Episode 3: The Big Three #NewProductDevelopment

This episode goes a little longer than normal as it approaches a full hour in duration, so apologies out of the gate, but we get to hear from one of my very favorite trios at Tridiuum. While I’m typically reticent to boast, these three people routinely amaze me in how they ideate, design, architect, and build world class digital behavioral health products used by patients, providers, caregivers, and health system executives every single day. Some quick stats on the scale and impact of the products created by this Product and Engineering trinity: 780,000 daily page views of the Tridiuum1 Platform; 7,000 unique patients supported in active treatment daily; 3,000 unique clinical providers delivering care to those patients; improvement among patients at twice the rate of those receiving traditional behavioral health interventions; and finally, when compared to the gold standard in U.S. health care today, a reduction of 70% of the time it takes patients to see a provider for their first appointment. And the accomplishments really can go on and on, as well as the stats. We thought that today’s episode could help anyone investing in, working on, or implementing digital health products. While it is sometimes true that lightning strikes and a special team forms around a unique mission, these three continue to work at the relationship a lot and that in turn has helped to bring some extraordinary products to market.


Mark Redlus [00:00:13] Welcome to episode three of the 10x Total Health podcast hosted by Dr. Gabriel Eichler and me Mark Redlus. The purpose of this podcast is to uncover and highlight breakthrough work that is being done in and around the healthcare arena in an effort to 10 X the level and quality of patient care leading to better outcomes and hopefully overall healthier people. Today, this episode goes a little longer than normal as it approaches a full hour in duration, so apologies out of the gate, but we get to hear from one of my very favorite trios at Tridiuum. While I’m typically reticent to boast, these three people routinely amaze me in how they ideate, design, architect, and build world class digital behavioral health products used by patients, providers, caregivers, and health system executives every single day. Some quick stats on the scale and impact of the products created by this product and engineering trinity: 780,000 daily page views of the TridiuumOne Platform; 7,000 unique patients supported in active treatment daily; 3,000 unique clinical providers delivering care to those patients; improvement among patients at twice the rate of those receiving traditional behavioral health interventions; and finally, when compared to the gold standard in U.S. health care today, a reduction of 70 percent of the time it takes patients to see a provider for their first appointment. And the accomplishments really can go on and on, as well as the stats. We thought that today’s episode could help anyone investing in, working on, or implementing digital health products. While it is sometimes true that lightning strikes and a special team forms around a unique mission, these three continue to work at the relationship a lot and that in turn has helped to bring some extraordinary products to market. Now, let me just run through and introduce each one of them. First up, Deb Cypher. She is the Chief Product Officer at Tridiuum. She is a native of Maryland. Deb has over 25 years of experience across many software disciplines, starting as a developer and moving to multiple roles of increasing responsibility including senior leadership positions in Fortune 500 companies until finally finding her niche in product management where she’s been exclusively focused for the past 12 years. Since joining Tridiuum, Deb has not only led the design and successful launch of the Tridiuum One platform but she’s also been developing a world class product team. Deb earned a Bachelor of Science in Mathematics from Salisbury University and she resides in Florida with her family and menagerie of cats and dogs. Next up James Flaherty, Chief Technology Officer. James brings over 15 years of experience in delivery and software development management. Prior to joining Tridiuum, James led delivery and technology at Enable Consulting responsible for overseeing the development of customer solutions for the firm’s clients. Prior to Enable James led several development teams at The Active Network, responsible for five customer-facing products and Active’s marketing presence. Previously, James led the delivery operations for Talisman Interactive, a digital agency that specialized in touch screen kiosk development and custom application development. James is a graduate of Rutgers University and holds a Bachelor’s degree in English with a minor in Computer Science. And finally, Scott Johnson, Chief Mobility Architect. Scott possesses more than 20 years of technology management, architecture, design, and software engineering experience across web and mobile development environments. Scott has spent the last nine years as Co-Founder and Principal of ObjectiveApps, a software company focused on building innovative iOS and Android-based mobile applications for both the consumer and enterprise business markets. Prior to his most recent position, Scott served more than eight years as principal at Five North, providing clients with an integrated approach to business process development, software engineering, and project management. While Scott can often be found managing technology development teams, he continues to keep his technology skills sharp, frequently rolling up his sleeves and jumping in with his team members to accelerate development. Scott received his Bachelors in Information Systems from the University of Redlands. Now without further ado, please enjoy this very wide ranging, interesting, and fun conversation with Tridiuum’s Three Musketeers.

Mark Redlus [00:04:58] OK thank you all for joining us for episode three of the 10 x Total Health podcast, hosted by me, Mark Redlus and Dr. Gabriel Eichler, PhD and general, smart guy.

Gabriel Eichler [00:05:15] Hi everybody.

Mark Redlus [00:05:18] Gabriel just talked again. I’m going to use that on every podcast. OK. So today we have the distinct privilege of getting to talk to the big three here at Tridiuum. So I just decided to call them. So we have some really interesting conversation today talking about making digital health products really resonate and creating consumable digital health products for patients and providers and the ecosystem out there. It is tough to do this stuff and these three people have worked together to make some products that really do work really well and they have great uptake amongst providers and patients, and I have the privilege to get to work with them. So going around the room. Why don’t we do that. But I guess first, Gabriel do you have any thoughts?

Gabriel Eichler [00:06:13] Yeah. You know Mark, I think that people don’t always appreciate the user experience side of health tech and how much that’s key to the success of health tech products, both from the user standpoint, from the patient’s standpoint, from the workflows, et cetera. And I think this is extremely exciting conversation because what I’ve seen of the work and the technology that Tridiuum has created is that there’s just real thoughtfulness that goes into how these products should work and integrate into workflows, and really serve the needs of the customers and the patients that touch them. So I think it’s going to be really interesting to hear from Deb, James, and Scott today, and I’m just excited to be here. So thanks.

Mark Redlus [00:06:57] Yeah. So we’ll go around the room so everybody recognizes the voices as the podcast rolls on. So welcome, our Chief Mobile Architect here, Scott Johnson.

Scott Johnson [00:07:07] Thank you. Thank you. Great to be here.

Mark Redlus [00:07:09] Awesome. Chief Product Officer, Deb Cypher.

Deb Cypher [00:07:12] Thanks Mark.

Mark Redlus [00:07:13] Awesome. And James Flaherty, Chief Technology Officer at Tridiuum.

James Flaherty [00:07:19] Good morning.

Mark Redlus [00:07:20] Good morning. All right. So we’re gonna get started. Should be a really fun podcast. Hopefully this will be really enjoyable and representative of the insane discussions that we all get to have most of the time. So this is–hopefully everybody out there gets the idea of it. Just like I really enjoy talking to Gabriel, these five people on this podcast should be a pretty good conversation. So why don’t we get started? I guess I’ll set the opening question here around–and anybody can start–and then you guys can just all riff together. But I always start with the easiest question possible, but what do you think the biggest challenge is in bringing digital technology to healthcare? Who wants to take that out of the gate?

Deb Cypher [00:08:12] Well I think simplifying things that are very complex. Understanding the market, your users, and the people, and being able to translate that into something that they can use, that they want to use. That’s the hardest challenge and I don’t know that it’s specific to health care. Each industry has their own little things. You know, payer/provider mix, workflows and providers, clinicians. Understanding those workflows I think for me is really the key to making the product successful and usable.

Scott Johnson [00:08:46] So I think another factor that has really started to play especially now as digital technology is just permeating every facet of our life is trust. Trust. You know we have to earn the trust of the users and the patients. Trust of–you know your health is the most personal, some of the most personal information you have. And so how we handle that, and how we approach that from an empathy perspective for the patient and the user of the technology is really key.

Mark Redlus [00:09:24] James do you want to–I’m sorry go ahead.

James Flaherty [00:09:27] Oh these are really good answers.

Mark Redlus [00:09:29] Yes sometimes it just works that way.

James Flaherty [00:09:33] Yeah I mean what I was thinking was a little more basic in the sense that I feel we have a hurdle in the health care industry that is higher than you might see in another setting, in that we’ve got a user base that, at least from my perception, is a little technology averse and they’ve really gotta love the experience. You don’t have to come in and just have some baseline, or meet some baseline of what it takes to enjoy using the application. They really have to love it. It has to be set apart from the tools that they’re using and… They have to be willing to adopt something new in their already super busy schedule… I mean that’s the biggest challenge. I mean, I think that’s a huge challenge. We’ve seen this multiple times, right, where we’ve got people pushing back before they even have an opportunity to use it because they’re being told that they’ve gotta layer something new. They’ve got to learn something new, and they’ve got to work this into their day. So, being able to bring something to the table that somebody immediately says, “Oh wow, this isn’t as hard as I thought it would be,” or, “This is really much more enjoyable than the past experiences that I’ve had.” Like that’s one of the challenges that we have bringing this tech in this space.

Deb Cypher [00:11:05] That’s absolutely true.

Gabriel Eichler [00:11:07] So tell me what you guys think about this. But as you were speaking I was kind of realizing healthcare seems to have incredibly fragmented workflows. And what I mean by that is that every care setting has different workflows, different requirements, different paperwork, different interfaces between systems. You know, that’s why people joke around that the common denominator of those interfaces is the fax machine because it’s just the lowest common denominator, and that you know, ultimately, technology in most other segments is built around standards and built around the expectation of interactions. Whereas health care has been based on the privacy and intimacy of the patient-provider interaction. And as a result, you know there’s incredible just fragmentation and insulation between these systems in ways that is kind of very difficult to make tech work and tech scale across different environments. How much does that resonate with you? Just curious. Or do you see it differently?

Deb Cypher [00:12:08] It definitely resonates. You’re absolutely right. These are things–I mean we spend hours, days, hours going over and over and over these problems and how we get them right, how we talk through it. To your point, how do we share information? How do we make it easy? How do we remove that click or this thing, make it look pretty, enticing? We do. We agonize over how those things come together.

Mark Redlus [00:12:40] I just wonder if–some of the conversations we had yesterday in the Week of Wonder that is held here at Tridiuum on a quarterly basis. You guys had a design thinking–maybe it was yesterday–design thinking conversation and with respect to Gabriel’s question about this, you have all these really bifurcated kind of frameworks of things that you have to connect together and you just talked about agonizing over a click or something to that effect. You know, do you put it into this design thinking kind of mode? And, you know, what’s the contribution to breaking through the barriers that Gabriel just talked about and that you just talked about? Is that thought process really different? And obviously the hope–you know, one of the big points of the podcast is to really try to get people thinking in a different way about how they’re going about solving problems, especially, obviously in health care. And you guys work on problems in a different way. So does that–is that part of it, the design thinking part of this?

Deb Cypher [00:13:45] Sure, sure. I mean I would say–I mean one of the things that I do all the time and even my team members, like, think about your users. Put yourself as best you can into the shoes of your users and really, really try and understand very deeply and personally what their day is like. What their experience is like. What their challenges, their pains, their struggles [are]. And if you can get to that point, then solving their problems becomes easier. At least for me.

James Flaherty [00:14:15] Yeah I mean the thought that I had–just sort of digesting the question–is that I personally don’t feel that when we’ve approached the problem in designing the software that we’ve made a significant distinction between a health care user, versus a user of any other piece of software. At the end of the day, these are people that need to do a job that they–obviously there are certain health care specific requirements that go into how the data is served up or presented, or how sessions are locked down, et cetera, et cetera, but it’s not an overarching driver of the design. For me at least, the main contributor is that we are dealing with people and I’m approaching it in a fashion that’s not dissimilar to how I would approach designing any other software.

Scott Johnson [00:15:18] To play off of that, James, I really think too, you know, how we design software for the enterprise environment or for the health care provider, just like you’re saying, versus the consumer of that software, or the patient, or the end user, in other words the non technology user–I think one of the things just that–one of the problems facing mobile, say, and wearables, for that matter, is reducing the friction of getting up. In other words, we don’t want to ask the user to have to do much. We want–we have to start thinking about how to collect and solve, you know–collect the information, solve these problems for them. And I think we’re really seeing that particularly with Apple Watch, where you know, you can just strap this thing on your wrist and it starts collecting information and starts surfacing things to you right away. How you breathe, how much exercise you’re getting every day, how many times a day you stand up. You know these kind of things. Reminding you, you know–I mean the apps to remind you to drink water you know every hour or whatever. I think that the less that the user has to do the better. And we just need to get smarter about that.

Gabriel Eichler [00:16:30] So is that about out of the box functionality or is that about total capability?

Deb Cypher [00:16:39] I think it’s across the board. In everything we do we have to make it simple. It has to be easy. We have to remove decision makings from them, but give them the ability to do the things they need to do.

Gabriel Eichler [00:16:54] But I’m under the impression that the phase of discovery about how these tools will be used, and workflows, and what are the dimensions of capabilities that are sort of table stakes that have to be addressed in order to have anything even viable; that that discovery process is not trivial either and I’m not sure you guys have articulated enough of what you do there. But I–my sense is that you guys have done a lot in that kind of a space to learn about these domains where technology, health technology’s being used, no?

Deb Cypher [00:17:25] Sure. I would say that’s an ongoing process. There’s a balance to knowing when to ship. Right? So there’s a process that says we have to understand the user. We have to design some things, come up with some ideas, build some things, and then we have to put it out there. Right? You can’t put it out too early because if it doesn’t have enough stuff, if it doesn’t have enough of the right things, the right components, doesn’t solve enough problems, they’ll hate it and they won’t use it. But you can’t wait till it’s perfect either because if we wait till it’s perfect you’ll never ship and you’ll never get that feedback. And it’s that feedback loop, and allowing us to refine in a rapid manner, that makes a big difference between whether or not a product is successful I think.

James Flaherty [00:18:11] And Gabriel I wanted to clarify the question, just to make sure that we’re guiding the conversation in the direction that you were hoping we would. Are you asking us to speak a little bit about the existing health care software landscape and how it informs our discovery process?

Gabriel Eichler [00:18:32] No I mean I was thinking more about discovery overall but you know I hadn’t even thought about how the existing software landscape could inform your discovery process. So yeah that’s a fascinating dimension to bring up. Tell us about that, James.

James Flaherty [00:18:48] So I think there’s a couple of things that we use as touchstones as far as existing software in the space. I think most of the software in the space is a bear to use, comes with–I mean if you speak with any health care professional that needs to use software as part of their job–generally weeks of training, crib sheets, really arcane user experiences, and a build and deployment cycles that are monumental. While I wouldn’t say that it necessarily informs our thinking in the sense that my attitude is that it’s kind of a no brainer to not do that, right? It’s not like we looked at that and said, “Oh man we’ve gotta do something better than that. I didn’t even think of that.” Right? I think it’s a no brainer and to Deb’s point about when to ship, one of the things that I think weighs strongly into our when-to-ship decision is that we can’t wait eons to get new functionality out. And while we’re dealing with a user base that is historically–does not want a lot of disruption in their workflow and the tools they use because they’re used to having to go through training and used to expect–used to the expectation that they just need to follow n-number of steps to do their job every single time, and if you disrupt that and you change that you’re going to upend their world, that we’re compelled to bring a new feature set to the software on a regular basis and do it in such a way, to Scott’s point about making it easier and removing barriers so that change–so that the change to the features are not seen as disruptive, they’re not seen as frustrating–that they’re a welcome change to the stuff that they use in our software every day.

Gabriel Eichler [00:21:01] Yeah yeah. Can I ask a question for you? Because I think that you guys have also…

Mark Redlus [00:21:06] It’s your podcast. You can ask a question. You can do it.

Gabriel Eichler [00:21:11] Thank you. Thank you. But my question for you is–you know you guys have gone now from an initial user base who was sort of intimately involved in the feedback of the early versions and helped design and sort of create the specification for various features to now a more national rollout and footprint which has providers that you know are kind of just customers that are buying a somewhat mature product. And that transition shouldn’t be underappreciated because that’s when the rubber meets the road it seems to know whether you’ve made generalizable valuable software or specifically valuable software that you know the generalizable software works in many environments with other workflows with other care environments. And I’m curious whether you guys have a sense about whether you know that–what–how that transition has gone and whether it’s opened your eyes to new functionality or whether you know your initial sort of test site and site where it was designed was a good representation of the needs…

James Flaherty [00:22:22] I’m looking at you.

Deb Cypher [00:22:23] I see that.

Mark Redlus [00:22:25] Just sit in a room and watch them all stare at each other.

James Flaherty [00:22:29] My natural tendency in a conversation like this is to just jump into the fray and I’m–I don’t know.

Mark Redlus [00:22:34] You can jump. It’s OK. I mean anybody can jump. That–you have a mic.

James Flaherty [00:22:37] Then we’re all just going to be talking over each other. We’ll figure it out.

Mark Redlus [00:22:40] We’ll say, “Oh, stop, hold on.”

Deb Cypher [00:22:43] So yeah. Yes to all of the above, Gabriel. We found that a lot of what we have done is very applicable to the new users that we’re rolling out to. But yes we also learn things every single time and we talk about how those impact the rest of the product. Are they just an anomaly and just specific to that you know maybe a small new user group or is it something that really is a requirement we had never seen before that needs to be incorporated back into the product as a whole?

James Flaherty [00:23:20] Well I don’t want to discount the process of the initial build and the care that we take in defining those at that initial build and how that lends itself to that scalability into the growing customer base. So I–in a certain respect I don’t like the use of the word “requirements” here because it suggests that somebody has handed us something, a discrete list of features and functionality that we have to build to. And we’re just checking off boxes as we go along. And that’s absolutely not what we do in our process. We take–we take what you would normally call requirements and use them as guidelines, if you will, for the subsequent design discussions and there’s a lot of work put in to evaluating whether or not something that has been communicated is applicable in that form, or if there is an underlying more abstract truth that we actually need to build to that has broader applicability outside of the space of that initial request… That wasn’t me.

Deb Cypher [00:24:43] No it wasn’t me.

James Flaherty [00:24:45] So I lost my train of thought. Oh so the point being that–I don’t think that we–there’s always gonna be the possibility that a particular set of features, as it’s exposed to a larger audience, that we recognize gaps in the functionality and we identify a new workflow or a new use case that we hadn’t accounted for. But in the cases that it has succeeded it’s not been accidental. It’s succeeded because we’ve taken that time to identify the broad applicability of a particular set of features in a more abstract sense than the initial ask. And I mean there are I mean dozens of examples of that in the platform where what we’ve initially set out to build was deconstructed on several levels before it actually made–before it actually made the final product.

Scott Johnson [00:25:51] I think one of the things too you know when you’re selling software into the enterprise space, or just you know corporate software in general, we all have varying degrees of like bespoke software kind of background. You know obviously doing custom solutions but there is there’s always that pushback of, “But we want it to do this you know,” like they’re never quite happy with just this. And so that’s the dance, that’s the constant balance of figuring that out. Whereas if you go to the consumer space, back to that thing where they’re really relying on us to solve the problem ultimately the uptake becomes: did we do it right; did we provide something interesting enough, useful enough, with the least amount of friction to adopt into? Because we all have so many apps now and so forth on our devices. And when you start looking at what each one of those apps does well, it usually solves a problem whether it’s a social problem or a health problem or you know a financial problem or whatever that is in a way that balances that need to or that requirement to adopt and overcome that initial barrier you know–that we launched the app for the first time, does it–you know, is it interesting? Does it look good? Is the onboarding process too complicated, versus you know, is it–does it do enough things? So these are the things I feel that are so different. Whereas in the enterprise space you know a lot of times I have such specific requirements it becomes a real dance to build a product that meets all of those needs.

Deb Cypher [00:27:39] But there’s a lot of you know–I ask why a lot, to the point I think sometimes people make fun of me and it’s annoying, but I’m not kidding. There are a number of–

James Flaherty [00:27:51] That’s the reason.

Deb Cypher [00:27:56] People come to us all the time with, you know, “Will you build this report?”.

James Flaherty [00:28:02] Right.

Deb Cypher [00:28:03] OK, why? What are you gonna do with it? Who’s going to see it? What problem are you trying to solve? Right. And oftentimes it turns out that it’s a completely different problem. The report doesn’t solve the problem. There’s a complete different thing. The case review is a really good example of that, right? That was a–that started as a request for a couple of reports. So that they could look at and identify patients who had certain criteria and then use that to facilitate a process where they review what’s going on with that patient, allow a provider you know providers to interact and get feedback. And when I understood the problem and I said you know why don’t we do this instead? Why don’t we facilitate that workflow for you by not giving you a report that you can print, and then you’ve got to go off and do something? Aren’t you just going to come back to our software and use a bunch of the other stuff that’s in here anyway? How about we do that? And then we started talking, developing bullets and requirements, if you will, to build a user interface and then we go back to them and say, “Does this help?” And then they go, “Oh! Yeah, we never thought of that.” Right? So there’s a lot of that that happens in what we do and that’s how the product evolves and that’s how you get to the crux of really solving problems and that makes people want to use the software.

Mark Redlus [00:29:31] Do you think–you know as you guys talked about design and iterating and things like that but–and you do ask that question “why” a lot, of pressing at it. It’s very fun for those of you out there. Sometimes it’s not very fun. It can be fun but it tends to spark you know a spin off of the story you’re telling. And I’m wondering if from each of your perspectives if you guys could talk about the use of storytelling, both user stories in the construct of development and sharing things like that but also storytelling in how you build products because it feels like we we craft a story that we’re going to go down and we’re going to build something to match to that–what that story says we need to do and then you go oh, you know oh, there’s this adjacent you know–to take this story metaphor really far you know there’s a set of actors over here that we also need to build a backstory on and and do that. So how does storytelling work from a product design and engineering and architecture standpoint and how does it make a big difference in–because I know, I think it does with you guys, it makes a big difference in building great products. The story. Who wants to take what.

Deb Cypher [00:30:53] James, I see you looking at me out of the corner of my eye.

James Flaherty [00:30:58] That’s my cue.

Scott Johnson [00:30:59] You’re the story man James.

James Flaherty [00:31:02] Oh man.

Mark Redlus [00:31:02] The story man.

Deb Cypher [00:31:03] Well we do weave stories… To talk through how people are going to use the software or what the problem is. You know again I go back to I always try and put myself in that particular user’s shoes and I say, “if I’m doing X, what’s going to happen when I do y, or when I look at the screen, or I hear this thing go off?” Or any of the things that we’re working towards and we sort of–we do craft a story around how they’re gonna use it, what they’re trying to do, what they’re trying to accomplish. You know we’ll talk about–you’ll hear me say things like, “OK if I’m a patient with cancer, what’s going through my head? What’s going to bother me about this software thing I’m asking them to do?” Or, “if I’m a provider and I’ve got 12 patients out in my office…” And then we just sort of weave these stories around each different way that we envision they’re gonna use this software and try and get in front of where the gaps are,, where the holes are where the pitfalls are and remove them.

Mark Redlus [00:32:09] You talk about though like inhabiting that persona and trying to feel like that but you know, to borrow Gabriel’s favorite word, candidly you’ve got you guys have all either–not just in your personal lives but also you know have spent time out in the field with actual patients. I mean providers are the predominant customer-user of what we have today and that’s evolving and changing but you spend time with patients, you kind of see them using the products and you can see kind of the pitfalls and you know down to mobility, down to the desktop, things like that. So that really seems to inform a lot of what you guys think about.

James Flaherty [00:32:50] Yeah absolutely. I think in the world of product design this is sort of a no brainer right? But this is one of these things when you explain it to people that aren’t doing this kind of stuff every day it tends to be surprising; that it’s really really really important to take yourself out of your own personal experience shoes because 9 times out of 10 your experience, your desires, what works for you in a software experience maybe might apply 25% of the time, right? There is a broad array of experiences and it’s our job to understand that array and how it manifests with our user population. My first experience in seeing this–it was bizarre. So I did, 15 years ago now, touchscreen interactives at visitor centers. This is–this was sort of my firsthand experience in seeing how people interfaced with technology. At the time, 15, 16, 17 years ago touch screens were still pretty rare. I mean we take them for granted today but you know, I mean seriously touch screen ATMs were rare. Right? You were still using the buttons on the side of the screen with the little arrows. And yet this was a point in time where a lot of people had personal computers in their home at the time. Right? And it was–I was dumbfounded by the fact that general people, you know, regular old people would come and interact with these touchscreen interactives and it’s like they had never used a computer before in their life. Right? They’re pressing with thumbs. That was the craziest thing that I never could have imagined because we’re building–we’re thinking that the screen is just in the pointer on the screen is an extension of your index finger on your mouse. Right? So all the developers, the designers would touch with their index fingers, but 50% at least of people that were visiting were touching with their thumbs and it informed the informed the UI because all of a sudden you needed a button that was at least 50% bigger than maybe you were designing.

Mark Redlus [00:35:18] Wow.

James Flaherty [00:35:20] Right?

Scott Johnson [00:35:20] Right.

Mark Redlus [00:35:20] Wow.

James Flaherty [00:35:20] Because of that hit state. And that was–and I always like to go back to that. And you’re still to this day surprised. Right? I think some of the experiences we had in rolling out the iPad application–there were absolutely things where we all collectively said, “man, I couldn’t have imagined that.” And so we’re constantly– even you know we’re a little long in the tooth now we’ve been doing this for a while but I think we’re still constantly adding to that cache…

Mark Redlus [00:35:52] You’re like wine, just aging.

James Flaherty [00:35:54] Oh, yeah there you go… Constantly adding to that cache of experiences to help inform every future decision that we make.

Gabriel Eichler [00:36:02] Do you think–I mean obviously James if you went back to go design a touchscreen system now–well number one it’s a different user base. People probably get the index finger now but in general do you find that these are lessons that get reused and that you’re kind of a smarter, let’s say a wiser, developer and a wiser architect because you experienced these.

James Flaherty [00:36:22] Oh absolutely. That said, we’re dealing with a space that is constantly evolving and a user base that is getting more and more and more sophisticated. I mean I think it’s–I think everybody here would agree that how our generation deals with technology when we’re in our eighties is a lot different than our parents’ generation deal with technology today. Right? And so you can put a 30 year gap–put a 30 year time span and envision how people will be using technology and I think they–it’s not of a huge leap to say “Well off course people are going to be more sophisticated,” but that applies year over year. Right? So you know you may see a very very very small incremental change over the course of a year. But you know it’s gonna be a hell of a lot more obvious in five years, ten years. And I mean Scott it’d be interesting to hear your thoughts on this. If we went back in time and talked about 2007 versus 2008 I think everybody knows what happened between those two–between January of 2007 and January 2008 roughly. You know there was a marked difference between what you can expect the general population to–how they would experience technology just in like one year there. And I think that’s constantly the case. And we have to re-evaluate.

Scott Johnson [00:37:53] Yeah I mean that transition was so huge. When we think about it from a design thinking experience, in the exercise you know of those engineers and designers and so forth at Apple at the time and the executives, you know they’ve spoken about this since then about sitting in a room and basically saying how bad the state of the phone was in the industry, like basically all this stuff was crap, and what are we going to do differently? And you know to come and completely rethink that. Obviously you know it has transformed personal technology you know forever at this point. And there might not even–I mean the smartphone is such a personal thing and we all carry them and so forth. I was gonna play off also on what you were saying back to the–there are certain constructs outside of just technology that exist, i.e. when we were talking about the iPad app, like the calendar. Right? And how people use a calendar. Right? And understanding–so there’s the technological implementation of the calendar but then it’s just all these things that their–the cognitive kind of relationship in the way that somebody thinks about their calendar. You know some people use their calendar–like we make assumptions about, “Oh well everybody uses a calendar, anybody that’s busy like that’s a professional and so forth.” And it turns out that yes generally people do use calendars but a lot of times they use them more like lists where they have things you know grouped by date and they might have an appointment here. And so when we’re asking him to use technology to transition from their current user behaviors around those actions, around those–you know that kind of user story–a lot of times it’s a big ask you know and it’s hard to get them over the hump, and I was just really surprised to see how much you know we ended up changing how we handle the calendar in the app. But I was really surprised at just how different and how difficult that was going to be for users to overcome.

Mark Redlus [00:39:58] Yeah I mean until you see it in their hands you just don’t don’t get it. Right? It’s–even you guys you’re just–you’re like, “wow!” That’s–as James said I’m still surprised you know all the time. If I don’t–you know we have–we’re kind of in the last third of things, the time we have. So I want to hit a couple of things that are more about interpersonal, kind of how you guys work together because I think– you know I’m sure digital health investors and board members and entrepreneurs are listening to this, I would hope, and you know just get a sense of how you how you all work together. So why don’t we start just from left to right? It’d be easier that way I think. So. So what’s it been like to work with one another in your various roles and building these products? What’s the toughest part of working with each other? Well I guess the best part too. So.

Scott Johnson [00:40:56] Yeah I mean of course I think part of being remote, sometimes we’re not all in the same room together, I think sometimes we do our best thinking when we’re together and we can kind of you know–I mean what do they say? 93% of all communication is nonverbal. I think being able to see some of that and and you know get that feedback real time is great. So I think that’s a challenge from just a daily basis. But one of the great things about working with Deb and James from my perspective is that they have such a commitment and passion for what they do, and and for the product, and the user, and the company, and they’re so invested as you know the people they are that you know I gravitate to that. And it’s–not only is it inspirational but it really feeds into the the iterative process that we do together. You know I’m working on product, so it’s a joy to work with them but it’s also really allowed us to–we trust one another. You know we trust one other, we allow each other the space to express our opinions. And I think to disagree and kind of go back and forth and that brings about some really neat results I think.

Mark Redlus [00:42:25] Awesome. That’s great. Deb?

Deb Cypher [00:42:28] You know I don’t know that there’s I could say a lot different than what Scott said. I mean I can tell you that across this team, like for me, this is absolutely the best team I’ve ever worked with. Hands down. And there’s just a tremendous–from my perspective out to these guys–a tremendous amount of respect and appreciation. I trust them implicitly. You know I think an example, we were doing a presentation for the board and you were coming to me I don’t know how many times, “Where’s Scott, where’s Scott, where’s Scott?” He’s got it. Right? And he came to me later and he said, “Thank you for not bugging me. You knew I was gonna be there and you knew I would have it.” And yeah. And we had that level of trust. I have the same thing for James, it’s just–you know they’re gonna be there, you know they’re going to make their commitment, and you know they’re going to do the right thing. Right?

Mark Redlus [00:43:29] Yeah. James?

James Flaherty [00:43:35] I think the hardest thing is that we don’t get to spend as much time doing this stuff as we used to when we were in the throws. And you know if we didn’t do it nobody did it. Right?

Mark Redlus [00:43:51] DNA of teams and people are doing stuff.

James Flaherty [00:43:53] Exactly yeah. I mean Deb and I have talked on a number of occasions about how–where we have to–we actually have to schedule time to make sure that we’re having one on one discussions around some of the harder problems. But we talked a little bit about this last night. I think one of the great things, and it took talking through it to really realize it, is that 9 times out of 10 our decisions are made via consensus. We’re not bulldozing each other. We’re not voting one another out. Right? We’re in it. And if it takes five minutes, if it takes five days we’re going to keep going at it and going at it and going at it until until we reach consensus. There’s definitely been times that I think it’s been a little challenged and you know maybe we may reluctantly relinquish the position. I think those are rare. On the whole, we get to something that we’re all–that we all passionately agree on and believe is the right thing. And you know the other thing–just to expand on that–I’ve worked in teams before where I felt frustrated that nobody else on the team is getting to the place that I’m getting to. Right?

Mark Redlus [00:45:28] Right.

James Flaherty [00:45:28] And you know that at points in time the team just sort of throws up their hands says, “All right, whatever. If–I guess we’ll do it that way.” Right? And I never have that problem here. I don’t think we ever… I don’t think we ever go into a design discussion and worry that somebody’s trailing behind or that it’s not clicking or anything like that. We’re there on the same page. We’re were constantly riffing. We’re building on what each other says and we’re all truly contributing equally and I think that that’s fantastic. That’s a hard thing to come by.

Mark Redlus [00:46:11] Yeah for sure.

Deb Cypher [00:46:12] It’s unique for sure.

Scott Johnson [00:46:13] Yeah.

Mark Redlus [00:46:18] Gabriel did you wanna ask something?

Gabriel Eichler [00:46:21] No I mean those have been great questions so far. I think that you know the interpersonal team at–team dynamics are so key because it’s a very very–you know it’s a very very intimate and interactive process that each of you go through a lot at working together and making sure that the chemistry and mutual respect is there is tremendous and it’s clearly shown that you guys have have invested in that and have great results because of that.

Mark Redlus [00:46:50] You know it strikes me and I feel like we’ll make the podcast go longer because this question and the answers will be really interesting to get. And then we have another one more question after that. But if you had to–and this again is for folks listening to this that are just getting started, you know about to build their first thing or they’re trying to stand up an investment and do something that would impact healthcare, in this very difficult, challenging market–if you were to start from scratch and had to think backwards to how would you design a team that you’d have a chance to be able to have this happen, where the three of you all work together. I mean it’s somewhat serendipitous it’s kind of how things work sometimes. But could you–is there anything you could think of that you’d say, “Wow, if you do this you have a chance with your team to get to where you are right now”?

James Flaherty [00:47:44] Man, I really think we got a lightning in a bottle thing, here.

Mark Redlus [00:47:47] Yeah.

James Flaherty [00:47:47] Right? And…

Mark Redlus [00:47:49] Great answer James.

Scott Johnson [00:47:50] Yeah.

James Flaherty [00:47:50] Sorry…

Mark Redlus [00:47:53] Thank you, audience.

James Flaherty [00:48:00] I mean there’s a lot of luck. I mean there’s a lot of hard work, but there’s a lot of luck.

Scott Johnson [00:48:07] I was just gonna say, I often ask myself the question, if I–like if I was just independently wealthy, if I didn’t have to be doing this what would I be doing? And the truth is I would be doing this.

James Flaherty [00:48:20] Oh yeah.

Scott Johnson [00:48:21] Like this is what–so I would look for people that, you know in that team, that are really, love this process, love the process of creation, love the process of crafting something, and love the experience of seeing people find joy or benefit or value or whatever that is in what you’ve created. I think that you know for me that is really what feeds it. If you find individuals that thrive on that they’re going to do what it takes, they’re going to learn what they need to learn, they’re going to develop the skills and you know push it over the finish line. I think.

James Flaherty [00:49:02] Yeah. You know I’ve woven questions integrated into interviews on that topic. Right? What’s your pet project? What are you doing on the weekends and at nights? Right? What can you not put down? Right? Because…

Scott Johnson [00:49:15] Bingo.

James Flaherty [00:49:16] The last the last thing I want– Like so if there is a template for building a team, and not that this is the one thing, but it’s definitely a contributor. The last thing that you want is somebody that’s just punching in and punching out.

Deb Cypher [00:49:28] Right.

Mark Redlus [00:49:28] Right.

Scott Johnson [00:49:29] Yeah.

James Flaherty [00:49:30] That has picked this career because they heard that they could make money. That. That…

Deb Cypher [00:49:37] I hate that. I do!

James Flaherty [00:49:38] That that they’ve chosen this life because they didn’t have a choice. Right? They were going to do this or they were going to be miserable doing something else. And I feel that way. I don’t think that I could just go and pick some other career out of a career book and come home and think about that all day.

Mark Redlus [00:50:03] So somehow you have to get to a point where, and again this is for folks I think building teams, it sounds like from your–from all of your perspectives that they you know they just have to have “it”. I mean and “it” is this passion, and I think it’s overstated to me, “Oh, this person works 80 hours a week at X job.” It’s actually probably–it sounds like it’s more interesting if they work 60 hours at that job and then their side hobby is doing stuff that reinforces their main job. Right? I mean that’s a better sign if you’re building a team and hiring and recruiting and things like–that sounds like what you guys are talking about.

Scott Johnson [00:50:43] Yeah. I mean zeroing in on people that have that natural inclination to want to learn and be better at something you know and they’re always up to the challenge I think, you know, is so key. I’m sorry Deb did I interrupt you? You were gonna say something.

Deb Cypher [00:51:02] Why would today be any different? You know just to play off what you guys were talking about, I weave similar types of questions into my interviews. You don’t always get it right. You really don’t. But I listen for things. I listen for sort of my cues, you know when I hear people talk about you know why they do what they do. Right? And you hear that passions start to come out. I listen for things like, “But I want to know why.” For them to say that to me. Right? When I know that they’re going to dig into the why, because I just think it’s fundamentally critical. You can’t do this job well, I believe, if you don’t get to the why. So I don’t know, I listen for sort of my cues my tells that resonate with me.

Gabriel Eichler [00:51:57] How long does it take to figure out you made a made a mistake on the hiring before you kind of really confirmed that? It must be pretty quick but then it takes longer to confirm it and to figure that out.

James Flaherty [00:52:07] You know I feel in retrospect, it’s always like an hour.

Scott Johnson [00:52:14] I know right. True.

James Flaherty [00:52:16] But it could take weeks for you to realize that that off feeling in an hour was telling. Though you know in fairness I’ve had an off feeling in an hour before and it’s been nothing. Right?

Scott Johnson [00:52:34] Yup.

Mark Redlus [00:52:35] It was just indigestion. So let’s finish up with the question we try to ask all the guests..all the guests, we’ve had four guests… Over two podcasts…all the guests.

Deb Cypher [00:52:48] All of them.

Gabriel Eichler [00:52:51] And one of the guests was your co-host.

Mark Redlus [00:52:54] Oh right. We didn’t ask this question, did we? No, well we’ll go back and do it. But again, we-ll start reverse order, starting with James here. Right to left. Which is what is your one bold prediction that you would make for five years down the line in health care, technology-related I would assume, that we’ll look back and say, “I can not believe we did it that way”?

James Flaherty [00:53:22] Man.. I feel like this is tough. Right? In the sense that…

Mark Redlus [00:53:32] That’s the whole point of the question.

James Flaherty [00:53:35] I mean all right, fair enough.

Mark Redlus [00:53:37] We can take a commercial break and go to Peloton. Because every podcast will reference Gabriel’s Peloton.

Gabriel Eichler [00:53:45] Sponsored by Peloton.

Mark Redlus [00:53:46] Actually not sponsored by Peloton. Hopefully we won’t go and get in trouble for that.

Scott Johnson [00:53:51] Love, love my peloton. Gabriel.

Mark Redlus [00:53:53] You have a Peloton too?

Scott Johnson [00:53:55] I have a Peloton too.

Deb Cypher [00:53:55] Oh my God.

Mark Redlus [00:53:55] Oh my God that’s great. It’s like Peloton groupies.

Scott Johnson [00:53:58] We’ve got to get usernames, Gabriel, later.

Gabriel Eichler [00:54:01] Definitely, I’ll follow you.

Mark Redlus [00:54:02] I have one for Gabriel. “Under the periscope”.

Scott Johnson [00:54:08] You can find me.

Gabriel Eichler [00:54:12] All right…I’ll find you.

Mark Redlus [00:54:15] It’s actually __, but I want to… I like calling it “Under the periscope” because it sounds exactly like it should be. All right you got–come on James… Or you could punt it and think about it.

James Flaherty [00:54:27] Yeah I might. I think part of the problem is that we all collectively talk about all this stuff. So I don’t feel like I personally own a prediction.

Scott Johnson [00:54:38] Could we reframe the question to…

Mark Redlus [00:54:40] Of course we can.

Scott Johnson [00:54:41] OK.

Mark Redlus [00:54:41] You guys love to riff.

Scott Johnson [00:54:42] Like what will be vastly different I think in five years? I mean…

Mark Redlus [00:54:46] Sure.

Scott Johnson [00:54:47] And I’ve got one thing…

Mark Redlus [00:54:49] Way to qualify.

Scott Johnson [00:54:50] OK. Is that I think what’s happening in Silicon right now we’re seeing it. I mean these air pods that you have in your ears, the technology you have on your wrist–that is only going to get much more sophisticated and there are going to be things that we are–we take for granted now. You know we’ve got the Apple Watch that’s obvious. I talk a lot about the Apple Watch because it’s really an amazing piece of personal tech. And I think personal tech in general–specialized devices and things that collect data about us and improve our lives, like that fall detection, like being able to take blood pressure, like being able to check glucose levels down the road. I mean the things that–heart arrhythmia–all those kind of things you know we’re going to continue to improve in that regard and I think it’s going to be–when we look back on it, you know we’ll wonder how we certainly lived without that kind of stuff.

Mark Redlus [00:55:46] Awesome.

Deb Cypher [00:55:47] Yeah I agree. You stole my answer. I was concerned.

Scott Johnson [00:55:51] Sorry.

Deb Cypher [00:55:54]  I’m gonna say I’m going to be really surprised that we didn’t deliver assessments on a Peloton.

Mark Redlus [00:56:03] Way to get all the messaging in in one statement.

Gabriel Eichler [00:56:07] I tend to use my thumbs on my flat screen on my Peloton.

Mark Redlus [00:56:12] You were that 50% group that needs the bigger button thing.

Gabriel Eichler [00:56:16] That’s right.

Mark Redlus [00:56:18] Anything else James?

James Flaherty [00:56:19] I mean I think that we’re already going down this path. I mean deeper patient engagement and providing easier access to your providers. I mean that’s going to become the name of the game for everybody. Right? The barrier right now is really communication and getting the patient population to realize that these things are available. But I mean hell if I don’t have to go drive to my doctor every time I need to see them in five years that’s going to be killer.

Mark Redlus [00:57:02] Yeah.

James Flaherty [00:57:03] And I mean we’re starting that…

Scott Johnson [00:57:05] Just ride your Peloton.

Deb Cypher [00:57:08] You can see them on the Peloton

Scott Johnson [00:57:09] Right. They’ll have access to all kinds of data that is already being tracked and monitored and so forth. Exactly. I mean I think that there’s going to be so much value and that comes down to the other things. Eventually we have to get the hard problems we were talking about at the beginning of the podcast solved, as far as you know, you were talking Gabriel I think–and I’m going to paraphrase here–about just the silos. And so once we kind of–once there are–there’s some way to federate this data in a way that people trust, that’s privacy focused, and you know this is a big responsibility for technology companies. But I think once we overcome this hurdle it’s just going to open up the floodgates to opportunities and quality of life improvements in health care. Because right now it is very opaque. People don’t understand the process. They don’t trust it. They don’t understand why they have to–you know I don’t have to get into the complaints of every time somebody goes and sees a doctor but it’s like, “why do I have to do all this stuff over and over again?” It seems like you should have figured this out by now.

James Flaherty [00:58:13] And I think a huge hurdle is going to be trying to figure out a way of putting the data in the patient’s hands that is easy to use.

Scott Johnson [00:58:26] Right.

James Flaherty [00:58:26] Right?

Mark Redlus [00:58:27] Consumable.

Deb Cypher [00:58:28] Right.

James Flaherty [00:58:30] I mean my primary uses Athenahealth for their EMR and for the patient portal, and the amount of data that I can get out of there is so much. I mean there’s so much more data. It’s insane what I can get out of there versus what you could have done 5, 10 years ago, but it’s still clunky. It’s not user friendly. It’s not particularly obvious. It’s–I may be able to get all of my labs, every single detail in my labs, but I have no idea what I’m looking at.

Mark Redlus [00:59:09] Right.

James Flaherty [00:59:10] Right?

Scott Johnson [00:59:10] Yeah.

James Flaherty [00:59:10] And it’s it’s taking a lot of that stuff.

Mark Redlus [00:59:13] Doesn’t decode well right now.

James Flaherty [00:59:15] It doesn’t… It doesn’t. There’s no sense–I mean I’m in technology. Right? I have no sense of how I can take that data out or initiate sharing of data or any of that kind of stuff. And if that is difficult for me to figure out then it’s totally inaccessible to most of the rest of the public. And to realize the vision of patients truly owning their data and being the broker–being their own broker for their data we’ve got tons of work to do as healthcare software providers to bridge all of those gaps. And it’s gonna be an iterative process. Right? I mean it’s not dissimilar to, if we go back to the iPhone right, it’s not dissimilar to the limited feature set when you’re bringing something to market that nobody’s seen before and nobody’s used before.

Scott Johnson [01:00:14] Right.

James Flaherty [01:00:14] Right? And getting them to adopt it and then building on that trust and building on that adoption. I mean if you took the iPhone 10 hopped in a time machine and handed it to people 10 years ago there’s no way in hell it would have gotten the adoption that it got. Because it’s far too feature rich. It’s building on those base expectations.

Mark Redlus [01:00:36] Yeah.

James Flaherty [01:00:37] So I think that we’ve got the same–we’ve got the same challenge ahead of us just as health care technologists as a whole.

Mark Redlus [01:00:44] Yeah.

James Flaherty [01:00:45] In being able to take something to market [that’s] simple, getting people to embrace that and then building on it.

Mark Redlus [01:00:54] You know I’d be curious Gabriel’s take on this too because our resident data superstar, Gabriel Eichler. But you guys also have to make data–you have to be able to make it work. Right? It’s gotta be consumed by patients. But you know, Gabriel, we talked on our introductory podcast about the idea of A.I. and things like that, but being able to leverage data to make decisions–we think about that from a provider standpoint but really a patient’s standpoint. So James [what] you’re talking about is can I leverage and can I consume data and leverage it and then make better decisions. Does that kind of lead to maybe transformational outcomes? I mean if you can do something with that–right now you can’t do anything with it cause you don’t know what you’re looking at right? But if that changed what would that do? Gabriel do you have any thoughts on that?

Gabriel Eichler [01:01:48] Absolutely I mean you know I’m reminded of a patient blogger that I was recently reading about and you know in 2014 she had a big hit with this visualization she made. Her name is Sara Riggare and she’s a Swedish Parkinson’s patient. And she made this ridiculous graphic that showed 8,765 little balls stacked up next to each other and one ball at the top was red and she said, “To manage my Parkinson’s disease I spend one hour with my neurologist and 7,000, sorry 8,765 hours in self care. And it’s just absurd to think that we would think that measuring and managing healthcare can happen in such a minority of the time. Right? And so I think that we’re transitioning into this much more continuous communication mechanism which is bolstered by A.I. and it’s bolstered by virtual check-ins and telehealth and you know other forms of communication that patients and clinicians are happy to adopt and that you know we transition the role of the physician from that of what I think of as currently being sort of drone pilots to air traffic controllers. Right? And that they’re sitting there directing, bring in the people that need to be seen immediately, and managing from afar the people that are doing just fine. And so you know these are the kinds of changes that I think are going to work, we’re apt to see in the coming years. And to be honest the fundamental aspect of this that’s so important to make this happen–it’s the least sexy thing out there–but it’s just missing is data standards because we don’t even have a standard way of describing a patient or describing a disease. We barely even have ways that EMRs can talk to each other. And so the more we have data standards that fulfill these reasonable description languages of various complex fields and topics the sooner we can actually address these challenges and start to make them real.

Scott Johnson [01:03:50] Gabriel I have a follow up question. Do you think the market will work that out or do you think that there needs to be some kind of–whether it’s legislation or something else that creates an environment where that’s mandatory to happen?

Gabriel Eichler [01:04:04] Yeah. You know so I think–you know the forces that I think will make this happen are both on two levels. There’s an enablement layer, which is you know the digital health A.I. sensing telehealth communications layer that has to exist. And there’s also an economic layer, which very simply put if we really find a way to scale the adoption of value based medicine this will work. Right? Because all the sudden now my clinician’s time is much more at his or her will and their interest in serving patients to retain them in their cohort are all aspects that that is going to drive that type of adoption right now value based medicine has been growing by leaps and bounds. But from an incredibly small basis. So you know 50% bigger this year than last year is still from half a percent to one percent of total here. Right? So it’s tiny but I think that we’re not going to get this genie back in the bottle and value based health care is the only way to do it and that’s going to become the platform that’s going to enable these types of innovations.

Mark Redlus [01:05:05] Yeah that’s great. Yeah. All right. Well I think we’ll stop there. This was a lot of fun guys. I–.

Scott Johnson [01:05:13] Definitely.

Mark Redlus [01:05:14] I liked it.

Gabriel Eichler [01:05:15] Yeah we should do it again. This was great.

Deb Cypher [01:05:17] Yeah.

Mark Redlus [01:05:17] Maybe episode four. Oh you’re talking about a sequel, Gabriel.

Gabriel Eichler [01:05:24] Yeah you know listen, we should keep the conversation going. I could see these these guys have been great guests. We have a lot to talk through.

Mark Redlus [01:05:29] Yeah. You know there is a lot more meat on the bone, I would say. So it’s–it was a lot of fun. Thank you all for coming on and I look forward to hearing what everybody thinks about this as it goes out into the ether.

Scott Johnson [01:05:43] Thank you. Thanks for having us.

Deb Cypher [01:05:44] Yeah. Thank you.

James Flaherty [01:05:45] Thank you.

Mark Redlus [01:05:46] All right.

Gabriel Eichler [01:05:47] All right. Over and out. Thanks Mark for hosting this… Oh, shit. I’m still recording. Oh no. What’s going to happen. We’ve entered the Twilight Zone. Oh my God, help me…

Mark Redlus [01:06:01] Thanks again to everyone who just sat through episode three of the 10 x Total Health Podcast. If you enjoyed the episode please feel free to drop us a line via our website, 10Xtotalpodcast.com or e-mail either of us at Gabriel@10xtotalpodcast.com or Mark@10xtotalpodcast.com. We’d love to hear your feedback. Without our listeners, we’re just two guys having a really interesting conversation, which is kind of how this whole thing got started anyway. As always, the show notes will be up on our website under Episode 3. Please stay tuned for upcoming guests across the health care delivery, product, and investing spectrum. This should be a really great ride. We hope that you enjoyed today’s episode and we hope that you continue to join us.