The Value-Based Healthcare Podcast - Episode 25: The New Medical Record: Redefining Member Data to Improve Healthcare

Introduction:
Welcome to Reveleer Value-Based Healthcare Podcast. In every episode, we discuss healthcare technology, innovation, and current events, presenting interviews with the thought leaders from a variety of disciplines of healthcare. Don't miss any episode by subscribing to the series via reveleer.com. And now here's our host, Jay Ackerman, introducing today's guest.

Jay:
Hey Wout, I'm delighted to have you here. You know what's great about doing this podcast with you is a fellow southern California CEO innovating in the arena of health care. So welcome. 

Wout:
Thank you. I'm excited to be here. 

Jay:
We've got a little bit of time to talk about how you've been managing through the pandemic. Talk about your views on healthcare and journey though healthcare and all the interesting and exciting technological change that's unfolding. Maybe to dive right in, it's been a difficult year for leaders, managing through this pandemic. Why don't you talk about how you've managed through that with you and your team. 

Wout:
Yeah. Sure. That's a great question. Like you said, it's top of mind for everybody, right? Well, we're a digital health company. We're selling software to health organizations. So obviously the pandemic wasn't great for us. We started 2020 fresh off our Series A, so we had money. We had a lot of vigor and energy. We thought this was going to be a huge year for us. We closed three deals in a matter of weeks in January and February so we thought this is going to be awesome and then basically March hits and everything came down to a grinding halt. Q2 and Q3 were basically flat and were actually some ongoing implementations and expansions and signed up clients were delayed cause our health system clients didn't have the resources. There were layoffs. There were furloughs. There were people working from home. They required their resources to focus on pandemic related stuff and not as much on new software deployment. That was kind of a tough time.

But what we really did is we really focused more inwardly. We tried to look internally, and okay this is a given. It's an external factor that we don't have that much control over. We can try to fight for relevance. We can try to fight for mind share of these health systems but I'm not sure if that's in the best interest of them. They have bigger fish to fry. Bigger issues to deal with. So let's make sure that we don't get in the way of our clients. Help them where we can. So we helped some of our existing clients with Covid 19 specific clinical trails using our software to find patients to replace part of their portfolio of other clinical research that was ever halted because they couldn't bring in patients to the site and relaunch them with Covid 19 studies. That's one of the things that we did do. However, I cannot say that we received the same boost as the same as telehealth companies from this pandemic. We had a limited way of doing this. 

So again, we really focused internally and we really looked at the team. We made an early decision not to lay off people and instead tried to keep the team together. We did look at cost cutting in many ways by being more efficient and stuff and being more together. Lots of that was our hosting and stuff. We did a continuous performance review. So some people actually did leave because of the performance reviews and because of the tightening of the team. So there was a little bit of that. But nothing close to a lay off. And what we did see is that, our investment in the team in redesigning the organization. Pushing for more autonomy. Pushing for more decision making at the source. Since people were all working from home. We're all fragmented. We really wanted to double down on that and turn this challenge into an opportunity. And I think it worked. We have a good team with people having more buy-in that ever before cause even if they're not in the office. Even if they not really asking their managers for answers. They're having and other stuff and they're just plowing forward. So, that worked out pretty well. 

Jay:
That's great. We were talking at the front end of this podcast about the new space you've taken in Pasadena. So, anything you learned from going from an environment like that to everybody distributed and working from home. Anything you've learned about yourself as a leader? 

Wout:
Yeah. A couple of things actually. Its interesting in a way. The office, as you just heard, I'm sitting in what used to be your old office. So now for the first time, after we closed our round we moved from to a real office space with more than 10,000 square feet and I'm the only person here now. I kept coming to the office every day because I'm alone and I'm not presenting a risk for anybody and I have to say at times, it reminds me of The Shining. You know, I'm walking around the office and I see red writing on the wall and I'm often talking to a bartender in our kitchen who's pouring me drinks. You know that guys not really here. So it's kind of weird in that way. 

But I have to say that our team adapted pretty well. Before the pandemic, we kind of insisted on having the team in the office cause we felt it was important. You have a serendipity of conversations. You have this cross pollination of ideas. As a young nimble company that's always trying to adapt and innovate. This serendipity of kind of having people interact and sitting close to together, I thought that would be good. You have like a pressure cooker of new ideas. However, since people are working at home, we've adapted pretty well and despite the challenges of kids barging into meetings and dogs barking and people concerned about possible exposure when somebody goes shopping and then not know what's happening for a couple of days. Again, the team really stepped up and so for us going forward, I'm not sure if we'll ever go back to fully in office work culture. I'm actually pretty confident we won't. And we also told people, you know LA is too expensive for me. If I can continue to work from home, I'm going to look for something else or for another location. We encourage that and for new roles. We are also looking outside of LA and it opened up a talent market so it's definitely in that plus at the end of this. 

Jay:
That's great. Thanks for sharing that. It has been interesting to learn how you can adapt. We've been working to do the same thing in our office in Glendale. Centralize the team. It'll be interesting to see, mid-year, as we're thinking about re-opening the office, how gradually that occurs. I think it's going to be a gradual move and I don't think we'll go back to five to five. Like five days a week in an office anytime soon. 

Wout:
Did you have any remote people working for you before this? 

Jay:
Yeah, we had some in select roles. I think sales, customer success principally. We have been talking about that for some other roles where we found it more challenging to hire in southern California if we start to embrace some areas outside the state. 

You've got a really interesting business and so let's talk about how you found your way into healthcare. Can you give us a view to that? 

Wout:
Yeah. Sure. There's quite a few dimensions in that process. In the past I would always refer to the rational decision, kind of the business decision to move into healthcare. We had previously built strong expertise mining unstructured data working for the US intelligence community. We won a big contract there. We were one of the biggest agencies beating out some really big names in learning and the and analytics and we felt like that's great. We built expertise but we never saw ourselves as a government contractor. We're very much a west coast company and when one of our patrons slapped me on the shoulder years ago. Said you know what, next step for you is to hire a retired four star general and start knocking on some doors. I was like, oh no. That is not me. I would not be good at that. The rationalization of what do we do with this platform. We have an expertise with dealing with unstructured data and you know were very familiar with that. What are some good industries and some good use cases for that? 

And obviously healthcare was the first thing that came to mind. After the US had spent billions of dollars digitalizing medical records, you'd expect there to be a subtle preponderance of big data and some kind of a way to connect all that data together and having shared insights having access to millions of patient's records. Instead, what we have seen is massive amount of little data that are locked and fragmented in individual patient records that really don't talk to each other. Beyond the politics of why that happened, we felt that the fact most of the salient data in these medical records is typically unstructured, IE physician notes, pathology reports, genomic reports that are hard for tradition software to mine and analyze. We thought, if we could actually solve that. If we could actually make all this analyzable. If we can actually unlock all of the unstructured data maybe we can help this data to collect and grow to that big data in healthcare. We call it collective medical intelligence. So that was kind of the rationale reason there, right? 

Then there was perhaps, and I don't want to do any grandstanding, but maybe on a very personal level there was an existential dimension. We only have one life to live. What do you want to spend it on? And I kind of knew I would not be excited about building marketing software or even fintech software. The two things I really cared about would be healthcare and education so it was a natural thing to look there. And between the two, both of them would have been attractive but healthcare was just a space of opportunity as you probably know. 

Jay:
That's fantastic. A wonderful realization on how your software could be for this massive problem for unlocking all this data that resident in billions of pages of medical record history. So now we're both charting our course in healthcare. Why don't you share what you see as the industry trends that you think are most beneficial to healthcare organizations? 

Wout:
There's quite a few and probably, like me, you've seen how things are changing rapidly in the last couple of years. What I think is probably the most promising change, is just in general, on a mental level, the openness to change. The fact that health systems are more open. I mean four years ago we got started. Talk to a client saying we are going to move your data in a cloud environment. Oh no. Everything has to be done this way. Now that is rarely a point of contention anymore. The fact that you can talk about not just storing data in the cloud but actually sharing it with other partners. 

Starting to consider EMRs not just as a locked system but as an open operating system in which you can plug in all type of other applications, and algorithms, and decision support mechanisms, etc. Building AI into the work flow. Focusing more and more on empowering patients to not just increase their engagement, because I think everyone talks about patient engagement but I think that an important next step is patient empowerment. Where patients will be at the crux of the data ownership and the data transfer of their own medical background and they will be much more informed when it comes to comparing themselves to other patients and to seeking out physicians and seeking out care plans. I think we've barely been scratching, kind of the tip of the iceberg, the surface there, and I think there's tremendous opportunity for change in the near and the long-term future. 

Jay:
So to take advantage of that opportunity and to help drive being an agent of change. What do you think are some of the biggest challenges that are continually confronted in healthcare? 

Wout:
How much time do we have? This is healthcare. You know that movie Chinatown?

Jay:
Yeah for sure. 

Wout:
At the end of the movie, it's Chinatown, Jake. I often think, it's healthcare. Anything that can go wrong will go wrong at some point. But I guess for a company in our stage what makes things hard the typical fragment of the decision-making processes in many healthcare organizations and the very long sale cycles. We often joke that before we can close a deal, 36 people need to say yes and because we touch data that's people that are the end users. But that's people from the CIO often and the backup data team. It's legal. It's research teams. It's everybody right? So, if 36 people say yes, we have a shot at moving forward. If one of them says no, that sends us back to the drawing board and we have to start the process again. 

And then the second thing, and that's something a little more recent for us. We had a couple earlier adopters with our software and those earlier adopters tend to be pretty well put together when it comes to digital transformation. i.e., they bought our software and they have some processes in place to get the best of software. What we've seen, moving past those earlier adopters. We are going to next wave of adopters. They often do not have a solid appreciation of the effort required to really make digital transformation a success because it takes commitment to change management. It takes a degree of executive ownership and a mandate. It takes hands on project management. And many health systems don't have that experience or the bandwidth or the resources to support that. So that means we have to make up for that. We have to provide some of that ourselves. And that's a lot of investment for us. 

Jay:
How do you think about taking those challenges and kind of rolling with them? For you to be successful in what you are doing, in unlocking all this data. Trying to drive the way clinical trials are launched with HCOs. How do you manage through some of those challenges in getting 36 people to say yes and not going back to the drawing board and trying to build a change movement so that even if they do say yes right there, their quick to follow through on it? 

Wout:
I'm going to shamelessly maybe bend a known humanitarian dictum to my own selfish needs and say be the change you want to see in the world. What we have to do in our case is ruthlessly look at all of the steps that slow us down across either the acquisition chain or the delivery chain and the deployment chain and see where we can actually help. Where we can hold the hands of our clients to move things forward more rapidly. More concretely, what that meant in the last year, we really doubled down on our customer success. We hired a really experienced head of customer success who's done deployments. We're investing more in change management. We are pushing more of our training and knowledge sharing inside our application. So, we’re less relying on getting face time with clients, also because of the pandemic, and with users. And we're making more self-service workflows around them. It's really trying to step forward where our clients can't take that step forward. Helping them actually be successful by taking on more of the ownership. Taking on more of the project management and giving more digital tools to make sure that these deployments processes are occurring to best practices. 

Jay:
Awesome. Stepping out of your role and what your business is all about. As you look across the landscape and see all this innovation that's taking place in healthcare. What do you think is going to have the biggest impact going forward?

Wout:
I think there's quite a few things right. And if you really think about impact on a massive scale because there are things that are... telehealth is going to have a big impact. But I think it's only part of a much bigger narrative and I think maybe two of the biggest trends I see and again, maybe somewhat self serving-ly but its way bigger than we are with AI. I think artificial intelligence has such a potential to optimize and align so many decisions throughout the healthcare delivery cycle and the patient journey. That again, we've only started to scratch the surface of what AI can really deliver. And I truly expect many profound changes to emerge from new use cases and better integration of AI system recommendations and decisions. True out all of those micro decisions and those seemingly decision points and touch points. I think that had a tremendous opportunity. 

I referenced the term to what I call collective medical intelligence and again imagine a future where all patient records are connected. And every time you go to see a physician, your physician can compare you and your entire medical journey and your medical DNA and footprint against 300 million other patients in the US. Or say seven billion other patients worldwide and see exactly what other patients looked the most like you. And based on that, which diagnosis seemed to have the most correct. Which prognosis were correct. Which treatment plans and kind of model their decisions after that. That's really that promise of big data. Supporting on point decisions. I think that's huge. 

Jay:
Yeah. I mean that's big data in the grand descent. 

Wout:
Yep. And to some extent, I believe that once you do that many of these decisions are going to be in the hands of patients not just in the hands of the caregivers and the physicians as we see today. Patients will not only be engaged, they will also be empowered and be more vocal proponents and agents of their own health journey. And they can kind of shop around and look for different things and be super educated which is going to raise the bar for physicians as well I think. 

Jay:
You have an interesting point of view informed by the work you're doing and the AI arena and unlocking these packets of data that sit inside records. So if you're talking to a health care executive take it from the plan side or the health system side what advice would you give them or what would you point them towards as you think about how the innovation you are driving can change healthcare? 

Wout:
It depends. I think data is your friend and data is your ally and don't distrust the data. There is a lot of fear around data because it's new. Data used to be something that has been locked and its all been very much between the four walls on prem and not shared. And rightfully so with HIPAA, with the privacy requirements and with the security requirements. There are lots of things that have to be in place to avoid major crisis but provide you can solve for that there's incredible opportunity in mining your data both from an operational improvement standpoint, just being able to deliver better care. As from a financial probability and resilience standpoint. There is so much you can do with your data. You can monetize it in different ways. You can share. You can exchange it. You can actually do things with it. I think any healthcare executive not spending the time getting up to date about opportunities and risks there is at risk of dangerously falling behind the curve. 

Jay:
So let's go to one other group that you kind of hit on a little bit earlier. The individual member seeking care. So you know the 300 million people in the US. Seven billion worldwide. What recommendations would you have for the public regarding their own empowerment and ownership of their own health? 

Wout:
It's a good question and again, I don't claim to have the answer there because there are so many things. What I do know is somewhat informed by personal experience and I think no one cares more about your health than you do. Even the most passionate, idealistic physicians in the world have to divide their attention and efforts across many patients and issues because they're just so over worked and they have limited bandwidth. And what we were talking about with my health journey, etc. One thing I always never bring up is there is a personal side to my health journey. 

My sister, years ago, fell into a coma after she had an acute case of pancreatis and since then, it's been 18 years, her life has been offended by it. Her pancreas and she has necrosis there. Her life is just not the same. She's a chronic pain patient. She has so many allergies. So many issues today that if she doesn't own her health. If she is not a vocal proponent of what works and what doesn't work because her file is dense and so long. No one can get up to speed in the limited time they have per patient so she has to take that ownership. And I believe that for anybody, new tools and technology will allow patients to become even more knowledgeable agents of their own health journey and this is a necessary  extension to our current healthcare practices. So I would say that as these things come about, embrace them.  

Jay:
You know it's easy to advocate that to the doctor who spent years and years in schools but I think your advice is right. Their time is limited. You need to take your own ownership and there're resources and tools that can put you in a position to better understand it. Manage it. 

Wout:
Of course, be realistic because physicians still have the final say. Don't distrust them. Use a wide sense of there.

Jay:
Good one to close on. While this has been a great conversation, we're going to start to bring it to a close but not before you have a little fun with me on kind of our quick five to close it out.

So, what keeps you up at night? 

Wout:
It depends. Nothing truly fundamental at this point, so knock on wood there. Most tactical issues. Thoughts, ideas, realization like little things you grab for your notebook in the middle of the night and make sure you don't forget about it in the morning. If you can decipher your hand writing. 

Jay:
Well if you're grabbing a book instead of a notebook to maybe read or put your mind elsewhere, what book might you be grabbing from your nightstand? 

Wout:
You know what, this was a good question and it kind of is reflective. I always been a voracious and omnivorous reader. I read so many books. I have to admit in recent years, my patient has diminished. I now require a very high information to content ratio to stay engaged and finish a book. So as a result, I'm always reading at least a small dozen of books simultaneously. Kind of stopping in between them when I lose interest. Maybe the most recent book that I finished because it was really short was Patti Smith, Year of the Monkey. It was nice and whimsical. 

Jay:
All right. I'll have to check that one out. I find myself bopping between books too but I don't think I can keep 12 in my head at the same time. So I'm impressed by that. 

Favorite app on your mobile device? 

Wout:
I'm not a big app or even mobile person. In recent years, again, I've aggressively triaged everything that I spend my time one to kind of hold on to the things I care about and that are really necessary. Maybe what I enjoy on my phone the most are podcasts and maybe some wind prediction apps so for like kite surfing or snow finder or stuff like that but it's like once every couple of months that I use those. 

Jay:
If it's not the value based healthcare podcast, what might be your favorite podcast? 

Wout:
I like Sam Harris's podcasts. You probably know him right. He's a new scientist. I started listening to the e-columnists for keeping up with stuff and I kind of shuffle through different things. I haven't really stuck with a podcast for that long. Again, I feel terrible saying this but my attention span is kind of broken at this point. 

Jay:
No we're getting the picture. We're getting the picture. How do you invest in yourself? 

Wout:
Another great question. To be honest I feel like I work pretty hard and over time, as you know, working for a start up and being founder and an owner, it becomes a big black hole that sucks everything in it and becomes a bigger part of your life. And so taking a real break to allow for some distance is incredibly valuable. And still, I know I need this, but I always feel a little bit guilty when I take time off regardless of how hard I work. Whenever, I'm always like I should be doing other stuff. So, the evidence at least at the end of one level for me, is that when I take time off I come back completely recharged as far as creativity. I'm so motivated. I cannot wait to get my hands on stuff. What I know, is to really disconnect and get to that point, I need strong sensations. I cannot just lay on the beach because I keep on thinking. So for me, it's skiing, down hill mountain biking, kite surfing. Then I can really kind of disconnect and move on. And that's what I do to invest myself. Every time, if I have a long week or if I have a little break, I try to just travel and get on a board or something. 

Jay:
Nice. I'm sure your board kind of crosses their fingers when they hear you're going downhill mountain biking making sure that you come back all in one piece. 

Wout:
Maybe we should talk about that before you publish this.

Jay:
All right. Last one. What's the most creative thing you've done during this stay at home period? 

Wout:
Not related to work because I feel like a lot of great ideas. Remodel. I love modern design. I love modern architecture so we took this year to completely remodel our first floor and I've been obsessively researching designing and sourcing, like designer stuff for that. And at this point we're almost done. It was going to be a three moth project, it is now in its 13th month. So, as it always is, and now I can't wait for it al to end and invite some friends and colleagues and celebrate that new space and enjoy it. 

Jay:
Wow. That's great. I'm sure it'll be beautiful. Wout, you've been a phenomenal guest today. Thanks for carving out a bit of time in a busy start to the year to share your background and perspective on healthcare and a little bit about Deep 6. 

Wout:
Thank you for having me.

Jay:
Yeah anytime. 

Wout:
All right. Have a great day. 

Jay:
You too. Over and out. 

Outro:
Thank you for listening to The Value-Based Healthcare Podcast. If you enjoyed this episode, don't forget to share it via LinkedIn, Facebook or Twitter. For more healthcare technology news and information, follow Reveleer on LinkedIn. We hope you join us next time.