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Charlie Lougheed successful Health Tech entrepreneur and CEO of Axuall joins us to take a look at the emerging blockchain solutions in healthcare. We're finally getting beyond the hype curve to a place of practical application. Hope you enjoy.


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 Welcome to this Week in Health, IT influence where we discuss the influence of technology on health with people who are making it happen. We are the fastest growing podcast in the Health IT space. My name is Bill Russell. We're covering healthcare, c i o, and creator of this week in health. It. I set up podcasts and videos dedicated to, TO two, developing the next generation of health IT leaders.

I only say that before every episode we're on episode 93. You would think I'd have that down by now, but still struggling with it. Anyway, this podcast is brought to you by Health Lyrics. Have a struggling healthcare project you need to go. Well, let's talk visit health to schedule your free consultation.

Today we're joined by a successful health technology entrepreneur, Charlie Lowed, former co-founder of B. And now off on another adventure. Uh, good morning Charlie and uh, welcome. Welcome back to the show. I guess it's been almost a year. Yeah. Hey, good morning, bill. Great to be here. Man. It, it has been a year.

Has, has, has anything changed since the last time we spoke? Uh, I got more gray. Uh, let me think here. I, I, I got a kid through college, uh, major stuff like that, I guess. Wow. Yeah, kid. Lot of fun this past year. You got a kid through college? Yeah, I wanted to graduate. She just graduated, so we're excited. Wow.

Now, are you, uh, are you one of those people? So my, my dad was one of those people who was like, Hey, when you graduate, you're done. Get out of the house. Now my son still lives with us and he's been graduated for a couple years now. So are you one of those kick him out or are you one of those Hey, come on.

Back and, and live here for a little bit. Well, she wants to get out there pretty fast. So we're working on, you know, she's working on college, I mean, on, on career plans and what she wants to do next. And, and, uh, she's got a pretty good idea. I think right now she's really looking at cities. It's at Cleveland or Chicago, or is it West Coast?

We'll see, but uh, you know, it's an exciting time. I remember that. It's a little scary too when you go from college right into the real world. Uh, I'm not sure, uh, all the universities really prepare kids for that. I'm not sure you can. Uh, so it's a little bit of a shock to the system. I think we see it in a lot of, a lot of, uh, other parents, uh, kids and, and so it's gonna be exciting though, you know, the, the, the world of opportunities so much different.

When, when I came outta college, you look at how, how much things have advanced. In some ways it's a little bit of a scarier world, particularly with automation. But in other areas it's, it's just like there's a whole new, uh, realm, uh, particularly around things, you know, we're gonna talk about blockchain today, but things like, like, uh, AI and, uh, and automation in general.

So it's gonna be pretty, pretty neat for her, I think. Yeah. No, that's, that's exciting. It's, uh, it is an exciting time. Did she take after you, is she. A, a technologist or is she in another field? She's entrepreneurialism. That was her major, uh, or one of them. But, uh, she is really, uh, not focused on technology.

It's funny. I mean, she's technology savvy, but she does not, uh, she doesn't wanna be a, a nerd like your dad, . That's okay. I'm fine with that. That's funny. I was, I was a consultant for 20 years and, and my son, when he, when he got out, I said, so what do you want to do? He goes, all I know is I don't wanna be a consultant.

I'm like, okay, . So we'll see. We'll see what happens. Yeah. Uh, so our, our two main topics for today's discussion are pri, it's gonna be primarily blockchain, but we're also gonna delve into emerging technology and how you determine what the, uh, technologies are. And you and I had a good conversation a year ago on blockchain.

Things have evolved a little bit, but let's, uh, we always have to set the, the baseline for this because, um, it's still a new technology. Some people are familiar, some people aren't. Um, so give us the, you know, the, the quick and dirty. What is blockchain and, and you know, what, what's it, what's, what's it gonna be used for?

Well, let's start with what it is. Yeah, I, you know, I think that there, there's just seems to be so much mystery in what blockchain is. It's, it's pretty simple. It's a database, right? It's, it's a, it's a way to store data. Uh, what's even more interesting about it, I guess, uh, maybe it's less interesting. Is it, like in earlier database, quite a while you've been able to take a database and update it.

Uh, make updates to not just inserts to uh, tables. Blockchain isn't like that. Blockchain is basically like a ledger. It says, okay, uh, I'm gonna allow you to write a, an event and I'm gonna store it. And, uh, we'll get, and the technology is such that. Uh, it provides the ability to track among multiple nodes, whether or not that data has ever changed or, uh, or, or been modified or tampered with.

That immutability is something that other databases obviously have, but when you spread that across many nodes that different organizations participate in, you have the ability now to be able to check that and audit that against, uh, many, many third parties. And so there's advantage of that. I think, you know, there's, there's also the advantage within blockchain of being able to.

Uh, digitally sign these events when they get, when they get rid of the blockchain and whoever that entity is, who signs that you can go back and, and see that that entity was indeed who you thought it was. Uh, and that's, and that's very secure technology. Again, not new technology, but combined, uh, makes a big difference.

You know, there's another element, I think a blockchain that's really important and that's, uh, its ability to have . A degree of digital sovereignty, uh, over those that participate in the process. Meaning in many cases you don't really store the bulk of the data on the blockchain. You store references to that data with, uh, ways to ensure that those references and that data has never changed wherever it's resides.

And so, uh, that creates an opportunity for whether you're a patient or an employer, uh, or a consumer to be able to say, well, I'm gonna provide access to this data, uh, only when I see fit, and if I wanna turn that access off to that data I can. And, uh, and so I think that's something that's really important.

And I think the last one as it relates to healthcare is the fact that this isn't a technology that sits behind any one organization's firewall. It's distributed. And so, In that, in that respect, it sort of creates this neutrality that makes it easier for, in some cases, competing organizations, payers and providers and, you know, where there are competing incentives, uh, to participate.

So it's, you know, it's, it's nothing technologically that new. In fact, it's a lot of the old stuff. It feels a little bit like back to the future. Uh, but uh, how they combine it into that recipe, I think is what, what makes it unique. Interesting. So the words we've used before I, I'm, I'm not gonna get all these, but distributed, uh, immutable record, um, smart contracts.

Um, you, you covered maybe a couple others that I may not have there, but those, those are the three main ones. Are, are there other, other attributes of, of blockchain? Well, I mean, I think it's the thing that what people always think of is the, is the digital currency component of it. Um, and uh, you know, you don't have to have a digital currency to have blockchain.

In fact, a lot of the implementations that we're seeing don't even involve a digital currency for it does it's way behind the scenes and nobody would ever know it's there. It's just for transacting behind the scenes. And the other area you just mentioned Bill, is, um, smart contracts. You don't necessarily have to have smart contracts.

In fact, you can run a lot of your smart contracts off the chain if you want, or your, you know, business rules if you will. Uh, but in some cases it does make a lot of sense to have that smart contract, uh, run on that chain. And that's where I think, you know, you'll see a lot of different implementations of it where you have very lightweight, smart, but simple contracts.

For everything from, um, consumer to, uh, having smart contracts that are smart enough to know, okay, if I one ve one autonomous vehicle passes another vehicle and that other vehicle pulls away. So it allows it to do it. There's some kind of a transaction fee that goes, uh, to the vehicle that yields. And, uh, and that's just another good example of a interesting smart contract.

So, but you know, they're, they're, they're still in their infancy, smart contracts. Once, once they get running, you, it's pretty darn hard to stop 'em. Um, and in some cases, if they're not developed properly, they, they will go on forever. So you gotta, you have to pay attention to 'em. And I think that's why the whole industry is just taking one step at a time with smart contracts.

That's interesting. So, and the other thing, digital currency kind of. Almost confuses the issue. I mean, it gets so much press, uh, around this that people think, well, you know, we're not, we're not, we're not gonna accept Bitcoin at our hospital. It's not, not that important. But there's an awful lot of use cases in healthcare.

And you and I went back and forth a little bit on, uh, the last time you were on the show, and I think things have matured maybe a little bit. Um, where do you think blockchain has the, you know, the most potential near term and long term within healthcare? You know, I think one of the areas that, that we're most excited about is what we call digital proof or digitized proof.

Uh, it's a, it's a big challenge in really every single industry, not just healthcare. So, lemme give you some examples. Uh, it, for thousands of years, business has been transacted based on one entity makes an assertion about something. Another entity has to accept that assertion. Now, in many cases, a third party

Comes in between them and verifies that. And that's something that you see a lot of in manufacturing, in transportation, logistics, in uh, financial services. And you also see it in healthcare, particularly around credentialing and for that matter, any kind of claims remediation. So this process has been going on a long time, which I think is something that's interesting.

Uh, so you know, as we look at that though, that process is very expensive. In healthcare today, your typical health system will take anywhere between 90 to 120 days to get a practitioner or a physician through the entire credentialing process. While a lot of this has been automated in systems like MD staff, Morrissey and others have made the process move smoother.

There are still the external third parties that in many cases, have to be weighted upon to be able to give that, that affirmative answer that yes, that physician worked during these time periods or, yes, that that particular, uh, credential is, is, hasn't been, has not been revoked, has not been suspended, or wherever it might be.

And what's interesting in healthcare is that can cost, uh, a lot of money over time. There's not only the wait time, the operational cost time, but as healthcare becomes more and more scarce because of the supply and demand issues, we're gonna see the need to be able to put a physician or any practitioner, for that matter, into a billable position as quickly as possible.

'cause time is money, and with a phys average physician, when an average physician bills around $7,500 a day. That adds up pretty quickly. Uh, and so we think there's a lot of money at stake. It's interesting. These are the kinds of things that are beginning to bubble up to the C F O office as they look at ways to, uh, drive better margin, uh, particularly as they sort of get squeezed from, from the, uh, From the payers and in some cases, rightfully so, right?

'cause we need to figure out how to reduce, reduce costs. But administrative is a, is a big component of that, arguably a quarter to a third between waste and administrative. And, uh, blockchain, you know, offers a big opportunity to, to correct some of that. Yeah, so that's a, that's interesting because you know, a lot of times when people talk about blockchain, they talk about disrupting healthcare, but you're not talking about disrupting healthcare.

You're talking about taking a, an existing process and existing system within healthcare and making it much more efficient and really streamlining it and reducing the cycle times to get a physician active within the system. Yeah, I mean, exactly. I mean, I think it's always, I think the media looks at this and says it's always sort of sexy to talk about how blockchain or any technologies can be completely changed the way we do things.

Um, the problem with that, especially a new technology that's got all, all this sort of baggage around it right now with some of the negative press around cryptocurrency, which again, You don't need cryptocurrency for blockchain, but it's still there, right? Uh, the, the technology hasn't been fully proven in production environments yet.

So to take a technology and completely disrupt an industry as large as healthcare is something, it's kind of like the third rail. Like nobody wants to touch that right now. But if you, if you focus in blockchain in areas where everybody's suffering, , right? Uh, and I gave the example of credentialing.

That's one of them. I think to some degree you have supply chain challenges. You have, uh, claims verification challenges. These are things that cost everybody money and in some cases, uh, limit access to care. I think in those kinds of situations, those win-win, you'll see it adopted more frequently and again, there's not a lot that's, that's revolutionary about that.

It's just making the existing process move faster. Do you think? We'll see. Uh, so I mean, you talked about, talked about claims, you talked about supply chain, you've talked about credentialing. Uh, do you think we'll see anything in the, in the area of, uh, data exchange and identity management? Or is that, is that one of those things That's pretty far off yet.

No, I don't think it's gonna be that far off. I mean, I think I, I think you have to, uh, I think we do have to accept and, and, and, and take our lessons from the past, uh, with regards to h i e and the challenges that Health Information Exchange, uh, has, has brought to the industry and, uh, And, and so they are out there, right?

There are obviously some good examples of HIEs in regions, certain regions where it's worked, but it's because of a lot of cooperation. Uh, there wasn't a business model in a lot of cases or, or a limited business model around that kind of exchange, but I think that's gonna begin to change over time again, uh, we, we sort of look at the, the patient record as a, as a very important problem to solve, but we also look at it a little further down the road, uh, be just for that reason.

It has a lot of history behind it, whereas, uh, credentialing from a, uh, from an individual, uh, provider perspective, it doesn't have as much. But yeah, I mean, I think, I think the opportunity for that's gonna be, uh, very big. I think, you know, switching gears a bit, financial services, uh, if you look at financial services, one of their biggest costs in, in fact, it's, it's estimated to be up to $20 billion a year.

Is around K Y C or know your customer. These are federally mandated regulations as it relates to understanding about understanding everything about the parties that are transacting. And in some cases where you have complex corporations or LLCs, it can get even more complicated and, and, and, and, uh, obscure.

And so that process of, uh, of adhering to those money laundering rules around. Uh, around knowing your customer is something that that industry is struggling with? Well, it's, if you think about it for a second, it's not all that different than, than a medical record that's passing between different entities and be able to know that information, uh, whether you're on the, on the, on the claim side or on the care side.

So, uh, I think you, one of the things that's always interesting is, We're beginning to see multiple industries have this problem, and when that happens, you begin to get, uh, economies of scale. And, and that's one of the areas that I think, you know, we as an organization are most excited about right now.

That's interesting. So, uh, you know, this is a, a new technology, so you have a lot of players sort of running at this space. And I did a little research prior to coming on the, on the show and, and you know, there's, I, I don't, you know, maybe 20 or so and now actual A X U A L L, which is, uh, the company that you founded and.

But you have, you know, you have big players, you have I b M, you have, uh, Microsoft, you have some, uh, some startups that have been doing this a while, like, uh, pocket Doc has been doing this for a while, and some others. Um, give us an idea of the different approaches that, you know, the providers are, are different approaches that you're seeing in the industry, in, in the healthcare industry from these providers?

Yeah. Well, you know, I, I would tell you that we're not seeing widespread, uh, Distribution or, or, or use of the technology yet. But we are beginning to see, uh, a lot of programs and pilots begin to form and with some big names behind them. Um, uh, you know, one good example is the synaptic network that's led by UnitedHealth.

Optum, I believe, is engaged with that as well. You've got Humana in that, you've got Ascension has, has announced that they're part of this. You know, they're looking at how do we solve, again, some of the issues related to providing provider base, provider directory information, uh, to make the process of selecting a physician and for that matter, managing some of the administrative components around it.

Easier. Uh, you see I B M and P N C bank. Interesting combination. I think, uh, Anthem is in that as well. Uh, and they're focused more on the transactional side. How do you, how do you, uh, streamline or in some ways change the revenue cycle process, uh, for both large and, and small, uh, health systems? Uh, 'cause we know that's a challenge for, for many.

So, uh, you know, you see that, you see some pure place coming into the space. You also see. Real peer plays, right? They're coming in from outside of healthcare, they're trying to apply this, this technology. In many cases it's open source, which I think is a good thing, uh, because it does, it does provide, uh, technology that, you know, we, we frankly are leveraging some of that.

Um, and, and so I think, but it's still very early days. Uh, it's, it's, it's gonna take some time. Uh, to flesh all this out and, and, but just like everything else, I mean, this is technology, right? It's, this is, this is in our first, first phase. We'll see how things evolve. Uh, I, I would tell you the thing that I've always felt was, is, is critical though.

At least in certain industries and healthcare is, is by no means immune to this. Is that for to, for these solutions to really work, you have to have very strong subject matter expertise. Uh, because the way that these things are done, the regulations around it, the sensitivity of the data and just understanding the workflow is not something that a.

A pure blockchain company of Silicon Valley is gonna be privy to or understand. So, uh, you know, those partnerships with, with these entities, uh, these customers I think is gonna be absolutely critical. I think, I think the leaders that are gonna merge out of this are, are gonna be the ones that, that start from the beginning with a focus on a strategic relationship with its early customer base.

Yep. So, you know, this is, this is your second time through the rodeo here, and I'm gonna a little higher level, 'cause I know you can't talk about, uh, in specifics, some of the things you're doing. But give us an idea. So you have this new technology and you're, you're trying to find where it best applies within healthcare.

Um, you know, what does it look like? I mean, you find a couple partners, you, you work with them. Um, and you, you, you do some pilots and you, you figure it out. I mean, what at, at that level, at a, a pretty high level, if, if somebody is an entrepreneur, like your, your daughter finally says, Hey, I, I want to do, you know, the next I wanna do AI in healthcare.

I mean, what's your coaching for her? Is it find part, is it the first step to find partners or is the first step to find a, a handful of solutions? Where, where does she start? I think you gotta, I mean, that's a great question, bill. I think you have to, uh, at least my experience, right, is that you need to parallel path.

Uh, you, you, you can't just show up to a healthcare system and say, Hey, guess what? Uh, I'd like to be an entrepreneur. Do you have any great ideas that, uh, that I can spin out that and, and that you'll buy, right? They'll, they will likely look at you and say, okay, well, uh, Why, why do I wanna do that? Or if, if anything, uh, it, it's, it's likely that you, you're not gonna have much of a leverage position or, or, or, or opportunity to really be seen as a, as a partner on a level playing field there.

So I, I think you gotta come to the table with, I. You know, some experience if you don't have that, we didn't have that with Explorers in healthcare. We had no experience, right. But we had at least the experience of big data in telecommunications and broadband at a very large scale. So, uh, and they were having some problems that were somewhat similar to what we had solved in the past.

So we had, we were able to at least create that connection, that bridge. And I think that's gonna be really important because you gotta put yourself in, in these or these organizations shoes, you know, they're approached by some, uh, some. Some tech person that says, Hey, I, I, I, blockchain is great. I think it can change the way that, uh, you do, you do your operations and, and that's gonna come under some degree of, uh, uh, uh, you're gonna be a bit skeptical of that by, by nature, I think, uh, for the health system.

So I think it's really important that. That they look for individuals that, and organizations that have not just from within, but also outside in their local region, who have been able to demonstrate the ability to learn fast, uh, to adapt to, uh, to partner. In a way that isn't about, okay, we'll we'll learn everything about your tech, about your technology and your process, and then see you later, right?

Uh, you've gotta hold that partner all the way through the process and see that they're, they're, they win on if it is an exit that they win on that exit, that health system. So I think, uh, I think, you know, it, it, it's a parallel process. I think you gotta, you gotta look at it from both perspectives and my, you know, my, my, again, I, I'll maintain that.

The, the, the really great technology is gonna be the technology that's built in conjunction with these, with these, uh, customers. So in health systems, you know, we think of our, uh, our strategics, and those are organizations that would invest alongside us. From the very beginning, they're in the garage with us, right, so to speak.

Uh, they are working on developing this. We think that builds a really strong relationship. It creates a lot of excitement within their organization. Uh, it creates connection and it de-risks the deal, right? It de-risks the investment for other, uh, other venture or angel investors as they get, as they get involved.

So, you know, I think that's, that, that's critically important, particularly in, in the Midwest where you typically raise, you know, a, a third to a quarter, which you raise on the coasts, and, and, and that's how you, I think you compete in, at least in this space. Wow. A third to a quarter of what you raised on the coast.

That's, uh, that's interesting. The, um, you know, changing gears a little bit here. So you spent about a decade or so in, in big data in healthcare, uh, with explorers. Uh, how are the challenges that you experience with, with explorers early on in healthcare, how are they similar to the things you're seeing right now with blockchain?

Uh, you know, one area I think would be that we chose a technology at the time that we knew needed to be fairly revolutionary in terms of how it's stored in process data. Uh, Because, just because of the cost. You know, we had learned in the last, last company that we built, we built on all standard off the shelf technology and, uh, standard vendor technology.

It was well established, it worked great for us, but when we looked at healthcare, it was an exponentially more complex problem. And so we, we picked a technology which was Hadoop at the time, which was very, very new. It wasn't even 1.0 yet. And so, uh, we had a lot of challenges just figuring out how it works.

Uh, documentation that maybe in some cases weren't up to date. 'cause there just wasn't enough people to keep it up to date. Uh, it was a, we got very involved in that process. We became committers to the open source, which I think helped. Uh, and that was a big challenge. We're seeing parallels to that in, uh, Blockchain.

Right. And, you know, we're focusing on the Hyperledger family in particularly within, uh, a subset of that called indie. This is really new technology. And so you can't just go find people that have this experience off the shelf. You gotta find people that have, uh, the ability to adapt to that, to this, uh, that have that, that, that can see and understand and connect the dots quickly.

And a lot of times that's, you know, that's folks that have a very strong . Uh, computer science background, uh, to, to bring together on that. Um, and so, you know, we, we, we see, we certainly see that parallel, but the other parallel we see at the same time. So that's the challenge. The other thing is, is, is you tend to get really interesting people that are excited about this really new stuff that wanna come work with you.

And especially if there's a cause, especially if there's a, there's, there's an opportunity to do something that really matters. You look at access and healthcare, it's a big, big problem and we're gonna help solve this. You know, the elasticity of workforce across the board is a big challenge. Uh, you look at freelancing, right?

Uh, Today? Uh, today, well, today there's a, there's a lot. There's about, I think about 47 million people, uh, oh, sorry. 57 million people that do freelance today, uh, of some sort. And while a lot of that freelancing, I. Is on the lower end of some of the skills, you're beginning to see more professional freelancing and healthcare's gonna be no exception to that.

So being able to, uh, expand healthcare, bring healthcare outside the brick and mortars can be really important. And a technology like this, if you have that kind of meaning and that kind of excitement with your company and you've got really, really bleeding edge technology to work on, you can find talent a little easier.

And so, You know, we're, we're, we're trying, we're trying to ride that wave. We think that's important. And, and so far we've been able to attract some, some amazing talent. Yeah. The, um, one of the things since the last time you were on the show, we've, we've really tried to pare it back to just be a half hour so people can listen on their commute.

So I'm gonna try to close this up with, with one question I'm sort of curious on, which is, um, you know, you spend a lot of time in the big data space, so I'm gonna end, not with a blockchain question, but are. With big data in healthcare and what's holding us back or what's the, what's the biggest thing that is going to, uh, you know, catapult us forward?

Yeah, I think probably one of the areas that's held us back is understanding the meaning of the data that you collect. . And much of that has to do with the context, right? Uh, how data is input into a system and what, how you abbreviate things. Uh, the sequence of things, how they go in, uh, especially in healthcare, has a lot to do with not just that the, the area of healthcare, but even more importantly, the specialty.

In some cases the delivery system, right? And that is information that varies so greatly that what we found is unless you have people who, in addition to your, your, your technicians can bring the data in, unless you have those data scientists and those informaticists that really understand the workflow and the meeting and the context of data in that organization.

Uh, it, it's, it's very difficult to do. Um, and, and I think Bill, we experienced that right? In working together, it's probably one of the bigger challenges and it's not just technology, obviously. I think where that will be augmented. Not replaced is when you start seeing, uh, more and more artificial intelligence and machine learning around identifying these patterns earlier, learning from them and then, uh, uh, applying that to the sort of the backend curation of that.

Now, that's also gonna, I think, have a big impact on the front end as well. We're learning more and more about the consequences of how data is entered into a system, and so I think that will begin to inform the next generation of . EMRs as they get developed and those workflows get built so that we're more mindful of the backend.

Because when EMRs were originally built, we weren't thinking about big data. We weren't thinking about how data curation and, and now we have to. So, uh, I think that's gonna be where you see the, the, the greatest evolution and change. Wow. Uh, that's great insight. And, uh, yeah, in our time together there was, uh, it, it's so important to understand, and I think you said this, the context of the data when it was put in, Because it being put in at different PO points along the way could mean different things.

The data, you know, and we used to have, like data dictionaries would tell us only, you know, part of the story. It's, it's such, it's such a complex problem. Uh, Charlie, as always, great conversation. Anything you wanna leave the listeners with, uh, way to follow you or keep up to date on what you guys are, are doing?

Yeah, I mean, I think if, uh, uh, obviously I keep, uh, connected on LinkedIn, uh, and we'll continue to publish some things out there. You know, we're in, in still an incubation stage with actual, uh, but, uh, you can, uh, sign up for information around And, uh, there is a signup page there to learn as new things are announced.

Again, that's A X U A L and, uh, we look forward to seeing how this plays out and we're, we're excited about the opportunities that are ahead. Yeah, really, really exciting work. I'm looking forward to, uh, looking forward to following you guys and, and seeing what happens. So, um, you know, please come back every Friday for more great interviews with influencers.

And don't forget, every Tuesday we take a look at the news, which is impacting health. It. If you're enjoying the show, I wanna support our mission to develop the next generation of health leaders. There's really five ways you could do that. Probably six if I thought about it. Share it with a peer. Uh, share it on social media.

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