Optimizing Pharmacy Efficiency with Precision Dosing Technology | Sharmeen Roy, PharmD, BCPS DoseMeRx, CSSO

This transcript was generated automatically. Its accuracy may vary.

[00:00:49] Mike: Sharmeen,, introduce yourself to our listeners.

[00:00:52] Sharmeen Roy: My name is Sharmeenn Roy. I'm the chief strategy and science officer at DoseMe. Me has a platform called DoseMeRx, which is a precision dosing platform. I oversee our product and I was talking to the pharmacists that are using our product.

[00:01:08] Mike: All right, Charmaine, you're down in Miami, I'm sitting up here in Michigan. It's a balmy seven degrees. What's the temperature there right now?

[00:01:16] Sharmeen Roy: I think it's in the high 70s or mid 70s. Maybe it's just gloomy and raining. And

[00:01:22] Mike: Yeah.

[00:01:23] Sharmeen Roy: The sun goes away in Miami, everybody complains. I'm actually originally from Chicago and,

[00:01:28] Mike: So, you know what we're going through here. 

[00:01:29] Sharmeen Roy: Yes, so I have family there. I know exactly how cold and bitter that wind can be.

actually in Chicago emailed me earlier and mentioned that it's minus one today and

So,

I should probably stop complaining and just, you know, appreciate that

in the seventies.

[00:01:49] Mike: 

So, Charmaine, the way you describe this, I'm thinking that your customer is somebody who picks up the phone and is using an app there. Correct dosing. Is that, is that kind of the nuts and bolts of it?

[00:02:06] Sharmeen Roy: So it's actually a precision dosing software. It's not on the phone.it's on,in the EHR

Yeah. So it's not an app. I mean, you can, I guess, access it on,

or whatever,

[00:02:19] Mike: it's not something you pull up for 10 seconds to get a quick answer. It's something that's more in the EHR and so on.

[00:02:25] Sharmeen Roy: So, I mean, the goal is to have it where it's very quick and easy to do something that's complex. So that's why, the users, which are clinicians, at the bedside, love it because,all that complicated math we learned in school

We don't like to think about it.

All those pharmaco, you know, PK equations are done kind of in real time.

[00:02:51] Sharmeen Roy: So yeah, the, definitely appreciate it because, you know, we're all strapped for time these days, and resources for that matter.

[00:02:58] Mike: 

What are some of the main calculations that a pharmacist, a clinical pharmacist, is going to be doing these days?

[00:03:06] Sharmeen Roy: So its precision dosing is a term that's used for like. Everything, it's a big umbrella term that can be used for multiple things as it relates to the software that is doing the calculation. It's really a PK model.

So it's an algorithm built into the software. And then it takes patients ' information to do those calculations. So the PK calculations, as you remember, we're mostly for anything that requires therapeutic drug monitoring, so you're doing levels for drugs. I know we're not going to talk about specific drugs,

[00:03:35] Mike: You can mention them only once. So here's your chance. What drugs are we talking about?

[00:03:39] Sharmeen Roy: mostly antimicrobials like vancomycin. like a size anything, any drug really that has a narrow therapeutic index. So, you know, you have a very small window where it works and outside of it. It either doesn't work or it's toxic, so we're trying to manage that very, delicate balance. and the software helps do that because for anything that needs therapeutic drug monitoring, you need to do the right thing.

Kinetic calculations. So those are the, those are really the, the drugs that the clinicians are using our, our software for

[00:04:10] Mike: there's some antibiotics that you just can throw the kitchen sink at, you know, aMoxicillin or something. You don't care how that's dosed because there's no upper end of really danger. the stuff you're talking about, I imagine that pretty important drugs because if you didn't.

Need that important drug. Why bother with that stuff? Just use something that's safer and easier to dose and just use that instead of people not using your thing just for fun. So I'm imagining that the drugs that you do, it's like they have to stay in that therapeutic range and they're important drugs because no other drug is going to do what those kinds of drugs do.

[00:04:55] Sharmeen Roy: Yeah, so I mean, antimicrobials, for example, there's a lot of different classes and things can be used interchangeably. That's, now, when, when a patient is starting on a treatment, when you discharge them, you obviously change them to something they can take at home. So there's obviously a lot of interchanging that happens, but these are medications used mostly in acute care settings.

So inpatient where you're receiving IV therapy. but really the goal is to, and, and these, these antibiotics, they can't like, you have to use them for these certain infections, so there

No other or even if there are, maybe they're not the best choice.

So there's really not an alternative to them. So that's why they're being used. currently, for the setting.

Patients look different. Clinical trials were different. And our patient population is changing, you know, everybody's, you know, there's, there's different factors. You have to consider that patients are getting older. know, the way they process medications is different than what we may know of.

And over time, we're also learning more about these medications, so what's the best and optimal way of dosing it. And, you know, for antimicrobials, for example, certain ones, You know, targets have changed, so we've learned more and more over time how to optimize it. I mean, I think with a lot of medications, it gets approved.

You start using it. And then as you start treating patients with it. That's when you really learn. what happens in the real world, what kind of challenges you face. I'm trying to be more individualized and provide more precise dosing. it has become more and more important to use softwares like this.

[00:06:32] Mike: And that might be things such as, Hey, for this kind of thing, we don't need this high of a level, so let's not do that. And plus, this person has this or that, so the range is down to three. We just don't have as big a range. So it's all that experience that happens and ultimately just to do a better job at making the person healthier without any.

damage from the drug.

[00:06:58] Sharmeen Roy: that whole notion of one size fits all giving the same dose to every single person, whether it's antibiotics you know, oncology medications, for example, It's really hard to apply that to everybody now, especially with all the data that's available and just all we know really about how medications work or what their toxicities are, what their long term effects are.

 It's just making it, just trying to be better with our dosing. And, you know, that's what pharmacists care about. I know we're here to talk about business at pharmacy, but really the clinicians want to make sure they're giving the right dose. to the patient. and for the right indication that may be different.

[00:07:39] Mike: Yeah. and if the pharmacist doesn't do what they need to do the patient dies, that's the business part of it. You have to have a good product in the end to have anybody make money or pay for anything. So that's where the medical part of that comes

[00:07:55] Sharmeen Roy: This severe effect would be death. And, you know, we never want that, but there's a lot of other, adverse effects. That causes you to live with a lot of disabilities or you have acute kidney injury. So, you know, if you incorrectly does something as a medication and then patient ends up being on dialysis, that's also an added expense, 

we have to think about the adverse event, like what the cost of adverse events is.

that means to not only the patient, but all, you know, and the quality of life, but also the health systems, the

are that keep continuing to rise. 

[00:08:32] Mike: Charmian, As I think about this product and having it in the system, does it then talk to any of these machines?

So you take out the human error, or is it still like looking at what the screen says, and then you got, you know, hired incompetent Mike in there for some reason. God forbid, even in this story, it's scary to think that I would be hired by somebody like that, but let's say I messed something up in the translation. Are there safety things in play or is it just the information?

[00:09:06] Sharmeen Roy: So the software is still, clinical decisions, support software. So it's not making the final decision. The clinician, the doctor, the pharmacist, whoever is using it still has to be the person who ultimately decides, because you have to remember with these pieces of technology, The human still has the full picture, 

of everything that's going on. So that assessment still lies with the clinician. And, if that ever changed where it's automatically talking to, the pharmacy system to tell it to change the dose

[00:09:39] Mike: it becomes a device. So that's not where this is. This is a clinical decision support software. So you still need that human to make that final decision. 

That's a strong delineation on that because you're right. I imagine it's a whole other. Ball game as far as even if it did like one little thing, like entering anything automatically. Now you're looking at a whole different product and FDA, you know, kind of like the difference between nutraceuticals and actual medicine or something like that.

[00:10:12] Mike: It's like a whole different ball game on what road you have to go down for approval and just the focus of the company too. 

[00:10:19] Sharmeen Roy: It's definitely different. It turns your software into a device at that point.

that is not the case, at least for now. And I don't think it's going to change just because I don't think the humans going to take the humans out of the equation, hopefully,

You know, when I was, I still think back to the time where I was, so I went to school in Chicago at University of Illinois. In the process of applying, you have to go through an interview process.

So you, you know, interview with anyone who it can be just a random assignment of a, of a faculty member. And I remember when I got assigned, I thought for sure, when I left, I'm like, there's no way I'm getting into pharmacy school because he asked me, he's like, well, robots are going to take over your job.

So why do you want to be a pharmacist? And I argued that that's not true. And he's incorrect in that assessment, that robots are not going to take over our jobs. They're going to just, you know, they may help us.

our job is better, but I don't think they're going to replace us. And I still, you know, believe that because you still need that human to take care of the patients and to make those, you know, information that can't be algorithmically Programmed into a software. You still need that kind of, you know, person to put all that information together. So I still believe that. I hope I'm going to be true. But you know that I still remember that question. It comes back and ironically, I've ended up in a role where I'm constantly working with technology.

So it's kind of, you know, ironic in that.

[00:11:44] Mike: Well, I, my listeners always hear this, but you talk about different things, AI and stuff like that. And it's like, all right, so that's going to do everything. It's like, all right. What's happened to the average lifespan now hasn't changed all that much. What's happened to compliance, what's happened to, you know, rates, all that stuff.

It's like. Yeah, there's a lot of technology out there, but until you wake up tomorrow and everything's 100 percent solved, there's still going to be room for humans in there because we know now that way you live with AI is it's no longer the, answers you're looking for, but it's the, Creativity of the questions and the creativity of the goals and things like that.

That's like the new, the new skill, you know, it's, where should this technology go? And humans still play a pretty big part of deciding that.

[00:12:32] Sharmeen Roy: yeah, for sure. It's one of those things that's not going anywhere. You have to use it. you can't fight it. You know, it's too late for that. to just kind of see how it's going to help you. 

There's a lot of things we don't like doing. We have to. But if I can figure out I can have a helper, an AI helper takes care of that. It just makes it easier for me to focus on the more important things that I have to focus on. So, I think we have to think of technology and healthcare the same way. You know, you can't be afraid of it. You have to just really use it to take care of things you don't want to really take care of and does it really need a pharmacist in this case to do some of the things that we do, if you approach it that way, I think there's really nothing to be scared of.

[00:13:13] Mike: Well, it's kind of like, I'll just say this show it's like, all right. has made this little hobby of mine quite nice because I can, you know, take the transcript of this and say, come up with 10 titles for me. And okay. I kind of like title three now. Give me 10 more titles on title three, you know, and I can do this and that.

It makes it sound better and all that kind of stuff. But it's like, look around, not that I care because I like people in this field to come out with more podcasts and stuff on this. I look around, it's like no other ones have popped up. It's like, it helps me who already has this going, do this better, but it's not like.

You know, it's not like it, at least currently it still takes a human that kind of has that drive and that desire and that kind of stuff. So I think so far AI has done a lot to help people that are already there, but it doesn't matter, get up and do something like this.

And that's across the board.

[00:14:16] Sharmeen Roy: Yeah. And it's like you said, the new skill is what you tell it, you still have to be the person who does that, 

not going to think for you.

it's not going to just say, here's what you need to do. You have to still prompt it. So I think how, in healthcare clinicians have to think of technology the same way oftentimes, you know, we hear, oh, is this, they're afraid of some of these softwares that are doing these calculations and things like, oh, well, that's my job as a pharmacist.

[00:14:42] Mike: And really that shouldn't define what a pharmacist does. It's not a bunch of math you're doing. You also do, you know, it's like the thinking behind it and how you're going to apply it. So if something can do the complicated work for you, and then you can take that information, apply it and provide better care and more informed care. I mean, that's really how everything in health care needs to be approached. 

I was just talking to someone the other day about this, about the different levels of AI. And I mean, it's coming where right now, of course, when I was a kid, we always talked about computers coming in and wiping out the blue collar jobs, the robots, the Jetsons and all that.

[00:15:18] Mike: They were going to wipe that out. And now it's like. Damn, if I had to go to school right now, I'd go be a plumber or an electrician or something that AI is not going to come in and, you know, they don't know how to fix my toilet, you know, that kind of stuff. AI has come from the white collar down and, you know, different levels.

I mean, I can picture someday where you've got the white collars and pretty soon AI is at this C level,

You know, they're making those decisions. And pretty soon AI is in the corporate world. You know, a boardroom with five, six people, including the CEO and AI is making better decisions.

So that might be coming.

that doesn't happen overnight. You deal with where you are now. I mean, if you were afraid of that, you'd be afraid of paper taking over stories around the campfire and you'd be afraid of, you know, calculators, figuring out math problems that it used to take a bunch of people with, you know, Slide rulers and stuff doing it so it doesn't happen overnight and as humans we adapt and we change and we've got to have that symbiotic relationship with a i just as we've done with everything through the years

[00:16:28] Sharmeen Roy: I think people underestimate how much technology is part of our life and

simplest things, remember one of the talks I gave was a picture of a doctor doing a pulse check then one with a stethoscope.

That's technology. Right. People may not think of it that way, but it's, you know, it's still made our lives easier. And we now it's, it's part of our daily activities and I guess they don't realize how much technology we're using because I think the perception is that technology is something on the computer, 

 everything else that we use that makes our lives easier. 

[00:17:03] Mike: Yeah. And typically you have early adopters where if you think back through all that stuff, think about, like Bitcoin and NFC, you know, the concert tickets on the handheld and all that kind of stuff. And there's early adopters. It goes up and then it goes under the radar for about five years.

In the meantime, all these companies are using, I want to say Bitcoin. What is the, what is the stuff behind Bitcoin? What's that term blockchain? You know, you look at things like, the basis of it, the blockchain and the AI and the calculations that start coming up through things like, automatic grocery.

Cart screen or, you know, just things like that, that people don't even know how it's do. But it's that stuff that we saw five years ago as early adopters went below the level. And now it's helping my grandma Do something. Nobody even knows what it is.

exactly. We're just so used to it. We don't even think about some of the things, like you mentioned there, how many people get there. grocery shopping versus, order and have it ready for pickup, you mentioned how much it helps the elderly, 

[00:18:13] Sharmeen Roy: if Driving up and getting your groceries put in your trunk is, it makes it easier for grandma. I think that's a really great use of technology. there's always going to be pros and cons and how it can be applied. you can take, how it works in one place and see where else you can apply it, 

like where, how else can it be utilized? So one of them, I remember when I was doing residency training. I had to spend some time with, 

and she had practice for a really long time. And, you know, she was kind of teaching me how you, you know, if there's an error, how you go about kind of reviewing it, doing an analysis, you know, how you can prevent it.

Cause there's, you know, it happens we're human, but you, what you want to do is prevent it from occurring again. And so you always have to think about it. Not how to prevent the same thing from reoccurring, but also else can that happen? So that's I think if you kind of take that and apply it to a software technology that maybe is being used in one industry, like how else can you apply?

And I think that there's been a lot of kind of cross pollination of certain technologies where we've. I think they've, I don't know where it's at, so I can't really speak to it, but like, you know, delivering of medications, can, can we have, you know, robots within the hospital delivering versus a person running from one place to another?

So, you know, those are all ways to utilize it. 

[00:19:38] Mike: I always thought being creative meant like Having this huge awakening to something, but someone said that their definition at least was taking something you've seen somewhere else and applying it to what you have, and it's like, Oh, well, I didn't know that was creativity, but I guess it is, you know, across the board, any industry from medicine, then to the food industry, then to banking and all that kind of stuff.

so that's a fair definition. I think,

[00:20:04] Sharmeen Roy: Yeah. And you know, I trained in pediatrics, so that was my specialty when I graduated. I did a residency in pediatrics. there, you always have to be creative with medicine and

Because you want to figure out how to take the medication. only the patient, but 

how are you going to get the patient to remember to take the

What tools can you use? I remember making calendars with like pictures, you know, so If a, if a patient can't, you know, either is not literate or can't figure out, you know, the, the literacy level is too low, then, you know, making calendars with pictures so they know when to take which medication just, you know, or, you know, a two year old who has to take a certain medication, but it doesn't come in a formulation of how do we. Make it palatable so they can actually take the medication because it's important. So I think in Peds, we always have to get creative on how we can kind of, make sure that the, you know, to get the medication to the patient.

[00:21:03] Mike: Well, and we're always dealing with us. Damn humans. I've got Sharmi up, about, I don't know, years ago. And then 10 years ago, I had two DVTs in my legs. And, I think it was from sleeping sideways in a love seat, you know, like a two seater with my legs over the end, like falling asleep that way, but they told me that wouldn't have been the cause, but anyways, I've been on Eloquist.

I guess since then, and I know it's supposed to save my life and all that stuff, but some nights it's like, my alarm goes off at 8 PM. It's like, I don't want to get up and walk three feet to my backpack and get my eloquence out and take it. I just wanted the day to be done, you know? and then I'll come up with some excuses like, well, I had a headache this morning.

I don't tell anybody, but I took Motrin, you know, at. 7 a. m. So I'm not going to take that tonight. My blood's thin enough. The point is we can have all these fears of AI and we can have all these, the answers, you know, this and that, but we're still just humans just trying to get by.

And, and until you get some stuff through our thick skull, you're always at the mercy of the human. So Charmaine, Grocery pickup. Do you do it?

[00:22:17] Sharmeen Roy: No, I'm going to get my groceries.

[00:22:18] Mike: You do?

[00:22:19] Sharmeen Roy: I'm old school. 

[00:22:20] Mike: my wife, she does grocery pickup. You go there sometimes and you pull up and you type in their space number seven, then they come out and. they're waiting on someone else. And then they finally get out there.

So a friend of my wife's said, here's what you do when you're at home. From home, you say, I'm here. I'm in spot number 13. And I'm like, how does that work? She said, well, everybody's superstitious. Nobody pulls into spot 13. So you just say from home that you're in spot 13, and then you go like 10 minutes later and pick it up.

sounds preposterous. Does that sound right? that people would be that much against the letter 13.

Do you know anybody against number 13?

[00:23:02] Sharmeen Roy: so I don't know how you knew to ask that question, because I stay away from 13,

[00:23:07] Mike: So you did grocery pickup, do you think you wouldn't park in spot 13?

[00:23:12] Sharmeen Roy: Yeah, if I had an option for something, it's

[00:23:14] Mike: You would pick something else.

[00:23:15] Sharmeen Roy: Yeah.

[00:23:16] Mike: 

fascinating. And I think in buildings now, don't they still in buildings not have a 13 on a lot of buildings? 13th floor?

[00:23:22] Sharmeen Roy: I haven't seen one. So

[00:23:24] Mike: you haven't seen a 13. It goes from 12 to 14.

Yeah. Pretty fascinating.

[00:23:30] Sharmeen Roy: actually. We don't have, uh, yeah, it goes from 12th to 14th. 

[00:23:33] Mike: You don't have one.

[00:23:34] Sharmeen Roy: The

is on floor 13.

[00:23:36] Mike: yeah. I guess I wouldn't really want to live on floor 14. It's like, come on, we all know it's floor 13, you know? I think that that's a pretty standard one, 

I guess so.

[00:23:46] Sharmeen Roy: to pay more attention, but I have yet to see one 

[00:23:49] Mike: you'd think of as that big of a deal, you know, they'd wipe 13 off the calendars and a bunch of stuff like that, or don't even use it anymore, just when you're counting, go from 12 to 14, you know, and then subtract one from everything since then. superstitious unless it's too tough to be superstitious. Then we're just going to go with the easy route, you know,

[00:24:05] Sharmeen Roy: Yeah.  

[00:24:06] Mike: Charmaine, your company, because it's so, 

Based on technology and things like that in your product, does AI make you guys shift in any way? Do you see it just as a positive? Do you see it impacting somebody that says, ah, screw it. We're just gonna ask Alexa through, chat GPT did you guys have to face that as a company?

[00:24:29] Sharmeen Roy: I mean, we get the question, from many people, if we're using AI or if it's going to Replace it. Do I really even need your software?

It's not going to be replaced because like you said, 

It's a little bit more complex than just asking a question and getting the information.

Right. And we're dealing with patient data. So you'll have to remember there is a lot of privacy. component to it, so for that reason, I mean, you still need to, you know, there's privacy issues.

There's data security issues. And as you probably read time and time again about all the cyber security issues that

with various health systems. I'm not too worried. we do get questions whether we incorporate it. we don't necessarily incorporate AI. I think there's still learning how and if it can be used.

But our models, because it's used for clinical care, we have to go through a full validation. The models that we implement are validated, then we go through an external validation and make sure that everything is working the way it's intended to. Because remember that this is going to be supporting decisions that clinicians are making.

So it's going directly to the patient,

So I would say, I'm not too worried about it. We do get the question people, you know, it's the new shiny thing, 

it's going to be so much better,

the case. It's still very nuanced,

is very nuanced, so can't really replace it. Could you use it for certain parts of the business? Possibly, but we're not currently utilizing it, sometimes they actually welcome that we don't use it because these medical centers, hospital systems, they're, you know, Concerned about what's happening to their data, this is patient's data and if you're taking it and putting it in. somewhere where they don't know where it's going to end

That's a security issue. I would say majority health systems have very strict rules around their consent and how patients' data is being used, especially in the larger system. So, yeah, I don't think I'm not too concerned.

like everybody else will continue evaluating and seeing if there's any good use case for it, but it's not, it's not, I don't, I think we're still a little bit. You know, from my perspective, of course, there's people who will tell you, Nope, it can be incorporated now, but we really need to think about the fact that , at the end of the day, there's a patient there that you're taking care of

being provided here.

[00:26:55] Mike: I've heard it one time. It's like liners. cause remember, I don't know, I probably was, I want to say it was five years ago. I was double stuff. So let's say it was 10 years ago. Cause I know how time flies, but you know, the one that they think the guy ditched the plane into the ocean and they can't find it.

Do you remember that one from a while back? It's like all of a sudden this plane disappeared for like three hours and then they think it crashed and this and that they think the guy maybe nosedived it. The pilot did, the lesson behind that was basically, do you want the computer to never let the plane go past 30 degree angle and not go at a certain descent and this and that.

So that doesn't happen. Or do you want the pilot to be able to override that? Because this pilot, you know, fought in Vietnam. And what if there was some kind of a funny thing going on where they had to evade some missile or something like that? Do you want this pilot to be able to do a 37 degree turn and to do this and that, you know, so there's that, there's that.

balance between what do we want to allow computers to do? Should humans still jump in? And I think that a company like yours, that as we talked about with the early adopters of things, all the cool stuff, a company like yours, and probably by definition, if we had to expand the definition, somebody would say, well, of course most companies are using it.

AI it's, it knows when to, you know, do this and that it's just a lot of that's with the definition, but I think with all of our companies, as we talked about that, it's going to go under, and then we're all going to be using it in its safe way, but we're not going to be so gaudy as to have to put AI on every piece of marketing material that, comes out.

[00:28:47] Sharmeen Roy: yeah, for sure. you said is the key, you have to strike that balance, in health care. there's different objectives,

thinking about different things. Like, you know, we want to think about operational efficiencies.

We want to see, okay, with the pandemic, I know there

of challenges with resources, so you

I think if you keep patient safety always front of mind and keep that as a goal and final goal, you know, you can put the appropriate guardrails there to make, you know, to have that time where you want it to protect.

And so someone's not making that accidental but at the same time giving the physician or the pharmacist that ultimate say into, okay, well, In my experience of however long they've been practicing, this is the right. dose to give a patient,

so having that ability to override, but maybe not make it so easy. So people think about it, why they're making that decision to override a guardrail that's been put in place.

I think that's what we have to kind of continuously balance, I guess.

[00:29:54] Mike: And you're dealing with a human, you have got an 83 year old person and I know your, your system's not maybe. Well, certainly it's not making moral judgment calls. I shouldn't even say morals. I should even say family calls, but I mean, all that combines in there.

You have two 78 year old people in one of them who want to go this direction with their health at all costs. And somebody else says I've had a. I know we're not talking about death here, but someone says, I don't want to be that aggressive. I want to use this drug instead of that drug and this kind of stuff.

So, that depends on who's in the room and what family pictures they have up there. Everybody's got a different story. And so that's where things aren't just numbers.

[00:30:37] Sharmeen Roy: Yeah, I mean, there is the human component that exists, that I'm saying it would. But if the clinician saw perspective gets replaced, you still have the patient, so the

still has to

in the decision

have a decision making ability for their care.

 I don't think you can actually, you know,

it or remove it completely.

 it's always going to be tools to help you make whatever decision it is, along with the patient, you know, what they want to do, because ultimately the patient is, it's their health, 

 I don't remember where this was. I think it was a recent meeting I was at, at ASHP.

They have like these little work groups, participate in round tables and stuff. this was more about, of course, everything has AI in

It was the informatics work group. And I remember around the table, they were talking about, you know, how they're incorporating it in electronic health records. it's baby steps, so it's not replacing anything. It's not changing anything. And I won't name the EHR, but they were talking about how they have a messaging system. So like clinicians, healthcare users who are using the system, this EHR can. Go in a patient's chart and ask questions to find information quickly or there's also messaging.

if there's messages that receive whatever AI version of this EHR response and say that, oh, yeah, people prefer the AI to respond. Rather than the person because the AI is nicer

they have that preference. 

[00:32:11] Mike: I know AI is going to be a hell of a lot nicer than I am. I had a case last week. I try not to answer the phone when I don't have to, because I'm kind of an ordinary SOB. AI is going to do a much better job than this old cranky guy.

[00:32:23] Sharmeen Roy: more empathetic is what somebody said that they preferred because it was more empathetic. 

[00:32:28] Mike: It's not the cliff to the end of the humans that some people dread, it's another great tool. It's a fantastic tool. I don't think we're going to come back a year from now and life expectancy for us old farts is going to go from 78 to a hundred overnight.

You know, they might either go down or they might increase by a week or something. and that proves to you that that's not the end all. So, Charmian, so who is the decision maker for your product? is it a head of pharmacy? Is it the head of the hospital? Who do you need to cozy up to, for this product?

[00:33:05] Sharmeen Roy: a lot has changed in the landscape of who's making those decisions

know, small even the smallest expenses. I guess our main point of contact, the people who want to use the champions, the ones that are advocating for our software

the pharmacists that want to use it to make their life easier.

the decision maker varies, depends on, the size of the institution. Frankly, sometimes it's like the director of pharmacy who decides to then take it to the but more and more, I feel like most institutions it's, it's going up to Some VPC C level, in the hospital to make these decisions. Because I think again, healthcare, we all know what is happening with it.

We all know that, you know, there's budgetary constraints, resource constraints. , but it starts from the pharmacy. We're international, so we have. users outside of the U. S. As well. And that, you know, the users vary because I think there are not just pharmacists.

There could be physicians in the U. S. It's mostly clinical pharmacist specialists who are championing it, and bringing it on to their teams and making, you know, starting the process of getting the software implemented.

[00:34:19] Mike: I didn't think much about that because right. I'm a C suite guy at a hospital and don't really want to spend a penny until, I mean, you'd think I'd have this great vision, but I don't really want to spend a penny until someone is. Bitching about it and saying, why don't we have this?

 I've never been in that position, but I imagine humans are humans and you kind of respond trying to get people to shut up below you and things like that and not rock the boat too much. And so I would imagine you want those champions, you want pharmacists, clinicians to go to their one ups and keep going up and saying, we saw this, this is really going to help things out.

[00:34:57] Sharmeen Roy: Yeah. And I mean,

case, you know, can't really get anything approved until you justify why you need it

benefits are. Right. So we help our champions with that process, help them, you know, do a business impact model and that the value of the software and how it's going to help their patients.

So there's two components to it, there's the patient care aspect, the patient safety, decreasing of adverse effects, but also, making sure everybody's being compliant with appropriate dosing, making sure that they're adhering to protocols, making sure they're, you know, just efficient. If operational efficiency is within the guidelines. Within the pharmacy team, cause pharmacists, I don't know. I feel like they were kind of like in the center of it all. Right. So everybody taught in healthcare, if you think about the interdisciplinary team. Everybody talks to the pharmacist about one thing or another,

whether it's, you know, the pharmacist having a discussion with the patient or the physician making the decision or helping the nurse figure something out. or, you know, insurance to get something approved. So it's, they're kind of in the center, it's like a very central role in my opinion.

And I think because of that, many of the technologies that are available. implemented in hospitals, you will always find a pharmacist, kind of in the center of it all. That's been my experience from all the implementations I've been part of, and I don't think it's changing because it's kind of the core of the interdisciplinary team.

[00:36:31] Mike: Charmian, what is your job description? Basically? Are you, are you, well, just, what do you do during the week?

[00:36:40] Sharmeen Roy: Oh gosh, I wish it was one thing, 

[00:36:43] Mike: No, you don't. You like the variety. 

[00:36:45] Sharmeen Roy: Yes, yes. So I, from a company perspective, oversee our product. so, everything that goes into our product from a clinical perspective, so I'm the clinician's view when we're implementing a new model or adding a new model, there's a lot of different phases, a lot of very smart people who are kind of making it all happen from a development perspective, but I oversee kind of our science team to.

determine, what are the needs? What model do we implement? Because we're going to continue to expand, so individualized care, individualized dosing is not going away. It's only being applied to more and more drugs. So we want to see, okay, what's the next drug?

What are our users saying? Existing and new customers that, you know, it would be great if we had drug X a model for that because it's really, really hard for us to figure out how to do that.

I oversee our implementation.

So any new customer that, is kind of signing up for our software or purchasing our software, the whole implementation

and onboarding. Thank you. and then there's, 

research aspect of my job that, you know, just kind of not only reviewing the most current research on what's being published, but also how we can support our users with research.

A lot of pharmacists like to use it. The data that is in Dose Me 

[00:38:03] Sharmeen Roy: um, you know, collaborate with on a specific project.So there's different, I'll say day is different,

works best for me because I like the change in the variety like you mentioned, and also,I say I'm a pharmacist, I'm a clinician, but at the same time, I'm also thinking about the business, the strategy, where we're headed and what we're doing. So that business development aspect, I really like combining those two. I think there's many technology companies that this is how it starts out. So somebody experienced a problem. They happen to be amazing developers and they develop them. Software to solve that problem, but they never really talked to a clinician or anybody in the health care

I think, This is the feature we want because this is what a clinician would want to utilize day to day, or this is what they're requesting and explaining and helping our developers understand what that means our science team, the bioinformaticians understand how what they're building the algorithms, how they're actually being applied to patients and just connecting that.

So I guess going back to pharmacists. serving as a core function.

I guess I feel like I serve as somewhat of that in our company to kind of Bring all the different teams together and understand what we're ultimately trying to do.

[00:39:49] Mike: in a company like yours, who's making that decision because your field experience is so valuable. In other words, I mean, to me, you're like, I would just put you in there and say, Take the company, whatever direction you think it should go, but you don't have to give me a name, but when you have these ideas, like, Hey, we got to be doing this, 

Where does that thought go from there? I don't imagine you just get all the developers together and say, this is the direction we're going to go. Or do you have people that you're? working within your company where you guys all get together and then make these decisions.

Maybe it's the boardroom. I don't know. How are you deciding where to go with the inclinations that you have that you picked up from the field?

[00:40:29] Sharmeen Roy: So we are a very small company. we're a small team and I have worked at large companies, large academic centers. And that's one of the things I really enjoy about being part of a small company is that you can move quickly. and it could come from a customer. It doesn't have to be something I think of. 

When you have a product, you're constantly thinking of, okay, how do I make it better? Maybe it's a. Just the workflow or just the flow of, one screen, something as simple as one screen or minimizing a few clicks here or

[00:41:00] Sharmeen Roy: look a little bit better to something more complex, like, oh, here's this new drug and there's a model published for it and we should implement this because it's going to be very valuable because I've talked to, you know, 10 pharmacists at 10 hospital and then they're all saying, okay, we're going to need this soon because This is going to be the new way of dosing or there's new guidelines

What, you know, depending on the situation, it could be different. So, take those continuously. So, you know, working in an agile environment, you can constantly pivot and change direction. So if something comes up that is important to incorporate into our existing software we do Talk about that in our team.

And that's, all of the team. So it's our leaderships, our CEO gets involved, our CTO and we,

because. You know, and they'll tell me.

I always say this. Oh, this must be easy to do. It's such a simple thing. But then you don't realize the work that goes on to implement the simplest piece of software feature but my job is to keep pushing, because if I feel like this is really important that we incorporate this, we need to figure out how to do that. I've heard it from our, you know, users. I've heard it from our advisory board. I personally know that this would be valuable and we do this on an ongoing basis. There's always ideas. So customers are, are we, you know, we're fortunate. Our customers are constantly telling us, you know, it would be really nice if you could add this, or it's very difficult to go from. This part of the software to this part of the software, and it would be really great if you could figure out a way to make it flow better. It could be something that simple, and so we're constantly, um, you know, our team is constantly gathering that kind of feedback, whether it's, right at the kickoff or even checking in while a system may have been using us for years, and they come back to us and say, you know what, we really would Like to see Y and Z feature implemented because it will help us and we can see how it would help others as well. a lot of our input comes from there. Of course, from my perspective, I'm constantly looking at what new models to implement and, you know, where, where in, 

is a big

where precision medicine can be helpful. And so we're definitely looking into expanding in that area. Sometimes the ideas just come from a discussion that we're having internally and talking about an issue that may have come or somebody may have raised and just talking through that solution.

And sometimes it comes from external parties.

[00:43:46] Mike: And then Charmaine, who's making the final decision. So you've got this great idea. I don't imagine you go directly to the developers and say, is it kind of the committee decision? Do you wait for the CEO to give the approval? How does it go from everything you get? How does it go, let's say, I'm going to say like a new, not a new.

Web page, but a new, let's say you have 10 features on your thing. And let's say who decides on the 11th, who actually decides to say, let's go ahead with this,

[00:44:21] Sharmeen Roy: So I do get to decide a kind of timelines on a lot of those features, but we have a team, I have a product manager, we have our technology team, and there's a whole roadmap that gets developed, so we plan it out and it's all Cool. You know, we try to stay ahead of it and, and plan, okay, this, these are the 10 features.

This is what we're going to do in 2025. Here's the list of features. And now we need to plan it out to see where we're like, what's going first versus second and third and

[00:44:54] Mike: But who decides if it's going to be these eight features or these 10 features in a company like yours, who decides that is it, kind of a group. And you say, let's move forward as a group, or do you get approval from who decides that, 

or is it nebulous?

you don't really know. It just sort of happens.

[00:45:15] Sharmeen Roy: It's not in the traditional sense where like, okay, I presented it to a committee and then they approved it and.

That's what I'm getting at. Because we're a small company. our product manager will outline, okay, these are all the requests and the ideas that have come up, which ones do we want to prioritize?

And we prioritize that there's different components to it. So it's, working with our CEO, our chief commercial officer, and just kind of seeing what the needs are of our

customers and new ones and really planning according to that. And so there's a whole roadmap that gets. Planned a timeline of prioritization and really like to work closely with our team to do that.

And then we just, Present to all of the leadership and say, okay, this is the plan. If there's, you know, and that's when we kind of gather feedback, if anything needs to be pushed, or if our CEO said, 

This is the first thing we will need to move this as number one and then the subsequent ones, but I get a lot of freedom in deciding that.

And I think most of the time, everybody's on board. because we're small, we talk so much

we are all on the same page as to what we need to implement

[00:46:19] Mike: I would imagine that it's kind of a funnel system that's there. You're already listening to the customers. You've got your software set up to how much is this rated? You know, who wants this more than that? It's almost like it goes down that road unless someone puts a kibosh on it, it's going to happen a certain way, almost just by the nature of your.

Company trying to improve. It's like, it's going to go this way. Or like you said, they say we need this one on top, even though we're not, maybe not hearing that from the field. We have to do this, but I imagine it's the process so you say with your company size and it's like, you're all kind of on the same page unless someone sees something of the ordinary too much.

[00:47:00] Sharmeen Roy: Yeah. Or if we hear something, I'll get a request of like, okay, we, you know, there's a health system that would like to implement, you know, fill in the blank and can we provide that? And so those are the kinds of things that would help you kind of shift a little bit,

The planning is very agile. So we can, you know, like you lay out the road map, but you just can't, you know, I won't know what's going to happen in October 2025. Right? Things may change.

I want to have a plan and a timeline we're working through. But then at the same time, if something were to change, we can quickly, you know, change directions or move around the timeline.

I mean, we're constantly looking at what we've identified as the roadmap for the year and seeing if we need to modify it.

[00:47:46] Mike: So Charmaine, we talked about the actual clinician that you want them to kind of bring that up.

 The ladder of their place, who would you really like to go to at this point? What do you want the listener to do? What listener are you looking for? And what would you like them exactly to do?

[00:48:02] Sharmeen Roy: Everybody who are decision makers so whether it's who's taking it upstream or the director of pharmacy who's making the decision or maybe VP level, because oftentimes what happens is, well, why do I need a software? You know, I can do this myself.

I can manually do this. I can use an Excel spreadsheet. I can go online and find a free calculator. And those are all Good alternatives. And sure, you can do that. But they have to remember that our software is validated. We go through a lot of trouble to make sure that it's secure and privacy and compliance is very, very high on our radar. And I think it is for many health care systems. So I'm sure there are free softwares available, but software not only integrates into the EHR, so it automates some of those, I guess, error prone, concerns that somebody may have, where there's input error because you're manually entering something, but also, you know, retains a lot of the information because it's HIPAA compliant. It has high trust certification. So that's the part that they have to keep in mind that it's not the, it's not that sure there's, there's free calculators, free software everywhere. I can go online and get access to it myself. But here you can be confident that this has been vetted, validated, and truly a safe tool.

, nobody's going to be able to kind of modify it or forget or have it. Slip of a, you know, an extra decimal point or extra zero or put it in an input error. So that's what they have to remember because, you know, that's why it's important to implement a software that's gone through that rigorous validation process.

[00:49:42] Mike: Well, it's a big deal when I'm at the pharmacy and if a customer trusts me enough to ask me a question, it's like, I'll take a guess on a skin rash or something. But as soon as it's, you know, someone's eye or both eyes, I'm like, don't talk to me. You know, I don't. These are your eyes. This is important stuff.

And so that's like this stuff too. It's one thing to do a calculation on your checkbook, but when you're talking about someone's life is in your hands, it better be vetted and you better know what you're working with. Well, golly, Charmaine. Nice talking to you.

Nice to meet you. We had talked earlier. You said, Mike, who are some of your guests on the show? I said, I don't want to talk to someone like me. I just bore myself if I talked to what I knew. And so I always love talking to people that I have no idea the ins and outs of a company like yours.

So, thank you very much. Keep doing the important work you're doing. I know you're busy. I know you have a lot to do. I appreciate your time. listeners appreciate it. And just a pleasure to meet you.

[00:50:38] Sharmeen Roy: Yeah. It was a pleasure meeting you. Thank you for having me. And, you know, I didn't even know where the time went. So, you know, we went on all sorts of directions

[00:50:44] Mike: great having you on and I look forward to talking to you again soon.

[00:50:47] Sharmeen Roy: Thank you. 

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