NOEL:  Hello and welcome to Episode 30 of the Tech Done Right podcast, Table XI's podcast about building better software, careers, companies, and communities. I'm Noel Rappin. 

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Today on the podcast, we have Table XI's Mark Yoon returning to the show and we're joined by Kyoko Crawford from SkinIO which is a mobile app for skin care tracking and change detection. We're using Kyoko's experience building SkinIO to talk about how to design applications where the audience audience is both patients and doctors. We're going to talk about liability issues and about designing for the unique amounts of trust needed to support a healthcare application and about the skills that a healthcare technology team needs. Along the way, you might learn a bit about dermatology. 

Mark's been on the show before, but for people who might not remember, Mark would you like to introduce yourself?

MARK:  Hi. Yeah, I'm a web and mobile software developer and the Director of Talent at Table XI. I've had various exposure to medical technology in the past. I'm very interested in the topic and really interested to hear what Kyoko has to say about it. 

NOEL:  And Kyoko, can you tell everybody who you are?

KYOKO:  Sure. Hi! I'm Kyoko Crawford and I'm the CEO and Co-Founder of SkinIO. It's a Chicago based startup. We do full body skin screening on a mobile device for the purpose of detecting skin cancer early and avoiding unnecessary invasive procedures in the skin.

NOEL:  We're here to talk about today technology and application design for healthcare. And I wanted to know, Kyoko, what makes designing a healthcare application like SkinIO different from designing any other kind of mobile software?  	

KYOKO:  It's a big question and I've wrestled with it a lot. And I think our engineering team and our design team wrestles with it a lot. The biggest thing is it's a completely different use case, context, expectation than kind of your traditional consumer-oriented tech. I think one of the biggest challenges with designing and implementing in healthcare is that you are developing something for audiences that sometimes have very different expectations, different incentives and a very, very heightened sense of liability. And so, that in and of itself, is a whole topic of conversation because that drives a lot of things. It drives a lot of behavior. It drives the risk aversion in the field.  

NOEL:  So, what's a specific example of a design choice that you need to make in SkinIO because of liability?

KYOKO:  It really actually is very manifest in kind of how we design for a physician who's using the application and how we design for a patient. With physicians, obviously, liability is always top of mind -- their utmost fear is medical malpractice suits and being sued for this and that. And so being mindful of that, partly because part of our mission is to use technology to really bridge that gap between physicians and patients and our goal is not to replace the physician but really to optimize the physician's time. The physician is a very key stakeholder in our technology but they're also somewhat reluctant, kind of in the traditional sense, where they don't want to have to do more than they already do which is a lot. And they also don't want to expose themselves in any way to this unwanted liability. 

Now in our case, it's especially pertinent because we are doing skin imaging and this is in dermatology. So, if you look at dermatology, it's a very visual specialty. These are specialist physicians who look at skin, our external organ the only really, truly externally visible one. But the standard of care right now doesn't really include imaging even though intellectually, I think, most people can objectively agree that that can probably only help if they have this visual reference. But for them also, they're not necessarily coming from the mindset where they want to necessarily open themselves up to having a catalogue of something they could have potentially missed. 

So, being able to design the interface such that it's non-threatening in that way but useful, that involves messaging, that involves kind of how we present this data in the most effective way without being threatening is kind of the challenge. And that's a little bit different from a patient who is increasingly more empowered in the self-care dynamic. We have the newly empowered consumer patient who's taking more control of their healthcare. They want to know more about their health at all times of the day. They want to track everything. And being able to present data to them in a way where we're again presenting something of value to the patient that also doesn't rely on a patient who is not a physician to make clinical decisions. 

There are very different inflections on how we present that data, and that presents a challenge when we're doing it in a universal app that is meant to be used by both parties. 

MARK:  For sure. I think when you're talking about tools in the medical space, there are some serious pitfalls or some places where all of a sudden you're falling off the cliff. Let's take the example of a pen or a Post-It note. Doctors use pens and Post-It notes all the time. They often get them for free. And there's no extra liability or insurance or regulation around 'this Post-it note doesn't show the right color on this pen, so it could cause a doctor to miss something. And so, we need to charge you $100 for a pack of that Post-it notes'.  But as soon as you start getting into tools that are used in medical care, all of a sudden you get into those kinds of issues where like this little rubber mallet with steel on it, now it needs to be able to go through a steam cleaning or maybe occasionally, the head breaks off and knocks somebody in just the wrong way. So now, this is a $1000 stainless steel hammer with a rubber mallet.  

The interesting thing is that that's the history of it and then it gets applied to software which is really tricky. And when you get categorized into, "Oh, you're a certain kind of medical tool or medical device," it comes along with a bunch of other regulations and liabilities. So to me, the really tricky part is that we do sort of feel like we're designing pens and Post-it notes, just tools for everyday use. But as soon as you drop into a certain category, it comes with a lot of regulations. 

KYOKO:  Right. It's not really a function of just utility alone, like utility is loaded in healthcare. I think that is really one of the key differences. 

NOEL:  Are doctors' offices particularly technologically savvy? Like for instance, I've designed for lawyers and at least historically, lawyers' offices are not particularly tech-integrated or at least they took a long time to become tech-integrated. How are doctors or the physicians that you work with in that regard?  

KYOKO:  Generally, I would say doctors are not at the forefront of technological savvy. The vast majority are not. In our particular case, we work with dermatologists, at least primarily right now, and dermatologists are a niche specialty within medicine, they are a luxury specialty. So, they are a little bit more gadget-friendly which kind of lends themselves to being more kind of the Apple fan club. So, EHRs and EMRs that have done really, really well in dermatology that basically have the majority of the market are actually not really the epics but they're modernizing medicine [inaudible]. They're all iPad based which works well for us because that means that pretty much every dermatology office we go to has an iPad or multiple. But just having an iPad and using it for a mandated EHR is not the same thing as being technologically savvy. 

NOEL:  Electronic Health Record, right?

KYOKO:  Exactly. And so, that doesn't necessarily mean they're technologically savvy. Doctors are much like lawyers and healthcare is kind of a still traditional industry. It's kind of the last bastion that's left that hasn't quite effectively been disrupted by technology. And so, they're very much part of that. They're not the ones that are going to be taking on the latest technology. And part of it is they can't, just given the nature of their industry but yes, that's kind of not the tech forefront. 

MARK:  I mean, there is some friction in there from regulation and from just tradition.  I'm divided about it because you do want some friction in there and you don't want necessarily your doctor to be trying out the latest medicine on you without really vetting it well. You don't want to have them try and put some implant in your body that maybe in 10 years we find out is toxic. So, it's all for well intended, it's all for good reason. But yeah, there's just so much friction there. It's not just regulation. It's also sort of from the ground up the way that doctors are taught and trained and educated. 

NOEL:  It sounds like there's kind of a legitimate tension between the speed that software people want to go and the speed that the medical profession for very good reasons and also for some more just entrenched reasons wants to go. 

MARK:  Yeah. It sometimes does feel like we have sprinters and we have crawlers and nothing in between. And in various parts of trying to introduce a new technology, you either have to crawl or sprint and have the patience for all that. So, I really admire people who take that on as their day to day. 

KYOKO:  It's tough, yeah. It's certainly a difficult industry to apply kind of the same sort of lean methodologies and agile development that works in other industries. The stakes are a lot higher and you're dealing with kind of that mindset that's a little bit different. 

MARK:  I think every once in a while you get a physician who is tech-minded, who's a visionary and who can see, "Well, if we just broke down a few of these barriers or found a way to get past them, we could do something really cool here." And I think like that is one of the most essential ingredients to launching a product or even experimenting with a product is a physician that's willing to stick their neck out and to hang their hat on, "Okay, we tried something new here." That's pretty hard to find because all the incentives are aligned the other way towards safety. 

KYOKO:  Yes, absolutely. And we've been lucky. My co-founder is a dermatologist and Mohs surgeon. He's a visionary. He actually comes out of the Northwestern system. And we've been lucky enough to work with other dermatologists, and they tend to be kind of the younger generation, not the ones who have been practicing for 20 or 30 or 40 years. But they're the ones that are still young that have a lot more of their career. And that generation, you can see kind of a clear divide among physicians. That younger generation we're looking at more patient-centric care and really moving healthcare forward and those are kind of the ones that will push kind of the new technologies and the new methodologies forward. 

NOEL:  That's interesting because a couple of weeks ago, actually for this podcast, I was speaking to Ed Livingston who handles podcasts for the Journal of the American Medical Association. One of the things that he said about the generational divide in Doctors is that over the last very few number of years, they've seen a huge increase in medical students being much more willing to get information from podcasts and internet kind of sources and much less interested in traditional journal kind of papers. And I wonder if that's something that will play out that as you get a generation of doctors who grew up immersed in the technology in a way that an older doctor might not have, whether that's going to start to affect the way that they want to... "Why can't I use a camera?" 

KYOKO:  And I think it already is happening and I think there is some concern there because on the flipside, there is a lot of misinformation that's propogated from all these online sources. But I think we are already seeing that. It is a very stark divide, at least from what I've seen. 

MARK:  And Kyoko, something that you mentioned earlier when you were mentioning doctors is you also mentioned patients and users. And that's something that now that I get to focus on software and people every day, it's such an important thing to me and it seems like that's the other half of your audience. 

KYOKO:  Yeah. 

MARK:  I'd love to hear more about that, simply because I had the chance to visit SkinIO and it was really attractive to me as a user. I think you nailed the initial touchpoint. So, I kind of want to hear about how did you go about doing that? 

KYOKO:  That's actually a really interesting lesson for us kind of over the last year. So yes, truly our audience for SkinIO is physicians on one hand and patients. With the future of healthcare and the direction which it's going, clearly the consumer patient market is by far the largest one. And it also is kind of the target market for, I think, technology playing a huge role in healthcare which is to really alleviate the access problems we have. 

It's especially bad in dermatology. We have fewer than 11,000 dermatologists in this entire country for over 300 million people. There is a huge, huge access problem. And so, that is where technology understandably, I think necessarily has to play a role. 

And so you know, we can't avoid dealing with the patient and developing for the patient as kind of the ultimate customer. However, it's interesting because we deliberately -- you probably can gather that we deliberately chose a commodity device as the basis of our technology because our thought is, "It's 2017, it's 2018." We have these commodity devices that everybody owns. Everyone's incentivized to upgrade every year and it's only going to get better with every single iteration. We have cameras that are of sufficient quality for what we're doing where the resolutions keep getting better. We have the true-depth cameras. And so, we can start to truly capture this longitudinal photography and track changes over time. 

So, if that's the case, there's nothing stopping this from being used by everyday people in the comfort of their homes. And as a technologist, I see that vision and I'm like, "This is great. This is how it's going to be." And then you realize then there are the actual people. 

NOEL:  So, how do you go about designing that first touch for people who -- what is important to you in that initial contact between people and your application to get them to overcome whatever concerns they might have in using it? 

KYOKO:  I'll be completely honest with you. We haven't quite overcome that. So what I was going to say is we actually get a lot of interest from consumer patients signing up and creating accounts because most people are aware that skin cancer is a problem. Most people have some sort of relationship with it - friends, parents, grandparents. Most people know about it. And so, there's a highly motivated group of people out there. 

However, what we still struggle with, at least in the direct to consumer approach, is we're introducing a new behavior which is kind of a number one hurdle where not only are we asking people to check their skin regularly and we're helping them do so through these regular notifications by the app, but we're asking them to take photos, scan their bodies unclothed on a regular basis. Not something you typically do with your device at home. And this isn't selfies for skin cancer, this isn't Snapchat or anything like that. This is full body scans, so you necessarily need someone else to take these photos right now. And that is a pretty big hurdle. Even if you're at home and you're highly motivated, you still need a spouse, a significant other, someone trusted that can make that time even if it's 5 to 10 minutes to do this. 

And so what we realize is that we have a highly motivated consumer patient base. Some of them would email us and ask, "Can I actually just get these scans done at like an office?" So that was interesting to us because we did actually do a lot of brainstorming and designing around those first touchpoints saying, "Okay, when you first sign up for the app, we'll explain to you what you need to do. Maybe we'll give you the option to kind of schedule a time with a buddy to take these photos and make it easier," and not just force them to take the photos first and give them a free set, all of that stuff. We found that people actually -- the highest conversion for us is actually in a doctor's office whether it's a dermatologist's office or a primary care physician's office, you're already there for a medical appointment. And this only takes about 5 minutes of your time at the end of your appointment or right before, you're already in that proper mindset as a patient that you're going to have your body looked at and your health kind of measured. And so, if it's just another 5 minutes of your time and you have a nurse or a medical assistant wearing scrubs in a professional medical environment doing this, a lot of people go for that versus actually doing that at home, which is kind of interesting.

NOEL:  Yeah. What I was thinking as you were talking about that is what kinds of things that you need to do to build the trust and the authority for somebody to trust this application both from a security level and also from a 'this is going to be useful to me' level. And it seems like having the first touch be in a doctor's office is actually a good way to get at both of those issues. 

KYOKO:  It's absolutely huge because yes, a lot of it is trust. That environment itself lends that level of credibility. And you're more inclined to do something when it's presented to you by a doctor or a medical professional. And so, that we've realized helps a lot. And there are some technological things that can happen to make this easier. I think requiring another person at home is still a bit of a stretch, like that's hard. So as long as we need that for this kind of full body scan, because for us the full body side of this is key. It's the key differentiator and it really goes to what we're trying to do which is we are trying to create a visual timeline of your entire skin surface because 70% of melanomas come from a new spot that wasn't there before. So, even if you were just tracking things like you selectively picked on your body, you're not going to necessarily be catching the melanomas that way because you're only going to be tracking things you can see and the things that you know are there. 

So, full body is huge for us. And so, those are kind of the challenges for the direct to consumer, reaching someone at home on their couch who is worried about this that I think with technology and with a little bit more shifts in mindsets and behaviors and just how we consume healthcare in general might help us go that way in the future. But as it is right now, with the new technology kind of starting up in this market, we found it's just far better conversion in that trusted place. 

MARK:  It sounds like you're doing a really good job of understanding your user. And that's something that -- at Table XI, when we are sitting down with technologists or business people, we really try and identify as soon as possible who the users are and then get as close to being in their shoes as possible. That's a hard hat, that's a difficult hat to put on especially when you're thinking about a lot of other things like how do we make this work with doctors. 

Some of the most impactful experiences that I remember from my time, academic medical centers actually in the hospital and going to a patient room with a neurologist and watching them prick the skin on somebody's shin while their spouse watches and watching somebody's hand shake as they try and hold them up or just watching a nurse go in and out of rooms and answer pagers and phone calls and reboot machines in a round robin order so that they can have a working medical record ready at any given moment. Those experiences impacted me more than probably any of the programming that I did. And they can only tell you so much, though. They can tell you that this is very intimate or that there's fear. 

And then I think there's something that just working on these types of applications over and over has told me that patients can't tell or that users can tell us. And that's like building habits is really hard. Feeling safe, it sounds like you've identified that as well. But there's many ways to feel safe. So feeling safe can happen with a trusted adviser like a doctor. 

Feeling safe can also happen over time. So like you said, the full body scan is really where the value is. But maybe if you just get to first base with your users and it's just the most likely spots, I'm not totally familiar but I'm guessing, mabye face and hands. If I know that I can trust you with my face and my hands for a month, then maybe I'm going to do my arms and my legs. Maybe it will take a little time for you to get to home with me but there's ways of introducing the idea of safety that can really build that trust with your users. 

NOEL:  Yeah. One of the things that's striking to me about healthcare applications especially user facing healthcare application is that the emotional register of the user is much different when they're dealing with something that's medically diagnostic versus like Evernote or something like that. Even if it's similarly trying to build a habit in the medical instance you're dealing with discomfort, fear, intimacy in a completely different way. How does that affect the kinds of usability decisions that you make in your application? 

KYOKO:  Yeah. But you bring up a really, really good point and I think ultimately, it really is about trying to establish trust. And for us, because we're asking for full body scans where you necessary can't be clothed and we try to effectively message as much as we can, we're encrypting your images and it's stored in a HIPAA compliant server configuration. All of those things, we're always trying to design to reassure. 

NOEL:  Does that affect even things like color choice?

KYOKO:  Yes. Hence kind of the calming blues and things like that and it is actually really delicate dance because you want to calm the user, reassure them to kind of build up that trust. But then also part of our main delivery results is whether there's been a change detected that you need to see a doctor for, or whether you're okay, like you just wait another cycle. And making sure when we deliver those results, that they're of adequate import to the user and making sure that that notification -- that notification we actually have a heightened liability around. We need to inform someone if we find a new spot or change that needs to be seen in person and we need to make sure we've kind of notified them all the ways we can and deliver it in a way where they understand that that is important. That's when we start to introduce some of the reds without being overly alarming because we also don't want to overly alarm someone, but present them with enough data to get the point across. 

So, that has been a challenge to kind of -- we've iterated on it a lot with how we deliver the results of our software, of our algorithm which is essentially your full body scans but you have kind of the detections, these circles around the moles, and spots and markings on your skin and being able to quickly show the patient what matters and what they need to act upon. But do it in such a way where they don't have to make the decisions. That is always a delicate dance and it's one where we want to make sure we're delivering that appropriate value and that appropriate sense of security to a patient. 

NOEL:  How do you go about -- assuming that your algorithm has a lot of testing and extra level of testing behind it -- user skin is an extremely variable commodity. What goes into the extra level, and of course you want the diagnostics to be completely accurate under all kinds of circumstances? What goes into that kind of test structure? 

KYOKO:  This is going to go into another huge topic which would take another whole series. Just to be clear, our algorithm, the output of our algorithm is non-diagnostic. What we are doing is tracking your skin over time and identifying changes. So, any new spot or any change to an existing spot in color or size, we are not saying that any new spot that we identify is a melanoma or a basal cell or a squamous cell or anything like that. We're just saying it's new. And that's an important point especially when we go to direct to consumer. 

And so, how our algorithm does that and how it's trained and how it's tested is based on the convolutional neural network model. So we do have a CNN that's driving this algorithm that is essentially to some extent classifying these lesions. And for that, we have to use these educated labelers, we have to use these dermatologists that are in our orbit. They are the ones who are classifying these lesions as they come in. And this is across a lot of skin types and there's a huge difference between the skin of a 75-year old and the skin of a 23-year old and everybody in between. 

And so, (a) we have continuous training of our CNN. We probably have over 50,000 data points at this point that have been kind of classified and feed our training set. And in terms of testing, there's obviously the integration testing that goes on throughout. Beyond that, because we're in the medical field and because this is something that is delivered to patients as, again as medical advice, not as a diagnosis but still within the medical realm. Because our technology is not designed nor can it truly interpret these results, we have a team of dermatologists who actually interpret the results. So, they see the raw output of our algorithm and they determine whether someone needs to be seen or not. And right now, that is really the only way to effectively kind of convey this type of service where you actually have a trained medical professional who is evaluating -- it's kind of like reading an x-ray. You don't necessarily just deliver the x-ray directly to the patient. You have a radiologist who is reading it. And so, it's a similar paradigm here because our algorithm could pick up a new seborrheic keratosis. Seborrheic keratosis is a type of lesion that's benign but it changes and dermatologists are very good and highly trained and can recognize that instantaneously. You or I cannot. So, being able to make those distinctions, our final step is actually through a dermatologist who reads these results. 

So, that goes into the whole conversation about AI's place in healthcare and why AI will not replace physicians any time soon. And so, that's very much a part of kind of our product and how it kind of got to this point. 

MARK:  I mean, you're building a measuring tool, a tool that still has to be interpreted or used by a professional. 

KYOKO:  Yes. 

NOEL:  Which I imagine is deliberate choice going back to the liability issue we started off by talking about. 

KYOKO:  Yup. It's absolutely a deliberate choice especially as a startup. It's hard to go through that regulatory process, if you claim kind of the diagnostic side of things. The liability and the regulatory expectations are huge. 

NOEL:  Right. So then you're trying to fill the space that's left over by the regulatory regime and do the thing that you can more easily do. 

KYOKO:  I think part of our thesis is yes, there aren't enough dermatologists but kind of the immediate side effect of that is that not only are there not enough dermatologists, because there are not enough dermatologists and it takes three to four to six months to get in to see one in some parts of this country, those dermatologists also aren't using their time efficiently. A lot of the dermatologists we talk to say, "Yeah, I feel like a TSA screener. I'm literally screening people. Out of the 35 people I see a day, I'm screening like 10 to 20. And there's nothing wrong with them but they're coming in because that's when they happen to get an appointment." 

The first part of what technology can do is addressing problem where we're better triaging patients to the specialists where there just aren't that many of them. Dermatologists should be spending their time doing kind of the procedures, the necessary procedures that people need. If they have a basal cell carcinoma, they should be biopsied and have those excised, same with melanomas and squamous. Those are what dermatologists are trained to do. It's not really worth their time to be just looking at people and checking them over and saying they're fine. But the challenge is asking people to check their skin themselves is also not feasible because we don't know what we're looking at. We could be super motivated, super vigilant about it, but we also are not dermatologists and we don't know what we're looking at at all. And so oftentimes, people go in to dermatologists with false alarm. They go in thinking that a seb kar is melanoma and it's nothing like that. So they run in and the dermatologist will just say, "No, I can tell in a split second there's nothing wrong with you." 

Where we think this technology can play a role is to take the onus out of deciding what to target as a consumer patient and taking that onus away from that consumer patient who doesn't necessarily know but creating kind of this objective visual record of someone's skin, tracking it over time so that once a change is detected, once a new spot is detected, you have a very good reason. You become a highly qualified lead to go to a dermatologist. And that work sets scalable through primary care networks, through rural healthcare clinics. That's kind of the model that I think better leverages a very, very scarce resource which is kind of the dermatologist's time. 

MARK:  This just highlights sort of the nature of where SkinIO sits and it's like a bridge over a chasm. The chasm is really that you have dermatologists or medical professionals in general that know there's a better way but they're just keeping up with their workload and they're firmly embedded in their industry and their world that they can maybe see a possibility of how it could be different but they've forced to overinvest in building up their current skill set and don't have the skill set to effect that change. 

On the other side, you have users, patients, and technologists who absolutely can see, "Oh yeah, you put a camera, some AI together, and there we go. We've got detection in skin changes." But there's a chasm for them too where all of the liability, connection to the doctors, to medical record systems, getting through making things work the way that our healthcare system works. We're not even talking about reimbursement or insurance. So, there's a chasm there and it almost feels like you have to build the bridge from both sides and like barely meet in the middle with a lot of delicacy and a lot of care. And there are not very many people or teams that have a team on both sides, the ability to bring together technologists, users, and medical professionals. So, I think that that is the bigger answer to why medicine isn't more up to speed. It isn't enough to like sort of launch a bridge from one side or the other. You kind of have to meet from both ends in the middle and that's a pretty hard combination to find. 

KYOKO:  That's very well said. Yeah. 

NOEL:  Is there a particular skill that you look for in your technology teams or your design teams that helps them deal with healthcare problems? 

KYOKO:  I don't have that answer yet. We built our team organically out of brilliant entrepreneurial people. We've all kind of learned this together. Obviously, I would say that exposure to healthcare kind of like what Mark has is a definite plus partly because some of the things that happened in healthcare that seem pretty irrational to an outsider aren't as alarming. That and of itself makes an already daunting task a little bit less daunting. 

And so, I would say more than any other industry I've had exposure to, that actually is a huge plus. But at the same time, all of us are patients. All of us are consumers of healthcare. And having that appropriate self-awareness and, I guess empathy as kind of a potential consumer, goes a long way too. All of us have had experiences of healthcare. We inherently know as a patient what we go through. And that certainly informs a lot of this. The challenge really is on the physician side actually because physicians are a completely different breed. As Mark kind of mentioned, you are looking at people who have invested a lot of their lives and a lot of their time and continue to in a very specialized fashion. So, there's a very different type there. 

NOEL:  As a group, they're known for their humility.

KYOKO:  Right, exactly. That's the piece that's actually a little bit hard now. We're fortunate in that we have a Medical Advisory Board. We have my co-founder who is very much a physician. When we meet and we brainstorm who brings that perspective which is like, "Oh, I wouldn't do that. I wouldn't do that in my practice," which is something that all of us as patients wouldn't necessarily think is crazy. 

So, it is tough but I think in a way, we've been lucky in the team we've assembled given we're all very entrepreneurial and driven by the mission. And I think the mission itself, we're trying to save lives, we're trying to increase access to skin screening. That's a mission that attracts the right type of people as well. 

NOEL:  I have a more specific design question that I was always curious about. Do you have an issue or how do you deal within the design a tension between precision of the medical data and usability? Is that an issue that is a problem at all? 

KYOKO:  In our case, it depends, usability for whom? And for us, from what I talked about and how we are deliberately and very inclusively collaborating with positions and being part of that physician-patient service, messaging this as something that a physician can use to kind of extend better care to their patients, we are somewhat relying on the physician to provide the precision and the clinical decision making. That we are purposely staying clear of that. In which case, yes we are providing automatic sizing of lesions based off of these images and helpful pointers to a physician, but we're trying to present it in such a way where they can, as quickly as possible because they have no time, get the data they need, perform their exam on the patient a lot better, and have the patient feel more reassured. 

And so for us, precision is not so much -- we're taking a backseat to the physician on that. From the patients' perspective, we're already constructing the use case such that they already have the proper context, the proper trust and security that they're doing this with their doctor, not instead of, not outside of their doctor. They're doing this with their doctor. And so then, the results are delivered in such a way where they're actionable and clear. 

NOEL:  Is that an issue of trying to not overwhelm the user with data at that point?

KYOKO:  Yes. 

NOEL:  And then to present the data as accurately as possible within a framework the user can understand? I would imagine that that's difficult. 

KYOKO:  Yeah. The challenge is in communicating to two different levels of expertise. And one can scrutinize a lot more than the other. And so, what we've basically done is made it so that it kind of funnels a doctor's knowledge and a doctor's credibility into the results but the results are already simplified for the patients so that they clearly see a change or they clearly see something new and it's something that they can act on. But our goal always is to bring that patient back to the physician because the physician is the one who's ultimately providing that end point of care. And our goal is to optimize that flow between the patient and physician so that both parties are getting kind of the maximum benefit of it. So the physician isn't seeing that patient unnecessarily, the patient is being seen only when they need to be seen. And that's kind of how we put together that and designed that entire service and kind of the product features around that. 

MARK:  I just think it's so cool that you all are making the best use of technology where technology can help and then the best use of human beings where human beings can help. That's really a wonderful combination of the best of people and the best of machines. It's nice to see that kind of efficiency coming to medicine. Like we said, it is very rare. 

KYOKO:  It definitely came to life this way, dealing with AI and all of that, it actually further highlighted for me kind of the value of humans and the value of physicians in this particular dynamic. They are very expensive for a society to create. And they're not something that can so easily be replaced just likely with technology. There are things that -- the understanding, the empathy, the kind of morality of medicine. Medicine is very much an art as much as it is a science. And that part of it is something that technology and AI at this point cannot replicate at all. So, it's a bit of a fool's errand to do that right now. We should be leveraging exactly as you said. The best of what technology does best and combine it with what humans do best, to be able to optimize that balance. 

MARK:  And that isn't the first time today that we've said empathy. I think it's maybe the fifth time. And going back to what you were saying earlier, I would echo that finding teams of people is difficult but one of the key skill sets that I would look for both on the technologist and the medical professional side is empathy because there is this big chasm being able to understand what it's like to sit in the other person's shoes, both a doctor understanding the patient and a patient or a technologist understanding the kind of system that the doctor has to live within and their constraints. It's really important. And on top of that, I would add a level of patience. 

KYOKO:  Yes. 

MARK:  Because I would say that most technologists are living in a world where the pace of change of blindingly fast. AOL Instant Messenger is gone. 

NOEL:  No!

KYOKO:  I know!

MARK:  Oregon Trail, we can play it but it's now funny to play it because it's really pixilated. These things that I remember, they're already so far in the past. Patience, I find that it's really necessary for the medical field. And then actually doctors need patience for technology because their expectations are pretty high that, "Well, this is outside of my field. The tech people can just make this happen in a few months." That's also not true. And then the last one, to echo what you were saying, also some level of maturity. And so, I would say even if somebody doesn't have domain knowledge or as much, if they come to the table with those skill sets, I think they can be part of the bridge building team, the team that finds a way to link together the medical and tech fields. 

NOEL:  Yeah, I really enjoyed the conversation. Mark, if people want to reach you online or find you online, where can they find you?

MARK:  I'm on Twitter @wimyoon. 

NOEL:  Kyoko, where can people go to find more information about SkinIO or about you?

KYOKO:  You can find more information about SkinIO at our website: SkinIO.com and I am online at Twitter @klkcrawford. 

NOEL:  Great! Well, thank you both for being here. This was a really interesting conversation and I'm glad that I got to be part of it. And thank you for being on the show. 

KYOKO:  Thank you. 

NOEL:  Tech Done Right is a production of Table XI and is hosted by me, Noel Rappin. I'm @NoelRap on Twitter and Table XI is @TableXI. The podcast is edited by Mandy Moore. You can reach her on Twitter at @TheRubyRep. Tech Done Right can be found at TechDoneRight.io or downloaded wherever you get your podcasts. You can send us feedback or ideas on Twitter at @tech_done_right. 

Table XI is a UX design and software development company in Chicago with a 15-year history of building websites, mobile applications and custom digital experiences for everyone from startups to storied brands. Find us at TableXI.com where you can learn more about working with us or working for us. I'll be back in a couple of weeks with the next episode of Tech Done Right.