We publish our conversations with inspirational individuals in the healthcare industry to promote the innovation discourse and support framework. We spoke with Dr. John Moore, Co-Founder and CEO of Twine Health. Twine Health empowers patients to take an active role in their care through a cloud-based software platform. Twine Health has been recognized by Harvard University as a Health Acceleration Challenge finalist.
Dr. Moore offers insight into his thoughts during medical school and residency that prompted him to become the healthcare IT professional he is today. Dr. Moore also discusses the future of healthcare innovation and provides a fascinating anecdote to encourage students on their quest for innovation. A transcript of our conversation is below.
Healthcare Innovators: Hi Dr. Moore, how are you?
Dr. Moore: Great, how are you doing?
Healthcare Innovators: Fantastic! We are very excited to be speaking with you. Could you please walk us through your background and how you have gotten to where you are today?
Dr. Moore: I went to undergrad with a path of being an orthopedic surgeon and went into biomedical engineering at [Boston University]. I knew nothing about biomedical engineering and was originally going to study biology, but then I thought that engineering was really cool because I really liked math. I worked with wearables, particularly wearables for elderly patient monitoring to detect changes in people’s behavior that might predict challenges in their health. That was back in the late 90s. Now, wearables are pretty big. Back then, it was pretty nascent research.
As I did that work, it became pretty clear to me that if I wanted to have a big impact on the medical field, I needed to go medical school, but I still enjoyed engineering. I deferred my medical school acceptance for one year to do research in Belgium in a hospital setting using engineering principles to learn more about neurological disorders and movement disorders. I tried to see how I could gain insight to help develop new approaches via engineering techniques. That was really valuable because I got to see what it was like to be a physician, surgeon, and engineer all at once. It reinforced what I wanted to do and made me realize I had to do medicine to have a deeper understanding of the medical field. At that time, I was still thinking that my main contribution would be on the lines of a new kind of device or peripherals to augment humans via brain stimulation such as artificial vision.
I went to medical school and explored lots of difficult specialties in medicine with a surgical bend. I looked at orthopedics, cardiothoracic surgery, otolaryngology, ophthalmology, etc. I ended up with an intense interest for ophthalmology because the surgery is incredibly precise and there is a lot of room for innovation with surgical robotics and more. I matched in ophthalmology and did an internship in medicine, surgery, and ER at a transitional internship. I then went on to Hopkins for my residency in ophthalmology. I lasted about 3-4 months there until I became really frustrated and embarrassed with our episodic, clinician-driven approach to medicine that is all about our schedule, our location, and our agenda.
I started to research and write code in my spare time to create a system to work with my patients more effectively, create plans for care, and connect with my patients after they left the office. I wanted to connect with their cellphone or home computer so we could work together. The technology was not going to solve the problem, but it would help me connect with them. I got really excited about that. This was well before iPhones or Android so people were not thinking about this with the exception of some Nokia smartphones.
I quit my residency to get a Ph.D. at MIT to learn deeply about human psychology, how it pertains to behavior change, and how to design technology to help people collaborate. I spent six years there to thoroughly learn how to do this. I wanted to embrace patient contribution. We had success publishing papers with spectacular outcomes on prevention in diabetes, HIV, and other conditions. From there, we felt that we had all the pieces in place to then start a company and bring this innovation to market, and that is what I have been doing for the past 2.5 years. It has been a linear path since I left residency. The big idea has been to same: how to reinvent healthcare delivery out of the office that is about continuous collaboration. It is not about doctor and patient anymore, it is about the patient and the whole care team. That is what we do at Twine.
Healthcare Innovators: That’s amazing. Could you fill in the gap about what you were thinking at the end of residency and your jump to the Masters and Ph.D. at MIT? What is the motivation for pursuing further education in healthcare IT?
Dr. Moore: I felt that most of the work that was going on in the technology field at the time was misguided. It was under the philosophy that digitizing medical records would make the medical world 100 times better. However, I had an underlying feeling that it had a lot more to do with understanding the psychology of what it means to have a chronic disease and how to help people learn self-management skills. I felt nobody really had a deep understanding of those pieces to build something that would work. In my eyes, I really needed to take a deeper look behind this and see how I could build something to make a difference.
Healthcare Innovators: Could you build onto what gave you the feeling that EMR was not the future and that it would not help?
Dr. Moore: It was pretty straightforward to me because I was using them on the front lines. It was driving me to focus on the screen and click through a bunch of buttons that would create documentation to generate a bill. Meanwhile, my patient was sitting next to me with a real need to work with them to understand what a good plan of care was to help them to leave the office and develop skills if they were to encounter problems. They needed help with their plan of care. The EMR tool did not touch any of those design points. As a technologist, there are two very different design points to consider. This EMR tool is designed for something completely different than what I wanted to do. There was a clear disconnect. This was all day, every day for years, really, through medical school, internship, residency. That kind of disconnect was pretty apparent. There was a big boom of EMR about what great value it would provide. But if you talk to any doctor ask if if EMR accomplishes what they want it to do in terms of helping them work with their patients, they will say absolutely not.
Healthcare Innovators: Thank you for clarifying. Where do you see EMR in relation to big data? Do you think the continued collection of electronic records will assist in predictive technologies to contribute to better care and better outcomes in the long run?
Dr. Moore: I do not think that EMR is needed to aggregate [medical] data for the appropriate analytics. There are tons of tools that have been developed in the past decade on the population health side. There is a new breed of tools on the frontline of care that were designed for collaboration, rather than simply for recordkeeping. I do believe in the promise of big data to help us further tailor therapies to help us determine what we are doing right and doing wrong in medicine. I think we took the wrong approach to it though. We took big data and ignored good personal care on the frontlines, and magically thought big data would solve the problems. Patients do not care about big data — they care about someone being there to hold their hand and to help them. We have done a great disservice by not focusing on that first. We want to provide care and then collect data. All the analytics and big data in the world can identify who needs help, but it isn’t going to fix the problem if, in the end, that’s your solution.
Healthcare Innovators: Very interesting to hear! We see your point. Which areas in healthcare require the most change in the future? Where should we focus now given our misdirection in the past?
Dr. Moore: I think that we need to focus on giving patients tools to build self-management skills, not simply give them blank educational materials without context, but real interactive tools that help them learn on a daily basis through associations between with their daily actions and their health outcomes, allow them to get support from members of the clinical care team in real time as they need it. To me, that is the most important. From there, we can start to build amazing insight into the plans, both behaviorally and medically, that will work for patients. You can build a healthcare system that drives its actions on who needs help and who is struggling, not based on appointments. That is the most exciting area for innovation now. People are building great wearables and mobile devices that can be leveraged for big data processing and machine learning. The key is how we provide a better model of care that engages the patient more. Part of that is technology development and new models of care delivery with new kinds of practices that operate very differently and further embrace the contribution of the patient.
Healthcare Innovators: Very fascinating. To wrap up, could you please tell us what advice you would give students now?
Dr. Moore: That’s a good question. I think that the biggest thing is not taking things for granted. Certain directions that are happening are certain people’s point of view on what is going to work. Do not take that at face value without evaluating it for yourself. That was the biggest lesson I learned along the way. There are many preconceived notions about what is going to provide value in healthcare. Most of it is all being conceived without talking to the people on the frontline: the patients, the nurses, and the doctors.
A prime example is my work with HIV patients. Everybody said that the problems with HIV are that there are too many medications with too many side effects that are too difficult to remember. Everybody was designing smart pill bottles and trying to combine medications in pills. I simply asked patients and they said, “No, that’s not the problem.” The problem is, “I went to see the doctor, they told me I had this disease that was going to kill me but was invisible, and I just had to trust them. They drew my blood, told me to take a pill that would make me feel lousy and told me to come back in a month to draw my blood again.” Patients said they were overwhelmed, shocked, and had no one to help them. It wasn’t that they forgot to take the pills, it was that they didn’t even perceive they had this disease. They were just in shock and had no one there to take their hand to help them through the challenges.
We tend to choose the problem that is easier to solve rather than try to solve the real problem. The biggest piece of advice is, try to find the problem yourself. Take a deep look at it and do not try to solve the easy thing. Try to solve what you believe is the heart of what needs to be fixed. That is where the real innovation occurs, when you have the courage to confront the hairier, messier problem underneath it all.
Healthcare Innovators: Thank you for that powerful anecdote, Dr. Moore, and thank you for being so generous with your time. We appreciate your comments and insight.
Dr. Moore: No problem. Thanks for calling.
About the speaker
John O. Moore, M.D., Ph.D. is the Co-Founder and CEO of Twine Health. Dr. Moore has been named one of 40 Under 40 Healthcare Innovators by MedTech Boston and has won numerous awards and competitions, including the CIMIT Prize for Primary Healthcare, iHUB Shark Tank, Primary Care Innovation Award by MedTech Boston, and more.