This Week Health

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July 10, 2020: Today we are talking “fancy backend stuff”. Our guest Niko Skievaski, President and Co-founder of Redox shares why their open source platform is currently one of the weight lifting champion’s in healthcare IT. How have they accelerated the development and distribution of digital health solutions? What does this mean for developers? And if the key ingredient in healthcare tech right now is frictionless adoption, how do we achieve it? Plus our host Bill gives invaluable advice to startups. 

Key Points From This Episode:

  • Find out what really accelerated Redox’s growth [00:05:50]
  • It’s not an innovation problem, it’s an adoption and integration problem [00:08:45]
  • The huge challenges for healthcare startups, why haven’t many platforms scaled up? [00:10:45
  • Niko talks health economics [00:14:00]
  • If you really want to make it as a health tech startup, Bill has invaluable advice [00:13:05
  • How Redox were able to grow a lot faster and win more market [00:17:20]
  • How healthcare is changing at lightning speed [00:21:05]

This transcription is provided by artificial intelligence. We believe in technology but understand that even the most intelligent robots can sometimes get speech recognition wrong.

 Welcome to this week in Health It where we amplify great thinking to Propel Healthcare forward. My name is Bill Russell Healthcare, CIO, coach and creator of this week in health. It. A set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. This episode and every episode since we started the C Ovid 19 series and now that we've exited the c Ovid 19 series has been sponsored by Sirius Healthcare.

Special thanks to Sirius for supporting the show's efforts during the crisis and now. Beyond the crisis. So Sirius will be a sponsor moving through the end of this year. So we are excited about that. Don't forget, we've gone to three shows a week now Tuesday we cover the news Tuesday Newsday, and we have interviews with industry influencers on Wednesday and Friday we, we are just introducing a new thing called clip notes, CLIP, clip notes for our interview shows.

What is CliffNotes? I'm glad you asked. Uh, in conversations with leaders, I've been asked if I can find a way to share with them a list of the best snippets from the show so they can consume it and share it with others, specifically with their staff. This is step one of that process for each show. I. That you, if you sign up for this email list for each show, we will send you an email that has a summary paragraph of the show bullet points on the key items covered in the show with timestamps.

So you can go right to those spots, uh, to hear about those topics and a couple of clips, actual video clips that we have selected. We've hand selected by the staff to capture what we consider to be the . Best thinking on the, on that specific show. This is gonna make it easier for you to decide which shows are most relevant for which members of your team, and you can even share just the clips via email with your staff.

So if you wanna sign up for this, please send an email to clip notes. CLIP. N-O-T-E-S at this week in health, and you'll be signed up to start receiving these to your in inbox. Okay, today we interview Nico Koski with Redox. We recorded this episode a few weeks back, and as some of you know, redox reduced their workforce by as much as 25%.

Since we recorded the show and what I consider to be a move, which shows the leadership that I admire in this company and, and the team that makes up the leadership. They did an amazing podcast episode on the Redox Pod podcast where they openly discussed the decision of the reduction and solicited on behalf of their team.

That was let go to help them find work. I think it's a great episode. If you get a chance to Redox podcast, listen to that episode. They have one of their, one of their investors on there. Two, two of the leaders are on there and they talk through, you know, how they're thinking about it, how they're repositioning or refocusing the company.

Uh, great episode and worth listening to. I'm excited to share this discussion with you, with Nico s Kovski on today's show. Hope you enjoy. Here we go. This morning we're joined by Nico Koski, the President and co-founder of Redox, a healthcare platform that provides data liquidity to accelerate the development and distribution of digital health solutions.

Good morning, Nico. Welcome to the show. Good morning. Thanks for having me. Happy to be here. You know, I, I, I did that off memory. Is that, is that still what Redox does for the most part? Yep. Yep. You nailed it. Yeah, at one point I had, uh, invested in a startup that.

I, I'm a huge fan of what you guys have done. I love the platform and what the team at Redox has been able to accomplish, but some of our listeners may not be aware of what you guys are. The short description of what, uh, redox is and, and. We'll jump into, uh, talking about digital health in, in the us Yeah, for sure.

So what Redox does is, um, at the highest level we are helping digital health companies. I mean, that's, you know, your early stage startups all the way to large health, you know, large EHR vendors and other groups like that. Uh, we help 'em share data with. With each other really. So, uh, for instance, you know, a lot of what we're doing right now during the pandemic is a lot of telehealth and virtual care type solutions are being purchased by health systems, and then they need to be able to share data from their electronic health record with those organizations.

And so we pull data out of, uh, EHRs, we standardize it in the cloud, then we make it available over an API to those, uh, software vendors so they can, uh, use modern . Kind of web experience to, to utilize the data. And we do that across the network. So we're in about 700 health systems now across the country.

And all the data that we're touching, we standardize in the middle. So if you plug into the Redox network, you can work with any of those organizations, uh, without having to do as big of a integration project to get your products up and up and running. Yeah. And Redox, you know, it's, it's interesting to me 'cause we talk about platforms a lot on the show and people may not understand the distinction of a platform, but really it generates value on, on both sides of the equation.

Right? But you now call it the Redox network. So the value to a health system is that if they plug in, there's so many other users of the system right now that they can benefit by plugging applications. Other side who are developing to your set of APIs. And so, so it has a network effect, right? It grows as, as each side grows.

Absolutely. And so when we first started the company, we, we weren't to network, right? It's like it's selling the first fax machine, right? You're not, you're not , you're not plugged into a network. Uh, so it was really more like outsourcing at the beginning where we were like, okay, you, you could either do integration or you could let us do it.

And we're experts and we have the software that we're building to help that, uh, happen. As we started growing, the more health systems we add. The more interesting it is for vendors because they can say, Hey, well if I, if I integrate on my own, I have to go one by one to each health system. Or if I work with Redox, I can just plug into all the health systems that are already on the network.

So that's the, the network effects on the left hand side, the vendors on the right hand side with, with. Health systems, when they, when they look at it, they can, they can now say, oh, there's all these vendors that are already plugged into Redox. So if we work with Redox, then we can get access to working with, you know, a number of different types of, of digital health vendors without having to do a big IT project to get each one implemented.

So that really accelerated in our growth after about two or three years of kind of growing at a, at a linear rate, we started seeing those network effects kick in and, and really started seeing the growth kind of. Grow exponentially. So that's what kind of 20 18, 20 19 was for us just holding onto the rocket ship as we were onboarding more and more vendors and health systems.

And by the way, for, for my listeners, this is not a paid episode. If people are wondering, I'm just a huge fan. I love, I love platforms and I love what you guys have done, but you know, you recently started a podcast and you cleverly named the podcast. The Redox podcast. How did you guys come up with that name?

Did you hire a firm? Long hours, lots of coffee. Well, what was funny is that we, we were brainstorming for, for months. 'cause because we, we had wanted to start a podcast for a long time and so we, it was always like, what do we call it? And so there's, there's a whole podcast channel we have in Slack of just like people throwing out names and us trying to figure out something.

And then we, I went to Maddox head of marketing and. I was like, Hey, which, which names do you like? These are our top three choices. And he was like, why don't we just call it the Redox podcast? That's what everyone's gonna call it anyways, if it's, you know, a podcast by Redox. And I started thinking about the podcasts I listen to, and I listen to a few podcasts from, um, from different companies that, that I follow.

And some of them have names, but I always call 'em, you know, the name of that company. I'm like, oh, it's the, it's the Okta podcast, for instance. Even though that podcast is called you, I. I was just like, yeah, I, I guess we could just call it Redox podcast, and I think it's worked out. It's, it's quite descriptive.

You know what you're getting into . You do. I'm actually gonna use your intro as a, as a framework for questions. I love the podcast. I, I recently listened to the, the two part series on platforms. I think it's a must listen to. I have Jonathan Bush queued up. To listen to. He's a quote machine, so I love listening to him whenever he Yeah.

Uh, gives, yeah, whenever he talks, he's, he's phenomenal. So your, your intro, let's, let's, let's just run through it and, and, you know, you say Redox is on a mission to make healthcare data useful, and in turn enable the frictionless adoption of technology and healthcare. And I'm just gonna stop there. How are we doing?

It's June of 2020. How are we doing on that, on that vision? Yeah, so that, that kind of goes back to some of the reasons why we started Redox. I, I worked at Epic before, before that's cut. Kind of how I cut my teeth in, in healthcare and looking around the industry. I. It's, it's very, you. Every time you go to the doctor's office, you could see 10 different ways that technology should and could be used to make that process more efficient and, um, more effective for, for the patient experience.

And so, so it seems like there's a lot of tech that technology could do in the industry, but as you start looking at all the startups out there, basically there's a startup trying to solve every single one of these problems. There's probably 10 startups trying to solve that problem with the amount of funding that we've had in digital health.

So what, what I started. Thinking about and realizing with that in healthcare we don't necessarily have a, an innovation problem. There's a lot of people throwing time and money in companies that trying to solve a lot of these, uh, challenges. Uh, but we have a technology adoption problem in that, you know, they still use pagers and clipboards in hospitals, not because they don't have a software solution to get rid of those, but because they haven't

Figured out how to adopt 'em in a, in a, um, seamless way. And a big barrier to technology adoption is, is the IT barrier, which is actually, you know, setting up the systems, integrating them with the legacy EHRs, uh, a lot of the stuff that Redox does to help enable these, these technologies to come to market.

Um, so that's what we mean by trying to, to enable frictionless adoption of technology in healthcare. That's actually one of our, that's, that's our, um, big carry audacious goal at Redox is to enable the frictionless adoption of technology. So just throw an homage to that. So I'm gonna, I'm gonna transition and start talking about some of the challenges we're facing.

Go on in the intro to talk about exploring the intersection of healthcare and technology, how technology is making a difference, and the barriers and how they can be overcome. And, you know, some of that I wanna talk to you about because having. Uh, led early stage, uh, investments in startups. There's a lot of barriers to overcome from the startup side, and then there's barriers to overcome from the adoption and the, uh, healthcare side.

But talk a little bit about, uh, being a startup and the, you know, what it takes to go from selling that first fax machine to platform. Uh, that in and of itself is almost a unicorn in healthcare, isn't it? Yeah. So, um, it, there there are not many platforms that have scaled in, in healthcare. I think Surescripts is probably the, the best example of one that's actually reached kind of a critical mass moment.

But, you know, if you look at platforms like Uber and eBay and Amazon, kind of in the non-healthcare space, in the consumer space, you can. You can reach network effects faster because consumers have word of mouth. They shop based on convenience. Best product wins, best price wins. You can differentiate on those, on those uh, factors in healthcare because of the enterprise B two B sale that you typically have to get into it, it becomes a lot harder to reach.

Sort of ubiquity and create, create the, the platform network effect experiences that a lot of, um, non-healthcare companies create. And that's largely because in healthcare, the people that are benefiting from your product are usually never the ones who are paying for your product. So, uh, you have to convince multiple people across the organization to say yes.

And there's probably a hundred people at a, a big healthcare organization that have to say yes. And if any one of those people says no, then it can kill your deal. And so that is a huge challenge for startups as they're trying to build something in the healthcare space is, uh, how do you, how do you actually make a sale into a health system without sinking two years of, of time and effort in the sales cycle to get alive?

And do you have enough funding to actually get through that process to get your product validated and start generating revenue before you run outta money yourself and have to have to go under? Uh, I think that's one of the hardest challenges for, for health tech companies. With Redox, what we do is we just try to, you know, there's a lot of barriers in place.

We try to remove one of them, which is when you get to it and it asks how are you gonna integrate? Can you handle HL seven? Can you handle a fire, can you handle, uh, whatever standard they throw at you? You can confidently say yes and, and give them the plan on exactly how that happens. That's what we work with our customers on.

And so we try to reduce that barrier. We help them with security concerns, things like that. But we're not gonna help vendors with their value proposition. They still have to make that sale to a health system. They still have to convince their clinical users and administrative stakeholders that their product is worth buying.

Um, but hopefully when they get to it, they're working with Redox. That process can go smoothly from that point on. Wow. Uh, you've given me a lot to jump off of there. I, you know, I heard someone on the platform say, you know, somebody came alongside them, somebody with some wisdom and said, you know, if, if you really wanna make it as a health tech startup, make sure you're not selling to the providers, um, the healthcare providers.

And having been on the other side of that equation and said no to about. 90%, if not 95% of the startups that walked through my front door. That sales cycle is long. And that, and if you don't have the, the funds, it, it, it can, it, it can really, I don't know. It, it can, it can end your company right there before it even gets started.

You know? That's, that's the first aspect of it. And the second is, you know, you talk about, you know, the people you're trying to benefit aren't, aren't really the ones if you're trying to do anything for. They're, they're indirect payers through the, you know, through the insurance carriers and other, other means.

So they're you. It's hard to build a platform that benefits consumers in healthcare because they're unwilling to pay for anything. 'cause they're already paying for something. Yep. Yeah. And it's, uh, so it's what we call in, in health economics derived demand in that. Consumers don't have a direct demand for healthcare.

Just like, you know, when you go to the store and you buy groceries, you have a direct demand for groceries and you know the benefit that you're gonna get from buying groceries and, and bringing 'em home and eating them. You don't know the, the benefit you'll get from buying healthcare as a consumer. We, we have demand for health.

We wanna be healthy, but we have to buy healthcare. And so there's a production function there between what we buy and what we actually want. And that derived demand actually creates a ton of challenges with really market failures in the healthcare space just because. We, it's, it's not a pure market in that consumers don't have a direct demand for the products that they're purchasing.

It has to come through an expert, like a doctor to tell you, oh, you need a knee replacement versus physical therapy, for instance. You know, if I, if I rewind to like, uh, 2012 or whatnot, we were talking about the app store. Is that essentially what you become a, a layer of APIs over, over this, uh, data that exists out there that people can plug into and write their apps?

Yeah. Well, so it, it's, it's funny, you know, you mentioned you, you worked with another company that was kind of in this integration space. I think the thing that has made Redox successful. Is avoiding selling to health systems and avoiding trying to become an app store. And the the reason is, is I don't think that healthcare organizations, these, these big enterprises, they, they all, they all think that they're very unique and in a lot of ways they are right.

They have their own demographics that they deal with. They have their own structures and culture. I don't know if they're going to standardize on a, a way to purchase software, um, that an app store experience creates. So like the, the iTunes app store are kind of first . App store example in the market. Uh, it makes it so that, that you as a consumer buys an app the exact same way that everyone else does.

It standardizes the process both for selling and buying and finding these applications. If you think about how software is purchased from a health system perspective, there's this huge procurement team. There's legal, there's security, there's it, and it is this gauntlet that startups have to run through to make a sale.

If for an app store to be successful, you'd have to reform all of those processes and make it so potentially someone as close to the end user as possible. Potentially like a actual end user, like a doctor or nurse could actually purchase software on this app store and implement it in their, in their systems.

And I think that we're, we're pretty far away, away from that. So yeah, with Redox there, there is that two-sided network. It kind of feels like an app store, but we don't, we don't. Match supply and demand. So most app stores you actually go in and you search and you try to, and you try to find, Hey, what's the best calendar app for my computer?

Um, and you can, and you can find that. So you match up supply and demand. Redox doesn't do that. We, we get involved after supply and demand is matched. So after a health system says, I wanna work with. You know, Visia for, for eConsults. Then Redox gets pulled into the mix to help facilitate the exchange of value between supply and demand, but not actually the, the matching of those of those sides.

And a lot of the, a lot of our competitors over the years. Have really tried to figure out how to, how to sell something directly to a health system, how to go through that sales cycles, how to reform that buying process. And that's why they didn't grow as fast. So by us avoiding and focusing, avoiding that problem and focusing on the problem of making the developer experience really good, we were able to to grow a lot faster and, um, win more market share.

You know, the, the, the other thing, and as I'm thinking about this, the other thing we're always concerned about as startups is, is one of the big players gonna turn and all of a sudden point their, their desire or their interest at the market that we're playing. And, you know, you're playing that, that intermediary between this, uh, really rich data that exists, um, behind the community are.

Hey, through fire, through, uh, I don't like mentioning specific things, but through a series of APIs and a store around it and those kind of things, and through developing, building a development community, we're going to open this thing up. Do you have to keep an eye on that at all times? Just to make sure that they don't just swerve.

Yeah, yeah, for sure. I think, I think it's great what EHR companies are doing and opening up more. That's, that's, that's the right side of history. That's what they should be doing because the EHR, you know, it's, it's grown too big and it does too much for them to keep up with the ever-changing demands of all of the stakeholders in healthcare.

So we need to be able to plug in applications and be able to work with EHRs to, to enable that technology to actually make improvements in the healthcare space. Um, one of the things that. Well, so the healthcare EHR market is, is quite fragmented. And of course we talk about the, the really big ones out there, like Epic and Cerner and stuff.

But, but still the, their market share isn't as big as if you think about like the, like the operating system market or, or even mobile operating systems like Android and iOS, right? They have pretty much a 50 50 split. And so as a developer, you can build to those two platforms and cover a hundred percent of the market.

Whereas in healthcare, because of the, um, fragmented nature of the technology systems you're using, it's hard to pick one vendor and use that as your channel. And so therefore you have to end up integrating with, with many, many, many long, a long tail of EHRs. So my, my, I. Hypothesis in the market is that it's much better to have an independent party that can integrate with everybody.

So developers can choose to integrate with that platform and then work with all of these, um, app stores that EHRs are coming out with. So Redox has partnerships with, with a few app stores out there that if you work with Redox, you're basically enabled on the, on the, on that EHRs marketplace. You don't have to go through their certification, but you can just do Redox.

So that's our approach to that and, and trying to help, help that. Ecosystem thrive and really help those, those EHR marketplaces become more successful than they have been to date. Because, like I said, uh, those marketplaces are trying to reform how health systems are purchasing software, and so they haven't been all that successful as being a, a channel for startups and vendors to work through to actually get more business, the health systems.

Yeah. And it's, yeah, you can, you can rest assured that Meditech isn't working on a set of APIs to get the epic data. Epic's not working on a set of APIs to get the Cerner data. And so there's always gonna be the need for that third party. You know? I, alright, so I'm gonna transition, we, we do a very quick podcast here.

No, no more than 30 minutes. So, uh, I'm gonna close in on the last two questions. You, you threw out a very big statement towards the end of your intro of the podcast. You say that healthcare will change dramatically in the next decade. Why do you believe that? And where do you think you're that we're gonna see it change the most?

Well, I, so it was when I recorded that, uh, this was probably December when I actually wrote that and recorded it. Um, so six months ago, I. I, I want, I guarantee you, you were omnisci, you, you knew what was gonna happen in, in healthcare, I guess. Well, so because of the efficient inefficiencies that happen in this market, I, it was more of a hopeful statement that I really hope healthcare changes dramatically over the coming decade.

And I gave it a decade because, you know, normally in a market with, with the inefficiencies that we have in healthcare, if this was a, if this was a more kind of customer focused market, it would change a lot faster. But I gave it a decade. 'cause I'm like, healthcare moves slowly. We're probably not gonna see the the change that we all want very fast.

But the pandemic has dramatically accelerated that change. I think it's exposed the parts of healthcare that people have been saying are broken for a long time. Access to care, ru rural care, um, not adopting technologies that everyone knows are, is obvious, like, like virtual care tools to telehealth type solutions.

So those things are things that were, uh, exacerbated by the pandemic and the need to adopt. It became so high that we saw health systems turning on telehealth products that, you know, in a normal . Time would take them a year or two years to implement and roll out pilots and test out in different areas.

They turned it on overnight and then they saw, you know, a hundred x increase in telehealth visits. And so that's the change I'm talking about. We're going to see a fundamental change in how care is delivered and that that, uh, change is gonna be driven off of technology enabling it. So it'll be technology enabled change in our healthcare delivery models.

And you know, like everyone's been saying, telehealth is not, and we're not putting that genie back in the bottle. It's been implemented. Patients are starting to get used to it. 80% of patients who who had their first telehealth visit over the past few months in the pandemic are say that they would like to do it again.

According to a recent survey that was put out, doctors are, are getting over the, the cha, like getting outta the status quo and learning how to use it and understanding that they can see patients effectively. For certain types of things over telehealth. So we're going to see that that settle down over the next six months or so, and the telehealth programs will become more established, but then they're going to start adopting tools to, that really are complimentary to telehealth, other virtual care solutions, remote diagnostics, remote patient monitoring, anything that that happens outside of the four walls of the health system.

And, you know, it's, it's pretty clear right now that the healthcare organizations that took risks on patients, the ones that were deep into their, their transition to value-based care, they, you know, the ones who were paid on a capitated rate or had a payer as part of their organizations are, are, are surviving more effectively.

But during this, during this economic downturn that's caused by the pandemic. Uh, so hopefully we'll start seeing more adoption of, of value-based programs and, and with the adoption of value-based programs, that means more incentives to tell. Figure out what's going on with patients outside the four walls of your organization.

'cause you're at risk on that patient's life. And what that means is technology is so suited to do that and your traditional EHRs aren't really in a place to help you out with that. So I'm expecting a lot more adoption of, of tools that will help healthcare organizations focus on how do we take care of our populations and, and make sure that we can track them and intervene so people don't become well, don't end up a high cost, you know.

Poor health situation that, um, causes a lot of the costs in the system. Um, so that's the reform that I, I hope we'll see. And I thought it would take 10 years, but I think it's gonna be over the next two years now as we pull out of this recession and healthcare organizations figure out how to generate revenue again.

Yeah. I'll tell you what, Nico, he is really. It's fascinating to me. One, one of the things I've been saying to people is we've, we've been talking about digital transformation for a decade, and we just did it in three months. I mean, the, the patients experience digital transformation on how they interact with us.

The physicians experience, digital transformation workers went out into their homes. The culture just in general has dramatically shifted over overnight. I'm not sure anyone could have. Predicted that, you know, if, if you would've predicted where we're at today. Majority of healthcare workers are the administrative workers working from their home, including finance and others.

The, the patients overwhelmingly across the country, at least at this moment in history, being seen via virtual means and, and liking it, the physicians delivering it, and essentially at a greater than 60%. They prefer it. And, you know, those kinds of things. If you would've predicted that in five years, I think you would've been aggressive.

And now we've just seen it in, in a matter of three months. It's amazing. Yeah. It's, it's phenomenal. And, you know, for a long time people have been saying that we, we need to have this digital transformation because, uh, a lot of people estimate that about a third of spending in healthcare was waste. But what this means is that coming out of the recession, I think we, this might, what, what we might be seeing is a right sizing of the industry in that

It would've been very difficult for a large organization to go digital because what that would mean is, is retooling their staff to, for different skills and potentially laying people off and, um, letting a large portions of their staff go. That's, that's happening anyways. Right now we're seeing furloughs and job loss in the healthcare space really dramatically, and the jobs that come back online after as people start to, to see volumes increase again, will be the necessary jobs.

And so the industry might come back and actually be smaller. Than in the past. And that's good. 'cause we were nearing 20% of GDP being spent on healthcare, which is phenomenally too high. You know, a country of our size should, should be staying around 12% of GDP. So what, what I'm hoping is that when it returns, we'll, we'll be in the, you know, 1670, 17% range.

The industry will be a little smaller, but a whole lot faster, a whole lot more nimble and a whole lot more efficient with how they use technology. Yeah. If we align the incentives, it's, it's interesting to just. Think about, you could literally go into a care pathway right now and, and, and look at the entire thing and say, does this need to be a physical visit or a virtual visit?

And now everyone in the room has a concept for what can actually be done virtually. Yeah. That wasn't done before. All the way through to rehab and home visits and those kind of things. And that has the, that has the opportunity to fundamentally change the cost model from end to end. And I, one of the things I talked about on on Tuesday's podcast was just the, the concept that the payers are gonna come back in and redesign what they're gonna pay for.

And they're gonna say, we're only gonna pay for this type of visit if it's a virtual visit and it's gonna drive change across the industry just because we've just experienced it. It's opened up just a whole new, uh, conversation. Yeah. Well, and I'm, I'm particularly interested in payers and how, so if, if, if they're only gonna pay for certain types of visits being virtual, why don't those payers provide those visits themselves by employing their own providers?

And so we've seen that sort over the past few years, the sort of vertical integration of payers into the provider space. I think that they should do that virtually. Let, let the hospitals and health systems keep the brick and mortar, but they can take a bigger, uh, a bigger step into that virtual care space.

Especially right now when they're, when, when, when they have, you know, so much cash on hand because they're not paying out claims. They can invest in, uh, solutions like that and actually provide more care at a virtual level, but then they're competing with their providers that they pay for. So it's an interesting space to watch and I'm, I'm.

I don't know what the payer strategy is gonna be coming out of the pandemic, but I could see a lot of them doing more vir, vertical integration in a virtual standpoint, providing their own telehealth solutions, employing their own docs in that network. Uh, I'm, I'm going a little long, but I'd be really remiss if I didn't talk to you about data and interoperability.

We have 21st Century Cures Act. We have final rule coming at us pretty quickly. A lot of people talking about, you know, just the overall impact on healthcare. I, I, I'm looking at this space and even before covid, I was looking at this year and saying, this is the year it really starts to transition. This is the year where the, the data starts to become more liquid across environment and data liquidity.


Data. Data. I mean, what, what, how are you, how are you view viewing this, this timeframe within interoperability and, and what do you anticipate are gonna be the, the most far reaching impacts of 21st Century Cures and the final rule? Yeah. Yeah. Like you, I was excited and pre preparing to go to HIMSS to talk to everybody about interoperability, you know, and everyone's plans for meeting the new requirements.

And then of course, IMS was canceled and the pandemic took over the Our lives and our industry. And it seems like the, the interoperability rule kind of went to the back burner, but it's still there. It's still really important. Um, some of the deadlines got delayed six months or so, but they're still, they're still coming up.

I think the, so there were a lot of things in it, and a lot of them were kind of incremental improvements to the interoperability legislation that we've seen over the past, gosh, 10 years now. But what I think was the most important piece of it. Was the, the push towards patient access to their, to their own data.

And what, what the law says is that patients should be able to use any app they want. And if that app meets the requirements of, of the API and those requirements are, have now been specified to, to use fire, then. Then they should be able to get data into that app. And what that means for, for patients out there is that, uh, you'll be able to download an app on your phone and get your clinical data onto it.

Um, and who knows what those apps will do. It's kind of what the government's saying is, it's almost like a, if we build it, they will come model where they're saying, if we mandate that the infrastructure exists for apps to get data, then. Entrepreneurs out there will make applications that can actually engage patients, can help them, uh, change their behaviors and get healthier.

So we're, we'll, we're likely to see this right now. Consumer health is really focused on like wearables and fitness, but we're likely to see consumer health as a sector grow and start getting a lot more clinical because that data will be made available over a standard format. So that's what I'm hoping.

Um, it's a bet because we haven't seen those apps exist yet. But I think over time, we'll, you know, there, there will be a, a, for lack of a better term, a killer app in healthcare that actually, uh, commands the attention of, of lots of consumers. And that starts the, the wave of people pulling their data out of their hospitals and health systems onto applications that they control and mediate.

Um, who gets access to. So I'm gonna push back on you a little only because the, the economics of that and, and you're an economist in, in, in some of your concepts that you talked about, the economics of that really don't make sense. And what makes sense to me is, okay, so I can get to it as a, as a patient, which is kind of cool, but it has to be somebody who's making money somehow, either from me, no, it has to be somebody who's making money from me.

So Apple can do that because every time I buy an iPhone and it's closed, uh, closed garden, if you will, they, they're making money. So they're more than happy to aggregate my data, make it available, create, uh, new opportunities for me on that. But others are gonna, they're gonna struggle. They're gonna have to create incremental value on that data.

And it could, it could be something that's as simple as, you know, taking all this disparate data. Because I know that certain CEO has said, you know, the patients what to do with this, and I agree with do, but I could a company and hey. And we'll put somebody on the line on a Zoom call with you who will explain your data to you.

Exactly. Yeah. That's a, that's a great idea, a great business idea. And, and it, and heck, bill, bill fart does a telehealth visit, uh, a wellness checkup . Um, right. So there, there are business models that we, we can't perceive yet that, uh, people will try. And if you think about all the apps on the app store, like if you go to your, your, your phone app store, there are so many apps out there that are all, they're all free, right.

I've, I've barely ever paid for an app. On the app store, and they, they figure out a way to exist and a business model that can derive value for their company while giving value to their users. And so we're gonna see things like that and really an, an application. And if you think about like software development, the application layer is what turns data into information.

And information is what's, what's actionable from a, a user perspective. So yeah, patients don't have . They, they, they don't have a demand for their data. They don't have a demand for an API, they don't know what an API is. But when they, they use an application that utilizes that underlying infrastructure, that application's job is to turn, is to surround that data with context so they can understand what it means for their health and what it means for their livelihood.

And you can think of ways to actually incentivize patients to do that too, because. If you're a company that's aggregating a lot of that data, um, that data becomes a valuable asset to you and you might be able to pay patients back for the use of that data, either, either through great features and technology like, like Google does or through actual monetary payments, like a data bank model.

So, so there's things that need to be tried out and fleshed out in the market, and that's what, that's what 21st Century Cures is about, is creating the landscape to allow, uh, innovators to, to try those things. And so we're gonna see a whole bunch of innovation happening. And a whole bunch of people fail, but the one or two who make it can actually start a revolution that hopefully will get people more engaged in their health data to, to the point where, where we might see a Cano consumerism trend in healthcare.

Where instead of being driven off of, you know, what your employer's coverage is from a payer perspective and what doctor to see through that, to really based off of like what's convenient for you as a patient and what matters most to you, and what's the price point, you know, more like a. More like a model where we have direct demand.

So going back to that, that initial concept of, uh, drive demand, and we can actually fix a lot of those market failures through great technology and transparency in the market. You know, Nico, I, you know, I'm reminded because I, I met with a lot of startups that we're looking for funding and whatnot, and talking to you, I'm reminded of what it takes to be successful.

You are so optimistic, have so much energy, so much passion towards this, but I think it's the optimism. It's, you know, you believe in the industry, you believe in the, the solution that you come up with and you believe in, uh, in the people appreciate.

Thanks a lot. This is really fun, bill. That's all for this week. Special thanks to our sponsors, VMware Starbridge Advisors, Galen Healthcare Health lyrics, Sirius Healthcare and Pro Talent Advisors for choosing to invest in developing the next generation of health leaders. If you wanna support the fastest growing podcast in the health IT space, most of you can see this now.

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