Uri Goren is the head of digital engagement and capabilities at Teva Pharmaceuticals, and just recently became a member of the National Advisory Board for digital health for the Israel Ministry of Health. Uri founded and continues to contribute insights through his digital magazine, e-Pochonder and is one of the first advocates for patient centric health care.

02:25 Uri Goren talks about his road to become a trailblazer and advocate for patient-centric healthcare.

07:20 When did Uri think it is the most important moment to listen to patients.

11:50 Uri discusses the role of the Society of Participatory Medicine and the E-Patient Movement. 

17:02 What is the best way to keep that balance of - the empowered patient, who is the most important person in the room, with the knowledge and judgment of the medical professional whose recommendations should be trusted.

21:40 At what scale is breaking away from traditional channel to market is happening on a wide scale in the industry?

25:51 Uri comments on how he is using different digital channels for his personal and professional messaging. What is the difference in how he weighs the value of each channel.

34:14 Uri talks about his role at Teva?

37:38 What exactly is digitalization of B2B?

40:28 Are there any social networking tools that can be used to differentiate B2B from B2C.

43:32 What is the National Advisory Board for digital health for the Ministry of Health in and what are Uri's goals in the advisory board?

48:12 What is Uri Gorenseeing that is special in the Israeli Digital Health ecosystem? And what does he think is missing, and maybe entrepreneurs should pay more attention to.

52:21 Uri's opinion about the main problem that needs to be solved for the healthcare market with technology.

Patient centric isn’t a trend, it's a concept. It's become the main thing that the doctors are looking at now. They're even learning about it in school. Tell us a little bit about how that happened for you. And did you know at the time that you were a trailblazer in this space?

Uri Goren: So, I guess my fascination with this came through a personal experience. So, I myself, was a care giver for my father. When he was going through his cancer, he died in 2004. And I've learned the power of digital or internet through that experience. So, I myself, was kind of tasked with go and search on the internet. Basically, I started teaching myself how to get good information outside the internet and see how that empowers us with our discussion with a physician with everything that we did. Like in 2000, I got a free teleconsultation with the largest cancer center in the United States about my father. Because they gave it for free, if you went online and asked for it, if you're international.

I guess it was a kind of a business development element. But for me, it was talking to the biggest cancer center in the United States, sending them information about my father, and getting back an hour-long discussion with an oncologist which was amazing. And then later on through my profession, I came upon a TED talk that I still think is one of the best TED Talks ever of e-Patient Dave.

And when I listened to that Ted Talk, it was like, 'Ka-Ching, ding, ding, ding'. So, many things connected for me, because patient participation is not just ... So, it's important for moral reasons, for ethical reasons, but it's really, really, really empowered by digital. So, what I found out or what I understood then is, that digital is one of the key drivers of that happening because it was shifting powers within the healthcare system.

It was enabling things that were not there before. And I found myself thinking if this is what digital can do, then it's worth pursuing. And listening to patients is really for me, in the basics connected to digital health. I think that was what it brought. It brought more power to different stakeholders in the system. It broke the confines of you being a doctor learning healthcare, learning to be a medical profession and that stayed there; it just broke it all.

And it's shifting the power. And what you're seeing here is just the internet, eating up more and more on that and shifting that powers. And I think also you what you see is doctors that grew on this kind of, bedrock, are more open for this because this is now part of the culture. And you see it in other elements of your life also. Shifting the power of care to patients. This kind of shift of power to consumers to a different relationship between power holders and those who need to consume that. So, for me, that was like e-Patient Dave's TED talk, and please go online and see it. It's a 15 minute that will drop your jaw, it was the change. And actually, that day, I decided to open up the blog. That day, I decided to start e-Pochondriac, which is kind of a play of words on hypochondriac is basically a tribute to e-Patient Dave. The 'E' there is a tribute to e-patients. And hypochondriac came out of those days and still on people talking about cyberchondriac. Those who go online. And then, you know you have a headache today, you go online and, in the morning, you decide that you have cancer, which is not true, because it's really hard to get cancer through a headache and Google. But that was the motif in all the panels that day. So, I kind of meshed it up and said, 'You know what? I'll be an e-Pochondriac.' And that's how it started.

When do you listen to patients? It might be silly question but bringing a drug to market takes many, many years. So, do you listen to them at the point when a pharma company decides what drug it needs to make? Or do you listen to them when the label is given to make sure a clinical study is done? Do you listen to them to improve your marketing and the way they should take the drug or the drug should be administered and so on so forth? When do you think it is the most important?

Uri Goren: I think listening to patients is across all the value chain. So, you see on one side, there's a special body of the FDA trying to listen to patients to find new targets for health and for pharmaceutical technology. Why? Because you know of all kinds of things that happened to the patient through what we know about disease.

But there's a lot of other things that bother patients and might be a target for healthcare technology, or pharmaceutical products. If you found a biological invention that you think makes sense and will become a target for medicine. It doesn't have to have patients inside it. But I think from the beginning, when you start First in Human studies, you need to start to talk to patients. But you excluded all those patients and then you don't understand why you can't recruit. If you listened to patients, they'll say, 'Yeah, I'll never go to this clinical trial', because of 1-2-3. Now, sometimes you can change it and sometimes not. If you listen, you might have a better design to get more patients on the trial, still get the valid results you want. Where you want to end in terms of endpoints and clinical development.

Because the way you design your clinical trials, might inadvertently get you stuck in recruitment, if you don't listen to patients at that time. The way you designed it, the way they need to come or what's your criteria, can actually exclude all your patients. Because you didn't know that point is really important to patients and without that they wouldn't join. Or that it excludes them, because you said something and it's a common comorbidity that you still don't know about.

But you'll do it faster and actually, they'll help you. They can help you recruit through those communities. They can help you do a lot of things. They of course, are also a danger in your clinical trials, because they might unblind it in their communities and stuff like that. But the more you engage with them, the more you understand. The more you're able to, basically, make yourself better and adapt more to those needs. And then you get better at getting faster through clinical recruitment, which we all know is one of the big roadblocks to getting a drug to the market right. So, you can get your efficacy but if you don't get enough patients on the trial. And those delays in recruitment and those delays are usually what gets you really stuck. So you start talking to patients, you don't need to win. You need to just start talking to patients as early as you can, and be as relevant as you can.

We had Omri Shor, CEO of Medisafe on the podcast, who said that it's sometimes the very small things that impact behavious. For instance, they're working with a drug company, who told their patients to start using the drug on Sunday. But what they found out that people don't want to be concerned with their health on a Sunday. They found that Tuesday and Friday are better days to start administering or taking their drug. And that was a huge change, not only in the outcomes, but in their bottom line.

Uri Goren: Yeah. And you should also check that when you do it in Israel. So, you start with Tuesday, but on Friday in Israel probably is not a good day. Sunday would be better than Friday in Israel. So, you need to culturally adapt. And you can also talk to patients much earlier. So, some work done out of the Broad Institute really takes data from patients, especially in rare disease, and uses that data to find new, unknown treatments that were tested. And the data is in the clinical data of patients, which they contribute. And you can find repurposing of drugs; you can find a whole lot of things out of what's written there. And this is why we advocate so much for people to have hold of their clinical data. We need to have our clinical, our EHR in our hands, not in someone else's hands.

What is the Society of Participatory Medicine and the E-Patient Movement, the two groups that you're involved with.

Uri Goren: e-Patient is a is a word coined in the early 90s already, which the 'E' was the electronic patient. We still use it in Israel, but it's not really an issue anymore. Everyone is an e-patient. Somewhere in the beginning of the 2000’s, the 'E' was defined for other things than electronic. It's not an electronic patient. It's empowered, enabled, engaged, and (equipped) ... I always forget the fourth. It has about seven 'Es', and they're not about electronic, it's about what happens with you. I think, once you are engaged with your healthcare. Once someone says I need to take care of myself, that change changes a lot of things. And that is e-Patient. Not being diagnosed correctly, not getting the care you expect. At that point, when someone says, 'You know what, I need to take care of myself. I can't let someone else do that for me.' At that point is where you become an E-Patient. And why is it connected to digital? Because usually today at that point, you'll go on Google and try and find a new specialist, new treatments, new research. And the fact that you have the availability online, almost as any other person or a doctor goes online, that's where it becomes so transformative. And then participatory medicine is just an evolution of it. It's basically a society that was brought up by doctors and patients that understand that healthcare is a form of partnership.

A funny story, one of the co-founders told me that they never agreed on what participatory medicine is exactly yet. They still have different views. But the idea is having that discussion, have that partnership, respect one another, respect to the patient that's living with a disease day in and day out, creates an expertise. Even if it's not based on science, it's based on living with it. I don't remember who was a doctor that was a diabetes expert for 20 years and then he became a patient. Okay, the irony? And when he became a patient, he didn't understand what it is living with diabetes; caring for what you eat day in, day out, stabbing yourself, taking all those drugs. You understand a lot of things.

And 99% of what happens with your healthcare happens outside the doctor's office. Even chronic patients do it like 4 or 5 days a year, then they have 360 days to care for themselves based on instructions. But they can day in and day out; decide not to carry them out, not to take their drugs, not to go to the next appointment, not to do the next thing, it's their decision. And the way they handled their healthcare will define the outcomes much more than those 4 or 5, and I'm exaggerating, meetings with their doctors. So, that needs to be understood by healthcare and that needs to be addressed. It's start in starting to be addressed, with all those patient engagements. But still not deeply enough and not, I think databased enough for most healthcare organizations.

By empowering patients, are we not taking away from the knowledge and the professionalism of the professionals and scientists who have been working on this.

How can we keep that balance of having the patient as the most important person in the room on one hand but having the professional that has knowledge they need to trust and needs to be their guide in this journey?

Uri Goren: So, I think that's why we call it a partnership. It's not that patients are going to now do everything alone, and they don't need doctors. We need doctors. We need that relationship; their expertise is crucially important. I think vaccines, in most cases, is a special case. Because anti-vaxxers have been there since there were vaccines. There were riots against vaccines in the 1700s.

I mean, it started from the day there was a vaccine. And I think it's a special case, because vaccines are one of the few medical things you do to yourself when you're healthy. You take a vaccine when you're healthy, not when you're sick, which changes the whole thing. And remember that most vaccines are taken as an infant. At a time when a person is basically, doesn't have anything to say what is done to them. So, it makes a sensitive subject. And second of all, you should see who leads the anti-vaxxer; it's usually doctors. So, being a doctor does not immune yourself, Pun intended, to anti-vaccine. It's has the industry behind it; it has a lot of things. I don't want to go into this because it could consume all our discussion. So, vaccine hesitancy ... And I'm talking about hesitancy is normal. Anti-vaccine is like, a very small amount. What we see in social media is an amplification of a very small group which creates hesitancy. But at the end, if you look at the amount of vaccination or the rate of vaccination in Israel, in most cases, it's not really affected.

It's effective. So, we need to treat it, we need to look at it, but it's not. So, what I think, and coming back to what I said is partnership, it's respecting the knowledge of each side. I don't think I'm a doctor. You need to trust the doctor. And I think the listening, the mutual listening then the mutual respect and understanding it's a partnership. This is where trust is starting to form.

This is when you start to trust your doctor. I actually, myself, always trust doctors more when they say, 'I don't know.' I have a problem with people who are omnipotence saying, 'I know everything. I don't need to know anything else.' I know everything you need to know about cancer. That is a lie. Every day, there is new research. There's not one human worth knowing.

I can say that if you have a logic to it, and you say 'Listen, it's a new research. This and this are a problem, I still don't know. We need to take care.' That's fine. When I met an IVF expert, he said, 'I don't know. I need to consult.' I respected him much more than if he would kind of throw an answer at me and say, 'Nah, that doesn't matter.'

How do you know? Stop, listen, have that discussion where trust forms. And it doesn't matter if it's one on one, or in congresses, or in an advisory board. You have to respect each one's expertise, and have the discussion and find the mutual grounds. And it's fine to sometimes say to your doctors, 'You don't understand.' And it's sometimes fine to say to the patients, 'You don't understand.' But you need to explain why you think that and you need to be reasonable and not just condescending.

You spoke about the use of dating channels such as Tinder, to address or communicate with the end user to promote health. Do you think that's happening on a wider scale in the industry? I mean, the break away from traditional channels to market and to instill or to spread knowledge?

Uri Goren: Yes, I think so. And I think actually COVID, as in many other parts of our life has changed the way we think. You see the number of physicians going on TikTok, using TikTok as a way to educate. You need to be where your audience is. And when your audience shifts to new places, you need to shift with them. I would say pharmaceutical industry is usually much more cautious.

But healthcare at large, can do more things. We are cautious in pharma because we have regulations and the boundaries, and their risks are higher. But I think doctors are going on there, advocates are going on there, patient organizations are going on there. They don't have the choice not to be there. But you need to know when you're going into these platforms and using them is what is their benefits and what their risk and put it together.

It's not just being there just to say, just for the PR fun of it. 'I did a TikTok about vaccines. Yay, I can do a PR and now I'm fine.' It needs to be real. It needs to be aligned with your business. And the fear, in those cases, what you're talking about is fluff. It is going on just for the PR sake of it. It is not really banking on it being there seriously for a long time creating those relationships, creating that knowledge and really transferring what you want to do. So, you have to understand what's your business goal, or what's your goal from a healthcare promotion point of view in order to do that. I think we're going into new places because people are in new places. We used to do conventions in hospitals, that's out. So, you need to find new places to channel that energy. And I think Tinder and other stuff, creates that benefit loss system. So, if you can benefit a day because you're vaccinated, usually that works. We're very simple creatures. We don't need to overcomplicate it. They brought food for vaccine; people vaccinated for a piece of food. It just works like that.

I don't know about food, but here it was beer.

Uri Goren: It was beer. I think in the US, it was burgers. It was all kinds of really stupid stuff. But it works because people are very simple at the end of it. It's sad. We think of ourselves much more, like nuanced and complicated. But we're driven by very simple stuff. We all talk about behavioral economics. That's the gist of it. You just change the wording and people will say, 'Oh, okay, fine. Good. I'll do that.'

You're very active on LinkedIn, on Facebook, on Twitter and I'm not on Twitter. But I do see some of the things that you cross post and you have an interesting mix of personal and professional in these channels. How are you using those channels? Why are you mixing all of those channels and why aren't you just picking one?

Uri Goren: So, I do have some of these kinds of big rules that I follow as far as I can. It's not engraved in stone. So, LinkedIn is my professional part. And I also decided, once I started to have more global roles that I will, as far as I can, stay in English. I do post in Hebrew on my blog, because my blog is written in Hebrew, sadly. I don't feel confident enough to write a blog in English. So, I write in Hebrew, but also because I think the message is for Israel.

I think on the global scale, I learned a lot. I probably have things to say, but I don't think it will achieve the same impact. So, my blog is intended to Israelis; it's written in Hebrew. And now even if I posted on LinkedIn, I post about it in English, I put the link in Hebrew. And then usually I take some kind of source in English and put it in English, just for my English followers. Because most of the people on my LinkedIn are not from Israel. I post there because it's professional; I usually keep it as professional as I can. I mix personal because I think if it's true that it came from a personal point, it touches people. Even if it's in a professional surrounding. So also, in all my talks, I talk about my personal background, and I started here also. because I think it's a core to what I think, to how I act, that it's relevant in a professional.

My Facebook is eclectic. Because I've been there for long; I have professional, I have personal, I have political, I have just goofy stuff. So that's eclectic, I post most of what I do. Actually, the only thing I think I've stopped or I think twice before posting, is if I want to post something very controversial, I don't have the time and the energy. And it happened inadvertently where I posted something about our Minister of Education. And how she basically promoted some kind of a conspiracy that the healthcare administration is increasing Corona (spread) to get rid of vaccine stock. Now, I know this will become controversial. And then it depends on if I have the power to start to have all that discussion because it's really tiring. And sometimes I don't have the power.

So, I'll post it on Twitter just to say I posted it because Twitter is much less of a mess, at least for my followers. I don't have a lot of conversation. So, Twitter started this very professionally. The Twittersphere for healthcare and healthcare information, especially through in the US is amazing. Some of the best content I see or I saw, used to come from the Twittersphere about health care. There's a lot of hashtags you can follow; really high-level doctors, really good organization posts, really good things on Twitter. It kind of morphed in the last year or so to a more Israeli political, cynical stuff. So, I'm still not clear about my Twitter. But I would say, Facebook is more personal, LinkedIn is more professional. And then the last one I really dabble with is Instagram. And there I now started to post only food. Like, I just do some what we call food porn on Instagram. Because actually coming into Corona, I felt that I had no interesting visuals. I mean, again, showing the room, again showing my sofa, again showing the mess in the house. It was like not interesting when you stay at home all day. So, I posted only food and kind of disengaged a little bit from Instagram in some ways.

How many hours a day do you commit or spend in order to promote your social media channels? Additionally, because you have a senior role at pharmaceutical companies, are any restrictions on your activity?

Uri Goren: So, I was never told to remove anything I posted. And because of my communication backgrounds, I do know to judge what is fine and what is kind of borderline. I would say that since I'm in Teva, I'm less prone to discuss other pharma companies, marketing ventures, or all kinds of things other companies do, because I don't know how it will look. So, I'm trying to take it from another perspective right.

So, I wouldn't like say something around a campaign of another pharma company. Unless it's really innovative and I'm kind of clapping (cheering) on for that, that's fine. But I'm worried. Also, everything around neuroscience, because Teva is very into neuroscience. I also choose what I do or what I don't. But more than that, I'm fine with everything.

If you look at where I post, and what I post, in most of the cases, I put a disclaimer that this is only me and not Teva. And actually, when I got approval to keep my blog when I came into Teva and it's in my contract. That disclaimer was one of the things that worked for me. They say, 'Oh, you have a disclaimer, that's great.' So, I have a disclaimer, I keep it. I have formal approval to work in my blog and to write in my blog. And I know where to keep it. And I try not to start controversy just for the sake of it. And yes, sometimes I won't post something because I know they'll make an issue.

How much time do you spend on an average day? Or do you dream at night, and then wake up at 3am and say, 'Oh, I have to put this on Twitter now.'?

Uri Goren: So, that's an issue. On my phone, I stopped all notifications from social media, because that would consume me to death. I still have LinkedIn. And I now think I'll drop that one also, because it became much more active since I became much more active. And it's kind of making me crazy, I have a weak spot for notifications. So, no Facebook notifications, no Instagram, no Twitter notifications. But I do look at it quite a lot.

I try to keep my morning schedule. So, usually half an hour in the morning to read something in-depth from social media and think about what I'm going to post. My plans are usually much more elaborate than what happens, actually. So, I do give my job the respect. And then I try to do it at night. I usually spend a little bit in the weekends. I don't know, that's my life.

It still doesn't have too much structure. I tried a few times, I don't know. And then I look at the report I get from iPhone, sometimes I get horrified. But then I continue.

Gali 33:53

Yeah, I feel the same way. Time spent on Facebook this week and I'm like, 'Okay.' I think we've talked enough that we can have ... Sorry, that was my mic falling.

I think we've talked enough that we can now ask you what you do at Teva?

Uri Goren: So, my role at Teva is part of the global digital commercial organization. And basically, it's a center of excellence that supports the three regions, the three commercial regions in Teva. Which is US, Europe and international markets, which is basically all the rest of the countries. And what we try to do is digitally transform the way Teva approaches the market from a commercial point of view. So, we don't touch on R&D.. It's out of our scope as far as I know. And in that, my role specifically, now is to try and promote our engagement to the organization. So, a little bit of how we promote the idea of digitally transforming into our stakeholders, our marketers, medical, all the commercial stakeholders. And try and basically bring some power and 'oomph' behind our efforts.

And then, the second part is trying and get the upskilling and the right capabilities and the right job descriptions. Because we cannot keep recruiting marketers as we used to 10 years ago or 5 years ago, today. We need to update our jobs and to update what it means to be a marketer in this kind of role. And on that point, specifically, in Europe, it's a bit broader and looking at commercial capabilities at large. That's something we do internally, and we kind of give it as a service. It's not particularly digital but it's something that was tasked to me and that's my role now. And we as an organization, we basically do two things. We support the countries and the regional marketing teams in developing their digital strategies, looking at where you could employ digital to bring more value. And that could be ... And mostly with our B2B customers; less with directly to patients.

You should remember that Teva predominantly sells generics. So, it's a bit different than selling specialty in terms of how you engage with patients. It's a different part of it. And then, mostly in our B2B customers, in supporting the digital strategy. But also governing from a business side; our platforms, our technologies, what is employed, trying to create a much more global digital backbone that supports all of these different use cases in the different countries.

Because when you come to generic marketplaces, they are very different in terms of portfolio, in terms of selling processes. So, you need to be agile but you can still keep a technology backbone and have very different use cases based on the same platforms.

Could you perhaps give a few examples or one or two examples? Because to me, it sounds a little vague. What is digitalization of B2B and supporting partners and doctors? Whatever you can share, that is not a big secret, of course.

Uri Goren: So, you would say that digital ... Let's look at how do you sell generics in Israel? Israel is a totally tender-based market for generics. For HMOs, do tendering, 95% of generics would be basically tender-based. So, how can you do that and still find like in tenders, you need to see how you do better in tenders? And can digital support you in tenders? And that depends on what data you have available. What is the real process?

Sometimes you can't. Sometimes the process is immune to digital because data is scarce and you really don't have anything to support that. But in other countries, tenders might be rich in data, in public data, and maybe you can do something with that data. In other countries, what we call branded generics market. So, you could have 9 different generics, but each of them has a brand and they're prescribed as a brand. That's much closer to, let's say a specialty. So, there is a physician engagement. So, how do you create better physician engagement with building up an HCP Portal? Doing personalized communication. Trying to create better content per segment. Better usage of reps’ time with digital tools, better engagement, increase their reach. Okay, so now you can increase reach because a rep is a great tool. But increasing that is quite pricey. You need those for your core, but then how do you connect with other physicians outside of the core segments? How do you do that? Employ marketing automation there. Create more information. Create more personalized views. Understanding more of what the customer wants. With our pharmacist, how do you give them better service? I mean, basically, we have a business relationship, we need to give them better service. How does digital promote that? With marketing automation, with answering to their calls, with promoting our products there in a better way, in order for us to bring better service. And also, bring efficiency and growth to our market, or to our position in the market.

Patients, and in this case, you're talking mostly about B2B. What do you use to kind of, make that differentiation? Are there any social networking tools that you can use to do that?

Uri Goren: So, we do. We use LinkedIn. There are also professional websites and networks that are for our customers. So, you get basically the customers you need. The issue is that if you use Google, and if you use general public networks. So, we do use those to reach physicians, either by audience-based or by segmentation, and then bring them into our platform to where we then validate. So, it's more a general communication, because you're not allowed to promote a drug on Facebook, based on that. Did I target the physicians? Because the targeting is not good enough. It's never good enough, you'll get spillover. So, you want to be very specific. So, what we do on social networks would be probably more general disease awareness, but on a level for physicians.

So if they are interested, they will come in. Basically, give us their consent and then we'll start communicating to them through email. Still, one of the best ways; through text messaging, through messaging services, others, that we can then tailor to them. Those are the kinds of things we do. And create, of course, the content websites, and content services and tools they might use.

Depending of course on the country, etc. But then that's what we do based on each country and what's their selling process. So, what's their engagement process? We try and find how we can make it better in order to either create efficiency, and usually, also to try and create growth.

The fact that you say LinkedIn is a good and active channel, surprises me. In most of the accounts I see for companies, the engagement is like fairly low. Do you see anything different? Is it specific for Teva? I'm sure that you're tracking the industry as a whole.

Uri Goren: So, it depends on what's your goal. For me, in some cases, LinkedIn is not to create engagement on the platform itself. I don't mind if I don't get any comments, I use promoted ads. But you look at the traffic you get, and what does it convert to and then is it worth it? And in most of the cases, it is. It brings you the traffic you want and it's a good enough traffic. So, it depends on what's your goal; again, you judge it to your goal. In Facebook, we might want to get engagement. If we don't get engagement, the right engagement, then we have a problem.

You recently joined the National Advisory Board for digital health for the Ministry of Health in Israel. Could you explain what it is? And what are your goals in the advisory board?

Uri Goren: So, the National Advisory Board is a part of a chain of advisory boards in a lot of healthcare and basically TAs, which is very unique to the Israeli Ministry of Health. Which basically, on those advisory boards, an eclectic bunch of people; from industry, from health care professionals, from patient associations that are related advises the Ministry of Health on a lot of things. Giving them input and sharing stuff that happens outside the Ministry of Health view, and tries to help them on strategic decisions on process, on gauging out what would the industry think, what would the healthcare providers think. And there is one formed a few years ago on digital health as part of taking digital health as a strategic pillar within the work of the Ministry of Health. And basically, this is a new batch the that was added to three generations of this advisory. Some people survived from generation to generation, and I'm a new one.

I was invited by the Ministry of Health; was very surprised and honored. I think after the first meeting it had even become more crystal clear what I want to say is, that patient engagement is not something altruistic that the healthcare system is doing. It's basically something that brings value in economic terms, in quality terms, in better healthcare terms. So, it's not just because the patient is entitled to their medical records, they should get it. It promotes better health. It promotes better health care quality. It promotes better efficiencies in the system. So, this is my thinking. My thinking is to take patient engagement and make it from a 'nice to have' or even a 'need to have' based on because it's ethically because it's trendy, to understand that there's real value to see there.

It makes me a little sad that, 10 years later, you still have to explain that to the Ministry of Health. So thankfully, you're going to be there to tell them.

Uri Goren: So, I'm not surprised. Healthcare is slow and cautious. And it should be slow and cautious because it's people's lives. And this is something I would say also to healthcare innovators. A lot of people that come from Tech to healthcare, say, 'Well, I built an app and it works.' And for a healthcare app to work from a technology perspective, you press the button, and the thing you want it to happen happens. In healthcare, when you say it works. It says okay, 'If that person clicked on that button, and that happened. What happens if he clicks on a button, then that happens but not for real? Would that change?' And I think that's a change. And I think it takes time to understand the value of this because it wasn't trialed. It's a process. It's something that takes time and it's a cultural change. So, 10 years, is basically nothing. And I think if you look, honestly, it's only the last, I think, 7 years, that something really started to change. But it's still nascent. Even in the US where they started talking about this in the 90s. They just got EHRs to their patients, like two months ago. So, we have a place to go and we are doing it faster than other countries at the end of the day.

You are part of the Israeli ecosystem and you see a lot of technology, and innovation here. And because you have so many different hats and so many different views of the ecosystem, can you say what you are seeing here that is special? And what do you think is missing, and maybe entrepreneurs should pay more attention to?

Uri Goren: I think the biggest advancements and the most interesting ones, whereas those where data met technology in Israel in a good way. So, if I look at Zebra, if I look at K Health ... When the healthcare systems data, found the right person to make wonders with it and the collaboration went well, and it was like really good, then you see those amazing things come up. I think that's a sweet spot of Israel. Using the healthcare because we have that computers. The issue is it takes time for the Ministry of Health, for the HMOs and for entrepreneurs, to understand that this is the sweet spot. It's also a sweet spot, also to get them to the next level. You see it in Zebra, with all those FDAs are coming in.

It's basically because they have so much data and such a big, I would say playing ground in some ways, that they can create really good science based on that. And I think this is where the sweet spot is. And I think the more we touch on that and use more and more of the data to get there. More and more you'll see interesting startups that have a gain over ...because a patient engagement app as good as it is. I mean, Israeli innovation and I don't undermine it. But in terms of Israel as a competitive advantage, I think data is much more than just good technology. Because you could have that in the US again, it's kind of the same. And actually, probably they have better engagement with the market. But if you have that inroad to a data, to an HMO, to the thinking and to applying science based on that, that's a sweet spot. The second part I think, is where data becomes more or the science becomes more advanced, people are starting to reach higher. I think a lot of us reached only to wellbeing. We'll do something for wellness. And I think that is crowded, it's hard to differentiate. I think, moving into more digital therapeutics. Taking the longer but more profitable road, I would say, at the end of doing an FDA, doing something that has meaning, getting a claim that that makes a dent is much better.

I've been preaching for that. I think now the roads are there. There're much more paved roads than, let's say 6 or 7 years ago, when the FDA didn't know how to improve it. At least now you have some roads and you have some examples. I think if I take digital therapeutics and the data here, the more you get close to those two, the more you'll get better results and bigger companies coming out of Israel.

And last, but maybe not least, is stop doing features. I mean, a lot of startups are a feature, you need to have something more. So, a feature is nice and it will be solved, probably and you'll get result but I think you need to go deeper. And then your strategic partnerships should go there. And not create small features, which could be interesting. But in healthcare, it'll die down quite quickly.

So, there are a lot of problems to solve. Some are big, some are small. Let's say, that we give you the opportunity to choose one. What is the main problem do you think that needs to be solved for the healthcare market with technology?

Uri Goren: So, I think it's solved. I still think the main thing is the availability of data for all the different stakeholders. We need to see our full EHRs and be able to leverage it to where we want to, based on regulation, but based on our choice. And you would say, 'Well, it's not a technology issue. It's a culture issue.' But I still see that as one of our biggest problems. I think a lot of apps you see, have to work so hard to get data into them. And it becomes a task for me as a patient. If I need to go on Medisafe and start logging my 12 medications and each time I take them. And when and what and blah, blah, I won't do it, I'd get tired. But let's say I plug in Medisafe to my EHR and click, all my medication, all my prescriptions with the doctor's orders are then logged on automatically. That will make it much more pleasant for me, better for my healthcare system, because I'd probably will be more adherent. And also, for Medisafe, because they get better data. They can then give me some better ideas, maybe find some drug-to-drug interactions and stuff like that. So, it might not be technology, I think in the US, it's still technology. They interconnected this, even in Israel. So interconnected this between our different parts of EHR where it sits in different providers. But getting them just to me, as a patient, is still the biggest problem we didn't solve. It might be technology, it might be cultural, it might be a mix of those. But I still choose that as something that will unlock so much value in terms of research, in terms of patient engagement, in terms of better conversations, in terms of quality, that I think it's still the biggest challenge.

It's politics. Those who hold the pot power and are the gatekeepers need to say or need to agree to relinquish some of their power.

Uri Goren: I totally agree with you there, it's culture and politics but it should be better. And there are some countries where they're much even ... We in Israel pride ourselves. But if you look at Denmark, they're still better than us. I mean, what you get as a patient there from your healthcare and the way it's all interconnected, it's amazing. And even though they fumbled with vaccines, because of different things. Now that they have vaccines, they do it better because they have that healthcare, especially like us. They know what people they need to reach and where. They can do that. So, data is like the fuel and we need to make it available for all in some ways.

Uri Goren's Profile on LinkedIn

e-Pochonder website (Uri Goren's blog)

Teva Pharmaceutical's website

Society for Participatory Medicine website