Episode 22: Meeting the Challenge

History has made clear that applying the same old remedies to the problem of medical error simply will not solve this longstanding crisis. How are the next generation of innovators looking to disrupt the status quo and bring new perspectives to improving safety in health care? Join host Karen Wolk Feinstein and young entrepreneur Reetam Ganguli, star of the documentary The Pitch: Patient Safety’s Next Generation, for a glimpse into the exciting potential for technology to transform patient safety.

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Episode Transcript

[00:00:00] Reetam Ganguli: They’ll wait for you to have these really life threatening complications when you’re on the delivery bed, and then they’ll kind of do damage control and rush for resources. Instead of waiting all the way till delivery, or inaccurately using like agent wait, that they used to use like 50 years ago, what if we could use more advanced machine learning frameworks to detect and forecast your risk as soon as the first day of your pregnancy, or as soon as your first prenatal visit?

[00:00:27] Karen Wolk Feinstein: Welcome to Up Next for Patient Safety. We’re thrilled to continue sharing compelling conversations with top experts doing important work to make health care safer. I’m your host, Karen Feinstein, President and CEO of the Jewish Healthcare Foundation and the Pittsburgh Regional Health Initiative, which is a multi-stakeholder quality collaborative located in my hometown, but connecting to the nation and the world.

We’ve been working to reduce medical error for over 25 years, and I might add, we never believed the progress would be so slow. However, I know that revolutions come from hope and not despair. These conversations are intended to inspire all of us with hope as we work for a safer future.

Throughout this podcast series, we’ve discussed the need to create cutting-edge technology that would engineer our healthcare systems for safety. In this regard, we understand that it will take experts in AI, machine learning, human factors engineering, and a new generation of entrepreneurs to transform safety in health care. We decided to expedite this process and scatter seeds for this work across the country. In 2022, the Pittsburgh Regional Health Initiative launched the Patient Safety Technology Challenge to fund patient safety technology awards and foster innovation across the country.

Over the past year and a half, we funded awards at Stanford, CMU, MIT, Columbia, Penn, South by Southwest, Johns Hopkins, and the University of Pittsburgh, just to name a few. The winner of the Patient Safety Tech Award at the Fowler Global Social Innovation Challenge at the University of San Diego was Reetam Ganguli, with his machine learning platform that can predict common pregnancy complications before they cause harm to the mother and baby.

Reetam’s story is being featured in a new documentary that we’ve helped to produce to highlight the ways technology can transform patient safety. And today I have the honor of speaking with him. Reetam Ganguli is founder and CEO of Elythea, a technology company using machine learning to save the lives of at risk expectant mothers.

Through Elythea, Reetam has created a variety of technology models and is currently overseeing global clinical trials using the tool across four African countries and at Harvard Medical School. Reetam was accepted to Brown University’s Medical School when he was 17 years old, but decided to leave medical school to pursue Elythea full time.

Where Tom is now starring in a forthcoming documentary called The Pitch: Patient Safety’s Next Generation, which highlights his story as well as other patient safety technology innovations that are taking off across the US and Canada. Welcome, Reetam!

So, you left medical school to build a technology solution to save lives. What led you to that decision, and how do you feel about that decision now?

[00:03:31] Reetam Ganguli: I guess, like you said, I was fortunate that I got into medical school when I was like 17. So I think for most people, once you get into medical school, there’s going to period of luster where it’s like, wow, I’m going to be a doctor. I’m going to be able to impact patient care. And in some, at some times it can like, kind of cloud your judgment and you kind of get torn up or like kind of tangled into the luster. so for me, I had like maybe a year or two to kind of, you know, be, be happy about that. And then once the luster wore off, I could kind of more critically evaluate whether medicine was the right fit for me.

 I think my conclusion was that medicine is obviously important. It’s really impactful work, but I guess as I read more into philosophy and I read, uh, I thought more critically about what I wanted for my future. I guess the startup route made a little bit more sense. So I talked about it a little bit in the documentary, but as I kind of started this whole journey, as I was thinking about what conditions I want to be met in my life in order for me to be content on my deathbed, which kind of sounds a little esoteric, but I think so much of my journey and so many other people’s journey, especially in the pre-med path, is you’re kind of heads down you’re focusing on the next stage each time, right?

So you’re in high school, you get a good grade on the ACTs. You do all your clubs and stuff and you get into a good college, and you do the same thing to get into medical school. And you do all your step exams and stuff to get into residency. And it’s just kind of you go on to the next process. You never really have time to kind of step back and evaluate. For me, I think I realized that to derive the most value on my deathbed, the ultimate kind of way I would derive meaning from is actually from irreplaceable impact.

And I think one of my choices as to why I wanted to do medicine over something like another career in like finance or law or something is that I thought the potential for kind of irreplaceable impact was high there. But as I kind of thought more into it, I realized that. Well, technically, if I drop out of medical school, the medical schools are super, super, competitive.

So someone else can take my spot. Someone else is going to take my residency spot, and someone else is going to be a doctor for the patients that I’m not, and they’re more or less going to deliver pretty good care. So I think areas like entrepreneurship with unmet needs specifically for, you know, postpartum hemorrhage in developing regions or maternal care and rural regions that genuinely can’t access good care, that’s more of the irreplaceable impact I want to be having. Because it gives me more reason to get up at like, you know, 5 a.m. or stay up until 5 a.m. and work on a solution where I know there’s no one else working on. So it feels like I can own that impact more and there’s more of an impetus for, for me to keep drilling on the problem. So, that’s kind of a part, big part of the reason why I kind of decided to leave medical school to work on Elythea.

As for how I feel about it now, by and large, I’m really grateful for it. I think, you know, it’s a classic startup advice of like, you have to, you can’t half-ass it, right? You have to go all in, you have to give it everything. You have to take the full risk if you really want to have the full reward. I think, you know, if I was having a full medical school course load, then the people I’m hiring wouldn’t, shouldn’t really work for me because, you know, I’m not putting in the work. I wouldn’t be able to impact as many people. So I would say I’m by and large grateful, but there’s still, I won’t lie. There are definitely days where I, I see my friends that were going to be in my batch in medical school, that I was with for like, 4 years during undergrad, and I get sad. I think about the memories we could have had, or I think about the, as stupid as it sounds, like the, the 2am study sessions where you’re rehashing notes and stuff. Or kind of the shared experience you have going, going through that. So, I do definitely miss it, I won’t lie. But, by and large, I’d like to say that I’m glad with the decision I made, but who knows? We’ll see where I am in a year or two.

[00:07:06] Karen Wolk Feinstein: Well, I like to think maybe this is unique to your generation. You’re probably going to live 120 years or more. You have lots of time. And as a curious person, you can just explore something that you have a passion for, something that’s maybe individual and personal, not a scripted course of study. Also, it sounds like you’re someone who wants to give back to the world, and I also have a feeling you’re not worried about ever going to medical school when and if the time comes. So I think this is a terrific thing for all of us because we want people like you to go out and invent the technology that’s going to disrupt medical care for the better.

So Elythea is focused on preventing complications in pregnancy before they occur. So tell me, as simply as possible, how does Elythea work, and what led you, the young single man, to focus on maternal health?

[00:08:06] Reetam Ganguli: Yeah, so to kind of take that one by one, during the course of pregnancy, as we all know, there are certain bad things that can happen. You might know of them by the name of, like, preeclampsia, or preterm labor. But there’s basically bad things that can happen. And right now, the way your doctor is going to deal with it is fundamentally, for the most part, reactive and not proactive.

They’ll wait for you to have these really life-threatening complications when you’re on the delivery bed. And then they’ll kind of do damage control and rush for resources. The only kind of, like, predictive analytic component is they’ll use, like, your age and weight and maybe some aspects of your previous history.

But these are very much, like, almost checkbox format of, like, yes and no, to try to forecast risk. But they do this kind of poorly. The whole idea with Elythea is, well, instead of waiting all the way till delivery or inaccurately using like age and weight that they used to use like 50 years ago, what if we could use more advanced machine learning frameworks to detect and forecast your risk as soon as the first day of your pregnancy, or as soon as your first prenatal visit?

And the whole idea behind this, and kind of under the hood, is that there are lots of hidden trends within your data that are invisible to the human eye. So, for example, right now doctors will, when they say age and BMI cutoffs, they’ll look at like, you know, is your age over 35? Is your BMI over a certain cut point, like 30 or something?

But as we know, your age might be 27 or 32 or something, not quite at that cut point, but slightly advanced. And it might interact with other variables or other factors, uh, in your clinical history, like other, you know, comorbidities like hypertension, diabetes, or other things in your history, like maybe a previous preterm birth or something.

And all these different factors interact statistically to kind of detect, develop a risk profile for you. So a lot of this, you know, it is very hard to detect with the human eye, but more complex statistical systems that we have under machine learning can deal with it pretty well.

And for the second part, I get the question all the time, right? You’re a single male. What are you doing? You know, in women’s health, it seems kind of disjointed. For me, when I was going into medical school, OBGYN, the field of obstetrics and gynecology, was kind of my first love. I was going to specialize in it, and I devoted all my research career to it.

The reason for why, it’s like kind of long, but in short form, TLDR, when I was younger, like in high school, most of my research focused on like-triple negative breast cancer and ovarian cancer. Uh, so it was kind of, you know, gynecology adjacent. It kind of led me to that path. But secondly, and it’s kind of like pretty unsubstantiated, but I just really, I fell in love with the field.

I think obstetrics is where life begins. It’s one of the most beautiful fields in medicine. And I think vastly underappreciated. And I think for most people, when they think of the most, like, I don’t know, sexy or attractive field in medicine, it’s like probably something like cardiology or neurology, but for most patient presentations that you see in those specialties, I think it’s pretty routine. And most doctors struggle with, kind of, patient engagement, right? You can counsel patient for 30, 45 minutes, but at the end of that 30, 45 minutes, and after you beg and plead them to take their statin medication, to exercise, to not smoke, they could leave that appointment smoking a joint, right? Or smoking a cigar.

So, maybe, so you don’t, you might not have as much of an impact as you want to have. But the field of obstetrics is one of the only fields I’ve seen where lifelong cocaine addicts will give up their fix purely because they care so much about their child. It’s such a beautiful kind of engaged part of the patient journey. And it’s beautiful, incredible in that regard. Uh, like a true story: My, my first-ever obstetric case, at Brown when I was working with Dr. Wagner, who’s now our CMO, was actually a hydrocephalus case, uh, which means that it’s a case where after the mom delivered the baby, she knew that the baby only had a few hours left to live.

And even in such a, I guess, morose and sad, solemn part of obstetrics, I still saw so much beauty where even though her baby only had a few hours left to live, she still held the baby, you know, so, so many tears, so much just vulnerability and honesty and just love for her child. And I thought to myself in that moment that, wow, if, if the sad moments in obstetrics could look so beautiful and be so, so meaningful, then I can’t imagine what the happy moments could look like.

And I was just, you know, through and through, just, just so, I just felt so privileged and honored to be a part of these patient journeys, and I just fell in love with the field. So, I guess I stuck with it, and that was kind of my area of research. Most of the past three, four years, my research has been, like, applying machine learning frameworks to understand hard-to-predict outcomes in the obstetric and gynecological space. To everything from residual cancer for gynecologic cancers, to, obviously, like, postpartum hemorrhage and preterm labor and stuff like that. So, I guess it’s one of those things that once I got into, I just never looked back and was very happy.

[00:13:05] Karen Wolk Feinstein: Well, for us at the foundation, maternal health is very sexy. We have a focus on it, simply because we looked at the data, and the U.S. is really doing a terrible job of protecting our expectant mothers, and their infants. So, we share your interests. How did you choose the name Elythea?

[00:13:29] Reetam Ganguli: Yeah, uh, so, I, it’s, it’s kind of, not, not like a crazy long story or anything, but my girlfriend is like an archaeology major, so she’s very into, like, classics and all that, so I kind of paid homage to her. I typically name my ventures after some kind of like Greek god or goddess. so Eileithyia was the Greek goddess of childbirth and maternity. So Eileithyia was like the child of I think Zeus and Hera, so I thought it was really fitting for, obviously a pregnancy company, and Eileithyia is said to help either prolong labor or to delay, uh, to stop labor from progressing too much to have the child develop more. And I just thought very, very apt for the solution I was looking for. So that was the name. The actual spelling in Greek mythology is a little different. It’s a little longer, so I’ve kind of short formed it to make with the Y and everything and L E T.

[00:14:18] Karen Wolk Feinstein: Well, it’s beautiful and it’s fun to say, and it’s very appropriate.

So, looking at the documentary, to get where you are now required a lot of travel, a lot of wear and tear as you pitched your idea at competitions across the country. Talk to me a little bit about that experience, and at some level, you were getting some joy out of it, right? You kept going and persevered.

[00:14:47] Reetam Ganguli: Yeah, I think, honestly, it started out of a space of necessity. So, when I started the journey with Elythea, one of our very first pitch competitions, it was because we needed just literally like money for computing, to pay for the models. And also, we wanted to kind of expand it beyond and do some kind of small clinical study. But we weren’t working with any affiliated lab, which now I’m grateful for it. We have the IP, but back then I was like, you know, we don’t have the funding, the resources, all of that. So we had to do it ourselves.

So that’s why I did my first couple of pitch competitions. And sincerely, first couple of pitch competitions I kind of went in blind. I didn’t know what to expect. I never really did like a pitch kind of thing before and was genuinely really, really shocked when, when we won. And I think it was a good experience for me to understand what exactly lands, what doesn’t land. And I think while you’re up there on stage, you’re, I’m fortunate I had like, a, I did a lot of debate in high school.

So I was able to kind of, you know, you can kind of check out the judges’ expressions and your competitors’ expressions and kind of see what lands, what’s not landing, by and large. And I think I had some, I had some good realizations from that, good insights, that as we went through our like fifth, sixth, seventh pitch competition, I was able to like hone and refine that more and more. So definitely super, super useful. It helped a lot for like pitching when I was like raising the ground. So grateful for that.

[00:16:09] Karen Wolk Feinstein: What advice would you give others who are thinking about pursuing their own technology solutions?

[00:16:15] Reetam Ganguli: Absolutely. So, in like regards to pitch competitions, yeah, right, I mean, it’s very much like you should do a spray and pray approach. So, some pitch competitions are more social impact–focused. Some are more like specific sectors, like health care. Some are just generally like, you know, which companies are most developed. You know, you maximize your odds by applying to as many as you can. Through these pitch competitions, I think the number-one thing to realize is, like, the story is really important.

So it’s literally impossible to summarize, to, sorry, not summarize, but to detail out every part of your business in just three to five minutes. that’s why you have to get pilots. So I think a lot of people almost fall victim to the mindset that I have to tell them everything my company is doing, every small widget, every small function, everything I’m going to do, which kind of spreads yourself thin, and because it’s like attention is such a hard currency to capture. It’s so limited. The more you throw at people, the less they’re really going to absorb. So what I’ve really realized is if you can tell a very, like, cohesive story, almost humanize the problem and have literally little to no text, many of my slides are really one image or like three or four words, it’s, it’s the most impactful. And then kind of secondarily to that, I think one thing most people overlook with pitches is like, ultimately, the people that are deciding whether they’re going to get the money or not are trying to make the most impact with their lives, right, and with their position or their role as your judge.

So I think many people don’t really execute on explaining what they’re going to do with the funds or why they need the funds. So a lot of the time, if you give a good pitch, then the judge can be like, okay, that’s a good pitch, but why do you need the $20,000? So kind of proving the inherency for like, you know, we’re right, we’re right up here. We just need the extra $20,000 to finish this clinical study or to finish this development so we can launch this to market and, you know, fulfill this LOI or something, that tends to help a little more, but some things I picked up.

[00:18:09] Karen Wolk Feinstein: Well, listening to you, I’m also becoming convinced that the narrative part of The Pitch, we call the documentary The Pitch, it’s really a bit of an art.

And you humanize the science. You, even at the beginning here, you gave us a very compelling and articulate reason for why you’re so passionate about this topic and the meaning it has for the world. And that you’re, you’re doing something that is very significant beyond just creating a useful technology. So, I think that’s a great lesson. It’s probably a lesson for life, right? If you’re going to persuade people. My son, who went from the lab, from bench, to actually doing something that involves selling said, “I feel so bad that I’ve now become sales.” And I said, “Why do you feel bad? Life is sales.”

We are always trying to convince people if we can, that maybe there’s a better way of doing things or that they should open their mind to a new approach. So I love that emphasis on having that compelling narrative. So, we’re looking forward to seeing the film—those who haven’t seen it are looking forward. I got to see an early version of The Pitch and understand more about the journey, how you got to where you are from the beginning of an idea. The film is very intimate. I love it. We meet your parents, your family. I’m sure it was a surprise when you said, I’m not going to medical school. I’m just going to move in with you and pursue my dream. What was it like sharing all that intimacy on film?

[00:19:55] Reetam Ganguli: Yeah, I mean, uh, for me it’s like probably one of the first experiences, the first experience like kind of being on camera and in my house and everything, so, that’s kind of cool. Like, I think you see it in like movies and stuff, but uh, it’s different when it’s like, you know, they’re in your living room and there’s a camera in front of where you typically have like breakfast or whatever. It was cool, like it was only one day when they were in my house, so it was interesting, I think what was most interesting, my father actually remarked this, was seeing what parts of the day that Mike captured and found the most relevant for the documentary.

So Mike was the person that’s kind of leading the documentary and filmed most of it. They filmed us for basically like 10-plus hours—everything from literally me like brushing my teeth to me opening the blinds to me like eating breakfast, to working, to whatever. so it’s interesting seeing what parts of like me talking for six hours he thought was interesting and what, how that condensed down into only like 5–10 minutes, but yeah, it’s interesting sharing that part of your life with, you know, a documentary crew, knowing that everyone else is going to be able to see it, but also to some extent, I think, it almost helps to reframe my own perspective, because I think entrepreneurship and startup scenes seem very kind of sexy from an outside lens. So you think, Oh, I’m going to be working on this high growth mission and it’s going to be super-cool all the time, but like 99% of the journey is like, you’re kind of slogging it out. You’re, you’re sending thousands of emails, you’re doing, you know, hundreds of pitches and getting tons of rejections all the way. So you almost lose sight of like the bigger meaning, and you’re kind of so bogged down in, like, this all-level details of, Oh, this code is breaking or this model is not doing what I what I want it to.

So that was, it was nice to kind of reframe the perspective and say, Well, here’s what I’m doing right now. But like a bigger picture and the bigger intent of this model is actually going to impact like tens of millions of women in the future. So it’s almost more motivating for me while I was doing it.

[00:21:41] Karen Wolk Feinstein: What is interesting, sometimes I meet people of a younger generation and they say, the problem with my job is I have to do some things that are boring. And I don’t know how to tell them that’s life. I am intrigued though, with the fact that. People of a younger generation, who are curious and confident, they may not want to pursue a prescribed course of study.

So you chose Brown University. I chose Brown University because, for me, it gave me that flexibility. They were willing to focus me on what interested me and support my own investigation, wherever it led. So talk to me a little bit. What do you see next in your career?

[00:22:27] Reetam Ganguli: Yeah, honestly, up in the air. So I don’t really have a defined answer for that. I’d like to think that it’s going to be at least half a decade to a decade more of Elythea. I think right now we’re at a pretty good place with the clinical studies. we’re in the middle of trying to get some contracts in the U.S. with payers. I think the way that’ll pan out in the next couple of years is, we’ll have somewhat of a U.S. presence, and once our global clinical studies show some level of efficacy data, we’ll start more of an international expansion and potentially try to contract with government systems. I think there’s a huge need for Elythea, especially in rural populations in the U.S., and one of the biggest needs is actually in low-income and middle-income countries, specifically rural regions there.

So I would love to see a world where Elythea is the standard of care in multiple of the African countries we’re having clinical trials in. Or abroad in more rural regions. So I think, I think that probably is going to be the next big steps for Elythea, but the devil’s in the details. I think the way we execute and how we execute is going to matter a lot.

[00:23:29] Karen Wolk Feinstein: Well, it’s interesting, Elythea is, and we’re very supportive of technology solutions. But I’m wondering how much more powerful Elythea would be if it was embedded in a system that was really designed to prevent harm before it occurs. And I know we did a study tour to Australia and looked at Australia’s approach to maternity. It is so different. It gives you an idea of the possible, and maybe we have to look at the whole design of our approach to maternity and fit Elythea into a different system of managing pregnancy.

[00:24:12] Reetam Ganguli: Yeah, could definitely be next steps. I think, most people realize, like, the way to create change in health care comes from kind of just directed partnerships and collaborations with like-minded organizations and platforms. So, I totally see that being a next step.

[00:24:27] Karen Wolk Feinstein: Well, given the name of the company, Elythea, I am guessing you plan on staying in obstetrics and gynecology and women’s health?

[00:24:37] Reetam Ganguli: Yeah, very, very likely.

[00:24:39] Karen Wolk Feinstein: Well, I am so appreciative of what you’ve done, what you’ve created. I know, both personally and professionally how important this is.

So I’m sure everybody listening to this is going to want to see the documentary, or if they saw the documentary, I know they’re going to want to know more about you and your journey and where you came from to take this on. So thank you so much for today.

To learn more about the effort to establish a National Patient Safety Board and any of the topics we’ve talked about today, please visit npsb.org. Also, we welcome your comments and suggestions. If you found today’s conversation enlightening or helpful, please share this podcast with your friends and colleagues. We can’t improve the effectiveness of our healthcare system without your help. You, our listeners, friends, and supporters are an essential part of the solution.

A transcript of this episode and references to related articles and resources can be found at npsb.org/podcast. Up Next for Patient Safety is a production of the National Patient Safety Board Coalition in partnership with the Pittsburgh Regional Health Initiative and the Jewish Healthcare Foundation.

It’s produced and hosted by me with enormous support from Scotland Huber and Lisa George. This episode was edited and engineered by Jonathan Kersting and the Pittsburgh Technology Council. Special thanks to Teresa Thomas, Carolyn Byrnes, and Robert Ferguson from our staff. Thank you all for listening, and please take action, whatever you can do, to advance patient safety.