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EF:  How does Salud Digna get value out of its data, and what are the right models in order to do so?

JCO: We are currently serving about a quarter of a million services per week, although sometimes the same person can make use of two services, for example, a mammogram and an x-ray. We have units operating from Ensenada to Mexico City to Cancun, we have clinics all over the country, and with all the data we have, we are now able to start publishing what we call Salud Digna Indexes, on different ailments. We have created, for example, a diabetic heat-map of the country, and with other ailments, such as breast and cervical cancer screening. We have very relevant information, and with proper management, it can give us a knowledge advantage and even more importantly, this allows better knowledge for decision-makers. 

Salud Digna collects data not only on the quarter of a million services it provides weekly, but we also have literally millions of historical results, all hard information on Mexicans’ health. For the development of this platform of health indexes, we approached the previous Secretary of Health, Dr. Kuri, who was very enthusiastic about this project. We also approached the University of Arizona, which is one of the leading centres for research regarding health. It is very important that our protocols be validated and published with the right footnotes so that nobody thinks the information is on the upper population, which it is definitely not, as can be seen in the results of breast cancer and more specifically from the results that come from mammogram screening. We have 8 or 9 indexes right now and we plan to go further to have a platform where the decision-makers of Mexico, either from the private or public sectors, researchers or students may all have access to this information, which is completely free. It is a platform open to everybody: if you have a web browser, you have the information. We have to achieve data value without risking letting the information fall into the wrong hands, especially concerning the data of our patients, so for this reason we assured the necessary certifications to strengthen our services. We are very excited about all this, and in fact, just this morning we received the Premio de Innovación y Buenas Prácticas en Protección de Datos Personales 2018 (Prize for Innovation and Good Practices in the Protection of personal data 2018) by INAI.

EF: What are the most unexpected people or institutions that are using this data, and what type of information and findings do you hope they will be able to glean from it?

JCO: Apart from the actual of sharing the information, which is the best part, what has been very gratifying is the acceptance it has received. We brought the idea and our first final products to UNAM and ASU, which are really important institutions, and when we showed the platform to UNAM they liked it very much. They liked the software that we are using (Power BI), because it is so much more friendly and accessible, and this was for us exceedingly gratifying. Last week we did the same thing with UNAN (the National University of Nicaragua) where we now have an operating Salud Digna unit, our first clinic in Central America, that will develop a research area with epidemiologists and other professionals. All this validation has taken us about 2 years, and when I refer to the good response we have had I include the authorities, which is great for us because if they make more data-driven decisions, it will benefit us all.  

EF: How difficult was it to find the right resources for this big data—the right management team, the right talent? 

JCO: Our first stroke of luck was a very special connection with Microsoft Mexico’s former CEO, Jorge Silva. He spoke directly to me and was very encouraging, and in a sense, he took us by the hand and helped us in using Power BI for our internal decision-making. Dr. Abraham Campos along with his team has done a remarkable job in this endeavour from the scientific standpoint, and they have worked shoulder to shoulder with the brilliant head of our Business Intelligence Area, Iromy Meza. They brought the use of that software normally used for operating and results in decision making in companies to this new area, with great results. To find the right talent for the different jobs, we went to academic institutions, got recommendations from people whose opinions we value, interviewed a variety of people and went from there. It is a work in progress, we shape and frame as we go as it is a new area for us, like a spin-off. 

We got the first glimpse of what digital transformation meant from a former high-ranking director of Google, Gonzalo Alonso, who after retiring from Google founded a digital transformation organization called Clowder Tank. I am not sure how good we were as a client for them, but the reality is that he and his team taught us a lot and brought the concept of digital transformation to Salud Digna, and we incorporated some of his concepts into what we are now. 

EF: There’s been a comparison between Salud Digna and Uber. How are you seen as a disruptive force, and are you looking to expand the scope of that disruption?

JCO: Salud Digna has fortunately been a force of positive disruption in many areas, especially regarding price and standard of service. Like many other actors from the public, private, and social sectors, Salud Digna has contributed, I believe significantly, to the improvement of many areas of healthcare delivery. An example of this is the rather new fact that most labs and radiology centres are open on weekends, which was not the case not so long ago in some big population centres in the country. This is convenient and accessible for more people. For example, in Mexico City, for us the strongest day in terms of patient attendance is Saturday. With transportation distances and traffic, weekdays are complicated for people who work during the week. It is important to note that Mr. Jesus Vizcarra, Salud Digna’s founder and our leader, never takes the position of the boss or the founder regarding all things Salud Digna, he always assumes the position of the patient and evaluates all proposals and projects through the light of the patient’s needs and dignity. If we are talking about technology, his input is, “My name is Jesus and I am a patient:  what is this going to do for me? Will it be quicker, more affordable, or more precise, or better quality?” And if our answer is “no” he doesn’t want to hear another word about it. And we all know this beforehand, as it is his standpoint on every topic we touch. So everything we work on puts the patient in the centre. Regarding the health industry generally, however, sometimes this is not the case, and I am glad that is changing. 

EF: The original Harvard Business School case on Salud Digna was published in 2011. How would you rewrite the case in 2019? 

JCO: At that time there were far fewer clinics; today we have close to 100 in three countries. We had a few hundred employees whereas today we have 6,500—so we are talking about a completely different scenario, although our values are exactly the same, and since we can now access more advanced technology, we can also access a lot of different resources.  The role that Salud Digna’s directors and people played in those years is critical because the organization was smaller and more vulnerable. They did a fantastic job. Our goals remain exactly the same, but the challenges are different. Even though we are growing fast we must be careful that growth never happens at the expense of our principles. We must continue to be efficient in delivery times and keep the patient always at the centre, never compromising quality. Joint Commission International Certification, ISOs, and many other world-renowned certifications, including the ones on the handling of data help us ensure we stay with a model that is strong and can only become stronger.

EF: Bill Gates wrote a recent piece in The Wall Street Journal titled "The Best Investment I've Ever Made," where he calculated that the US$10 billion he has invested in global health funds has turned into US$200 billion worth of social and economic benefits. With this incredible return in mind, why do you think there is such reluctance to invest?

JCO: From my experience of meeting and working with government officials, they have mostly been dealt a very bad hand to play. There are resources to be used, but it is easier to go with the flow. If one wants to make changes, I suspect that it can be very hard for them in the public sector. I have seen very committed government officials and I have been exposed to some very gifted hard workers, like Dr. Narro, and I believe he made his biggest effort.  Incidentally, 80% to 85% of the people who go to a Salud Digna clinic can go to IMSS, ISSSTE and Seguro Popular for free. With us, they have to pay—not very much, but they still have to pay. 

EF: In two or three years from now, where do you hope to be, what would you like to have achieved, and what about international expansion? 

JCO: We are developing a model that can serve people in smaller population centres, with multifunctional staff, making software changes, reevaluating services, also seeing what solutions have been used in other parts of the world. Our business is non-profit, so we try and reach as many people as possible, although going to smaller places sometimes is harder. Salud Digna has a new department which looks for critical points where we are most needed. It is the need for what Salud Digna delivers that drives us. That is the logic we use to expand. 

There is always room for improvement and we are always looking to be a better solution for our patients. The goal is to be able to help people avoid the devastating consequences of losing health. 

Information-based decisions are the best decisions—it is really that simple. And we are in a very special place looking to get the upper hand on many illnesses. For example, the undersecretary for prevention could profit a lot from the information which we make available on treatments and prevention of diseases, and of course, the government has its own sources of information. Our data is open for everybody and has a great scale. We really hope that we can continuously provide value to society using this information. 

January 2019