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Not many Health IT startups get to the successful exit. This week Charlie Lougheed co-founder of Explorys now an IBM company joins us to discuss technology and the Healthcare Startup space.


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Welcome to this week in Health it where we discuss the news, information and emerging thought with leaders from across the healthcare industry. This is episode number 20. It's Friday, May 25th. Today we talk blockchain. What healthcare can take from FinTech and hard-earned wisdom for your healthcare IT startup.

This podcast is brought to you by health lyrics. Are your strategies constrained by infrastructure or tied in a nod of applications? Break the bonds. Visit health to schedule your free consult. So my name is Bill Russell, recovering healthcare, c i o, writer and consultant with the previously mentioned health lyrics.

Before I introduce our guest today, I wanna share, uh, share with the audience, uh, just, uh, an exciting opportunity. Uh, we've reached some milestones in the show, and upon reflection, uh, and, and in talking many of you, we found that the content is relevant and timely. And now what we'd like to do over the next couple months is get that content into as many, uh, current and future healthcare leaders as we can.

Uh, that's why I'm excited to announce that our sponsor has agreed to give $1,000 for every a hundred, a hundred new YouTube or podcast subscribers. Over the next 90 days to Hope Builders. Hope Builders, uh, provides Orange County's most disadvantaged youth, the life skills and job training needed, uh, to achieve personal and professional success.

I've hired some of these graduates at, uh, my previous employer and, uh, their, their stories are nothing short of amazing, the trajectory their lives are on as a. Being a part of this program, uh, is really exciting, and that's why I'm really excited to be a part of it. I hope you'll join us in sharing the show with your friends and your peers, uh, to maximize this opportunity.

Okay, so today's guest is, uh, one of the brightest minds in data. Hopefully that won't go to his head. A successful health IT entrepreneur who actually saw an exit, one of those rare occurrences in, uh, in the health tech startup world. Uh, my good friend Charlie Loge, is with us today. Good morning, Charlie.

Welcome to the show. Hey, good morning, bill. It's good to be here. Thanks. Wow. You, you, you, uh, you actually got to an exit. Um, that, that really isn't all that common yet within the health tech world, is it? Yeah. Not as much as it should be. Uh, a little surreal, right? And still sink. Even today, it's still sinking in, but, uh, I think we'll see more of it.

I think we're seeing some maturation in the market. Yeah. So we're starting to see some things, uh, some technology take off. Uh, so how long has it been since, uh, since Explorer? Uh, since the exit of Explorers to I B M, it's been just a little over three years. So April of 2015. Wow. Those were exciting times.

I think I was with you, um, at, at a conference either the day of or the day after the announcement. And, uh, uh, it was really surreal on that day. You were just, your eyes were sort of glazed over like it, I mean, Was that something you, you were really looking forward to, or just something that just came out of the blue and surprised you?

Well, you know, I think we were growing so fast in 2014 that we recognized that we had a either raise more money so that we could get presence on the coasts. Uh, Or either go public or do some something, some kind of acquisition that made sense. And, and the third wasn't what we focused on. It was really how do we continue to do the good stuff that we're doing and grow the business.

But, uh, I b M came along and kind of late in the game and we, in about nine days, we went from a term sheet to. Signed agreement, uh, to do the acquisition. And that was, you saw me probably the day before HIMSS or the day of himss. So all that happened that, that weekend before, that Sunday before that, uh, was when the close happened.

And uh, so at that point we were all a little exhausted. Yeah, I would, I would imagine. And, uh, yeah, the life of the startup. I mean, when we first started off, I think we were, uh, at my employer, we were one of the first customers. So I got to see you a fair amount. Yeah. And then, and then it really ramped up.

You were flying all over the country talking to clients, uh, everywhere. So, and, and that's the, the point at which you just either need more capital or you need a, you need a, uh, bigger partner like I B m I guess. Yeah. Yeah. So, but it, it worked out great and, uh, I'm excited to see how the team's been doing and, and really proud of them.

That's great. So let me, let me give people some of your background. You're, uh, so co-founder of Explorers, uh, in 2009, served as the president, uh, this is, I'm sorry, I pulled the bio off a, a website. It was probably written in 2009 'cause it says you're serving as, so we'll say no longer. Yeah. Served as President, uh, chief Strategy Officer and Chief Technology Officer.

True startup. Uh, you also served as the president of Everstream until, uh, 2007, uh, co-founded Everstream in 1999. Served as its chief technology officer, executive vice president. Uh, also extensive experience with the financial services industry, having led National City Corporations consumer online banking division, as well as position in P N c, uh, financial as senior vice president of the online channel for its customer segment.

Had been with Everstream since 1999, led the product strategy development initiative prior joining. Everstream served as Vice president. Of electronic consumer marketplace systems at KeyBank National Association. Um, and then it says you're also, you, uh, very involved in the community. Uh, service chairman and member of Advisory Board of Everstream.

Uh, also, um, uh, chairman of Galen Foundation, chairman of St. Ann's Technology Group. Uh, advisory board member to Genesis Innovations, uh, and you have your bachelor's degree from John Carroll University. That's probably the most I've ever read of somebody's, uh, bio, so I'm feeling pretty old now. Yeah, , I know.

Well, the, the thing I wanted to really point out is, I mean, you really are, I. The data and technology person as well as an entrepreneur. So because we're gonna dive into some, uh, we're gonna straddle that line today of talking entrepreneurial venture, but we're also gonna go into, uh, some deep dive in some of the technical areas.

Um, alright, so one of the things we like to do with all of our guests is, uh, to give them a moment to just tell us what you're excited about or what you're working on today. Yeah. You know, I, you mentioned being a recovering, uh, C I o I think I'm a recovering entrepreneur. There's probably a good chance I'll relapse or fall off the wagon here, uh, at some point.

'cause I'll probably do at least one more. But, uh, it's been, I've been taking a break and it's been kind of nice, uh, spending a lot of time with my family, you know? Uh, Just trying to catch up on some time you miss two startups is a, is a big commitment and, uh, I, you know, I balanced it. Okay. But, uh, there's, there's a lot of stuff I'm, I'm, again catching up on, uh, my wife Katie and I are about to be empty nesters in the fall, so that's a little surreal.

We'll have three in college and we'll have a little chance to, to do some, um, traveling, going to Europe and and Africa later on this year and, and have a little fun there. But up. In terms of my professional life, I'm still staying pretty engaged. I'm, uh, I'm doing a, a

bit of advising. Uh,

Yeah, I kind of go towards the stuff that's disruptive. That's the things that, you know, generally be the areas that excite me the most. You know what, Charlie? But I tell you most of my time, it, it actually broke up there for a second. You, you got to be sort of the, the robot going. So, um, okay. Could, could, could you hit that again, just what you're working on?

Yeah. Uh, yeah. I'll just start, kind of start from the, uh, Well, I'll start from spending time. Did you hear the part about recovering entrepreneur? Recovering entrepreneur? Heard about spending time with the family, which is phenomenal, by the way. Yeah. So you spent like five years doing explorers and didn't see the family, and then three years of being in the house every day, I, I know how that goes.

And the family's like, okay, dad, when are you gonna go back to work? That's right. That's right. They're like, what are you doing here? Too many trips to Costco, uh, companies that are sort of in traditional spaces but are looking at this from a disruptive approach. And that's been, that's exciting. But I'd tell you the thing that I'm doing the spending the most time with, You know, probably 40 to 50 hours a week right now is this nonprofit called Unified Project.

Uh, it's really exciting. It's kind of like my Blues Brothers project. We're, you know, getting the band together on a mission from God, et cetera. , it's, there are some people from my past endeavors, so Steve McHale and Sonny Nixon and Aaron Cornell. Uh, we're, we're working together on it. We've got some other amazing leaders that I haven't worked with in the past from healthcare and social services and philanthropy and financial services and education, even government.

So, uh, it's, it's a really neat, uh, endeavor. Uh, our board we've gotten together, it's all the CEOs from the major, uh, organizations, both healthcare and education and philanthropy and banking from the Cleveland area. And, uh, it's an interesting mission. It's essentially, and it's not an easy one, it's fix the economy.

Um, you know, the economy's rolling, rolling along for a lot of people, uh, but that a lot of people really amounts to about the top 10%. Uh, the rest are still struggling. And, uh, and the bifurcation of wealth in the US and the bifurcation of income is continuing to be a pretty big problem. And we think it's gonna get even worse, not just for them, but for all of us.

And, uh, And so, you know, we, we started looking at the economy and, and what just seems to be wrong, right? The US Bill spends more than anybody else, as you know, on healthcare yet we're ranked 28th in life expectancy. I. We, uh, we're the one of the biggest spenders in education, yet we're 20th in literacy and, uh, in our urban core, less than 10 or 15 to 10% of, of those kids go off to college or secondary education.

Wow. Uh, we're the most generous, uh, country on the planet. Uh, we give more to philanthropy than anybody else by far. Yet we are ranked third in poverty among the O E C D nations. 50% of the US population makes less than 20 bucks an hour. And uh, if you look at what some of the experts are saying about where they see the economy in 25 years, they project that well over 50% of them.

Close to 80% in some cases will be out of a job because of automation and globalization. Well, now, now I'm depressed, so whatcha gonna do about it? I know. So even, even more so, you know, we, we, so we look at it, the saying, okay, what is happening with charity? What's happening with all this? And one of the other things we, we noticed as we sort of did this walk about, so we did this, remember we did this in healthcare a while back to see what's, you know, what, what can we help with?

Within charity, we also found that there's about $800 million that are literally sitting on the sidelines in these charitable foundations. Uh, if you amass all the wealth together. So, Bill Melinda Gates Foundation. Ford Foundation. Cleveland Foundation. Right? And, and you're wondering why is, why is only 7% of that money going to the, going, to the, uh, the people in need?

And a lot of it has to do the fact that in order to maintain those organizations of perpetuity and have them continue to grow year over year, they need to be able to hold back a lot of that money, invest it. And usually the stock market or Wall Street, that's their mechanism for return on investment.

And uh, and, and that's really their only means of, of, of sustenance. So in addition to just continuing to get money piled in, well, we looked at that and said, why can't there be a return on investment for raising up our population, for helping them? Participate in the economy and participate in the next economy as this rolls around.

And we believe that, you know, if you look at someone who's in poverty today, Full subsidy spend. It cost a taxpayer close to $50,000 a year, maybe even a little more. In some cases. You turn that around and get someone from a position where they don't have good secondary education and training. You get 'em into a role in computer science or data sciences or other things, and you flip, you flip the scales pretty significantly.

You've got someone now who's making a a living wage. They're, they're thrown off tax revenue. And so we think there's a really big r o I and we think there, there are mechanisms to return that r o I, but it's gonna take an operating system. And what Unified Project is doing is implementing an operating system.

We're building it, and it takes visibility and transparency to data just like it did in healthcare. That's gonna take some ai. And machine learning to understand all this big data and trim out the biases, and we believe it's gonna take a piece of blockchain as well, uh, particularly around smart.

To sort of bend behavior and permits and around performance and ultimately engage those entities that can return estimate, uh, back to those foundations, back to those investors in social good. And, um, and actually bring more money into the system. So what, again, what we're trying to do is, is, is bring about a, an operating system that

Uh, begins to change the dynamic and, uh, bend the curve away from the dangerous position it's going in right now. So we, I'm pretty excited about it, the opportunity. And it's an op, you know, I think it's an opportunity for healthcare, financial services and technology to really do a good thing, uh, as opposed to, uh, always sort of be blamed for the things of the past and, and be concerned about the things of the future.

I think there's more positivity in front of us than anything, and it's just a matter of grasping that. Wow. That's, uh, well that's exciting. I'm looking forward to, uh, following that and seeing how that progresses for, uh, for you guys. I know with the smart people that you've put together, the solution's gonna be pretty exciting.

So let's, um, let's jump into the show. So we, we have three sections in the news soundbites and then, uh, social media close. I'll kick us off. We each have a story. My story is, uh, given your background and, and, and, uh, the show. So why healthcare should study up lessons learned from FinTech. Uh, there's a story from health IT analytics.

Uh, let me, let me kick it off here. So, uh, clinical, uh, from the story, clinical quality, patient safety and long-term outcomes will always be a top priority for healthcare providers and payers. But, uh, but the consumer experience is or should be running very close second for stakeholders across the industry.

Soaring out-of-pocket costs for patients are leading to chewier, consumers who are considering more than proximity to the local hospital when making decisions about where to seek care. Uh, federal efforts around transparency, availability of of your data and whatnot are making, uh, consumers out of, uh, out of patients and growing expectations that digital services for payments, communications, and.

Is putting the squeeze on providers who haven't yet invested in online consumer relationship tools. So nothing new there. We're here, we've been hearing this for several years, then they go into some numbers. Uh, 80, 88% of patients wanna be able to pay their insurance bills digitally. 68% would like to be able to clear their balances with their provider by using online tools.

77% of providers are still using paper billing statements to conduct least some of their financial transactions. In 2017, only 4% of practice leaders expressed any interest in the digital bill. Pay options according to the survey. Um, this mis mismatch. It doesn't just indicate an opportunity for digital payment companies to fill or, uh, to fill a, a clear need.

It also exposes a worrying disconnect between how providers view their existing processes and what their patients really want and want to experience. Earlier in 2018, a poll by N T T Data Services pointed out that 59% of patients want their healthcare experiences to align with what they're offered in retail.

Half of patients said they would consider leaving their current providers if they found another option that offered more technology tools. Okay, so, so let's stop there. We'll come back to the story, but you know, the first question I wanna bat around with you is, you know, let's, let's just, let's do this on a scale of one to 10, uh, one being the patient has, uh, has choice, uh, oh, well, actually, one being the patient has no choice, they're locked in, and 10 being the patient has, is a full-blown consumer of healthcare with choice.

Uh, where do you think we're at on that continuum today? You know, I think, uh, I think we're probably closer to, well, zero was the no choice. Is that right? one. One is the no choice. And ten, ten one is the no. Zero. No. You know, I think we're probably close to three or four, but it, I, I think the attitudes are changing a lot.

Uh, and we see it everywhere. And I think say healthcare just takes a little longer to catch up. Right. Uh, but I think what's happening in other spaces is gonna begin to have a profound impact on the attitudes people have at healthcare. I mean, clearly the high deductible was a shock to the system for a lot of people, as it is.

It, is it related to cost. Like, wow, I'm paying a lot on my pocket, so I'm going to make some different choices about this now. But I think other things, I mean, here's something that's completely unrelated, but related Bill, uh, Take the gig economy, right? Uber and Airbnb and other things people are thinking differently about, uh, things they never would before.

Right? That you'd, you'd have some stranger drive you around or you'd stay in some stranger's house. Uh, that wasn't something we really considered two years, uh, 20 years ago, or even 10 years ago, right? Uh, and that, and that, that's changing. And you're even beginning to see some interesting, innovative companies like Nomad and.

Uh, who are bringing some of the giggy economy to healthcare, particularly around a $15 billion a year market for locum, uh, temporary physicians or, or practitioners. So, uh, I, I think, I think the, the age of having a single dimensional channel to healthcare are gonna change. I think, uh, you know, you've got the other factors of all these baby boomers who have grown up around technology.

They've been pretty avid adopters at technology will look at this and say, I, I, paying my bills should be easier. It should be more straightforward, um, getting care when I want it, where I want it at the edge. Uh, it should be easier, and I think they'll move towards organizations and provider systems that are, are progressive in that matter.

Right. Uh, my, my, my son had to go to, uh, my son's 20 something years old. Uh, works for a, a large company and he went to, he cut his finger, had to get stitches. He went over to the, uh, emergency care. And, uh, I happened to be available, so we went over so we could just hang out and whatnot. And as they're stitching him up and whatnot, they're handing him stuff like, here's your gauze, here's your stuff.

And he's, and they walk out of the room and he looks at me. He goes, am I paying for this? 'cause I don't really want it. . I'm like, I don't. I don't think you have a choice. Um, so, you know, as, as I look at this, I, you know, there's, there's really two directions this can go. Single payer or market driven, and I agree with you today.

It's really neither, uh, you have trends that happen. It was heading towards single payer. Now it's heading a little bit. Um, You know, more towards market driven, but the reality is, uh, the consumer still has no idea how much healthcare costs. Uh, the bill doesn't reflect actual cost. Um, you know, you, you, you then run it through an insurance machine and you get another bill.

It, it, it feels a little bit like playing the slots. You know, you pull the handle hope for the best, and, and you take whatever. Whatever comes to you, there's some choice, but you know, it's, it's not based on any facts. We're, we're still not looking at price and, and uh, and those kinds of things. But, but I think the trend is, is right.

I think you have, uh, pressure from the con the, the retail world and the consumer world and we're saying, Hey, why can't healthcare be more like this? Yeah. High deductible plans are, are making us more, uh, I dunno, discerning, um, And then I think medical interoperability is starting to get there. Some new options, like my insurance carrier has, uh, a telehealth option that they want me to go to before I see even see my primary care physician.

So I, I find that to be fascinating. I, I think we are seeing an advent. Uh, you know, of, of really moving. But I would agree with you. I think it's a, you know, a three or four moving in the direction of building out a market. But, um, but you know, that could easily change. You have another election in, uh, whatever, two and a half, three years, and swings back in the other direction.

Um, You know, we'll, we'll have to see how it plays out. So here's another area I want to get into with you. So, data, it's it, the article goes on. Data is the current, is the currency of these new ventures. And FinTech, uh, is powering, uh, predictive analytics, fraud detection, identity management, uh, security protocols required to compete, and it's modern environment.

Customer intelligence will be the most . Important predictor of revenue, growth and profitability in the FinTech world and translating those insights into personalized experience will be close. Second, without the right technologies to create meaningful, engaging experiences, uh, that exceed baseline expectations, they may soon find it challenging to maintain their revenues, especially as value-based care alters their cashflow.

Um, so data is new currency. Customer intelligence will be the most important predictor of revenue and profitability. Um, technology will be central to creating engaging experiences. Um, is this a reality in healthcare or how do, uh, a better question would be how do we make this a reality in healthcare where data is actually, uh, beginning to be used to, to make those kinds of changes with either predictive models are new experiences.

Yeah. Yeah. Great question, bill. I think, I mean, here's, I think we're evolving to a data economy. I mean, it's gonna be interesting, you know, what is the output of, of the, of the American economy 20, 30 years from now? Data's gonna be a big component of that, and we know that those that work in the data space, In many ways have a much brighter, uh, economic future than those that don't.

So I think, you know, it's, it's, it's translating to a lot of different areas. When we, when we founded Explorers, our whole premise was BA was based upon data and how data was the real value and that it could. In many ways bend the cost curve if, if used appropriately. And, and when I say appropriately, both, uh, morally and ethically as well as just financially in a prudent way.

But, you know, having spent a lot of time in the financial services sector, I. I tell you that that's been around a long time as well, and they've seen that they've learned some very painful lessons. The 2008 financial crisis was really all about a recognition that they weren't leveraging their data as effectively as they should have.

And that's why you see now so much emphasis in FinTech around things like K y C or know your customer. Uh, the ability to predict and mitigate risk. Apply ai. To drive those mitigation strategies, address the regulatory requirements that are out there. And I mean, the parallels to healthcare are amazing. I was, I spoke at an event yesterday, uh, a FinTech event yesterday, and this is what came up and it's interesting, they actually used healthcare as an example where they need to start thinking in terms of, uh, patient privacy and protection of information and whatnot.

So, I, these, these markets are so interconnected. I think, uh, you know, I, again, I think information is absolutely critical. What's ironic that one of the major reasons why people have health issues is stress. And so they go in front of their doctor and they tell 'em about it, and there's their doctor prescribes a medication that may be needed for one thing or another.

That that physician in, in many cases doesn't know what that's gonna cost the patient. Uh, it seems like a vicious circle, right? The patient gets home and finds out that their copay that, or that drug's gonna cost 'em $500, uh, and they'll wind right back up at the, at the doctor's office again. So, we need to think about our data.

We need to be put better data in front of our practitioners, better data in front of our, uh, of, of the patients. That's gonna be critical. To this. And I think the organizations that take that really seriously, again, will get rewarded with, uh, a new, a new kind of loyalty. Yeah. So I, I, I go in for stress, I get medication, I go home, I get the bill for the medication, I get stressed.

I go back for . Yeah. It's, uh, I, you know, I find that know your customers thing to be very, uh, you know, it's a. Because we talked about it a lot. It's a, it's a interesting balance, right? So when you send that email to the, to the consumer and they realize, oh wow, you know more about me than I think, you know, you may have crossed the line.

So there's always that, that balance of we wanna provide great care. I. By knowing the customer better and, and being, and the patient and the consumer better. Um, but you don't wanna cross that line by having information that you really shouldn't or acting on information that you really shouldn't. And there's, there's that, that, uh, I, I, I guess it's a, it's an ethical balance and it's also sort of a, um, I don't know, a cultural balance of, you know, how much privacy, um, how much privacy do we really think we have, and how much, uh, should we be afforded, I guess.

Uh, yeah, I mean, I. Oh, go ahead. Um, we talk about met, we talk about metadata all the time. Right? And, and big data. And, and big data creates more big data. One of the things that, that I think is gonna be really important is that we have more and more metadata around the appropriate and the allowed uses of.

Patient data or consumer data for that matter. Right? So these are the, these are the situations where I permit it being used. Here's where it's completely off limits or opt-in models where it needs to be used. It wasn't anticipated, but it needs to be used in these ways. Am I good with it? And you know, again, we'll talk about it a little bit later, but that's one example of where the blockchain can show some promise.

Yeah. Alright, so we're gonna have to pick up the pace here a little bit. Let's kick it over to your, uh, To your article, uh, why don't you set it up and, and we'll talk about it. Yeah, so, uh, one of the articles I saw this week that sort of caught my eye was an article by Brad Perillo in mass And you know, I've seen a number of articles that are similar like this.

Uh, this was entitled Six Reasons Why We Shouldn't Bet On Blockchain Disrupting Healthcare. And you could, you could supplant healthcare for pretty much every other industry. And, and it's a fair statement, it's a fair title because the amount of hype that's around blockchain is pretty deafening right now.

Uh, but the article goes and, and covers these six topics. You know, one is that dev, that development is stricter and slower. I totally get it right. But the reality is in, in that, in that place, The high stakes coating's always been this way, uh, for a long time, and, uh, blockchain's a nascent technology. It should get better as it matures.

He also talks about things like, uh, maintenance is very costly. This is an issue with blockchain today. I think what he meant when he said maintenance means operating costs, but man, that is definitely the case, uh, that power consumptions. Right now for the standard proof of work, consensus models are just absurdly high.

Frankly, they're, they're horrific for the environment, and, and we need some changing. Uh, the good news is, is there's a lot of new technology that's on the, on the forefront. Things like, uh, proof of stake, consensus models and permission models, that, that should improve this. It also talks about how, uh, users are sovereign.

Uh, and the, the, the challenges associated with getting something on a blockchain, you really can't change it after that. It's immutable for a good reason. But again, that depends to some degree on the blockchain ar uh, architecture that's being deployed. Uh, not as, this is not as much of a factor for permission networks or private networks.

Talked about a forced upgrade is not, is sometimes not an option. Uh, there's been a lot of controversy around this. Uh, there a lot of times people mistakenly think that the Ethereum network was hacked last year. Uh, with the d o A incident, that wasn't the case. It was actually a, just some bad code. But the bad code had a $50 million implication.

Uh, and that community had to come together to decide what they wanted to do. And, uh, It was an interesting outcome. And then scaling. Um, and I think scaling, he talks about scaling being really hard. Distributed computing is difficult, right? We've been doing it, I've been doing it for a long time, Hadoop and, and other environments.

And I think it just boils down to the philosophy of, of M P P versus vertical approaches. But I think. Really, bill, uh, said, I've seen so many articles like this. I think it kind of misses the point because despite all the hype, blockchain is really not the elixir for everything. And we've gotta stop treating it like that, right?

Uh, just like internet banking wasn't the elixir, it was gonna change everything about banking in the financial space. It was just another channel. I think we need to think about it in a different terms. I think hybrid models where you have on chain and off chain. Particularly around big data and medical records.

It's gonna be really important. And uh, and I think the real promise around blockchain, as I mentioned a little bit earlier, is it's, it's really around three things. It's around medical record, portability and interoperability. Certainly a lot of opportunities there. Identity management, not just in healthcare, but in human trafficking.

A lot of spaces around that. It's a big issue today among our underbanked population. I. And probably the biggest is smart contracts. This idea that we can have a multilateral accountability. An accountable care model, right? Not just make the medical provider accountable, but also have the patients in certain conditions along the way be required and other entities that are involved and controlling those incentives.

So that's a, so that's a great setup. So, uh, you know, distributed, so the nature of blockchain is distributed, immutable records, smart contracts. So I wanna give you five, uh, healthcare use use cases. And, uh, let's just go through, you know, um, You know, likelihood of happening and impact on healthcare. So here are the five use cases, uh, provider licensing and credentialing.

Do you think blockchain has application there? And then what would the impact be? I think it has incredible potential there. I, and, and it would've a big impact. Uh, the process of credentialing is, is slow. It's cumbersome, it's redundant, it's expensive. Uh, if you're gonna get to a gig economy in healthcare, it's absolutely critical.

Blockchain based, h i e based, uh, know between, well, actually between anyone, payers, providers, whatever. But blockchain based, h i e. What do you think? It could be the next generation of h i e. I mean, h i e technology has, has struggled, right for a lot of business reasons, but some technical reasons. So I think it's got a pretty good chance there.

Not as high as, uh, as credentialing, but a decent chance. Uh, medication supply chain. A lot of talk about that. Uh, what are your thoughts on that? Yeah, the question is as to what degree the, the, the consumers really care. Uh, you know, I've heard a lot about this in the food industry, but then I talk to people and they say, well, yeah, if, I guess, if I'm, if I,

generally, generally people don't think about it. So, uh, I, I think it has publicity. I think it's really more regulational drive that though. Okay. How about revenue? Uh, revenue cycle and more specifically fraud prevention and auto adjudication of medical claims processing. That's another one I think will be a big opportunity.

Uh, you know, that, we all know that process today is fairly broken. It's extremely expensive. It's a big part of the cost of healthcare. So I, I, I, I'm bullish on that as well. Uh, efficient prior authorizations and referral through smart contracts. I don't know. We'll see. I think we've got some pretty good systems in place to do that today.

Uh, uh, maybe later, but that one doesn't come to the forefront for me, uh, right now. Yeah. And so I, I think I'm telling my clients the same thing that you are saying here, which is, um, blockchain's gonna have a place, uh, how it gets implemented is gonna be important. Uh, we need to keep an eye on it. It does have a potential to be disruptive.

Um, but we're, we're not seeing that yet. Um, and, and some of these areas could be, you know, For some systems, you know, million dollar plays. And so that's why I'm saying, you know, don't dismiss it because it's, it is at the peak of the hype cycle. There's no, no doubt about that right now. I mean, you know, blockchain, you know, replacing doctors I'm sure is something that's an article that's been written, but it's, it's just craziness how hyped it is right now and hopefully, Um, you know, hopefully it'll come back down to Earth.

But while it's doing that whole thing with these emerging technologies, I just always recommend keep an eye on it. Think through, uh, based on its characteristics where it can be applied. Alright, so we have this section called soundbites. In the soundbite sections, I'm gonna ask you a handful of questions.

Uh, you know, one to three minute answers and, uh, we'll just, we'll just start here. So, uh, you've a lot of people wanna know this answer. So you've, you've had a successful entrepreneurial venture in health. It. Um, so I really have two questions around this. Uh, what was the one thing that surprised you as you got into healthcare, and what's the one thing you would tell someone going into this space today?

Uh, you know, I think the one thing that surprised me getting into healthcare, not knowing anything about healthcare, Was how gracious and helpful the healthcare community was, particularly to me and, and Steve and others that didn't have experience with it, uh, about getting up to speed. They knew that we had something to offer from data, so you have to bring something to the party.

We understood big data, we understood different industries, but it is a good market to be in. Uh, a lot of really smart people, people that like to teach, and if you, if, if you give 'em the respect and, and, and be patient, uh, they'll do that. They'll coach you. They'll, they'll, they'll tell you what they need.

So that is something I really do love about the, the, the market and still do. Yeah. So what would you tell somebody who's just starting off their health tech firm and they're going into the space, you know, maybe something you've learned as they, as they get started on this, on this path. I think, you know, understand the, the economics, that's absolutely critical.

Um, you know, you have to follow the money. You have to understand how, how these models work because you can have a great idea, a great technology, but if it doesn't improve the situation for the provider, for the payer, for the patient, or at least two, two of those three, uh, you know, it's, it's, it's gonna be a tough sled.

Yeah, the clear message around the economics and, uh, the, the other thing, I, I, I do consult with a bunch of, uh, startups and, and one of the things I always tell them is we've really gotta look at the sales cycle. 'cause almost ev everyone makes this assumption around the sales cycle within healthcare. And it's, uh, invariably it's double it, or even triplet, depending on how aggressive they've been in their predictions.

That's. Um, so I've asked this before, but, uh, to, to other guests, but I was wondering from an entrepreneur's perspective, you know, what's the biggest impediment to innovation in healthcare and, and maybe what, what can we do to overcome it? Uh, you know, I think probably the biggest impediment right now is the fee for service model that just won't quit.

Uh, you know, it, it, it and, and how do we overcome it? I, I like some of the things we talked about, bill. I, I think the more we can push this market to a consumer model, the government's done some right? Uh, and, and we see how easily an election can swing that once the consumer. Gears get going. I don't think there's any ch any stopping 'em.

We won't, we won't go back. I don't, I, I don't think we're gonna go back from, from value-based care. Uh, it'll continue on its slow journey and progressive journey, but consumerism is gonna, is gonna be the key in my opinion. I. Great. So data science is talked about as the hottest job. We now most health systems have this canon Now that we've collected all this data, we have our big data platforms, um, you know, where can data science be applied?

Where can we point this canon at to do the most good Within healthcare today, I.

Well, a lot of places. I think one of the areas that I think are really, is really important is artificial intelligence and the development of machine learning. Data science right now is at a state where . Or I should say machine learning is a state right now where the big data that's out there still isn't big enough and it isn't clean enough.

So data scientists that understand how to clean and standardize data and then write great models around it, uh, I think are gonna mean very high demand. I think that's a really big opportunity to make a big dent in the cost of healthcare and, and, and enable some . Pretty amazing breakthroughs, but data scientists are gonna have to be at the forefront of that.

And, uh, there is a lot of work to do yet. Yeah, I can see that. So, um, how will technology change healthcare in the next five years? Well, I.

There's gonna be a move towards consumerism, uh, especially as we get more data in front of them. I think the cost of care and making that more transparent at the encounter is gonna be critical. And, and the more patients see that happening, the more they'll expect it. Uh, again, I think the gig economy is, has a big opportunity in healthcare, particularly, is

As many consumers of healthcare as they get, especially as they get older, are gonna want to have that care pushed to the edges, whether that's assisted living facilities or, or it's the, the commercial population at the place of work. And I think Giggy is a great, uh, uh, space for that. Great. So if you were gonna do another startup in healthcare today, so you and I are gonna do a venture.

Uh, what areas might you be looking at? Well, I think, uh, decision support, particularly around, uh, analytics and, uh, and cost are, are gonna be, continue to be important. Like I mentioned before, I do believe that we need a better . Operating system, if you will, to coin another germ from earlier, uh, for value-based care.

I think you look at the a c o projects that have, uh, have started out there. Some of them have been very successful, others haven't. A lot of it has to do with the fact that it's hard, right? You've got a lot of competing elements, but I think you start getting some of that. Uh, those decision processes onto a blockchain, uh, into, they become more transparent and more enforceable from an incentive and performance-based payment standpoint.

I think that can have a profound effect on the effectiveness of many of those programs. I. Yeah. And that's where you were going with explorers, right? I mean, it's, it's, yeah. It's the ability to have a platform, if you will, or you keep referring to it as an operating system, uh, for that, uh, for that today.

So. Alright, well, we've, we've gone over time, as is usually the case when I get on the show with, with, uh, friends who I like talking to about this stuff. Uh, what's your social media close for the week? Well, I, uh, looked at a couple of different things that were out there and one of 'em was a posting by Bill Gates on his top five books for the summer.

And, uh, two of those books I thought were pretty interesting. One was, it's called an Origin Story, uh, A Big History of Everything by David Christian. And it's just interesting 'cause it focuses on societies, a lot of what we're dealing with with the Unified project, how complex they are. Weaving these insights together using this evidence.

There's a lot of system and social dynamics. I've started reading this book and it's just really fascinating. And the other book was written by Hans Rosling, recently passed away called Fact. Fact, again, focuses on understanding the truths from a data perspective, uh, and how life in some respects has gotten a lot better in other respects.

Has a long ways to pro, uh, improve and in some cases, unfortunately, has gone backwards, but it does give a lot of hope in terms of what technology can do to turn things around. All right. So mine is, you know, see if this one resonates with you. You know, a second grader said they wish cell phones didn't exist because their parents are on them all the time.

So, uh, you know, I know, you know, my, my wife is always saying to the kids, you know, put your phone away at the table. And now they just look at her like, Do you realize how hypocritical that is? ? Yeah. Yeah. I hope she doesn't listen to this show. I'll get in trouble for that one, but, um, but it is, it is true that parents are on their phone an awful lot in front of their kids.

So, uh, Charlie, thanks for coming on the show. Um, you're gonna be an empty nester, so is there a good way to, for us to follow you? You're gonna be on, on social media or, or something more? Yeah, I'll always be online so you'll be able to find me. Bill, it was great being part of this. Uh, thanks for having me on today.

Uh, great conversation. I appreciate it. So, uh, you can follow me on, on Twitter, the at the patient CIO health lyrics website, HealthSystem I just wrote an article on, uh, telehealth and it's imperative. Uh, I think we've reached a tipping point with, uh, the VA's announcement, uh, to forego the. Uh, uh, boundaries on telehealth.

Now, you can see a veteran across the, uh, across the country. I think you could see that happen in c m s as well. And if that does, I think you'll see telehealth become an imperative for every health system. Uh, that's on health system Don't forget to follow the show at this week in h i t and check out the website this week in health

Uh, and take, take a moment to, uh, Follow the show on, uh, on our YouTube channel. We're now up to about 130, uh, videos, uh, short segments that you can watch, uh, in three, a couple minutes. And, uh, great conversations with, uh, industry influencers. So please come back every Friday for more news commentary, uh, from my friends.

That's all for now. Thanks.


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