Real World Wednesdays: Insights from the Current RWD/RWE Landscape

Welcome to Real World Wednesday, the weekly live discussion about real-world data and real-world evidence at the RWD and RWE house here on Clubhouse. Almost every Wednesday from 11 to 12 eastern time, and we are eager to introduce our guests. But before we do, as we highlight at the outset of every Real World Wednesday, please note that our guests’ views are their own and not those of any company, agency, or any other organization. 

And specifically, statements made by our guests are their own personal opinions expressed during a live audience discussion, and eventually a podcast that can be found at rwd-rwe.club. And today’s discussion is with Dr. Purav Gandhi, CEO of Healthark Insights, a global management consulting firm focused on strategy, analytics, and digital transformation. Prior to starting his own firm, Purav worked with Deloitte for five years, where he was a member of the founding team for Deloitte’s RWE venture called Converge Health by Deloitte. And additionally, Purav recently published a book titled Lead from the Front, covering leadership stories from armed forces that can inspire everyone to become better leaders.

He has several international publications and patents and also teaches about health informatics and AI and healthcare. So welcome, Purav. But before we turn to you, I would like to introduce special guest moderator, Stuart McCulley.

Stu, thanks so much for joining us. Would you like to open with a few welcoming comments to the audience? Absolutely. Thank you, Matt, for the honor of co-hosting with you.

And Purav, I’m eagerly waiting to hear your story. And to everyone, welcome to Real World Evidence and Real World Data Wednesdays. These are always epic with Matt and Aaron.

So this is going to be an interesting journey today, certainly with the topics that we’re going to be covering. So over to you, Matt. Yeah, thanks, Stu.

And apologies extended from Aaron, who is in a meeting today that just conflicted with Real World Wednesday. So unable to join, but he gives his best and he will rejoin us next week. So with that, Purav thank you so much for joining.

You’ve got a fascinating background. I’ve really enjoyed getting to know you. We’ve had some preparatory discussions and just hearing about your journey.

And like everyone in this space, it’s convoluted in a good way. There’s been many decision gates and decision points where it’s really influenced your career. Why don’t you take us through that journey, take us through your career background and how you got to where you are today?

Sure. Thank you, Matt. Thank you, Matt and Stuart and Aaron for inviting me on Real World Wednesdays. I have to start by congratulating you for successfully running this program for such a long time.

You know, once in the past, I tried running a podcast and from that experience, I have to tell you, it’s not easy to sustain so much momentum. I wish I had known about Real World Wednesdays a bit sooner in life, but nevertheless, very, very excited to be here. I’ll start a bit with my background.

So I was born in a city named Ahmedabad in the western part of India. The Prime Minister Narendra Modi of India comes from this place. My father is a physician.

My grandfather was a physician. So I was born in a setup where the only natural choice was to be a doctor. And so I finished school, went to med school as a natural extension of what everyone did in my family.

Had a great time doing medicine, loved the subject, but somehow I felt that I didn’t want to do clinical practice. So after finishing medicine, I decided to do an MBA. I went to B school – had two very interesting years there. It was very different from medical school. I always thought that what would be the biggest change in life once you move from med school to B school. And the biggest change was Saturdays were off. It’s never the case in medicine. You work almost six or seven days a week. But I went through that transition, did an MBA.

After my MBA, I joined Deloitte as a part of their strategy consulting unit. Worked in the strategy consulting group for a couple of years, spent time advising pharma clients in the US, and started learning a bit around health IT. And that was the time when Deloitte was forming an internal business focused on health IT and mainly focused on real world data.

And I had this unique opportunity to be a part of co-founding team. I was very young, just two years into my career. And this was an amazing opportunity.

It was a subject which I think I could naturally understand coming from a medical background. It again gave me the opportunity to start contributing back to doing something related to medicine as opposed to standard market research or strategy work that many of my MBA colleagues were doing. I felt that I could relate to what my other friends do.

It was very exciting. So I started on that journey at Deloitte. Back in the day, the concept of real world data was not as advanced.

This is around 2012-2013. So anything beyond claims data seemed to be very innovative at that stage. When we were starting the business, there were two small startups which were coming up, both of them are acquired now.

One was Umedica, which was later got acquired by Optum. The second one was Explorys. And at Deloitte, we were fascinated by the kind of research that could be possible using clinical data.

So again, at that time, a very new concept. We partnered with three health systems, Intermountain Healthcare, Moffitt Cancer Center and the Institute and figured out how could we take their data in an anonymized compliant format to run various different types of studies, be it comparative effectiveness, outcomes research, be it safety signals, be it epidemiology and patient journey studies. And we formed a product line, which was called as a minor product line.

We started with something called as outcomes minor. And then there were different use cases. There was a tool we called as population minor.

There was a tool which we called a safety minor and so on. And as we were doing this, the biggest learning came in that there’s only so much data that a large firm like Deloitte could acquire given the legal complexity and risk involved. But at the same time, the entire tooling that we developed to source data, double blind it, take it into an anonymized format and provide it for self-service analysis tool is very valuable.

And then we formed a full product suite, which could be fit within any large pharma infrastructure and can take the data all the way from the health system to different analysis use cases. We did a pivot on that. And I used to lead this entire piece.

So I led the product strategy and product management for the life sciences products called as a minor suite. Then Deloitte did a couple of other variations. There was a variation for value-based care and payers.

There was a variation for health systems. And gradually that unit started to scale very quickly. At that time, we also acquired a company called Recombinant, which used to take open source tools like I2B2 and Transmart and use that to drive various RWE use cases.

And I had a chance to meet this gentleman called Dan Hausman. And he comes back into the story, a serial entrepreneur, co-founder of Recombinant, which Deloitte acquired. But I did this for two, three years.

It was a phenomenal exposure at a very young age in my career. Learned so much about RWE. The journey started with a lot of optimism, like many people in terms of what all data can do.

Gradually learned the challenges that come in the RWE business around data access, interoperability, consent, data standards, gaps in data, and so on. Now, I did this for two, three years. And then for most of you would not be aware, so within India, there’s a specific community called as Gujaratis.

And Gujaratis are very entrepreneurial in nature. Everybody aspires to run a business of their own. And the entire two, three years exposure to building a business within Deloitte, the Gujarati genes kicked in.

And I decided to quit what I was doing and decided to start on my own. So this was around 2015 when I started on my own, left my corporate career. The first venture that I ran was called Remedy Social.

The idea was to take the concept of real-world data and bring that to a country like India, where EHRs are still in a very nascent stage, but use alternative techniques to use health risk assessment tools, other patient surveys, and try and basically harness the real-world data. I ran the venture for a year, year and a half. It was a very difficult time.

I was starting on my own for the first time. So I started learning all the challenges that come with establishing and running a company, challenges with creating a market when it’s in a very nascent stage in a country. And then I had a chance to exit that.

One of the online pharmacy players in India wanted a health risk assessment platform. I handed it over to them. And then I was between jobs.

And while I was between jobs, I did a freelance consulting assignment that went really well. The assignment scaled. So then I had to ask a colleague of mine who was again between jobs to come and help me out with the assignment.

Gradually, I hired an analyst. And as a matter of serendipity, it started converting into a professional services firm, named the firm Healthark, and gradually started building that business. We started the business mainly focusing on life sciences, strategy, and market research.

But when I was at Deloitte, and Dan Hausman, who was a serial entrepreneur whose company Deloitte had bought, when I was leaving, I had gone to meet Dan for some advice saying, hey, I’m just starting. This is the first time in my life. Any advice? And then he gave me some very sound advice.

But at the same time, he asked me, what’s my business idea? I had a half-baked business idea. And then he showed me this Google document where we had some 900 business ideas that he had detailed out. And he said, ideas are cheap, right? It’s very difficult to execute.

It was an aha moment for me. I told Dan that, look, if you start, I’ll drop this idea. I’ll just join you in whatever you do.

So fast forward five years, he eventually did leave Deloitte. And he and I met. By then, I had started Healthark. I was midway in my journey. But then Dan brought us on board as consultants. And then since then, for the last four or five years, I’ve been helping this company, Graticule, doing a lot of cool stuff within real-world evidence.

A lot of other colleagues like Dan from the Converge Health time at Deloitte left their jobs, went to different places, did some really cool things in RWE and are still doing some cool things in RWE. And through Healthark, we continue to serve them in different capacities, helping them with RWE-related stuff. A little bit about Healthark.

So now, from 2015, I’ve been running this company. It’s been almost more than eight years. We have a team of around 100 members right now, focusing on strategy, analytics, and digital transformation.

We have three offices in India, and then some presence in the US. Most of our clients are based out of the US and Europe. And it gives me the opportunity to continue to work on very interesting RWE problem statements through different clients.

It keeps me involved in the space. So I feel it’s very fortunate. I have to take this opportunity to do a bit of self-promotion around my book.

So tangential to the work I do, in the last five years, I’ve been really fascinated by the concept of leadership in the armed forces. So what I’ve learned through these years is that the concept of leadership within the corporate world or in business world is really by chance. You’re taken, depending on the size of company, 10, 20, 100 best people you have.

And then you let these people work, and some natural leaders might emerge. But that is not the case when it comes to the armed forces. Every single officer at a very young age of anywhere from 21 to 24, 25, is commissioned to be a leader.

He or she, from day one, will lead more than 100 men and women. Failure is not an option. They all look up to him or her in terms of what to do next.

And they’re being constantly judged. And all of them are trained to be leaders. Every decision that they make as a leader can be life or death.

And these are, again, otherwise very ordinary everyday people. For them, the life in armed forces is like a job. They have their promotions. There could be organization politics. They have day-to-day family issues to deal with. So life is very similar to business or corporate world.

But when the moment arrives, these individuals consistently step up because they have been trained to be leaders. So like any other management consultant, I started studying them with my co-author, Sudeep, and building a framework around the concept of leadership that we can learn from armed forces. But frameworks are generally boring.

So we figured eventually we would check the framework and said that there are nine very interesting stories which everyone can get inspired from, and decided to compile those stories. And just recently, in January, published a book. If you get a chance, please read it.

It’s on Amazon. I would love to hear your comments and feedback on that. And with that, thank you, Matt.

I know it was a long intro, but I’ll pause. Great background, Purav. And just to hear your background, experience, the transition from medicine to business.

Fascinating, fascinating journey. I’ve often said in Real World Wednesday that my entire career has been about the business of science. And as a physician and a business person yourself, what was the transition to being an entrepreneur? What was that like for you? Because being a part of an organization and having a business background is much different than setting up the business.

And you commented on the cultural considerations that foster entrepreneurship. For you personally, what was that like? What really cemented the decision to set up a business yourself? It’s a great question. At least as I look back into the past years around starting on my own, I think it’s a combination of two things.

Part of it is there’s a lot of naivety around decision making. And I believe for anyone to start, you have to be partly naive. You have to partly underestimate the challenges, be over optimistic about the future scenario. And I guess that is something which propelled me to not think much and just take the leap of faith. You do these things despite of challenges, because you enjoy them. You don’t do it despite of challenges, you do it because of the challenges you enjoy and you thrive in those situations.

Also, as I entered, I think it was a really mixed bag. A part of it was like homecoming. All doctors, I strongly believe are very entrepreneurial from medical school.

They all think as individual business unit. From the time they graduate, they might be working in a hospital, in a health system, but they all, even though they have not studied, naturally think in terms of P&L, opportunity cost. At least all the doctors I know, they all do.

So that part of it was very comfortable and homecoming for me. At the same time, it was, of course, a little bit of a hard reality check, because there are just so many things that you don’t know about running a business from setting up a company, to having employees, to going and selling, setting infrastructure. There’s so many of these things that all of us take for granted when we work in a large organization.

Everything starts and stops at two. So that was a bit of a hard reality. But then gradually, I guess, one of the things they say here in Gujarat, the part of India where I live, is that everybody who starts business has to go and warm up their seat for at least a thousand days.

You cannot quit. You cannot change your mind before a thousand days. If you spend time religiously for a thousand days on your chair in your office, gradually you figure it out.

And I guess the same thing happened for me as well. Thank you very much for that, Purav. I’ve got a very big grin, which you obviously can’t see because this is all audio.

And one of the reasons I have a big grin, and there are many, but one of the reasons I have a big grin is I was an officer in the UK’s Royal Air Force. So I will be purchasing your book. And telling my colleagues about it once I read it.

So epic. And I’ve got to say, and this is an aside, if nothing else, it always fascinated me when I moved into the pharmaceutical world and the big corporate world, when they talked about teams and team play and what a team meant. Having been brought up in the armed forces, and then being in the armed forces myself, it’s a different world where it’s all about life and death.

And trust is a very integral part of what we do. And I’ve spent many years trying to translate that into the corporate world. So yes, love the fact that you’ve addressed this, and I’m really looking forward to reading this story.

One of the questions I’ve got for you, because I looked at your LinkedIn profile, and my mind was blown with how much you’re currently involved in. My automatic question when I looked at your profile is, what drives you? What drives you? And why real-world evidence? What does this mean to you? Thanks, Stuart, for asking the question. I think, specifically, when it comes to real-world evidence, I studied medicine.

I loved the subject. I was reasonably good at it as well. And yet, I decided to make a move, come to the business side.

When I moved to the business side, I worked on different areas, as you would do as a strategy consultant. I worked on the commercial side, on launch planning of medicines, on medical tourism, and so on. And all my friends were doing really, really well.

Someone was becoming a cardiologist, someone was being a neurologist or an oncologist, someone was doing critical care. And a part of me started feeling that I’m drifting away from science, and I desperately wanted to hold on to it. It took me a while to figure out how do I hold on to the medical science and contribute meaningfully.

And for the first time, as I started working on real-world evidence, I found that olive branch to which I can hang on to medical science and contribute something. And then as I started spending more time on it, I could see that some of the stuff that you could do using real-world evidence was really impactful. It was more often than not really cutting edge.

And then this combination of excitement to do something really meaningful, focused on medical science, which is where my roots are, and also the fear of missing out on that part and staying behind as compared to a lot of my friends and colleagues from my graduation days, started becoming the driving force. And I would say to a large extent has been the driving force. It would sound very basic, as opposed to some individuals who would have very profound stories, very deep personal stories around why they do it.

Mine is a bit more simplistic, but the fear of kind of missing out and not doing something meaningful, as many of my colleagues were. And I’m sure that I stay focused and I continue to try and be involved in as many things related to RWEI. I no longer can do clinical practice.

So this is my way of staying associated, I would say. So question for you and question in common. You used the word nation a couple of times when you talked to say about India and EHRs and also the word challenge.

Did you not then find, based on what you’ve just said, that actually what this gives you is opportunities because things are so new, things are at the forefront. And then what that makes you as a pioneer? That wasn’t a question, so I apologize for that. But do you see where I’m coming from? No, I see where you’re coming from.

And absolutely. So I absolutely do see that. At the same time, I think this is what you also learn in your entrepreneurial journey.

So now at Healthark, when I started this entrepreneurial journey, I started with a very singular mission of focusing on real world evidence in a country like India, which would be a very interesting challenge. And it continues to be an interesting challenge. But your resourcefulness becomes very limited when you are just doing that, because you have to convert so many non-believers, including the doctors, the pharma companies, the investors, patients, your employees, everyone.

And the edge that you have, that you bring from a more mature market like US, would also disappear over 12 to 18 to 24 months. And that’s where at Healthark, over time, started achieving a good balance, where we continue to be associated with the US market, the Europe market, where some really interesting innovation is happening, both from a technology standpoint, as well as from a process standpoint. It keeps us in market, ensures that we continuously learn and challenge ourselves, also become more resourceful, and at the same time contribute to a more developing ecosystem like India.

And we’ve been doing that. So my company right now, there are two or three very interesting things that we are doing. We have been associated with the NITI Aayog, which is the central government’s think tank in India.

And with them, we are running, we are participating in a program where they are developing a knowledge platform across 22 different sectors. Our team has been focusing on the healthcare sector, building a knowledge repository, and a good part of it is around data interoperability, interoperability of information. So now we are getting a chance to contribute to that in a very meaningful way.

There is a large team under it called One Health, where you take data not only in terms of 360-degree real-world evidence, but you combine it with data from environment, from animal health, from various other societal aspects like education, social data, and through that drive healthcare system development. We’ve been writing thought papers in terms of how that concept could be more matured in India. Second, we are working with one of the other governments to set up a World Economic Forum Center for the Fourth Industrial Revolution.

This center focuses in terms of healthcare ecosystem development where RWE is a key pillar. So one very important part around India, and then we’ll come to the third theme, is at least in the Indian market, most of us look at it in two parts. One is India for India, where all the capabilities you develop, how do you use those capabilities to serve the Indian patient population? And then the second thing you look at is India for global.

We have a very large workforce. It’s fairly talented. There are many engineers, many scientists, many doctors.

How do you use that to help scale some of the innovation at a global scale? And this involves a lot of ecosystem development work where you work with global companies to ensure that they use capabilities in India to serve global markets, serve global science in a larger way. And then the third piece which we have been doing as a part of it has been participating in different scaling programs for real-world evidence. India produces a lot of engineers, a lot of data scientists as well, but rarely have I seen good programs, and there are a few, but they’re very rare, who produce good real-world evidence, real-world data scientists who produce clinical research scientists, at least in India.

And now we are working in terms of also figuring out how do we do the right kind of scaling and talent development around real-world evidence, real-world data. So to your question and comment, now we have been doing, taking this challenge as an opportunity and trying to do our part. There’s still a lot to be done, and it’s not easy just to educate so many people along the way.

But it’s been an interesting journey, and also working in global markets equips us to do that better.

Purav, this is fantastic just to hear and have you reflect on parts of your journey, how it ties into real-world evidence, real-world data today. And with that, why don’t we pivot just a little bit more to the topic of today, and focusing on kind of the category of analytics, platform adoption, talent. But before we do that, this is going to be a little bit non-sequitur, but I noted in your profile that you are an ardent coffee lover, and I have many memories of roasting coffee from my various travels to Chennai.

And I have to note India is absolutely one of my favorite countries. I think I’ve had over the years something like 15, 16, maybe even 17 trips to India, and I’m just always amazed with the wealth of talent, the accessibility of the people for new ideas and new thinking, and it really is a lot of fun. And I think that what you have been able to do is embrace advanced analytics and methodologies.

And this is not a conversation today about AI and those things. It’s really about the human side. We can have all the analytics and technology that we want, but at the end of the day, it still requires people to do things.

And maybe you could just start there in terms of, and this might tie a little bit into the health art, excuse me, health art business model, but it is what specifically are clients approaching you and your team to do, and what does the response look like? Oh, thank you, Matt, for asking that question. Essentially, like kind of what we do at Healthark, and also generally a lot of companies in India have been able to do. The depth of talent in India has been fascinating.

And India right now, as a country, kind of is on this journey to transition from a developing to a developed nation. And growing up in a developing country, you learn to be very resourceful. You learn to be problem solvers within limited means.

And that is what kind of Healthark also reflects in terms of what we do for a lot of real world evidence companies. And so when we started our journey, we used to focus on the data part of the business where we could take real world data and understand it with a lot of deep nuance, understand the medical parts of it. But gradually, as we started working with our clients, we understood that every client has a 360 degree business.

It starts with defining an offering. It starts with a sales cycle where you have to identify target customers and reach out to them, bring in leads, pitch to them, build proposals, sell projects, do project management. And gradually, at Healthark, what we have been able to do is work with many of our real world evidence clients, as well as some other digital health clients, to build an extension of their teams, which is flexible and rapidly scalable.

And so when I say an extension, it could mean anything. It could be people supporting the marketing and sales part of their journey to product design, product development, and product engineering, compliance support, documentation support, HR support, administrative work, all these things are what we would figure out for our clients to help them build an extended team. And the thought of working with a team in India usually starts with just the thought of cost arbitrage, but also beyond cost arbitrage, because of the depth in talent market in India, we are able to scale teams very, very fast.

And what it means is if an organization has to go from five people to 25 or 25 to 125 within a 12 to 18 month period, without compromising on quality, India and Indian teams would have a big role. And that is what we now do for some of our clients in terms of supporting them in terms of developing their organizations. So, Purav, you’ve got me thinking, and I have this question.

So we talk about scalability, and we talk about, you know, the cost of things. I had a question with a colleague who is part of the Asia Pacific world, and they brought in Alibaba to look at, you know, how do you make money with real world evidence? And we talk about the patient, but also, you know, as businesses, we need to make money. The Alibaba representative turned around to him and said, why don’t you do clinical trials, because you can make more money.

For me, that’s, you know, that’s not an option. But when, you know, you’re an entrepreneur, and you believe in return on investment, where is the touch point with real world evidence that allows us to justify our existence, do you think? Interesting question. I don’t know.

So at least I do believe that within real world evidence and real world data, unlike the Alibaba guy, I do believe that there is a lot of opportunity, both in terms of contributing to finance, contributing to science, but also getting sound financial returns. Multiple use cases that I have had a chance to work on, whether it is recruitment of patients, or early access to treatment and therapy, being able to identify which treatments work and hence again, generating financial value apart from patient outcome value. It all is kind of very, very rewarding, both in terms of science as well as in terms of economic returns.

So with that, I personally don’t think that there is a lack of financial incentive with regards to real world evidence. Of course, when it comes to the Asia Pacific region, and I can speak a lot more about India than China, there is a lot of lag in infrastructure. You’re still behind when it comes to both physical and digital infrastructure.

And hence, what happens is more often than not, whether it is at the government level or at an organization level, infrastructure development tends to get prioritized over looking at data and making data-driven decisions. Some of the gaps are so glaring and obvious that data-driven decisions might not be required. The challenges are just obvious and you need to start working on them.

But in a more advanced economy and system like US, I think most of those low-hanging fruits in some way or shape have been taken. And so data-driven decisions have a lot of value, whether it is science or finance. And I believe that will eventually be the case in other countries as well.

Not sure if that answers your question, but that was my interpretation, Stuart. No, that is spot on. And it was a loaded question and it was a horrible one.

So I do apologize for that. I live in the world of real-world evidence. And if there wasn’t a need for it, then we wouldn’t exist.

So no, it was a great answer. Thank you.

Indeed. Yeah, no, that was great, Purav. And actually, it was a good question, Stuart. I really appreciated that and your response, Purav.

And something that I often encounter, and of course, having had a full-time consulting practice, very focused in real-world data and data access, I’m just curious, Purav, in terms of clients that you’re working with, the analytics, the need for the resources, the staff extension, absolutely foundational to what they’re looking for. I’m just curious, are you also involved in obtaining access to real-world data? And what does that look like? I mean, do you have a model to actually engage data providers? Is it a combination of analytics, the resources, and the data? It’s a great question, Matthew. Most of our team and presence is based in India.

So we initially, during our early days, made some attempt to access data in other countries. And we were not very successful. And then we made a conscious call that probably this is not what we’ll pursue as a business model.

But recently, now we have started getting access to some data in India and surrounding regions. So we have now, for example, in the last two, three years, we did a lot of work on vocal biomarkers. In fact, at one point, we were working on developing a vocal biomarker of our own, using voice data for screening of thyroidism.

And as we were doing that, we also worked with a couple of consortiums to figure out how to make that data available in a repository format at scale. So now we have some access to that data, which we could bring on for some of our clients. We as an organization are still very small.

We don’t own data within our own repositories. But through that, we have, for an example, access to some data. Through some of the work we have been doing with World Economic Forum, we’re building a center of 15 high-performing sites from where real-world data can be used for some research purposes.

And now we bring in that access to clients as required. We’re trying to figure out how to build a repository of variable data combined with healthcare data within the Indian context, because a lot of digital biomarker studies, variable studies require representation across the world. And right now, getting access to that data in India and surrounding regions is difficult.

So we’re working on that. So gradually, we have started working on how to get that data accessible in this region. And we bring that on for our clients.

But for that, at this stage, we are very region-specific because all the challenges and legalities involved are fairly complex to do it across the globe. And I’m sure you guys have faced that very often in all your previous businesses. Absolutely.

Yeah, that’s a critical issue. And at the same time, I find it fascinating because having been within a number of Indian health systems myself, literally in the hospitals, seeing patient care, seeing clinical research and outcomes research and action, it struck me that there’s just so much opportunity. And especially with the annual growth rate of electronic medical record systems and use in India, that it is poised to become a real leader in real-world data access.

And I think that the advancements over the last couple of years in patient privacy, that is yet another area of growth and development and regulatory science advancement within India. And so those are all very positive things. And I can absolutely see the market nuances of India and surrounding regions are increasingly important.

It’s a huge patient population and the ability to rapidly capture the insights from that accessible data is going to be a very exciting thing as it becomes more and more common to access that data and be able to use it for various use cases. With that, let me pause for just a moment to invite the audience to raise their hand. We would welcome a few questions of folks on the stage.

So please raise your hand. We’ll bring you up. And with that, Purav, as we’re waiting for folks to join or post questions in the chat, maybe we could delve just a little bit more in terms of the analytics considerations, you know, the team that you have accessible and available, what is the typical engagement? What does that sort of involve? You know, there’s exploratory conversations for the client that sets the stage for the resources that you want to bring.

There’s a launching point at some point. You talked about, you know, sort of the scoping and proposals and earlier comments. What sort of timelines do you find in that engagement process and what really sets the stage for a good, solid client relationship? Typically, and it always varies, like you can imagine, but typically, what we have seen is, generally, when we talk to clients, there is a bit of skepticism with regards to working with India for those who have not had a chance to work with teams based in India.

And then, again, being a smaller firm, so typically, it starts with a small engagement where it could be, let’s say, a fixed scope engagement to deliver X or start with two people who are doing a small piece of the work for the client. It could be either on the engineering side where we are doing something around data management, data cleaning, or it could be something around sales and marketing support. And then gradually, we have always been able to build trust with the client, both in terms of quality, as well as processes around data security, information security, that over a period of time, anywhere between the third month to the 12th month, gradually, they would start scaling the team.

Each organization also has a learning curve in working across time zones. So gradually, the team members would start becoming more comfortable working across time zones and would work more seamlessly with our teams. As we work on deploying a team for our client, actually, that team also has a bit of norming forming in terms of its own team dynamic, team structure.

That is, again, anywhere between three to 12 months cycle. So typically, that’s what the cycle has been, that from the conversation to starting work would be around three months, four months. And then from there, from starting to scaling, again, it’s a zero to 12-month journey.

Got it. Okay. That makes a lot of sense.

Stu, why don’t we turn to you for a question or comment? Thanks, Matt. So, Purav, I’m a regulatory scientist, so I can’t help myself. I’m always going to ping back to the regulatory side of things.

What is your feel for India when it comes to accessibility to those companies and researchers outside of India with regards to the regulatory framework to access both existing data, secondary use, and primary data and doing observational studies or non-interventional studies? So, Stuart, is the question that how do Indian researchers access data from outside or outside of access data from India? That was a very Stuart question, so I apologize for that. So it’s more of a case of, okay, so how does anyone access the data? Is your regulatory framework when it comes to what you need to do for approvals, regardless where you are in the world? Is it sympathetic to real-world evidence? It is. It is fairly sympathetic to real-world evidence, right? I believe, and now in the era of cloud, a lot of things are enabled really well.

So for us to access data from outside, it’s very straightforward. We would have teams here with all the data security features built in to not have the data come to India and access it outside, access it within the firewalls of the client or organization we are working with. Very similarly, for Indian data also, now the Indian government has started setting up similar guidelines in terms of how to store data, what data can be accessed in identified and de-identified format.

And in general, the guidelines that are coming up are very friendly. In fact, I want to go to the earlier comment that Matt had, right? So in India, I believe that in the next two, three years, the opportunity to do real-world evidence stuff would be very mature because now the Indian government has set up a unique identifier for every Indian citizen. And it takes time to scale it, but now there are 400 unique patients who have their national identifier allocated to them and their data gets tracked.

The guideline right now is to track 15, 16 fields of data and not all the data in an interoperable format and associate it to that identifier. But gradually as time progresses and more and more people come on to having that unique health identifier called as the Aadhaar ID, government will also consistently increase the number of data parameters that you have to make interoperable to get paid by the national insurance scheme called as PMJ. And as that happens, a lot of data will become more and more analyzable, will become more and more interoperable and longitudinal.

And at this scale, it could be very, very interesting to analyze this data and look at trends in terms of both outcomes data, but also like healthcare financing, healthcare access, socio-demographic patterns of healthcare delivery could become very interesting in terms of looking at Indian data to drive insights. Also, the regulatory framework in the country is fairly open where government recognizes and a lot of Indian companies also recognize that methodologies and science around real-world evidence has been more advanced in other countries because they have been doing it for a longer time. Collaborating with researchers across the globe makes us better positioned to analyze the data and derive results.

So I feel the regulatory framework as well as the trend is very towards a high degree of optimism. Sorry, Matt, before you jump in, I was just going to say thank you very much for that because yeah, it’s fascinating based on the population that you have, the nascent kind of emphasis on the EHRs, but the opportunities are really exciting. So thank you.

Indeed, yeah. Well, with one eye on the clock and the old cliche, time flies when you’re having fun, this is absolutely flown by. But Purav, I would like to ask one question, just maybe probing a little bit more around AI, the focus of Healthark in artificial intelligence and solutions and working with clients.

I know that you’ve done work with NLP and sentiment analytics, image analytics, voice analytics and a variety of other things. And in focusing on that, what sort of growth area is that for you right now? Obviously, it’s very important for the future. It’s sort of the buzz of every industry right now.

But I’m curious how that ties into your future vision of where Healthark is going and what you see are some of the areas of real growth and opportunity over the next few years. Thanks, Matt, for that one. So when it comes to AI, we’ve been doing very interesting work for the last four or five years in terms of doing natural language processing, doing voice biomarkers by looking at voice and doing pattern recognition to identify diseases on voice data.

A lot of this work was very, very difficult and strenuous. And in some cases, our size as an organization also was a challenge. But in the last 9 to 12 months, using generative AI has been a game changer for us in terms of the speed at which we could annotate data, the speed at which we could interpret things, the speed at which we could clean up data.

If we had to extract data from a very complex… And we recently are doing this work where we take adverse event reporting forms, and these are in PDF formats. And we have to take out some very specific information from those adverse event reporting forms. It was a complex NLP task.

It was a complex OCRing task. For every new field, it would take us anywhere from four to five weeks to figure out how to extract that information through writing an algorithm in a nuanced way. Suddenly, now through generative AI, one or two smart folks and they could do it in a matter of hours, not even days.

So suddenly, we are at this point where we have now started to unlock some of these AI-related activities tasks, which otherwise would have been very challenging for a small-scale company. Now, scale for many activities goes out of the equation. You could annotate data at tremendous scale very quickly.

You could extract data from multiple sources in a structured table by writing a few prompts. You don’t even require to write complex code. And with that happening, I feel that we’re quite optimistic in terms of delivering some very high-use cases for our clients over the next few months and years.

Fantastic. Thanks. Well, one additional offer of questions from the audience.

I think we could probably get one question in. And if not, Purav, this has been fantastic. We’ve really enjoyed hearing about your journey, thoughts around the market, opportunities.

And I guess if there was parting comments, what would you like to leave this audience with? Obviously, not just the audience that we have today participating in this live discussion, but also the podcast listeners later. What’s something that you’d like to leave them with? I think if I were to leave one parting comment, but again, build on the theme that I talked about, real-world evidence has tremendous potential. I believe that there is a lot more scale that needs to be provided, a lot more energy that needs to be put in to solve various problem statements.

And looking at the talent market in India, with companies like Healthark or others, sometimes the scale that is required, sometimes the agility that is required could come in very quickly. There are different problem statements in the U.S., in Europe, across the world. I believe there is a strong role that India can play in that.

And I would like to leave that as a parting comment, if you will. So, Purav, thank you very much. It’s always fascinating to follow the journeys of physician, entrepreneurs, especially in the world of real-world evidence.

And your journey has been fascinating, especially Deloitte and the companies you’ve created, and certainly the impact that you’re making in what I would call the revolution of real-world evidence. So not the evolution, the revolution. And I’m really looking forward to reading your book.

So, thank you. Yeah, just to echo that, thanks, Purav, so much. Great to hear about the journey, your entrepreneurial endeavors, some of the decision gates that you faced, the fact that you tapped into other experienced entrepreneurs for insight and guidance.

I mean, that’s kind of the hallmark, I think, of a good entrepreneur. It’s being receptive to input and feedback from others. And also, echoing Stuart, I can’t wait to read your book, Lead from the Front.

I did publish the link in our chat for folks that are interested in that. It’s the Amazon link. I’m sure there’s other resources for the book.

Hard copy, and it looks like there is a Kindle version as well. So, Purav, thank you so much for joining us. This has been a great journey.

Any final comments? And with that, we will close. So over to you for a final comment, Purav. Well, thank you so much, Matt, to you, to Stuart, for being such kind hosts.

Really loved the discussion. Like you said, time flies when you are having fun. So, again, just would like to end on a thank you note.

Perfect. Well, thank you again, everyone. Thanks for joining.

Have a good week, and we will talk again in Real World Wednesday next week.