Joseph Kim The Digital Health Office at Eli Lilly

Hi, I'm Tom Rhodes, CEO of Spencer Health Solutions. Our podcast guest today is Joseph Kim, who is a member of the digital health office at Eli Lilly and the host of Lilly's podcast, The Elixir Factor. On our podcast, he talks about digital health innovation, the IBD challenge, sponsored by Eli Lilly, his podcast and cross-departmental drug development. We're proud to welcome a fellow podcaster to "People Always, Patients Sometimes".

Janet Kennedy (00:34):

Welcome to the "People Always, Patients Sometimes" podcast, a presentation of Spencer Health Solutions. Healthcare has come to a crossroads and it's time to start listening to new ideas that challenge our "always done it that way" thinking we hope you enjoy our conversations with the disruptors, the innovators and the transformers in clinical trials and healthcare. With me today is Joseph Kim from Eli Lilly. He has a title that's quite a mouthful. Senior advisor, digital health office, translational technology and innovation and we're going to talk about all of those things on the podcast today. Joe, welcome to the conversation.

Joe Kim (01:12):

It's great to be here. Janet, thanks for having me. I know it's been a little bit of a challenge to get our schedules to line up, but we're here now.

Janet Kennedy (01:19):

And I'm absolutely thrilled to have you here. We talk about you a lot over at the office because you are putting out a lot of great new ideas on your podcast, which we're going to talk about in a little bit and at events, conferences and trade shows. You're often a keynote or panelist member, but also imagine you're doing some pretty exciting things that Eli Lilly. You've certainly had a couple of changes in your title in the past few years, so things are very exciting where you are and I'd love for you to tell me a little bit about your history and how you got to Eli Lilly and then what you're doing now.

Joe Kim (01:53):

Yeah, sure. I mean I've only been at Lilly for about five and a half years, a little longer than that, which is a long time for me at any one company, but a very short time for anyone at Lilly. A lot of people who joined the company are there for 2030 35 years. So I'm still, despite for me, this being the longest role I've had at any one company, it's short time for others, so I still feel like the new kid on the block, but I joined their clinical innovation group when it was still in forest and that was run by Jeff Kasher who was the VP and well known in the industry. Still has, he hasn't faded into the background after leaving Lily, so he's still got his fingers in a number of pies helping other clinical research entrepreneurs and other pharma folks. I think I'm making sense of how to do things better.

Janet Kennedy (02:41):

Does that mean you have an intrepreneurial system going on at Eli Lilly where you are sort of embracing that spirit of entrepreneurship within the company?

Joe Kim (02:50):

Yes, but that's not really about how the company is set up, but there is plenty of room for people with that kind of ambition to develop new things and make the place better and better. Which is kind of a hallmark quote from our founder, which was to make Lilly a better and better place as you work here. So there's no like formal mechanism to do that per se, but everyone is encouraging it. It often happens and Jeff was one of those guys, created a big function where we spent a few years really focusing a lot of resources on trying to make clinical research to revolutionize it. And so that was, that was a great run for me. I did that for about three and a half years and then the company sort of switched gears to start trying to get some of these innovations in place so you can only dream for so long before you have to actually get some stuff done and apply it.

Joe Kim (03:42):

So there was a transformation that happened awhile back and I ended up moving into something called the design hub. In my role there for about a year was patient experience and design innovation, which is really about helping all the molecule teams figure out how to do things from a patient experience. Everything from awareness to recruitment to participation in learning. Anything we could do responsibly as it pertained to patients after the study, which is a thorny issue for a lot of good reasons. And then most recently in may, I moved into the digital health office shortly thereafter, started the podcast. So I'm always taking on new challenges and it's been a really great ride so far.

Janet Kennedy (04:23):

Well that's the definition of an exciting job, right? Where things are evolving and changing and new challenges come your way. But tell me what is the digital health office?

Joe Kim (04:32):

Yeah, the digital health office was born last year and it's basically a new team of a bunch of different kinds of folks, UX designers, developers, commercial strategists, and my group, which is translational technology and innovation and the remit has kind of evolved over time. It's a bit like a startup company within the company. And at first we were trying to figure out really the way to bring new digital health solutions to patients and doctors and health systems and that sort of thing. But we've also realized that you can't turn your back on digital health for drug development either. And so now we have these two sides of our work that we're really excited about and can reinforce each other. So for example, if you figure out a digital biomarker for a new way to measure drug efficacy, that could be repurposed as a, as part of a total digital health solution for a similar disease or something of that sort.

Joe Kim (05:34):

I can't talk in too much detail about those sorts of things, but I can give you some sort of hypothetical examples. So for example, if we think about asthma, is there a way you could forecast some sort of asthmatic flare using a bunch of different sensors and real world data and can you start to develop drugs that can alleviate those flares before they happen? Sounds great and you can use this to help the drug development process, but then it could also be part of a total digital solution where it's coupled with an inhaler or some sort of other mobile app that works in conjunction with the drug to do a lot more than just deliver medicine. We don't do anything in asthma, so I pick that as a safe topic. But you, you sort of can hopefully it gives you a sense of what the digital health office is here for

Janet Kennedy (06:23):

Would I be correct in assuming you're not trying to reinvent the wheel and design digital apps from the ground up, that you're actually looking for companies or startups to partner with to look at their technology?

Joe Kim (06:36):

Well, me personally, I don't do any of that actually. So translational technology and innovation is something slightly different, which I'll get into in a moment, but I'll say this much, as a company, we want to obviously use the best ideas and that doesn't mean we shut ourselves off from those ideas that are already out there in the world. We acquire companies, we in licensed compounds, and there's no reason why we wouldn't also consider external innovation as well. In fact, we just finished a external innovation challenge in IBD. That winner was selected last year. We actually have a podcast episode on that story itself, so you'll hear more about that hopefully in the next couple of weeks.

Janet Kennedy (07:18):

The IBD challenge was really fascinating and when I read through all the applicants, which I don't know, I'm even guessing 60 or more, they were so different from physical products to supportive apps, to medication delivery systems, to support groups and peer groups. It was fascinating how many different ways people imagined how to solve the problem of the IBD challenge.

Joe Kim (07:43):

Yeah, and that's a, that's a therapeutic area that hasn't gotten a lot of attention compared to something like diabetes, let's say with regard to helping patients use technology to help them manage their condition. So yeah, it was a good sort of new space for us and the general community to sink their teeth into.

Janet Kennedy (08:03):

All right. And I don't want you to have to give away any secrets here of your future podcast episode. But what was the technology that won? What was the idea?

Joe Kim (08:11):

It's mostly in the public domain. The technology was very simply a VR virtual reality format for children to focus their ability to understand their disease in a way that made sense to them. And specifically after some sort of colonoscopy or invasive procedure that they couldn't get their heads around and leaving that procedure in the fog that they're in. And then trying to learn about what just happened and understand the disease was just a big gap left in the whole health system. And that's no one's fault. It's just some unfortunate set of circumstances that leaves the patient kind of in the dark, so to speak. So this virtual reality application is supposed to really help a patient see exactly inside themselves and understand their disease up close and personal.

Janet Kennedy (09:02):

Well for children being sick is so frightening and some of the procedures they go through are uncomfortable if not painful. And the more they can try to understand at their level, the better off they're going to be. What was your role with the IBD challenge? Did that come out of your group?

Joe Kim (09:19):

No. So yeah, our group is pretty, pretty broad and it covers a bunch of different verticals that are required to bring digital health life. Our group is actually translational technology and innovation is really focused on sensor driven digital biomarker development. My team doesn't build apps. What we try and do is look for all the various sensors out there and you know, there are dozens of them. This is not just Fitbit and Apple watch. There's dozens of sensors out there that are all perfect, so to speak. Meaning they all behave a little bit differently. They have different combinations of sensors. They sample at different frequencies. Their battery lives are different, their charging modalities are different, their form factors are different. And what I mean by that, they're all perfect is depending on what you're trying to study, what you're trying to measure, there may be the right device for you.

Joe Kim (10:09):

Don't think that one device is perfect for all indications and sometimes there are these invisible so to speak. So the sensors that you don't have to wear but are monitoring you in the home. Well that's great too except you know many people leave their homes so for certain diseases and measurements it's not that useful. But if you're going to measure things that happen at night in the home then great. It's even better. So this is part of what our team does is make sense of all those sensors and help figure out new ways to measure things using those sensors. Our team is pretty diverse. It includes biomedical engineers, behavioral scientists, physician scientists, clinical research, operations professionals, data engineers. We're really excited about the team we've put together. I think for too long it's been teams that are just commercially focused or teams that are just technology focused or teams that are just sort of clinical research focused. We believe you can't do this properly unless you have that multidisciplinary team and everyone needs to start learning about each other's worlds because you can't just throw a Fitbit in a study and expect to make hay out of that. If you don't do it responsibly rigorously and understand exactly what you're getting into.

Janet Kennedy (11:26):

All right, so that leads me to a bookend to question. One is it kind of starts with as you refer protocol design that that if the study isn't written to accommodate this digital technology, then it's kind of hard to squeeze it in later in the trial. You're now working with patients. So I'm curious about protocol designers. Are they part of your team and how are you engaging patients in the evaluation and use of any of this technology?

Joe Kim (11:54):

To the extent that we are all sort of that protocol designers aren't a role and that we all design them as teams. Yeah, so as a team, because we're focused on this squarely and not, I say this with respect, not distracted by developing a medicine. We're all hired just to do digital biomarker work. We do this together. As you can imagine sometimes doing this early work is a square peg in a round hole, so we've had to really work the system to make sure that the other controls that are around protocol development for us to do this responsibly are sort of dialed into what we're trying to do. We're not giving some money an interventional drug where we don't have to look for a safety signal for that interventional drug. So there's lots of different nuances there. We work hard to really figure out how this will land operationally or pragmatically for a patient, particularly if we do it virtually, and we do a lot of virtual trials too, which is easier to do now because there's no drug, there's no medical procedures.

Joe Kim (12:59):

In short, you're mailing them a device or devices to where and they have to use apps to participate in the research and the data that gets pulled passively. But as simple as that is, it can be quite a learning process when you start to deploy these things. Something as simple as the way a question is ordered either together on the screen or not can create a lot of confusion. Or you know, if the battery is not charged and they don't know that it's not charged and the data's not streaming to the phone, right? There's only so much all devices can store certain amount of data before it stops collecting. Totally. So then you can end up with these empty spaces of data. It really depends on what you're trying to measure. So if you're trying to measure sleep, maybe a wrist worn thing isn't all that necessary. I don't care about what's happening during the waking hours. You should wear something only at night when it charged during the day. But if you're measuring something like activity and exertion, well then you can take it off at night, right? These are just simple ways to think about it. So it really starts with what you're trying to measure and then you try and design the experiments.

Janet Kennedy (14:06):

It sounds exciting. This cross functional team that really has kind of a whiteboard open to new innovation ideas. I love that. But it seems to me that's not going to happen unless your C suite is on board. So is this top down or did you guys push up and say we need to have this?

Joe Kim (14:26):

Yeah, this was a top down approach. Well, not from the very top of the very top. You know our C suite styled into this. It's not easy to just start a new thing called a digital health office and have that be publicly known. So when that happens you can bet that it goes all the way up to the top. You did ask another question around like how we get patients involved. Fortunately here at Lilly we have a pretty good history bringing patients into our drug development design work. You may have heard of something called Co-Lab or Co-Design. It's still happening now, but two of my great colleagues, Megan Laker and Susan Gilchrist, they are at Lilly running that capability now. We actually have a podcast episode on that too. I think it might be podcast number 11 at any rate, and we go into a deep dive of what that actually looks like, but in a nutshell, what that means is we literally bring patients into the company and we sit them down with the scientists and other site personnel and we work through the real issues of how this research may play out on people's lives.

Joe Kim (15:32):

We start off with a whole empathy session around, you know, what is a day in the life, a week in the life, a year in the life as it pertains to a study and really try and overlay some study design concepts and see where some of these things match up or don't. There's not like a recipe to it. It's really, it starts with empathy and listening and then really great dialogue around trade offs, which surveys can't do, right? You can't do this through a questionnaire or discussion board. It's gotta be live. It's messy. So we'll be using that framework as well or some version of that and just riding their coattails because they've been doing this for a while now.

Janet Kennedy (16:12):

Well, I understand you also had a podcast episode that I listened to having to do with matching up employees at Eli Lilly who had very serious health issues with individuals in other countries and they did a program together. So you know internally you have your own small ecosystem of people as patients.

Joe Kim (16:34):

Yeah, that was a very interesting episode. Terri Wingham, she was our guest on the episode. She's the founder of a company called A Fresh Chapter and she connects cancer survivors and brings a few from Lily and we go to developing country who needs help in some way and everyone pitches in and it's just a different way to continue one's healing. Yeah, that was a, that was a really amazing episode. Yeah, you should. You should check it out. It sounds like you did, but others should check it out if you haven't hadn't heard it.

Janet Kennedy (17:06):

Well, every episode you mentioned, I will put a link into this podcast so people can click right over there and see it. And yes, I love that idea that you are a global company, but it was very, very cool that you had your own employees who had had that serious health experience really going and working with folks in another area which made them feel so much more empowered so much outside of themselves. The problem with any health issue, and it's different for everyone, you get so focused on your own health is sometimes you kind of lose sight of the bigger picture. And this sounded like all of those folks really grew and benefited from the experience.

Joe Kim (17:50):

yeah. And these connections with patients get very deep and we need more folks in the company to build the right kind of relationships where possible. For example, myself, for a long time I've been building relationships with patient influencers and I gotta be honest. While it made sense to me sort of intuitively for awhile I was struggling with the quote unquote business value of doing that because if I was not responsible enough I could step on a landmine, but when the podcast came up as an opportunity and we really thought about what kind of guests we wanted to share, it was clear to us that in a lot of the other science podcasts out there, there was a lot of scientists on there and that's great, you want, you want experts on there, but there was a lack of the patient representation and we decided that that's a voice we wanted to amplify more and we wanted to bring them on together with scientists often to have a deeper dialogue around the state of medical advancements in that specific disease and what's on the horizon.

Joe Kim (18:58):

I think it's rare that many patients get to sit down with a leading scientist in that field to have some sort of exchange there. To bring it full circle, all of these patients that I've been sort of building relationships with. All of a sudden now I had people to call on and say, Hey, would you like to be on this podcast to talk about this disease that I know you're an influencer or you have a strong audience for? And because I've built that investment, I made that personal investment over the last five or six years. I wasn't coming in cold as some weird pharma guy, Hey, would you like to be on my podcast? And everyone was just super gracious and if they can fit it in, they did. I have plenty more I want to have on the show. It's really great now that wow, there is a quote unquote business value to me, building relationships with patient influencers. They're happy to talk to me on the podcast, which is, which is fantastic.

Janet Kennedy (19:56):

Well, I was noticing that the last episode of your first season, Episode 11 is the promise of genetic innovation and cracking the code of ALS as a lay person, not a scientist and not a medical professional, I'm coming at my information to medicine literally through social media, through podcasts, through posts that people put up there and I did think this was fascinating that you had both Brian and Sandra with I AM ALS representing a patient centric viewpoint coming on your podcast and then you also spoke to your Lilly scientist Andrew Adams about some very sciency stuff. That's something I will admit I can't pull off, but I love the fact that you are able to be the interpreter for both groups, enabling patients to speak to scientists and scientists to explain to patients the complexities of of these diseases.

Joe Kim (20:48):

We partly just got really lucky there in terms of the timing because Brian was in town, but he's really well known in the Alice community and Andrew is just focused on some really exciting genetic modalities to think about helping a number of diseases because this isn't just focused on neurodegeneration. We really want to try and do more of that where we get patients to actually sit down and because they were there across the table from each other and it was really great to have that kind of interaction. We may even do it a little bit more purposefully and just have it just be about the disease and where it's going from a medical, scientific perspective. Certainly not every episode needs to be that way, nor nor do we want to always do those things, but the more we can do that, I think that's a really exciting format because you don't see that. I haven't come across the science podcast that way either. So yeah, this has been super exciting to do. Looking forward to the next several episodes coming up,

Janet Kennedy (21:44):

You had 11 episodes in your first season. Are you going to do this quarterly, semi-annually? What? What's your plan for the podcast?

Joe Kim (21:52):

We only launched in May, I think we recorded earlier than that. I think we're really going to shoot for once a month and we've already started recording late last year and early this year because of who we are. It has to go through a pretty rigorous process to make sure we're not getting into trouble for saying the wrong sorts of things, but you know, we're not talking about products. We're really just talking about stories that inspire scientific advancement. We can all identify with some of these diseases because there are people in our lives to have these things. Nearly everything that's been on the show, you know, I've, I've had some sort of personal connection with one of these illnesses. It's great to use some of my background that I've ditched in my early career. I was a science teacher and while I loved to teach working in a school environment, a traditional school environment was just, it didn't fit me. But to your point about having scientists and patients come together, they don't often talk the same language. I mean patients are really sophisticated now, but there is a certain level of biology that if you understand it more deeply, you'll get even more out of it. And then scientists, they've been talking to each other for so long, you know, they're using $5 words that no one else really uses. So if I can be that interpreter, that's really a great place for me to be.

Janet Kennedy (23:12):

And that's a challenge, not just on the pharma side. That's a challenge in healthcare when physicians are explaining issues to their patients, you know, are they speaking in plain language? Are they easily understood? As a matter of fact, I did an interview with your global health literacy person and that was the focus that we've got to put this information out in a way that people can understand it and take action with it.

Joe Kim (23:37):

Yeah, I mean just say the word rash, right. Don't, don't use the Latin words that that the five different Latin words that describe rash. Just saying rash. Right, or it works versus it's not working.

Janet Kennedy (23:51):

Absolutely. Well, tell me a little bit about where you think we're going in clinical trials. When you joined the pharma industry in the late nineties early two thousands you had one experience. If somebody were coming into the industry now, I'm sure it's a totally different experience. So over your 20 years or so, what do you see that has really changed in the industry?

Joe Kim (24:14):

The use of data to make decisions has been really transformational. I think I recall one of my earliest clinical trials I was working on and we were selecting which sites to go to. We literally had a stack of resumes that'd be go through and say A, B and C like yes, maybe no, which is not a great way to pick sites who might be useful or great at enrolling and conducting the trial. So even from a site selection standpoint, you're using more data to think about who's been really great in the past. Do they have access to patients? What does their demographic look like? So using a lot more data to do that. And then even further upstream thinking about medical informatics to design the patient eligibility criteria. So in the past you'd just be looking for, "give us all men who asked for directions when they're lost", right?

Joe Kim (25:07):

Not a lot, but now we have data to say, Hey, we want people on drug A not on drug B with this condition and not, and then let's see if that patient actually exists because that might be a perfect one for this study. But if they don't exist, this is not perfect for anyone. So we can use that kind of data to really find the right trade off between stringent enough criteria so that we find a signal, but at least have a enough abundance of patients. So those two things are been really game changing in terms of how we design protocols and set up the operations to do that. I think a lot of people are also thinking about this notion of a sightless trial or decentralized trial. I don't want to use the word virtual. I think that really means to trial without patients.

Joe Kim (25:53):

So like a simulated trial. So we should, as an industry get away from this virtual notion. I'm really think a bit more about these centralized to some degree or location flexible is probably more even more accurate. But it's the idea of how does a patient participate in the study without always having to go to the clinic.

Janet Kennedy (26:11):

How do you feel about the word hybrid?

Joe Kim (26:14):

Well, I'm not sure what you're hybriding what's the two, but really it's about flexibility and location. That's the name of the game. But you know, if you think about medical research as a set of medical procedures that all have to be done within a window, then you can really start to take apart this notion of a visit, visit, one visit to visit, three, forget to visit. Here are the procedures that need to be done, the activities. So you think of more of like an activity based set of medical procedures.

Joe Kim (26:46):

Now, which one of those can be done with telemedicine? Which one of those can be done with in home health, which can be done at a clinic, which can be done at retail, right? So not everything can be done at home. Not everything can be done through telemedicine. So it's really thinking about which ones can be done in a variety of, of ways. And even then we've discovered at Lilly through some of our research that a good healthy portion of patients don't want anyone coming into their home. They just don't, and I get that. My home is a mess. On Wednesday, I'd rather just go to the doctor. Now, do I want to go to the doctor to do a visit for three hours? No, but it'd be great to do what I can in that window if it takes me 30 minutes. That's how we have to start. You have to dismantle the visit construct and just think about individual activities.

Janet Kennedy (27:35):

Now you use the word retail. Are you actually thinking like someone going to a CVS or a Walgreens or a Walmart just to have a simple blood draw done or something like that?

Joe Kim (27:45):

Sure, that's possible. Right? It has to be done responsibly and rigorously, but even in some of our early pilots of flexible location trials, one of the drugs was marketed, so we were able to have patients pick it up from your local drug store instead of having them come into a site. Now this is a very different kind of study. It wasn't part of the efficacy trial, it was more real world evidence, but at any rate, it can be done under the right context. So it's really just about thinking under what context can X, Y and Z be done versus saying this can't be done, so you have to sort of pick and choose.

Janet Kennedy (28:21):

Are you seeing enough evidence that it's making a difference that it really can impact either the adherence levels of patients or the persistence of taking a drug by incorporating a variety of different ways to engage with a patient?

Joe Kim (28:36):

I think we are still trying to get good use cases under our belt. We being the industry in terms of what kinds of trials are fit for this kind of thing. The logical argument makes a lot of sense, right, so there is a logical argument there which is if you don't make it too inconvenient on a patient, they'll do more of it. Right? That's the very same thing to say. Now at the same time, there is a component of clinical research where the bond between the patient and the clinic staff is such that that's also a main contributor for why patients either stay in the study or are able to follow along what they're committed to do. Because you've got someone on the other end expecting you to cross all the T's and dot all the i's, and this is a, this is a component and behavior change.

Joe Kim (29:31):

There is a social component in behavior change and participating in research is behavior. Change is a social component that if that's there, you're more likely to have people stick to it when that's absent and there's no evidence of a larger connection with a person or people. Sometimes you could get really easy to drop off because guess what? No one's watching. No one cares. A research kit study came out years ago. Stanford, the heart health study. I joined that because it was super easy and I was able to do a lot of the stuff because I suppose super easy. I was walking my kids to the school. I did the six minute walk tests, but then after awhile I stopped doing some things. Now I get reminders. I ignore them. It was actually very easy to drop off without anyone calling me on the carpet. So you could argue that if you do everything virtually, you run the risk of people just disappearing because there's no commitment. There's no gym buddy. Right. To help keep you honest.

Janet Kennedy (30:27):

Right. Definitely. When we talk about patient engagement, a lot of people will think it's about pushing a button and really it's also making sure that that patient feels like their actions matter.

Joe Kim (30:40):

That's right.

Janet Kennedy (30:41):

Tell me a little bit about your road show when you hit the road in 2020 I know you're going to be doing some speaking engagements. What are the topics you're addressing this year?

Joe Kim (30:51):

Well, because of my role as squarely focused on digital health and sensor research, I have to be careful not to be swimming outside my lane, though I have some knowledge and experience with things and traditional drug research. It's not my role anymore, so I have to be careful to let my other colleagues to represent themselves or our company for those sorts of things and having me kind of stay in my swim lane. While I'm happy to do it, I have to do it with integrity, I guess. So I've actually pulled back a little bit because to be frank, I'm not an expert in digital health and sensor research. I'm an amateur here and that's partly why I took the role is I want to be the dumbest guy in the room. Let me learn and get up to speed and grow my skillset and knowledge base. So I'll do a lot more listening actually this time around. But there's plenty of me on the airwaves through the podcast, so hopefully people aren't going to miss me too much.

Janet Kennedy (31:49):

Well, I think it's going to be a very exciting year, 2020 or 2020 whatever you want to call it. We're going to have, I think a lot of interesting changes come about as we finally fish or cut bait and we, as an industry, really start to include digital health and new technologies into the clinical trial process. 'm very excited about what's going to be coming up in the next year or two.

Joe Kim (32:17):

Yeah, me too. I think this notion of digital biomarkers is a key enabler of decentralized trials, right? So one thing that anchors people or science to the clinic is the fact that an endpoint needs to be done by somebody in person. And as long as that happens, you're not going to enroll somebody a hundred miles away. They have to be within a driving distance, reasonable driving distance, except for some exceptions like rare disease and oncology. But for the most part, if you're not in a reasonable driving distance, you're not going to enroll because the primary end point has to be done at the clinic. What digital biomarkers enable is for that to be done remotely through a sensor and now you're not tied to the clinic if you don't want to be. Now I'm generalizing, it's not going to happen for every single kind of study, but that is one thing that is definitely anchoring research to the clinic. So the more digital biomarker work we can get, the faster we can get to decentralized flexible location trials.

Janet Kennedy (33:18):

Absolutely. Well, I'm voting for that, and I really hope that that's going to be something that becomes much more of a reality going forward so that we can get much better representation in diverse communities and in rural communities involved in our clinical trials.

New Speaker (33:34):

Yeah, likewise.

Janet Kennedy (33:35):

Well, I can't thank you enough for being part of this podcast. Joe, you've been listening to "People Always, Patients Sometimes" with my guest, Joseph Kim, who's the senior advisor, digital health office, translational technology and innovation for Eli Lilly. Thank you so much for being here, Joe.

Joe Kim (33:51):

Thanks for having me, Janet. It was a lot of fun. 

Hi, I'm Tom Rhodes, CEO of Spencer Health Solutions. Our podcast guest today is Joseph Kim, who is a member of the digital health office at Eli Lilly and the host of Lilly's podcast, The Elixir Factor. On our podcast, he talks about digital health innovation, the IBD challenge, sponsored by Eli Lilly, his podcast and cross-departmental drug development. We're proud to welcome a fellow podcaster to "People Always, Patients Sometimes".

Janet Kennedy (00:34):

Welcome to the "People Always, Patients Sometimes" podcast, a presentation of Spencer Health Solutions. Healthcare has come to a crossroads and it's time to start listening to new ideas that challenge our "always done it that way" thinking we hope you enjoy our conversations with the disruptors, the innovators and the transformers in clinical trials and healthcare. With me today is Joseph Kim from Eli Lilly. He has a title that's quite a mouthful. Senior advisor, digital health office, translational technology and innovation and we're going to talk about all of those things on the podcast today. Joe, welcome to the conversation.

Joe Kim (01:12):

It's great to be here. Janet, thanks for having me. I know it's been a little bit of a challenge to get our schedules to line up, but we're here now.

Janet Kennedy (01:19):

And I'm absolutely thrilled to have you here. We talk about you a lot over at the office because you are putting out a lot of great new ideas on your podcast, which we're going to talk about in a little bit and at events, conferences and trade shows. You're often a keynote or panelist member, but also imagine you're doing some pretty exciting things that Eli Lilly. You've certainly had a couple of changes in your title in the past few years, so things are very exciting where you are and I'd love for you to tell me a little bit about your history and how you got to Eli Lilly and then what you're doing now.

Joe Kim (01:53):

Yeah, sure. I mean I've only been at Lilly for about five and a half years, a little longer than that, which is a long time for me at any one company, but a very short time for anyone at Lilly. A lot of people who joined the company are there for 2030 35 years. So I'm still, despite for me, this being the longest role I've had at any one company, it's short time for others, so I still feel like the new kid on the block, but I joined their clinical innovation group when it was still in forest and that was run by Jeff Kasher who was the VP and well known in the industry. Still has, he hasn't faded into the background after leaving Lily, so he's still got his fingers in a number of pies helping other clinical research entrepreneurs and other pharma folks. I think I'm making sense of how to do things better.

Janet Kennedy (02:41):

Does that mean you have an intrepreneurial system going on at Eli Lilly where you are sort of embracing that spirit of entrepreneurship within the company?

Joe Kim (02:50):

Yes, but that's not really about how the company is set up, but there is plenty of room for people with that kind of ambition to develop new things and make the place better and better. Which is kind of a hallmark quote from our founder, which was to make Lilly a better and better place as you work here. So there's no like formal mechanism to do that per se, but everyone is encouraging it. It often happens and Jeff was one of those guys, created a big function where we spent a few years really focusing a lot of resources on trying to make clinical research to revolutionize it. And so that was, that was a great run for me. I did that for about three and a half years and then the company sort of switched gears to start trying to get some of these innovations in place so you can only dream for so long before you have to actually get some stuff done and apply it.

Joe Kim (03:42):

So there was a transformation that happened awhile back and I ended up moving into something called the design hub. In my role there for about a year was patient experience and design innovation, which is really about helping all the molecule teams figure out how to do things from a patient experience. Everything from awareness to recruitment to participation in learning. Anything we could do responsibly as it pertained to patients after the study, which is a thorny issue for a lot of good reasons. And then most recently in may, I moved into the digital health office shortly thereafter, started the podcast. So I'm always taking on new challenges and it's been a really great ride so far.

Janet Kennedy (04:23):

Well that's the definition of an exciting job, right? Where things are evolving and changing and new challenges come your way. But tell me what is the digital health office?

Joe Kim (04:32):

Yeah, the digital health office was born last year and it's basically a new team of a bunch of different kinds of folks, UX designers, developers, commercial strategists, and my group, which is translational technology and innovation and the remit has kind of evolved over time. It's a bit like a startup company within the company. And at first we were trying to figure out really the way to bring new digital health solutions to patients and doctors and health systems and that sort of thing. But we've also realized that you can't turn your back on digital health for drug development either. And so now we have these two sides of our work that we're really excited about and can reinforce each other. So for example, if you figure out a digital biomarker for a new way to measure drug efficacy, that could be repurposed as a, as part of a total digital health solution for a similar disease or something of that sort.

Joe Kim (05:34):

I can't talk in too much detail about those sorts of things, but I can give you some sort of hypothetical examples. So for example, if we think about asthma, is there a way you could forecast some sort of asthmatic flare using a bunch of different sensors and real world data and can you start to develop drugs that can alleviate those flares before they happen? Sounds great and you can use this to help the drug development process, but then it could also be part of a total digital solution where it's coupled with an inhaler or some sort of other mobile app that works in conjunction with the drug to do a lot more than just deliver medicine. We don't do anything in asthma, so I pick that as a safe topic. But you, you sort of can hopefully it gives you a sense of what the digital health office is here for

Janet Kennedy (06:23):

Would I be correct in assuming you're not trying to reinvent the wheel and design digital apps from the ground up, that you're actually looking for companies or startups to partner with to look at their technology?

Joe Kim (06:36):

Well, me personally, I don't do any of that actually. So translational technology and innovation is something slightly different, which I'll get into in a moment, but I'll say this much, as a company, we want to obviously use the best ideas and that doesn't mean we shut ourselves off from those ideas that are already out there in the world. We acquire companies, we in licensed compounds, and there's no reason why we wouldn't also consider external innovation as well. In fact, we just finished a external innovation challenge in IBD. That winner was selected last year. We actually have a podcast episode on that story itself, so you'll hear more about that hopefully in the next couple of weeks.

Janet Kennedy (07:18):

The IBD challenge was really fascinating and when I read through all the applicants, which I don't know, I'm even guessing 60 or more, they were so different from physical products to supportive apps, to medication delivery systems, to support groups and peer groups. It was fascinating how many different ways people imagined how to solve the problem of the IBD challenge.

Joe Kim (07:43):

Yeah, and that's a, that's a therapeutic area that hasn't gotten a lot of attention compared to something like diabetes, let's say with regard to helping patients use technology to help them manage their condition. So yeah, it was a good sort of new space for us and the general community to sink their teeth into.

Janet Kennedy (08:03):

All right. And I don't want you to have to give away any secrets here of your future podcast episode. But what was the technology that won? What was the idea?

Joe Kim (08:11):

It's mostly in the public domain. The technology was very simply a VR virtual reality format for children to focus their ability to understand their disease in a way that made sense to them. And specifically after some sort of colonoscopy or invasive procedure that they couldn't get their heads around and leaving that procedure in the fog that they're in. And then trying to learn about what just happened and understand the disease was just a big gap left in the whole health system. And that's no one's fault. It's just some unfortunate set of circumstances that leaves the patient kind of in the dark, so to speak. So this virtual reality application is supposed to really help a patient see exactly inside themselves and understand their disease up close and personal.

Janet Kennedy (09:02):

Well for children being sick is so frightening and some of the procedures they go through are uncomfortable if not painful. And the more they can try to understand at their level, the better off they're going to be. What was your role with the IBD challenge? Did that come out of your group?

Joe Kim (09:19):

No. So yeah, our group is pretty, pretty broad and it covers a bunch of different verticals that are required to bring digital health life. Our group is actually translational technology and innovation is really focused on sensor driven digital biomarker development. My team doesn't build apps. What we try and do is look for all the various sensors out there and you know, there are dozens of them. This is not just Fitbit and Apple watch. There's dozens of sensors out there that are all perfect, so to speak. Meaning they all behave a little bit differently. They have different combinations of sensors. They sample at different frequencies. Their battery lives are different, their charging modalities are different, their form factors are different. And what I mean by that, they're all perfect is depending on what you're trying to study, what you're trying to measure, there may be the right device for you.

Joe Kim (10:09):

Don't think that one device is perfect for all indications and sometimes there are these invisible so to speak. So the sensors that you don't have to wear but are monitoring you in the home. Well that's great too except you know many people leave their homes so for certain diseases and measurements it's not that useful. But if you're going to measure things that happen at night in the home then great. It's even better. So this is part of what our team does is make sense of all those sensors and help figure out new ways to measure things using those sensors. Our team is pretty diverse. It includes biomedical engineers, behavioral scientists, physician scientists, clinical research, operations professionals, data engineers. We're really excited about the team we've put together. I think for too long it's been teams that are just commercially focused or teams that are just technology focused or teams that are just sort of clinical research focused. We believe you can't do this properly unless you have that multidisciplinary team and everyone needs to start learning about each other's worlds because you can't just throw a Fitbit in a study and expect to make hay out of that. If you don't do it responsibly rigorously and understand exactly what you're getting into.

Janet Kennedy (11:26):

All right, so that leads me to a bookend to question. One is it kind of starts with as you refer protocol design that that if the study isn't written to accommodate this digital technology, then it's kind of hard to squeeze it in later in the trial. You're now working with patients. So I'm curious about protocol designers. Are they part of your team and how are you engaging patients in the evaluation and use of any of this technology?

Joe Kim (11:54):

To the extent that we are all sort of that protocol designers aren't a role and that we all design them as teams. Yeah, so as a team, because we're focused on this squarely and not, I say this with respect, not distracted by developing a medicine. We're all hired just to do digital biomarker work. We do this together. As you can imagine sometimes doing this early work is a square peg in a round hole, so we've had to really work the system to make sure that the other controls that are around protocol development for us to do this responsibly are sort of dialed into what we're trying to do. We're not giving some money an interventional drug where we don't have to look for a safety signal for that interventional drug. So there's lots of different nuances there. We work hard to really figure out how this will land operationally or pragmatically for a patient, particularly if we do it virtually, and we do a lot of virtual trials too, which is easier to do now because there's no drug, there's no medical procedures.

Joe Kim (12:59):

In short, you're mailing them a device or devices to where and they have to use apps to participate in the research and the data that gets pulled passively. But as simple as that is, it can be quite a learning process when you start to deploy these things. Something as simple as the way a question is ordered either together on the screen or not can create a lot of confusion. Or you know, if the battery is not charged and they don't know that it's not charged and the data's not streaming to the phone, right? There's only so much all devices can store certain amount of data before it stops collecting. Totally. So then you can end up with these empty spaces of data. It really depends on what you're trying to measure. So if you're trying to measure sleep, maybe a wrist worn thing isn't all that necessary. I don't care about what's happening during the waking hours. You should wear something only at night when it charged during the day. But if you're measuring something like activity and exertion, well then you can take it off at night, right? These are just simple ways to think about it. So it really starts with what you're trying to measure and then you try and design the experiments.

Janet Kennedy (14:06):

It sounds exciting. This cross functional team that really has kind of a whiteboard open to new innovation ideas. I love that. But it seems to me that's not going to happen unless your C suite is on board. So is this top down or did you guys push up and say we need to have this?

Joe Kim (14:26):

Yeah, this was a top down approach. Well, not from the very top of the very top. You know our C suite styled into this. It's not easy to just start a new thing called a digital health office and have that be publicly known. So when that happens you can bet that it goes all the way up to the top. You did ask another question around like how we get patients involved. Fortunately here at Lilly we have a pretty good history bringing patients into our drug development design work. You may have heard of something called Co-Lab or Co-Design. It's still happening now, but two of my great colleagues, Megan Laker and Susan Gilchrist, they are at Lilly running that capability now. We actually have a podcast episode on that too. I think it might be podcast number 11 at any rate, and we go into a deep dive of what that actually looks like, but in a nutshell, what that means is we literally bring patients into the company and we sit them down with the scientists and other site personnel and we work through the real issues of how this research may play out on people's lives.

Joe Kim (15:32):

We start off with a whole empathy session around, you know, what is a day in the life, a week in the life, a year in the life as it pertains to a study and really try and overlay some study design concepts and see where some of these things match up or don't. There's not like a recipe to it. It's really, it starts with empathy and listening and then really great dialogue around trade offs, which surveys can't do, right? You can't do this through a questionnaire or discussion board. It's gotta be live. It's messy. So we'll be using that framework as well or some version of that and just riding their coattails because they've been doing this for a while now.

Janet Kennedy (16:12):

Well, I understand you also had a podcast episode that I listened to having to do with matching up employees at Eli Lilly who had very serious health issues with individuals in other countries and they did a program together. So you know internally you have your own small ecosystem of people as patients.

Joe Kim (16:34):

Yeah, that was a very interesting episode. Terri Wingham, she was our guest on the episode. She's the founder of a company called A Fresh Chapter and she connects cancer survivors and brings a few from Lily and we go to developing country who needs help in some way and everyone pitches in and it's just a different way to continue one's healing. Yeah, that was a, that was a really amazing episode. Yeah, you should. You should check it out. It sounds like you did, but others should check it out if you haven't hadn't heard it.

Janet Kennedy (17:06):

Well, every episode you mentioned, I will put a link into this podcast so people can click right over there and see it. And yes, I love that idea that you are a global company, but it was very, very cool that you had your own employees who had had that serious health experience really going and working with folks in another area which made them feel so much more empowered so much outside of themselves. The problem with any health issue, and it's different for everyone, you get so focused on your own health is sometimes you kind of lose sight of the bigger picture. And this sounded like all of those folks really grew and benefited from the experience.

Joe Kim (17:50):

yeah. And these connections with patients get very deep and we need more folks in the company to build the right kind of relationships where possible. For example, myself, for a long time I've been building relationships with patient influencers and I gotta be honest. While it made sense to me sort of intuitively for awhile I was struggling with the quote unquote business value of doing that because if I was not responsible enough I could step on a landmine, but when the podcast came up as an opportunity and we really thought about what kind of guests we wanted to share, it was clear to us that in a lot of the other science podcasts out there, there was a lot of scientists on there and that's great, you want, you want experts on there, but there was a lack of the patient representation and we decided that that's a voice we wanted to amplify more and we wanted to bring them on together with scientists often to have a deeper dialogue around the state of medical advancements in that specific disease and what's on the horizon.

Joe Kim (18:58):

I think it's rare that many patients get to sit down with a leading scientist in that field to have some sort of exchange there. To bring it full circle, all of these patients that I've been sort of building relationships with. All of a sudden now I had people to call on and say, Hey, would you like to be on this podcast to talk about this disease that I know you're an influencer or you have a strong audience for? And because I've built that investment, I made that personal investment over the last five or six years. I wasn't coming in cold as some weird pharma guy, Hey, would you like to be on my podcast? And everyone was just super gracious and if they can fit it in, they did. I have plenty more I want to have on the show. It's really great now that wow, there is a quote unquote business value to me, building relationships with patient influencers. They're happy to talk to me on the podcast, which is, which is fantastic.

Janet Kennedy (19:56):

Well, I was noticing that the last episode of your first season, Episode 11 is the promise of genetic innovation and cracking the code of ALS as a lay person, not a scientist and not a medical professional, I'm coming at my information to medicine literally through social media, through podcasts, through posts that people put up there and I did think this was fascinating that you had both Brian and Sandra with I AM ALS representing a patient centric viewpoint coming on your podcast and then you also spoke to your Lilly scientist Andrew Adams about some very sciency stuff. That's something I will admit I can't pull off, but I love the fact that you are able to be the interpreter for both groups, enabling patients to speak to scientists and scientists to explain to patients the complexities of of these diseases.

Joe Kim (20:48):

We partly just got really lucky there in terms of the timing because Brian was in town, but he's really well known in the Alice community and Andrew is just focused on some really exciting genetic modalities to think about helping a number of diseases because this isn't just focused on neurodegeneration. We really want to try and do more of that where we get patients to actually sit down and because they were there across the table from each other and it was really great to have that kind of interaction. We may even do it a little bit more purposefully and just have it just be about the disease and where it's going from a medical, scientific perspective. Certainly not every episode needs to be that way, nor nor do we want to always do those things, but the more we can do that, I think that's a really exciting format because you don't see that. I haven't come across the science podcast that way either. So yeah, this has been super exciting to do. Looking forward to the next several episodes coming up,

Janet Kennedy (21:44):

You had 11 episodes in your first season. Are you going to do this quarterly, semi-annually? What? What's your plan for the podcast?

Joe Kim (21:52):

We only launched in May, I think we recorded earlier than that. I think we're really going to shoot for once a month and we've already started recording late last year and early this year because of who we are. It has to go through a pretty rigorous process to make sure we're not getting into trouble for saying the wrong sorts of things, but you know, we're not talking about products. We're really just talking about stories that inspire scientific advancement. We can all identify with some of these diseases because there are people in our lives to have these things. Nearly everything that's been on the show, you know, I've, I've had some sort of personal connection with one of these illnesses. It's great to use some of my background that I've ditched in my early career. I was a science teacher and while I loved to teach working in a school environment, a traditional school environment was just, it didn't fit me. But to your point about having scientists and patients come together, they don't often talk the same language. I mean patients are really sophisticated now, but there is a certain level of biology that if you understand it more deeply, you'll get even more out of it. And then scientists, they've been talking to each other for so long, you know, they're using $5 words that no one else really uses. So if I can be that interpreter, that's really a great place for me to be.

Janet Kennedy (23:12):

And that's a challenge, not just on the pharma side. That's a challenge in healthcare when physicians are explaining issues to their patients, you know, are they speaking in plain language? Are they easily understood? As a matter of fact, I did an interview with your global health literacy person and that was the focus that we've got to put this information out in a way that people can understand it and take action with it.

Joe Kim (23:37):

Yeah, I mean just say the word rash, right. Don't, don't use the Latin words that that the five different Latin words that describe rash. Just saying rash. Right, or it works versus it's not working.

Janet Kennedy (23:51):

Absolutely. Well, tell me a little bit about where you think we're going in clinical trials. When you joined the pharma industry in the late nineties early two thousands you had one experience. If somebody were coming into the industry now, I'm sure it's a totally different experience. So over your 20 years or so, what do you see that has really changed in the industry?

Joe Kim (24:14):

The use of data to make decisions has been really transformational. I think I recall one of my earliest clinical trials I was working on and we were selecting which sites to go to. We literally had a stack of resumes that'd be go through and say A, B and C like yes, maybe no, which is not a great way to pick sites who might be useful or great at enrolling and conducting the trial. So even from a site selection standpoint, you're using more data to think about who's been really great in the past. Do they have access to patients? What does their demographic look like? So using a lot more data to do that. And then even further upstream thinking about medical informatics to design the patient eligibility criteria. So in the past you'd just be looking for, "give us all men who asked for directions when they're lost", right?

Joe Kim (25:07):

Not a lot, but now we have data to say, Hey, we want people on drug A not on drug B with this condition and not, and then let's see if that patient actually exists because that might be a perfect one for this study. But if they don't exist, this is not perfect for anyone. So we can use that kind of data to really find the right trade off between stringent enough criteria so that we find a signal, but at least have a enough abundance of patients. So those two things are been really game changing in terms of how we design protocols and set up the operations to do that. I think a lot of people are also thinking about this notion of a sightless trial or decentralized trial. I don't want to use the word virtual. I think that really means to trial without patients.

Joe Kim (25:53):

So like a simulated trial. So we should, as an industry get away from this virtual notion. I'm really think a bit more about these centralized to some degree or location flexible is probably more even more accurate. But it's the idea of how does a patient participate in the study without always having to go to the clinic.

Janet Kennedy (26:11):

How do you feel about the word hybrid?

Joe Kim (26:14):

Well, I'm not sure what you're hybriding what's the two, but really it's about flexibility and location. That's the name of the game. But you know, if you think about medical research as a set of medical procedures that all have to be done within a window, then you can really start to take apart this notion of a visit, visit, one visit to visit, three, forget to visit. Here are the procedures that need to be done, the activities. So you think of more of like an activity based set of medical procedures.

Joe Kim (26:46):

Now, which one of those can be done with telemedicine? Which one of those can be done with in home health, which can be done at a clinic, which can be done at retail, right? So not everything can be done at home. Not everything can be done through telemedicine. So it's really thinking about which ones can be done in a variety of, of ways. And even then we've discovered at Lilly through some of our research that a good healthy portion of patients don't want anyone coming into their home. They just don't, and I get that. My home is a mess. On Wednesday, I'd rather just go to the doctor. Now, do I want to go to the doctor to do a visit for three hours? No, but it'd be great to do what I can in that window if it takes me 30 minutes. That's how we have to start. You have to dismantle the visit construct and just think about individual activities.

Janet Kennedy (27:35):

Now you use the word retail. Are you actually thinking like someone going to a CVS or a Walgreens or a Walmart just to have a simple blood draw done or something like that?

Joe Kim (27:45):

Sure, that's possible. Right? It has to be done responsibly and rigorously, but even in some of our early pilots of flexible location trials, one of the drugs was marketed, so we were able to have patients pick it up from your local drug store instead of having them come into a site. Now this is a very different kind of study. It wasn't part of the efficacy trial, it was more real world evidence, but at any rate, it can be done under the right context. So it's really just about thinking under what context can X, Y and Z be done versus saying this can't be done, so you have to sort of pick and choose.

Janet Kennedy (28:21):

Are you seeing enough evidence that it's making a difference that it really can impact either the adherence levels of patients or the persistence of taking a drug by incorporating a variety of different ways to engage with a patient?

Joe Kim (28:36):

I think we are still trying to get good use cases under our belt. We being the industry in terms of what kinds of trials are fit for this kind of thing. The logical argument makes a lot of sense, right, so there is a logical argument there which is if you don't make it too inconvenient on a patient, they'll do more of it. Right? That's the very same thing to say. Now at the same time, there is a component of clinical research where the bond between the patient and the clinic staff is such that that's also a main contributor for why patients either stay in the study or are able to follow along what they're committed to do. Because you've got someone on the other end expecting you to cross all the T's and dot all the i's, and this is a, this is a component and behavior change.

Joe Kim (29:31):

There is a social component in behavior change and participating in research is behavior. Change is a social component that if that's there, you're more likely to have people stick to it when that's absent and there's no evidence of a larger connection with a person or people. Sometimes you could get really easy to drop off because guess what? No one's watching. No one cares. A research kit study came out years ago. Stanford, the heart health study. I joined that because it was super easy and I was able to do a lot of the stuff because I suppose super easy. I was walking my kids to the school. I did the six minute walk tests, but then after awhile I stopped doing some things. Now I get reminders. I ignore them. It was actually very easy to drop off without anyone calling me on the carpet. So you could argue that if you do everything virtually, you run the risk of people just disappearing because there's no commitment. There's no gym buddy. Right. To help keep you honest.

Janet Kennedy (30:27):

Right. Definitely. When we talk about patient engagement, a lot of people will think it's about pushing a button and really it's also making sure that that patient feels like their actions matter.

Joe Kim (30:40):

That's right.

Janet Kennedy (30:41):

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Tell me a little bit about your road show when you hit the road in 2020 I know you're going to be doing some speaking engagements. What are the topics you're addressing this year?

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Joe Kim (30:51):

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Well, because of my role as squarely focused on digital health and sensor research, I have to be careful not to be swimming outside my lane, though I have some knowledge and experience with things and traditional drug research. It's not my role anymore, so I have to be careful to let my other colleagues to represent themselves or our company for those sorts of things and having me kind of stay in my swim lane. While I'm happy to do it, I have to do it with integrity, I guess. So I've actually pulled back a little bit because to be frank, I'm not an expert in digital health and sensor research. I'm an amateur here and that's partly why I took the role is I want to be the dumbest guy in the room. Let me learn and get up to speed and grow my skillset and knowledge base. So I'll do a lot more listening actually this time around. But there's plenty of me on the airwaves through the podcast, so hopefully people aren't going to miss me too much.

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Janet Kennedy (31:49):

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Well, I think it's going to be a very exciting year, 2020 or 2020 whatever you want to call it. We're going to have, I think a lot of interesting changes come about as we finally fish or cut bait and we, as an industry, really start to include digital health and new technologies into the clinical trial process. 'm very excited about what's going to be coming up in the next year or two.

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Joe Kim (32:17):

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Yeah, me too. I think this notion of digital biomarkers is a key enabler of decentralized trials, right? So one thing that anchors people or science to the clinic is the fact that an endpoint needs to be done by somebody in person. And as long as that happens, you're not going to enroll somebody a hundred miles away. They have to be within a driving distance, reasonable driving distance, except for some exceptions like rare disease and oncology. But for the most part, if you're not in a reasonable driving distance, you're not going to enroll because the primary end point has to be done at the clinic. What digital biomarkers enable is for that to be done remotely through a sensor and now you're not tied to the clinic if you don't want to be. Now I'm generalizing, it's not going to happen for every single kind of study, but that is one thing that is definitely anchoring research to the clinic. So the more digital biomarker work we can get, the faster we can get to decentralized flexible location trials.

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Janet Kennedy (33:18):

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Absolutely. Well, I'm voting for that, and I really hope that that's going to be something that becomes much more of a reality going forward so that we can get much better representation in diverse communities and in rural communities involved in our clinical trials.

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New Speaker (33:34):

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Yeah, likewise.

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Janet Kennedy (33:35):

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Well, I can't thank you enough for being part of this podcast. Joe, you've been listening to "People Always, Patients Sometimes" with my guest, Joseph Kim, who's the senior advisor, digital health office, translational technology and innovation for Eli Lilly. Thank you so much for being here, Joe.

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Joe Kim (33:51):

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Thanks for having me, Janet. It was a lot of fun.