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What Is the Future of Patient Experience? With Maneesh Juneja: Episode 64

Episode 64 

Maneesh Juneja is a Digital Health Futurist who has dedicated his entire career to studying and utilizing emerging technologies to improve people's quality of life. In the last decade, Maneesh has been helping various organizations from start-ups to governments, hospitals, and pharmaceutical companies to foresee possible future scenarios. He's consulting companies on how to become resilient, prepare for various outcomes of situations, and stay customer-focused and relevant to their customers' needs.

This article summarises the three main topics Maneesh focused on: the concept of health beyond healthcare, the current challenges the NHS is facing, and future predictions of the healthcare sector.

Episode 64

Episode Summary

Health beyond healthcare.

Firstly, Maneesh introduces the idea of health beyond healthcare, stating that if we are really serious about improving the health of the country, we need to link together a lot of databases about our health. This is because what happens in the hospital is only a snapshot and not the full picture of a patient’s health. Instead, there is the need to consider everything that is happening outside the hospital to truly understand the patient’s situation, take preventive actions and predict changes in their health.

Current challenges.

Some significant challenges that the healthcare sector, and more particularly the British National Health Service (NHS) is facing, are as follows.

  • Lack of joined-up thinking

This leads primary and secondary care to have knowledge gaps on the patient’s situation, making him act as the glue that fills in those gaps. This way, the burden falls on the patient’s shoulders and his patient experience is compromised.

  • Digitalization as a veil to hide a flawed process

The NHS has a very good level of digitalization, especially if compared to national health services of other countries, but most of the time this is only to hide a flawed process that is fundamentally non-efficient and still provides a negative experience to patients.

  • Lack of collaboration with patients

People want to be consulted and therefore there is a need to co-create new ways of accessing healthcare where patients are considered partners and have the power to shape the way data is used and shared.

The future of healthcare.

In terms of the future of healthcare, Maneesh identified five main points to highlight.

  • Unified system

To make sure data flows within that system and different databases are linked together, providing a comprehensive view of the patient.

  • Consistent high-level delivery

Every touchpoint has to have the same frictionless high-end experience.

  • Focus on prevention and prediction

The big shift will be on prevention and prediction as the aging population grows. People will be able to get tailored preventive measures that adapt to their lifestyle, and early diagnosis for potential illnesses.

  • Inclusivity and accessibility

The key theme is also inclusive design, making sure data is accessible to anyone and no advanced tool/skill is needed.

  • Hiring CX experts

Recruiting CX leaders from other sectors will translate into access to best practices, and new and diverse ideas to innovate the healthcare sector.

This article summarises podcast episode 64 ”What Is the Future of Patient Experience?" recorded by CX Insider. For more information, listen to the episode, contact Maneesh on hisLinkedIn profile, and check out his website.

Written by Alessia Trabucco

 

 

Full episode transcript

Maneesh: In the report, they talked about, and this is very relevant given what's happening in Ukraine and Russia at the moment because they talk about scenarios where and they outline different kinds of attacks that could happen when it is deployed in a healthcare setting, how could malicious hackers interfere? And the developers of the algorithm wouldn't even know that the data used to train the AI model? That's maybe let's just use to predict whether the dose of the drug that needs to be given in intensive care right in a COVID ward. The algorithm could be modified and the data modified to cause harm to the developer the tech developers wouldn't know. Even though this is all regulated, the hospital staff wouldn't know until people started dying.

Valentina: Hello, everybody, and welcome to another episode of CX Insider. In today's episode, Simon and I talk to Maneesh Juneja, who will speak in detail about the future of the NHS and the current challenges the health care industry in the UK is facing. We will talk about futuristic technology, data privacy, cybersecurity, and much more, so stay tuned. Maneesh is a digital health futurist who has dedicated his entire career to studying and utilizing emerging technologies to improve people's quality of life. In the last decade, Maneesh has been helping various organizations from start-ups to governments, hospitals, and pharmaceutical companies to foresee possible future scenarios. He's consulting companies on how to become resilient, how to prepare for various outcomes of situations with again the help of technology, and how to stay customer-focused and relevant to their customers’ needs. Because many an area of specialization is health care and patient experience. Today, we will focus specifically on that and we will discuss the current challenges the NHS is facing and his perspective. But also, we will dive deep into some scary scenarios which, as we all know right now, are extremely realistic. So to understand the goal of today's conversation, let's start with Maneesh's ultimate vision of what he believes everyone should aim for health beyond health care.

Maneesh: When we think about our health, we often just think about what happens inside of the doctor's office or the hospital, and that data that is captured within that interaction with a health care professional is stored in our medical record. And the thing is, though, our health in terms of actually what influences our health is largely what happens outside of a health care facility where data typically isn't captured or although it's increasingly being captured. But essentially, our bodies are generating data 24 hours a day, seven days a week. And by and large, that data isn't being captured, it isn't being analyzed, isn't necessarily even being linked back to our medical record that is updated whenever we visit the doctor. So when I try and explain to people, what do I mean about health beyond health care? Here are a few examples. So let's just say it's your back pain, lower back pain that is caused by working from home at the kitchen table. You don't have your normal office chair or maybe you can't sleep and you're having insomnia because you've got noisy neighbors or even the impact of traffic jams that we get stuck in on the way to work and that impact on our mental health and stress levels. So the bottom line is I'm trying to point out that we need to be if we really want to understand people's health and what happens over time and also tying into this prevention agenda that at least here in the UK, there is a focus on how do we prevent people from becoming patients? How do we intervene and nudge them to make healthier choices? Well, that requires ultimately data and information about what is happening to each of us outside of the hospital, outside of the doctor's clinic, and then being able to nudge us to better health so that actually we do get back on that healthy path and we don't end up being a patient or needing to use the NHS.

Valentina: The concept of health beyond health care could enormously impact and potentially improve the quality of our health. No surprise that there are companies outside the health care industry that are developing technologies whose secondary function is to keep you healthy.

Maneesh: For example, there was I read about Herman Miller, the people, the company that makes the office equipment, chairs, and desks, and they were talking about launching an operating system for their desks and chairs so that the chair is smart enough and has the sensors to track your posture. And when you're slouching or you're slouching too much, that information is recorded and that information is sent to yourself and even possibly to your manager at work. And then, you know, you think about that. In that scenario, then how many days at work are lost to sickness because of back pain and you think about? An office chair in a desk and a combination that is integrated and emailing you when you have been slouching a lot or your posture is bad and you're at risk of lower back pain. And so somehow there's a feedback loop to try and, you know, improve your posture at work. And then there's I know that there's a vision from Audi in Germany who make cars, and they're not the only car manufacturer looking at this. I know there are others looking at this, but the future of the car with health sensors that track your health as you drive and in particular, your emotional state and perhaps even the car knowing that you are too tired or too stressed and to reduce the risk of an accident you, it reminds you to pull over.

And so they're talking about, I think, Audi, we're talking about cars with empathy. And I and again, if you think about how going back to when I talked about health beyond health care, that that's another example where there are organizations and sectors that you wouldn't think of impacting your health are saying, Hey, look, health and well-being is going to be of increased importance. How can we play a role? But I'm going to go into another example. But it's also the pandemic has made everyone realize that keeping people healthy and giving ordinary people or giving the population tools and techniques to help stay healthy is not just of importance in terms of reducing the burden on the health care system because you want to keep people out of the hospital, but actually, economically, you want to keep people healthy so that they can go into work and they can contribute and the economy is stable. You know, the third example I've got is this is research at the moment. So it's not actually well, actually, it's two aspects. One is some of us have used smart speakers where we speak to this device like Amazon Alexa or Google Home. We ask for the weather, the news, whatever. And researchers are working on what they call vocal biomarkers. So could one day an algorithm be embedded in your smart speaker? So as we are speaking to and asking for the news and blah blah blah, it's analyzing the sound of our voice.

Time after time and the algorithm that has been clinically validated, this is the hope can actually detect early signs of disease, whether it's early signs of Alzheimer's or early signs of Parkinson's disease, or even possibly early signs of depression. And you think about, well, that sounds really futuristic, but this is what researchers are working on now, it's another story whether we as consumers in our home, want a device from an American Big Tech company to be analyzing our voice and possibly determining whether we have an early a risk of a particular disease. But just going back to where we are even today. So there's an American company called Teladoc Health. They have just announced a partnership with Amazon Alexa, whereby I think it's at least in the US. So Teladoc is used for telemedicine normally, but here they're talking about being able to. Um, have a conversation with a doctor using Amazon Alexa for non-emergency conditions, so things like flu symptoms, and minor illnesses. So but these are this is another channel or another way or in terms of how health is going beyond the health care system itself, especially using sort of these internet-connected devices that are in our homes.

Valentina: The idea of all these different kinds of technologies that are constantly generating data about your body to prevent serious diseases or detect an early stage of a health problem sounds truly desirable. But before we dive deep into the problems of these almost futuristic systems, let's address some of the current issues the NHS is facing.

Maneesh: We are, unfortunately, we've inherited in the NHS in the UK, we've inherited a lack of joined-up thinking when it comes to health care. So many different parts of the NHS doing their own thing, different computer systems in the same hospital information can't be shared and if you think about the best customer experiences we've had in our lives outside of health care, it's because data is shared and there's a unified, frictionless experience. To give you an example if you walk into an NHS hospital, tell you there are pockets of innovation within the NHS. But if you walk into an NHS hospital because it's secondary care, they're unable to access my medical records from primary care, i.e. where I've seen my GP. So the burden often falls onto the patient to bring information along with them from their primary care experience to help the people in the hospital figure out what they need to do clinically. Now, to give you a practical example of where, how challenging it can be and how some patients are fortunate that their digital and connected and savvy like that. I went to Urgent Care Hospital in the NHS a few years ago. I was able to open the NHS app on my phone and help the clinical staff there because they couldn't access my medical records from primary care.

I said, Look, I'm going to open the NHS app, I'm going to open my medical records. I'm going to share with you what the GP has written in my medical records that will help you determine clinically what to do next, as well as obviously hearing my symptoms and my story. So that was amazing. I thought because in one way the patients are the glue in a system where the system doesn't talk to each other, right? So the patients are helping or managing to be that bridge, but the burden is falling onto me as a patient. What if I wasn't rich enough to afford the latest smartphone? Know how to use the NHS app, have it downloaded and then be quick thinking to think in the urgent care part of the hospital? Hey, you don't. You can't access my medical records, so you're kind of you're not sure entirely how to proceed. Oh, and I'll show you my medical records or my phone. But why should it be such a burden on the patient? Because think about it. I was talking to the nurse who saw me, and she said, like, you can do this, Maneesh. But if it was a patient who was 85 years old such as dementia, some other health problems, if she or he or she are going to be able to do what you've just done in terms of helping us and fill in those gaps.

And the other thing is that we have like I said, pockets of innovation with the NHS. There are great things that happen, but we also have an issue with layers of digital veneer. What do I mean by digital veneer? So often it's like, let's create a digital service, let's create a website. And this happens not just in the NHS, but in many sectors. Let's digitize a process. But even after digitization, the process remains flawed. The experience for the consumer, for the patient remains flawed because, on the surface, it looks like we've ticked a lot of boxes when it comes to digital transformation. Hey, we've got an app, we've got a website. But the actual experience, because the process hasn't been improved before, they've digitized it. It's the same crappy process with a layer of digital veneer. And so that is what is contributing to people saying, Well, we've invested a few million pounds in creating this digital service in health care, and wait a minute. People, the doctors are not liking it. The patient's not liking it because they haven't looked at fundamental processes. First, they just digitized things straight away. And that's one of my frustrations.

Valentina: On one hand, we are talking about some really advanced technologies that are measuring your posture while working and reporting it to your manager, and on the other. The current digital processes that are supposed to make your life easier are doing the opposite, as in the following example.

Maneesh: So I recently went for another blood test routine blood test. Now, my GP had said, OK, you're going to go to this hospital, Maneesh. And here's the form, I emailed you the form that you print out and take to the hospital on the date. On the day of your blood test. You have a fixed appointment time now, and I think I'd waited about two months because, during COVID, we have long even bigger delays for getting routine care. So within two months of this blood test appointment. Then when I went there that morning and I turned up at 8:15, I realized as I walked into the hospital in the blood test area, it says, Please have your blood test form from your GP ready for the reception. I thought, Oh my God, I forgot to print it out before I came, and it was an hour's journey to get to the hospital. So then I asked the person in reception, Look, I've got an appointment, 8:15. It's like eight 10. Now I know you need this form printed out, but I forgot to print it out, but I've got my smartphone with the form. Here you go. No, we can't accept that we need a paper form printed out. Good luck. Ok, hold on a second, then what's your email address? Because I'll email it to you right now and then you can print it out and use it however you want to do. No money. No, we can't do that. We have no way of you transferring this form to us digitally, OK? Oh my god, what do I do? Like, I've traveled an hour for the blood test and I've waited two months for it because of the delays at the moment with COVID.

So they said they said What you can do is if you go to a local printing copy shop, go there outside the hospital, you can print it there, upload it, print it, and then come back. And you know, even if you come back after now, we will still squeeze you in. Somehow, in this morning's appointments, I thought, OK, cool this. By the way, if you do print your form there at the print shop, it's not secure. So because the NHS, no, there is a date of birth, etc. What blood test you're having, somebody may see that. So it's not private. Just to be aware I am. I would like another thing to be thinking about, right? So this burden fell on the patients I went to the printing shop outside the hospital doesn't open until 9:30. I thought, What do I do? I've got other things to do during the day, so I found a printing machine that's open 24 hours a day. That was at a tube station about a forty-five-minute walk from the hospital, so I walk 45 minutes, managed to upload the file, and set up the account on this printing machine and the tube station. Print my paper form for the blood test walk. 45 minutes back and they managed to see me and take the blood. But I just thought, what when we think about our interactions with organizations as a consumer and how seamless things can be, and how many organizations from a customer perspective, focus relentlessly on making the experience as? Hassle-free as possible. And then here you have what I've described as, Oh, this is like you. This is unnecessary aggravation and stress. It doesn't have to be this way.

Valentina: Other underlying issues that touch on the problem of creating multiple streams of data about your health are, how do you put all this information together and enable a seamless experience? Second, what if people don't trust you and they have a legitimate reason to be doubtful

Maneesh: If we are serious about improving the health of the country? We're going to have to link together lots of different data sets about our health. As I mentioned, you know, we have a challenge that we only have a snapshot of what happens in the hospital. We need to have all this information linked together, both inside of health care and outside to truly understand what impacts their health over time, where best to intervene, and to predict changes in our health. Then you throw in artificial intelligence and all these algorithms. It becomes even more critical that we engage with people at all levels to let them have a say in how their health data are collected, shared, and use. And so what's happened in the past is that there have been efforts in this country to try and create a central database in the NHS with very noble aims. But the trouble is, and I think that backfired. I can't remember the exact name of that project, but it backfired a few years ago because they fail. They just thought like, we know what's best for the population. We're going to collect this data. We're going to use it for public health to improve patient care.

They did not understand. That people want to be consulted. People want to be involved, and it's about. So when we are thinking about, you know, building retaining consumer trust, considering all these privacy concerns, it is about co-creating these new products and services in this digital era. And especially when it comes to an AI and we have the concepts of bias and how this algorithm could work against me because I'm a person of color and people of color in the NHS data may be, have they don't? The data itself is biased that feeds into the algorithm. So right now, this is why it's so critical that health care continues the shift from being paternalistic of knowing what's best for you, the system to one of Hey, actually, you know what? We're going to treat you as a partner in your own health care, in particular when it comes to data, does it matter whether you have a Ph.D. or whether you've left school at 14? We are going to find a way as the NHS in the UK to give you a chance to be involved and shape how this data is collected and used and shared.

Valentina: Maneesh mentioned the potential of artificial intelligence in health care, but not that many people actually talk about the possible risks this technology is carrying. We are getting into the bigger challenge of this and that's the scary possibility of hacking the algorithm.

Maneesh: So right now, a lot of what I'm looking at is actually about artificial intelligence in health care. But with respect to ethics and the governance of AI and health care and actually the darker side such as cyber security in terms of what if somebody has got somebody using AI in the hospital? And there are and the AI model gets hacked. By hackers, and that I model actually has the algorithm change that anybody in the hospital knowing it, knowing and that actually can cause harm to patients and that you've got these malicious hacking. And so people aren't talking about this yet. They're just talking about like, let's use AI in health care because it's going to reduce costs, improve outcomes, and reduce wait times. But there are so many risks in AI that we are still not discussing when it comes to ethics and what happens when things go wrong.

Valentina: You might think this could only happen in the worst of the worst scenarios, and you're absolutely right, but we have to acknowledge the fact that there is cyberwar in Ukraine and Russia at the moment and now more than ever, despite how much you hate this phrase and we've heard it enough times. But now, more than ever, cybersecurity should be the top priority not only because of malicious hackers but because institutions are understandably highly motivated to collect as much data about you as possible.

Maneesh: There is a report published in August last year looking at AI ethics of AI ethics and governance of AI for health. In the report, they talked about, and this is very relevant given what's happening in Ukraine and Russia at the moment because they talk about scenarios where and they outline different kinds of attacks that could happen where when air is deployed in a healthcare setting, how could malicious hackers interfere? And the developers of the algorithm wouldn't even know that the data used to train the AI model? That's maybe let's just use to predict whether the dose of the drug that needs to be given in intensive care right in a COVID ward. That algorithm could be modified and the data modified to cause harm to the developer the tech developers wouldn't know. Even though this is all regulated, the hospital staff wouldn't know until people started dying because they being the algorithm told the clinician to give the wrong dose. Now, remember, we are heading towards this future where so many people are under pressure and imagine, you know, as an under-pressure to say, we have to find ways to incorporate AI into clinical decision making. And remember, a lot of this is almost like a race. We want to be the first NHS hospital to use AI for dermatology. So there's almost like this ego coming in like, you know, we have to be first to deploy or partner with Google. And so when we are caught up again in that rush for digital veneer, people are not necessarily thinking about the bigger picture and holistically about all the different things that could go wrong.

And so they're kind of like, it's almost like, Well, hey, Maneesh is talking about stuff that's the stuff of science fiction. But this is a probable scenario, but it's a scenario that many in leadership don't want to consider. So, you know, if we don't consider it, it's not there as a risk. But we get a call award because we're the first NHS trust to implement AI in ICU. What people don't realize is that there is a global race. Many organizations accumulate as much data on our health as possible, both inside the health care facility and outside, and link it all together so that they are able to provide new products and services. And I don't think we realize just how important it is then for us as individuals and collectively as a society to say, Hey, where is our data being stored and what rights do I have? And are my rights slowly slipping away because we're not even part of these conversations? We're not even aware of how these health data vaults are being built around the world, and we need to be involved in those conversations. And it's not just about having one patient group having to be input and treated as a stakeholder, but genuinely getting the masses to understand data is going to be the currency of these algorithms powering artificial intelligence. Ai is being seen as a future for so many services, not just in health care. Your data is going to be really powerful, so you need to be able to have a say about your data.

Valentina: Moving away from what's happening now, let's focus on the health care system in 10 years’ time with a more positive outlook,

Maneesh: I think because the NHS might come across to us here in the UK as a single brand. It's not a unified organization. Things are changing, but there are so many different organizations. So we are going to have to put pressure, on whether we are a policymaker, whether we are a tech supplier, providing the NHS, whether we're a patient, a member of the public. For the NHS to really focus on unifying the systems, to focus on ensuring the data about each of us flows within the health care system, and if you think about it from a customer experience perspective, we've got to get to that point that regardless of where we interact with the NHS. Each of those touchpoints has to be the same high, high-end experience, frictionless experience. So like I said, you've got aspects of the NHS which are great when it comes to digital, but that's not repeated at every hospital, every interaction with the healthcare system here. So in terms of in 10 years' time, I'm hoping that with the work that's going on behind the scenes, as well as this push from everyone in this country for the NHS to transform digitally, we will have the whole patient journey is considered rather than just let's design a bunch of individual interactions, which are great digitally, but they're not linked up, they're not seamless. And so we need to be thinking about end to end, and it's organizing the services around people.

So if I'm somebody using the NHS and I have lower back pain, so whether I reach out to my GP, whether I'm dealing with the physiotherapist and these may all be sitting on different systems, that experience is a patient consumer customer for me that in 10 years’ time should be seamless. Fingers crossed it is seamless and I don't have to worry about paper forms and, you know, apps that aren't able to connect my data. And the other thing, though, that I think in ten years’ time the big shift, in my opinion, will be so whether it's the fact that we have an increasingly aging population or we have rising costs of caring for people once they get sick. There is a focus in the NHS on prevention and keeping people out of hospital and wellness. So that will be a big driver in 10 years’ time, much bigger than today in terms of using digital tools to personalize not only your healthcare but personalized prevention. So at the moment, we all might be subject to this generic message of walking 10000 steps a day. Sleep eight hours a night, right? Get five portions of fresh fruit and vegetables. But what we're going to need and hopefully the NHS will be able to move towards this with input from others, is that I want the NHS to tell me what's optimal for me and people like me. So how much sleep should I be having? How much, how much activity, physical activity do I need? What what's the best intervention to keep somebody like me healthy and the people from a data perspective, if I sit into a particular segment, people like me healthy rather than these generic messages that often fall on deaf ears because, hey, it doesn't take into account that I'm an uber driver, for example, and I sit in my car 12 13 hours a day.

I don't have a chance to walk, walk 10000 steps a day, so I want personalized prevention. I want personalized health care. But. Using again, these digital tools, these digital nudges that are supposed to nudge me to make healthier choices should be compatible with my life and whether it's my income, my education levels, or my digital literacy. So what's the point of developing an app that requires an iPhone 10 or above when you've got a cohort of the population that has poor health, but they've got they don't have the latest iPhones that are required to run these apps, does that make sense? It's about terms of the patient experience in 10 years’ time. The key theme is inclusive design. So we've got to design so that it's not just people like me who can afford a lot of these technologies and digital savvy, but it's about as many people in the country as possible able to benefit from these new digital tools and innovations.

Valentina: With this unified system carrying data from all sorts of sources, there's also a risk of creating a massive gap between patients who require a preventative health care check-up because their app detected a possible health risk and the actual capacity of hospitals and medical staff to carry out all these appointments.

So one of the areas when it comes to the patient experience of the future is if we're talking about prevention and trying to predict when people are going to have early signs of disease. We're using all these new sensors and we are able to monitor people in their own homes 24 hours a day, seven days a week, right? But the problem is that health care at the moment is structured around the fact that you have some symptoms or you get to a point where you need emergency care. You go to the hospital, you get an intervention. But if we're to make this bold future where, hey, we can prevent people from getting sick, we can predict early signs of disease. And this AI and machines can detect who's at risk through all these different scenarios. But then when you speak to people today, both inside and outside of health care, they're like wondering why we're not set up for this, for this future world where we have to intervene because the computer has identified these are the 10 patients at risk in my community. So are we going to send a nurse? We're going to send a doctor to their house, we're going to send a text message. How does it all work? So we have this brave new world when, especially when we think about customer experience, how does it work when these machines are flagging up all these scenarios and concerns? And hey, somebody is at risk of a fall in their own home, they're 85 years old. But then you speak to people and they're saying, So what, Maneesh? How does the system actually act upon these so many signals that are going to be generated by this technology? So I think that's another big thing to incorporate when it comes to customer experience and in, you know, over the next few years, how does this all come together? How does all of this integrate when it's almost like you have different? Technologies and different pilots and innovations almost going at warp speed in different directions, and we have to bring it back and say, what is this? How do we just keep it to this unified, streamlined experience where both I as a user of technology at home being monitored, I'm not overwhelmed with alerts and signals, and my doctor is not overwhelmed and saying and saying I don't have the resources to act upon all these new signals that I'm flagging up because it can analyze a stream of data 24 hours a day from my toilet to figure out he's got early signs of kidney disease.

Valentina: Finally, as we're getting to the end of the episode, Maneesh has one last tip to give the industry leaders.

Maneesh: So one of the things that I think over the next 10 years is the NHS will have to recruit more customer experience people from other sectors outside of health care, where maybe best practices and things that have been done in a better way than the NHS has done. And that's in order for the NHS here in the UK to really have the best chance of learning from all sorts of different sectors, having diverse ideas to get to that frictionless, seamless, unified experience when it comes to us as users, both patients using the NHS, but also for people working within the NHS, they also are desiring that amazing customer experience as a user of NHS systems working in a hospital, for example.

Valentina: And the last bit before we finished this episode is Rapid Fire Questions. I hope you enjoy this episode as much as I did, and if you did, please don't forget to like, share, comment, or subscribe to the podcast on your preferred channel. And if you would like to know more about what money does. Feel free to connect with him on LinkedIn or check out his website. Both links are provided in the episode description below. That's it, and I will see you in two weeks. Could you pick a project you worked on and are most proud of?

Maneesh: So probably. One that made the letter instant change was a few years ago when I was testing these conversational systems. I was testing the Google and Alexa and how they respond. When you say I'm stressed, I'm tired, I'm sad, I've cut myself, I've hurt myself. And I was testing Microsoft's Cortana as well, and I was sharing this stuff on social media and just this is independently my own testing, right? And I tested Cortana and I said something like Microsoft Cortana, and I just said something like, you know, I'm bleeding or I've cut myself or, you know, I've cut my arm off or something. And it just said, OK. And I was like, Huh? And then actually, it turned out that one of my followers on Twitter was somebody who worked at Microsoft in the Cortana team. And then he says, like Maneesh, tell me a bit more about what you've just tested and watch. And then he says, I fixed it. Can you go in and try it again and see if it's been improved? And then he had fixed it where it now said, If you say you and I've cut myself, it'll say, like, you know, pho in the NHS and for help, etc. And I just thought that was a really powerful example of how one person using social media can influence a large organization like Microsoft to make a change like this in terms of this real-world testing that I've been doing a lot of with consumer technology for health.

Valentina: What futuristic technology that could improve people's health fascinates you?

Maneesh: So futuristic technology, so again, when I was thinking about I was talking earlier about aging populations, I am really interested in the possibility in the future that we when we get old and we are frail, we become weak. We have trouble walking up the stairs. And the whole point is that we want people to. Be able to age in their own homes without getting into an institution, into a hospital, right, because they're too weak to look after themselves and do ordinary things and keep people's independence. I was thinking about robotic exoskeletons. What would it mean that you know, 10, 20, 25 years in the future? If we, or even if we're young and we have back pain, injury, or something goes wrong, we're unable to walk up the stairs, or lift heavy items. Would there be robotic exoskeletons that we can rent? Right? A bit like if you think about crutches that you might get given after you've broken your leg and your walk around, what about a robotic exoskeleton that allows us to, even if we're 90 years old to still play tennis, the still go jogging, even though our physical body is getting old and isn't is able to allow us to play tennis or go for a five-kilometer jog. But this robotic exoskeleton allows us to do those things.

Valentina: What is your favorite habit to stay healthy?

Maneesh: My favorite habit to stay healthy is walking at sunrise every morning, whether it is. Half a mile, whether it's five miles, but walking at sunrise and seeing the sunrise is amazing.