Hello Friends 👋

We are very excited to present our first episode of TECH TUESDAY, where we introduce you to the latest tech tools available for neonatal providers. We are starting off with the mobile app PREEME+YOU which supports parents in the NICU in a very innovative way. Listen to today's episode where we chat with Dr. Yaya Ren, a medical and cultural anthropologist, founder of the Preemie+You app.

Disclosure: The incubator and CATO Neonatal Innovations Inc. have no conflict of interests to report in relation to our interview with Dr. Yaya Ren and the Preemie+You startup.

You can find out more about Preemie + You at: https://preemeandyou.com

Feel free to contact Dr. Yaya Ren for questions and potential collaboration opportunities at yaya.ren@preemeandyou.com

The transcript of today's episode can be found below 👇

Ben 0:39

Welcome Hello, everybody. Welcome back to the podcast. It's Tuesday. We're doing Tech Tuesdays, Daphna, how are you?

Daphna 0:51

We're excited for our very first Tech Tuesday, and gosh, I can't think of a better organization and app to kick us off. You know, this is a personal area of interest for me. So

Ben 1:03

yes, yes. And this is actually the reason why this, this series of podcast episodes is coming to life, because you've had this wish to have an app that does what we're going to talk about today. And then it turns out this app was created. And it took us time to actually connect with the people who created the app. And so we thought, we're probably not the only ones who are missing out on a lot of mobile technology and potential improvement tools that we could use in the NICU. And this is where Tech Tuesday really came from. So we're, we're super excited today to have with us Yaya Ren. She is a medical anthropologist. She is the founder of the app preemie and you. Yeah. Thank you so much for being on with us today.

Speaker 3 1:48

Oh, thank you both. I love your podcast and listening to it. And, you know, we can like nerd out and talk about a whole bunch of things. So this is really cool for me.

Ben 1:58

Thank you. Thank you. So So for the people who are some people may be familiar with with the app. First of all, it's premium new. And it's it's, it's sometimes written as Premier Plus you correct? Yeah. So that's yeah. So that if you're looking for it, you could find it like that as well. But can you tell us a little bit about what the app is like? What is it? What is it aiming to do?

Speaker 3 2:21

You know, it's sort of an app that is trying to address the medicine, the patient parent experience, and also, you know, allowing medical teams to be able to communicate thoughtfully and meaningfully in a way that fits with their workflow. And kind of the big picture of the app is when parents come in every day, you know, their first question is, like, how was my baby doing? And when am I going to go home? Right. And we know that in neonatology and this app is aimed right now, just at prematurity, that, when it comes to prematurity, you know, 90% of the babies are discharged. But it's hard to predict, like what the long term outcomes are, it's hard to predict length of stay, especially at the very beginning of a of a journey. Right. Right.

Ben 3:24

And so So, so the app basically is is helping parents with understanding a little bit of the of the NICU course, especially related to prematurity, and have a sense of what is really happening in more basic terms so that they could have a grasp of what's going on, I think, I think where the app really shines is because we tend to talk about like, I guess, quote, unquote, the roller coaster of the NICU. And it's like, oh, there's highs and there's lows. And it's like, but it's why are their highs and lows? What's going on? Why is my baby now back on the ventilator? What is that mean? And that's something that parents have a very difficult time grasping. And I think also the lack of, of knowledge in terms of when these things are going to happen. It's really anxiety provoking. So I think your app if I understand correctly, really comes in and fills this need to try to walk parents through all right now your baby is on a ventilator, what does that mean practically? And and it helps them understand and also ask specific questions. Is that Is that correct?

Speaker 3 4:23

That's really incisive and like a beautiful, elegant description. So yes, absolutely. It really came out of a place where, you know, my, my sort of dream when I was younger, was to be a neonatologist. And I actually, my first research job was with a neonatologist. He was Bill meadow and he worked a lot in predictions of mortality. Kind of like looking at predictive analytics, you know, snap scores versus like, doctors intuitions, right? And what we learned from those Studies was that, you know, doctors and nurses when they've been in the NICU for a long time have Gestalt intuitions about the progress of a baby. And that is as accurate, if not even more accurate than even, you know, snap scores, because you're doing it daily, and you're getting a day to day kind of assessment that you can read as time moves on. And the way I talk to parents about this app is when they come into the NICU, they sort of feel like, I don't know what's happening. It's like a blank piece of paper, right? And I think about like, connect the dots, right, you have to have the dots, and then the numbers, and then you have to connect the numbers, and then you get kind of a visual or an image of what you see. And I think if a NICU for the parents, like all they have in the comment is like this blank piece of paper. And it's like, we have to kind of put the dots on the paper first. And that's the progress of the baby. And then you have to kind of number it, and then the parents have to connect the dots, or you have to help them

Ben 6:08

right. And so I think where the app does a tremendous job is because of this color coding system, right? Because I think you could have easily provided an app that made things more complicated for parents, because of how complex things are. And yet you've, you've managed in this color coding system to walk parents through the different stages of the hospitalization, can you tell us about how this color coding system works?

Speaker 3 6:30

Yeah, and this was really, you know, in collaboration, uh, you know, with my partner, Dr. Barry Andrews at University of Chicago, you know, and actually being an anthropologist, and being in the NICUs, and just talking to doctors following them. You know, I spent probably three or four years every single day just working on different research projects in the NICU. And this color coding system really came out of, you know, observing parents, and then talking to medical providers, doctors or nurses. And I realized that there were sort of like five levels of knowledge or, you know, sort of epistemologies, if you think about it, there's the, you know, the baby's, you know, fetal growth and development, right, which is like, biological genetic, and it's unfolding at, you know, slightly, perhaps different ways than it would have had the baby still been in utero, right, that's kind of the Barker hypothesis. About the next level is the medicine, like neonatal medicine, trying to just sustain the body as it attempts to develop. And then there's like the parents experience and knowledge of their baby as they're going through the NICU. And then there's a parents as experience of themselves as kind of a secondary patient, right. And then there's the anthropology that's trying to integrate all of these things. And so the color coded system really came out of that, to be able to anchor all these different perspectives and experiences, but anchored in neonatal medicine. And when we, you know, speak to different neonatologist and your technology have been amazing, because if you get a neonatologist time and your time is so precious, like if I had infinite time with you like we could sit down, and everybody would be in pretty much kind of agreement that like this is kind of a process that the baby kind of goes through. But if you don't have like infinite time to download that with every single parent, like if they had your time infinitely, everybody would know this, right? You would be like the most amazing spirit guides. And so I thought, well, how do I take these amazing doctors and nurses and kind of make them spirit guides. So we put it all into an app?

Daphna 8:49

I think that's a really neat description of neonatology in general, it makes me It's humbling. It makes me feel like oh, that's why my job so hard sometimes, because they're all are all these different levels. And I think maybe it would be helpful concretely. So what's cool about that, so lots of programs have discharge readiness or pathways through a hospital plan. But like you said, they're really one dimensional. They don't allow for like, kind of backtracking. And they don't allow for really individualization of the baby's care. So what's really intuitive about the app is that, that the parents actually have to input some information. So they have to have some engagement with the app for it to tell them kind of where they are on the pathway. And I think that's what's so special about this. So maybe tell us a little bit like from the from like, the parent experience, like what that looks like.

Speaker 3 9:51

Yes. Thank you so much for bringing that up. You know, when we started creating this, we realized that, you know, understanding where Baby is and what color stage are there in, maybe I'll just go over the color stages really quickly. So, you know, synthesizing all of the different kinds of medicine we sort of decided was, we kind of go through four broad stages. And it goes from, you know, highest, you know, Nicu acuity. So like highest level of NICU care, all the way to, hey, we're starting to prepare you for home, but we never tell you exactly what day you're gonna go home, because every unit is a little bit different. And so the stages move from purple, to blue, to orange to yellow. And the idea is that as the colors get brighter, the baby's becoming more interactive, you can do more with a baby, we didn't want to use, you know, red or green, because obviously, those would be really, you know, those those would be sort of inaccurate for the Nikki right, there's never red and green. And then we decided that talking to unit ologists, that, you know, people are looking at multiple factors, right, parents are sometimes only concentrated on growth, but there's obviously, you know, key areas, breathing, eating, sleeping, temperature control, and sort of general growth. And each of the, you know, five kind of key areas, you have to get to yellow before the baby is covered, ready to be thoughtfully discharged. And so that's just a guide for the parents to understand that you're, you know, 28 week old baby is different than somebody else's 28 week old baby, because babies have different, you know, issues that they're addressing in the NICU. And for the parents, we understand from an anthropological perspective that when parents engage with the data and touch it, they feel more empowered. And then they actually have better questions for their medical teams. And the conversation flows easier, because if they pre engage with some of the questions, they can either say to their team, like, Hey, let's go through the app together, which really only takes a minute if you're doing it with your patient. And that actually just puts everyone on the same page, it de escalates anxiety for the families, and allows them to review, right, so they can actually scroll back and see a history of their baby's progress, they can communicate it to the dad, or if it's a mom, you know, or other, you know, family members. And so I felt like patients constantly or parents want data, because we're so obsessed with data. But yet, we don't know how to interpret it. Right. And so what they want is they want to get into like your minds, they want to have like a doctor in their pocket.

Ben 12:48

And I think and I think from that standpoint, it's it's, I don't like you said, I don't think you can ever get to the point where you have like a doctor in the pocket. But I think many times you go to the bedside and time is is is a is a scarce resource. And you find yourself explaining the basics of like, this is what your baby is on, this is what your baby, this is your baby is NPO. And you explain these very basic items. And by the time you've you're done explaining all these things, then time is up, you have to go see another patient. And I think where the app really shines is that it it? It does this front end of the work for you where by the time you get to the patient's bedside, the parents are aware of what the baby is on, what does that imply? And then you can have a much more meaningful discussion about what does the next few steps look like? And and I think it prevents having a multitude of discussions where as the parents are learning more through the clinician than they have even they have more questions. And you can go straight to these questions because the app breaks breaks down some of this early work for you.

Speaker 3 13:55

Right. And I think it shifts the, the sort of like intellect interactional balance in the actual human interaction, because one of the key things that we wanted to create was, We never wanted the technology just to be, you know, a patient, a parent and an app. Because I you know, when now we go to a doctor's office, like when I go to my son's, you know, doctor visits, everyone's like, sort of you have to turn towards your EMR system and sort of figure out the patient that way, rather than sort of like engaging from the very beginning. So, you know, my dream is you use technology in certain times to be that bridge so that when you come together, that's more meaningful. And then when you're apart, it's reiterated, but I don't ever want to take that human because all patients want is a doctor patient relationship or a nurse patient relationship.

Ben 14:52

Yeah, but I think I think this is where it's really, really helpful because number one, the app has these little messages that are being provided to the parents and these messages break down what's going on meaning, oh, you're on iPhone is or cannula which means your your body is your baby's body is really learning to, to work on breathing more independently. And, and, and the progression is never, like you said, you never really make any promises, you're like, you know, it takes one one day at a time and, and this will, this next step will happen soon, but that may not have happened yet, et cetera, et cetera. And that's and that's really helpful because it customizes the information that the parents are receiving towards the actual clinical care that's being delivered. And it is tailored to their baby and the unit that they're in. So I think this is this is also where it's really, really innovative.

Daphna 15:40

Yeah, and I think you touched on some really important points, because the data is really clear about what parents are looking for in the NICU, they're looking for information. But the information we frequently give is not the information they're looking for, right? Like we give a lot of numbers, and we talk about our fancy technology, and what parents are really looking for is okay, but what does that mean? Like, so how many steps more till my baby can come home, or how many steps more till they're not attached to all of these things. And so I agree with you, it totally just provides this in between education that I think is really lacking. And the studies of parents in the NICU really show that, you know, they want somebody who's obviously knowledgeable about neonatal medicine, and they're looking for somebody who's willing to connect to them, because they, it makes sense just through human nature or looking. It's easier to trust somebody with your baby, when you have this opportunity to sit and to talk with them. And to have like you said, a really a relationship. And so I think like you said, if the parents are able to do some of the this legwork in a safe space, then we can really work on a relationship building that I think is still lacking, even in the highest acuity highest ranking NICUs is this, the sense of community that parents are looking for, and that they're not finding in, you know, the quote, unquote, typical parent circles. So I love it, I love it I've sold, one thing I really wanted to talk about is, you know, you're you're not a healthcare provider, you're not a physician, you're a medical anthropologist, and I think that actually provides so much additional value. And before we started, you were talking a little bit about how technology can help pay or play a role in equity. And in our healthcare systems. And obviously, the the NICU is the perfect place to discuss to discuss certain health care disparities. And so I'm hopeful that you'll you'll talk a little bit about that.

Speaker 3 18:02

Oh, my gosh, thank you so much, and what you said was so eloquent about, you know, patient experiences. And I think that, you know, this initial project started because we work with University Chicago, which is, you know, Southside of Chicago under resource families. And we were noticing that, you know, people have this presumption that if people aren't educated, they need everything written to them at like, a third grade level. And, you know, as an anthropologist, like, I realized very early on that that's making a very, very

Daphna 18:37

huge, or worse, or worse, we, we, the community doesn't give families certain information, if they don't feel they can digest it, when maybe that has nothing to do with their educational level. Right.

Speaker 3 18:51

And also, they're put in an environment where it's complex medicine. So whether or not they like it, they are thrown into a situation, and a complex medical journey that is not third grade level in any way. And so we realized very early that it was very hard for them to, you know, get access or even feel like they had access to kind of getting a big picture. And so we thought, okay, if we parse the information into color stages, then we can all at least communicate, right, like the babies in this color, based on this key area. And what we found in our initial study of using this app in a very, very early model was that, you know, families, indeed, could understand this very well. And in fact, after two or three times, they were doing the app by themselves without any help. And they would come up to our research assistants and say, you know, Hey, Abby, like let me show you my baby's colors today. Right? And so then by the time that they were ready to be discharged, like if your baby's on a ventilator, for 2030 4050 days, in purple, you will just naturally start to have that intuition. Like, are they gonna need some oxygen support when they go home? So it's not a surprise.

Ben 20:13

I think this is huge. And then and then. And then the one thing that I mean, we're getting, we're getting already short on time. But I think the one thing that was very interesting to me is that you, you have this app that interfaces with the family, but you have this partnership program with with NICUs, in order to create a model, right? Because that's the fear of all the clinician is like, Yeah, I'm going to bring this app into my units, but maybe our bradycardia watch is five days when the is group in Chicago was three days. But it actually you partner up with the clinicians to create a system where the app can be customized to each unit, so that the parents have the expectation, matching the protocols of the unit so that if the baby is under really watched the app will say yes, your your this is a five day countdown until the baby doesn't have another bradycardic episode. And this is This is revolutionary, I think this is because this again, goes against all the things that parents will read on like Facebook groups and stuff where they might read something that applies to a unit in Cincinnati, but doesn't apply to their unit in Los Angeles. So can you tell us a little bit as to how you're partnering with with neonatal intensive care and units and physicians to really make the app even more powerful for these families?

Speaker 3 21:29

Yes, and I think, you know, the way that we wrote our algorithms was that we basically work with each neonatal intensive care unit. So University of Michigan has a slightly different incubator protocol than University of Chicago than community health systems in Indiana. And what we do is, as part of the beta onboarding process, we sit down with the neonatologist, with the nurses with PT with anybody that you think would be helpful, and we get their, you know, what I call anthropological ethnography of the things that they generally tell their patients. And then we collate all those things. And then we put them into the color scale so that your NICU, when you use the app, you enter a NICU code. And it could be anything like Michigan has little Victor's somebody has monster minis. And it actually uploads all of your content. And that content actually can be changed throughout time. Right. And so, you know, depending on the neonatologist, that month, you could have that person's, you know, sort of ways.

Ben 22:34

If you're, if you're feeding protocol changes, changes, then you can update the feeding protocol. And now the app will say, well, then your baby is going to come off TPN, and a few next few days, if the baby tolerates this much of feeding. And this can be an issue. And this is how you, you adjust the content of the app to the to the different units. That's that's really cool, right.

Speaker 3 22:53

And we can also adjust the speed in which you move through the colors, right, we took a very, very conservative route, which was, you know, your baby could possibly be more ahead than they are based on how your unit, you know, defines different discharge elements. So we wanted to give providers and clinical teams that flexibility as well.

Ben 23:16

And I think one of the other thing that's kind of great about this, this color scheme, is that you're we've talked about moving through the color scheme in one direction. But you could also move in the other direction, sadly, as as we know, happens on a day to day basis in the NICU. But can you tell us a little bit as to the app doesn't crash what right when you when you can you tell us a little bit about what how does that work? And how do you how do you not stress out the families? Right? How because that's super, I'm assuming you must have agonized over how to design this, this phase of the app where how do we walk patients through Hey, this is a setback, you're moving back one step? Right? How do you do it in a way that's, that's not anxiety provoking, and that's helpful and supportive.

Speaker 3 24:05

You know, we put information in there throughout the journey. And so even when parents are progressing, we say, you know, sometimes we can go back and it was three steps forward, two steps back, so giving them kind of that general philosophy. But the app algorithm is also reading, how many days you're in a certain color and how many days you've gone backwards. Right? And so like, if you're going backwards for a day, we'll say, hey, you know, this is just a little bit of a baby needing some extra support today, check in tomorrow, right? Tomorrow, you're moving back again, we'll say you must be concerned, you know, this is a really good time to like, Ask your nurse about this. So we always directed back to the medical provider, the nurse or the doctor, because I think people want to know like when you know, when should I come in and really talk to you and when can I kind of like not worry. Right? And of course, if you're really doing poorly You know, we will just say like, you know, the Apple just shut down. Like, we'll just say, you know, this is probably a time where your NICU providers are taking over. And then, you know, we always work in conjunction with the clinical team, and then you would say like, the app is probably no longer appropriate. Right. Right. into that, and to the other end, you know, we always say that, like, you decide when the parent and the baby should go on the app. Right.

Ben 25:30

So very neat. Yeah. And I think it's probably when it's I mean, the app really is it is at its best when you start, like you said, like, there's this journey that that's being used this format that's being used in the app to help the parents walk through. And to be honest with you, we communicate very well with the sickest of the sickest babies, but it's usually what the parents developed this exists. Yeah, it's quote, unquote, NICU is when the parents have gone through the hard part. And now it's slow. And they're like, I have what's going on now? And like, why is it taking so slow, and then they're getting less face to face with their clinical team, because obviously, they're less sick, and the ratio of nurses is different, and the ratio of doctors is different. So I think this is really where the app really fills a void that that that needed to be addressed. And so we're very happy to be able to talk to you about that today.

Daphna 26:17

So how do so how do people find it?

Speaker 3 26:21

Well, the best way to find it is, you know, emailing, you know, emailing me at yahoo dot read at premium new.com. And if you'd like to take a look, we'll give you a NICU code that's currently being piloted, and one of our units, we have not, we have not put this out for sort of every parent, you know, fully accessible, because, you know, we really wanted to work with individual units. And we wanted to make sure that it's always guided by medical practitioners. However, at the same time, we've had so many requests that we are thinking of, you know, pairing with the neonatal nurses association to do a very, very generalized template so that people can have a general idea of the course of the NICU, whether you're, you know, in high risk pregnancy and think you know, about to deliver, or you just want to take a quick look. So that general template should be coming out probably end of summer, where everyone can have access. But that won't have as much sort of like in depth, high level information. Yeah. But we really want to work with individual units, because I think that's where things are most powerful. Because otherwise you're just like every other app providing general information.

Ben 27:33

That's exactly right. And that's also where I think people can, can fall. There's a pitfall there where if you go on the iOS App Store, right, you will find the app. So you will, you can you can search for Premier Plus you and the app will come up. But at the end of the day, you need to you need to make your code right to enter the app. And this is where reaching out to you first makes makes more sense where this partnership again, like you said, I think if you don't if you don't partner, if you don't, if people don't talk to you, and they don't customize the app to their unit. I think it doesn't do the app justice. I think like you said it's Yeah, so this is very important. And we'll put all the information on our website about how to get in touch with you, and some of the some of the pitch deck that you've sent us. So yeah, thank you. Thank you very much for presenting. Yep, definitely. Anything else?

Daphna 28:18

Yeah, well, and for listeners, as we're starting with Tech Tuesday, we really don't like to talk about things that we don't kind of believe in. So I mean, we we are going to be beta testing the app ourselves, right? And our unit.

Ben 28:33

So we have no financial ties. That's right, with Yeah, and we're not getting anything out of this. I mean, this The goal was people on rounds always pull up different apps, we always send people to go, which app are you using? And it's like, maybe it's time to highlight some of the technology that's going to help us take better care of babies. And, and the NICU despite our technological feats is lagging behind when it comes to mobile, and stuff like that. So, yeah.

Speaker 3 28:58

And then yeah, and I'll just say that, you know, in creating technology, it's always iterative. And there's no such thing as a perfect technology. And so I really felt like for that to be democratic, we really have to bring in collaborators that can actually like input the things that integrate with their workflow, because they know their patients best. And so, you know, we try to we try to do that with our algorithms.

Daphna 29:24

Well, and I mean, it is becoming less and less common that people are empowering healthcare teams, right. So a lot of powers is being taken away from healthcare teams. So this is an exciting opportunity to collaborate, do the right thing for families. So we're, we're pumped neither,

Speaker 3 29:42

my gosh, thank you for this opportunity to chat about it. And you know, it's so fun to talk to both of you and so inspiring. Thank you. Yeah, thank you both had like such innovative mindsets, both working in medicine and technology and bring it all together. Awesome.

Ben 29:59

Thank you is that What we're trying to do means a lot. Thank you. Thank you so much for your time Daphna. See you. That's right. Yeah. Thank

Unknown Speaker 30:07

you both so much. Bye. Bye.

Ben 30:10

Thank you for