you have to aggregate it to the point. And the only point you could reasonably aggregate it is the individual. And that's what Digi.me is all about - enabling individuals to get their data for themselves, and then providing a simple method for services, whether that's a health service or anything else outside of health, to ask you for the data and for you then to share it with your consent.

So that we have achieved the ability to aggregate the richest data about an individual together. At the individual, only held by the individual and then for that individual to be able to consent it for use in any number of different services from there. And that's what Digi.me is all about. And it's very much based upon technologies and experience from that 25 years of military Internet that we did before.

[03:34] The primary value of using Digi.me, and how users can share and control their data.

Ivan Dunskiy: And just for more context, could you please share how exactly users can share their data with Digi.me?

Julian Ranger: So if we think about it in an easy to describe the way, and then I'll tell you how people will experience it for the first time. So the easiest way to think about it - to download the DGB app. And you say, right, I would like access to my GP record, wearables, social data, and your Digi.me acting as a data facilitator for the individuals. So in your case, you, Ivan. We make the connection to your GP, your wearables, your social data and pull a full copy, which will store in a repository, which is yours, fully encrypted, and only you have the key. So you've now got all that data. And we do one other thing, which is we normalize it. Data comes in lots of different forms.

If you think about health, we often want it in HL7, version 4 FHIR. But you might get it. So in the US, you might get a variation of that in picking a variation to surmount; you've got a blue button, CBA formats, all of which are different. We will normalize all of that to HL7, version 4, which you hold now. That's one-half of Digi.me. You get the data. The second half is we have a consent stack, as we call it. So a service might be a diabetes app. It might be a hospital. It might be a researcher. It might be anything. Once access to your data per value exchange. So maybe it's to keep you alive.

I guess I'll share my data for that purpose. So that service implements the Digi.me consent stack, which is an API. They registered for a consent certificate, got a token, which they put into our API. That will then cause the individual to see a consent certificate come up on the screen. It says explicitly what data will be shared for and why.

And if the individual says yes, then there Digi.me extracts a copy from their library and passes it to the service in that normalized format. And that's how it works. If you think about it in that flow. Now, that's a kind of logical flow, but it's not a practical flow, a wisely practical one because most of us as individuals don't care about our data. We care about the results.

So if there's a diabetes app that wants my medications, my wearables to keep me alive, I care about that. 

Ivan Dunskiy: You do whatever you want, just keep me alive. 

Julian Ranger: Just keep me alive, right? Now, many other use cases. But so, therefore, the way that most people will experience Digi.me is they would download the diabetes app.

It will then say that I can keep you alive if you can share your health data and wearables with me. They then implement Digi.me. So somebody sees the certificate, authenticates, the data then goes into their repository, and they are now using the app, becoming a Digi.me user. Over time they'll see the power of their data, and they'll download the app, and they'll use it for many other purposes. But the price so, therefore, the pragmatic way most people will come in is through the first use case. And then people will see the power of their data, and slowly, over time, more and more people will want to have their data for many use cases, not just one, but for multiple use cases. And this covers health. But it also covers finance and retail and all sorts of things.

And the interesting thing is we're seeing a blurring of the lines of what is used for health data. For example, my social data can be really important when thinking about my mental health and understanding that. So we must think about health, not just think of my medical data, wearables. Other factors, phenotypic factors, may also be essential and accessible when you have all data. 

Ivan Dunskiy: As I understood, a patient can share data with Digi.me and other apps. But can they share data through the Digi.me app itself? 

Julian Ranger: They can. I mean, you can see the data. And then you can choose to use the operating system capabilities to see if you like forward some of that data via email or whatever else, but that's a fairly clunky way of doing things.

Ivan Dunskiy: Okay. 

Julian Ranger: Most people, most services that will want your data, will use Digi.me API and the consent system. And that's important to you, the individual, because of course you give consent, but you're also able to withdraw it later. You can say, no, I won't delete my data, or you're not going to get anymore. So that ability to have individual control is important for you, the individual, the ability for the service to have data that they couldn't otherwise get access to, but it's important for them. And the reason they get that data is because the individual has the right of access to all the data. So because the individual requests it from the GP, hospital, and wearables company, they get all the data. And then once it's the individuals, they can do with it, as they please, nobody is saying you can't share it.

If you get a copy of your medical record, physically in the paper, you can photocopy and share it with whoever you like, with the same when you own it digitally, you now have the control. So it's not up to your GP whether they like the diabetes app or not; it's up to you because you own the data at this point. 

[09:13] How Digi.me cares about patient data privacy.

Ivan Dunskiy: So, you focus on patients and try to explain the value of using Digi.me and then they can go to, for example, other wearables, providers and ask them to share their data with Digi.me, right?

Julian Ranger: Yes, I've always got to make clear, the data is never shared with Digi.me. We're just, if you like, a courier company, we get the data to the individual, and we allow the data to go from the individual to the service.

We don't see all the data. It just transitions, and we're dealing with the flow. We're never holding it. We're never looking at it, all right. So it's very much data from source to the individual, from the individuals to the service. Now, the two different modes I used. One is the individual gets data and then decides to share it.

The other is they have a service. And they say, we want that service. So then they get the data for that service. It doesn't matter which way wrap this what you took. It's always to the individual then to the service.

Ivan Dunskiy: And what is your selling point to patients? Why do they decide to use Digi.me? 

Julian Ranger: The patient really doesn't decide to use Digi.me, the service that does. But the service is then saying to the patient, We have this capability using Digi.me to get your data, but privately, consented, you have control.

And so the service is selling to the patients. So they're using our services much like imagine you're on a website, you want my credit card. I'm not very happy to give you my credit card details, but it comes up if you use a company like Stripe. And I know that my credit card details are safe. I've got accreditations and stuff. So we're the safe way for companies to ask you for data. But not only the safe way, the only way to get some of that data and get the whole variety of data and give you control. 

Ivan Dunskiy: To name it very simply, medical data. 

Julian Ranger: Yes, but not just for medical data. The medical data, financial data, social data, wearables, media.

We cover all the things now. It's true. However, one of the largest markets and where we're doing a lot of early traction is health because health has a unique challenge: the data is huge, locked away. And in fact, we only need to know this. I'm just moving home. And I know that all my data will not get to the new GP in my mood.

I should, but it won't. But if I moved abroad, it would be worse. None of my data would follow me, right? So the only way to get to personalize medicine, which is the direction of travel for health, is if the individual will have a full copy of data, it is the only solution. And that is why countries like Holland, for example, the leading edge of implementing this, got all the laws to make it done. It's why the US has meaningful use three legislation, patient-directed access. So governments understand, even if they've got national health services, which is not the case in the US, of course, but the patient has to be the aggregation point elsewhere.

If we move to the future, we want to personalize medicine.

[12:31] Why companies don't have to think about HIPAA or GDPR while using this model

Ivan Dunskiy: Am I right that, for example, if there is a service, a healthcare service that wants to collect patient data, they can use you as storage in a way and do not think about HIPAA compliance or GDPR compliance? Like they can handle everything for you. 

Julian Ranger: Effectively, yes, because the individuals are holding it. When they share the data, GDPR applies, right, consent, but we have over consent for the business. Now, if they take the data and have the consent, and that's fine in GDPR terms, if they hold the data, they've got to keep it secure and everything else to apply to GDPR. But if they process the data and then throw it away, keep the results - well, that's fine, that sidesteps the issue. The same in HIPAA. But if they hold it, they have to do it, but one of the nice things, let's take the diabetes app as an example, so say what my medications and wearables data are. If it holds that data in the app on my phone, the company never sees it. There is no GDPR. There is no impact. So it opens up new models of processing. You don't have to bring it back into the web service and business; you can deal with consent. So the consensus typically says, where will it be held?

Is it off the device or on the device, right? Cause it differs. There may be some companies that I'm not sure I want you to have that data. You're only going to process it on my phone. You're not seeing it. That's fine. I'll let different people have different things they will be happy to accept. 

[14:17] How the stored data works

Ivan Dunskiy: That's interesting. So, is data stored on patients' devices? Is this correct? 

Julian Ranger: No. The data is stored in the user's own repository and encrypted with a key that only they have. Now there are two ways the user can have a default store. Let's say it's global, as with the app, they can choose to have that store in their own Dropbox, their own Google Drives, whatever you want to drive.

So people have the choice of where they store it. Now, in the inevitable way of things, cause people do trust Digi.me, and we don't look at the data we can't, like the architectures. Most people use the default store. But we give people the ability to put it where they want it. So it's fully decentralized data. And this is really important because your data is safer with Digi.me where it came from. Because it's individually encrypted, it's completely decentralized for the individual. That's important because you're collecting your life's, medical data, bank data, et cetera. This is a very private thing. So you do need that decentralized, fully encrypted, secure storage.

Ivan Dunskiy: I'm just curious, do you use any blockchain technologies?

Julian Ranger: We don't, in fact, and there's a reason for that so that the data is immutable. The encryption makes it beautiful. But blockchain is when you've got a transaction-ready, you need a public record of it, something that happened. This is storage. You don't use the blockchain for storage. You don't knock at a store, every single bank transaction on the blockchain. So as the storage. So no, we don't. Now the consent certificate. Some people may want those stored on the blockchain for long-term proof. At the moment, that's not the case. It's not applicable in the storage situation that we are using. So it's just a technology that is not applicable to what we're doing. 

Ivan Dunskiy: Got it. I'm going to ask the next question: I assume that you work with companies, right? So on one side, you help patients store secure, but then maybe you provide some insights to other companies about this data.

Julian Ranger: No, we don't. We don't see, touch, or hold your data very important. So we've got those things. We don't process the data apart from doing the normalization.

We are not doing any insights or anything else. Your data isn't sold by us individually or in a group or anonymized. We don't do any of that. We are just a courier company. So when you put a check in the post, the Royal Mail or the courier company doesn't open the envelope and say, look, 1.50 check, 500,000-pound check.

They just deliver a check. They have no knowledge of what is in that letter. And we are the same. We're doing the movement of data, the normalization, but we're not seeing it, not touching it, not holding that data, right. We're completely blind to that data. 

Ivan Dunskiy: And not doing even in an anonymized way?

Julian Ranger: Nope. 

Ivan Dunskiy: As I understand, you don't want to affect a patient's trust, right? 

Julian Ranger: Correct. I talked with a health company this morning, and they are researchers; they got 10,000 patients, they want the data for 10,000 patients, and they got a credit anonymized pool. They've got a particular medical condition, and they're going to do some research on that.

That's fine. So they're going to go to their 10,000 patients, say to them, Can you share your data using Digi.me and say you want to get it? We, this is the company, will anonymize it and then use it for this research purpose. That's fine. But Digi.me, we don't do that. We're just data facilitators.

We help with data go from A to B, to C. B is always the individual cause services can be C, D, E F, G. 

[18:11] Main focus of Digi.me and why is it safe to use it.

Ivan Dunskiy: I think that's a very interesting approach that you focus on very complex, but only one thing. And that's your primary business. You do not do anything like any other side things that you can do, but you just do one thing.

Julian Ranger: The idea is that we're this horizontal layer. I use an analogy that might help make it clear cause the analogy works on many different levels. So, think about electricity. We've got many, many different appliances. I could probably buy ten washing machines if I went to a washing machine company. Why? They just wash clothes or because different people want one that looks good. There are lots of functions that are smaller, bigger, whatever. Now, if I provided the electricity and the washing machine, you get one type of washing machine, that wouldn't really work very well.

So that's not a good answer. My job is just to provide the electricity in this case. Now the data sources, there are lots of it just like there's lots of power stations, nuclear power, wind power, solar, gas, coal, whatever. So think of those of the different data sources. I'm like the national grid. I bring the data to your home, right. Or the electricity to the home. You've got to switch. You could have any apart, so you can have any service you want. There might be ten different diabetes apps, all using electricity in this case, Digi.me. You get to choose which one rather than me saying, no, I'm just going to give you one option.

That doesn't make sense. I'm the national grid. That's all I do. I get the electricity from the power supplies to the appliances and give you the switch. And the nice thing is that's the important piece, isn't it? Making the electricity available. What we don't say is the national grid safe?

Is it safe to plug it? We assume it's safe. The good news is with Digi.me. It is safe because its private security consented. So that's just like, you wouldn't be allowed to use electricity if it wasn't safe, you shouldn't be allowed to move data if it isn't safe. We think of privacy security centers, the basic things, the key thing that we're doing is enabling data to flow to the devices and new services, but you should choose which service. It shouldn't be up to me to say. This is the only research that's been done on your data.

You want to be able to choose. And that's why we're a horizontal layer, and anybody can use it. 

[21:00] What is military Internet, and how does it work.

Ivan Dunskiy: With the electricity analogy, I think it clarifies how everything works and what your main focus is. That's great. And that's interesting that you mentioned that much of your technology is based on the concepts and technology development for the military Internet. Could you please share and elaborate more on that? Like what is military Internet? 

Julian Ranger: The insight was that if your work in the military, the one thing you don't want is what we call a node, a single place, which, if you could destroy it, would interrupt the flow of data.

That isn't good. But so we implemented these networks, lots of different networks, lots of different platforms on it, but you find that you have to have a node. It is impossible to aggregate all the data if everybody's trying to talk to everybody else. You have to create aggregation points. And in fact, I helped create some. When you realize that even in the military, we've got standards, we've got one customer, a defense department, strong contracts. We can't do anything else to introduce nodes, this ability for everybody to try and communicate, because it quickly makes you realize it's impossible in the commercial world to get every service, to try and deal with every data source and everything else.

You have to have an aggregation point. So the first thing was, it was obvious the only way to solve the data availability problem was data aggregation. And the only place you could do it was the individual. That's the first piece. The second piece is when we did that was recognizing. You can't then expect if you will make all this data available, everybody to understand every data language and the sources used.

Because you'll never get it used, I can't speak 110 languages or 180 languages. I can't say more than one, even though I used to be fluent in Japanese cause I was born in Japan. But I like everything in English, right. I'm sorry, but I do. I know you're multilingual. So you can go in a couple of languages.

So, therefore, normalization is a key part of making the data useful, and the technology to do that and do it in a scalable way doesn't require a code, right, and could be done. That came from work that we did originally for the military in the late nineties, early two thousands. We've improved those toolsets, of course, and things like that.

Those were two key things. It was a key understanding that you've got to bring data together and that you have to normalize it. And of course, the security architectures and stuff like that mean you understand how to make sure that the data is ultimately totally secured.

[23:42] How does Digi.me enable patient data security.

Ivan Dunskiy: Patient data security is a big thing and concern. And do you have any other mechanisms other than these private storages? How do you enable this patient data to be secure? 

Julian Ranger:  So it's difficult without diagrams to show everything that we're doing.

But what you need to think about is that the most important thing about security is encryption. Of course, it is. People think that that's enough. But it is the most important thing where the key is held. Because if I can get access to the keys, then the encryption is pointless.

And most issues come around because the keys are not very secure either because they've got stupid passwords attached to them or default, or because someone can get into the key store, right. So people say, okay, your data's encrypted. It's all fine. But it isn't all fine. It's the architecture where the key is out. We do not hold the keys.

The individual holds the keys. And so that's completely decentralized. So that's number one is because of that way of doing it and in a way in which they don't have to remember it. It's not like a blockchain wallet, it's dealt with in a much more user-friendly way. So that's number one. 

Ivan Dunskiy: But how do patients store their keys? 

Julian Ranger: It's held in the Digi.me app and then held in a secure store on their phone. And then, if they don't have the app, it's held by the service they're using. But the service can't use it without arbitration sensitivity. So it's quite a complicated model in some of the models, but fundamentally it's held either by the individual or the service, but in a way, in which only the individual has control over both cases. So that's number one. 

Ivan Dunskiy: The patient can lose it, right? 

Julian Ranger: Correct. And number two. Unless the patient or the user is giving permission, in which case we have temporary control, we never hold it.

Ever. It's always deleted and gone. So having no centralized history makes it hugely secure because there's no single point you can get. And remember, it's not worth getting one person's data. But it might be. If you're Justin Bieber, it might be getting your data, getting your social photographs, might get your music, and it might make quite a lot of money of it.

So you do have to care about individual security. So what we actually do is we don't encrypt all your data with one key. We encrypt it with random numbers and then encrypt around the numbers with your key. If much about encryption, this means that it's really hard. If you get hold of the encrypted library, it is virtually impossible to decrypt that even with government-level service.

So the way in which you do it now, that's not the only security we do. There's more security than that. Just to give you a feel for the importance of it. And this is critical for us. I mean, if people's data leak out of Digi.me, there'll be no Digi.me. It has to be secure. And we've been audited by governments for health data or other data and passed every time.

And that's a key, fundamental piece for ourselves. 

[26:48] Different geographic regulations of patient data and government compliance.

Ivan Dunskiy: There's interesting how we come to this next question about the governments and compliance. How do you deal with this different geographic regulation of patient data, and how do you work with them? 

Julian Ranger: When I look at compliance, privacy isn't the problem.

So privacy laws, HIPAA laws, because it's baked into our architecture. So we are compliant with the architecture by default. Our biggest problem is access to data. Because in the US, where it's private companies, they make it difficult, and governments just make it even more difficult. Nearly everybody around the world, all the sort of high-tech health countries, will say, of course, you have a right to patient access.

Of course, you do. But then they do nothing to enable it. They don't actively make that happen. Now there are notable exceptions, like the Dutch. So we have had to go to places and companies and kind of force our way in and say, We're getting the data for the individual.

Then when you do it. And there's like the UK. And I'm going to be very polite about the NHS. It's a great organization. By the way, it saved my life. I died at 18, and, they got me back again. So pretty much in a happy position with them. Nonetheless, their whole view of data is owned by the NHS. The NHS uses it.

And yes, we find it very difficult to send, but nobody else could do that, only weaker. And then we come along and say, Well, we want access for individuals. They get access for individuals. We have to allow that. Yes, we'll allow you to do that. But which contract vehicle? So you've got to get onto a contract vehicle. So I have to get a contract. It didn't make it easy. It's not like an API that I can just do that. Now then, of course, there are many rules to make sure that I'm a pocket company secure. Those I will agree with you. You should do that to make sure that I'm not a shark. But then we say: when the data goes to the individual, it's up to them what to do with it. It's got nothing to do with it. But it's our data; it's the individual's data. And they go like no, no. Cause it came from us. It came from you. But if I got a printout record, can I photocopy that and give it to anyone I like? Yes, of course, I can. If I get a digital copy, can I just make a digital copy and give it to who I like?

Like, no. It's not the same, but it is the same. But it's not because they're deliberately trying to frustrate things. It's just because it's new, right. There's no process. There's no procedure. There's no manual on the shelf. So every time we have to go through the process with them and say: Look, if it's okay, I could get a physical copy, and I could photocopy, and I can get a digital copy.

I suppose so. But what about data controllers? It's not your problem. That's my problem. But aren't we responsible? You're responsible for making sure that if Digi.me is helping the individual get the data that we're not a shyster company, we're a good company. Yes, you are responsible. If you're giving me Digi.me access to the API to get someone's data, you should check my security, privacy, safety, and safety policies. But that's all you should be doing, right.

Once the data hits the individual, it's theirs. So there's a lot of issues we've had with access, the compliance, the understanding, but it's more the question of its early days for what we would call patient-centricity, and inevitably people take time to do it. The interesting thing is that people are beginning to understand if this is the only way to get to where they want to for patient-directed medicine, right. 

Specifically for ourselves. But the logic versus the implementation isn't there yet. They are still saying: well, I'm sure we could do that. I know I spent 8 billion trying to get data from hospitals to GPS and back, and I failed, but if I spent another 8 billion, maybe I can make it work. No.

Just give it to the individuals that will cost you nothing. We do this for free. Yes. But if I spent another 8 billion, I could make it work. So, you've got to do it this way. So there's a lot of learning if you like, and that's going to be a question of time, people seeing those first use cases, which are coming through now, and so on.

I think you'll see the flood gates open within a year to two years. And for example, the EU has stated that every individual in the EU should have access to their health data by 2030. Now they're not doing anything about it, but at least it's a statement. But countries like the Netherlands are proactive and not just proactive in saying: Yes, companies, you can get qualified.

I think we're the only ones that allow people to unshare it, but that doesn't matter. But that is giving a subsidy. So they're giving us 7 euros, 50 subsidies in terms you get the data.

So they're paying to encourage the market to go direct patient-centric doing all that. And I think when that feeds through, and you start to see what that means for healthcare in Holland, there more and more nations will follow, but at the moment you have to drag them, they're screaming.

Ivan Dunskiy: Interesting. And what do you think their perception? Why do they incentivize this approach? The shift. 

Julian Ranger: It's difficult. There are thousands of Harvard business review papers or changing culture in organizations and everything else. It's the same. Is there a burning platform?

If you follow the laws, there's a wonderful book for anyone who wants to talk about culture change called 'My iceberg is melting' with a penguin on it. It takes you through the seven stages of culture change, what you need to do. And of course, the first is my iceberg melting. Is there a radical reason for the change?

And when you're inside a health service, you may not see those random things. You may not know that the house is on fire. The iceberg is melting. And if you don't, you will never get down that change process. So the seven-step change process says, first of all, you have to recognize that what you're doing today isn't working.

And if you don't recognize that state, everything is new is difficult. And if you're inside of health services, it's hard to say. We've got a broken data exchange, which they have. So when someone like us and others doing the same come along, they can logically intuit that we're right. They can see that it works, but they haven't inside their hearts.

Not the burning platform, the melting iceberg of whatever is initiating down that line. Now, you can get them there, but that's the thing that takes time. So what we need to do in the industry, for those of us trying to change healthcare data to be patient-centric, is to show the world that there is a burning platform.

And there's a much better platform over here. You can move over here. Everything's really good. But that's a joke. It's a cultural change. 

[34:16] How to change healthcare data to be patient-centric, and how culture change relates to this.

Ivan Dunskiy: That's a great mission, but how do you want to do this? How do you want to accomplish that? How do you want to make this shift in perception? 

Julian Ranger: What we've done is through a lot of very hard work.

We've opened up the data in four nations. So we've now got really good quality health things with wearables, that stuff. So my job now is to get those new services and everything else using that data to demonstrate to the world it's better. Demonstrate that what I say is true. And not just what I say. I mean, the communities go to patient centricity.

So for all those who believe patient-centricity is the right answer, we now have the tools to do in Digi.me, and there'll be others following. So we now need to prove that this is the right answer. And then the culture change will happen. But it's much easier to see and to understand when it's real than when it's on paper and people talking about it.

So we've done the hard work of getting the data out to the individuals. We've done the hard work of the first studies and proof cases, which we'd be doing with other apps and stuff for the last two or three years. And now, just as we are moving into 2022, you will see real-life into the hands of consumers and other apps, services based.

And that's when people will go: I can see it, I can feel it, I can touch it, It's real. Now that will help in a culture change. 

Ivan Dunskiy: I think that's also part of it that you need to convince the end-user. That is worth it because, for example, for me as a patient, if I go to different hospitals right now, part of my data is stored in one hospital, and then in other parts of my data stored in another hospital.

If I go to another city and go to the third hospital, I can't provide data from those two. 

That works in Ukraine, in the US, like most countries. 

Julian Ranger: In most countries. 

[36:26] Why is patient access to their medical records is a must?

Ivan Dunskiy: Unless you're using one big healthcare system that has a presence in different cities whenever you move in.

And I think that in this perspective, your service is really valuable and can really make a difference when you have all your data, and you just provide data to different providers. And with all of that, you can also enrich your data with your daily activities, for example, from your wearables, when you do, like when you go to the gym, or so on.

That's really like your passport. You provide your passport with the data you have.

Julian Ranger: It's absolutely the case. Of course, the issue there is that it's a no-brainer. If you're a patient, this is obvious that you must have all of your data together. But it's too expensive for me to go to all the individuals and market to the individuals, right. So I have to do it by the services first, but I expect within two to three years at the outside, and maybe earlier in some countries, the people will very rapidly go: I get it because I have my data together. I can now do this and this. But yes, it's utterly bizarre. I'm leaving home. And as I said, the probability of all my data going to my new GP is fairly low, but it is accurate. So, just to use as an example, I didn't know what it said because I never had my data. I discovered in the early two thousand that I had no spleen. I told you I died at 18.

I had loads of stuff, cutting all sorts of things. And my medical records said I had no spleen, which was just wrong. Now, what that means is for the best part of 30 years, I was medicated as if I had my spleen. And that's very different. Somebody who has a spleen and the only got discovered cause I had a wasp allergy, and then they gave me wasps things to desensitize me. Then they stopped, and they did a white blood cell count to check that it's a good time to stop desensitizing you, et cetera. And they said, Jesus, for someone who had no spleen, you've got much too high white blood cell rate. So what do you mean no spleen? Of course, I've got a spleen, but I had this argument with the GP, right?

He sent me for an ultrasound, and they said, strangely enough, you have a spleen. Now had I had access to my own record? I haven't seen that. So for 30 years, I never harmed myself. But for 30 years, there was the potential for harm because my medical record was wrong, but I didn't know.

It's as simple as that. So even at the most basic level, patient access to their medical records is absolute, an absolute must. 

[39:12] Patient-centric model as the future primary focus of Digi.me. 

Ivan Dunskiy: That's true. Could you please share with us the problems you will overcome in the nearest future, and what is your primary focus in your work now?

Julian Ranger: The primary focus is to get these use cases that prove this patient-centric model. So we're working with researchers. We're working with apps. We're not familiar enough working with hospitals and GPS to pull the data in, even though they should, but they're not there yet. They're not at that point.

So we're working primarily with researchers and apps, pharma, et cetera, who have had difficulty accessing the data, but now can provide you services. So our focus in health is to get those use cases, get them into the hands of individuals, and show how easy it is. It is fundamentally inordinately easy, and nothing in health data has been easy ever before. And certainly, if you have to have that, and you're in one of the countries we currently support, you could have health data from individuals provided you, convince them of the value exchange. In 24 hours, you could implement the Digi.me interface and have access to health data.

That's just never been able to be done before. You have had to spend a year begging, filling out forms and, to God knows whatever, to get access to health data. So now that we've made that available, as I said, 24 hours, you can have access to health data. Now our job is to get people using it for values that make sense in the health environment so that we've got those proof points.

So, therefore, more and more health data will be opened up, and then that's a self-fulfilling spiral at that point or flywheel. So that's our key focus.

Ivan Dunskiy: And I have a kind of a technical question. So as a patient, as a user, can I download my data from the storage in any single form, for example, the CSV file or something like that?

Julian Ranger: Yes, you can. So we always allow. One of the most important things is working on portability data from your GP, your hospital, and your wearables. You must not be locked into Digi.me. There may be a better version of us. So we've always had the capability for an individual to export their data. It's an export in JSON format because this format makes sense to do it, which may or may not be useful for an individual, but it's useful for other applications that they would use. So your data is never locked into Digi.me. You, as an individual, can go through the export capability and export data. 

[41:51] Primary advice to other professionals who would like to develop or implement technology in healthcare.

Ivan Dunskiy: We are coming to the end of the interview, and I have a question for you.

What kind of advice can you give to other professionals who want to launch their healthcare app or do something, some startup in healthcare? What kind of advice can you give to them?

Julian Ranger: First of all, if you want data, use Digi.me, of course. But seriously, healthcare is a slow burn. So, you must be prepared for roadblocks with government rules and regulations and everything else.

And you have to be detail orientated if you like. Because it is somebody's life, if you receive diabetes type one - is a signal, and you convert it to diabetes type two by mistake, you could kill someone. So you've got to be very detailed oriented. You got to expect it to take time.

But we are all in a new era. So if you have a good idea, whatever that might be -purchasing it, displaying it, using it, searching. If you are actually in a new era, we're getting access to the data, now is not your problem. What you do with it, what value you extract from it, now that's your problem.

That's where you add value. So we're in this chaos, but you must always recognize that there are rules or whether you're a medical device or you're trying to sell it, et cetera, et cetera. So compliance and detail if you're in healthcare are absolutely attention to detail is the most important.

But I would say, yes, it is a bit of an advert of Digi.me, but we're not the only ones in the world doing this. We write and say we are the leaders, but you can now access healthcare data much easier than ever before. And with lower compliance. 

Ivan Dunskiy: That's a really big thing. Because you can do nothing without data, if you want to do it, for example, an AI app or something like that. I think that the things we covered are very important, I would say you're doing the fundamental work for healthcare. 

[44:02] Rapid Fire Round (3 questions)

Now I want to end the interview with a rapid-fire round exercise. I will ask you several personal questions, and you will answer whatever you like. I assume you're a busy man. Do you have a hobby? 

Julian Ranger: I have a number of hobbies - rugby, cricket, woodworking, reading. A variety of different things. Sports has always been my release from, doing these team sports. So rugby and cricket generally, but then reading and woodwork, which is a sort of quiet thing.

Ivan Dunskiy: And what is your favorite book? 

Julian Ranger: My favorite book is a book that will probably mean nothing to you, but it's Biggles Flies East, so from where are you. So I was an aeronautical engineer, but any Biggles could go east. So I've got one of the world's largest Biggles and Captain W. Johns Collections.

You have to be kind of British to understand. We'll look up Biggles, he started as the first World War hero, but he represents all the right morals, can-do attitudes, and everything else. And aviation. 

Ivan Dunskiy: I'll check it out. What is the location that impressed you the most? 

Julian Ranger: I've been very lucky. I have done an enormous amount of travel, and I spent two years traveling the world, many out of the way, places, et cetera. And I'd say it's the wide-open spaces when you go to the wide-open spaces, as well as the Gobi desert, Antarctica, African Plains. They just, they're amazing. Cause you can just stand there so much to see, so much do. And it's nature at its best. It's raw. It's lovely. And I just think, given a choice, I'll always go to a wide-open space. I was a farm laborer at 16, but the wide-open spaces are definitely mine; why is that. 

Ivan Dunskiy: And what is the one piece of advice you would give to your 20 years old self?

Julian Ranger: Actually, it would probably take more time off work. So in my twenties, I was, cause I had started my business very early at 23, which is an assistant business. And I spent an enormous amount of work. I'd always take every Saturday off, which was a real relaxation, but I've worked some days. And I'd say I'd probably overdid it. And having your whole utilization of holidays is important to mental freshness and some things you can only really do when you're young. So I'd say work hard, but make sure you play hard, take your holidays. And you'll be mentally fresh, and you'll achieve just as much. 

Ivan Dunskiy: Maybe not so fast. 

Julian Ranger: You'll probably do it as fast.

I always remember one key time. This is back before emails. So when you went on holiday, you really had all of them, these days sometimes really got hold of it. I remember I'd been building the company from 86 to 98, right. I was going through this period of time. And, for about two years, I really didn't have a whole of that.

We can sit down at the pub, some British and I went away for three weeks skiing and then to New York, with my girlfriend at the time. And when I came back in January, I was very relaxed. And I chewed through work. And I realized that the previous three months I'd been so tired. I thought I was achieving a lot, but I probably had a month without work in those three months because I was too tired. I didn't know it. And it was a real lesson to me. That's when this lesson really hit. If you just work, you get so tired that you're not achieving. So you've got to have that mental break to make you achieve more in the time that you do spend. So it may seem strange. I'm not saying 35 hours a week, which the French seem to do much better in condition. 

But I am saying I put in a 90 hour week, every week is just ridiculous. Right? So 50 here, 40 there. Whatever the number of hours you do, make sure you take five weeks of good holiday a year. It will pay you back. 

Ivan Dunskiy: I will also add that when you're under stress, you can find yourself in a bubble, you want to work more and more, and there is a constant loop. And unless you're out there, you can't see that you are in this bubble. It's true. 

Julian Ranger: You definitely need to take time off. 

Ivan Dunskiy:  So thank you for your time today. Before we finish, what is the best way to reach out if somebody wants to talk with you. 

Julian Ranger: On Twitter, I'm @rangerj, and you can always email me at julian@digi.me.

It's the easiest way, or reach out to me on LinkedIn. I think I'm the only Julian Ranger. So, with gray hair, it's pretty obvious. Any one of those three ways would work fine.

Ivan Dunskiy: I'll put all this in the resources section after the interview if you don't mind. 

Thank you, Julian, for your time. That was a fruitful conversation. It was great to learn about your experience and what you're doing at Digi.me and thank all listeners and see you in the next episodes. 

Who is behind the HealthTech Beat podcast

We are a team of IT professionals who like sharing technical knowledge with healthcare industry people.

At Demigos, we generate ideas on how to improve product performance, design, and positioning based on our experience building complex health tech solutions.

Check our blog with articles on the related topics, and our cases in healthtech. Also, connect the podcast host and the CEO of Demigos Ivan Dunskiy on Linkedin.