Health Innovators
Health Innovators

Episode 82 · 8 months 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, apodcast and video show about the leaders, influencers and early adoptors who are shapingthe future of healthcare. I'm your host, Dr Roxy Movie. Welcome back healthinnovators. On today's episode we are doing something really crazy. We areflipping the script. Typically, we are pure in a interview show where I'minterviewing 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 differentconversation. So, instead of just explaining about the commercialization and the healthcare innovationjourney, we are actually going to problem solve. We are going to talkabout ideas, thoughts and real, live, real time actions, solutions that youcan implement right now. And so we're going to talk about some ofthe 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 introduceyou to our fearless guests who have actually agreed to this. We don't wedon't know each other. We've never met each other before. They don't knoweach other and I've never met them. Of course, we've had some communicationvia digital channels to get to know one another, but I'm really excited aboutthis very organic conversation that we're going to be trying out today. So ifyou'd like it, please let me know and we'll continue to do more ofthese. 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 foryou seting me straight. And then we also have Jeff Carlyle with us. He is the president of Numa Systems Corporation. Welcome, Jeff, younice to be here. And how it rose in. He is the founderand president of life wire and forward to discussion. Awesome. So what Ilike to do before we get started into the topic of today, is justto kind of give each one of you an opportunity just share a little bitabout you know, no more than two minutes, about your background and whatyou'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 controland then went into cardiology related products and ended going back into fluid flowcontrol. 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 ninetyfive percent, at reducing your cost by eighty percent, increasing the sophistication byan order of magnitude and really being driven by the respect for changes in workflowand information flow. Although the disruption nominally comes from fluid flow, the realdisruption 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 internationalfinance and marketing. So naturally, with that I spent twenty years producing filmand Television, which is a natural segue and health. I it's a asimple story exactly, and it was. There is a story behind that andit doesn't involve some bottles of wine. But in all that I came upthe idea of what has become life wire about fifteen years ago, which I'vebeen doing this. Essentially, you lie. Far As evolved into is a cloudbased communication platform that allows patients providers...

...have an ongoing dialog as different infront of each other, but automated and remote basis. What drove me fromthe film and Television World is engagement, and so the key thing is reducingbarriers. So partly technology or the patents that we have is the patient canchoose whatever device they want, so the cell phone, a tableted computer,a landline, even a flip phone, and they can choose whatever of howeverthey want to communicate. So could be text, email, interactive voice chat, instant messaging. We actually now tie into over four hundred wearables and medicaldevices. It's instantaneous communication. There is no software, there's no APP there'sno equipment. It's truly using the cloud power of the cloud to using whatever'snative on the individual device. Instead of telling them how to communicate, theytell us and open some communication flows from their well consumer and control. Ilike it and break all right. Thank you. Roxy. I have avaried by ground, from family position, by training to more of an appliedtechnologist. 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 peopletend to look at that as Google glass. You know, if you look atthe pandemic and how tell a health help to transform, you know howwe delivered healthcare. Actually was the only way we could deliver healthcare and manysettings for a long time with during the initial time in the pandemic. Lookingat smart glass technology and how you can bring expertise to the patient regardless oftheir location, and changing that telehealth paradigm where you brought someone into a facilitythat was heavily in a data with technology so you could broadcast to a remotespecialist. Now Technology is so mobile and so fluid, utilizing smart glasses toallow the expertise to be there, to allow a person to act as aclinical Avatar for the remote expert and really break down barriers. You make expertiseand health care much more fluid. That's super exciting cool. Yeah, sovery diverse backgrounds and I think that's what's going to make this conversation just sointeresting. So today's topic, we're talking about breaking through the status quo we'retalking 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 currentlyobserving in, you know, in meeting the last few months, are nowin 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 controversialstatement here. I think in innovation, I think maybe we have too muchinnovation, Uh Huh, and I think we have an overabundance and innovation.Now let me, you know, explain that, and that is if youlook at healthcare, it is so important to develop into advanced care, thatwe've not coordinated care well, and where I live in you know, onmy training and background in primary care, is that we deal with the coordinationof health care and healthcare data every day, not to the optimization of patient carebut, I think, to the detriment because we're always on the cuttingedge, on the bleeding edge of what healthcare does. I really would liketo, you know, bring in that and you know, do we havetoo much innovation or do we temper our innovation appropriately? You know, I'malways going to be for innovation. And then when we talk about the statusquo, your your question is, you know, I really divide that outinto one of these yes and no diagrams. You know, if you do diagnosis, you get a test, then you go yes or no, whetherthe test is positive or negative. I think when you look at the statusquo, you have to ask yourself you have to apply disruption. Doesn't needdisruption, or does it not? You know, doesn't need innovation, ordoes it not? Because I think we can waste a lot of time ona taking status quo areas that actually, you're good, that may be anappropriate incumbency, incumbency, but you know,... status quo healthcare, we allhave to realize that health care is so incumbent. I mean health careis 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 itmore difficult. So I'm interested in Howard solution there. I think that soundslike something that can really be a benefit, you know, into what we're dealingwith. 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'tthink that. I I see innovation as being one of three arrows in yourquiver. Sometimes the status quo is exactly the right thing to do. Sometimesreversion is the right thing to do. Let's go back to what we usedto 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 ifit 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 andit you know, one of the things people ask is how do youcreate innovation? I said, well, to Brent's point, maybe maybe youdon't want to, but the real key is if you do want to createinnovation, you don't have to do anything. You just have to work real hardat not killing it. It'll be there like it'll be there like avirus. It's there. It's going to be there. Just quit killing itand will happen. But you don't need to do anything right to actually increaseit. I love your points on creation there, because to me I thinkthat's important, drawing a boundary between creation and an innovation. I've always seeninnovation is taking existing in parts and putting them together. I think that canbe 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 itneed to be created like an invention? You know, we said it's sortof an inventor's paradox. Are, you know, the invention versus just aninnovation? So you know it. Innovation to me is making things better appropriatelyto your bank. Essentially. You think it's all preaching to the choir hereand we're rocks these sits, but it's also what is innovation that you've gottalket 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 APPSfor example. You know, but the APP fatigue on the average patient oreven physician is insane right now. So that's not innovation. And, toJeff'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. Youdon't want to see that. You just want things to happen and as simplyand easily as possible. And sometimes, yes, reversion. But I thinkinnovation in itself is a somewhat is that's the controversial word of the whole thingis, because what is innovation? Yeah, yeah, exactly. And you know, one of the things that comes to mind when I hear you guysspeaking, is there's a big difference between like, being technology or product obsessedand 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'swhy we have so many innovations that end up in the Zombie graveyard, becausethey 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 athoughtful three by five card, yeah, instead of fifteen gigabytes updated. Ican't hug you through zoo. You're exactly right. Thank you for saying that'sright, 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 zeveryone's got to use it, but because in their perspective it's cool, theaverage perspective it may not be. And it's sort of that balance in termsof 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 stillhave to have a value proposition. How is it? What? What painpoint are you're solving by doing all the anything? What cost and at whatcosts? Well, some of these things are so expensive and so difficult thatyou you say, well, if it's this expensive, this difficult, itmust be valuable. But if you take a look at, quote, smartpump 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 andyou can mention. How could you argue against it? But if you lookat where is the Lexus of information, where do you what is it you'retrying to achieve? It absolutely and no doubt in my mind, causes moreharmed and good. It creates the illusion of safety because it's so difficult andso laborious and so expensive, but it doesn't doesn't really move the needle.No Pun intended. I like it. Keep being punny, Jeff, keepbeing funny. So so the status quo. You know, how how it toyour point that you guys are talking about. You know, how doesthat help us or how does that hinder us? And for those folks thatare in the audience that are at different points of the innovation process, youknow, how do they overcome some of the just traditional status quote that wehave, and when do they win and how do they identify that this isa status quo that's a good thing and and that I should just leave thatalone. Just just jump to the end user right, look at the enduser and say are there unmet needs? And you start there and you endthere, because once you created a solution to an unmet need, it's thepower of the consumer voice that will influence in organization. It's not going tobe the RD team, it won't be the manufacturing team, it'll be thesales guy who who finds out from his customer, Hey, these guys aretalking about something that's really, really interesting to my customers, to the endusers or to the patients or the pharmacist or wherever. And so you gotto you really have to start with have you satisfied an end user on meantneed, a consentially, it's also identifying the end user use. Let's useyou know horrible covid pandemic and the explosion telehealth. Yeah, we're all thesalesmen were making sales to the providers and the payers and they weren't as interestedin tell health. But if you ask the patients, they said, Iwant to communicate, I want to know, get this information as much as possible. But the providers and payers, and you know, the sales areoriented to them. With the you know, Covid, of all the horrible things. The one thing I think people started recognizing, oh, need tosatisfy the patient for what their needs are and have them be able to accessthe system. And I think it is very few patients went, oh mygosh, this tell health thing isn't this great, as opposed to where hasit been? We've been we've been asking for it but not being able toget it. It's again, it's just being aware of that end user isultimately the biggest point of important peace,...

...because that's what you need to satisfyin innovation and in the business proposition for the innovation, because it's not goingto 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, youknow, 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 thatit starts off with an early adoption lens and when you're building out your commercializationstrategy, thinking about that for your segmentation, because if you're talking, if you'retrying to sell your solution to the mainstream market, you're just beating adead horse right like those are the people that are digging their heels in andthey love the status quo like they are so risk averse they are never goingto buy something even like what you were describing right Howard, even if you'relike even if there is a real need from the end user, they're justlike, nope, not until it becomes an industry standard and until all thepeers in my community are telling me that I can trust it. I don'tcare what the brand says. You know any any comments or any experience aroundthat 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, andI use shows my age, but it's like the old days that we're noone ever got in the old days of computers. No goot fired by buyingan IBM product. It wasn't the best, but it was kind of like theywere the computer at that time. Yeah, and you're seeing that today, quite honestly, in terms of the larger to peep. The procurement sideis no one. You know, if if you went with a name brandor provided a certain thing that's been done before, you'll continued on what waspreviously done. You know, these are if ay, it's more safety inthe work that I'm doing and it all comes down to how you're measured onthose pieces. And that's that really comes down to. Back to the pointof he as your job to satisfy end users need, or is it tosatisfy something else? And it's really where's that risk reward for the individuals whoare making those decisions as to what direction that they go in and can sometimesa status quot is going. Okay, well, nothing's going to happen tome if I stay the status quote. Maybe it's a slightly cynical approach toit, 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 isthat the end user, the financial pair, the provider, the PRESCRIBER, theinsure the ultimate financial guarantee, or they're all different and to have allcross purposes and there is no where there is alignment, like when insurance companiesnot involved, like Lacic Surgery, all of a sudden, holy cal pricesdrop like a rock. Availability is there they get new technology every twenty fourmonths 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 Officelook like the twenty one century. Right. You go into the an obgy inplace and I got a rapids flood hanging over the woman. Go toa 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 nowthe 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 onis, you know, the telehealth thing,...

...right, so that that movement,that acceleration of adoption. You know, one of the barriers that we're allfamiliar with is the regulatory and the reimbursement hurdles, right, and sothen once that was lifted, you could actually give the consumers what they wanted. And so, you know, when I'm working with clients. We talkeda lot about was it better to go be tob or BTC, and OBCis a real costly path. And you know to what degree or patients goingto want to be out of pocket versus, you know, cash pay out ofpocket 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 toovercome. What do you think? That's a good question in terms of andit'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 isfor the for the clients or the patients, when it goes through a provider thatthey know or pair that they know, it's basically okay, here's a validatedproduct for us to use, because the problem with just the open APPmarket, for lack of better term or solutions, is how do you decidewhich works or what's good for me? You're not good for me as apatient. So we look at his providing sort of at least that a orientationto it and on the price basis it's a stratification of a market place asto 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 amonth, but if I got ten of them, but it's fifty dollarsa month? And right where? Then your prioritizing where. They want toplay another round of legends race cars or you want to wait management. AndI think the more it's provide and it's where you place the values, andthe more it's provided through a provider. Just right now, and that couldchange tomorrow, but right now at least it's providing a means of validity asto why and which one should I use? And if it's in some and someof the cost you there's a Copay, at least with some of the costscovered, 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'sa great question on what the health care consumer is willing to pay. Youknow, 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, Iwould say selfpay now is me more people who are willing to pay besides theirinsurance, like concierge, scare, Yep, the different ways of obtaining care inthat way. But what I have found in a lot of time whenyou 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 topay 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, tocome in to see someone. So and you know, I would participated withthe program here we tried to roll out with Medicare where you just had topay eight dollars for a monthly telephone evaluation where you could go over and gothrough all the data and update and try to aggregate the information better, becausewe all know that there's issues with aggregation in data sharing when you have alot of consultants involved in the healthcare process. It wouldn't pay eight dollars a monthout of pocket. And so I've been you know, that sort ofhit me, you know, right between the eyes on how adverse people areto pay and though. So when you talk about extra you know there's goingto be a population that pays that premium dollar, that say yeah, it'sworth it, fifty for telehealth services, and then people are going to say, well, you know, my time is not worth as much. SoI think that pricing discussion is extremely interesting when we could probably spend a lotmore time on yeah, I think you could take consumerism and personally owned healthrecords. 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 youtied that to consumerism, to actual shopping. As you know, with any medicalprocedure, that difference in charges for any one medical procedure is commonly tento 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 fortyone and sometimes it's twenty one in the same facility, and so it dependson how you get in and it so the ultimately a coherent, accurate practice. Your goal transportable medical record, combined with consumerism on pricing, would wouldtransform what we could have better quality for half the cost easily if those twothings were done. And then it comes down to healthcare education, just tocrust understand all the, you know, some of the pieces to its underyou know, it's your point, Brent, to understand what eight dollars really meanscompared to what you're getting for it. It's, you know, again itbecause people sort of balance out. I've got a budget and this isgoing to spend on again. How do you make that decision? and toit's not understanding and to your point, Jeff, the value of all thesepieces. You know, the average person understandably doesn't have a handle on allthat and if they did understand the logic and rationale is there, but there'sso 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 youalmost relinquish that to your doctor, to the state or to somebody you knowit. 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 alot of the healthcare resources. Hey, it's Dr Roxy here. With aquick break from the conversation. Are you trying to figure out what moves youneed to make to survive and thrive in the new covid economy? I wantevery health innovator to find their most viable and profitable pivot strategy, which iswhy I created the covid proof your business pivot kit. The pivot kit isa step by step framework that helps you find your best pivot strategy. Itwalks you through six categories you need to examine for a three hundred and sixtydegree 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 thetools, tips and strategies you need to make sure you can pivot with speedwithout 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 theirbehalf then I have in my lifetime. I'm not someone that really consumes alot of healthcare and and it has rocked my world. These are all phenomenonsthat I've known theoretically or intellectually, but now I'm experiencing them firsthand. andto keep up with all of the medications that my grandmother is allergic to versusthe ones that she's on and how I need to know that in real timeand 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 myselfis like really smart, smart, very organized, very competent and helping her. And come to find out, we just found out last week that she'sbeen on this medication for the last four months and she's been itching and Inever put it together that that was a side effect from the medication that shewas 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'sdon't but to the question that's your whole thing. I read. Iread if this was my with my mother in law who just passed, knowwho ninety one, and my father in law, where we had to becomethe 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 ofa 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 intojust medication issues where they've had the wrong medication in the pack or that thecontraindicated medications in the pack because you have five doctors, each one prescribing somethingdifferent and there's nobody coordinating all that. You know that on its own outnot 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 youcan actually centralize that information so you're not dealing with these contra indicated medications thatcan cause, sadly's itching or a more serious conness like are there are somegood there are some good innovations. Unfortunately it was acquired by Amazon, butwill pack, Bill Pack is one company that took a very, very seeminglylow tech approach to it. You know, they ship the packages. They're allbig, 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 houseor anything. It's very, very nicely done it and they they treat youlike you're their only client. They're really good company. Now they got acquiredby Amazon, so that's not going to last very long, but it isit 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'sa people around the healthcare continuou around that person who is also involved in theabsolutely, yeah, yes, part of all this. Absolutely. They shouldn'tbe forgotten as part of the equip, the equation of any kind of innovationor whatever you're going it goes back to end user piece is also defining whothe end user is. He but an end user, but you have asupport person or persons around them who really are part of that. So youguys touched on Emar Systems and so I think that's a great topic for usto Jill a little bit deeper into around uncombents. Right. Mind, ifI get a mind, if we get a beer. Anybody want to takea break? Go to a five minutes for wine with the beer. isgoing to do it, Jeff. I think of a single vault that's overthere, right, actually some good products in Kentucky. Yeah, he provethat. Send US some drinking products, not Amur product. I know whathe'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 ourlisteners. 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 thereanything we can do? Or Our hands tied? It could actually be solvedin 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 stateor 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 threepage document. It does not need to be totally complicated and it could bedone 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 alock, you know, right now, with handful of companies that really dominatethat space, and I think it's just going to there are simpler approaches toit and I think there will be innovators with some small hospitals that can beproof sites to show that you can achieve a better clinical assult at one tenththe resources. And that's the right ratio to look for. You don't wantsomething it's twenty percent better than epic right, you know, you need something that'sgot any fifty times better and the but it's both in the price andperformance. It's going to be, you know, five times better at onefifth the cost. You know, that kind of ratio, but it itwill happen. The system is absolutely broken. But these hospitals, the bigger theyget, 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 ownershipof that simple, transportable, practical, accurate record. has to belong tothe patient and there have to be lots as a structure to allow that tobe updated and maintained. But it's not a not a big structure. It'snot a very complicated thing. It's a matter of setting standards and allowing thatto happen. I think the real search here is is finding a sustainable revenuemodel. You know, if you look at the Hie's, they were goingto give every state to Hie and then you would get regional his and theywould be like a Federal Reserve where you could exchange information. But if youlook at any state Hie, show me one state Hie in the country that'smaking money. I don't think anybody has any kind of revenue bottel, muchless. They may have some revenue models, but they're not sustainable. So there'sno if you look at healthcare data, there's no transunion equifax experience that aremoving 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 mylaces prescription, and I say that because people spend a week in the hospitaland they may not get their prescription and it may not be that it wasa fault of writing it. Maybe it was they couldn't get it filled orthey just didn't know that they weren't on laces when they left the hospital orthey 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 aCBC from two small towns here in Kentucky or from New York to Chicago ifyou are on two disparate Emar centers, m e Mars. It's worse thanthat. It's worse than that if you are on the same system. Thestate of right island pretty much got for every primary care doctor the exact samesystem for primary care. Everybody had the same system, but if a primarycare doctor went from one facility to the next, they couldn't transfer the recordsto the patient. Now, technically, of course they could, but therewasn't any support structure that allowed them to transfer the records, and that's becausethe locust was in a wrong place. It was in some doctor's office didn'tbelong to the patient. So you you highlighted some financial models and you knowit was the visa network that allowed the exchange of information. The creation ofthe 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. Butthe free market really has to have a revenue model to make it work andit's really worth while. The return on investment is enormous if you've got theright 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 thata new company you're starting? No, Ha, I've tilted at the windmillof a trying to medical records for almost forty years. When I first hadhad a guy named Dr Larry Weed, the father of the problem oriented medicalrecord, I became a zeal it, but I was I thought it wasfive years ahead of the curve and I wasn't. I was fifty. I'vegot 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 thatspace good, very interesting and looking at some very counterintuitive place here, becauseI think that the real issue. If you think about it, you talkabout incumbency and in bear with me here, there's sort of an incumbency of knowledgeand that, I'm going to say, maybe an incumbent, see of ignoranceand that I don't think really patients had this conceptualization that I have anelectronic medical record, much like I have a bank account, and that needsto reconcile and balance everywhere I go, because we do not have that mindset. If I ran a bank, and I do have banking background, youknow, in my work, and if I ran a bank and you gaveme a check and you came in are then you had another check. Ididn't deposit that first when then you were overdrawn, you probably wouldn't keep meas your bank very long. But in healthcare we're overdrawn on reconciliation every dayand health care and until we get to that point where patients understand that Ihave to have a reconciliation of my healthcare data, and until you have thatplace 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'snot going to reside in one hie. There has to be a way toeither reside that information or to continually move it and make sure that people knowthat it's been updated. I don't need to know necessarily the results of atest, 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, becausepatients will say an MRI I was done two years ago when it was donesix months ago, right, and if I hear that from a history Imay repeat the MRI. But if I know it's six months and sometimes it'ssuch a barrier to gain the knowledge and over utilization of office staff to trysomething down, you may go ahead and spend the money. You know andI 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 wastein healthcare. Yeah, yeah, that's kind of what we try to do. is in terms of our early because I said that last moment, connectivityto the patient is usually, you know, and whatever communication they want to navigatesome of the the solution sets are with their clients are doing and beable to pull information that is important to them using natural language to get astart 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 thedata from the HR, even if it's your own information, but it's astart 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 understoodso they can get that information. But I think it's a as yousaid, 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 Iwant to in this on some actionable insights things that people that are listening canactually can start implementing now. So we think about some of the barriers andchallenges that we've talked about today and maybe even some myths. What's what's onestrategy or tactic? What's one thing that you think the audience can do?It can be, you know, something that they listen to, something thatthey explore, something that they implement. What is what is some something thatthey can do to have more success in their commercialization journey as they're navigating thisentrepreneurial, corporate innovator changing the world kind of mission? Well, first youhave to care to do something. Yeah, and then, secondly, you haveto be very respectful and listen to end users. It can't be drivenby technology, it can't be driven by copying somebody. It's got to bedriven by respectfully, quietly listening, finding out what is an unmet need.And then, I think start slow and do pilot programs and keep expanding thepilot in which you end up selling and everyone's selling something. Your end upselling the results of what you've done, not what you're doing, but theresults of what you've done. So it all starts and ends with the enduser. What what? And and as Howard's is set several times, whothey heck is the end user? You know, it may not be thepatient, may not be the doctor, maybe in an intermediary group. SoI don't think there's anyone one thing, but there are a lot of lessonsto be learned in a lot of pitfalls to to avoid. So it justwent through the market scan. If you play absolutely the end user, thinkwe all agree you look at the end user, but when you're looking atyour competitive stet you know, look at the sort of see who you thinkof competitors. You look to see what they're saying and how they're addressing theend user and also, more importantly, what are they not saying, butwhat they're doing. And you may find that actually that's where the intersection ofopportunity exists, where it's not being said right, is not being said,it's likely not being done. Yeah, good stuff. You know. II'm going to say this. I still believe in magic. When I saythat, I say that I as we talked about technology, I still believethat there's a magic between two human beings interacting with one another, and Ijust cause for one second and go, oh my gosh, why are younot 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 acrossa 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. AndYeah, but when you look at technology you have to have an enable andlet me give you an example here. If you look at tell a healthusage over the pandemic, you know, it exploded. It's like, youknow, seventy eighty percent, and as soon as people can get back inthe office it just goes down to less than fifteen percent, less than twentypercent. So if technology was that great, if telehealth was that great, it'sa great tool. Okay, it's a tool, but still, thereis something that people receive from working with people who care about them and workingwith office stabs. So what I see in working at with an office staffevery day and working with providers, you know, throughout the state and throughoutthe nation is you you do have an issue with burnout, in fatigue inyour healthcare workforce. So this is near and dear to my heart and thatwhen you have when you design innovation,... has to be with workflow inmind, it has to be with efficiency in mind and keeping that in userand for me, the end user, the consumer. You know, Ilook 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 thankyou for the opportunity today. Yeah, yeah, absolutely, and I thinkto your point, Brent, is that, you know, not everyone is goingto ever really want on demand, self serve care and not everyone isgoing to want to go back facetoface and have that human inner, high touch, human interaction. I think, you know, one of the lessons thatwe can learn is to not really swing either way and for us to thinkabout our businesses and programs as hybrid models, because I think that we're going tosee that if we're trying to personalize care for specific population, even ifwe'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 inthe exact same way as human beings were really different, and so thehybrid 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 getAhold of you if they want to follow up after the show. For meit's easy. You could just email me at Jeffrey Carlyle at mecom, JeffreyCarlisle at m ECOM, and for me it's Howard Rosen, which is hrosen at life wire groupcom. And for me it's our dot right, wrGht 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. Itwas such a wonderful discussion. I think that we gave the audience some alot of stuff to chew on, a lot of empathy for the challenges thatthey're facing, hopefully some encouragement and certainly some wisdom and some things that theycan do going forward. Thank you. Appreciate the opportunity. Thank you.Thank you so much for listening. I know you're busy working to bring yourlife changing innovation to market and I value your time and attention. To getthe latest episodes on your mobile device, automatically subscribe to the show on yourfavorite podcast APP like apple podcast, spotify and stitcher. Thank you for listeningand I appreciate everyone who shared the show with friends and colleagues. See Youon the next episode of Health Innovators.

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