Episode’s transcript

Julio Martinez: 0:00

<silence> Welcome to the Latin MedTech Leaders podcast, a conversation with MedTech leaders who have succeeded or plan to succeed in Latin America. Please subscribe on your favorite podcasting platform. Apple Podcast, Spotify, Google Podcast. Amazon Music is teacher. Tune in iHeart Radio, Pandora or Deezer . Welcome to the La MedTech Leaders Podcast, a conversation with leaders who have succeeded or plan to succeed in Latin America. Please subscribe on your favorite podcasting platform. Apple Podcast, Spotify, Google Podcast, Amazon Music, Stitcher , and others. Today our guest is Riley Normandy, director of International Sales at a MD Global telemedicine. In this capacity, Riley is helping new and existing telemedicine programs find the best solution to fit their program needs. A MD has over 8,500 patients, endpoint installations in more than 96 countries, and delivers preeminent telemedicine solution designs our Turkey installations and training for telemedicine programs across the globe, including Latin America. So, Riley , it's great to have you here today. Thank you for joining our podcast and the episode today.

Riley Normandin: 1:17

Thank you for having me, Julio.

Julio Martinez: 1:19

Fantastic, Riley . So let's get started by talking about your involvement with Latin America. How do you first get , uh, contact with the region on a personal professional level?

Riley Normandin: 1:30

Sure. So, I , um, joined the company about 11 years ago. The company had been in business now for just over 30 years. But , uh, when I first joined, we had done business deploying hardware, telemedicine devices to a lot of countries in Latin America. But a lot of that was, you know, only government based or grant-based care, which is what the telemedicine market was at the time, where it was a lot of grants. Right. Reimbursement hadn't really been fine tuned . So from there, it's grown with kind of the adoption of telemedicine in general. So we've been able to help programs or countries, I should say , um, you know , initially start their pilot programs when they're trying to say, Hey, what is this telemedicine thing I keep hearing about? And , um, from there, it's a lot of shared experiences with, with other countries, and they're able to grow , um, whether I think, whether it be in, in Bolivia where we've done some big programs too in Mexico or Paraguay, there's a number of ways that we've kind of reached the Latin American region some easier than others.

Julio Martinez: 2:54

And you've traveled all over the region, I guess, or a few select countries?

Riley Normandin: 2:59

Yes, I have done , uh, quite a bit of travel to the region. A lot of countries that I've checked off and quite a few more that I , uh, are on the, the bucket list to visit hopefully soon when the world gets back to normal. Yeah,

Julio Martinez: 3:12

Yeah. Good, good. All right , Riley . Um, let's talk about trends , uh, that you see happening in Latin America. What economical, social, political or epidemiological trends you see happening in Latin America that are good for your business or for the business of commercializing medical technologies?

Riley Normandin: 3:32

Sure. So I think there's really a couple ways to look at it, right? So the telemedicine market in general has been growing. I think the numbers pre covid , it was growing 15% year over year . And now with COVI , they're expected to be about 20% or more year over year , because what it's done is it's accelerated the adoption of telemedicine and telehealth in , in general, one of the big barriers pre covid was making the average patient understand what telemedicine or telehealth could do, what were the benefits? And because of the way the world has been for the last year and a half, a lot of people have been forced to have their first telemedicine or telehealth consultation, whether they like it or not. And they've seen say, oh, you know what, this isn't a robot doctor, which is actually what a lot of the perception was that, Hey, I want to talk to a doctor I don't want to talk to. So they've seen that, oh, it's, I'm still talking to a doctor or a healthcare professional, and it's convenient. So the adoption has really grown. So, you know, it has also made a lot of countries kind of revisit what their telemedicine policies were regulations for sure. Um, for example, in Brazil, prior to Covid , Brazil wasn't doing a lot of telemedicine because their policies and frameworks were that it had to be doctor to doctor , right? So there was no, you had to have, the patient could be involved, but there had to be a doctor on both sides. So it was mostly being used for second opinion, which has some value, but that's a very small piece of it, right? So now they have, they have loosened that that framework or legislation to allow the patient to schedule an appointment within certain parameters to see a doctor. One thing that's halting the growth completely is that they haven't set a definitive regulation for the country yet, right? So they've set it as a temporary policy to allow these types of consultations to take place, but they haven't said that this policy is gonna be there moving forward. So it's kind of in limbo. But I think just like most of these other countries, they're seeing that the adoption has grown, the convenience of it, and the power that it can have. And I think most expect it to become more of a permanent policy. It makes too much sense not to,

Julio Martinez: 6:26

You're still turning back. I think once you, you have a taste of it. I just have mine for my first time ever. I'm 50 years old. I just got my first telemedicine consultation about a month ago for an eye infection that I had. I'm like, this is so convenient. I don't have to travel anywhere. I have to park, I don't have to dress, I don't have to do anything. I mean, it's so convenient that being , they prescribe my medication, go to a pharmacy and pick it up. And that's it. And I'm so glad to have you here today because , uh, this is a trending topic. And I recently interviewed a fascinating guest who is like you in the telemedicine world, but he is, he's a very prominent dentist. He's from Venezuela, but he's been in the States for over 20 something years. He's licensed in about 10 different states in the United States, and he's leading a teledentistry initiative for a major teledentistry company in the US that is looking to venture into Latin America. So I'm like, wow. I mean , now you can have dental appointments online, or you are telling me this is really fascinating.

Riley Normandin: 7:30

Yeah, it is. And you know, I like to joke for , um, I mentioned I've been with the company for 11 years and for the first 10 years, if I was ever at a cookout or somewhere and someone asked me, oh, what do you do for work? Having to try and explain to them what telemedicine was, was difficult. And now for the first time I say it and they say, oh, I know what that is. So it's nice. Yeah.

Julio Martinez: 7:57

Yeah. I, I think , uh, it is in everybody's mind that online first that mentality that online first for shopping and also for medical appointments. So the first thing you will think is, let's have a consultation online is like recently I need to speak with my attorney and having spoken with him in about a year, and then my first reaction is, let's send him an email and let's have a zoom meeting. Even though we are in the same city in , in Orlando, I mean like before Covid, that wouldn't have been possible. You know, people will immediately assume we have to meet in person face to face . I have to dress, I have to schedule time for travel to his office. I have to wait in his , uh, waiting room and then I have to enter his office. I have to have the conversation with him and then drive back to my place. So it will probably be a two hour deal, whereas now is I spend about 15, 20 minutes with him on, on Zoom and that's it.

Riley Normandin: 9:03

Yeah. And another one of the interesting parts of the adoption has been along with the patients forever, thinking that, oh, I want to talk to a doctor. I don't want to talk to a robot. A lot of the doctors for so long have had this misconception that telemedicine is designed to replace them. That's still something we work with. But, you know, thinking that, oh, this is, they're automating everything and they're gonna replace me, I'm gonna lose my job. And now a lot of these doctors and healthcare workers are realizing that's not the intent, right? It's supposed to be a tool to see more patients and it's making best use of resources. Right. I had mentioned briefly that project we did in Bolivia a few years ago where, and not a, a challenge that was unique to Bolivia, but in a lot of these rural areas that are underserved and a lot of the , uh, people living in these underserved areas had limited access to care, you know, and the providers of the doctors, they don't wanna live in the, the rural areas, right? So the government put in telemedicine at 340 locations in these remote municipalities. And overnight, whether they lived in a rural area that was 12 hours away from La Paz , they now have access to the same quality physicians that someone does that lives right next to the hospital in LA p . So it's uh , kind of leveling the playing field for everybody. Yeah,

Julio Martinez: 10:40

Yeah. Yeah. That's great for Latin America and the region, badly needs solutions like this. So let's talk a little bit about that, about that project. I mean, how was people's reaction? I mean, you were telling me a story about people embracing you and so happy to see you bringing this technology. Let's talk a little bit about that for listeners.

Riley Normandin: 10:58

Sure, sure. So that project started in 2014 in the Ministry of Health. At the time, their focus was increasing access to care for, it was pediatrics and women's health. That was their main focus. They wanted to increase the infant mortality rate and maternal mortality rate. And a great way to do that or address that is increasing or routine care for these pregnant women, you know, early so they can be seen by a doctor early in their term. So that was the focus. So each village or each municipality had received a telemedicine cart that had an ultrasound on it, a video colposcope, vital signs, monitors, essentially all the medical devices that could be used to examine the patient as if they were right there with the doctor. And I had the opportunity to go down when we first started and to go to one of these rural communities and help with the initial launch and kind of installation. It was in a , um, rural community of , uh, the se guero , and I probably am pronouncing that wrong, but I traveled out there and when we set up the equipment, they had a patient there ready to be examined. And it was a woman that was pregnant. She was probably seven or eight months pregnant. And they said she had four children and this was the first time that she had seen a doctor during any of her pregnancies. And me looking from the back of the room while they're talking afterwards, she was so grateful for the ability to see a doctor. And it was, you know, it's something that it really touched me, right ? I'm in the business of telemedicine, but being able to see something like that firsthand is really powerful. And it still gives me goosebumps a little bit talking about it because it's one of the more rewarding experiences I've had since I've started with the company being able to see it firsthand and how her self-worth where value was on par with everybody else . She wasn't a forgotten person and it was very touching. Yeah,

Julio Martinez: 13:10

I'm really happy to hear these success stories in Latin America and we need a lot more of that, of those success stories in the region. I mean, even in , in a developed country like Columbia , I'm sure there are areas like that with people like that who have never seen a doctor or very rarely see a doctor. So , um, let's , uh, move to other countries. I mean, what other countries have you had experience or have you seen adoption , uh, taking place in Latin America, Riley ?

Riley Normandin: 13:39

Sure. So, you know, different levels of adoption. I think there are a lot of countries that, like for example, Chile has done a fairly good job of having some telemedicine frameworks and policies, right? So Chile as a country has been pretty good. What's currently probably separating the adoption in certain countries is , um, if it's the government or the ministry of health hospitals that are deploying them is having a program, right? Protocols and processes are probably the biggest, or not having them is probably the biggest inhibitor of , of having a successful program, right? We've had a , uh, number of countries that have purchased or deployed a couple systems, but they do that without having protocols in place on okay, when are they gonna use it? What is the process for saving the data? You know, Columbia, I think recently has put in the early stages of good regulations and policies in place. Like interoperability is a big one now. So having the ability to have a central electronic health record system for the country where regardless of where you live, the doctor, when you're seen, they can pull up your record and see, okay, I can see that you had a ophthalmology exam a few months ago, or a diabetic screening test, and they can pull up those results. So Columbia is on the right path to having a really well structured program. Yeah , I mentioned Chile, Brazil, hopefully we'll get there . Peru is also starting to have some structure or the policies. And in Paraguay we just deployed a decent sized project. Again, it's a brand new project beginning of last year, but they're putting the policies and guidelines in place for a lot of these remote municipalities. 'cause a lot of them , what they're trying to do is keep their doctors, you know, they don't want them moving to another country. They wanna make best use of their resources. And you know, you can have one doctor provide care to many locations at one time. So it's also a , a real cost savings too. 'cause they're not just primary care in remote areas. It can specialized care. The distance might be 15 miles, but if there's a lot of traffic that may be an hour and a half drive, right? So having a specialist that can connect while you're still at your physician's office or wherever is valuable. And uh, it can be places like schools or prisons where you need to provide some level of care. But you know, I'm sure doctors aren't lining up volunteering to go provide care in the prisons, but you still have to provide some level of care so you're able to provide them access overnight using the same doctors that you have.

Julio Martinez: 16:50

So it's my impression that Latin America is still a few years behind the US and Canada or North America and general, perhaps Europe. But the way I see things unfolding in Columbia , Riley , and you've have probably noticed this or or not, but uh , the recent regulation in Columbia was reading the law about a month ago. And in preparation for our interview and the interview that I just had with this dentists that I just mentioned, and I see that they created a new category of healthcare provider, they created something called an orientation service, which is different from the healthcare providing service that is currently in place. In other words, what I'm really saying is that , um, it looks like in Latin America, governments are trying to protect their current infrastructure of providing healthcare services, which is brick and mortar, right? A building a , a clinic that is inside a wall that wants to have a telemedicine program because they wanna keep their patients coming in because they have to pay their bills, have to make money somehow, and the , regardless of being private or public , but they have to keep patients coming in. So they take the initiative with their own resources or grant or whatever they have their IT people implement a telemedicine program for them and just for them. And the clinic next door will probably do the same. I don't think we are ready in Latin America to see virtual clinics a hundred percent because probably the regulation is not there to enable or to certify a clinic that doesn't exist in the physical world. You see what I mean? In the US you see already different , um, virtual clinics, a hundred percent virtual, I mean stop by doctors where a patient can just connect on a cell phone , on an app and via chat or a telephone call or a um, video conference call. They can talk to a real doctor specialist In Columbia, for example, that's not the case. You can only have a hundred percent virtual tele orientation services where they can direct you to the right doctor and they give you the phone number or they connect you, they patch you in with the right doctor that is working at a clinic that is, is a brick and mortar clinic in the traditional world. Whereas in the US or probably Canada, you have already the legal framework to, for healthcare services to be provided a hundred percent virtually. Is that your take in Latin America or , or not?

Riley Normandin: 19:35

Yes, but I also think part of what you described is okay, 'cause even in the US right? So there's two types of telemedicine or telehealth. There's the direct to patient, which is, you know, talking to the doctor, having a video call on your phone or you know, having a zoom call, which is great. Which adoption has soared during covid , right ? That is great for a few reasons. One quick easy access follow ups , you know, late at night I've used it with, you know, a newborn baby, you know, it's 1:00 AM and I'm a new father and kids making a sound that I've never heard before. So, you know, calling doctors say, Hey, is this normal? Yeah, it's fine. Um, those type of things. But they're also with those services , you are limited on what you can diagnose as a doctor without medical devices. Right?

Julio Martinez: 20:29

Okay. Yeah. But that's a physical limitation of the actual devices. Yeah,

Riley Normandin: 20:33

A physical limitation for sure. But you're also limited legally on what they can diagnose or prescribe. They're not allowed to prescribe any controlled substances. Your hands are tied a little bit as a doctor. They're used a lot of times for referrals saying, Hey, you know what? I am going to refer you to another doctor, or you should go see a specialist at this location because you know, they need to either have a more hands-on consultation or maybe they'll refer you to a telemedicine clinic. Something similar to like the Bolivia system where you have a mobile cart and medical devices that isn't staffed by a doctor, but the doctor would connect to in real time to be able to look in your ears, you know, of your eyes, take your vitals, things like that. So I think you're right in that it seems like at this stage, a lot of countries, they're trying to find the ways to, what are the incentives for the doctors to do it right? Or the hospitals they're trying to maintain their patient base, you know, and is it who's paying for the services? Those type of things. There's not a universal answer to that. And it seems to vary by country or continent. It's all over the place. So hopefully we're getting somewhere where it's all easier to regulate and legislate.

Julio Martinez: 21:59

Exactly. It's about time that we kind of , uh, expand in the way healthcare is provided. That doesn't have to be limited to a brick and mortar area. And that's kind of the mindset that Latin America has to kind of , uh, overcome. Right? Eventually we're gonna get there. I mean, it's slowly we're doing it. Covid uh , accelerated the adoption of different technologies in different areas of the economy and our lives. I just read yesterday in Columbia , now public noties can notarize documents online. There's a new law for that, which is fantastic. I mean, it's being already out there in the US for probably five years, <laugh> , but it is good to see countries like Columbia already adopting these newer technologies. Anyway, so Riley , let's talk about , um, what do you need to make this work in a deployment in a country? I mean, what are the pieces that you guys as in a MD put together? I mean, let's talk about a typical deployment.

Riley Normandin: 23:02

Sure. So one of the really nice developments in the, in the , the world over the last, what it seems like maybe five years or so, is that broadband internet has been so much easier to get in, in all of these countries and around the world really. It's not perfect by any means, but it's a lot easier and more affordable than it was, you know, five, six years ago. And, you know , I think the Penn Health Penn American Health Organization said that they recommend, I think a minimum of one megabit per second for internet to be reliable and stable. And , and now that is , um, a lot more attainable for a lot of these rural areas. So typically when we start deploying or helping a country start designing their telemedicine program, we go in and we tell them, okay, you know, there's, lemme take a step back. When we talk to someone, a lot of say, Hey, we want telemedicine. What do we need? Reality is that it's not a one size fits all type of technology, right? So if their focus is on pediatrics and women's health like Bolivia, then maybe they don't need the dermatology equipment or um , ophthalmoscope , uh, look at the eyes. So, or how is it being used? Is it being put in the back of an ambulance to do house calls? So maybe it needs to be portable and easily carried. So depending on how it's used and kind of what is the medical focus? 'cause that's the most important part is, you know, why do you want to do it? That's how we help them determine what accessories, what devices need to be deployed. And then the second part is how is your health system going to deploy it? What's your workflow? Right? Where are your doctor's going to be? And a lot of programs already know and have an answer for all of this, right? I think with the adoption, the education on what telemedicine is, is taken such a significant leap over where it was a few years ago where, you know , you asked me five or six years ago when I started talking about workflow and where your doctor's going to be. A lot of these organizations were like, oh, I didn't even think about that. I don't know. Now they already say, all right , we have a plan in place. You know , if they don't, we help 'em with it, but helps 'em so that they shouldn't have to change the way that they treat patients. Telemedicine should help them . It should not hinder anything that they're doing. So think of it this way, a doctor should still be able to, if there's five clinic rooms in their hospital and if they have a patient in clinic room one, a patient in clinic room two, they may also have a patient in clinic room three. But that patient happens to be, you know, a hundred miles away on the other side of the country and they're being seen through a monitor. So they should not have to change the way they deliver medicine should be easily adaptable so that any data that they collect can go into their existing health record system. 'cause those are the things that are important. Telemedicine is so far past the proof of concept stage or the even the pilot stage. That should be just a , an added tool to help improve the way they deliver care.

Julio Martinez: 26:35

Okay. So A MD is a consultant, a system integrator. You guys don't manufacture devices, you incorporate whatever device is needed for the specific application or purpose of the telemedicine program, right?

Riley Normandin: 26:49

Exactly. We provide, what we make and develop is our software. And we take, yeah, the medical devices, we're an ISO certified organization, but we take third party devices or you know, devices that we distribute and we integrate them to kind of provide whatever it is outside of like invasive surgery. We have hardware and devices that can, you know, be used in every type of medical specialty or however they wanna deliver care. So we'll do that and we'll we can help train them and deploy them and kind of help them put the protocols and processes in place so that, you know, once they start using it, they keep using it. In our experience, you know, we've deployed, the majority of them are extremely successful, but those programs that aren't successful or maybe the equipment isn't used as often as they should is because they don't have those processes in place in the protocols. So eventually stops being used and starts to collect dust because the um, you know, the staff stop using it and then, you know, there's turnover and you're someone new is coming in saying, I don't know what that is exactly .

Julio Martinez: 28:08

A new government or something like happen in Bolivia, <laugh> , she told me That's too bad, that's too established change of government. I mean the mothers are not , uh, seeing doctors as frequent as before. Hmm . Alright , Riley , we're close to the end of the show. Um, the last question I have for you is, what would you say to the CEO of a medical device company that is just starting or to look at Latin America as a place to do business? What do you think about the region? What's your perception about the region? What will be your muscles of wisdom uh, to him?

Riley Normandin: 28:37

I get very excited about the, the prospect of the region, right? I think that it is, in my experience and especially in telemedicine, I think it's the fastest growing region in the world. It's the region I'm most excited about. Wow,

Julio Martinez: 28:49

That's great to hear. Yeah,

Riley Normandin: 28:51

So I think that there's such a large opportunity in a lot of these countries like Brazil, Peru, where, you know, a lot of the telemedicine space is largely untapped, right? In Brazil, the in visa is so prohibitive for medical device regulations or it's not prohibitive, but it's just a long, painful process that, you know, the opportunity to get in in these early stages and put your stamp on the telemedicine market as it's growing, I think is huge. So yeah, I think that it's , uh, hopefully, you know, 12 months from now we'll be sitting here talking about how unbelievable the last 12 months have been in, you know, central and Latin America. And I think it's a , uh, very exciting time for , uh, medical device companies and healthcare companies in , uh, in the region.

Julio Martinez: 29:47

Excellent, Riley , I'm really, really happy to hear that. Alright . Thank you so much for accepting my invitation to being in our podcast and I look forward to being in touch.

Riley Normandin: 29:57

Yes. Excellent. Thank you for having me.

Julio Martinez: 29:59

Bye-Bye Riley . Bye.