About the episode

Millions of people lack access to reliable healthcare. Can technology help bridge global healthcare gaps?

Dr Jackie Rabec (AGSM MBA 2020) is co-founder of MedTech company ThinkMD, which builds tools that put a doctor’s expertise into the hands of frontline healthcare workers. She explains how the company is bridging health divides in low-income countries where doctors are scarce, and what technology could mean for healthcare all around the world.

This episode is hosted by Dr Juliet Bourke with insights from Professor Barney Tan. 

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Transcript

Dr Juliet Bourke: It’s one of the biggest challenges facing healthcare around the world. How do we get quality care to people who don’t have access to doctors? MedTech, short for medical technology, is stepping in to close that gap. It covers everything from digital tools to AI-driven platforms designed to diagnose, treat and manage healthcare conditions, transforming the way that patients and providers interact.

Dr Jackie Rabec: If you think about the care continuum, it’s like, what does technology do for prevention, health, education, improved diagnostics, treatment, follow-up to care, and we have so many players that are running hard at the wall for each of these paradigms.

Dr Juliet Bourke: Dr Jackie Rabec has seen both sides of the system. She began her career as a doctor in South Africa’s hospitals, and then went on to work at Google, having completed her MBA at UNSW Business School. Today, she’s building tools like ThinkMD, which puts a doctor’s expertise straight into the hands of frontline health workers.

Dr Jackie Rabec: So what we’re doing with ThinkMD is saying, How can we use machine learning capabilities and software to enhance the clinical capability of frontline healthcare workers who are not doctors, ThinkMD kind of levels up their thinking and reasoning, essentially.

Dr Juliet Bourke: So what happens when a product or algorithm replaces a doctor, and what does this mean for the future of healthcare?

Dr Juliet Bourke: This is the Business Of, a podcast from UNSW Business School. I’m Dr Juliet Bourke, an Adjunct Professor in the School of Management and Governance. So Jackie, can you explain what exactly ThinkMD is?

Dr Jackie Rabec: ThinkMD is a clinical decision support tool. So you can imagine an app that can be used on any device, online and offline, by frontline healthcare workers who are out in rural and remote communities and low and middle-income countries, and allows them to operate at the top of their scope of practice. So someone that is not a doctor is able to see a patient make an appropriate differential diagnosis and deliver the right treatment as if they were a doctor, with some caveats, obviously.

Dr Juliet Bourke: And so why is your app important in these communities? What? What problem does it solve?

Dr Jackie Rabec: The core pain point that ThinkMD solves is to increase the capacity of frontline healthcare workers in under-resourced healthcare settings. So we have some touch points in Southeast Asia, but predominantly focused in Africa, where the doctor-to-patient ratio is about one to 10,000 so that’s one doctor to 10,000 patients. So we see that there is a massive shortage in the clinical workforce, and Ministries of Health have tried to address this by training more doctors, but inherently, what happens is, once they’ve trained, they’ll end up leaving the country. So it’s kind of the concept of a brain drain, and so now we’re moving towards the concept of task shifting in saying, ‘How can we use machine learning capabilities and software to enhance the clinical capability of frontline healthcare workers that are not doctors?’

Dr Juliet Bourke: So let’s step back from ThinkMD and just think about the implications of any industry or profession in which you’re introducing a disruptive tool. Would you have some insights on that?

Dr Jackie Rabec: What I believe this always comes down to is, are you actually solving a real problem or a need for an end user? Historically, digital health and innovation were all about creating efficiency in the system, better billing or claims reimbursement or documentation or whatever that may be, and that introduced an additional workload to clinicians, so change management was quite challenging. Then, within the last couple of years, the risk appetite of a clinician to use a new tool suddenly changed, because, oh, there’s a whole bunch of tools, these AI scribes that I can use that actually make my life easier, because now I don’t have to stay for 20 minutes after my patients typing out my notes. And so I think if you’re truly solving a problem or a pain point for an end user, the change management becomes simpler.

Dr Juliet Bourke: Do you think that there are applications for what you’ve done in more developed economies?

Jackie: Yeah, definitely. If we look at a low to middle-income market, because the problems are so big, the risk posturing to enable frontline healthcare workers with tools that are obviously clinically validated (and ThinkMD has had really robust clinical validation) is somewhat lower, whereas in a developed country, because the doctor-patient ratio might be something like one to 800 patients, not only are your expectations from patients different, but the risk posturing of a ministry of health might look a bit different. And so I guess it’s like, what is the baseline from which you’re operating, and then where are the deficits, and how do you look to solve them?

Dr Juliet Bourke: In our advanced economies, where we do have access, you know, everyone thinks of themselves as a semi-expert here. So, you know, I can Google something, I can put it into ChatGPT, and I wonder what that does. Do you have thoughts on that?

Speaker 1: At the end of the day, a patient or a citizen is going to engage with whatever health information is at hand for them that is helping them navigate an acute health care need. And so we have to meet the user where they’re at, how we then think about it, and we’re moving into the citizen space, is how do you ensure that you are able to provision guardrails to say that this is information that’s vetted and that can be trusted, but is also culturally and contextually appropriate for how you perceive your healthcare needs, because it might be very different for you if you’re in a rural and remote community In Sierra Leone, where there’s a big focus on like community advice and support and navigating health needs versus, let’s say, Sydney, Australia.

Professor Barney Tan: As you can see with ThinkMD, Innovation often emerges where constraints are greatest. It’s a reminder that some of our best MedTech doesn’t begin in a high-tech lab in a major city, but rather on the ground in clinics where doctors might have to make critical decisions with limited tools.

Dr Juliet Bourke: That’s Professor Barney Tan. He says MedTech often develops in under-resourced contexts.

Professor Barney Tan: These are environments where the luxury of over-engineering doesn’t exist, so the technology must be accessible, affordable and robust. At UNSW Business School, we engage with precisely this kind of innovation through the lens of implementation science, that is how to make sure solutions actually work in real-world settings. We’re currently working with several MedTech ventures to bridge the gap between clinical efficacy and operational sustainability. So a great example is the UNSW Praxis Lab, which brings together researchers, industry experts and frontline practitioners to co-design digital health solutions that are both technically feasible and socially impactful. For instance, one of their projects looked at digital health tools for chronic disease management done in partnership with an organisation in Singapore, the Praxis team and partner clinicians worked to integrate mobile apps into existing care pathways for patients with multiple chronic conditions, uncovering design reality apps and feeding those insights back into implementation, Planning and adaptation. Now, what this means is that it’s not just about whether the technology can work, but whether it will work across different systems, regulations and stakeholder expectations. And that brings us to another key insight: no one stakeholder group can build effective MedTech in isolation. You can’t just have the clinicians designing tools for clinicians or engineers building tech in a vacuum. Business Professionals, whether it’s in logistics, user adoption, procurement or market scaling; they play a vital role as well. In terms of examples from a developed context, we are seeing transformative impact from AI-driven diagnostics like Google’s DeepMind for diabetic retinopathy or Babylon Health in the UK, which offer digital GP consultations. Interestingly, these innovations often circle back to support developing markets, almost a case of reverse innovation, where a tool designed for constrained environments ends up solving cost efficiency and excess problems in wealthier health systems too.

Dr Juliet Bourke: So Jackie, we’ve looked at how MedTech is changing healthcare and its applications around the world, but closer to home, I’m sure that many people have experienced a doctor using Google or ChatGPT when they go in for a consult, and I’m interested, what do you think about doctors using tools like that?

Dr Jackie Rabec: I think the reality is, clinicians will use it, but they need to ensure that they’re using it judiciously and applying their own critical lens on the information, because I would rather have a doctor that is sense checking their thinking to make sure they’re not missing something, than only relying on like what they’ve seen in the last 10 years of practice and maybe the last two papers they’ve read in the gap that they had between patients last week.

Dr Juliet Bourke: And so what has been the sort of implications? What’s been the reaction of people in Sierra Leone, when they see their healthcare provider looking something up on think, MD, it’s the same sort of experience in a way. It doesn’t matter if it’s looking it up on chatgpt Have they said, that’s great. I’m glad to see that you’re checking things. Or do they think, why are you looking something up?

Speaker 1: So I think if they can perceive that they’re receiving a higher quality of care, which they are, then generally they are happy and they’re satisfied, because in these environments. So the patient journey often looks something like this. You might have a mum that lives day-to-day, hand-to-mouth, and needs to take a young child to a clinic, and will have to utilise, like a week’s earnings to catch multiple points of public transport, to travel hours to get to a clinic. When they arrive at the clinic, there might be super-long waiting lines. They might not have the medications available to be able to treat whatever is wrong. She might not get the right diagnosis because the skills of the healthcare workers that are there are limited, or they haven’t necessarily been trained, or they don’t have the equipment to do the right investigative procedures, and so the expectation is often just if a patient can walk away feeling like they’ve been seen and heard and their healthcare needs have been met, that is the ultimate outcome, because the worst outcome is they then have to take all the money to go back home, and then they often can’t afford to come back the next day or the next week, and the healthcare condition deteriorates so often these patients will just want to be able to walk away with something like a medicine that they can take an injection that they’ve received, like a procedure that was done, if it was like a wound or something of the sorts. Whereas I think for us, digital perception is much more prominent as a kind of barrier to accessing healthcare of the sorts.

Dr Juliet Bourke: I guess the other side of it, though, is if you have these digital solutions, they might be replacing a medical practitioner? Is that something you can imagine in your world? Is that real? Are we seeing pushback from clinicians themselves because they feel that they might become redundant?

Speaker 1: Yes, to all of the above. I think this is super topical at the moment, given that one part of what doctors do is ingest large amounts of information, process the information, notice kind of patterns and trends, and then kind of pull out what is most likely to be the problem at hand. And the other big part of what clinicians do is that kind of contextual human-to-human interaction, but also understanding everything else about a patient that is not just necessarily how they present to you in terms of their symptomology at any given point in time. So I think the reality is that there will be facets of healthcare delivery that will be automated. So we’re already seeing that this is particularly acute in the radiology space, where a big part of what you do in radiology is like pattern recognition of 1000s and 1000s of images. So you know exactly what the right configuration of a potential breast cancer might look like on a mammogram, and that’s something that AI is very good at doing. But there are other facets of health care that are not as well suited to the problem-solving capability of novel technologies. And so I think in some parts of the healthcare system, it’ll replace doctors, and in others it won’t. And so that’s something that I think we’ll kind of have to navigate as a fraternity.

Dr Juliet Bourke: I think radiology seems to come up a lot because of the ability, as you say, for AI to do pattern recognition. But there is that other side of it, which is the relationship to the patient, and is there a world in which people become much more accepting of the advice being given by some sort of digital technology, do you think? And they just don’t need the, inverted commas, TLC, of a doctor? They’re happy to get just the advice?

Speaker 1: I’d like to believe that the human touch will always be critical. I do also think we’re currently still in a world where there are human and loop systems. So you’ll have a recommendation that’s given by a decision support tool, let’s say, in radiology, and that’s vetted and kind of confirmed or denied by a clinician who then delivers that outcome to a patient. But if we look at the proliferation of like asynchronous telehealth, we want to believe that patients value seeing the same GP over time, someone who understands their relationship. But for many patients, they just want to understand what they need to do right now, to go get a script to treat the thing for their kid right now, and so I think that it will vary based on, like, the needs of patients.

Dr Juliet Bourke: How does asynchronous telehealth work? I’ve never even heard of that concept. My experience has been the Telehealth is I get an appointment with my doctor, and I talk to them about the symptoms, and then I get advice a prescription. Yeah. What does that mean?

Speaker 1: So asynchronous is almost in like a chat forum. So people will submit their initial kind of symptoms and description or photos of whatever is going on, and then we’ll have an asynchronous chat with a doctor who then delivers either you need to go see someone face-to-face, or I need to have a call with you, or here is a prescription. To meet your needs, and we’re starting to see that increasingly, almost like a front door into primary care. And there are a number of players in Australia who are also playing in that space.

Dr Juliet Bourke: So you write your symptoms into a chat, and then at some point, a clinician or a health practitioner will come back to you.

Speaker 1: Yep, obviously that’s like trying to address low-acuity, low-risk conditions, and then escalate ones that are more complex.

Dr Juliet Bourke: And there must be risks associated with that, because if someone puts something into the chat that needs immediate attention, but the whole system is geared to delayed verification of those issues, dealing with those issues, that’s got to be high risk.

Dr Jackie Rabec: Of course, yeah, there is a big emphasis on trying to have fast response times. So there’ll often be like a portfolio of doctors that are kind of monitoring multiple chats. What we’re also starting to see is almost like a degree of triage that is picked up based on the symptoms that are presented. And then there’s often a lot of kind of caveats and disclaimers built into these tools to say, like, if you’re having a medical emergency, please make sure that you, you know, seek care. So there’s a real kind of onus of responsibility that’s essentially also put onto the patient, from a medical legal perspective. That’s how I’ve kind of seen it play out.

Dr Juliet Bourke: I’ve seen that too, and I’m just thinking as it expands, though. It’s not just this issue of risk. There are issues around ethics, there are issues around confidentiality, privacy. I mean, they’re not new issues. But where do you see the context, the system going as MedTech, as digital expands and these issues become much more prominent?

Speaker 1: Yeah, it’s a great question, and it’s critical, I think, at a macro level, when I think about kind of compliance, data privacy, information security, the space that we sometimes find ourselves in is that you operate in a bit of a grey space where there’s bits of regulation that is clear on what you can and can’t do, and then there’s bits that haven’t caught up to what technology is able to do, and it’s a bit grey, and you need to interpret where you stand, and that is where, as digital health innovators, we have the responsibility to self regulate and to hold ourselves to the highest bar as it pertains to data sovereignty, patient privacy, etc, etc. And so we have best practice guidelines that exist. So even when those are not the regulations within a country in which we operate, we will adhere to that. And then where it comes to, like, making sure that you have patient trust, it’s also putting in place the right consent mechanisms, divulging of like, what patient data is used for, and then all of the right anonymisation, de identification and aggregation practices, where data is being used at a like macro level for whether it’s training or other secondary data use purposes.

Professor Barney Tan: What Jackie just described is key to business success in the digital age.

Dr Juliet Bourke: Professor Barney Tan again,

Professor Barney Tan: There is a need to be self-regulating, regardless of what the local laws say. This is emblematic of what I’ll call technology governance maturity. It’s when a company doesn’t just ask what’s the minimum I need to do to comply, but instead asks what’s the right thing to do for the people that we serve, that’s a cultural and mindset shift, and it’s not just in healthcare. We are seeing this across sectors. Companies like Apple, for instance, are positioning privacy as a product differentiator, even in sectors like retail, where regulation might be looser, customers are becoming increasingly attuned to data use and misuse. An academic article in 2022 talks about the concept of data as a product, and with that framing, businesses understand that trust is built not only through the service you provide, but also how responsibly you manage other people’s data. When companies get it right, the benefits are tangible. You get brand loyalty, lower compliance risk and smoother cross-border operations. But when they get it wrong, you only need to look at the fallout from the Optus or Medibank breaches in Australia to see what’s at stake. You get plummeting customer trust, shareholder backlash and regulatory investigations. So self-regulation isn’t just a risk management exercise, it’s a core pillar of digital era competitiveness. And again, this is where business professionals, especially those in governance, ethics and tech strategy, need to work hand in hand with developers and operations to create systems that are trustworthy.

Dr Juliet Bourke: Do you feel yourself, Jackie as a doctor, having this deeper sense of responsibility, because you’ve got the Hippocratic oath, and it doesn’t matter what regulation says, in a way, if it’s a baseline, do you have a sort of higher purpose? And. Is that the same kind of mentality that pure technologists, who aren’t doctors, bring to the table when they’re doing MedTech?

Dr Jackie Rabec: I think yes, to some degree. So for example, in our product prioritisation framework that we have, we have fixed criteria that we have to address for any new feature development of like, Is this helpful, neutral or harmful to a patient? And if it’s in any way harmful, we just don’t do it or build it at all. And so that’s like an essential North Star, because at the end of the day, if you’re not improving like clinical outcomes for patients, that should be..

Dr Juliet Bourke: Isn’t that the essence of the Hippocratic Oath – do no harm?

Dr Jackie Rabec: Exactly, but it’s almost like making sure that there is a mechanism to account for that in how you build your product. Because if you just rely on it as like a heuristic in your brain, there isn’t like a gate that has to be passed whenever we’re building something new. And I think that it is essential that there is a clinical presence in any technology company that is building digital products for healthcare, not only from a clinical governance perspective, which is really what we’re speaking to here, but secondarily, to just bring a perspective of someone who understands the patient, clinician relationships and the pain points of clinicians and the pain points of that part of the healthcare system From a product development

Dr Juliet Bourke: perspective, that’s just a user experience. Yep, yep. So ThinkMD is obviously a great technology to help those communities which have significant inequalities. And I’m wondering, have you seen other innovations to help these underserved communities?

Speaker 1: Yeah, absolutely. So I think there are many players in the space that are looking to try and play their part, whether that’s creating tools for community healthcare workers, case management, data analytics capabilities, and then, interestingly, a couple of companies that, for example, have built TB detection models. So you’ll have somebody who coughs, and they have their audio that is ingested like, let’s say, on a device that has ThinkMD, and then it’s able to recognise, like, what are the characteristics in terms of the cough that might indicate that this is probable of either a TB or some other respiratory diagnosis? And so there are more these, almost like niche use cases that are coming in similarly with diagnosis of TB using like an AI, more, from an image pattern recognition perspective, is also prominent. And so I think there’s a world in which kind of combining all of these into a single mechanism that a frontline healthcare worker can use to say, not only is this helping me understand clinical reasoning, but I can tap into the capability on my phone to plug in like, what does a patient’s cough sound like? Or can I get their biometric data and ingest that through something that helps understand, based on whether it’s a combination of their heart rate or facial features or anything like that, what else they might be able to detect.

Dr Juliet Bourke: So ThinkMD is not just then reading information, but it’s actually taking in isometrics or other data. Is that right?

Speaker 1: Yep. So that’s part of the roadmap. Is like, how do we incorporate other biometric data and plug that into this, really, where we operate as like undifferentiated primary care. So we’re helping a frontline healthcare worker help a patient who comes in and they might come in with anything, they might come in with an antenatal or postnatal issue, they might come in with a child who has an issue. They might come in with any array of conditions, and then plug in the right complementary, innovative tools that other ecosystem players are building at the right point in time to then increase the likelihood of diagnosis for a specific condition. And that’s usually focused on, what is the disease prevalence like? What do we see a lot of in these regions? Because we won’t just plug in things for the sake of it. Again, are we actually meeting the needs of the community and the regions in which we’re operating.

Dr Juliet Bourke: What’s next for ThinkMD?

Jackie: So we’re now taking ThinkMD into, I guess, its next iteration of how do we scale this product and get into the hands of as many healthcare workers as possible? How do we reimagine what the product is able to achieve in terms of delivering clinical outcomes, but also getting into the hands of citizens, which is what we would call like a patient, or some people might call it a consumer. So really, like, what is the next frontier of the product development look like, building on the foundations of a rich clinical validation and a lot of proof points in market to show that this is something that really works.

Dr Juliet Bourke: What do you think is going to be the future of digital technology and medicine?

Speaker 1: The honest answer is, I don’t know, because the rate of change at this point in time is just phenomenal. If you think about the care continuum. Them. It’s like, what does technology do for prevention, health, education, improved diagnostics, improved treatments, improved follow-up to care. And we have so many players that are running hard at the wall for each of these paradigms. And so I think it’s going to change dramatically. The one bit that I’ll say, and it’s a big passion area for me, is that I do think we are at risk of creating more inequity, because there’ll be countries that have more prevention, more personalisation of healthcare, but are we still serving the needs of the patients in like the most rural and remote settings who may not have access to all of these emergent technologies in their healthcare systems at scale. If you had to imagine where it plugs into everywhere, from primary, secondary, tertiary hospitals when basic infrastructure is not even existent there.

Dr Juliet Bourke: And I can imagine that even in a developed economy, because even in Australia, for example, it’s quite different if you’re in Sydney or if you’re in the bush.

Dr Jackie Rabec: Yep. 100%

Dr Juliet Bourke: Thanks to Dr Jackie Rabec for joining us on this episode. If you enjoyed this conversation, try listening to our episode with Aussie entrepreneur Hayley Saddington, who has founded not one but two MedTech companies.

Hayley Saddington: So at the time, before I started Halo and Halo medical devices, my partner at the time had passed away. So pivotal point to go. What do I do here? I had a very small and painful inheritance. I could have done something sensible with it, which has never been my pathway. It was, it was only going to be taken in one direction. So I used that small amount to start Halo, and I matched that with a grant that I applied for, which doubled it. And I was really careful about where every dollar went, because it was money from the heart.

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