Health Innovators
Health Innovators

Episode 1 · 3 years ago

How to Build Healthcare Innovations With a Bottom-Up Business Case w/Ed Bukstel


There’s technological inertia and cultural inertia in healthcare innovation, and a lot of hard work is required for us to overcome it. What are some of the biggest challenges innovators are experiencing because of this? What would be a powerful pivot or pathway that would enable the successful commercialization of clinical blockchain? How do we break down the silo walls in healthcare? 


On this episode, Ed Bukstel, CEO at Clinical Blockchain, shares on how he successfully commercialized one of his first innovations, and how he’s working on commercializing his latest healthcare business venture.   


3 Things We Learned 

How Ed took a bottom-up approach for marketing his innovation 

Doctors and clinicians are part of the equation, they should always be involved in the decision making loop. Instead of approaching the labs with his EHR software product, Ed Bukstel approached the people who really had use for his service and that was cardiologists, infectious disease physicians and other clinicians. 


Why be cautious with strategic partner funding 

You’re looking for money but you also have to pay attention to the kind of money you take. Most innovators aim for strategic partner money, but we have to be cautious. It can completely swallow up your culture and the pace of growth of your business. 


Why healthcare data is so important right now 

33 million people suffer from rare diseases, and every bit of medical data they can get is vital to their health. When you have people who are really involved in their healthcare, it becomes critical to supply them with that data and work collaboratively with them. If patients don’t get that, they will move to a provider who can. 


Even though there’s an explosion of innovation taking place in healthcare, innovators are still  struggling, whether it’s with their reimbursement models, competing for the attention of CIOs or raising capital. A huge part of what drives that struggle is the inertia which has set in from the legacy of the old model. The culture of that inertia will always trump any piece of technology or innovation, so it is critical for us to break down those walls, address the fear of the unknown and usher in a new age. 


Guest Bio- 

Ed is founder and CEO at Clinical Blockchain. Go to for more information.

Welcome to Coiq and first of its kind video program about health innovators, early adoptors and influencers and their stories about writing the roller coaster of healthcare innovation. I'm your host, Dr Roxy, founder of Legacy DNA marketing group, and it's time to raise our COIQ. Welcome to Coiq with Dr Roxy Show. I'm Dr Roxy, your host from Legacy DNA marketing group. Our show is the first of its kind video program about health innovators, early adopters and influencers and their stories about writing the roller coaster of healthcare innovation. So let's raise our COIQ. On today's show we have Ed Buckstall, who commercialized one of the first HR systems in one thousand nine hundred and ninety three, and he's going to share with us the lessons that he learned back then and how he's applying those to commercializing his new blockchain venture. Welcome Ed, good to have you on the show. Hey, Dr Rocky, how you doing? Thank you so much for inviting great so I'm going to start off with going back in time. Back in time about twenty five years ago. Obviously, EHR systems were very uncommon in one thousand nine hundred and ninety three. So tell us a little bit about what it was like for you to commercialize that Eh our system then. Well, there were, I mean you're a hundred percent right, there was. There was definitely a lot of interest. There were some magazines, actually magazines that would you wait once a month to get and it come in the mail and they're kind of glossy and that was the way you found out what was going on. As far as this this new area of sports healthcare information systems. There was hath. I remember going to a hymns and there was only, you know, like Fivezero people there. We thought that that was a lot of people, but we so back in the day, the issue, the issues were, and it's actually it was. It was a little bit better because right now, so the healthcare landscape is so complicated because there's so many different vendors, so many different legacy systems, so much invested. But what was occurring there? It really took a kind of a cultural shift because most of the systems were built for financial purposes exclusively. There was just gabits and credits. They were basically called systems for ATT which meant I missed admit this charge transfer and at the time very few doctors were even involved in utilizing these systems for political purposes, let alone even being involved in the process. It was just basically, you know, folks that were, you know, data folks, the folks that were chief financial officers at the hospitals. The CIO role was really more of a data processing manager.

But what happened? You know, we I started a company and we would go around and talk with different companies that were communicating. Let's say, we contacted laboratory coups that are right now like lab fort was a client of mine. West quest we used to be a combination of Smith Clin laboratories and met path laboratories in New Jersey and currently, but I'm had met with folks at met path as Law Smith cline, and this what it was very interesting back in the day. The CIOS of those companies initially said, and doctors don't care about this clinical information, they don't want longitudinal results, you know, get out of here, we're not going to use this system. So I basically last the officers. I remember like it yet it was yesterday. I left the officers kind of dejected thinking, Wow, I spent all this time, you know, going down a rabbit hole. And you know all these people, these big companies, say nobody's going to want those, that information about laboratory test things that nature. Right, and I thought to myself, you know, those are that at the labs at the hospitals, those are cio's talking to me. What if I go out and talk to some of the positions that are out there and I say, I said, you know, take a look at this system. Here's humlive reporting, Longitudinal tracking, notification for health maintenance, reminders, things that nature. You know, wouldn't you like to have this in your office? And sure enough, I met with some doctors that said, yeah, we definitely want to have this in our office. You know, how do we do it? So I thought to myself, just tell them to contact the laboratories and and I said, well, you know, we can interface with any of the laboratories that you're working with. You just have to tell them. Now the dynamity that you have to understand all always comes down to a financial dynamic, because many of these doctors were referring tests to these laboratories. That will be worth a hundred thousand dollars a month of revenue to the laboratories. So when if a doctor said, you know, look, I want you to interface with ED system, all of a sudden the laboratories called me. Packet said, Hey, we understand you met with Dr Smith, the Dr Jones, we now want to work with you and and and those she ios. It said, no doctors interested, and up calling me back in their office is kind of saying okay, I remember I kicked you out before, but it looks like some big accounts that are representing millions of dollars in revenue actually want to work with us or work with your system. So how do we go ahead and interface? So of course I said, well, what's going to cost you? Of course. So, I mean that's just went up big time. But but you know, you had a situation now that it's assumed that people want data, but for whatever reason that data is still being with help and I see the mentality, you know, and no questions. Right now, for instance, the idea of having a physician involved in the process of design.

The question that comes up, which is very much like the question twenty five years ago, are that's being as how do we bring the patient involved in the design, because it's their data, and we got to get their data to them. We've got to give them better control or better access. I'm not saying ownership, because that gets into a whole set of legal issues that nobody wants to deal with. I think. I don't think ownership is really that much of a it's not a decided issue because, you know, patients it's got. You can't own a hundred percent of your day the even if you want to, which chunge Nice, but patients are not investing in that scray machines or analyzers and things of that nature there. So so a patients should have access to their data as opposed to full ownership. Yeah, Yep. So let me ask you a question. That was a pretty unique strategy that you were talking about, going directly to the ends user and creating demand up the chain, since the target audience, you know, wasn't wasn't getting it or didn't believe that there was an opportunity there. So so let me kind of in that same vein. How did you get investors to believe in what you were doing to raise the capital that you needed to commercialize your ea to our system back then? If because it was so revolutionary? Well, yeah, actually it was. It was kind of one of those strategy. I guess, if you can't be eat them, join them. So one of the laboratories invested two million dollars. Smith client invested two million dollars in my company because we were very strategic using the battle. They would actually go to doctor's officers to say I'm using this doctor chart system that ED design and and at. Essentially they would use it as a selling tool and the doctors would say, wow, we get all those longtitunal results. Okay, we'll switch from met path or Mayo or the local hospital and will refer more of our business to so there was it was once again a financial dynamic. Why? A clinical change, you know, a change in viewpoint from the financial to the clinical. Okay. So then it sounds like Smith Kline really understood what you were trying to accomplish and it was a very strategic investor. Not just anybody throwing money your way, but somebody who is actually going to be able to drive adoption. Absolutely. And what of my other clients was early one. United Health Group was one of the big innovators in information systems, even back in the in the day as far as connecting their providers and they were also applient of mine as well, a pretty significant client. At one point on I think we had close to Eightzero installations from main to Malle and on some outside of the US, as well as a number of hospitals also, you know, in from in the main, demaliy type of flipprint.

So you've talked about really two unique strategies. I think that probably helped you, you know, reach market success. Are there any other decisions that you made around that commercialization process that you think had such a big impact on you, on your on your success? I think a fundamental aspect of any of the strategies you know then and I think even today, and today once again it's the laser focus, is war on the patient and how to get the patient involved in the process. But it really was a new dynamic to bring physicians into the process and when doctors started telling Information System people we want this, you know it really you really have to focus on who your customers and the customer in this case what was not necessarily the laboratories and the hospitals. They were writing the chat. Okay, there's no way, but that wasn't the kind of go to market strategy. To go to market strategy was to go downstream to the ultimate end users, which were, at this point the individual physician officers that referred business the laboratories in the hospital. So there was a there's definitely a push pulled dynamic. Sometimes the doctor's will and asked for special customized reports. At the back of the day, that laboratories would send entire computer systems as quart of strategy. And then all that any kickback stuff kicked in and of course you know the stark laws try to kind of stop that. So some of the computer systems, what would be done? They would bring them in at put them in a position office and block all functionality of the computer, except we're being able to do one item, which was utilize our system and see laboratory results online. HMM. So what were some of the the obstacles that you had to overcome? Obstacles billion yeah, it's like any business. You have the same obstacles have today. You have perception, you have inertia, you have people worried about the not invented here syndrome, people saying, Oh my God, it's new, therefore we must fear it. You know, no one wants to have I don't know how many times people said why do you need a personal computer? You know, or why do you need to no one wants to put anything on the Internet, putting lab results on the Internet. You know, it's not it's too it's not sure enough, it's etc. So every single time you know, and then people are saying, you know, as how there's still help your ganizations today that have not even adopted the cloud. So you know, I think it's obstacles that they are. They're absolutely out there. You know, whether it's back in the day or today. It's the perception issue, the culture. You know, I at all points in time you know, and... doesn't matter how Whiz Bang and amazing the technologist, culture will trump technology every single time. You know, and that's it. You don't have something that makes things a little bit better for the people that are going to use that system for maybe even there's a perceived use of the system and you may as well just find another business because you're going to die a very old copy person and also quite pretty poor. So I think that's a great phrase. Culture trump's technology every time. So kind of just continuing on down this path. What, what advice would you have for other health innovators that are in the trenches right now that are facing this perception in inertia issue. I think. I mean I've really been immersing myself on the blockchain side. You really have to think and understand your use cases and you know the and how what the friction points are. Technology, for the shape of technology is not going to make a system a situation better. You know, a lot of other considerations that show up and we need to to be cognizant of those considerations. I mean, it's a you really need to study the market. You need to see how people are using the systems. I would say also there's always this people want to add features and customizations and capabilities and you know what, you may not need all that feature creep. When you create a package. It might be as simple as just taking an image and extracting data and and not worrying about, you know, a whole bunch of other, you know, phenomenal features. I mean, think about it. We use the Microsoft word most of the time. There's like a zillion capabilities there that we really never use. Yourself was able to build that jilling capabilities into the products. I had a lot of money to do it. You know, right, right, cool. As a small company we can't build all those you know, awesome features. That focus on the ones that makes sense and going forward. You don't do that, it said, you're better be road killed. Yeah, that's so true. Ed that. You know, a lot of the innovators and entrepreneurs that we speak to are really talking about that same thing. Sometimes I see that they over develop the product so much but they don't even have any money left to actually go to market, and so that just can sabatize their success. Right there, you must be talking about some talking to some of the same people, because, yeah, it can become a waste land and then then people just develop things that just don't make sense. You know, we talked a little bit about, you know, blockchain, some of the what's occurring right now with the excitement, the hype. You know, I think I think people are finally getting to the Valley of despair, you know, because the height was really I you've got ninety five percent of the hundred and forty plus healthcare related icos that you know say that use...

...blotching. Are often by ninety three percent or more as far as their valuations from their ICO. So the bottle when you know, the bottom line learning thing. Or literally that's a hundred and forty just an incredible amount of the group of companies that the all thought they had, or many even thought they had great ideas, but fundamentally they were trying to token eye healthcare and I think one of the things people need to realize is, you know, that type of script has been tried many, many times and it's fail you can't token eye health care. If if a patient has to pay a bill for one five hundred hour medical bill, they're not going to care whether or not they get a token that allows them to buy some night year or, you know, get a an Amazon discount for twenty five bucks at they're say based one one fifteen hundred or two thousand or five thousand dollar bill. I mean just it's just astutely bottles of mine how some smart people can cut fall on a some really delusional of business cases. Yeah, absolutely. So you've kind of we both have kind of tossed around the the phrase of the term blockchain quite a bit, and so for those of our listeners that don't really understand blockchain or know what that means, it helps us explain that in its most simplest form, what is blockchain? Blockchain is a is a is a technology that that, because of the nature of its decentralization and because of the architecture as to creating what are called blocks, they are linked together, and that are also cryptographically secure. It is a mechanism that that allows trust to be built, and that trust component is actually built by virtue of a consensus mechanism that allows decentralized groups to all agree that something may be true. So the the the issues and without getting into the weeds on the the technology aspect, because that's that is really not necessarily for the average person. The we're and a people, they're going to actually interact with the technology right really not as important. I mean, for instance, when we're talking right now, we're on this distruction. I'm not sitting there saying wow, you know, this is through a TCPIP connection and you know we've got a secure server and I'm and and and here's this is the IP protocol that we're using, or whatever the case. Maybe we don't care because there's no it works all right.

Blockchain is kind of that will be at that same level. In fact, you know, the best blockchain applications and capabilities that will be out there will be the ones probably where users have no idea that blockchain has been utilized. They'll just realize, wow, you know, this information seems a heck of a lot more precise than what it used to be. I mean, I don't know if if you remember, you know when they had different browsers out there and search engines and you get all these ridiculous search results. You know before had their stuff. I mean yet you would do searches in the first things that will come up would be, you know, advertisements, you know, corn sits, all kinds of things. It was. It was almost non usable. Search was almost non usable until Google came up with, you know, their algorithms. Now I relate that to blockchain. We're going to find out, I believe, you know, that there are some features and functions with blockchain that you know that no one is really thought about yet or at actually implemented yet, and our experiences, I think, for the most part, are going to be much higher from a user level. I've used the example before. You know, Steve Jobs, when he created the IPHONE, had no idea that Uber are BNB, we're going to be created. He wasn't thinking about them. He was thinking about, you know, device that was you know, could form a platform for other functions in capabilities which you know. Obviously those business cases came to came came to Fortune and continue to and today we're in the same type of situation. We're still looking for the business cases that are going to tell you know, blockchain and and and the user experience followed. So Ed, what is the you know, the number one or the most important friction point that you know, you as the founder and leader at Clinical Blockchain, is what is it that you're solving? That most important friction point? Problems? There's there's a there's a couple of them. I the most important, the most important? There's two. I would say that the well, let's I'm going to take one step back. The most important friction point that I'm I'm dealing with today, whether it's in the life sciences and farm is space or helping enhance patient experience, is the situation of the digitated at the digitalization of records, the fact that the fact machine, yes, the fact machine, is still responsible for about seventy five percent of all healthcare communications outside of hospital setting, in you know, in the ambulatory setting, in that, and that's a fact that your bottles the mind and the ability to on board. You know that proliferation as well as the situation that what factory we have to run. That's the truth that we...

...can't avoid that situation. So let's go ahead and, you know, take that and you extract out of that whatever we can, even if it's recognizing any that fact machines are on Ram what's go ahead and get that information as well, PDFs all aligned into at least an identity, and that identity is is one of the items that we also address with put insut of blotching. So so ed help us understand kind of just going a little bit more personal and deeper here in into like the psychology of an entrepreneur, right. So there's all of the strategies tactics associated with the commercialization process that are like really tangible. Write the launch stuff, the marketing, messaging, branding, all that stuff that you know. We kind of know, but there's also a major fact, after you know, the mindset of the entrepreneur. So kind of help us understand either, what that was like for you when you are commercializing the HR system in one thousand nine hundred and ninety three or, you know, the venture that you're doing right now with clinical blockchain. How are you? You know, every entrepreneur faces challenges, obstacles, knows, door shut. How are you overcoming that? Hey, I've even have monitors thrown out of four story windows going right through the today. These led's. You can't really break a window when you get mad and sw it out, but they're literally was. I remember our landlord came up and said, oh my gosh, you know, they thought there was a break in, and then I think the land would realized that all the glass was out. You know, it's fun. You're going to be frustrated. Yeah, I'm going to hear no a lot. Okay, it's going to. It's going to cause you possibly to, you know, just, you know, question everything that you believe in and so often there's something that likes your fire and you got to got to stay passionate. You know, sometimes it may be hard to do, but it right. You believe in it and then you find so surround yourself with the right people that you know, know what you know, know what they're talking about and and you got to respect opinions of others, right, you got to respect opinion of others. You know, even if, even if sometimes you you want to say right off the bat, you know, and really start to after respect your opinion becose. It doesn't make sense. But you know what, you stop respected because you a nugget that comes out that's like wow, I did not expect, you know, that groundbreaking type of alert to come out of you, but it and it happens. It's and you and you. You have to wake up every day. You know, some days is a little bit tougher. You're like, she's I got to do this again. And you you got to put yourself out...

...there. I've gone to these, you know, I make a point to go these meetups in Philadelphia, whether the theory and blockchain meet up or there's a Philly blockchain technology and Philly. I'm actually I just involved in working to plans some events for Philly Tech Week and yesterday I went through a meet up and they were they were doing a decentralization of the creation of toolish and and in a in a game of five format, and they were representing this information on a blockchain. Is a company called Talit. Some real smart people talking about you know, how are we going to go ahead and trade and and share and work together in a in the digital realm, and they add this add this gamification portion to it, which is which I just thought was absolutely brilliant and one of the guys, what the guys a developers who, you know, talking with them easy, had buzz let your ear rings on, but, you know, absolutely creative and you know, I got me to thinking. How could so a technology like that and that's type of gamification or that sort of thought process potentially help in healthcare? And there's a there's there's definite areas. I think the future is incorporating some type of blockchain and some type of game nation Schema into patient interactions, provider interactions and interactions amongst other people that you don't even think about right now. HMMMM. So earlier you were talking about the inertia and the culture of healthcare, and it's you know, it's obvious that, you know, healthcare moves slower than most other industries and you also talked about how it's really oversaturated with an explosion of innovation. So anybody that's part of the target market, you know they're have people calling them, texting, knocking on the doors, you know, saying my widget's going to change your wife right. So how are you? What are what are some of the strategies that you have to be able to rise above the noise and get the attention of your target audience? Yeah, you're like, the noise level is at, you know, at freefish portions right now, and trying to get above the noise is important, but it even of even that noise, you got to recognize there even an audience, and I'm referring to blockchain specifically, for instance. What are what are the motivations? Why would information systems officer, a CIO at a hospital want blockchain in their institution or small? I don't think there's a business model, even you know that that can be created for CIO's to say yeah, you know what, go to the board and say we want to go ahead and build this infrastructure at...

...once it's built out, all of our patients can share all their information with our competetitors. You know, any more directors is going to basically say you want to do what, you want to spend our money to and and I would say there are some forward thinking groups out there that may be willing to take that type of risk to go forward. You know, I think of Jefferson health system here in Philadelphia. They're buried to the trying making making the community and the ZIP codes around Philadelphia much healthier, even means, you know, sacrifice you a little bit of business opportunity, but I think that, you know what the motivations may be, we should go in, you know, and it makes the almost makes me laugh when I see some of these companies and icos that, you know, are and people. They're talking to me saying we want to launch an application, we're going to sell the positions and they don't realize it. Four hundred physicians killed themselves last year and one of the number one stressers saying as to why they killed themselves was that they had to play with the information system. So, you know, depression amongst healthcare providers and clinicians is that epic proportions. He so if you go in there and say hey, guys, I got this new thing, then Whiz Bang and runs on blocks instance, you know, and they're going to be saying just back down of my office because you know they're already stretched down. The last thing someone wants to hear about is another type of product that's going to save the day. Now one of the things that you mentioned, which is the key point, and it comes back around, is okay, but maybe he can help solve a friction point that these folks have to deal with and create a helping to smooth the workflow with, you know, from the fact machine integration or just being able to help a patient collector records onto a single identity instead of having records all over the place. That white help. And if you can go into the physicians office and say, you know, instead you say, doc, I have all of my information here. Would you like to go ahead and take a look at that? You know it's a situation where, you know, it looks like the patient already went ahead and did all that home, where all that, you know, gathering of their data at all we did from critical block change perspective, is to help them connect that information and we're not going in and saying the doctors, you know, we're going to we're going to change your lives of practices for the better, because you know, frankly, that's not that. This friction point right now are the information systems right doctors have to deal with and unfortunately the inertia is there. You know, and I've said you know before I said it again. You know, you've got these ethics and SERNS and groups out there and you know, someone once told me that, you know, one of the reasons why God was able to create the world and seven days or...

...six days was because he was working from a blank slave. You didn't have any legacy systems that you had to deal with, or she had to deal with, like the words of definitely correct me on the sheet and Daddy, that got into the God is a woman. I said, yes, she is. Yeah, the bottom line is that we have to recognize that we do have all that noise that we have to deal with and that noise, so kind of noise, create some really ridiculous circumstances. Of But, like I said, when you when you wake up in the morning, you go out there and make sure you're passionate about what you're doing and put yourself out there. Yeah, yeah, your question. That was a long wow. It no worries, no worries at all. So, you know, we're kind of talking about these two paths that you've taken where you've, you know, commercialize the HR system in one thousand nine hundred and ninety three. Now you're out going to market for the clinical blockchain venture. You know, what's one thing that maybe you've done in the past that you're doing different in this new, you know, go to market strategy for clinical blockchain? I will I think I've opened up a lot more I've said to my investors, as I said, look, we have, you know, things are open source. You have to share, you have to decide, you literally have to have as part of a business case, you know how you're going to go ahead and create a community. Now you go ahead and you're not going to create a community if you just say, look, I'm going to go ahead and build this product and I want you everybody to work with it. You have to go ahead and give a little bit and, let's say, give in. Might be making sure that certain source code is available and Github or there's you know, you're helping develop and share. So I think, I think people are much more open about intellectual property when, and you know, we're not necessarily like the absolute secrets and technologies that you're planning on working with. But you no, you're right, you're the the a build to open up and you know, in our connected world, and spite with you know, India, Romania, Estone or wherever and connect you. You don't know all the people that are out there that they want to help you. If you go ahead and provide just a little bit of help, that makes that engagement a little bit easier to go and so I think I'm, you know, I've definitely opened up a bit, you know, in the way I look at things, definitely a bit less critical about what other people are doing. I mean hack at a meeting with people making toolips and, you know, in on putting on a blockchain and I started in as they're making the...

...toolips and creating the colors with different three hundred and sixty degree you. I'm thinking about the three hundred and sixty degree you with a patient and how you could try and maximize interactions and create, just like they were trying to create the perfect tool of I'm thinking about creating the perfect health experience. So those things, you know, and the the the mat or the the the image that we that they were creating was, you know, look like a new interface. Possibly it's just, you know, you have to be open and questions about everything you're thinking about and and it even if it hurts. So the last question that I have for you had before we wrap up this part of the interview and go ahead and open up to the QA session, is what do you think is the biggest driver of success when commercializing the healthcare innovation today? The biggest driver or influence for an entrepreneur or for a founder innovator like yourself? What do you think the biggest driver is for success? It's, you know, this is this is old school, but it's you know, he's good. You got to show up. If you show up and don't shine, you got it. You got to show up even, you know, at that events. You got to show up at locations. You've got to go ahead and show up on a digital realm as well. You've got to be you know, I've got about on Linkedin, about twenty fivezero books that you know follow me on. I participade and tweet shots with with some different communities. There's that's that's it. I mean your one hundred if you don't show up, your guarantee. There's one thing you're guaranteed one hundred percent of time. If you'll show up on hundred percent of the time, you will fail, you know, and that's and that's it. And after that, you know, hopefully it's something that it's going to make you money, but it's you know, you want to get in this environment. You want to you want to help people out and be a little bit more open to to that quest. All right. Well, thank you, ed. So we're just going to pause right here. If you want to find out more about clinical box chain or watch more episodes of our show, head to our video show page at Dr Roxycom. And, of course, if you would like to tell us your story, go to the my be it be my guest page on the Dr Roxy Website and apply. We'd love to hear about your healthcare innovation experience and thanks so much for watching the show. You can subscribe to our program for my Youtube Channel at Coiq with Dr Roxy. Until next time, let's raise our COIQ. What's the difference between launching and commercializing a healthcare in avation? Many people will launch a new product, few will commercialize it. To learn the difference between launch and commercialization and to watch...

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