Interview Series: Nadia Smati and Zaha Masri, co-founders of Amal Health

In our latest interview we speak with Nadia Smati and Zaha Masri, co-founders of Amal Health, a company set to transform the patient’s story into a clinical history.

Nadia and Zaha met at Stanford University during their undergraduate studies and moved to London shortly after. Nadia completed her graduate medical studies at Imperial College London and is currently a doctor in London, while Zaha went to UCL for her entrepreneurship and management studies.

They both started working on their digital health start-up in 2020 after recognising an opportunity in healthcare delivery systems during the outbreak of COVID-19.

Nadia and Zaha begin by telling us about their backgrounds and work with Amal Health.

Can you tell me about yourself and your role at Amal Health?

Nadia: As we are early stage with lots of work, our roles as co-founders can be blurred and we do nearly everything together. Zaha is our technical point person for development of the software and data management, clinical partnerships and focuses on business growth strategy. I am the clinical lead focused on the clinical aspect of our platform.

Zaha: Amal Health is a digital health software that combines evidence-based biomedical and health psychology practices to help people manage their chronic disease. The aim of the company is to improve inflammatory chronic disease management in the primary care ecosystem. It does this via two integrated aspects.

Firstly, we focus on patient-centered care through biobehavioral tracking and targeted health psychological interventions. Our tracking software simplifies patient self-symptom monitoring and keeps track of both the physical and psycho-social features of their disease. This information is then supplemented with phone-based CBT (cognitive behavioural therapy) and health coaching services. Patients’ responses are then turned into their own personal graph in which they can keep track of all aspects of disease management.

Nadia: Secondly, Amal Health incorporates this practice into the primary care clinic. While Amal Health always aims for patient empowerment and motivation for managing their disease, the role of the patient’s physician is critical. Therefore, Amal Health incorporates the clinic into this by feeding back a clinical summary of the patients’ relevant collected health data.

What technology have you implemented in primary and outpatient care during the past six months?

Nadia: The software we are building enables an automated and more personalised approach to chronic disease management to be used in primary and outpatient care settings.

The first and most important feature of Amal Health’s technology is  ‘Symptom Tracking’. We began trialling our symptom tracking questions with patients in the community to understand what barriers and problems they face with regular symptom monitoring. Symptom tracking is a critical aspect of chronic disease management – having patients share long-term, accurate information about all aspects of their disease is important for treatment but at the same time it is a very difficult health behavior to maintain.

Through Amal Health our goal was to build a product to address two things; how can we adapt symptom tracking in such a way that is sustainable for patients, and be robust enough to include not only biomedical details but also health psychology information.

We wanted to incorporate how patients manage their disease on a day to day basis with markers not only being physical symptoms but to also assess if their illness is impacting their social life, self-esteem and stress levels. Stress in particular was a key aspect to focus on because, for inflammatory chronic conditions, it can have a huge impact on their disease progression.

Zaha: We worked with health psychologists and primary care doctors to iterate our first version of questions, and then fed this back to our test users to optimize the questions from a physical and psychological symptom tracking perspective.

The next thing we developed was the two kinds of graphs based on our analysis of the patients’ recorded information – a patient receives a graph populated with their responses that they can use to keep track of their illness journeys. The other graph is curated specifically for doctors with relevant clinical information to facilitate a cohesive, more efficient consultation using this information.

What have been the challenges of implementing such technologies?

Nadia: As for all healthcare technologies, when trying to build something it is important to remember that no two patients experience a medical condition the same way. This greatly impacts clinical management long-term, pending how a patient is able to be compliant with a lifestyle change or medication regime and their mental health alongside this. Each patient has their own distinct set of experiences and challenges that need to be addressed and the challenge is to make sure your technology can be adaptable enough for this.

It is challenging in healthcare to adapt to a new way of doing things, such as during the pandemic when many consultations were converted into telephone consultations or there was an increase in virtual outpatient monitoring. Implemented change is a lot harder to see through, even though it can seem like we hear about medical innovation on a daily basis. Having it distilled down into daily practice behaviours often takes much longer for many reasons, whether that be structural, systemic bureaucracy or simply getting healthcare players on board with a “new way” of delivering healthcare.

The healthcare system is very structured, there are many more key players than simply healthcare providers and doctors. While our focus is healthcare improvement, to be sustainable as a start-up and business…it is important to show our utility to these stakeholders and understand the management system of every company or clinic we work with.

What’s coming up for your company over the next six to 12 months?  

Zaha: In the next six months, we are primarily focusing on improving the early version of our product tailored to GP clinics and their patients. We are putting a lot of emphasis on the feedback loop, so that we can tailor the product based on what our end users and our customers found to be the most efficient and useful in terms of improved outcomes and clinical efficiencies.

We’re going to use the build-measure-learn model to make sure whatever we will incorporate in the final version of our product is what’s actually desired and needed by our end-users and customers.

At the same time, we will be fundraising our pre-seed in January and hiring a bigger tech team to work on our AI platform to automate and scale-up our physical and psychological symptom-tracking software.

Nadia: In the next 12 months our goals will be to expand our features, in particular health coaching and health psychology interventions, further build on and enhance our machine learning technology to better automate symptom tracking for our patients and optimize our clinical summaries for our doctors. And finally, optimize our feedback to clinics and healthcare stakeholders to be used for audits and clinical reviews.

What learnings have you acquired during the past six months?

Nadia: Empathy and listening to patients truly matters most at the end of the day, for them as healthcare users. It was illuminating during our feedback sessions during our early trials having an overwhelming amount of responses around the theme of “it was nice to feel like I was being listened to” or “this gave me the confidence to talk about how hard my flare-ups have been for me personally during lockdown”.

While clinical outcomes are critical, I think sometimes as healthcare professionals we might forget that, at the end of the day, what a patient takes away from a consultation is also how validated they felt by their doctors and how much they were able to share.

Obviously, this is very difficult to ensure with every consultation, due to time constraints, and perhaps the focus we have to place on purely biomedical aspects of a disease, but this is where we think digital health can play a role.

Zaha: Another aspect of technology is that we can offer phone-based CBT services, and eventually health coaching services, to be able to continuously ensure patients are being listened to and cared for even when not having an appointment. Technology has huge potential to disseminate emotions and increase empathy and communication between healthcare providers and patients and does not face the same cost or time constraint barriers that traditional physical appointments have.

What advice would you give to a new tech start-up or those companies that are in their infancy?

Zaha: When starting out, make sure you’re really identifying and honing in on a specific problem you’re trying to solve, and who you’re solving it for. Even if you think you have a sense of what the problem is, spend a significant amount of time really listening to different perspectives and realizing what the real problems and needs are.

Also, always “fall in love with the problem, not the solution”.  As soon as we think we have found an answer to a problem, we tend to stop ideating, and that shifts our focus from finding the ‘right’ solution.

Nadia: And the next thing I’d say is, after identifying the problem you’re trying to solve, try to launch a product as soon as possible. It doesn’t need to be a fully developed version, but a prototype or an MVP (minimum viable product) which you can test with your users because it is the only way to fully understand their problems and whether you are meeting their needs.

Put your product out there, talk to your customers and iterate, rather than waiting to build the ‘perfect’ version, because this is essentially the only way to get there.

Anything else you’d like to add?

If you are a healthcare professional or patient interested in learning more about our Amal Health, visit the website here.