Episode 21: The Innovation Cohort Part 2 – Talk to strangers

March 24, 2020

Part two of our conversation with Dr. Jennifer Monti focuses on how we can increase the speed of medical innovation, better serve rural populations, invest in public health, and the importance of building partnerships between medical professionals, universities, and the private sector to solve critical problems in healthcare. Dr. Monti asserts that the best medical ideas can come from anyone and anywhere: patients, medical professionals, and even complete strangers.

Dr. Monti is a general cardiologist most interested in the intersection of medicine, public health, and entrepreneurship. She developed the Innovation Cohort at Maine Medical Center in response to her experience as an inventor and entrepreneur. She firmly believes good ideas come from every corner of an organization, and that Portland, Maine should be the easiest place in America to learn to invent and to be an inventor.

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Notes

 
Episode Notes

Part two of our conversation with Dr. Jennifer Monti focuses on how we can increase the speed of medical innovation, better serve rural populations, invest in public health, and the importance of building partnerships between medical professionals, universities, and the private sector to solve critical problems in healthcare. Dr. Monti asserts that the best medical ideas can come from anyone and anywhere: patients, medical professionals, and even complete strangers.

Dr. Monti is a general cardiologist most interested in the intersection of medicine, public health, and entrepreneurship. She developed the Innovation Cohort at Maine Medical Center in response to her experience as an inventor and entrepreneur moving an idea from scribbled drawing to working prototype, company formation, fundraising, and clinical trials. She firmly believes good ideas come from every corner of an organization, and that Portland, Maine should be the easiest place in America to learn to invent and to be an inventor. She received a degree in biochemistry with honors from Harvard College, as well as degrees in medicine and public health from Case Western Reserve University in Cleveland, Ohio. Jenn’s favorite lunch spot is LB Kitchen, her favorite place for dinner is home with her kids, and her favorite local business is Print Bookstore on Congress St. in the East End. She is a huge college basketball fan and is still upset that the Big East fell apart.

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Produced by the University of Maine Graduate and Professional Center, with help from WMPG

Episode Guests

Dr. Jennifer Monti is a general cardiologist most interested in the intersection of medicine, public health, and entrepreneurship. She developed the Innovation Cohort at Maine Medical Center in Portland in response to her experience as an inventor and entrepreneur moving an idea from scribbled drawing to working prototype, company formation, fundraising, and clinical trials. She firmly believes good ideas come from every corner of an organization, and that Portland, Maine should be the easiest place in America to learn to invent and to be an inventor. She received a degree in biochemistry with honors from Harvard College, as well as degrees in medicine and public health from Case Western Reserve University in Cleveland, Ohio. Jenn’s favorite lunch spot is LB Kitchen, her favorite place for dinner is home with her kids, and her favorite local business is Print Bookstore on Congress St. in the East End. She is a huge college basketball fan and is still upset that the Big East fell apart.

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The information provided in this podcast by the University of Maine System, acting through the University of Maine Graduate and Professional Center, (the University) is for general educational and informational purposes only. The views and opinions expressed in this podcast are those of the author(s) and speaker(s) and do not represent the official policy or position of the University. Assumptions made in the analysis are not reflective of the position of any entity other than the author(s) and speaker(s) – and, since the author(s), speaker(s) and listeners are critically-thinking human beings, these views are always subject to change, revision, and rethinking at any time. All information in the podcast is provided in good faith, however the University makes no representations or warranties of any kind, express or implied, regarding the accuracy, adequacy, validity, reliability, availability or completeness of any information in the podcast and will not be liable for any errors, omissions, or delays in the information in this podcast or any losses, injuries, or damages arising from its broadcast or use. It is the listener’s responsibility to verify their own facts. Your use of the podcast and your reliance on any information in the podcast is solely at your own risk. The podcast does not contain nor is it intended to contain any legal advice. Any legal information provided is only for general informational and educational purposes, and is not a substitute for legal advice. Accordingly, before taking any actions based upon such information, the University encourages you to consult with an appropriate legal professional or licensed attorney.

Transcript

​This transcript has been lightly edited for clarity.

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The Greater Good: Episode 21

Carrie: Welcome to the Greater Good: a podcast devoted to exploring complex and emerging issues in law, business and policy. I’m your host Carrie Wilshusen, Associate Dean for Admissions at the University of Maine School of Law.

Carrie:

We’re welcoming back, Dr. Jennifer Monti, a cardiologist with Maine Health cardiology and the founder of the Innovation Cohort at Maine Health. So let’s move to Maine. We did a previous podcast where we talked about the crisis in rural health access and I’m wondering how your work might be able to impact that or what vision you might have for that particular issue that we have in Maine.

Jennifer:

I think one of the most exciting things that’s happened recently under Bill Caron’s leadership is the integration of some of the smaller hospitals doing remarkable work out further out from the urban centers now into a network that can draw on some of the resources that exist across Maine Health. And now that we have those hospitals within our sort of ecosystem, we really hope that we can number one get ideas from people who are there because people have been doing heroic work, caring for people in rural areas for a long time and we need to understand how we can learn from what they have done but also how some of the innovations that we might develop in places like Portland can serve our all populations and solve some of the huge challenges that we see now in that we’re going to see more of in the future.

Carrie:

So you’re eager to hear from medical folks outside of the Portland area to try to help solve those problems?

Jennifer:

Absolutely. The most exciting application I received was from a physical therapist at Waldo County General Hospital who has been working on a walker that’s hydraulic that goes upstairs. So the problem that he was seeing in his hospital is people might have surgery, be ill for a while, get quite debilitated, you need to go to rehab or home. And one thing that often keeps them from going home is the ability to go upstairs cause a standard walker can’t go upstairs and putting in a ramp or one of those chairs that go up for you, that’s an eight to $10,000 expense. There are many veterans who have orthopedic injuries who can’t get up and down their own homes. So he developed in his barn with his dad who was an engineer a way to do that. And he would come down to Portland, meet with me. I say, this is where the rubber meets the road, right? Somebody who is serving a rural population with a deep scientific expertise sees a market fit who’s now coming down to Portland to connect to the ecosystem. That sort of part of Maine Health.

Carrie:

Can support the development of the actual product?

Jennifer:

That’s that sort of exciting to me and my hope is we can do more of that. You know, both, both help cultivate ideas and, as our innovations advance to make sure that things are available in a low cost and scalable way because that’s how we’re going to solve the problems that we have across Maine and everywhere.

Carrie:

Can you talk about that a little bit because that is a huge problem, right? The cost of these things. So if, if the idea is that, I don’t mean to be crass, but if the ideas get sold off to big companies, their interest is going to be in getting a huge financial return on their investment. So how do you keep this affordable?

Jennifer:

One of the fun things by doing the work here is when people ask me that question, they’ll say, well, doesn’t it take millions of dollars to get anything to market? I say, not necessarily and my patients don’t have millions to spend. So it’s another great constraint on our thinking that actually catalyzes more innovation in any unique way that you might not expect. And I’ll get my thinking on this was drastically influenced when I was in graduate school by a book that’s called The Profit to the Bottom of the Pyramid and by this guy named C. K. Prahalad. He’s since passed away, but he was a faculty at the University of Chicago. And the basic idea is that most products and services are designed for people at the very top of the income period and ignores everybody else. But if you integrate for the people at the bottom right, who may only have a few dollars to spend that’s been the tremendous market that’s usually ignored. So that’s where I think, and I could be wrong because this is all a learning environment, we can make some really interesting advances that can help people cross across Maine or across the sort of urban rural divide that gets talked about in healthcare. It’s also exciting because that means they’ll be homegrown companies, right? In some cases that what we develop will be licensing arrangement with bigger companies. That’s how some of these ideas are going to get out. But several of them we’re going to develop with the target goal that things be low cost and scalable. I’ll give you an example. There’s a very basic but important sensor technology that we’re working on that we are going to sell for dollars, not thousands of dollars, any sort of mobile application that we look at developing. They are very hard to monetize and people can’t afford them, which is why you don’t see health apps sort of killing it, right? And people, there just hasn’t been the uptik that you would expect. So when we work on those, I say we are working on a $3 a day price point. That’s it. Because that might be what people can tolerate for a two week prescription of a mobile application or a digital prescription. So we try to put those constraints in advance because they’re not constraints there the reality of people, and by the way, many of my patients maybe have, you know, didn’t totally complete high school. Maybe they read at an eighth grade level, maybe they’re a trucker and on the road most of the time. So I think it’s a great kind of cauldron for inventing and because doc’s see people from across the spectrum, and I think we’re very realistic about who we’re inventing for.

Carrie:

And that could shift the model of healthcare delivery.

Jennifer:

Potentially delivery or potentially things like costs of durable medical equipment, right? If we can figure out a way how to 3-D print from biomaterial, some basic medical devices that are now being, you know, you’re being charged literally hundreds of dollars for, that’s something, of course there’s a thicket of regulation, and IP and we try to figure out ways to, you know, respect those constraints when needed, but also plow past them if we think there’s more clinical urgency in there eminently solvable. So we talk about those things a lot.

Carrie:

Again, because you’ve got the user end of it as part of the equation as opposed to top down thinking.

Jennifer:

We call it inventing with empathy. If you have the urgency of having seen something that makes you uncomfortable, that’s really powerful. Kind of part of the kind of mix.

Carrie:

A driver in the innovation.

Jennifer:

A lot of people who come in, they look like me. They’ve had something personal happen. Usually when you talk to people that yeah, they’re driven by what they do every day, but sometimes what they do everyday in their work is intimately related to something that’s happened in their life. So we do try some of that back as we, I talked to people about what it really means to take something from back of the envelope, sort of through to that clinical trial. It’s a ton of work and you know, no one is paying any bills. It’s just sweat and hustle and you generally have to be motivated by something beyond sort of like being motivated by the mission.

Carrie:

And the understanding that the back of the envelope didn’t come out of the void. It didn’t come out just out of your mind. It came out of your life experience and the discoveries of all the people before you.

Jennifer:

And that’s why I asked you to tell people don’t discount what you come with if you think it’s basic, it might be basic cause it took you 20 years to have insight to do that. We’re working on one device now with one of our cardiothoracic surgeons. You look at it and go, that is the most simple thing. And then you go, yeah, but he has 20 years of expertise to get to that simplicity. So not to discount things that are simple.

Carrie:

And in fact those are often the most powerful.

Jennifer:

Exactly right. It’s who is put it in the hand of the user who’s really going to do it.

Carrie:

You collaborate with University of Maine graduate programs and with local businesses. Can you talk to us about that?

Jennifer:

Yeah. And we, I knew we were going to talk about this, so I started to sort of write down some of the examples because as I, we’ve gotten started doing this, I’ve tried to say one of the most important things here is velocity and we’re going to know that which projects to look for further investment. If we can sort of rapidly accelerate them and get the help that we need to do customer discovery and build early prototypes. So these two projects we’re doing right now, I got to know Jeremy Qualls who’s a Dean of Engineering here, came from the UC system fairly recently. And I said, here’s what we need, you know, and I said, you know, can we look at weeks, not months in terms of development timeline? And he was like, yeah, sure. Sounds good.

Carrie:

That’s beautiful collaboration.

Jennifer:

Really helped to get the team together. And I said, these are, these are my people, right? Because I mentioned the reason that this sort of worked in Philadelphia was dense co-location. Here, I think it’s about a mile from here to the hospital. That’s what we need people to do. Just drive down the hill, walk down the hill, have a meeting, get back to what we’re doing. That’s where it’s going to be exciting, push and pull.

Carrie:

How do you think the students, so what are the students getting out of this work?

Jennifer:

We have just worked with professors at this point. We have, I haven’t had any direct engagement with a student team here. I have had with the capstone engineering teams at Orono, so I have gone up to Orono and described some of the problems that we are working on in a cohort setting to see who might be interested cause they need projects, right. They, you know, they need to figure out how to apply technologies to clinically meaningful problems and we need engineers who are interested. So it’s like a meeting of the mind. I’m due to go back, I need to go back again soon cause I’ve got two ideas for him that we need engineers working on. I think, and I have done this at Hopkins and at Penn where you had student led engineering teams. I think it’s a deep experience for them to see something clinically relevant come to life. And once I think they do it and it’s not it’s not all sort of in theory or in play.

Carrie:

What an amazing teaching tool to know that the thing that you’re working on is actually going to impact people’s lives as opposed to being an academic project.

Jennifer:

And that’s how a startup that I led from Penn got moving. I had an engineering team of these three women who are biomedical engineers, one of who is from Maine and I hope she comes back, she’s in medical school now and I’ll never forget writing to them and be like, guys, it looks like it works. And like the excitement that was going back and forth and our little prototype held together with rubber bands that then led to us really making a case and, and raising money. That stuff is addicting. It’s really exciting to see an idea take off like all the hard work comes later. Right? But then the idea sort of iteration pieces, pretty exciting.

Carrie:

Talk to us a little bit about how you got started and the other institutions that you’re working collaboratively with.

Jennifer:

Absolutely. This got started when I came to interview for a job as a cardiologist. I said to our chief, Dr. Sawyer, yes, I want to do all the cardiology pieces of this, but here’s something else that interests me for my sort of academic and research background. I’m really interested in building a path here to see if we can do some of this work. And what I loved about Doug is he said, great, I don’t know anyone that’s done that, but yes, please come. And that was a real signal to me that it’s something that could be supported here.

Carrie:

And there are multiple organizations across the state that you’re working with and even outside of the state.

Jennifer:

Right. We got started initially with a small grant from our chief academic officer at the time, Dr. Peter Bates, who is now a dean at Tufts. And then subsequent of funding for the group has come from The Maine Technology Institute, which really is a quasi public organization of the state charged with catalyzing the development of new businesses. Now hypothesis between the, the hypothesis really that they were funding was the idea that we could curate better applications to their funding process by having early innovators or entrepreneurs work in a cluster Maine Med cluster versus trying to do the work independently on their own, as in funding individuals kind of across their individual ideas that we could curate sort of a better quality set of potential deals. Or that’s how they sort of think of it in investment terms. So that’s how we’ve kind of continued to grow and have the resources to then reach out and capitalize on some of the really interesting companies and organizations that are here. I mentioned USM and U. Maine have done a lot of good prototyping work with us. We have also done work with the New England Ocean Cluster, which is building a space out on Commercial right right near the Flatbread where I take my kids you know, for dinner. We have it started right now looking at extracting some high value molecules from our ocean that are well known to be used in development pipelines. Companies like pharmaceutical companies, cosmetic companies, packaging companies we can do that now. And so we have started to use people who have scientific expertise, really getting to know better people in the Marine space. And I think there’s a lot of interesting interplay there between the bio-science biotech in the aquaculture space. We have joined the Boston Biomedical Incubator, which is something that Maine Med that was not a part of previously which really allows us entree to the Boston ecosystem of investors and scientists who know well how to commercialize some of the things we’re talking about.

Carrie:

More input into the idea?

Jennifer:

Absolutely. I view it as a runway. You know, we should not be trying to rebuild a mecca when you’re not, we’re not going to be one. We don’t want to be one and we can just take the highway down to the mecca 90 miles away. But we need to have runways. We need to have a way to get there. So that has been a really valuable experience, particularly in the device space because they know it so well. So that has been part of the work of the early cohort is figuring out who is here, how do we map to them and how can we deliberately interact more to add value?

Carrie:

And do you see a role for the Roux Institute that’s moving in?

Jennifer:

I think that’s an awesome advance for the city. And as a clinician who takes care of patients every day, we need radically smart new connections to advance technologies that can help us be smarter, do better.

Carrie:

One of the things you talked about earlier was the idea, and we did a podcast on this, but how important compliance is in all of this and how that is a big factor in the work that you do?

Jennifer:

I think particularly if you’re talking about devices or potentially down the road therapeutics, there are well-defined compliance sort of regulatory pathways in that space. And if you get it wrong at the beginning, you’re going to spend a lot of time and money and pain. So we have tapped into some of the expertise here, looking again at a sort of biotech slash aquaculture space opportunity. And got some easy to connect to helpful advice and on that project early.

Carrie:

As we think about the rural health crisis that we have that’s really a public health question, right? Are there other factors? I mean, you alone can’t solve that problem, right? I.

Jennifer:

I think a great thing about the innovation cohort is that we also view it as a sort of truth telling space, right? How do we get out of that sort of, you know, frustrations or realities of the good work that we do in our day jobs and talk about what we know to be true from data. And one thing we know is that 10% of your health is related to the healthcare you receive. And the rest of it is often public health inputs. So when I talk about trying to build things or their products or services that are low cost and scalable, those are often code for public health, right? How can we do things with a lens that really intersects medicine and public health and can be rapidly deployed? Those are, those are ultimately public health questions. Public health has not, it’s pretty easy to raise money around a good device. All right. A good, good therapeutic, there’s gotta be resources there. It’s much harder to scale and gain resources around things that can really be home runs, but have more of a public health lens.

Carrie:

So we just spoke recently with some folks around public housing and the crisis in public housing and I can’t imagine a person can avail themselves of the device if they don’t have a place to put their head at night.

Jennifer:

Yeah. I think we need to have a lot more robust dialogue about public health everywhere.

Carrie:

And food security.

Jennifer:

Right. That’s all part of that. It’s been disinvested in for years. It’s not a secret and it’s everywhere, on kind of every level.

Carrie:

You know, it reminds me of, in all of these conversations we have, it’s the interconnectivity between all of these various realms, which speaks directly to the work that you’re doing, right. Input from all of these realms in order to come to the right solutions.

Jennifer:

I think it’s extremely interesting when you get the right mix of people who think about these problems in the room to see what we might be able to come up with because I, we all know the current system’s not working.

Carrie:

And you need to talk to people.

Jennifer:

That you know, I often say that people, the best thing you can do is talk to strangers. The company I started in Philadelphia, I met our CFO on the train and the COO was my neighbor who I happened to chat up while we were shoveling snow. So the most interesting connections really are going to come out of just being comfortable with what you do and do not know and having a sort of radical curiosity about the world around you. And it starts to come out of the woodwork, but it has to be practiced. You have to learn how to think like that. And once you know, it’s like riding a bike, you don’t go back to talk to strangers, to strangers.

Carrie:

What do you wish people understood better about the work you do?

Jennifer:

That it is progress by inches and you don’t see results immediately. And you have to take the long view and, and push rapidly when appropriate. But also as I think about our little project as part of the bigger ecosystem of what is happening for our region, that you have to give resources and attention to things that either may take longer than you always take longer than you want and maybe don’t make it. And that’s okay. It’s okay to kind of shout from the rooftops about what you did wrong too.

Carrie:

You learn a lot from failures.

Jennifer:

Yeah, I think it takes a lot of confidence to do that. But I think that this, this place and this time is exactly the right place for it.

Carrie:

So we call our podcast The Greater Good with the idea that people are working tirelessly on behalf of the greater good of their communities nationally, locally, in ways that people don’t always see as working for the greater good. Can you talk about your work in that context?

Jennifer:

I view I wish that, and they’re welcome to people can actually sit in on our sessions and hear the way that people who maybe don’t view themselves as inventors come and just talk about sort of the heartbreak about the problems they see every day. And people that are in that room, we meet at 7:00 AM. It’s not part of their job, right? They’re, they’re trying to solve a bigger problem because of their heartbreak about how we care for people. That to me is the best essence of caring for other people and working at an academic medical center. That’s the beauty of it. So I really welcome anybody to, to get to know that process or to participate in that process in whatever organization they live and work in.

Carrie:

So you see a piece of the greater good work in changing the culture of how people think about problems?

Jennifer:

And also the problems that we work on. I view it as kind of, we have microscopes and macroscopes in healthcare all the time. You can do great work in the microscope and then the next day you might be thinking about the bigger sort of system and how all the pieces come together. So I think the important thing is that we just have beginner’s eyes on those processes all the time.

Carrie:

And do you have a vision for where this work will take your team and Maine?

Jennifer:

My hope is that we are, it becomes a two way street, right? First that we are inventing useful products, services, processes that help us solve our problems locally and that where appropriate can get on the runway to accelerate and scale as either licenses or businesses that are selling goods and services all over the globe because this area deserves that much attention because there’s that much potential. So I think that’s the outbound piece of it. And then there’s this interesting inbound challenge to say, how do we make our environment the best learning environment for companies that want to learn about healthcare and iterate and build new things. A lot of companies want to get into healthcare. It’s weird, it’s opaque, it’s hard to understand. I don’t even understand the billing, you know, I don’t know what all the codes mean that I write and am in there doing the work every day on? I say, how can we create a place that companies can come and learn or that we start companies out of that then can learn in our ecosystem. It takes a lot of thought to do that. What are the IT needs? What are the legal needs? What are the research needs? I think those are all good things that an organization needs to think about and which I think it’s great that, you know, Maine Health is looking at getting a team together, right? To look at some of those really difficult, interesting, exciting, but ultimately challenging options that are on the table for big organizations to think about.

Carrie:

So if a listener is captivated by these ideas and wants to learn more, where can they go? How can they, or if they have a great idea they want to bring to you?

Jennifer:

You know, I want to tell you about a story that happened to me in my office. I got a padded envelope and my secretary said, Oh, this came. Okay, thank you. Open it up. And it is a letter from a woman who lives in Yarmouth and it’s talking about and in the envelope is this sort of perfectly designed sort of exacto knife, part of a pool noodle. And it’s explaining how she had radiation for breast cancer and there was a lot of pain in the skin, but that she built this kind of perfect device to help position herself perfectly that didn’t hurt anymore and she thought that maybe it’s something that other people would want to know about. And she just wanted me to have it. And I was so sort of touched by that. I wrote her back a letter saying, thank you for doing this. This is why I want it to be a doctor in Maine that this, you know, people will reach out in this way. So I really sort of welcomed the dialogue and my email is known to everybody, jmonti@mmc.org and if people want to learn more about this here, what we do, tell me what they do, we need to hear it because we need to map it all because it is valuable.

Carrie:

Thank you so much for your time. It’s been delightful to have this conversation with you. 

Jennifer:

Very excited. Thank you.

The information provided in this podcast by the University of Maine System acting through the University of Maine Graduate and Professional Center is for general educational and informational purposes only. The views and opinions expressed in this podcast are those of the authors and speakers and do not represent the official policy or position of the university.