From Space to Your Home: The Tech Behind Clinical Grade Wearable Sensors with Pierre-Alexandre Fournier, co-founder and CEO of Hexoskin

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[00:00:30] Hey everybody, Saul Marquez with the Outcomes Rocket. I want to welcome you back to the podcast. Today I have the privilege of having a guest that has been on the podcast before and is back. His name is Pierre-Alexandre Fournier. He's an engineer, scientist, designer and entrepreneur. And he's the co-founder and CEO of Hexoskin, a Montreal-based company focused on clinical grade wearable sensors and AI software for health and clinical research.

[00:00:56] They just have an incredible platform and an opportunity to take remote patient monitoring to the next level for various stakeholders in the space, including providers, payers, pharma and many more. We had Pierre on the show four years ago this month, and I was so excited to hear that he was up for coming up again. So Pierre, thank you for joining me for another episode of the Outcomes Rocket. Thanks for having me.

[00:01:20] Of course, of course. And so let's get started. Before we dive into Hexoskin, for the people that haven't had the pleasure of meeting you yet, tell them a little bit about why you decided to get into this healthcare space.

[00:01:33] So I'm from a technology background. I worked in telecoms and signal processing, natural language processing. So I started my career in AI in the early 2000s. And at some point, I decided that I wanted to apply this knowledge, these techniques to help improve access to healthcare, especially in the context of an aging population with growing needs.

[00:01:55] We need more and more healthcare in the next decades. But we want to have a lot more doctors and nurses. So we need to become more efficient. We need to decentralize healthcare, bring it closer to the home.

[00:02:07] So everything that we've done at Hexoskin since we started is with that goal in mind, empower patients, bringing healthcare closer to the home, making all the services related to better diagnose and treat different health conditions easier and more accessible to patients of all ages. Yeah, that's a fantastic goal. I mean, it's been four years. So maybe we start with an update. What has changed since we last talked, Pierre?

[00:02:34] So many things happened. So I'm just going to say a few things. So last time we talked, we had just installed our technology, our monitoring technology. So the Astroskin version of the Hexoskin shirt in the International Space Station for life science research in space. And since we've done 15 space launches with new equipment for different astronauts, there are four clinical trials running in the International Space Station using Hexoskin technology.

[00:03:03] That's amazing. That's really exciting. The same technology has been used by Chris Hemsworth on Limitless by Chris Hemsworth on Disney+. So that was an amazing way to demonstrate what our products can do in the context of the show that you can watch on Disney+. Now it's about stress management and the link between your emotion, your brain and your cardiorespiratory system. I'll have to check that one. Limitless? Yeah. Okay.

[00:03:29] Limitless with Chris Hemsworth. Very good show. The sixth episode about health, aging and longevity. We're going to link that up in the show notes, folks, so you can check it out. Sounds like a good one. And they're using the Hexoskin on it.

[00:03:40] Yeah. And then we're always growing the research community that's used the Hexoskin platform to do clinical research. We have an open API. We have a transparent platform for data collection of high resolution continuous vital science monitoring. So our community has published over 200 peer reviewed papers using our data platform so far. And we have about the paper coming out every week. And we're very proud of that because, you know, part of our mission to empower patients in decentralized healthcare is to be able to do that. And we're very proud of that.

[00:04:10] We're very proud of that.

[00:04:40] And that's what we see right now. People doing research on neurological disease, on rare diseases using the Hexoskin platform. And this is very exciting for us. It makes it worthwhile, you know, to see all that science happening on the platform. And I think it prepares us to enter the healthcare market and support medical applications with the product as we go.

[00:05:03] That's great. No, appreciate the update. You've been up to a lot of things since we last talked. And it's exciting to hear about the International Space Station. By the way, my son and I keep track of where it is. And we have this little app. And whenever we know it's going to be close by, we go out. We spotted it a couple of times. So I'll have to let him know that I interviewed a guy that sent some of his equipment up there. He'll be impressed by that.

[00:05:25] And then, you know, just ways to bring wellness into life, but also speed up research. So it sounds like you're doing some really great things, Pierre, you and the team over there. What exactly are you measuring with the Hexoskin? What parameters do you pick up? So the Hexoskin shirt measures an ECG signal to monitor cardiac rhythm. And then it monitors abdominal and thoracic breathing continuously to measure breathing rate, but also to report on different types of breathing patterns.

[00:05:55] So it's a lot more than breathing rate that we can report with these sensors. And I'd say we have the most accurate wearable breathing sensors available today on the market. And then we monitor activities and sleep metrics and other things. So put that together, you can monitor cardiac health, respiratory health, stress levels to HRV, so heart rate variability and breathing rate variability.

[00:06:17] And then activity patterns, sleep patterns, gait, a lot of things that you can use to derive digital biomarkers for different applications. That's great. And what do you think the biggest promise? I guess, you know, really two things. What is the biggest use case for you guys today? And what is the biggest promise in the near future when you get the FDA approval?

[00:06:38] So today, most of our users are conducting clinical research projects. That's the biggest use case. It's not just in one sector. They do a lot of things, like I said earlier, from rare disease to epilepsy to cardiac disease to cardiac rehabilitation, pulmonary rehabilitation, these kind of things.

[00:06:57] We're very varied in the users of the users of the patients. Once we get FDA clearance, we see a lot of potential in post-acute care monitoring, early discharge of patients, post-acute cardiac rehabilitation, and heart rhythm diagnostics, and pulmonary monitoring as well.

[00:07:16] There's a lot of monitors who can do heart rhythm monitoring today, so each easy monitoring. There's about nothing to measure long activity on the market today, and nothing that's as accurate as what we do with the existing shirt. So I think that's where we see the most potential in the short term. Yeah, so it sounds like it's a nice niche that you guys have here and an opportunity to take it to the next level. Definitely excited for the progress you guys have and are making there.

[00:07:45] It's a pretty sizable niche because there's 3.5 million patients who should be in a post-acute cardiac program every year in the U.S., and most of them are not because these programs are not easily accessible. And there's about 2 million people who are admitted to the hospital every year in the U.S. for a respiratory condition. It can be COPD, asthma, COVID, cystic fibrosis, pulmonary fibrosis.

[00:08:10] So these are pretty sizable populations. But then you have all the other populations that are smaller that we less often talk about. For example, we talk about rare diseases, but there's thousands of rare diseases, and there's a lot of these diseases that affect 50,000 or 100,000 patients. We don't currently have a standard of care in terms of monitoring to manage their condition.

[00:08:35] There's so much work to be done, so many niches to develop based on a platform like that, so many patients waiting for technology to catch up and provide them with better tools to manage their conditions, and better ways to look at these medical conditions so we can actually develop better clinical trials, and we can accelerate the research for treatments. That's great. Hey, Pierre, question for you, and thanks for clarifying and expanding on that part.

[00:09:02] If, for instance, pharma clinical trials, does this thing need to be FDA-approved to do that, or can it be used for a clinical trial? Well, it can be used for a clinical trial, and it is used for clinical trials today. Of course, FDA clearance makes it a lot easier for pharma companies to use the product because there's less documentation that they need to provide to the FDA once they collect the endpoints in their trial and they need to submit it.

[00:09:29] So we think FDA clearance will help with that as well, help expand our activities in clinical trials. And where we'd really like to be in clinical trials is phase four trials. So to be able to supply real-world data on all these pharma products after they're being introduced, either to clarify indications, to better measure their value for patients, and to expand the uses of these therapies to different classes by patients.

[00:09:59] Yeah. Sounds like a promising area and a much-needed area, right? Because these drugs take forever to get to market. They cost too much. We need ways to accelerate it, like Hexoskin. So I love that. In the last four years since we've talked, talk to us about a setback that's happened that maybe has made you guys stronger or you learned major lessons out of.

[00:10:20] Well, I'm not going to talk about one setback in particular, but I would say one challenge that we've seen is working with large healthcare organizations. We've had some successes and we've had some failures. And what's sad is that I'd say that most of these failures were not due to the lack of need or the lack of interest from physicians. You know, we had champions inside the organization who wanted to use the product. We had patients who needed it.

[00:10:48] But then there's a lot of red tape and administrative processes. And you need velocity. If you want to adopt digital health, it has to happen within a certain timeframe. You have to have a plan where you say, okay, we're going to invest in this. We're going to invest in technology and adopt it and train our teams.

[00:11:05] But it has ideally to happen within six to nine months. Because when you go through these long processes and it lasts 12, 18 months, suddenly what you have is that you have people changing jobs in the teams. You have to retrain people. You have people quitting. You have new people coming in who might not be as interested by these types of innovations.

[00:11:27] And things are moving. And then the project, in one case that I have in mind, the project set apart just because there was not enough velocity in moving forward the project. So ideally, if I have one advice for people who work in the healthcare community, when they're looking at adopting new software, wearables, any type of digital technology or project, they have to have a timeline where from the start to deployment on patients and adoption, and it has to happen within 12 months.

[00:11:57] You have to do it within 12 months. And you have to work with technology companies that can make it happen within 12 months. And you need to make sure you have the buy-in from all the stakeholders in your organization to do that within 12 months, which means you should be able to think you can do it in six months if you want it to happen within 12 months. Well said. And it's hard in large organizations. What we've seen is that working with smaller hospitals, sometimes it was easier to get all the stakeholders in the same room because they all know each other.

[00:12:27] And in some cases, in larger organizations, they don't even know each other. So it's a lot harder to put together a project. Pierre, I love that. Yeah. And truly spot on. This idea of velocity. Aim for six months. Get it within that 12 months. These things take a lot longer than you want them to, than we all want them to. And I think there's huge value in what you just shared, Pierre.

[00:12:51] So folks, are you working on a project that is looking like it's going to take more than 12 months? Find a way to accelerate. Velocity is the key to success in the market. Pierre, I love your share there. If you had to point to one piece of tech or a trend that you think is going to change the way healthcare runs as we know it, what would you say it is?

[00:13:13] It's a good question. There are so many exciting things happening right now in biotech, in digital health, in all sectors. It's moving really fast. We have new blockbuster products coming to the market that will have a major impact. We're not sure yet what it's going to be.

[00:13:29] But in terms of technology, I think the game changer was the smartphone because it was not enough to have broadband at home. Having it in your pocket was a major game changer. And I'm very bullish on everything that's going to happen at home. So all the connected objects that we're going to have for healthcare.

[00:13:48] With COVID, there was a strong acceleration of the adoption of telehealth. People got used to it, providers and patients. So we gain, I'd say, we're now at a multiple in terms of usage where we were four years ago. But in many cases, it's still a glorified phone call. You have video or you have a phone call, but it's still what it is.

[00:14:10] And over time, I think we'll be better at adopting technologies to provide objective data to support that conversation between the provider and the patient. The provider can be a physician, of course, but it can be a case manager, a nurse or someone else.

[00:14:25] So I think more and more we'll see that the blood pressure monitor will be connected. People will use SmartShirt for cardiac and respiratory monitoring and other things and other devices. And then that conversation that happens over phone or video will be much richer because there's going to be a lot of medical evidence attached to it. There's going to be a lot of objective data attached to it. And I think that's, you know, Hexoskin solves part of the problem, but there are many companies working on that. I'm very excited by that.

[00:14:55] We're kind of all in the digital health infrastructure business. We're building the infrastructure that will enable that data collection, that will lower the cost of medical evidence, both for clinical research and for delivering healthcare, where the patient is. And that's very important.

[00:15:41] Yeah, I love that. I love that. I love that. We love that.

[00:16:24] Do not stop at listening. If today something Pierre said or that I said inspired you, take action, reach out, connect and make things happen. That's where you get on the Outcomes Rocket. And Pierre, I want to thank you for taking action and being here with us today. This has been a lot of fun. Thank you so much.

[00:16:41] Thank you.