In our latest episode, we talk with Dr. James Dromey, COO of Murdoch Children's Research Institute and self-proclaimed 'digital believer'. 
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James gives us his insight into the balancing act between a measured, evidence-based approach, and the fast-moving, rule-breaking, 'start-up' mindset that innovation so often requires.

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About Ahead of the Curve in Digital Health

Welcome to Ahead of the Curve in Digital Health, where we take a deep dive into the growing field of digital healthcare each month.

We talk with experts in the field to uncover the latest digital innovations within the healthcare space.

Presented by Curve Tomorrow, a leader in digital healthcare that aims to improve 1 billion lives through transformative health technology solutions.

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Episode Transcript

My twitter profile says digital health believer. And that probably harks back to, you know, the digital health was kind of while it wasn't very cool.

It was science fiction almost!

I'm a believer, you know, so now you fast forward, you know, seven, eight years, and it is probably one of the hottest areas.

Welcome to Ahead of the Curve in digital health, a podcast about innovations, leaders and opportunities in digital healthcare. My name is Beth Caniglia.

And today I'm talking with Dr. James Dromey and national leader in pediatric medical research and digital health innovation. From humble beginnings, James now resides in Melbourne, Australia as the Chief Operating Officer of the Murdoch Children's Research Institute.

Welcome, James. And thank you very much for joining us on ahead of the Curve in digital health. It's a real pleasure to be chatting to such a leader in digital health innovation.

Thanks, Beth. It's great to be here.

Awesome. Now I understand that health innovation wasn't the most obvious path for you and that you started your life in different surroundings in Ireland. So, can you tell us a little about how you ended up in this industry and in this world?

So, I've been in Australian out for 17 and a half years came for two and came actually as an immunologist, research scientist, and I think I got out too early, right, because COVID made immunology, very sexy.

So got into immunology came to Australia to do a postdoc, so a researcher with my lab coat on, I don't think they let me near one now be quite honest, and actually just got a love for translation and turning research into something that's of value, that creates impact. So I could see that as a researcher, while I didn't really want to do medicine, I didn't kind of like the idea of you know, necessarily the medicine pathway, I love the impact that research could create. So it's always interested in the discovery, the curiosity, the innovation, learning something new. But I really wanted to make a difference at the end. And so the type of work that I did was always quite what we would call applied or translational.

And over the years, I had this opportunity to work with some amazing people. And one great example is a guy who started a company and one of the organisations I worked with, and I spent a year with him kind of learning the ins and outs of a startup, I'll be honest, was a fairly brutal exposure to startup biotech world in Australia many years ago.

But there it gave me a real taste for actually how do you turn something from an early stage research, idea into something that's going to have a benefit to patients, to families, the community at the end.

But even before that are going back, what is now, 25 or 30 years, if you'd asked me, ‘What do you want to do when you're grown’, I think I'm still asking myself that question. Now, you know, it's been a kind of a meandering course of curiosity is how I describe it. You know, I grew up in a dairy farm, the only son of a dairy farmer in Ireland, I had a very supportive family who said, ‘you’ve got to try university’ and thankfully, I went down that course. And while I really enjoyed dairy farming, I think, you know, the great experience of had travelling from Ireland to London, different parts of London, spent some time in France and then to Australia has just been incredible. But certainly it wasn't one where I said, ‘when I grow up, I want to be you know, I want to work in healthcare innovation’ - but it's certainly one that I've embraced, and I've enjoyed.

Awesome. And you touched on something there that's really interesting, because something a lot of the researchers we work with, they find difficult is taking innovations beyond the lab and translating research into sustainable businesses. And it sounds like that, was it a biotech startup experience you had? It can be a very frustrating experience for some, you know, I know the startup world is full of crazy highs and lows. So what were some of the challenges that you came up against? What were some of the advice that you would give to other researchers that want to take that plunge?

Yeah, it's been really interesting, I guess. Now, having lived in kind of two sides. One is a researcher in that lived experience, and now more as someone who helps facilitate innovation and try and you know, create a better way to translate your research into that ultimate impact, often, which involves, you know, creating a startup or working with a commercial partner, so I guess what I would say is that there's no right or wrong way. And often, you know, it's been really interesting the learnings, even through the institute here, where I didn't say, like the Murdoch Children's Research Institute, we have this incredibly broad research base run, and some of its very public health, population health based, has incredible impact. And I think that was highlighted with some of the work we've done during COVID. And some of the policy that we informed at the state and federal government level, and they kind of look at that and they say, well, too many times I think the sector in Australia focuses on commercialization only. And one of the reasons I got into digital health was because we sold it was all this great insights from research that didn't necessarily it wouldn't be suitable for a spin out wouldn't be suitable for venture capital investment, and is unlikely to attract a commercial partner in your standard commercialization kind of approach, but yet wasn't fully capitalised and stayed in the walls of this amazing building in the hands of these amazing people who were talking to other research leaders. And so a big part was how do you take some of this amazing insight and make it available to all stakeholders who would benefit from it?

And I think that's where digital in particular has had an incredibly powerful role. But one advice, I think, just coming back to your question, I think there's no right way. Talk to lots of people. And I think the sector has, you know, matured dramatically. You know, it's been really interesting talking about digital health now versus even in 2013.

When we started and I work closely with two of the founders and Curve kind of by accident, I guess they're already doing some work here. It's funny, someone pointed out to me that my Twitter profile, which I very rarely use, my Twitter profile says, digital health believer, and that probably harks back to, you know, digital health wasn't very cool. It was science fiction, almost.  So, I'm like, I'm a believer, and I believe there's something in this.

And now you fast forward, you know, seven, eight years, and it is probably one of the hottest areas. So, I think the pathways to create that impact are so varied, and there's so much opportunity. Now, when you look at digital, you look at public health policy, and then you look at commercialization, working with commercial partners. And sometimes I think that the sector here in Australia hasn't quite realised that yet.

We're still stuck in the old model of the commercialization one, and I think we've got to break that a little, but you did mention something really important, and that's sustainability. So we've also seen that a lot can be developed. And we've learned this ourselves the hard way, you can develop a lot, you can make it available. But unless you've got that business kind of mindset, and that sustainability plan and understand that you know, who's going to fund it? Who's going to pay for it? Who's going to support it? You know, who's going to continue to improve it, it just won't survive.

Absolutely. So you mentioned MCRI and ended up there 2021. So, what was that transition, like coming into this massive Institute and taking on this big role that you have? Can you talk us through, you know, just hitting the ground running and what that journey has been like for you?

Yeah, so I'll be honest, actually when I joined MCI, in 2012, I didn't know a lot about it. And I think the thing that struck me most was when I even though I only worked in another Research Institute, just a little bit down the road, what struck me was just the scale of what was here and this amazing environment of research institutes embedded within the Royal Children's Hospital run at this, you know, specialist, huge, incredible paediatric tertiary hospital and the benefits of having this almost access to the frontlines of health care.

From the point of view of seeing the everyday problems in healthcare setting, looking into how that extends out to the patient journey outside that continuum of care was just incredible. But I'll be honest, when I joined first, having come from an immunology background, where I was looking at things like drug discovery, vaccines, you know, kind of heavy formula, IP rights, and very kind of standard pathways to commercialization and pathways to impact, I was a little stumped to be honest thinking, how am I going to, you know, coming in as head of commercialization at that point, how am I going to actually drive commercialization in an organisation like this, we're probably over half of it is more public health based. And really, that's where I guess really started to look at digital health as a great means, you know, an enabler, a medium of how you solve the problem, or how you take something that exists, whether it be content or otherwise and put it in a way that people can easily access and use.

We've got lots of examples of that. I think we've over the years now created about 14 different products of over 200,000 users, using lots of trials validated a lot across many countries in the world. So, it's been really exciting journey. So, I guess that's how I felt was how am I going to commercialise stuff? And I’m probably realising more than anything, coming back to my earlier comment, it isn't all about commercialization, it actually starts with the impact. Impact is the driver, what difference is going to make?

In our case, how are we going to benefit children or families. I think commercialization is one method of getting there. I think some of our digital health products are not commercial, but they have enormous impact, and they are sustainable. And, you know, we don't want to get hung up on one and not the other, because it comes back to the impact. And then I guess four and a half years ago, I took on the role of CEO and an almost have taken a slight sabbatical from innovation with a bit of a heavy heart, but really starting to, you know, look at the organisation more broadly. And that's been really exciting as we're starting to look at what's the next chapter going forward for us and the incredible growth we've had over the last four years.

So, what would you say are some of the key factors that have helped you over the time that you've been at MCRI to deliver success in innovation? And, you know, obviously, it's not your key focus anymore, but what do you think helps digital technology and digital health to be successful?

I think there are a few things. So, I think, you know, in our case, we embedded Curve Tomorrow and I think that was a real game changer for us. And it can comes back to this incredible environment of you know, researchers, you know, from public health with this incredible breadth researchers working you know, many who are clinically trained working within the context of the Royal Children's Hospital you know, mixing engineering, design, software development, you know, and then that kind of business mindset was just this magical mix, right.

And we're naturally an innovative company, right and organisation, we've got about 1600 people's, staff and students, 65 different research groups working on everything from, you know, prenatal all the way to adolescent health. And so, it was really about how do we capitalise on this opportunity with all of these amazing insights and discoveries and turn them into something tangible. And I think having a team like Curve embedded and bringing in that external view, external skillset and bringing that almost structured innovation process thinking was very valuable. So that helped also the culture piece. So ultimately, and I think this has changed a lot again, over the years, but ultimately, researchers and thinking back is when I was researching myself, you were measured based on your publications, can you track funding its publications, now it's focused much more on, well, what are you doing about it? What's the impact you're going to create? We're not quite all the way there yet. But certainly, it's shifted a lot. And so having that environment that we created around innovation helped drive that culture of saying, okay, our job doesn't stop at the end of a publication. And being the fact that were already quite translationally minded as an organisation, it just helped really ramp that up.

Look, the other thing is similar to bringing Curve in was just bringing that external, in bringing the outside in. So we brought in a real mix of skill sets. So we had some entrepreneurs and residents, so people who had started up companies, but some in health, some not in health, and just need again, that fresh eyes fresh kind of lens to things. And that really made a difference then, because sometimes we kind of didn't know what we didn't know, when they would see opportunities that we wouldn't necessarily see that absolutely made a huge difference.

I got to give me a couple of examples. So there's a lady called Aenor Sawyer, who is a professor at the University of California, San Francisco, we've developed a very close working relationship. Aenor is just phenomenal but you know, very early on became an advisor to the innovation work that we're doing at the institute and the kind of things like she always talks about digital as this enabler. And in fact, you know, want to be careful that we don't immediately think of digital as the solution. And we need to keep an eye on what she calls the value to nuisance ratio. So, are we introducing something that's actually going to increase nuisance for an end user? Okay, and have we got that balanced nuisance ratio. And, you know, I guess playing off of that one of the things that we were doing was working in sleep and behavioural sleep, and recognised that there's this opportunity. We'd done these randomised control trials around some of the sleep interventions for young kids, and obviously a hot topic for any parents out there.

As a new parent, I can confirm.

And, you know, we had all these interventions, and we're thinking, what's the best medium to make these interventions available to parents, like you and others. And we came up with some digital solutions where you could screen essentially, to determine, you know, what's the behavioural issue, and therefore, what's the best intervention. And as we were working through it, one of the entrepreneurs in residence said, actually, I think are value to nuisance ratio is up. I was like, what are you talking about? He said, we're asking parents, we're saying, this is your problem, but then we're asking them to come up with, you know, might be something around the child's coming out frequently, after they go to bed, asking the mom or dad all the time. And so said, you know, you have to actually create this bedtime pass, for example, you got one bedtime pass per night. No parents is going to be wanting to create a bedtime pass, we're already busy enough. It's also why don't we make this into a story and create a series of books, where we essentially are reading to the child at night. And we're actually going through the intervention through the means a story so it's almost individual.

So rather than a digital app, which my first thought was I imagined you build an app for that – instead you used a physical object.

That's right. So we've actually got a book, not an app. So we've gone back, that’s the joke, we've gone back from, you know, digital therapeutics to paper based therapeutics. And we're just close to, you know, publishing these books now. So we've got a series of books, which are essentially evidence based, gone through randomised controlled trials with interventions written in essentially to the stories and we've created a little character written into these stories that you read to your child at bedtime. That’s just example of outside in lots of advice, lots of voices, different ways of thinking stuff we'd never have done before.

Well, that's fascinating. Because I wonder what's the pushback like for that from, say, the team that's like, they've spent all this time and effort on this amazing digital app? And then someone from the startup world, which is it's very, you know, what's the Facebook motto? Move fast and break things? Yeah, that's a real spanner in the works. So how does that culture clash play out in real life when you're going from just really agile, let's move let's try something different to we've got a methodology we need to take our time. What's that good interaction like?

It's actually really good. And I think the important thing being aligned, right. So yeah, it's really good now - when we started, was there some friction? Absolutely. Is there some friction now, for sure. So there is absolutely a difference in cultures right? So, if we're coming in, like you said, you know, move fast, move quickly, but ultimately, at the core of the institute, it's all about being evidence based. And so the validation piece is absolutely critical.

So we, you know, we're going to have to make sure that it goes through that rigour. And so sometimes we do have to slow it down. In this instance, the sleep example was an easy one, because it already been through trials. And yes, I recall a few meetings where we're going well hold on is that it's a terrible idea, actually, I think recall saying and tell me prove me wrong several times, you know, I just don't see that flying. But then it's the willingness to give it a try, to explore it. And ultimately, the clinical team were really supportive because for them, it's how do we take the work that we've done that we've gone to the trouble of validating, and if we're not going to be putting this into the hands of people were going to help. And that, in turn, is going to reduce wait times in hospitals, etc. That's exactly what we want to do as an organisation. So there can be a bit of tension. But I think we've seen over the years as well, there's much more alignment now between that need for validation, the regulation, and that kind of new startup break it, the agile kind of approach. And the two worlds are coming together, I think, and more like,

So where do you see the digital technology taking health from here? And that's I asked that question in light of COVID-19, where it's made massive changes to things like telehealth and people's adoption of digital technology to enable healthcare. Where do you see it all kind of moving to?

I think there's two parts. I think one is appetite creates urgency, right. So I think the appetite, you know, from everyone, myself included with the convenience of telehealth still just a phone call. But nonetheless, it's just so convenient. And I think people have recognised that it's something they want to keep, right. So that's clearly going to massively influence and shape and put pressure on the need to change. And we've certainly already seen and experienced that. And I think following that there's this urgency, right? There's like, well, we have to do this, now. It really is this moment in time, I guess, around the value of digital.

I think what will be interesting to see is where we land if we were to fast forward five or six years, and I don't think we're going to be entirely digital. And many of the promises we had, you know, 10, 15 years ago, aren't fully realised, and I think the importance of the human interaction is still going to be there. And certainly the need to help people find and navigate their way through a system is still heavily required.

But I think it's an incredible moment in time. And certainly, as we're looking at it, the appetite, internally, externally is just, it's just fantastic to see. And I think it's really accelerated and it's put it on the map. I mean, the digital health sector is really interesting in Australia now.

And I suppose that brings with it a lot of new challenges, in that there's even more of a push to move into that discomfort, as you were saying, you know, that's been a little bit of tension on that relationship between the startup and the need for innovation versus that need for slow and steady and evidence based. But you know, hopefully, that's all a good thing.

I think it's a great thing. And, you know, when I look at the maturity now of the digital health sector in Australia, and I think, you know, you look at something like ANDhealth, which we've talked about in the past, the way in which that's come and evolved to digital health sector and rolled those two worlds together. So how do you create these startups and try and use some of that startup methodology would have the rigour around the evidence base, the clinical validation, you know, I think it's just incredible. Now having seen that evolved, and I think, you know, as the sector in its own right, and having a voice in its own right is incredibly powerful.

Absolutely.

Well, thank you so much for your time, James.

If you enjoyed hearing James's story, and you keen to hear what we talk about on our next episode, please like subscribe or drop us a rating will chat to you next month on ahead of the curve in digital health.

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