524: From Personal Loss to Pioneering Pediatric Health

Hosts Will Larry and Victoria Guido are joined by Hans Kullberg, Co-Founder and Head of Product at Pathfinder Health. Pathfinder Health is an early-stage startup that provides objective insights into children's developmental health to pediatric clinics. Hans shares his journey, starting with his career on Wall Street, moving through various startup experiences, and finally, his pivotal role at Visa, which was significantly shaped by the tragic loss of his daughter, Aviva. This loss inspired him to focus on helping families get timely and accurate developmental diagnoses for their children.

The episode highlights pediatricians' challenges in monitoring developmental health due to time constraints during appointments and the lack of detailed observation that these brief interactions afford. Hans explains how Pathfinder Health aims to address these challenges by enhancing the collaboration between parents and pediatricians through technology, providing detailed tracking and insights into a child's development outside of clinical visits. This includes innovative approaches like using machine learning to analyze video data of children in their natural environments, helping to pinpoint developmental milestones more accurately.

Hans also discusses the broader implications of early and accurate developmental diagnosis by emphasizing the importance of using data to overcome the limitations of current medical practices. By integrating detailed developmental data into health records, Pathfinder Health hopes to transform pediatric care by being able to allow for earlier interventions for its patients.

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Transcript:

WILL: This is the Giant Robots Smashing Into Other Giant Robots podcast, where we explore the design, development, and business of great products. I'm your host, Will Larry.

VICTORIA: And I'm your other host, Victoria Guido. And with me today is Hans Kullberg, Co-Founder and Head of Product at Pathfinder Health, an early-stage pediatric developmental health tech startup focused on bringing objective insights on children's developmental health to pediatric clinics everywhere. Hans, thank you for joining us.

HANS: Thank you, Will. Thank you, Victoria. It's really awesome to be here.

VICTORIA: Great. Well, I met you at the San Diego Founders Hike at probably 7:30 in the morning on a Friday [laughs] a couple of weeks ago. So, tell me just a little bit more about what do you do for fun around San Diego?

HANS: Yeah, I do a lot of fun. First of all, I'm a dad of four kids, so that keeps me busy, and it keeps my fun time relegated to the windows that I can do it. But I love to start morning surf right out here in Mission Beach in San Diego. I love to cook for a lot of people, house parties, and as well as hunger suppers. And then, I love playing saxophone when I can.

VICTORIA: What's your favorite song to play on the saxophone?

HANS: So, I'm messing around with it right now. I'm not great, but I'm learning Happy Birthday right now.

VICTORIA: That's a great song, and you have a lot of birthdays to celebrate, it sounds like, over there. So, good to have that handy.

HANS: Mm-hmm. Yep.

VICTORIA: Well, awesome. Well, why don't you tell us a little bit more about your background and how it led to Pathfinder Health?

HANS: My background is in data science and economics, and started my career actually on Wall Street, really looking at economic data, things like GDP and inflation, and macroeconomic variables like employment nonfarm payrolls. And I really tried to figure out a way to understand how to predict those at a very high degree of accuracy. That kind of led to my very first startup called, EconoCast, which was fairly successful. And that was exited back in 2013.

Then I did a few other things, some startups that were successful, others that were not. But then I really wanted to kind of chop my teeth into product and really learn product from the inside out at a much bigger company. So, I joined the innovation team at Visa. I was working on Visa Acceptance Cloud, which is really kind of a point-of-sale solution in the cloud. So, if you're familiar with Apple Pay and Google Pay, it was pretty much the mirror image of that for receiving payments and accepting payments. And that really helps a lot of long-tail merchants, if you will, kind of in places like India, and Nigeria, Brazil, et cetera, that are traditionally accepting cash payments to be able to accept credit and debit payments.

However, life took a turn. And while I was at Visa, my third child, Aviva, passed away. And there's, you know, a lot of backstory on that side, but she still doesn't have a diagnosis to this day. It was certainly the hardest part of my life and time of my life for my wife, my family. And I took some time off, really embraced the grieving process, but really tried to figure out what I wanted to do next. And really, that centered around a promise that I made to my daughter was to really try to get parents and families the answers that they deserve to really understand their diagnosis.

So, I talked to a lot of different people in the healthcare community, trying to figure out what I wanted to do with my particular background in data science and technology and building products to be able to kind of marry that with getting parents the answers that they need. And so, that's where I really came in contact with my co-founders at Pathfinder Health to really build what we believe is the most advanced way to really help pediatricians and providers understand how children are developing outside the clinic by collaborating, having parents and pediatricians really collaborate to understand the development across social, emotional, language, cognitive, and movement, all of those things that happen that require observation where pediatricians just have very little time.

And we really kind of package that in a way to give them a snapshot of how they're developing relative to the peer group, to really kind of clarify a lot of these gray areas, if you will, and not take that wait-and-see approach, but rather to make that referral or diagnosis or get them on any kind of therapy that they need as soon as possible. And really, that's the diagnosis that this problem. The meta-problem that we're trying to solve is 25% of all children have some type of developmental delay, yet only 3% get diagnosed before the age of 3. And so, that's, you know, something very near and dear to my heart and something I'm working on every single day. That's how I got to where I am.

WILL: Wow. I am so sorry to hear about your daughter. And I'll just be totally honest: that's one of my biggest fears as a dad. So yeah, I am so sorry to hear that about your daughter. What was that situation like? How long ago was it? And kind of not having to answer, like, where are you at with that?

HANS: My daughter was born in January of 2020. Aviva lived for over ten months, and she passed away here in San Diego in November of 2020. I won't get into the background of it, but the short end of it is she never really had a diagnosis. But she had some anomalies that really created a condition called bradycardia, which is slow heart rate, only intermittently. It happened every couple of months. So, it wasn't really even a daily thing. Doctors didn't have any answers for it. We saw teams of specialists and I'm talking about cardiologists, neurologists, mitochondrial specialists, pulmonologists, every single type of specialist under the sun.

But throughout six different hospitalizations and then the autopsy afterwards, they never figured out what the root cause was. And she had some signs that were different, but, you know, we live in this world where data is abundance. Generative AI is huge, right? We have all these tools and everything else, but yet when it comes to medicine, a lot of times we rely on the human knowledge of the physicians that we see. I'm not saying that they did anything wrong because they did the best they could.

But what really upset me was that, you know, we go through this differential diagnosis of A, B, C, D, and this and the other, and they all strike out. You know, what's the backup plan? And that's where, you know, we should be using a lot more data at the big data level to really understand, you know, these anomalies. And maybe someone out there had something similar that she did or maybe a doctor in New York, or Boston, or Atlanta, or Miami somewhere would have known what to do. Unfortunately, that wasn't the case.

And really, that set me off my journey, really trying to understand that problem, in particular. There's a lot of things that kind of stand in the way from real AI being used in medicine. Of course, radiology is one exception. But when it comes down to interoperability of electronic health records as well as HIPAA, and privacy, and all the data silos they're in, Google's tried at this for a while to get to a place where you can have more precise type of data from a diagnostic perspective. Similar to the way that Facebook, and Amazon, and the Googles of the world know precisely how likely you are to click a button, I think medicine should be moving in that form and fashion. And so, yeah, that's really where I came across this journey.

And the grieving process that's a whole 'nother subject as well, but I'm a very big believer in embracing that. Each of us took a year off and really just made sure that we were taking a lot of self-care and healing. And I went to therapy for the first time in my life, did a lot of writing and a lot of other therapeutic activities, including writing children's books. So, I'm a children's book author. And that's kind of what led me to finding out what I wanted to do on a day-in, day-out basis to help parents get the answers they need, knowing that, you know, mom and dad play a very big role in this, those first five years of life which, in my opinion, are the most critical and crucial and also the most precious years of your life.

VICTORIA: You know, I really admire how you took such a painful moment and turned it into, how do I solve this problem for other people and really build community off of that as well? I don't have kids myself, but I have a niece and nephew who's two and four now. And I remember watching my sister-in-law try to keep track of all of the things that are happening for her child in the first year of their life, and it's not easy. And how do you identify if something has gone wrong? And I'm curious, like, what you learned from that process, or if you've learned anything about that process that's shifted your direction with Pathfinder.

HANS: I mean, the biggest takeaway from my own personal experience is knowing that parents can play a very proactive role, an important role in the care for their child. And so, when you look at the pediatric visit, and, Will, you probably can relate to this, you know, for 15 minutes, you know, they're checking your eyes, ears, throat, heart, giving you your vaccines, et cetera. And there's a lot of different things they have to do to check off on their task list.

But yeah, when it comes down to developmental health, we're talking about social, emotional cues, movement, cognitive, and language; it really requires observation. And they have very little time for that. Plus, you know, kids never [inaudible 08:49] themselves. There's well-child visits as well. It sort of leads to a lot of these gray areas. You know, on average, a pediatrician sees about 20 to 24 different kiddos a day, which is quite a heavy burden. They're definitely the most overworked and underpaid specialists across the whole healthcare system.

But when you think about it, you know, what they do after the well-child visits is they give usually mom or dad a two-page handout of "This is..." you know, "Your child is two years old, and here's what you can do." A lot of times those handouts just, you know, get lost, and they're very not personalized.

So, what we're doing we're a team of developmental-behavioral pediatricians, as well as early childhood specialist. We're talking about occupational therapists, physical therapists, child psychologists, and speech therapists. We're really combining all our interdisciplinary skills as well as machine learning experts on our team to be able to give parents the type of knowledge that's packaged in a way, on a parent level, that they really can understand how to track, monitor their child's growth and development. But also, if they're falling behind, or even if they're ahead, be able to enhance their development through daily activities that are tailored and customized to each individual's unique developmental trajectory.

And so, we've come up with what's called developmental biomarkers, similar to what you know as height and weight charts, to really measure and monitor a child's progress versus peers. On the physical side, we're doing that across all of those developmental domains and being able to make those conversations, and insights, and visits with the doctor a lot more comprehensive in scope, including video-based data, where we kind of isolate the milestones. We call it smart detection, really show the parents what those milestones are happening.

Parents know a lot about walking, talking, sitting, rolling over, but there's over 400 milestones that happen in the first five years of life. And so, being able to kind of understand pincer grip, you know, picking up a cheerio or looking when you call their name those are really big milestones that are very significant when it comes to determining where that child stands relative to their peers. So, yeah, that's a little how it works at a high level.

WILL: Yeah. Wow. I want to go back and tell you this just so that...I try to whenever I think of something, especially positive, I just try to tell people. And so, like, your inspiration of how you dealt with your child's passing away and everything...because I think the statistics and what I've heard is most people hit a downward spiral. Most marriages don't make it. So, it's very inspiring to hear that you grieved and you worked through the process. So, I just want you to know that, like, that's super, even for me, that's super inspiring to know that that is even possible in that situation. So, I just want you to know that.

HANS: Yeah. And I'm glad that you brought up that point. You're absolutely correct. I think over 50% of couples do get divorced after a death of a child. And a lot of times, it's not the event itself. Certainly, losing a child is very, very painful. But the cause of that separation is really the differences in the way that each other grieve, you know, the spouses grieve. And that's something that, honestly, you don't learn until you're going through it.

And so, what we did was, just like other things in our life, we were very intentional about it and really sought out as much help and support through books. Books were fantastic, also grieving groups. There's a lot of great different grieving groups out there to really understand that, hey, you're not necessarily alone. Certainly, the pain of losing a child is definitely, in my opinion, the hardest thing that anyone can go through. But in terms of being able to empathize and even commiserate, but even to hear other people's stories, you start to learn, you know, what that journey looks like five years, ten years, 20 years down the road.

But you also, you know, one of the things that I say is there's no right way to grieve at all. You can't tell someone how to grieve. But there is a wrong way to grieve. And I know that sounds like an oxymoron. But the wrong way to grieve is not doing it at all. And that's usually where we saw a lot of people kind of turn to negative addiction, or self-inflicted behaviors, or a lot of other things where they try to bottle it up, put it away, lock it in the closet and not think about it, you know, maybe bury their heads in work or any other kinds of addictions.

That's something we learned very, very early on that we try to be conscientious of and try to really steer clear from. But, again, it's a very individually unique path, and I'm definitely not an expert at all, but have certainly learned, you know, tenfold what I didn't know about grief beforehand. And so, you really don't know grief until you actually go through it.

In terms of being able to kind of parlay that into motivation to help others...and really, for me, that's my North star is really helping others, if that's helping detect diagnosis, or even, you know, just smiling to the person on the street, you know, that's what really gives me a lot of fulfillment. And so, in terms of that motivation, where does that come from, and how do you actually take that grief and transcend that into something productive like that?

The only thing I can actually say to all the parents that are listening out there it's akin to when you hold your firstborn, especially when you become a new parent. And you have that magical feeling where you're holding that small, little infant in your arms. And you have this great burden of responsibility as well. And you start thinking to yourself, man, now it's not just my life that I'm in charge of. I'm in charge of this little human being's life, who you have to do everything for them.

And so, that inspiration to be the better parent or better person that you feel as a new parent is only correlated, I would describe, to actually losing a child where that same feeling is, I would say, magnified times 3. And that's, you know, for me, I know my daughter's looking down on us, and I know that she's behind a lot of things that I'm doing, but I'm certainly inspired in a whole 'nother way apart from being just a parent.

WILL: Yeah, definitely. You said something that really caught my attention. Like, it was around how when you're holding your child, like, you're responsible for your child. I have a background in sports medicine, spent four years doing it. I still have no idea a lot of medical history when it comes to a kid. I feel like majority of the items that you're supposed to be looking for or even thinking about is totally different with a kid.

I don't know how to say this, but, like, the healthcare, the more that I have my kids, I'm seeing that there's different sides of healthcare. So, we moved from North Carolina. Our first pediatrician we loved. Every time we had an appointment, probably spent 30 to 40 minutes just talking us through, hanging out with our kids, asking questions. You know, they always gave us this list beforehand to say, "Hey, look out for these things. When you come in the office, we're going to ask you, 'Have you noticed it, or how are they doing with that?'"

And then, we moved to South Florida, and it's been totally different. Totally different. We had to fire one pediatrician because it wasn't the same care. The pediatrician we're at now is a lot better, but it's nowhere near what North Carolina was. And so, there's a lot of times that we're questioning ourselves. It's like, what does the development of our kid look like?

My oldest he had a tongue tie where he couldn't touch the top of his mouth, and we didn't know how important that was to take care of. We finally got it taken care of, but he is delayed in speech because he couldn't touch the top of his mouth. So, whenever I saw that we were going to have this podcast interview, I was just so excited because this is a huge issue. As a parent of three, this is a huge issue because you just don't know. And even when I didn't have kids, the knowledge that I had of even being a parent, yeah, I didn't know anything [laughs], and it's just learning on the go. So, everything you're doing is just speaking to me, and you are helping people. It's needed out there. So, I am so excited that you're doing it.

HANS: That warms my heart. Thank you, Will, for saying that because I didn't realize that you're actually from North Carolina. I'm from North Carolina myself from a little town called Gastonia. But when it comes to, you know, developmental health, it is the biggest gray area in all of pediatrics. And we know that pediatricians just don't have the time. That's a very big burden.

In addition, when it comes to specialists, we're talking about, you know, autism, for instance. You know, they have to be diagnosed through developmental-behavioral pediatricians or a child psychologist, and there's just a very big dearth of them. There's long waiting lines. It could be 12 to 18 months to actually get in front of them and get that evaluation, and then another 6 to 9 months to actually get therapy. And by that time, there's a lot of time lost, which is absolutely precious when it comes to the child.

90% of your child's brain, actually, develops by the time they're three years old. Another stat that parents actually don't know is that there's centers called Early Intervention Service Centers across the U.S. There's over 4,000. Their specific remit, their mandate is actually to go out and find children in their community, in the region, that do have developmental delay. And, you know, it's a very labor-intensive process to do that. I've actually done it here with my fourth child here in San Diego.

They send out two therapists. They come in, do an evaluation, talk to the parent, see how they're doing, jot down some notes, you know, it's at least an hour of their time, driving included, but it's a very kind of manually intensive process. And what we can do is really be able to preempt that and really give parents the fidelity and advocacy to speak on behalf of their child. And I would say that's the number one thing that our parents say is they thought there was a concern. They knew there was some kind of gray area.

And we know that there's a lot of stigma and denial around delays. What we're trying to do is actually lower that barrier so they have the wherewithal to actually have that conversation with their pediatrician. And simply to ask that question from a clinical-based evidence perspective, you know, that could do wonders, you know. If a kid's not speaking by the time they're two years old, if they're not saying a word, that's a big red flag. And a lot of the de facto status quo, a pediatrician will say, "Well, let's just wait till the next visit because every single child develops uniquely," which they do. But their next visit is at three years old, 12 months later. And that's time that's lost in that process.

Apart from the evaluation, they can actually do at-home interventions. There are a lot of different activities and modules that we have for parents to actually be more proactive in enhancing that child's development along the way. And so, yeah, at the end of the day, we're committed to making sure parents have those tools and knowledge that's necessary.

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VICTORIA: As a head of product, how do you approach the design for the app you're building given just how complex it is? And you said there's 400 milestones in the first 5 years to track. How do you prioritize which one to do first?

[chuckles]

HANS: Yeah, that's a good question. And now I get into the nitty-gritty. But there's certainly been a lot of focus, and it really starts with the users, and so that's both parents as well as pediatricians. And so, personally, I've visited, even in six months, I've visited over 70 different pediatric clinics here in Southern California as well as New York and Washington State, you know, really talking to pediatricians and really understanding what would actually help, you know, make it a lot more useful and helpful for them in their own day to day.

You know, the biggest capacity constraint is really their time crunch. And so, can you get me those answers immediately? And they tell us they don't want to go to some other system. So, we've integrated directly into almost a hundred different EHRs (Electronic Health Records) across the board to the point where parents can actually just search for their pediatrician on our app and then be able to send their data directly to the pediatrician. Because when it comes down to trust, in healthcare, it's all about trust. Parents really trust the pediatrician the most at the end of the day, and so getting them on board and making sure that they're the biggest advocates for our platform will speak a lot more than just having our app in the App Store, which it is.

But in terms of the parent's side, we want them to have a really great and engaging experience where they're getting a lot of joy. We could talk about this concept called burst of joy from watching their child grow and develop. And so, there's a fine line between creating too much anxiety versus giving more information. And when it comes to development [chuckles], there's a very fine line on that. But being able to kind of track those milestones on a continuous basis, not just that point in time, you know, that one time, you know, every three, six months that they're in the doctor's office, but even on a weekly basis, kind of seeing that growth that actually happens organically on a day-to-day basis is a huge part of the parent experience.

Being able to kind of look and see what that is, why it's important, and oh, by the way, if the child's not doing that, here's some activities that you can do to really help them excel and get to the next level, you know, that's the type of thought process. And if you do have concerns, here's resources. We put together these 4,000 early intervention centers, where on the web, you have to go to each individual website. We basically just took all the information and just put it right there in one place where it's just a zip code lookup functionality.

And so, a lot of those types of approaches is really great. I think, in the future, being able to connect directly with therapists and providers might be another step because we know that the gaps in care is really one of the most critical problem. Right now, we're trying to solve that through that parent-led approach. But even reducing that 6 to 9 months down to 1 or 2 weeks, I think, that's actually a possibility.

VICTORIA: I love how you described it as what you're going for is a burst of joy and that you want to focus on having it be a joyful experience for parents. And it should be because I have also seen the anxiety part and how anxiety-inducing it can be when you're trying to keep track of all these different milestones. And, like you said, you have a handout from your doctor, or maybe you're looking up things on TikTok or Instagram [laughs]. How do you work those emotions into your design? Can you say a little bit more about that?

HANS: Yeah. So, for example, after completing an activity...so, we have all these daily activities that you can do. We start the app. We've got inspired from Headspace in terms of what they ask you to do. Here's 2 or 3 things that you can do with your child. We start with an activity, and it takes nothing more than items lying around in your home.

We believe in this concept of serve and return approach when it comes to that parent-child interaction. And so, you have those materials. You have the 10, 15 minutes that you have with your child. You're asking yourself, like, "What can I actually do to really stimulate development?" We want to meet them where they are. So, we have even at bath time, or on the playground, or in a car ride, or while you're doing laundry, sorting socks, right? Any place in time could actually have that really great approach.

And then, after completion of the activity, we have this kind of pop-up that it's almost like an accomplishment, like, we did it as a joint team, as a joint effort, with a little celebration and kind of that approach. And then, also, when you're checking off milestones, and when you check off frequently on our app, there's little hearts that kind of come out of the button to celebrate this little...we call them smilestones, but it's a small part of that celebration that happens day in, day out.

VICTORIA: I'm definitely going to say smilestones to my team next week. That's how we're going to rebrand our milestones as as well. I love it.

HANS: Yeah. I don't think that's copyrighted, so go ahead. Take it away.

WILL: What is your, I'll use that, smilestone for the next six months or, you know, next year? What's in the future? I saw on your website you're incorporating some AI into it. So, can you talk about that and anything else that you have coming up?

HANS: Yeah. So, one of the places where we're really, you know, focusing on is really getting objective about the data. So, we want to take a lot of the subjectivity, a lot of the guesswork, a lot of the recall bias, even misinterpretation of milestones, as well as language barriers of milestones. And so, just really being able to not just have the parent kind of fill out, you know, the checklist, but also, being able to incorporate the videos component as well. And so, being able to upload any kind of video of the child at the dinner table, playing with friends in the playground, playing at home in the living room. Parents have tons of these videos, right?

We're able to kind of spot and detect where those milestones are actually taking place. And so, we can isolate that three to five seconds of, here's where their child's doing the pincer grip, which is basically picking up a cheerio between your forefinger and thumb, and really being able to kind of give that validation and confirmation to the parents so they can actually say, "Oh, wow, my child actually did this new thing that I actually didn't even know about."

But on top of that, being able to turn that into a highlight reel, you know, similar to like SportsCenter highlight reel. Like, you're taking all of those different clips and turn that into maybe a 60-second highlight reel of everything that happened that transpired in between the last visit. So, when you talk about going from, like, a 12-month visit to an 18-month visit, here's all the things, in 60 seconds, that the kid's been doing to give a lot more comprehensive evaluation for their pediatrician to make better decisions at the end of the day.

Again, we are clinical decision support. We're not making the diagnosis ourselves. We leave that to the providers. But what we believe in our ethos is really giving all that information and packaging it up so that those decisions can be much better made at the end of the day. So, that's one use case of AI.

But there's still a human element to it right now, but we want to be able to kind of transpire that to a fully autonomous computer vision, which, when you look at generative AI, understanding videos and being able to detect that when you think about all of the different angles, shapes, lighting, et cetera, it's the, I would say, the last frontier of being able to kind of get data insights out of videos itself. It's very easy to go from having a text prompt and generating a video from it. It's much harder to take a video and spitting back out what we have as milestones. So, that's one part.

And the other is developmental biomarkers which is another...what we think is groundbreaking in the pediatric space.

VICTORIA: Can you explain what developmental biomarker is?

HANS: Yeah. So, it's a concept similar to what we know as the height and weight chart. And when I first became a parent, a lot of times you're speaking with other new parents, and you are, you know, on the playground, right? And they're saying that "Hey, my kid is on the 90th percentile in height or weight," or "Hey, they're 80th percentile on head circumference," because that's literally, like, as a new parent, like, that's the only basis you have other than their sleep habits, which, Will, I know you can probably attest to most parents track a lot.

But similar to that, like, in terms of, you know, how developmental tracking is done right now, the status quo is using developmental screeners. And so, that's, again, point in time, static approach while you're in the well-child visit. But the problem with developmental screeners is it has what's called a low sensitivity and specificity in terms of really over-detecting or over-failing basically one side of the distribution. So, it's typically 40% to 50% of kids would fail a screener when, in reality it should be around 20 to 25.

To really get more granular and very objective about understanding a child's developmental trend, one has to kind of be able to, we believe, understand both the right and the left side of the distribution and being able to understand, hey, is this child actually tracking ahead of the curve or behind the curve relative to everyone else?

And so, we've developed an algorithm. It's fairly complex, but it uses a lot of the underlying data sets that we have to kind of give a much more high-fidelity picture of, hey, your child's in the 60th to 65th percentile. At the end of the day, we want to be able to identify delays. And so, anything below 20% or so, you know, parents should be more informed about that and looking at it on a domain-by-domain specific level.

So, it's very common for a kid to be accelerated on 3 of the four domains, but maybe they're behind on speech. And so, what does the doctor do with that? If they're at 15th percentile in speech, they can then come in the clinic and say, "Hey, I see the screening results, but I also see this Pathfinder report. Let's spend the next 5 to 10 minutes actually seeing how you verbalize and how you're able to speak and express yourself." So, that's really what we're talking about when it comes to developmental biomarkers.

VICTORIA: Gotcha. Okay. Yeah. I think I knew what you were referring to, but I wanted to make sure [laughs], but that makes sense. So, it's like whatever the data that helps the parent identify where there might be an area that some intervention or some more time might need to be taken to help move them forward.

HANS: It is on a longitudinal basis, which, if you're in healthcare, you know longitudinal trend. Really understanding what that looks like is hugely important versus point in time. And so, we're able to see it not just at the sixth month and nine month, but every day in between as well. And we believe, you know, the early results are kind of showing that we're able to even preempt what those potential red flags will look like, or a failed screening result will look like at an earlier rate as well.

VICTORIA: That's really interesting. I'm curious if you have other statistics like that or some results from the first year, almost two years of data that you have now, on how people are interacting with the app. And what kind of outcomes are you getting?

HANS: Yeah, as I said, you know, the biggest outcome is really being able to give parents a really highly objective look at how their children are developing, and so giving them the level of advocacy to speak on the child's behalf with clinical evidence. If you look at our testimonials, that's probably the number one thing. We have different personas for different types of moms.

But there's some moms that are the Nervous Nellies, the ones that are concerned about every single cut, scrape, and bruise. There's also the Inkling Ingrids, the ones that think there might be something there, but they're not necessarily sure. But then there's also the Ambitious Amandas, these types of moms that want to put their kids in every single type of advanced activity, right? Music classes, Legos, et cetera. And then, the Brand New Brendas, the ones that are brand new to parenting and want to know, learn, explore, and track the child's development.

So yeah, there's different things for different types of personas that we have. By and large, it's really giving that information in a very parent-friendly way so it's not overwhelming them with too much anxiety or, you know, going over their heads as a lot of times medical jargon does as well.

VICTORIA: Wow. That's great. Thank you for sharing that. And I wonder, actually, Hans, I wanted to ask you a question about bias and about bias in AI and in health tech. And how do you approach that in Pathfinder and making sure that everyone's getting equitable health incomes and recommendations within the app?

HANS: Yeah, bias and accessibility are two big topics that we think a lot about, you know, first of all, on the underlying data bias, you know, that could present itself. Right now, our app is available on App Store and Play Store. We have over 50,000 parents, you know, still small but growing in about 120 different countries, mainly English-speaking ones, because right now the app is completely in English. That's about to change. We're about to go multilingual, starting with Spanish, which is definitely the biggest request.

But so, when it comes to, like, being able to compare across different groups and subsets, you know, we do believe we have a fairly heterogeneous group. Only about 50% of our users are actually here in the U.S. In terms of the actual milestones themselves, there could be, you know, some differences in cultures. Something like "Eats with a fork" is a milestone that happens, I think, around two or three years old. You know, in cultures like India, for instance, they usually eat with their hands for a lot of time. So, that would be obviously a difference. That milestone wouldn't necessarily apply as much.

But then when you talk about accessibility, one of the things that we screen for in our standard screening that we do have, and I forgot to mention this earlier up front, we almost have, like, a four-legged stool, if you will, in terms of the underlying data that we capture. One is standard screeners because that is status quo. That is reimbursed on the pediatrician's side. And the biggest value prop to pediatricians to adopt our platform is, hey, we can help you get towards 100% developmental screen adherence, which right now it's only about 60 or even less than 50% across the board. So, that's a reimbursable event. So, that's layer 1.

Layer 2 is parent concerns, caption that in a good, valid way, and then continuous milestone tracking. And then, finally, the videos as well. So, certainly, some parents don't submit videos for privacy reasons, which is okay. We still have all of the other 3. So, going back to social determinants of health and health equity, that's one of the things that we screen for as well, knowing that the more vulnerable populations and minorities, lower socioeconomic classes, actually do have a higher prevalence of delays. And so, we want to be able to be accessible to them as much as we can but also, raise those things to the surface when it comes to getting those answers to pediatricians.

There's another big movement happening called Adverse Childhood Experiences screeners (ACEs) that really looks at, you know, how the child's been developing and what their background, their environment actually looks like. So, looking at those questions of, is that child being raised in an environment of neglect, or abuse, or a broken home, or drug addictions in the home? Those can really have an effect, not just on the early part of life, but even later in life when you talk about physical as well as mental well-being. And so, just having that awareness and that insight into how that child's been developing is really important on the background side.

And so, at the end of the day, when we're talking about who actually holds the bag, if you will, in terms of this big gap that we're trying to solve, at the end of the day, it's really the government. If the child does have a delay that doesn't get addressed at an early age, doesn't get, you know, therapy, a lot of times, it leads on to run-on consequences, whether that's mental issues or maybe not being able to be self-sufficient, independent, job seeking, tax-paying, delinquencies. There's a lot of different ramifications from things that happen at a very early age.

That's where we believe in partnership with Medicaid through clinics like Federal Qualified Health Centers that focus on the Medicaid population, which 38% of all kids fall under, those are ideal partners for us. It's a longer, harder slog and a long road. But we believe there's a lot that we can offer at that level as well as more ACO and value-based payer type of model.

VICTORIA: Oh, wonderful. Well, thank you so much, Hans, for coming on and sharing your story with us. Do you have anything that you would like to promote?

HANS: I know we didn't get a chance to speak about it, but the children's book I've written very near and dear to my heart is called Baby Aviva, Orangutan Diva. You can get that out on Amazon, anywhere. But it's A-V-I-V-A. If you're a parent and if you have a kid under the age of five, feel free to check out our app called Pathfinder Health. And Pathfinder is just one word on the App Store and Play Store. But thank you, Will, and thank you, Victoria.

WILL: Thank you. It was great talking to you. And I'm going to go download the app.

HANS: Absolutely. Thanks so much. And I really appreciate it.

WILL: You can subscribe to the show and find notes along with a complete transcript for this episode at giantrobots.fm. If you have questions or comments, email us at hosts@giantrobots.fm. You can find me on Twitter @will23larry.

VICTORIA: And you can find me on X or Twitter [laughs] @victori_ousg or on Mastodon @thoughtbotsocial@vguido.

This podcast is brought to you by thoughtbot and produced and edited by Mandy Moore.

Thanks for listening. See you next time.

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