Health Innovators
Health Innovators

Episode 82 · 1 year ago

Breaking through the status quo and dethroning incumbents with Brent Wright, Howard Rosen and Jeffrey Carlisle


Sometimes we like to shake it up a little - okay, a lot, like in this week’s episode when we go completely loose-cannon and host a panel discussion on a variety of topics.

If you’re struggling with the status quo, facing an uphill battle against industry incumbents, or simply trying to navigate your way through consolidation, this is where you want to be!

Jeffrey Carlisle, CEO at Pneuma Systems Corporation, Howard Rosen, CEO and Founder of LifeWIRE, and Brent Wright, Associate Dean for Rural Health Innovation at University of Louisville join us this week for a roundtable discussion of all things innovation.

So, grab a chair (and possibly a drink) and hang out with us a while as we discuss ideas, tricks of the trade, strategies and outlooks that could put you on the path to success.

Here are the show highlights:

What if the controversial word is “innovation”? (6:29)

Customer obsessed or product obsessed - your innovation needs to meet a need (11:58)

When to disrupt the status quo, and when to let things ride (14:13)

Building out a commercialization strategy when your customers are risk-averse (16:40)

What is a healthcare consumer really willing to pay for? (20:16)

Breaking into the EMR space, can you really dethrone an incumbent? (29:58)

Guest Bios

Jeffrey Carlisle is CEO at Pneuma Systems Corporation. He earned his ScB in Applied Math/Biology from Brown University. 

If you’d like to get in touch with Jeffrey after the show, feel free to reach out to him via LinkedIn at Jeffrey Carlisle or via email at J

Howard Rosen is CEO and Founder of LifeWIRE Group. He earned his HBBA in Economics and Marketing and an MBA in International Finance/Marketing from York University, Schulich School of business.

If you’d like to get in touch with Howard after the show, feel free to reach out to him via LinkedIn at Howard Rosen or via email at

Brent Wright is the Associate Dean for Rural Health Innovation at the University of Louisville. He earned his BS in Human Studies from the University of Kentucky and his Masters in Medical Management from the University of Southern California  

If you’d like to get in touch with Brent after the show, feel free to reach out to him via LinkedIn at Brent Wright or via email at

You're listening to health innovators, a podcast and video show about the leaders, influencers and early adoptors who are shaping the future of healthcare. I'm your host, Dr Roxy Movie. Welcome back health innovators. On today's episode we are doing something really crazy. We are flipping the script. Typically, we are pure in a interview show where I'm interviewing a guest one on one, and today we're doing something really different. I've invited three guests to join me today for us to have a somewhat different conversation. So, instead of just explaining about the commercialization and the healthcare innovation journey, we are actually going to problem solve. We are going to talk about ideas, thoughts and real, live, real time actions, solutions that you can implement right now. And so we're going to talk about some of the challenges that we're facing in healthcare innovation and then, like I said, some ways that we can solve it. So first off, let me introduce you to our fearless guests who have actually agreed to this. We don't we don't know each other. We've never met each other before. They don't know each other and I've never met them. Of course, we've had some communication via digital channels to get to know one another, but I'm really excited about this very organic conversation that we're going to be trying out today. So if you'd like it, please let me know and we'll continue to do more of these. So, Brent, let me introduce you first. So Brent Wright, who is the dean of rule health innovation at the University of Louisville. Welcome, thank you. It's associate dean. Associate Dean. Okay, thanks for you seting me straight. And then we also have Jeff Carlyle with us. He is the president of Numa Systems Corporation. Welcome, Jeff, you nice to be here. And how it rose in. He is the founder and president of life wire and forward to discussion. Awesome. So what I like to do before we get started into the topic of today, is just to kind of give each one of you an opportunity just share a little bit about you know, no more than two minutes, about your background and what you're innovating these days. Let's start off with you, Jeff. Well, I'm Forty Year serial entrepreneur of worked in some big companies as an intrapreneur, but all in the world of medical devices. So started off in fluid flow control and then went into cardiology related products and ended going back into fluid flow control. So today we're working on a disruptive technology for intervene DI suffusion therapy. So we're taking the legacy devices and reducing their size and weight by ninety five percent, at reducing your cost by eighty percent, increasing the sophistication by an order of magnitude and really being driven by the respect for changes in workflow and information flow. Although the disruption nominally comes from fluid flow, the real disruption comes when you tie together fluid flow, information flow and workflow. Wow, that's fantastic. Can't wait to learn more. Howard so again life wire. I'm a typical health ideas story by education. I have an MBA international finance and marketing. So naturally, with that I spent twenty years producing film and Television, which is a natural segue and health. I it's a a simple story exactly, and it was. There is a story behind that and it doesn't involve some bottles of wine. But in all that I came up the idea of what has become life wire about fifteen years ago, which I've been doing this. Essentially, you lie. Far As evolved into is a cloud based communication platform that allows patients providers...

...have an ongoing dialog as different in front of each other, but automated and remote basis. What drove me from the film and Television World is engagement, and so the key thing is reducing barriers. So partly technology or the patents that we have is the patient can choose whatever device they want, so the cell phone, a tableted computer, a landline, even a flip phone, and they can choose whatever of however they want to communicate. So could be text, email, interactive voice chat, instant messaging. We actually now tie into over four hundred wearables and medical devices. It's instantaneous communication. There is no software, there's no APP there's no equipment. It's truly using the cloud power of the cloud to using whatever's native on the individual device. Instead of telling them how to communicate, they tell us and open some communication flows from their well consumer and control. I like it and break all right. Thank you. Roxy. I have a varied by ground, from family position, by training to more of an applied technologist. Now, with my work is an associate dean. I love technology. I love looking at how that can be applied to rural healthcare population. Something that we're looking at very closely now a smart glass technology. Often people tend to look at that as Google glass. You know, if you look at the pandemic and how tell a health help to transform, you know how we delivered healthcare. Actually was the only way we could deliver healthcare and many settings for a long time with during the initial time in the pandemic. Looking at smart glass technology and how you can bring expertise to the patient regardless of their location, and changing that telehealth paradigm where you brought someone into a facility that was heavily in a data with technology so you could broadcast to a remote specialist. Now Technology is so mobile and so fluid, utilizing smart glasses to allow the expertise to be there, to allow a person to act as a clinical Avatar for the remote expert and really break down barriers. You make expertise and health care much more fluid. That's super exciting cool. Yeah, so very diverse backgrounds and I think that's what's going to make this conversation just so interesting. So today's topic, we're talking about breaking through the status quo we're talking about dethroning incumbents and we're talking about navigating consolidation. So, Brent, just start us off by telling us some of the things that you are currently observing in, you know, in meeting the last few months, are now in the landscape as it might relate to any one of those three phenomenons. You know, I'm going to start off with something and maybe make a controversial statement here. I think in innovation, I think maybe we have too much innovation, Uh Huh, and I think we have an overabundance and innovation. Now let me, you know, explain that, and that is if you look at healthcare, it is so important to develop into advanced care, that we've not coordinated care well, and where I live in you know, on my training and background in primary care, is that we deal with the coordination of health care and healthcare data every day, not to the optimization of patient care but, I think, to the detriment because we're always on the cutting edge, on the bleeding edge of what healthcare does. I really would like to, you know, bring in that and you know, do we have too much innovation or do we temper our innovation appropriately? You know, I'm always going to be for innovation. And then when we talk about the status quo, your your question is, you know, I really divide that out into one of these yes and no diagrams. You know, if you do diagnosis, you get a test, then you go yes or no, whether the test is positive or negative. I think when you look at the status quo, you have to ask yourself you have to apply disruption. Doesn't need disruption, or does it not? You know, doesn't need innovation, or does it not? Because I think we can waste a lot of time on a taking status quo areas that actually, you're good, that may be an appropriate incumbency, incumbency, but you know,... status quo healthcare, we all have to realize that health care is so incumbent. I mean health care is like twenty, thirty years incumbent. So we have to be very, very careful. But right now I think we're really heading into the appropriate time, if you're going to be a healthcare innovator, to make great changes. But again, back to my original point, do we have an overabundance of innovation? Because I see people innovating in spaces that really create more problems, because it is we innovate, we create fragmentation and that fragmentation, for me, someone trained as a clinician, as a physician, that just makes it more difficult. So I'm interested in Howard solution there. I think that sounds like something that can really be a benefit, you know, into what we're dealing with. It's okay and I can jump in a sorry, sorry, I'll just I just wanted to say that your comment wasn't controversial. I don't think that. I I see innovation as being one of three arrows in your quiver. Sometimes the status quo is exactly the right thing to do. Sometimes reversion is the right thing to do. Let's go back to what we used to do, and innovation just gives you another tool. Right. It's not. It by itself is not of any value. It's only a value if it achieves the intended objective. So I agree. I people ask me. I wrote a book called we love innovation, so long as it's nothing new and it you know, one of the things people ask is how do you create innovation? I said, well, to Brent's point, maybe maybe you don't want to, but the real key is if you do want to create innovation, you don't have to do anything. You just have to work real hard at not killing it. It'll be there like it'll be there like a virus. It's there. It's going to be there. Just quit killing it and will happen. But you don't need to do anything right to actually increase it. I love your points on creation there, because to me I think that's important, drawing a boundary between creation and an innovation. I've always seen innovation is taking existing in parts and putting them together. I think that can be very important to innovation. Sometimes, if you try to create too much, you can actually want there's a time factor there and one does does it need to be created like an invention? You know, we said it's sort of an inventor's paradox. Are, you know, the invention versus just an innovation? So you know it. Innovation to me is making things better appropriately to your bank. Essentially. You think it's all preaching to the choir here and we're rocks these sits, but it's also what is innovation that you've got talket with corporates in terms of people say, well, you've got to innovate. Well, what does that mean in terms of if it's making more APPS for example. You know, but the APP fatigue on the average patient or even physician is insane right now. So that's not innovation. And, to Jeff's point, sometimes innovation is having the determination. So, you know what, we're actually on the path we need to be on right now. But, as you have just the premise behind what I did to me innovation, the Ouphan Innovation, what we do is where the technology is invisible. You don't want to see that. You just want things to happen and as simply and easily as possible. And sometimes, yes, reversion. But I think innovation in itself is a somewhat is that's the controversial word of the whole thing is, because what is innovation? Yeah, yeah, exactly. And you know, one of the things that comes to mind when I hear you guys speaking, is there's a big difference between like, being technology or product obsessed and being customer obsessed and really solving a real problem that people are facing, versus innovating for the sake of innovating because it's sexy. And I think that's why we have so many innovations that end up in the Zombie graveyard, because they were never needed to begin with. Well, or they may be adopted. You take a look at a typical...

...acute care electronic medical record system. Well, it gets adopted at great, great, great expense. Yeah, and there are, there are many patients that would be better off with a thoughtful three by five card, yeah, instead of fifteen gigabytes updated. I can't hug you through zoo. You're exactly right. Thank you for saying that's right, because, well, a lot of the time you've got you know, and we experience and we've seen it is I t departments are saying, Oh man, this is so cool, this new ultra x y and z everyone's got to use it, but because in their perspective it's cool, the average perspective it may not be. And it's sort of that balance in terms of saying just because it's cool doesn't mean it has the value that it should. And, to Jeff's point, you have, and Brents, you still have to have a value proposition. How is it? What? What pain point are you're solving by doing all the anything? What cost and at what costs? Well, some of these things are so expensive and so difficult that you you say, well, if it's this expensive, this difficult, it must be valuable. But if you take a look at, quote, smart pump and fusion pomp technology, how could you argue against it? Oh, it's it and you can. You can pick up an antecote like that and you can mention. How could you argue against it? But if you look at where is the Lexus of information, where do you what is it you're trying to achieve? It absolutely and no doubt in my mind, causes more harmed and good. It creates the illusion of safety because it's so difficult and so laborious and so expensive, but it doesn't doesn't really move the needle. No Pun intended. I like it. Keep being punny, Jeff, keep being funny. So so the status quo. You know, how how it to your point that you guys are talking about. You know, how does that help us or how does that hinder us? And for those folks that are in the audience that are at different points of the innovation process, you know, how do they overcome some of the just traditional status quote that we have, and when do they win and how do they identify that this is a status quo that's a good thing and and that I should just leave that alone. Just just jump to the end user right, look at the end user and say are there unmet needs? And you start there and you end there, because once you created a solution to an unmet need, it's the power of the consumer voice that will influence in organization. It's not going to be the RD team, it won't be the manufacturing team, it'll be the sales guy who who finds out from his customer, Hey, these guys are talking about something that's really, really interesting to my customers, to the end users or to the patients or the pharmacist or wherever. And so you got to you really have to start with have you satisfied an end user on meant need, a consentially, it's also identifying the end user use. Let's use you know horrible covid pandemic and the explosion telehealth. Yeah, we're all the salesmen were making sales to the providers and the payers and they weren't as interested in tell health. But if you ask the patients, they said, I want to communicate, I want to know, get this information as much as possible. But the providers and payers, and you know, the sales are oriented to them. With the you know, Covid, of all the horrible things. The one thing I think people started recognizing, oh, need to satisfy the patient for what their needs are and have them be able to access the system. And I think it is very few patients went, oh my gosh, this tell health thing isn't this great, as opposed to where has it been? We've been we've been asking for it but not being able to get it. It's again, it's just being aware of that end user is ultimately the biggest point of important peace,...

...because that's what you need to satisfy in innovation and in the business proposition for the innovation, because it's not going to be you can build it, but if it's not going to be used, is that's going to go to Zombie graveyard. Hmmm, yeah, you know, it makes me think of a couple of things. One is, you know, a lot of the research that I've done is really say that it starts off with an early adoption lens and when you're building out your commercialization strategy, thinking about that for your segmentation, because if you're talking, if you're trying to sell your solution to the mainstream market, you're just beating a dead horse right like those are the people that are digging their heels in and they love the status quo like they are so risk averse they are never going to buy something even like what you were describing right Howard, even if you're like even if there is a real need from the end user, they're just like, nope, not until it becomes an industry standard and until all the peers in my community are telling me that I can trust it. I don't care what the brand says. You know any any comments or any experience around that type of Lens that might be used in building out that strategy? So, from our experience in terms of being the in terms of sales, and I use shows my age, but it's like the old days that we're no one ever got in the old days of computers. No goot fired by buying an IBM product. It wasn't the best, but it was kind of like they were the computer at that time. Yeah, and you're seeing that today, quite honestly, in terms of the larger to peep. The procurement side is no one. You know, if if you went with a name brand or provided a certain thing that's been done before, you'll continued on what was previously done. You know, these are if ay, it's more safety in the work that I'm doing and it all comes down to how you're measured on those pieces. And that's that really comes down to. Back to the point of he as your job to satisfy end users need, or is it to satisfy something else? And it's really where's that risk reward for the individuals who are making those decisions as to what direction that they go in and can sometimes a status quot is going. Okay, well, nothing's going to happen to me if I stay the status quote. Maybe it's a slightly cynical approach to it, but it's kind of the practical realities of the trench warfare up there. Not nearly cynical enough. I'll dial it up for the next anecdote. Yeah, one of the one of the problems we have in our industry is that the end user, the financial pair, the provider, the PRESCRIBER, the insure the ultimate financial guarantee, or they're all different and to have all cross purposes and there is no where there is alignment, like when insurance companies not involved, like Lacic Surgery, all of a sudden, holy cal prices drop like a rock. Availability is there they get new technology every twenty four months and it's like it's phenomenal because it wasn't adulterated by insurance. Yeah, I. and Dentistry is in similar than there isn't enough, you know, there isn't big component of insurance or as much in dentistry. And Dennis Office look like the twenty one century. Right. You go into the an obgy in place and I got a rapids flood hanging over the woman. Go to a dentist office and it is twenty one century. It really is untruly unbelievable. Well, my goodness. And their primary business of preparing cavity went away. Their entire floor, the base business they had went away, and now the you know, the it's all change entirely to cosmetics and other yeah. So, so one of the things that I think you guys are touching on is, you know, the telehealth thing,...

...right, so that that movement, that acceleration of adoption. You know, one of the barriers that we're all familiar with is the regulatory and the reimbursement hurdles, right, and so then once that was lifted, you could actually give the consumers what they wanted. And so, you know, when I'm working with clients. We talked a lot about was it better to go be tob or BTC, and OBC is a real costly path. And you know to what degree or patients going to want to be out of pocket versus, you know, cash pay out of pocket type of things that they can't get the the payment model alignment versus. You know that's just a barrier that you're not going to be able to overcome. What do you think? That's a good question in terms of and it's something we deal with all the time. So I get are just our approach. WH or be to be to see and and part that is is for the for the clients or the patients, when it goes through a provider that they know or pair that they know, it's basically okay, here's a validated product for us to use, because the problem with just the open APP market, for lack of better term or solutions, is how do you decide which works or what's good for me? You're not good for me as a patient. So we look at his providing sort of at least that a orientation to it and on the price basis it's a stratification of a market place as to who will pay for what? The average person goes, you know, goes to how many apps going to have? will one APP is five dollars a month, but if I got ten of them, but it's fifty dollars a month? And right where? Then your prioritizing where. They want to play another round of legends race cars or you want to wait management. And I think the more it's provide and it's where you place the values, and the more it's provided through a provider. Just right now, and that could change tomorrow, but right now at least it's providing a means of validity as to why and which one should I use? And if it's in some and some of the cost you there's a Copay, at least with some of the costs covered, you have the value. So you're paying something for it, but you know you're getting some reduction in price as well. I think that's a great question on what the health care consumer is willing to pay. You know, you also have to look at, you know, how that breaks down, whether it's in different populations, whether that's Medicaid, Medicare. Yeah, they'll pay. You know less of that now, but when, I would say selfpay now is me more people who are willing to pay besides their insurance, like concierge, scare, Yep, the different ways of obtaining care in that way. But what I have found in a lot of time when you have bigger payers, more your quasi government or your pseudo socialized payers, like Medicaid, Medicare, those people are very averse to any alipocket charges, I mean no in Medicaid. Here in our state we moved from having to pay a dollar for a visit to taking that dollar payment away. You know, couldn't believe that we were arguing about a dollar, you know, to come in to see someone. So and you know, I would participated with the program here we tried to roll out with Medicare where you just had to pay eight dollars for a monthly telephone evaluation where you could go over and go through all the data and update and try to aggregate the information better, because we all know that there's issues with aggregation in data sharing when you have a lot of consultants involved in the healthcare process. It wouldn't pay eight dollars a month out of pocket. And so I've been you know, that sort of hit me, you know, right between the eyes on how adverse people are to pay and though. So when you talk about extra you know there's going to be a population that pays that premium dollar, that say yeah, it's worth it, fifty for telehealth services, and then people are going to say, well, you know, my time is not worth as much. So I think that pricing discussion is extremely interesting when we could probably spend a lot more time on yeah, I think you could take consumerism and personally owned health records. That's that's about forty five days...

...worth of discussion. It's so important, so critically, critically, critically important. Eight dollars a month. Yeah, to try to assimilate a coherent medical record would be worth an if you tied that to consumerism, to actual shopping. As you know, with any medical procedure, that difference in charges for any one medical procedure is commonly ten to one, with no no correlation to what you might think of is quality. Ten to one is common there in the Boston areas. Sometimes it's forty one and sometimes it's twenty one in the same facility, and so it depends on how you get in and it so the ultimately a coherent, accurate practice. Your goal transportable medical record, combined with consumerism on pricing, would would transform what we could have better quality for half the cost easily if those two things were done. And then it comes down to healthcare education, just to crust understand all the, you know, some of the pieces to its under you know, it's your point, Brent, to understand what eight dollars really means compared to what you're getting for it. It's, you know, again it because people sort of balance out. I've got a budget and this is going to spend on again. How do you make that decision? and to it's not understanding and to your point, Jeff, the value of all these pieces. You know, the average person understandably doesn't have a handle on all that and if they did understand the logic and rationale is there, but there's so much to learn and it's so complicated, as we were, you know, we're joking earlier about how compact I would say those that even even you, Howard, or you Brent or you roxy, if you are ill, you're really in an impaired frame of mind to make good judgments. You you almost relinquish that to your doctor, to the state or to somebody you know it. It's really it's really a challenge when you're when you're not feeling well, and of course, that's when you take a lot of the consume a lot of the healthcare resources. Hey, it's Dr Roxy here. With a quick break from the conversation. Are you trying to figure out what moves you need to make to survive and thrive in the new covid economy? I want every health innovator to find their most viable and profitable pivot strategy, which is why I created the covid proof your business pivot kit. The pivot kit is a step by step framework that helps you find your best pivot strategy. It walks you through six categories you need to examine for a three hundred and sixty degree view of your business. I call them the six critical pivot lenses. As you make your way through this comprehensive kit, you'll be armed with the tools, tips and strategies you need to make sure you can pivot with speed without missing out on critical details and opportunities. Learn more at legacy DNACOM backslash kit. I'm a caregiver for my ninety two year old grandmother and another relative. That's really, really sick. That's in his late S or s. So I have consumed indirectly a lot more healthcare and the last year on their behalf then I have in my lifetime. I'm not someone that really consumes a lot of healthcare and and it has rocked my world. These are all phenomenons that I've known theoretically or intellectually, but now I'm experiencing them firsthand. and to keep up with all of the medications that my grandmother is allergic to versus the ones that she's on and how I need to know that in real time and then be able to give that information to all of the different providers. I mean, it's a it's a it's...

...really hard and I think of myself is like really smart, smart, very organized, very competent and helping her. And come to find out, we just found out last week that she's been on this medication for the last four months and she's been itching and I never put it together that that was a side effect from the medication that she was on. The roll. Ship your kids, but that shame on you. I know I've felt I was like, I'm so sorry, I feel it's don't but to the question that's your whole thing. I read. I read if this was my with my mother in law who just passed, know who ninety one, and my father in law, where we had to become the healthcare navigators in this case there's seven, seven hundred miles away. Yeah, and in part because they didn't know what to ask. But second of a talk my medication and I know I pulled in an informal poll monks. Everybody have known with elderly parents. I don't think anyone is not run into just medication issues where they've had the wrong medication in the pack or that the contraindicated medications in the pack because you have five doctors, each one prescribing something different and there's nobody coordinating all that. You know that on its own out not on topic, but just talk about innovation. If you want to innovation, someone can figure out actually to be able to automate that process so you can actually centralize that information so you're not dealing with these contra indicated medications that can cause, sadly's itching or a more serious conness like are there are some good there are some good innovations. Unfortunately it was acquired by Amazon, but will pack, Bill Pack is one company that took a very, very seemingly low tech approach to it. You know, they ship the packages. They're all big, big, big labels and they're all organized right and it's beautiful. It's not not a not a you know, a computer in your house or anything. It's very, very nicely done it and they they treat you like you're their only client. They're really good company. Now they got acquired by Amazon, so that's not going to last very long, but it is it was a good it was a really good innovation in a very important field. But to your point box, he involves it's not just one person who's a people around the healthcare continuou around that person who is also involved in the absolutely, yeah, yes, part of all this. Absolutely. They shouldn't be forgotten as part of the equip, the equation of any kind of innovation or whatever you're going it goes back to end user piece is also defining who the end user is. He but an end user, but you have a support person or persons around them who really are part of that. So you guys touched on Emar Systems and so I think that's a great topic for us to Jill a little bit deeper into around uncombents. Right. Mind, if I get a mind, if we get a beer. Anybody want to take a break? Go to a five minutes for wine with the beer. is going to do it, Jeff. I think of a single vault that's over there, right, actually some good products in Kentucky. Yeah, he prove that. Send US some drinking products, not Amur product. I know what he's talking about. Libations here. Yeah, all right, okay, urb it. You know. So. So what do we do about this? Right, we know the problem. You know, be good just for our listeners. Let's, you know, somebody talk about what is the problem? Jeff, let's go with you, because this going to be interesting and fun. And then, like, what do we do about it? Is there anything we can do? Or Our hands tied? It could actually be solved in a very simple way, and that is to in in medical records. Think of it not as something that belongs to the insurance company or the state or a doctor, but think of it as the property of the patient. And then you have professionals that help like that you do when your tax return. Help you organize that, and the...

...interoperability can be done in a three page document. It does not need to be totally complicated and it could be done with people like Howard to manage it in every kind of format you can, yeah, imagine, and it's so the structure of it can be simple. Now, once you get into the acute care hospital, there is a lock, you know, right now, with handful of companies that really dominate that space, and I think it's just going to there are simpler approaches to it and I think there will be innovators with some small hospitals that can be proof sites to show that you can achieve a better clinical assult at one tenth the resources. And that's the right ratio to look for. You don't want something it's twenty percent better than epic right, you know, you need something that's got any fifty times better and the but it's both in the price and performance. It's going to be, you know, five times better at one fifth the cost. You know, that kind of ratio, but it it will happen. The system is absolutely broken. But these hospitals, the bigger they get, the more they think they have to follow, you know, the lead of the Cleveland Clinic or somebody. So it's going to be slow, slow in coming, but I think that the key is to get ownership of that simple, transportable, practical, accurate record. has to belong to the patient and there have to be lots as a structure to allow that to be updated and maintained. But it's not a not a big structure. It's not a very complicated thing. It's a matter of setting standards and allowing that to happen. I think the real search here is is finding a sustainable revenue model. You know, if you look at the Hie's, they were going to give every state to Hie and then you would get regional his and they would be like a Federal Reserve where you could exchange information. But if you look at any state Hie, show me one state Hie in the country that's making money. I don't think anybody has any kind of revenue bottel, much less. They may have some revenue models, but they're not sustainable. So there's no if you look at healthcare data, there's no transunion equifax experience that are moving that data sort of creating that phyco score, creating what's happening. Hey, I was discharged from the ear are as, discharged from the hospital. We seehf my gosh, it's really important that I got home with my laces prescription, and I say that because people spend a week in the hospital and they may not get their prescription and it may not be that it was a fault of writing it. Maybe it was they couldn't get it filled or they just didn't know that they weren't on laces when they left the hospital or they got put on more laces. We're dealing with very subtle issues here. When I talk about maybe too much innovation, I'll put it in this way. We can transplant organs. That's a big deal. We can't share a CBC from two small towns here in Kentucky or from New York to Chicago if you are on two disparate Emar centers, m e Mars. It's worse than that. It's worse than that if you are on the same system. The state of right island pretty much got for every primary care doctor the exact same system for primary care. Everybody had the same system, but if a primary care doctor went from one facility to the next, they couldn't transfer the records to the patient. Now, technically, of course they could, but there wasn't any support structure that allowed them to transfer the records, and that's because the locust was in a wrong place. It was in some doctor's office didn't belong to the patient. So you you highlighted some financial models and you know it was the visa network that allowed the exchange of information. The creation of the ATMs. Is that kind of structure...

...that allowed enabled all that stuff. It's a structure of GPS that allows mapping. It's a structure of all these things. So there is a role to play in a central structure. But the free market really has to have a revenue model to make it work and it's really worth while. The return on investment is enormous if you've got the right information, not the right data, the right information at the right time. Great the the cost of treating a patient drops like a rock. Yeah, so how is that? So who's doing it, Jeff? Is that a new company you're starting? No, Ha, I've tilted at the windmill of a trying to medical records for almost forty years. When I first had had a guy named Dr Larry Weed, the father of the problem oriented medical record, I became a zeal it, but I was I thought it was five years ahead of the curve and I wasn't. I was fifty. I've got another fish to FRY. Well, I'm following Reste. I'm gonna, I'm gonna follow the money, follow where it ain't. It ain't there. So let's let's wrap up. Oh, Brett, did you say something? I'm just going to say I'm working with a startup right now looking at that space good, very interesting and looking at some very counterintuitive place here, because I think that the real issue. If you think about it, you talk about incumbency and in bear with me here, there's sort of an incumbency of knowledge and that, I'm going to say, maybe an incumbent, see of ignorance and that I don't think really patients had this conceptualization that I have an electronic medical record, much like I have a bank account, and that needs to reconcile and balance everywhere I go, because we do not have that mindset. If I ran a bank, and I do have banking background, you know, in my work, and if I ran a bank and you gave me a check and you came in are then you had another check. I didn't deposit that first when then you were overdrawn, you probably wouldn't keep me as your bank very long. But in healthcare we're overdrawn on reconciliation every day and health care and until we get to that point where patients understand that I have to have a reconciliation of my healthcare data, and until you have that place to park it, you know, much like you do with coin base, you know you have to have where's that information going to reside? It's not going to reside in one hie. There has to be a way to either reside that information or to continually move it and make sure that people know that it's been updated. I don't need to know necessarily the results of a test, but what's important for me is to know that a test was done. And insurance companies really need doctors to know that Mris were done, because patients will say an MRI I was done two years ago when it was done six months ago, right, and if I hear that from a history I may repeat the MRI. But if I know it's six months and sometimes it's such a barrier to gain the knowledge and over utilization of office staff to try something down, you may go ahead and spend the money. You know and I think to the point that was brought up earlier a lot of waste. Just this simple mechanism of communicating effectively could reduce a lot of cost and waste in healthcare. Yeah, yeah, that's kind of what we try to do. is in terms of our early because I said that last moment, connectivity to the patient is usually, you know, and whatever communication they want to navigate some of the the solution sets are with their clients are doing and be able to pull information that is important to them using natural language to get a start to it all. Obviously it's not a full indepth, you know, grab everything, because there's a lot of reasons why it can grab all the data from the HR, even if it's your own information, but it's a start to try to help them navigate some of that. To your point, it's got to be simple, you know,...

...natural language and a question that's understood so they can get that information. But I think it's a as you said, Jeff, ultimately comes down to whoever thinks they own the data. That's where your problem is going to be and that's where your opportunities are. Yeah, yeah, so we talked about a lot of stuff today and I want to in this on some actionable insights things that people that are listening can actually can start implementing now. So we think about some of the barriers and challenges that we've talked about today and maybe even some myths. What's what's one strategy or tactic? What's one thing that you think the audience can do? It can be, you know, something that they listen to, something that they explore, something that they implement. What is what is some something that they can do to have more success in their commercialization journey as they're navigating this entrepreneurial, corporate innovator changing the world kind of mission? Well, first you have to care to do something. Yeah, and then, secondly, you have to be very respectful and listen to end users. It can't be driven by technology, it can't be driven by copying somebody. It's got to be driven by respectfully, quietly listening, finding out what is an unmet need. And then, I think start slow and do pilot programs and keep expanding the pilot in which you end up selling and everyone's selling something. Your end up selling the results of what you've done, not what you're doing, but the results of what you've done. So it all starts and ends with the end user. What what? And and as Howard's is set several times, who they heck is the end user? You know, it may not be the patient, may not be the doctor, maybe in an intermediary group. So I don't think there's anyone one thing, but there are a lot of lessons to be learned in a lot of pitfalls to to avoid. So it just went through the market scan. If you play absolutely the end user, think we all agree you look at the end user, but when you're looking at your competitive stet you know, look at the sort of see who you think of competitors. You look to see what they're saying and how they're addressing the end user and also, more importantly, what are they not saying, but what they're doing. And you may find that actually that's where the intersection of opportunity exists, where it's not being said right, is not being said, it's likely not being done. Yeah, good stuff. You know. I I'm going to say this. I still believe in magic. When I say that, I say that I as we talked about technology, I still believe that there's a magic between two human beings interacting with one another, and I just cause for one second and go, oh my gosh, why are you not an entrepreneur or commercializing innovation if you believe in magic and you're in academia? I don't, I don't see. I don't feel like I come across a lot of people in academia that are like, I believe in magic. Now, that's why I have I wear a lot of different hats. And Yeah, but when you look at technology you have to have an enable and let me give you an example here. If you look at tell a health usage over the pandemic, you know, it exploded. It's like, you know, seventy eighty percent, and as soon as people can get back in the office it just goes down to less than fifteen percent, less than twenty percent. So if technology was that great, if telehealth was that great, it's a great tool. Okay, it's a tool, but still, there is something that people receive from working with people who care about them and working with office stabs. So what I see in working at with an office staff every day and working with providers, you know, throughout the state and throughout the nation is you you do have an issue with burnout, in fatigue in your healthcare workforce. So this is near and dear to my heart and that when you have when you design innovation,... has to be with workflow in mind, it has to be with efficiency in mind and keeping that in user and for me, the end user, the consumer. You know, I look at that as being, you know, that relationship, that Dr Patient relationship, and it's it's vital you know what we're doing here. So thank you for the opportunity today. Yeah, yeah, absolutely, and I think to your point, Brent, is that, you know, not everyone is going to ever really want on demand, self serve care and not everyone is going to want to go back facetoface and have that human inner, high touch, human interaction. I think, you know, one of the lessons that we can learn is to not really swing either way and for us to think about our businesses and programs as hybrid models, because I think that we're going to see that if we're trying to personalize care for specific population, even if we're treating or supporting a all patients that, you know, have breast cancer, even all those patients with breast cancer, aren't going to want to engage in the exact same way as human beings were really different, and so the hybrid model, I think, is going to be really important going forward well, as has as brand experienced earlier, it's hard to hug in zoom. Yeah, that's wrong. Yes, absolutely so. As we wrap up here, if you guys could just give a shout out of how folks can get Ahold of you if they want to follow up after the show. For me it's easy. You could just email me at Jeffrey Carlyle at mecom, Jeffrey Carlisle at m ECOM, and for me it's Howard Rosen, which is h rosen at life wire groupcom. And for me it's our dot right, wr Ght at Louisville Dot Edu. Or connect through me the linkedin. Awesome. Thank Linkedin Works, works for Manto. Yeah, linked in nearby? Yes, exactly right. Well, thank you all for joining me today. It was such a wonderful discussion. I think that we gave the audience some a lot of stuff to chew on, a lot of empathy for the challenges that they're facing, hopefully some encouragement and certainly some wisdom and some things that they can do going forward. Thank you. Appreciate the opportunity. Thank you. Thank you so much for listening. I know you're busy working to bring your life changing innovation to market and I value your time and attention. To get the latest episodes on your mobile device, automatically subscribe to the show on your favorite podcast APP like apple podcast, spotify and stitcher. Thank you for listening and I appreciate everyone who shared the show with friends and colleagues. See You on the next episode of Health Innovators.

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