Health Innovators
Health Innovators

Episode 82 · 7 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

I you're listening to health, innovators,a podcast and video show about the leaders influencers and early a doctorswho are shaping the future of health care on your host Doctor Roxy Movie Welcome Back Health Innovators ontoday's episode. We are doing something really crazy. We are flipping thescript. Typically, we are pure in a interview show where I'm interviewing aguest one on one and today we're doing something really different. I'veinvited three guests to join me today for us to have a somewhat differentconversation. So, instead of just explaining about the commercializationand the Health Carnovan Journey, we're actually going to problems solve, weare going to talk about ideas, thoughts and real, live real time actions, solutionsthat you can implement right now, and so we're going to talk about some ofthe challenges that we're facing in health care, novation and then, like, Isaid some ways that we can solve it. So, first off, let me introduce you to ourfearless 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 nevermet them. Of course, we've had some communication via digital channels toget to know one another, but I'm really excited about this very organicconversation that we're going to be trying out today. So if you like it,please let me know and we'll continue to do more of these so Brent. Let meintroduce you first, so Brent Wright, who is the dean of rule healthinnovation at the University of Louisville Welcome. Thank you. It's associate Daneassociate an okay thanks for you setting me straight, and then we alsohave Jeff Carlyle with this. He is the president of Numrous SystemsCorporation, welcome, Jeff, Cute Mace to be here andhow it rose in. He is the founder and president of life wire and forward to discussion awesome. Sowhat I'd like to do before we get started into the topic of today? It'sjust to 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 into leaving these days. Let's start off with you Jeff: Well, I'm a forty year, cerealentrepreneur. I've worked in some big companies as a intra Preneur, but allin the world of medical devices, so start it off in fluid flow control andthen went into cardialgia related products and ended going back intofluid flow control. So today we're working on a disruptive technology forintervene. This infusion therapy so we're taking the legacy devices andreducing their size and weight by ninety five percent, reducing theircost by eighty per cent increasing the sophistication by anorder of magnitude and really being driven by the respect for changes inwork flow and information flow. Although the disruption nominally comesfrom fluid flow, the real disruption comes when you tie together, fluid flowinformation flow and work flow. Wow. That's fantastic! Can't wait tolearn more Howard. So again, I'm life wire, I'm a typical health. Itstory by education. I have an MBA international finance and marketing. Sonaturally, with that I spent twenty years producing film and Television,which is a natural Segua into health. It yeah it's a it's a simple story exactlyand it was. There is a story behind that and it does involve some bottlesof wine, but in all that I came up with the idea of what has become life wireabout fifteen years ago, which I've been doing this, especially what youlife far as evolved into, is a cloud...

...based communication platform thatallows patients providers of an ongoing dialogue as different in front of eachother, but an automated and remote basis. What drove me from the film andTelevision World is engagement, and so the teething is reducing barriers sofor part of the technology of the patents that we have is the patient canchoose whatever device they want. So we cell phone a tablet, computer a landline, even a flip one, and they can choose whatever De. However, they wantto communicate so it could be text. Email, interactive voice, chat, instantmessaging. We actually know tied over four hundred wearables and medicaldevices. It's instantaneous communication. There is no software.There is no apt, there's no equipment, it's truly using the cloud power of thecloud to using whatever is native on the individuals device. Instead oftelling them how to communicate. They tell us and opens a communication flows from there.Well consumer and control. I like it and Branka Right. Thank you, Roxy. Ihave a buried background from faily position by trading to more of anapplied technologist. Now, with my work as an Associatin, I love technology. Ilove looking at how that can be applied to rural health car population,something that we're looking at very closely now a smart last technology.Often people tend to look at that as Google glass. You know if you look atthe pandemic and how tell a help help to transform. You know how we deliveredhealth care actually was the only way we can deliver health care in manysettings for a long time with during the initial time of the pandemic,looking at smart glass technology and how you can bring expertise to thepatient, regardless of their location and changing that tellee paradigm,where you brought someone into a facility that was heavily in Idatenwith technology, so you could broadcast to a remote specialist. Now thetechnology is so mobile is so fluid utilizing smart glasses to allow theexpertise to be there to allow a person to act as a clinical Avatar for theremote expert and really break down barriers. You make expertise and helpyour much more fluid. That's UPER, exciting e, so ver, diverse backgrounds- and Ithink that's what's going to make this conversation just so interesting. Sotoday's topic, we're talking about breaking through the status quo, we'retalking about dethroning incumbents and we're talking about navigatingconsolidation. So Brent, just start us off by telling us some of the thingsthat you are currently observing in you know it maybe in the last few months,are now in the landscape as it might relate to any one of those threephenomenons. You know I'm going to start off with something and maybe makea controversial statement here. I think in innovation I think maybe we have toomuch innovation. I think we have an over abundance and innovation. Now, letme you know, explain that, and that is, if you look at health care, it is soimportant to develop and to advance care that we've not coordinated carewell and where I live in you know my training and background and primarycare is that we deal with the coordination of health care and healthcare data every day, not to the optimistic of patient care,but I think to the detriment, because we're always on the cutting edge on thebleeding edge of what health care does. I really would like to you know bringin that and you do. We have too much innovation, or do we temper ourinnovation appropriately? You know I'm always going to be for innovation andthen, when we talk about the status quo, your your question is, you know. Ireally divide that out into one of these. Yes and no diagrams, you know.If you do diagnoses, you get a test, then you go yes or no. Whether the testis positive or negative. I think when you look at the status quo, you have toask yourself: You have to apply to disruption, doesn't need disruption ordoes it not? You know, doesn't need innovation or does it not because Ithink we can waste a lot of time on attacking status quo areas thatactually are good. That may be inappropriate, incumbentes incumbency,but you know, and status quote health... We all have to realize thathealth care is so incumbent. I mean health care is like twenty thirty yearsincumbent, so we have to be very, very careful, butright now I think we're really heading into the appropriate time, if you'regoing to be a health care innovator to make great changes. But again, back tomy original point, yew, we have an over abundance of innovation because I seepeople innovating in spaces that really create more problems because, as weinnovate, we create fragmentation and that fragmentation for me, someonetrained as a clinician as a position that just makes it more difficult, soI'm interested in Howard solution there. I think that sounds like something thatcan really be a benefit. You know into what we're dealing with a give. It token jump in. I sorry sor I 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 your quiver.Sometimes the status quo is exactly the right thing to do. Sometimes, reversionis the right thing to do. Let's go back to what we used to do and innovationjust gives you another tool right, it's not it if by itself is not of any value,it's only a value if it achieves the intended objective. So I agree I people asked me. I wrote a bookcalled that we love innovation so long as it's nothing new and it one of the things people ask is how doyou create innovation? I said well to Brent's point. Maybe maybe you don'twant to, but the real key is. If you do want tocreate innovation, you don't have to do anything. You just have to work realhard at not killing it, but it'll. Be there like a it'll, be there like avirus. It's there. It's going to be there just quit killing it and it willhappen, but you don't need to do anything to actually increase it. I love your points on creation there,because to me I think it's important drawing a boundary between creation andan innovation. I've always seen innovation as thinking existing partsand putting them together. I think that can be very important to innovation.Sometimes, if you try to create too much, you can actually won. There's atime factor there, and one does does it need to be created like an invention.You know we say I sort of an inventor's paradox there. You know the inventionversus just an innovation, so you know it. Innovation to me is making thingsbetter appropriately. To Your be, essentially, you think it's allpreaching to the choir here and we roku's, but it's also, what isinnovation that you've got talked about. corporates in terms of people say well,you've got to innovate. What does that mean in terms of if it's making moreAPPS? For example, you know, but the AP fatigue on the average patient or evenphysician is insane right now. So that's not innovation and to Jeff'spoint. Sometimes innovation is having the determination say. You know whatwe're actually on the path. We need to be on right now. You know, as you havejust the premise behind what I did to me: innovation, the open innovation.What we do is where the technology is invisible. You don't want to see thatyou just want things to happen and is simply and easily as possit andsometimes yes, reversion. But I think innovation in itself is like someone isthat's a controversial word. The whole thing is because what is innovation,yeah, yeah exactly, and you know one of the things that comes to mind when Ihear you guys speaking, is there's a big difference between like beingtechnology or product obsessed and being customer obsessed and reallysolving a real problem that people are facing versus invading for the sake ofinnovating, because it's sexy and I think that's why we have so manyinnovations that end up in the Zombie graveyard, because they were neverneeded to begin with we or they may be adopted. You take a look at a typical,acute care. Electronic medical record...

...system- well, it gets adopted a great great,great expense yea, and there are. There are many patients that would be betteroff with a thoughtful three by five card yeah instead of fifteen gigabytes up dat, I can't hug you through Zo you're, exactly right. Thank you forsaying at'Sa a lot of the time you've got. You know when we experience anwe've, seen it because but 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 theirperspective it's cool the average perspective it may not be, and it'ssort of that balance in terms of saying just because it's cool doesn't mean ithas the value that it should and to jes point you have and Brents you stillhave to have a value proposition. How is it what what pain point are yoursolving by doing at a an what cost and it want cost? Well, some of thesethings are so expensive and so difficult that you you say well, ifit's this expensive this difficult, it must be valuable. But if you take a look atquote a smart pump infusion pup technology. How could you argue againstit? Oh it and you can. You can pick up an ANEC like that you can mention. Howcould you argue against it? But if you look at where is the Lexis ofinformation, where do you, what is it you're trying to achieve it? Absolutelyand no doubt in my mind, causes more harmed than good. It creates theillusion of safety, because it's so difficult and so laborious and soexpensive, but it doesn't doesn't really move the needle, no pun intended.I like it, keep being ponty Jeff keepingfunny so so the status quo. You know how. Howis to your point that you guys are talking about you know? How does thathelp us or how does that hinder US and for those folks that are in theaudience that are at different points of the innovation process? You know, how did they overcome some of the justadditional status quote that we have and when do they win, and how do theyidentify that this is a status quo. That's a good thing and and that Ishould just leave that alone, just j just jump to the end user right, lookat the end user and say are their unmeant needs and you start there andyou end there, because once you created a solution to an UNMEANT need it's thepower of the consumer voice that will influence an organization. It's notgoing to be the rand team, it won't be the manufacturing team, it'll, be thesales guy who who finds out from his customer. Hey. These guys are talkingabout something. That's really really interesting to my customers, to the endusers or to the patients or the pharmacist or whatever, and so you got to you really have to startwith. Have you satisfied an end user unmeant need? I could sentais alsoidentifying the end user us? It's us, you know horrible Covin pandemic andthe explosion tell health yeah, where all the salesmen were making sales tothe providers and the payers and they weren't as interested in tell health.But if you ask the patience they that I want to communicate, I want to know getthis information as much as possible, but the providers and payers- and youknow the sales- are awanted to them with the: U N, W Covin, all thehorrible things. The one thing I think people started recognizing Oh need tosatisfy the patient for what their needs are and have them be able toaccess the system, and I think it's very few patients went oh my gosh. Thistell health thing. Isn't this great as opposed to? Where has it been we, but we've been asking for it, butnot been able to get it again. It's just being aware of that in user isultimately the biggest point, important...

...peace, because that's what you need tosatisfy in innovation and a business proposition for the innovation, becauseit's not going to be, you can build it, but if it's not going to be used as Ithat's going to go, the son be graveyard yeah. You know it makes me think of acouple of things. One is, you know, a lot of the research that I've done isreally say that it starts off with an early adoption lins and when you'rebuilding out your commercialization strategy. Thinking about that for yoursegmentation, because if you're talking, if you're trying to sell your solutionto the mainstream market, you're just beating a dead horse right like thoseare the people that are digging their heels in and they love the status quolike they are so risk averse. They are never going to buy something even likewhat you are describing right, Howard, even if you like, even if there is areal need from the in user they're, just like no, not until it becomes anindustry standard and until all the peers in my community are telling methat I can trust it. I don't care what the brand says. You know any anycomments or any experience around that type of lines that might be used in buildingout that strategy sertain from our experience in terms ofbeing in terms of sales, and I use shows my age, but it's like the olddays that were no one ever got in the old days of computers, no good fired bybuying an ibn product. It wasn't the best, but it was kind of like they werethe computer at that time. Yeah and you're, seeing that today, quitehonestly in terms of larger to peep the PROCUMATIA, no one you know, but if youwent with a name brand or pro did a certain thing, that's been done beforeyou continued on what was previously done. You know this are a it's moresafety in the work that I'm doing and it all comes down to how you'remeasured on those pieces- and that's that really comes down to back to thepoint. We yes, as you job to satisfy in users, need or is it to satisfysomething else, and it's really werds that risk reward for the individualswho are making those decisions as to what direction that they go in and andsometimes the status quote, is going. Okay, well nothing's going to happen tome. If I stayed 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 nearlycynical enough I'll die it up for the next andecy. One of the one of the problems we havein our industry is that the end user, the financial payer, the provider, thePrescriber, the insurer, the ultimate financial guarantor, they're, alldifferent. I need to have all cross purposes and there is no, where thereis alignment like when insurance companies not involved like lasixsurgery, all of a sudden holy count, prices drop like a rock availability.Is there they get new technology every twenty four months, and it's like it'sphenomenal because it wasn't adulterated by insurance, yeah anddentistry is in similar. There isn't enough, you know there isn't big component ofinsurance are as much in dentistry and Dennis Office. Looked like the twentyfirst century right, you go into the ogy place and I got a rapid ploodhanging over the Wongo to a dentist's office and it is twenty Fort Century.It really is UN truly unbelievable. Oh, my goodness, and their primary businessof preparing cavity went away the entire floor, the face business. Theyhad went away, and now you know it's all changed entirely to cosmetics andother a yeah. So so one of the things that I thinkyou guys are touching on is you know...

...the tell a health thing right so thatthat move that acceleration of adoption. You know one of the barriers that wereall familiar with is the regulatory and the reimbursement hurdles right, and sothen, once that was lifted, you could actually give the consumers what theywanted. And- and so you know, when I'm working with clients, we talk a lotabout well. Is it better to go, be a be or be to see and obt is a real costlypath and you know to what degree or patients going to want to be out ofpocket versus. You know: cash pay out of pocket type of things that theycan't get the payment model alignment versus you know, that's just a barrierthat you're not going to be able to overcome. What do you think? That's a good question in terms of andit's something we deal with all the time, so I got a e. just our approachwere B to BBC and, and part of that is, is for the for the clients of thepatients when it goes through a provider that they know where payerthat they know it's. Basically, okay, here's a validated product for us touse, because the problem with just the open now at market for lack of betterterm or solutions is how do you decide which works or what's good for me ornot good for me as a patient, so we look at his providing sort of at leasta a orientation to it and on the price basis. It's a stratification of amarket place as to who pay for what the average person goes. You know goes orhow many APPs going to have. We one APP is five oars a month, but if I got tenof them, but fifty a month, he were then you're prioritize where you wantto play another round of legends race, cars or you want to you, wait management and I think themore it's provide and it's where you place the values and the war isprovided through a provider just right now, an I I could change tomorrow, butright now at least it's providing he and means of validity as to why andwhich one should I use, and if it's in some and some of the costume with heras a Copa, at least with some of the cost covered, if you have a value, soyour paying something for it, but you know you're getting some reduction inprice as well. I think that's a great question on whatthe health care consumers wanted to pay. You know you also have to look at. Youknow how that breaks down, whether it's in different populations, whetherthat's Medicaid, Medicare, yeah, don't pay. You know less of thatnow, but when I would say self paid now is me more people who are willing topay besides, the rich shirts, likeconcierge Yep, the different ways of obtaining care in that way. But what Ihave found in a lot of time when you have bigger payers for your casegovernment or your pseudo socialized payers, like medicate Medicare, thosepeople are very averse to any alamode charges. I mean no in medicate here inour state. We move from having to pay a dollar for a visit to taking thatdollar payment away. You know couldn't believe that we were arguing about adollar. You know to come in to see someone so, and you know I was 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 goover and go through all the data and update and try to aggregate theinformation better, because we all know that there's issues with aggregationand data share. When you have a lot of consultants involved in the health careprocess, he wouldn't pay eight dollars a month out of pocket and it so I've been. You know that sort ofhit me. You know right between the eyes on how averse people are to pay Endo.So when you talk about extra, you know there's going to be a population thatpays that premium dollar that so yeah, it's worth it fifty for telaesthesiaand then people are going to say. Well, you know my time is not worth as muchso. I think that pricing discussion is extremely interesting and we couldprobably spend a lot more time on the yeah but think I could take consumerismand...

...personally own health records. That's that's about forty five daysworth of discussion. It's so important in so criticallycritically critically important eight dollars a month and to try toassimilate a coherent, mackel record would be worth an if you tied that toconsumerism to actual shopping. As you know, with any medical procedure, thedifference in charges for any one medical procedure is commonly ten toone with no no correlation to what youmight think of his quality. Ten to one is common there in the Boston area.Sometimes it's forty one and it sometimes is twenty one in the samefacility and it so it depends on how you get in and it so the ultimately, a coherentaccurate practicaltransportable medical record, combined with consumerism on pricing, wouldwould transform what we could have better quality for half the cost easily.If those two things were done, and then it comes down to health care educationjust to cross to understand all you know some of the pieces to it under.You know to your point Brent, to understand what eight dollars reallymeans compared to what you're getting for it. It's you know again, becausepeople started balance out. I got a budget and this is what I to spend onagain. How do you make that decision, and so it's not understanding and toyour point jeff the value of all these places. You know the average personunderstandably doesn't have a handle on all that and if they didn't understandthe logic and rationales there, but there's so much to learn and it's socomplicated as we're. You know joking earlier about how come, I would say,those an even even you Howard or you Brent. Were you roxy if you were ill you're really in an impaired frame of mind to make good judgmentsyou you almost relinquish back to your doctor, to the state or to somebody.You know it, it's really. It's really a challenge when you'rewhen you're not feeling well- and of course that's when you take a lot ofthe consume, a lot of the health careresources- hey it's Dr Roxy, here with a quickbreak from the conversation. Are you trying to figure out what moves youneed to make to survive and thrive in the new Co vid economy? I want everyhealth innovator to find their most viable and profitable pivot strategy,which is why I created the Co. Vid proof, Your Business Pivot Kid. Thepivot kit is a step by step framework that helps you find your best pivotstrategies. It walks you through six categories. You need to examine for athree hundred and sixty degree view of your business. I call them the sixcritical 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 sureyou can pivot with speed without missing out on critical details andopportunities, learn more at legacy: Hyphen Daco Back Kit, I'm a careg from a ninety two year, old,grandmother and and another relative. That's really really sick that in hislate O s, so I have consumed indirectly a lot more health care in the last yearon their behalf, then I have in my lifetime, I'm not some one that reallyconsumes a lot of health care and- and it has rocked my world. These are allphenomenons that I've known, theoretically or intellectually, butnow I'm experiencing the first hand, and to keep up with all of the medicnations that my grandmother is allergic to versus the ones that she's on andhow I need to know that in real time and then be able to give thatinformation to all of the different...

...providers. I mean it's a it's a it'sreally hard and I think of myself is like really smart, smart, veryorganized, very confident in helping her and come to find out. We just foundout last week that she's been on this medication for the last four months andshe's been itching, and I never put it together that that was a side effect onthe medication that she was on like Rosier Shit, but that shame on you. Iknow I felt I was like I'm so sorry I t O, but to the question. That's yourwhole thing I I read into this was my with my mother in law, who just passednow who's ninety one and my for father in law, where we had to become thehealth care navigators. In this case, her seven seven hundred miles away,yeah and then part because they didn't know what to ask, but second of we talkby medication- and I you know I pulled in you know and in form a polmonteverybody had known with elderly parents. I don't like anyone, has notrun into just meditation issues where they've had the wrong medication in thepack or the the Contra indicated medications in the pack, because youhave five doctors, each one prescribing something different and there's nobodycoordinating all that. You know that on its one else, not on topic, but justtalk about innovation. If you want a Adain, someone can figure out actuallythat bill to automate that process. So you can actually centralize thatinformation, so you're not dealing with these contridicted medications that cancause. You know, sadly, itching a on more serious, but there are some good.There are some good innovations. Unfortunately, it was acquired byAmazon but plack to pack his born company that took a very, veryseemingly low tech approach to it. You know they ship the packages, they'reall big, big, big labels and they're all organized an IT's beautiful. It'snot a not a, not a you know, computer in your house or anything,it's very very nicely done it and they they treat you like you're,their only plant, they're a really good company. Now they got acquired byAmazons. So that's not going to last very long, but a it is. It was a good.It was a really good innovation in a very important field, but to your pointbox, it involves it's. Not just one person is a people around the healthcare continual around that person. A is also involved in L. absolutely yeah, aspart of all this at the inthat should be forgotten as part of the Qu. Theequation of any kind of innovation or whatever going it goes back to in user.Pete is also defining who the end user. is you but an end user, but you have asupport person or persons around them. Who really are part of that? So you guys touched on Em r systems,and so I think that's a great topic for us to Jill a little bit deeper intoaround unconvent. He you mind. If I get A, do you mind if for get a beer, I may want to take a break. I will do afive minute in with me beers gonna. Do it Jeff, I just think of a single Balt, that'sover there, but I think exactly got some good products in Kentucky a hurt. Ye Send US drinking products, not Amr product. Iknow what he's talking about libations here, all right, okay early, you know so so what do we do about thisright? We know the problem, you know be good. Just for ourlisteners. Let's sit, 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 likewhat 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, notas something that belongs to the insurance company or the state or adoctor, but think of it is the property of the patient, and then you haveprofessionals to help like that. You do on your text, return help you organizethat, and the interoperability can be...

...done in a three page document. It doesnot need to be totally complicated and it can be done with people like Howardto manage it in every kind of format. Youcan imagine, and it's so the structure of it can be simple now, once you getinto the acute care hospital, there is a lock. You know right nowwith a handful of companies that really dominate that space, and I think it's just going to. There aresimpler approaches to it and I think there will be innovators with somesmall hospitals. That can be proof, sits toshow that you can achieve a better clinical result at one ten, O resourcesand that's the right ratio to look for. You don't want something. It's twentypercent better than epic, but in is something that's got to be fifty timesbetter and but it's poseing the price and performance it's going to be. Youknow five times better at one fifth, the cost. You know that kind of ofratio, but it it will happen. The system is absolutely broken, but thesehospitals, the bigger they get the more they think they have to follow. Youknow the lead of the Cleveland Pleni 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 beupdated and maintained. But it's not not a big structure. It'snot a very complicated thing. It's a matter of setting standards andallowing that to happen. I think the real search here is isfinding a sustainable revenue model. You know if you look at the hies, theywere going to give every state a Ha and then you would get region Aa's and theywould be like a Federal Reserve where you could exchange information. But ifyou look at any state, hie show me one state hia in the country: that's makingmoney. I don't think anybody has any kind of revenue bottle much less. Theymay have some revenue models, but they're not sustainable. So there's! No.If you look at health care data, there's no Trans Union equitiexperience that are moving, that data sort of creating that Pico score.Creating what's happening, hey. I was discharged from the ER R s dischargedfrom the hospital with CHF my gosh. It's really important that I got homewith my lasix prescription and I say that because people spend a week in thehospital and they may not get their prescription- and it may not be that itwas a fault of writing it. Maybe it was, they couldn't get it filled or theyjust didn't know that they weren't on Lasix when they left the hospital orthey got put on moral lasix. We're dealing with very subtle issues herewhen I talk about maybe too much innovation I'll put it in this way wecan transplant organs, that's a big deal. WE CAN'T SHARE A C B C from twosmall towns here in Kentucky or from New York to Chicago. If you are on twodesperate em or centers a more at it, it's worse than that,it's worse than that. If you are on the same system, the state of Rhode Island,pretty much got for every primary care doctor the exact same system forprimary care, everybody had the same system, but if a primary care doctorwent from quint facility to the next, they couldn't transfer the records ofthe patient. Now technically, of course, they could, but there wasn't any support structurethat allowed them to transfer the records, and that's because the locustwas in a wrong place. It was in some doctor's office, didn't belong to thepatient at so you highlighted some financial models, and you know it wasthe visa network that allowed the exchange of information. The creationof the ATM is that kind of structure...

...that allowed enabled all that stuff.It's a structure of g PS. It allows mapping it's a structure of all thesethings, so there is a role to play in a central structure, but the free marketreally has to have a revenue model to make it work, and it's really worthwhile the return of investment is enormous. If you've got the rightinformation, not the right data, the right information at the right time,great t e the cost of treating a patient drops like a rock yeah. So how is that so so who's doing it Jeff? Is that anew company you're starting I tilted at the windmill of atropatiarecords for almost forty years, when I first had that a guy named Dr LarryWeed the father of the problem, oriented medical record, I became asalad, but I was I thought I was five years ahead of the curve and I wasn't Iwas fiffy. I've got other fish to FRY. Well, I'm following E, I'm gonna, I'mgonna follow the money and it ain't it ain't there. So, let's, let's wrap up o Brent, didyou want to say something? I'm just going to say: I'm working with a startup right now, looking at that space, a very interesting and look in at somevery counter intuitive place here, because I think it's a real issue. Ifyou think about it, you talk about incumbency and and bear with me here,there's sort of an incumbency of knowledge and that I'm going to saymaybe it incomes of ignorance and that I don't think really. Patients havethis conceptualisation that I have electronic medical record. Much like Ihave a bank account and that needs to reconcile and balance everywhere. I gobecause we do not have that mind set if I rent a bank- and I do have bankingbackground- you know in my work and if I ran a bank and you gave me a checkand you came in or then you had another check. I didn't deposit that first.When then you were overgrown. You probably wouldn't keep me as your bankvery long, but in Holtcar we're overdrawn on reconciliation every dayand help care, and until we get to that point where patients understand that Ihave to have a reconciliation of my health care data and until you havethat place to park it, you know much like you do with coin base. You knowyou have to have. Where is that information going to reside? It's notgoing to reside in one Hie? There has to be a way to either reside thatinformation or to continually move it and make sure that people know thatit's been updated. I don't need to know necessarily the results of a test, butwhat's important for me is to know that a test was done and insurance companiesreally need doctors to know that M R is were done because patients will say inMri was done two years ago when it was done six months ago. Right and if Ihear 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 utilizationof office staff to track 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 wastejust this simple mechanism of communicating effectively could reducea lot of cost and waste in health care. Yeah. That's kind of what we try to dois in terms of our Norway, because I said that last me connected a to thepatient is usual. You know in whatever communication they want tonavigate some of the the solution sets or what their clent are doing and beable to pull information that is important to them, using naturallanguage to get a start to at all. Obviously, it's not a full in depth.You know, grab everything because there's a lot of reasons why you can'tgrab all the data from the HR, even if your own information, but to start totry to help them navigate. Some of that,... your point, it's going to be simple.You know natural language and a question, that's understood, so theycan get that information, but I think it's a as you said Jeff. Ultimately, itcomes down to whoever thinks they own the day that that's where your problemis going to be and that's where your opportunities are yeah yeah. So we talked about a lot of stuff todayand I want to end this on some actionable insights things that peoplethat are listening can actually can start implementing now. So we thinkabout some of the barriers and challenges that we've talked abouttoday and maybe even some of myths. What's what's one strategy or tactic?What's one thing that you think the audience can do it can be? You knowsomething that they listen to something that they explore, something that they implement. What is what is somesomething that they can do to have more success in theircommercialization journey is they're navigating this entrepreneurial corporate innovator,changing the world kind of mission? Well, first, you have to care to do something yea and then. Secondly,you have to be very respectful and listen to and users. It can't be drivenby technology. It can't be driven by copying somebody. It's got to be drivenby respectfully quietly listening finding out what is an unmeant need andthen I think, start slow and do pilot programs andkeep expanding the pilot in which you end up selling and everyone's selling,something you end up, selling the results of what you've done, not whatyou're doing but the results of what you've done. So it it all, starts andends with the end user. What what in and is Howards have said several timeswho the heck is the and user. You know that may not be the patient may not bethe doctor. Maybe you know an intermediary group, so I don't think there's anyone one thing, but there are a lot oflessons to be learned in a lot of pitfalls to avoid so it just when doingthe market scar. Think you play absolutely the and news er think we allagree. You look at the end user, but when you're looking at your competitiveset, look at to serious see who you think of competitors, you know look tosee what they're saying and how they're addressing thin user and also, moreimportantly, what are they not saying, but what they're doing? And you mayfind that? Actually that's where the intersection of opportunity exists withnot being said right, Ombi said it's likely not being done. Yeah good stuff. You know I'm going to saythis. I still believe in magic when I say that I say that as we talkabout technology, I still believe that there's a magic between two humanbeings interacted with one another, and I just paused for one second and go. Ohmy gosh. Why are you not an entrepreneur, commercializinginnovation? If you believe in magic and you're, an 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, inmagic at I have. I wear a lot of different hats, yeahyeah, but when you look at technology youhave to have an enable- and let me give you an example here. If you look attell a health usage over the pandemic, you know it exploded. It's like youknow seventy eighty percent, and as soon as people could get back into theoffice, it just goes down to less than fifteen per cent less than twenty per cent. So iftechnology was that great, if Teeho was that great, it's a great tool, okay,it's a tool, but still there is something that people receive fromworking with people who care about them and working with office staffs. So whatI see in working it with an office staff every day and working withproviders, you know throughout the state and throughout thenation, is you do have an issue with burn out and fatigue in your healthcare work force? So this is near and dear to my heart and that when youhappen, when you design innovation, it...

...has to be with work flow in mind. Ithas to be with efficiency in mind and keeping that in user. For me, the Indus,the consumer, you know I look at that as being you know, that relationshipthat door, patient relationship and it's it's vital. You know whatwe'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 reallywant on demand self serf care and not everyone is going to want to go backface to face and have that human inner high touch human interaction. I thinkyou know. One of the lessons that we can learn is to not really swing eitherway and for us to think about our businesses and programs as highbornmodels, because I think that we're going to see that, if we're trying topersonalize care for specific population, even if we're treating orsupporting all patients that you know have breast cancer, even all thosepatients with breast cancer aren't going to want to engage in the exactsame way as human beings were really different, and so the hybrid model, Ithink, is going to be really important. Going forward. Well, as Brenexperienced earlier, it's hard to hug in zoom, yeah t, Yes, absolutely so as we wrap up here,if you guys could just give a shout out of how folks can get a hold of you ifthey want to follow up after the show. For me, it's easy, you could just emailme at Jeffrey Carlyle at mecom, JeffreyCarlyle, at mecom, and for me it's Howard Rosa I just H, Rosen at lifewire group Com and for me it's our dot, right, Wrightat Louisville, dot, edu or connect through me, the linked in a Oiktos e works for my co yeah linkedin your bike. Yes, exactly right! Well, thank you all for joining metoday. It was such a wonderful discussion. I think that we gave theaudience some a lot of stuff to chew on a lot of empathy, for the challengesthat they're facing, hopefully some encouragement and certainly some wisdomand some things that they can do going forward. Tankapic the opportunity. Thank you. Thank you so much for listening. I knowyou're busy working to bring your life changing innovation to market, and Ivalue your time and attention to get the latest episodes on your mobiledevice automatically subscribe to the show on your favorite podcast tap likeapple podcast, potii and stitcher. Thank you for listening, and Iappreciate every one who shares the show with friends and colleagues, seeyou on the next episode of Health Innovator, a.

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