On Digital Health with Debbie Gamble and Zayna Khayat

Debbie Gamble: I’m Debbie Gamble, Chief Strategy and Marketing Officer at Interac, and you’re listening to Everyday Trust. We are witnessing a period of accelerated digitization in Canada. With this come new opportunities and increased efficiencies. It also highlights one of the most important questions innovators face today. How can we give Canadians the confidence they need to participate fully in our emerging digital economy? The answer that I come back to over and over again is trust. Trust unifies our families, our communities, and even the way that we’re governed. Trust can take years to build and a singular moment to break. And in a digital world, the way we build and maintain trust is constantly evolving, and we need to stay ahead of the curve. In this series from Interac, I’m talking to leaders about what trust means to them. A quick update for our audience. After this interview was recorded, Zayna transitioned to a new role as Health Futurist at Deloitte, which sounds like a very cool job. Now let’s hear from Zayna.

DG: I’m excited to be talking today to Zayna Khayat. Zayna is a leader in the future of health. In fact, she was recently recognized as one of the top ten women shaping the digital health landscape in Canada. She’s the Vice President of Client Success and Growth at Teladoc Health. She is a global leader in virtual care and before that, she was the Future Strategist at SE Health and led the Health System Innovation Platform at Mars Discovery District, the innovation hub in Toronto. Zayna also teaches Health Sector Strategy at the Rotman School of Management. Zayna, thanks so much for taking the time to chat with me today.

Zayna Khayat: Excited to do this with you, Debbie.

DG: Me too. So, let’s kick off our conversation by defining some terms. What is health care at the most basic level and what does trust mean in health care?

ZK: Before we define health care, let’s define health. That’s why we have health care. Health is what you are and what you can do for yourself. It’s the result you want. It’s you. It’s not the absence of sickness as we like to think. So, when do you do health care? Well, when you can’t do health for yourself, and you need to go to somebody else. It means you’re outsourcing your own health to an agency because you don’t have the tools or the knowledge to take care of this very complex thing called the human body and mind. Then, what does trust mean in this context of health care when you’re outsourcing to an agency? Trust is like lubricant. When I think about trust, I think about three things that make it up: transparency, authenticity, and benevolence. Just knowing that who’s giving you this care is doing it for the right reason and for good. This kind of trust in health care doesn’t happen on one encounter, one visit to a hospital or a pharmacy. It’s built over time with fidelity and consistency. I know, Debbie, you’ve been at this for a while. How does that framing of trust compare to other sectors? Are we way out to lunch out here in health care?

DG: Not at all. I think it’s interesting how you could probably apply those three very important factors to pretty much any industry. But I think the importance of those three points resonates across sectors. When you started with transparency and certainly in my world of payments and identity and security, transparency is all about, being able to see what’s happening in a way that allows me to feel comfortable, confident and maintain a sense of control. Authenticity is incredibly important. Not only from the perspective of ensuring any engagement, digital or even an analog is authentic, but certainly, in the digital realm it becomes even more important to ensure that you can trust who you believe you are engaging with. And certainly, benevolence in my world is probably characterized more in a way of are you ensuring that my interests are a priority and are relevant to my needs? I think those three factors that you highlighted are incredibly important regardless of the industry, but it certainly resonates as it relates to health. Let’s think about trust from two perspectives: the challenges and the opportunities. So, the first one from I guess the weakest link, where is trust in the health care industry the weakest?

ZK: I mean, if you think about all the points where trust can be created or destroyed and broken, there are millions of interactions a day in this country alone. And, in any business you can break it into one interaction. So, let’s unpack a couple of the areas. On transparency, there is a massive information asymmetry: we don’t really know why decisions are made about our therapies and tests, our results are held from us. There’s a strong belief to this day from clinicians that we can’t handle our own data about our own body, and we’re not really given choices or alternatives to optimize decisions about our health for our situation. We’re given what works for the average, which actually means it doesn’t work for anybody. And then, just on benevolence, if you think about it, health care is going through what I call a Copernican shift. Well, our health care system was designed around the system, around the payers, around the buildings, around the clinicians. But the center should be patient. That’s why we have health care. So, we’re in the middle of this major Copernican shift. That’s gonna be a source of creating trust in the future, but now, has it broken trust? And then the second area where we’ve broken trust is a little bit more pointed, and that’s many populations that have been marginalized and have learned to have a growing distress of health care providers and systems: our indigenous communities, black and other racialized communities, LGBTQ. Particularly right now, there’s so much data on people going through a transition where the medical establishment is actively asking them not to proceed with what they’re trying to do because that’s their own biases. So, these are major places where trust is broken. I actually think what’s coming around the corner is gonna help us quickly close that trust gap.

DG: I agree and again it’s interesting regardless of the sector those points resonate. So, customer centric design of course means that the customer has to be at the center. But the notion of the importance of inclusivity is key here. We all know that the more inclusive the design the better the outcome will be. Even in the payments world this is incredibly important to us and this notion of digital engagement, our digital reality and I wanna talk a little bit more about healthcare in our increasingly digital world. Before we do that though, I guess a basic question is why does healthcare need to go digital?

ZK: Pick a study that racks and stacks any global core sector of how much it has digitized to date against how much it has to go of what can be digitized. Health care tops them all. We’re more behind than construction, agriculture, mining, these extremely asset intensive industries. And in that context, why digital? I think of three main reasons that have been the obsession of all of us in digital health for about thirty years. One is affordability or fiscal sustainability in health care. When ninety percent of your care is labor and there’s just no way, because care is growing demand is growing exponentially, and you can’t add enough people, buildings, and beds exponentially, it’s a linear, industrial model. We’re just so behind in digitizing all our analog processes and infrastructure. Most studies estimate twenty-five to forty percent and those are big numbers. Twenty-five to forty percent of everything we do in health care today is either wasteful, duplicative, unnecessary, or harmful. So, Debbie, imagine you were running a business and forty percent of your delivery was inefficient: you would be out of business. We’re asking our health care providers to do one, three, six hours of computer work a day, documentation before the shift, after the shift, during the shift. There are a lot of those cognitive tasks of health care, that a machine can do better, smarter, faster and cheaper. We can start to shift, and free up the human to be human and why you need humans in health care, and you will always need them. It’s fundamentally a people industry. Secondly, once you’ve digitized, now you’ve got an intelligence layer of health care. Every transaction, every action produces data that has secondary use. You know this in every other industry. We don’t know about this in health care. So, we get better clinical outcomes, much smarter investments, and you actually can create an ROI calculator in near real time. We’ve never had that in health care. So, I always say we move from an evidence-based health care system or even I would suggest we have a reimbursement-based health care system. We only do what gets reimbursed to an intelligence-based health care system. Number three, which is what I get excited about as a futurist, is digitalization allows us to do things we simply can’t do in the analog channel. Reminder, we’ve been doing it analog for a hundred and fifty years. So, we’re talking about some amazing new opportunities, but, wow, are we disentangling some very locked in institutional mindsets? That way we can deal with inequitable access, resilience to shocks like COVID. We had big supply demand imbalances in COVID of PPE and vents, people and vaccines. Well, you can digitally distribute that. And then most importantly, we can evolve our care models to keep up with the times, and we haven’t been able to do that. We’re gonna democratize access and overcome a lot of barriers in the analog channel on, you know, inclusion, cultural norms, language, all those things digital takes care of. Forget the clinicians, but us as consumers or patients, as you’ve said, we’ll have a lot more control, more agency, at least joint decision making over what’s done about our body and health.

DG: This seems pretty obvious, right? From the operational efficiencies that you mentioned to inclusivity, to the intelligence of okay how we can continually optimize, continually improve, and put back the control in Canadians’ hands to managing their own health. The way technology and digitization can truly change the way we go about our day to day and our environment. As Canadians, we’re an aging workforce. There are many opportunities here and this is so important to the future prosperity of Canada.

ZK: I couldn’t agree more, Debbie. And I see what Japan’s doing, what Germany’s doing, even England, Australia, China in seeing this lever of digital health as a fundamental value creator for society and for the economy. And then I look at Canada, and we’re just not seeing and framing it that way. I really see a big opportunity there, that we’re missing out on.

DG: So maybe we need to join forces, Zayna, and make sure that some of these opportunities are acknowledged, recognized, and addressed. Let’s think about what happens when the health care industry goes digital? What does that look like?

ZK: So, every jurisdiction in the world is going through this digitization. We’re all at different maturity models. I’d say the most advanced I’ve seen in the world as a country would be Estonia. There’s a whole mindset there, but others and we’re very early in this journey. The first step of what it looks like is, as we’ve talked about, just digitizing the most basic analog processes like forms. You know, I did my vaccine the other day at my local pharmacy and the whole setup was digital. You know, I made my appointment, I put my intake form online, showed up, then they gave me the clipboard with the pen, and I repeated all the same information that nobody’s gonna read. That’s everywhere, and we all can relate. That will get to the third, twenty-five to forty percent inefficiency. And that’s now getting into those the second and the third buckets I talked about: an intelligence-based system and digital allowing us to do things we cannot do analog. And I think about five big shifts. One, it’ll move from being reactive sick care to being not just proactive, but predictive. There’s an entirely new practice of medicine emerging called predictive medicine or predictolytics. And some health systems like in Israel, they have all the data, twenty years from womb to tomb, birth to death. They can predict you’re gonna have kidney failure. They can predict when you’re gonna have a schizophrenic episode and reallocate the health care resources to actually stop it from happening instead of mopping up the mess when you’ve got symptoms. So that’s gonna be a game changer, predictive medicine. Health care today is episodic and intermittent. That will all shift to being continuous, to being much more integrated and kinda what we call whole person. You will not be the sum of diseases and body parts and treated that way and be expected as a patient to stitch it all together. The third shift is from this kind of very crude one size fits all paradigm to hyper personalized and very tailored, very configured one. Let’s think about personalized medicine. That’s a very popular word, and we obsess about, like, your genetics predicting if a drug will or won’t work. That to me is a minor use case of personalization. Personalization might mean Debbie prefers to access health care, while at home because she can’t drive for four hours and prefers to engage in a different language. That’s personalization in my opinion, but sometimes it could be your biology as well, and science is getting amazing there. The fourth shift is the modality or location or in the retail world, we’ll say channel. We have had mono channel for a hundred and fifty years called you come to the clinic, you come to the hospital, you go to the lab, you go to the pharmacy. Just like there’s no more retail banks or very few or you rarely will go to the mall to shop, that decentralization will come to health care to really a kind of a care everywhere. That’s gonna be a big deal for a lot of physical assets that we built over time. And then the final shift, Debbie, what does it look like with digital? And to me, this enables all the others to change the business model. We’ve had one business model for a hundred and fifty years. I don’t know a single industry that hasn’t evolved its business model except us, which is a fee for service, pay for inputs activities, pay by the pill, by the visit, by the MRI test and we can finally shift to fee for health. That is gonna unlock a ton of value.

DG: That’s a key element of innovation, right? Changing the model, changing the paradigm. Lots of people think about innovation as technology, which it is, but there are many things that can be innovated to be able to really change that experience. I think though one of the things that is super important and certainly in my world which sounds like it is also very applicable in the healthcare world is relevance. So that hyper personalized engagement model as you say might just be because I have a particular desire or preference around not traveling. It might be because I actually have a complicated set of medication that needs to be taken in a particular way. But how we can, as futurists like yourself, working with technology and some fabulous capabilities out there, remove all of the friction and make that for the customer, for the patient.

ZK: I mean that’s my life’s work.

DG: I think this is where our whales collide, right? Is that kind of how can you reimagine that experience in a way that’s intuitive and in a way that gets us all to the end goal as we said earlier which is health and prosperity for Canadians?

ZK: I do wanna pick up though. You mentioned verification and that aspect of authenticity and cyber trust if you will. Tell me a bit about how you see that help fitting in with these shifts I talked about in digital health.

DG: I think the notion of being able to deliver a simple experience, a simple engagement to a customer, to a patient in the health care world where that patient can engage and feel confident that they can log in. They don’t have to worry about personal details, they’re confident that there is a secure simple engagement process, and they can then start to navigate whatever it is that they’re trying to do whether it’s to book an appointment, verify a blood test or do a regular health check. So, the notion of whether you want to call it ID or verification or authentication is critical for us to be able to engage in a digital reality. Whether it’s digitizing a form, so somebody doesn’t have to collect it, key it in, verify it. If you can do that in a very easy engagement to authenticate and verify who you are and if you’re engaging with the right person, then it actually removes all the friction and we can move away from some of the rhetoric around privacy and security and actually just start to think about how we deliver better experiences. How we put control back into the hands of Canadians to manage their health. To have access to the data, be able to remember if I have done my fourth booster shot or not, to book an appointment without the nightmare of trying to get through on the phone line to your doctor’s office which just doesn’t work for anybody. Back to your point, the promise of these richer experiences really relies on fundamentally being able to provide that interaction with many of the service providers in the digital environment both in the payment space obviously but in other sectors like the healthcare sector. You know, better business models, better business cases, but ultimately giving, Canadians control of their agency.

ZK: Debbie, I love that framing. So, a couple quick reactions. My mind’s a little bit blown. One is the fact that our health system is going to a trusted brand and set of capabilities like Interac to build these things. Instead of what we love to do is build it all in the house ourselves because it’s not enough just to be amazing at medical care. We have to be great at cyber security and documentation and build these core competencies that are not core competencies. So, I think that’s gonna go a long way. But secondly, the way you frame the value of verification, you didn’t give me your technocrat. That’s not the language we use. We talk about why you need to verify because we come from a place of risk, not to unlock this value from digital and health care. I just think it’s a huge reframe that’s sorely missing.

DG: So there has to be a level of confidence and security in the engagement and luckily for us technology has allowed us to do that whether that’s kind of voice recognition, whether it’s facial recognition. We do that every day buying a cup of coffee using our phone, right? As Canadians we’ve done this for years in the payment space tapping your debit card at a point of sale. You don’t think as a consumer, oh how risky is that transaction because it works the same way, and it works that way every time and it’s what technologists do is they try to build in those capabilities to make sure that behavioral change can happen and that happened in many different industries. So, it sounds like we are at the right point to start to apply that to the health care industry.

ZK: To put a finer point though, that said, given the amount of data generated in health is on an exponential curve and depending on what report you read, Debbie. So, I think a year ago, the number was that the health care dataset globally is doubling every eighteen months. The latest was seventy-three days, and I’m sure it’s the same in every industry. We were never designed to process, manage this amount of data because everything we generated data wise was largely analog for so many decades. So, there is a long history, and maybe it’s rightly placed, of what I call privacy panics. I just find the panics are based on not something actually happening. It’s about what could happen. And I see every time statements when we see a new technology that can enable, let’s say, an AI that can do all your upfront diagnosis before a doctor appointment, which is in the market in most countries. Here, people say there’s no chance in hell that will ever happen, or we’ll never share the data with the patient. You’ve just now tuned everybody out. So just thinking about these I don’t know if you call them privacy panics.

DG: I’m sure they’re not unique to health care. What’s our most important asset? Our health. So, this is not trivial. It’s super important and our privacy goes hand in hand with that. At Interac we’ve done a number of research activities and in one of the recent surveys over sixty percent of Canadians that we surveyed said that they care more about keeping their identity data safe than they did in the past. So, it’s a really important topic for us, and I think a lot about how we do that. How do we ensure that you can authenticate easily? How do we deliver confidence into the ecosystem? How do you ensure that those experiences work the way you expect it to work the same way every time? That’s how you change behavior. So, I think there are definitely some learnings from the payment space that we are applying whether that are some technical terms like credential management and tokenization where privacy and customer data is actually not shared. Given the vast changes that you see coming in healthcare, what do you think we can count on, and what will stay the same?

ZK: In the future, and I think this lends itself to what you do. Whenever I teach at the university, I get asked a lot from people who want me to mentor their children, who are going to university, what are gonna be the big jobs in health care? What don’t we have enough? Other than, obviously, nurses and clinical, it’s three. Data and coding, we’re gonna need it like crazy in health care. Cybersecurity, we will not have the capacity given the data. And ethics. We are gonna need ethicists and a way to have a conversation as a global species about what will be possible in health of humanity, and we don’t have a framework at all. We need the framework like we have for climate change where the world can have an approach and we’re gonna need that for a lot of things coming in health care, and we’re nowhere close.

DG: To your point, I mean those three things are a constant actually regardless of industry also, right? Data, cyber security, and ethics and I think, I’m sure universities are all getting ready to teach programs around ethics because it is going to be so important to every industry. I like to close off these discussions with a handful of rapid-fire questions if you’re up for it. So, Zayna if you could complete the sentence. Trust is just another word for

ZK: In a health care context, we got your back when you need us.

DG: Love it. The most trustworthy person I know is?

ZK: My mom.

DG: What’s one thing an organization could do to quickly earn your trust?

ZK: Well, that’s easy, Debbie. We’re gonna bring it back to where we started. One of these three, transparency, benevolence, or authenticity.

DG: Zayna, it’s been insightful, and thank you very much. This has been a great conversation.

ZK: Thank you too, Debbie. You’ve actually helped me think about my own industry very differently. So much value in analogous thinking, and this platform is perfect for that.

DG: Thanks, Zayna.

Conclusion: For Zayna, trust has three components, transparency, authenticity, and benevolence. I find this a fascinating way to think about trust. These are essential considerations as we think about the future of our health care system where trust is paramount. Canada needs to ensure we get this right. It’s no secret that the Canadian health care system is due for a paradigm shift. And as we heard from Zayna, trust is a huge part of that. After speaking with Zayna, I find myself thinking about how health care will evolve over the next decade. While eliminating long wait times and some of the more analog systems currently in place is an important element, my sincere hope is that we can build a more patient centric system, including putting the control of patient’s data back into the patients’ hands in a secure, accessible way. Giving us all access to information about our bodies and, ultimately, our own health is key to building trust in the health care ecosystem and removing some of the barriers that challenge trust. To accomplish this, Zayna believes health care delivery needs to be designed around the needs of the patient rather than the requirements of the system. Interac can play a key role here as we work to close the trust gap in the digital economy. Today, Interac provides verification solutions that are helping Canadians connect with many public services. And our consistent and reliable delivery products like Interac e-Transfer and Interac Debit have earned as a place amongst Canadians’ most trusted brands for years. We can apply the knowledge we’ve acquired from payments and from credential management, where consumers’ data is carefully safeguarded to other industries. Canadians won’t tolerate risk in their dealings with the health care system any more than they would with payments. And quite frankly, why should they? Thank you for listening to Everyday Trust. If you found this conversation valuable, please take a moment to subscribe to the show and rate and review us on Apple Podcast, Spotify, or wherever you get your podcasts.