Accelerating Access to Medicine Through Research Collaboration and Innovation

Speaker 2:

Yes, this is the Healthcare Rethink podcast. I am your host, Brian Urban, and today we have one of our biggest executive round tables of this season. We're going through accelerating access to medication through research, collaboration, and innovation, and we have a great table of experts to take us through that journey. Let's get them introduced. Right now we have the Chief Clinical Trial Officer of Walgreens, Ramita Tandon. Ramita, thank you for joining us.

Speaker 3:

Thank you for having me, Brian.

Speaker 2:

Next up, we have becoming maybe an in-house expert, multiple episode guests on the show here, Dr. Mitesh Rao, the CEO and founder of OMNY Health.

Speaker 4:

Thanks, Brian. It's great to be back.

Speaker 2:

Good to see you. And to round us off here is the Senior Director of the Global Head of Scientific Data, that's a lot and a good title there of Parexel. This is Dr. Jaime Smith. Jaime, thank you for joining us.

Speaker 5:

Excited to be here. Thank you.

Speaker 2:

This is going to be so much fun. Hopefully my brain can contain all the knowledge you all are going to drop on our show here today. So to better get to know our round table for our audience, we want to talk about what led you into your world of expertise in making the impact you have across the healthcare ecosystem. So let's start with Ramita. Ramita, if you don't mind, I got to throw out some amazing titles that you've had, and this is going all the way back to 2018 Pharma Voice Top 100, 2022 Top Women in Health, Wellness and Beauty, and most recently, 2022 50 Most Influential Leaders in Pharmacy. There's more to this list, but to save us time, that's amazing. So congratulations on all these accolades. Let's go back before all that though, who is Ramita, the person, and how did you get into clinical trial diversity?

Speaker 3:

That's awesome, Brian. Thanks for asking. Listen, I'm based here in Boston, Massachusetts. I've been here for about 28 years and started my career in medical research in academia, and it's been very focused on how do we bring forth innovation, technology, and how do we start to disrupt this entire clinical development product lifecycle. I'm a firm believer that the status quo that exists today around how drugs are being developed and brought into the marketplace needs to be disrupted. So my career has been really centered around looking at innovative trends and seeing how we can apply that in the clinical research ecosystem so we can bring novel therapies, device, and other diagnostics to patients' hands a lot faster so we can start to treat those ailments that are out there today. And so my career has been really centered around pushing that status quo. I've had a chance to work in academia in large CROs where we've provided a number of services to the pharmaceutical industry.

I've been at startups leveraging technology and real world data and evidence. And as we think about the entire clinical research ecosystem, there are issues around diversity, access, and equity that is still plaguing this ecosystem. And so I joined Walgreens in 2021 as we made the grand announcement that we're moving into healthcare. We're making this massive transformation, and we'll talk more about that later in our session. But I was asked to come join and build a clinical trials business, sort of a startup within the large ecosystem. So for me, it was really about centering around the why of why I do what I do and start tackling those issues and start to see if we can get more efficient and more productive in how we bring novel therapies into patients' hands. So it's been an exciting journey.

Speaker 2:

Thank you, Ramita, and only just beginning. And I love your public health background mixed with now your application in research and clinical trials. Just so amazing to have you on the show. Let's head over to Dr. Rao. We've seen you on our show before, but let's check in here. Please share a little bit more about your background and maybe what you've been up to since the last month here.

Speaker 4:

Yeah, well, it's been a busy month. Thanks, Brian. So my background, I'm an emergency medicine physician, spent most of my career as a health system executive. Prior to starting my company, I helped lead quality and safety at Stanford. Before that was helping to lead innovation at Northwestern and then before that was a health services researcher who trained with the Robert Johnson Foundation at Yale.

My focus has always been around data and we built our company out of frustration where I kept seeing opportunities for data to serve as a common language, to really allow for organizations to connect. Organizations across our industry, patients and populations who were traditionally excluded or not included in research opportunities, really thinking about democratizing access across the country. So it's been a busy year. We're about to surpass 20% of the country's data on the platform, and so we've really grown into a powerful national network now that helps support quite a lot of the R and D and research space across the country. So thrilled to where things have been going, it's kept us busy. I'm looking forward to this conversation because I think there's a lot in this space to unpack.

Speaker 2:

Yes, there really is, and everyone's clearly going to be representing a unique perspective around our virtual table here. So thank you Dr. Rao, great to hear from you. Dr. Smith. Jaime, you are new, you're new to me, you're new to our little show and you have, I don't want to brag on your behalf, but I thank you were 16 or so when you were entering university. So you're just a brilliant mind and I'm so excited to have you on the show. Tell us what took you into your line of research and what you're doing today.

Speaker 5:

Thanks so much, Brian, and I'm happy again to be here. A bit about me is I'm coming from a family of entrepreneurs actually who are also college graduates. So of course I thought I would go in that direction. I'd attend Tufts University, major in economics and start a small business. I quickly realized though that the importance of coalescing around the social, historical and cultural aspects of econ would lead me to deciding to double major in American studies and economics. And I got my first taste of research through my undergraduate thesis there on demographic disparities in economic outcomes using statistical techniques. So I instantly fell in love with research and conducting meaningful and high impact research specifically. I spent the early part of my graduate career investigating what we now think of as social determinants, so individuals' access to primary basket of food, individuals' access to transportation, women and children programs. And that was 20 years ago, so it was well ahead of the time.

Speaker 2:

Yes, I'd say so.

Speaker 5:

Ultimately, I went obviously into industry and I spent some time doing predictive modeling for large insurer, and I cut my teeth, however, my professional teeth, for about a decade at a company called Surescripts, which is the largest health information network in the US, leading statistical research there, statistical design, publication on the adoption and utilization of health information technology on a national and state level basis, addressing the opioid crisis, disaster response, health outcomes, and much, much more. I left Surescripts though because I really wanted to get my feet wet in the global arena, and so I went around to a large CRO company and I spent some time there, but then I saw an amazing opportunity to join the Parexel family where my professional ambitions and Parexel's growth strategy really aligned. So I have the distinct pleasure currently, of course is serving as the global head of scientific data there. And just a bit about my organization, we are a strategic investment by Parexel to grow and innovate the RWD space by investing in data acquisitions and strategic partnerships and strong collaborations across the ecosystem.

Speaker 2:

Love what you're doing at Parexel. Thank you, Jaime. As you can see for our audience here, a rich cornucopia of research background and experiences across the ecosystem. So I'm just excited to dive in here. So let's bounce this back to start off with Ramita here. So Ramita, you've alluded a little bit to your work in terms of clinical trial diversity at Walgreens. It's a big mission, big investment of not only dollars, but people and other resources and partnerships. This is a huge, huge deal for Walgreens. So please give us some context into the work and the origins in terms of improving drug effectiveness for all.

Speaker 3:

Yeah, Brian, it starts with the fact that we're undergoing a massive transformation as an organization. For those that recognize Walgreens as a traditional retail pharmacy entity, we have 9,000 stores and pharmacies across the US, 78% of the US population's within a five miles of Walgreens, and we service roughly around 110 to 120 million lives. And so certainly during the COVID-19 pandemic, we learned a lot when everything was shut down, the retail pharmacies were tapped by the administration to distribute the vaccinations across the nation. And what we learned firsthand that simply, it wasn't just the media outreach or other sorts of advertisements that got people to go into the locations to get their vaccinations, it required a lot of education. It required a lot of empowerment of our patient communities, consumer communities to be able to get the shots in the arms. And so we said, look, there's a lot more we can be doing in healthcare given our footprint, given our brand and trust, there's an opportunity to start to deliver healthcare more locally and start to close those care gaps.

And as we think about clinical trials, we're familiar with less than 5% of this nation participates in clinical research. And of those that participate, 75% are Caucasian. So what that means is no matter how much work we've all done, and even including myself in the industry, we still haven't moved the needle in terms of making medical research inclusive and representative. And as we think about diversity at Walgreens, it's not just race and ethnicity, but it includes sexual orientation, disabilities, rural parts of America that we represent. And so for us, launching the clinical trials program and initiative was about ensuring that people viewed clinical trials as a care option, that if standard of care therapy is not a viable option for patients, that our pharmacists and our pharmacy care teams for those that the patients have this engaged trust, we have the ability to be able to introduce clinical trials for their particular disease areas.

And so in the last two years, and certainly I'll talk more about that, but to see the people coming into our locations and at least being introduced about what a clinical trial is, particularly our communities that are in underserved areas, our communities of color who perhaps don't know what a clinical trial is, who have perhaps some mistrust, fear around the notion of clinical trials. The first step is, we're leveraging our physical footprint as welcome entry points so people can be educated and empowered around the notion of what a clinical trial is, and then feel comfortable about signing up and then participating at a Walgreens and the clinical trials that we're conducting today. So for us, and one of our KPIs around this business model is really around tackling the issue around diversity. And it's not easy, because again, the lion's share of this nation don't even know about a clinical trial or certainly may have some misconceptions about the clinical research ecosystem. So we're spending a lot of time at the community level and starting to educate and empower our communities about what a clinical trial is.

Speaker 2:

I think that's amazing, Ramita, the engagement side of how you're leveraging your footprint, the actual physical stores and the relationship that pharmacists have with individual patients, it's an extension that goes beyond what we think of the primary care relationship. It's very unique, deep rooted in community, and so excited to see the growth with this. And Dr. Rao, I want to get your perspective. Really, I love talking data and humanity with you because you've done so many different creative projects over the last several years, especially with OMNY. How are you seeing the emerging space of data in clinical trials and research just explode? How are you seeing it from your vantage point?

Speaker 4:

Yeah, I mean, I think Ramita hit a lot of really key aspects to this, which is how do we ensure that these lifesaving trials are available as a standard of care to patients and populations who traditionally never had access to them. We center that on data. That's one of the biggest pieces that we've been trying to connect the dots on. We used to joke that we don't need yet another clinical trial in a very clinical trial heavy environment. We need rural populations to be able to have access to trials. We need community groups to be able to actually center on trials. We think of it from an aspect that I think is really centered around effectiveness and capability. And two parts to that, the first piece being so many parts of the community would benefit incredibly from having trial access and being included in trials.

But how do you ensure that a trial can happen, that it can be brought to completion, that you can get the right resources around it, that you can center the data around it to ensure that it's effective? It's not an easy enterprise. Clinical trials are a lot of work, and they take a lot of resources, which is why traditionally you see them at these big academic centers and not in the community. So that's been a big component part for our mission is, how do we bring the right resourcing capabilities so that the communities can actually participate in these trials and patients can get access? And then the second piece is really centering on the data, which data infrastructure is challenging the further you get away from call it well subsidized academic environments. And so how do you bring those right capabilities around there so that the community organizations can have the right resourcing, not just around personnel and capabilities, but also around data to successfully complete those trials.

I mean, that's a really big piece, and I think it doesn't just impact the ability for patients to get access to these lifesaving trials, but also when you think about all the incredible advancements we make in healthcare and the incredible new treatment patterns and new treatments that we bring to the market, if we're not building these with every population across the country included, then people are being excluded from the get-go. And that's an important piece when we start to look at things like precision medicine and where healthcare is headed. So those are huge aspects that I think we focus on, and it's great to hear that other parts of the organizations center on this too.

Speaker 2:

And it's amazing too, the statistic that Ramita mentioned, 5% participation overall in US, and three quarters of that being Caucasian, that has not changed for many moons. And to your point, diversity is needed now more than ever, not only just for medication effectiveness, but for access, the literacy side and how you recruit. I mean, this is just, it's an amazing feat, but it's needed now more than ever. We've definitely reached an arc in our healthcare society that we need to address it. So real world data. I want to shift over to Dr. Smith for a second. Jaime, we got an opportunity to chat a little bit before this episode, and this is a very, I'd say, descriptive term that has taken many other names in patient insights data and so on. But can you help us better understand the term real world data and how it's being used in research from a CRO perspective, a clinical research organization?

Speaker 5:

Sure, Brian. So I think about the definition of real world data, RWD, from the FDA, and it's data related to patient's health status and/or the delivery of healthcare routinely collected from a variety of sources. And the question here is what are those sources? So those sources can include electronic medical records, electronic health records, claims databases, registries, other digital technologies. So when I think about its application and the use of RWD to generate RWE, real world evidence. And what we do at Parexel with a keen focus on actually implementing RWD throughout the drug lifecycle. So we often think of RWD really as a post-authorization, post-marketing exercise. But at least on my team, I'm really interested in imputing RWD all throughout the drug life cycle. So that can include patient journeys, burden of disease assessments, control arms, cost-effectiveness studies, and of course those post-authorization studies.

I'll also bring an additional aspect to say that there are additional insights that the FDA has highlighted and the industry as well on the use of RWD for AI and machine learning applications. So the FDA recently released a considerations paper, discussion paper on the use of AI and machine learning and drug development. And they specifically call out site selection, patient selection, recruitment. Those are also activities that would really leverage RWD in order to be able to shine and to share insights as Ramita and Mitesh have mentioned as well. But we really have to have a robust infrastructure to be able to handle those data. And I believe that that data infrastructure is really the true catalyst for us to be able to utilize AI and machine learning in healthcare. So there are lots of really cool, innovative things going on.

Speaker 2:

Thank you, Dr. Smith. It's great to have that broken down. I think sometimes we comb over a lot of acronyms and descriptive terms and just accept them as something else in the tool bucket within our industry. But thank you for breaking that down, extremely helpful. I know Mitesh, you have a lot of background in real world data and how it's being adopted at a rapid pace. Just let me get a quick question into you, because I'm also wanting to know the journey of clinical trials here too. But give me a little bit of perspective on real world data being used across the ecosystem from your vantage point.

Speaker 4:

Yeah, Jaime hit it right on the head when she talked about infrastructure and what's really needed to align this. Not all data is created equal. And I think traditionally we've struggled from having dated, incomplete, shallow information that has formed our RWD layer and that call it that lack of depth and the lack of timeliness impacts the RWE that we generate off of it. And so the idea of really getting in and creating deeper, more timely information that's more comprehensive, I think that forms that, call it initial layer of value that you can really use to transform the space. The second piece is how inclusive it is, because the more you get deeper into this data, the more you talk about timely data, that's where you start to run into these infrastructure issues where not every organization has the ability to bring that data forward. That's something that traditionally we've seen across the provider world is each organization has their stage of evolution in their IT infrastructure, their ability to bring data forward and corralling that information is its own challenge.

And that's just when you're talking about, call it the EMR, EHR side, once you get beyond that into wearables data and other sources of information, it becomes even more complicated. And so that's been a battle that I think has, it's evolved over the years. We're at a stage now in the evolution of real world data that we've gotten into really deep, timely information. We've created that infrastructure, at least the foundational layer of it to start to connect those dots and bring that information forward. And that's what gives me, I think, a lot of hope into the potential where we'll take trials because now you have the information to be able to move at a much deeper, more timely, more accurate pace.

And this does impact the larger question too that you brought up around social terms of health. SDOH data, health equity information is the types of pieces that we're trying to pull out from a lot of the underlying architecture. It's not something that we've traditionally done a great job capturing or really bringing forward or leveraging. And so now I think the newer approaches to gathering data have allowed us to really bring that to the forefront.

Speaker 2:

I had to ask you right off the top Mitesh, because the engineering side of your brain and the physician side of your brain, they're always working, and that's your background of your family. Your mother was a physician, your father was an engineer from what I recall from our last conversation. So wanted to get that piece and you hit exactly what I was hoping to hear. But in terms of data application into clinical trial recruitment, that journey, from an outside perspective, Ramita, it seems quite complex. You have over 9,000 stores, I believe, and that's huge. So leveraging the footprint of your stores in terms of a recruiting mechanism and education mechanism for clinical trials is clearly a strong pillar of the strategy here it would appear for me. So can you help me understand maybe what other data sets you might be leveraging to see where you prioritize or how you see more of the person? And then how do you kind of pinpoint your strategy in recruitment? Take us through the journey a little bit more if you could.

Speaker 3:

Yeah, and I think Mitesh hit on some really key points, particularly as Walgreens is going through this transformation, and particularly in clinical trials. You can imagine at Walgreens, we're sitting on a plethora information. I call it the data jungle to some extent, but we have access to the pharmacy records of a patient. We have access to front of store consumer information. We have elements of the social determinants of health, race, ethnicity, zip code of if you go in to pick up your script, there's a lot of information that we have on our patients. And so, as we are evolving as an organization, our data architecture and the use cases and how we're leveraging the data that we have access to is also changing.

And so for the case of clinical trials, as we think about recruitment, we are using the real world data that we have access to, including through partnerships where we have access through clinical records of a patient. We're stitching those elements together. So then we start to understand that patient journey more holistically. So as we think about, one of the applicabilities is identifying patients or what I call the patient identification acquisition process. So today, our goal is to be able to identify a cohort of patients within the Walgreens ecosystem and to be able to match them for trials for partners, whether it's for sponsors like pharmaceutical companies, CROs, the government agencies, healthcare systems, and even payers.

We have been able to canvas our ecosystem very quickly to be able to identify a cohort of patients that can be rightly matched to a trial. It's no longer a desire to simply just send out massive outreach campaigns or letters, particularly to our consumers who have trust in us. So I'm not going to send you a diabetes clinical trial if you have no health conditions associated with diabetes. So we're using our data and access to the patient insight information that we have and be more precise in the targeting that we're doing today. And I think the social determinants of health is absolutely critical for us because not only does that help us to identify the patients, but as we do the outreach, we have the ability to do the outreach, whether it's texting, emailing, call center, snail mails, and it really depends on the communities because we're recognizing some of our communities have the health literacy, digital literacy, technology is an issue.

Not everybody embraces technology. I mean, when we go down in some of our deep south locations, we hear firsthand from our consumers that if you're going to ask us to participate, how will I get access to broadband? How will I get access to wifi? By the way, my plan is free after 6:00 PM. So those are the challenges that we have. So that level of information is so critical when we start to engage and make the outreach to invite communities to participate in clinical trials. And so we've put that in motion and we're starting to see some good results as we're again, heavily focused in moving the needle around the diversity. And so for example, we've got some clinical trials that we've completed where we're now seeing an increase of Black and Hispanic populations approximately two times the average rate of participation in clinical trials. For example, there was a placebo controlled, I think it was a double-blind randomized phase three study where Walgreens was asked to use our real-world data ecosystem to engage underrepresented populations and be included as an educational campaign.

And the result of that was that we had the Black African American, around 17% that were recruited Hispanic Latino was 19%. And if you compare that against the average of clinical trial participation, which is roughly around 8% for Black Americans and 11% for Hispanic, we're surpassing that. So what that means is, we've got to be more judicious in identifying those patient populations to participate. And I think we start to recognize what's happening community by community, and we start to do the work at the community level. There's going to be more of a readiness to want to participate at minimum to learn more and then move them through that workflow.

Speaker 2:

That is fascinating, Ramita. And you're really having this multifaceted approach to engagement, improving trust, and then also appealing in terms of the culture of health to those populations as well, understanding where they are and their means of access and their barriers. It goes way beyond what I think a lot of the external audience sees as, hey, they're doing an outreach campaign or they're doing maybe a personalized outreach campaign. It's far more thoughtful and sophisticated, and it sounds like it's only going to become more sophisticated as your team grows and your impact grows as well.

So I think what's interesting is the data side too. I mean, the real world data ecosystem that you mentioned at Walgreens, Ramita is huge. It's a jungle, but you're becoming very precise. And I think immediately of Jaime, your research background, I want to talk about Parexel, what you look at beyond some of the common SDOH attribute data, which is race, ethnicity, gender, and language, but also the socioeconomic kind of drop down as well. And with your background going deep 20 years ago when you were first standing up examining social determinants of health, can you help me understand what you found across the last 20 years to be some of the most intriguing, unique data elements that go deeper than a lot of what our audience wouldn't be aware of?

Speaker 5:

Thanks, Brian. I think about the fact that just as you mentioned, when I go back to my early days and I was literally creating these questionnaires, going door to door, asking individuals about their personal lives, and it's interesting to see how far we've come as a society to start to embrace that. It was something that I really had to actually put down for several years because it wasn't something that was a focus in society, but now it has emerged as a major focus. And so it's something that I'm very excited about continuing. And so I appreciate the concerted efforts because they weren't there before to really highlight and focus in on race and ethnicity, given its importance and the historical lens from underrepresented participation in trials and we have to continue those efforts. It's interesting, as Ramita mentioned as well, some of the other additional characteristics such as gender identity and age, socioeconomic status, pregnancy status, those are other variables that we really weren't looking at, but now we are.

And the FDA has again, sent out recent guidance on diversity in trials. So it's something that as an industry we're really starting to capitalize on the CDC and WHO as well have additional characteristics such as food insecurity and education and housing. And again, those were variables that I was looking at 20 years ago, but now they're coming back to the forefront as something that's important to understand. And you think about what are some of those actionable steps that we can actually take to start to address these social determinants? And I think about having translators at sites for sites where individuals have English as a second language, I think about giving transportation vouchers to individuals to participate in trials who don't have access to a car, who have to travel long distance to sites that aren't in their communities.

I also think about decentralized clinical trials. We saw a huge uptick in that over the pandemic. We really wouldn't have been able to make as many strides without the on vent of access to electronic data and decentralized trials as we did over the pandemic. And then also just simplified literature and education. When we talk about literacy, not only educating professionals, but also educating the community, but in a way that they can understand. So I would always say, give it to them where the goats can get it. So that just means provide the information in a simplified way so that all audiences can understand it.

Providing food at sites. When we talk about addressing food insecurity, why not have food at sites? Supporting staff with the target population, I think this one is huge. Making sure that you have, if you're trying to attract Black and Hispanic participants, have Black and Hispanic staff at those sites. We want to have that representation so that individuals will feel more comfortable. It is a trust exercise as well. We're asking about patients' lived experiences, their circumstances, their daily lives. We want to understand that so that we can get the holistic picture for the whole patient.

Speaker 2:

Jaime, that's so insightful. And Ramita, I'm looking over at your screen because I see you nodding your head and smiling with everything that Dr. Smith here is sharing. And in terms of a trust exercise, Ramita, have you seen your work with clinical trial diversity uptick the engagement and trust you have into communities?

Speaker 3:

Yeah, I think Jaime hit on so many key points. As we are trying to build, and what we're saying is that trying to build the right highway into our communities so we can make trials more accessible and palpable, particularly in our underserved locations. I mean, 57% of our locations are in underserved populations. And the one thing that we're seeing is as, and I'll give an example in South Florida as we're activating our locations as clinical trial centers. So we've got a number of centers across the nation that are fully compliant as clinical trial sites that are meant to number one, be that welcome entry point to educate. So the pharmacists are slowly having that dialogue in private health rooms around what a clinical trial is. And Jaime's right, it makes a difference, particularly in our Black and Hispanic populations.

In south Florida where it's largely Hispanic, our pharmacists and our pharmacy care teams are of Hispanic descent, and they are having that conversation in Spanish. So to help them understand what a clinical trial is and why their participation is so critical, but one of the things that you'll start to see as you go into a designated location, when you pick up your script, if we are participating in a particular clinical trial and you're eligible for that trial, that patient will get flagged as a potential candidate for that trial. So there's that proactive engagement with the patient community and saying, look, you've been on this diabetes treatment for a while that I've known, it's not working, but this trial just given what it can do for you, I think it's something worthwhile to explore. And in those instances, it's great. We're seeing a good uptake to say, okay, pharmacist, let's talk. So then they'll go into the private health room, have the conversation, and then make the decision on their own that yes, this is something that I want to participate in.

So in that scenario, that in-person engagement with the pharmacist that has the trust that look like them, speak in their language is making a huge impact. Is it going to happen overnight? No. Now as I think about our rural areas, it's very different. During the COVID-19 pandemic, we had the mobile Walgreens buses that had to go into the rural parts of area because as Jaime mentioned, not everybody could travel to academic medical center or another provider organization just because of where the distance was. And a lot of these are farming communities, and so we had to put our mobile pharmacy units to be able to support the vaccinations. And we're doing the same with clinical trials where we're having folks come into these locations or these mobile units to be able to support that workflow and dialogue. So I would say 100%, it's about making sure that we are, again, recognizing what is happening in the communities, who they are.

And as we start to deploy solutions, whether they're technological solutions or platforms or anything else, we've got to be cognizant of who we're dealing with, otherwise they will not participate. And we've heard that firsthand. And so this is not an easy road or a highway to build, and it's going to take an ecosystem of partners to be able to work together. So this is not just a Walgreens thing, but this is going to require community leaders and other technology partners who know how to help to unlock and make sure we can get our Black, brown populations into clinical trials.

Speaker 2:

I'm glad you said that last comment, Ramita, because you simply didn't have your mobile units going back to the vaccine equity campaign, I believe yourself, Dr. Kevin Ban and other great leaders across Walgreens led, you didn't just simply have your mobile vans just roll into neighborhoods unannounced. You work with a lot of anchor systems, a lot of anchor community leaders to be able to not only be able to get access to the vaccinations, but also trust and engagement to know where they can go for continued help. So I love that you commented on that. And I got to go back to Mitesh for a second. You were a physician at one point in your life, albeit maybe in a lot of emergency room service points of care. But have you, I guess, ever imagined if you were a physician back now practicing that a lot of this work would be taking place and eventually being fed into an EHR and fed to visibility for you? Would you ever imagine if you're now a physician, that would be happening?

Speaker 4:

Yeah, that's a great question, Brian. And part of the problem that we run into is that a lot of the aspects of what Ramita and Jaime are talking about, really important pieces of the patient's voice and the patient's experience, they're not very well captured within the electronic record. The structured data fields, I mean, look, let's be honest, it's a billing tool at the end of the day, that's what the EMR is. And so capturing those aspects, understanding the impact that the patient's disease burden has on their daily life, how it's impacting their ability to not just pursue, call it their healthcare journey, but rather their larger life journey, that's a piece that's often missing when you look at things like claims or structured data. This is one of the reasons that we center so much of our work on unstructured information, because there's such a wealth of knowledge of the patient's experience trapped in that unstructured data.

So much of the patient's voice, the burdens that they're dealing with, the challenges that they're facing, which run in parallel with their diseases that they're trying to address, that's such an important piece. And so we spend a lot of our time leveraging the unstructured information to really connect those dots and provide that information layer. And that's a piece that I think is always missing. Even as a practicing physician, I would look at the structured data and try to make heads or tails of lab results or prior testing, and that often missed the patient experience. I would say that the other piece to this too, Brian, that's really important is, again, another thing that Jaime and Ramita brought up, which was the community and how do you actually engage the community side?

That's one of the reasons when we started building our data network, we focused on community providers, we focused on rural health networks, we focused on community health systems because we knew that those were the groups that struggled the most to really center things on data, to bring the right data forward, and to build those right collaborative relationships. And for many of these organizations, they're serving their populations incredibly well. They serve as the only source of clinical care, and there's big communities that rely on them. And so how do we bring the right resourcing capabilities forward to help those groups excel and to help them succeed in a future that's data-driven? That's a really important piece, and I think both those aspects are where we really centered a lot of our work.

Speaker 2:

I love that because I immediately think about our conversations around the longitudinal EHR and what will it truly become in the future, capturing all the different aspects of someone's existence, challenges, needs, et cetera. So let's round up our conversation here. We've gone deep into the world of research, clinical trials, data exchange with our table here today. I want to look into the future and get each of your perspectives here. In terms of improving research and access for hard to reach populations that have higher social health needs, what are going to be the biggest contributions your work will be bringing to the table there? And maybe what are the biggest hurdles maybe to advancing the CRO research in this space, clinical trial diversity, data exchange? What do you think the big stuff you're going to contribute to is going to be, or maybe your biggest hurdles? Ramita, let's start with you.

Speaker 3:

Yeah. I continue to go out there and say, look, we are trying to build the right highway into the communities that we serve here within the Walgreens ecosystem, and it's not going to happen on our own. It's going to require an ecosystem of partnerships to make sure that that gets unlocked. So our goal is to bring trials closer to where the patients are today, and whether it's at the pharmacies, whether it's in sort of a hybrid fashion where we can use technology to support that workflow so that where there's patient populations that are a bit more sophisticated to use technology, they can do so, and the ability to do it at patients' homes. And certainly at Walgreens, we've made the investments in home health, in a hybrid. So our goal is to be agnostic, but flexible in the options that we give to our patients as we bring trials into these communities.

And we have to because it's not a one size fits all for the communities that we serve. So I think that's probably going to be the biggest challenge, is that as we work with partners that are activating trials, we need them to understand, it's not a one size fits all for the communities. And I recognize especially with the 2023 spending bill, diversity plan is a mandate now. So it's not a nice to have, it's a must. And so behaviors have to change infrastructure, processes, non-traditional thinking has to be brought into this equation for this to work. And so our ask and our continued ask is, as you think about your trials and how you design trials, let's keep the patient in mind. And as we start to bring them into the communities and to where they're located, we've got to be flexible in the options that we are able to introduce to these communities.

Speaker 2:

Non-traditional thinking, I love that Ramita. And I feel that your inspiration is going to echo across our audience and of course, way beyond to be able to help bring that into frame for a lot of people. Mitesh, what do you think? What's going to be the big thing for OMNY Health coming into the future or the biggest challenges you all face?

Speaker 4:

Yeah, I mean, health equity is a big focus of our work and has been a big focus of our work and will be a big focus of our work going forward. And I think about it from the concept of empowerment. What I would love to see is that every community, every provider group, every aspect of, call it clinical practice in every part of this country, patients should have access to that same cutting edge research, the same cutting edge clinical care. And the way we do that is sort of twofold.

One, it's by ensuring that we provide that right infrastructure, as Ramita mentioned, to be able to support. Some of its centers on data, but some of it also centers on capabilities because not every organization in the country, not every community has the right resources to be able to successfully support the work that we want to do. And that requires the right level of not just infrastructure, but also resourcing and that financial support. So we think about it from that perspective, and if we can accomplish that, there's a lot we can do in this country to really democratize access to where healthcare is headed.

Speaker 2:

Democratizing access, indeed. You summed it up very well in that sentiment. Dr. Rao, thank you so much. Jaime, take us home. What's coming down the pike? What do you see here?

Speaker 5:

So we all have expressed that data holds immense power and potential to transform our industry. And I think about the development of AI and machine learning to be able to better leverage our real world data, the data privacy initiatives that are going on, the advancements of new GDPR and new regulations in Europe. I'm looking at the global landscape as well. So that's something that we're keeping a close eye on, especially as we start to think about linking data across a variety of platforms and transparency and trust. We talked about that as well, but that's really at the crux of the entire exercise, is transparency and trust. So I would say those are the biggest advantages and the biggest challenges that we'll face.

Speaker 2:

Thank you, Jaime. Very insightful and right on point with a lot of other things that you had taken into the conversation today. So I have to stop us here. I would love to continue to learn from all of you. It's seriously a master's class in the clinical trial, diversity research, data exchange and beyond, but I am so appreciative of your time. Ramita Tandon, Chief Clinical Trial Officer, Walgreens, thank you so much for being on our show today.

Speaker 3:

Thank you, Brian.

Speaker 2:

Dr. Mitesh Rao, CEO, OMNY Health. Thank you. And so good to see you again, my friend.

Speaker 4:

Thank you, Brian. It was a pleasure.

Speaker 2:

And last but not least, of course, Dr. Jaime Smith, Senior Director of Global Scientific Data at Parexel. Thank you so much for being on our little show.

Speaker 5:

Thank you.

Speaker 2:

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