Healthtech Optimists Episode 2: Developer perspective on building software for healthcare
Hi, I'm Alex. And this is the health tech optimists. Hey, I'm Courtney. Today we're going to delve into some background on Courtney. We're going to talk about what it's like to start founding a health tech business from the, the perspective of an experienced founder, um, having their first couple of months, uh, in health care space. So Courtney, I'm really curious for you to talk about what led you to co-founding a business in, in health and health tech of all the industries that you could have chosen to do next.
Yeah. Um, yeah, I mean, I think it's, I think it's a great question and an aside from my shiny objects syndrome and you know, my, uh, career and kind of technology, I've found a lot of interest in looking at different markets and seeing what, what is out there, right? And so that has led me to a career of doing, uh, pet food to working in government to working with email marketing and now healthcare. And some would say maybe a little schizophrenic there. Um, but I do like different challenges and I, and I've enjoyed those. Um, in terms of, you know, actually looking at this business, what I've realized and my history too, is that there's a definite evolution, um, in technology and where the world is moving. Um, if I look at the pet food market, when I started, uh, it was, you know, we ship, we ship food to one another, right?
So, you know, I've got a shop and you don't want to get onto the pet food store and so I'll ship you a heavy bag. And that made sense. And then we realized, well, the market realized then that actually you can do that on a subscription basis, rather dog eats the same food every six weeks. And so that same amount. Yeah. And so technology enabled that to happen. Um, and in the same way, you know, many years ago, we send email to one another and then somebody realized, Oh, it'd be really great if there was a tool that could send marketing email to everybody. And now we're forever spammed with great marketing emails. Right? And so
can, we can, we can partly thank you for that. From your growth to work at campaign monitor, which yes. Second largest, the most marketing campaign in the world. It's suddenly up. Yeah.
I don't know what the official numbers are, but it's definitely a very big gorilla in the room. And like literally, and we all know who that is. I don't want to do any marketing for them that I needed. They, their budget's big enough. Don't Google it. Yeah. Um, so yeah, I mean I think there was a, there was a evolution there too, right? Like we're sending emails to each other and we said marketing emails to each other and maybe then we start doing automation, right? So, you know, you, you need, you like want things from the store. Um, every time you click on, you know, a certain button or performance at an action on the store, then we can start to new automations based on that. So, um, there's a whole bunch of things that happened there. And I think my point, my original point was that in healthcare market, I don't think we've seen that as much. Um, we've seen a fairly stagnant market from a technology point of view here with all due respect to everybody. Um, but I think there's so much we can do in this market. When I look at it, I, I compare it to the SaaS market of say 10 years ago, right?
I mean this there's, there's doctors that are, you know, in first world countries literally down the road here, you know, from all North shore residents, um, that are running practices on paper. Like how exciting is that?
Mmm. Yeah. That's a, that's that massive opportunity. That sounds like you've, you've, you've, you've had a look at and you've seen the evolution in other industries and then said, well, maybe it's time that health has a similar
yeah. Growth. Yeah. And I think whenever you look at other startups and you look at other things that you might be interested in, you realize how far we've come. And when I look at healthcare, I just don't feel the same. And I feel excited by that challenge.
Hmm. I think that's something that we share, which is, you know, from coming from different places. But looking at the opportunity to create value in health is, is something that we certainly ran to each other about quite, uh, quite a bit. Yeah, I heard an interesting, uh, comment or article recently that the United kingdom's NHS or national health service, uh, was up until recently, the largest procure of fax machines in the world. Really, I think that run about in the order of 10,000 fax machines. And I think the government's in the process now banning them, banning the NHS from buying anymore machines as of this year.
Not for like a problem that should have happened in 2005.
in most of the industries that that is the case. I mean, I don't think I've ever used the fact I literally have never used a fax, yeah. Yeah.
So that's the, uh, the wonderful state of the opportunity that we have. Um, so when you, you know, when you have your, um, or when you've had your, your recent journey into healthcare and health tech, more specifically, what do you see as you know, what stands out and what, what stands out as the good? What stands out as the surprising, um, what's it like having educated, um, um, an educated perspective on a new market?
Yeah, that's a good question. Um,
I think, I think what stands out. I mean maybe we, maybe we start with the hardest stuff and then we can, we can move to the good stuff. Um,
I think my, my first view has been that in the healthcare market, especially in Australia and I think a lot of more developed countries that are very government funded and now this is not necessarily a bad thing. In fact, access to healthcare is a great thing. Um, and the government totally should be it, you know, part of the process. I think what it means though is that things may naturally flow a little slower. Right. Um, you know, things like procurement happen a little bit slower. Um, yeah. And that, that leads to maybe the flow of money between say businesses selling to medical, um, you know, just not as, um, I guess not as flush. Right. And so that becomes a little bit of a problem for businesses getting into, into health. Um, probably the other thing which I knew just because both of my parents were doctors, um, or our doctors, uh, is that they generally they hate change. Um, and so if you look at another business and you go, well, Hey, I can do email marketing for you, I can do email automation and this is going to lift your business by five or 6% they're in right, or, or 10% or whatever it is. Whereas in, in medical, it's like, well, it can do this thing for you. And you know, there's a lot of consideration and there's, Oh, I'm quite quite happy with the way I'm doing things now is my perception. It may not be the case. Um,
yeah, something that got described to me well was, um, you know, as a practitioner and not as a practitioner myself, but as a practitioner, um, it's very helpful to often think in exceptions because exceptions, uh, can cost people their lives, things that aren't picked up. So there's a, a, an and, and understandably low appetite for risk in, in many settings. Uh, and I think there's a natural on flow of that to other, um, other aspects of health care apart from just the delivery of care. Um, but it becomes, as you said, are limiting, can become a very limiting approach to, to change.
Yeah. I mean that's an interesting point in something I never really thought of is that if you do, if you do change things, um, that is a risk to any business rod. And so in healthcare you can't really afford to have risks and this is people's lives. Yeah. But
right my perspective, the time that we're at now, there is so much opportunity and so much hope, so much upside for so many people to such a large extent. Um, I think we have to be a little bit more, um, I suppose pragmatic about managing those risks in order to capture the upside because it can be, um, so big. And that's something that we'd like to talk through on this podcast more and more is bringing the people who are going to be exploring or demonstrating these really profoundly positive impacts that technology is having in the healthcare space. Definitely. Um, yeah,
I mean you can, you can see the impacts on other markets with the move to cloud to all those kinds of things. Right. And when that hits healthcare properly, it's going to be amazing. Yeah. It already is looking amazing.
Yeah. I describe it as the crossing the event horizon, which is the analogy from black holes, which is there's no going back, but all the excitement is still to come as we accelerate towards the center, hopefully not with a fiery death. Um, that the like all experiences, um, going slightly more technical now obviously as you know, you're somebody who's
Oh, could I get some good points because I think I didn't have any, and I'll give you a couple of good points, which I think, Oh, upsides. Yes. Upside. Yeah. Cause I don't want to be mr negative yet. Um, I think the good thing is, like it said is we're just already for change. Right? Um, and you know, interoperability has to happen. Um, we all want data to flow between healthcare parties and we all want less paper. We all want to fill out, name out, you know, and our medical histories, you know, way less times when we move between practitioners. And I think, um, the good part is that that's, um, that's still to happen. Right. And so there's so much opportunity as you said. Um, and the best part is that, and I don't feel like people know this yet, but you know, in primary care market, the opportunity for people to reduce costs, increase profitability as a business from a business point of view and most importantly provide the best care that they can for patients is totally going to be enabled in the coming years. And that's the most exciting part for everybody. Every stakeholder
in this whole process. Yes. Especially the patient. Yeah.
And that can't happen without lots more software. I think so. I think so with, with the human.
Gotcha. So it's important like softwares on the answer about enabling humans to be better. [inaudible]
the software software is definitely part of the answer. Definitely. Yeah. Humans are not going anywhere anytime soon. Um, but augmented humans is, uh, is where I think the care's going to get. Wonderful. And I think the health industry more broadly, getting used to running more software and understanding all the roles that different software can, can make from not just the, the health care delivery, but from finance, from scheduling, from rostering, from asset management, from, you know, all the other aspects to running at running a business. That's what I'm really excited about, to see the massive stratification of software into, um, into the healthcare market. Yep. Um, and moving away from, um, you know, single legacy software that kind of runs the whole show. Yeah. Um, so that does bring me to the, the question or the technical element that I get really interested about, which is, you know, now that you're understanding the healthcare market and you've had a history of building software in a bunch of different industries for both your own company that you've, you've started in and grown and for some really big, really big companies, um, you know, what's it like building software for the healthcare market?
What does that feel like? What does it, what does it take to get started and jump in?
Yeah, that's, that's a good question too. Um, I think, you know, initially the first, the first thing that I, that came to mind or comes to mind is the focus on security. Um, you know, I think building, building software with, with people's data and patients' data means that security needs to be at the forefront of what you're thinking about. Um, you know, I, I think, you know, I've equated it to credit cards 10 years ago, everyone was paranoid about where the data is, you know, as being stored and, and breaches and things like that. And now you buy stuff from most, most stores right without even thinking twice. And I think we, again, here, we here with, we here in a tech space in healthcare where people are worried about that. And I feel I in ten years time we won't worry about that. Um, but it is a very big concern for us.
Um, especially here at vibrance, uh, making sure that we are first and foremost, very secure. Yeah. Um, and so you think about it from that point of view. Um, I suppose, uh, you know, in the same way, like we're, we're actually making, we're actually making the, uh, medical data more secure, uh, you know, and not carrying around a piece of paper anymore that is hopefully passing through two systems which have some security measures on it. And so, um, you know, I think, uh, we probably gonna get to a more secure place. Um, I think also the interesting part is that when you building it, um, I realized that the data that I'm playing with all the entities that I'm playing with in the code or, or be real human beings that have, you know, um, all these properties about them, right? Like, you know, names and first names and, but then you think about like data flying between two places or you know, somebody's life actually changing because you're able to connect two dots together and you think, man, this is such a cool option.
That's pretty profound. That really is profound.
Yeah. I think, well, you know, email marketing is fun. Um, you know, and, and probably getting somebody they dog food, uh, quicker than what they could have done going down to the store is cool. This is
cool. On a scale of impact, it's, it feels pretty good. Yeah. I, um, I think about that impact a lot and that's, you know, a personal mission. And for me that kind of keeps me oriented. I had a great, um, a great rebuttal to the financial, uh, analogy where this person said, look, with a finance transaction or with your credit card, if your credit card gets stolen, if somebody steals some money from you, you know, unless you have Bitcoin, it's usually insured by the bank and you get your money back. Even if someone steals $10,000 from you, you get your money back. I think the fear that the logical fear that, that, that we spoke about was that if that information gets lost, disclosed, gets, um, breached, gets sold, uh, it's kind of out there. And so I think that some of the healthcare, the health get at it.
Yeah. So that you can't like recall your health data. Your bank doesn't, your hospital doesn't recall the health data once it just once is breached. So change change healthcare. Yeah. Numbers. Exactly. So the, the breach, the breach is kind of much more final than with a, uh, financial breach. And so I think that's, um, that's the downside risk that I can understand. And I think what I'm really passionate about doing, and you are to, you, you're building this is demonstrating all the positive things that happen, um, to balance out that risk and hopefully too a much, you know, to a much, much greater extent, um, the wonderful impact on patients and on their health care and ultimately on their livelihoods with business models that we haven't even thought of yet. And products that we haven't even thought of yet. Um, you know, it came to the evolution of, uh, you know, using a credit card online and now we've gone all the way to, um, say the Apple wallet where the idea of your credit card is almost abstracted away again with a onetime use number, um, in a bio authenticated, way that, it looks at your faces.
So, I don't know what the analogy is there with health data or I'm not saying there's a magical solution, but I'm really excited to see the applications that we build that take us forward and protect the downside of, of some of those risks.
There are a lot of downsides, like you said. Um, uh, yeah, I'm, I'm also excited, I think, I think humans generally are quite, um, or can be quite fear first programmed to be like that, right? Yeah. This whole sort of flight or, or fright. Yeah. I say that wrong. Flodell plot of sign.
Well, describe it as, it's helpful to be scared of the tiger because even if you, even if you're wrong about there not being a tiger, you're alive. And you know, if you're wrong about there not being a tiger, then, then you die. So the fear aversion, I understand.
That's why he's so lucky to have you on this podcast. You can, uh, fill my by Kevin or you can make up tiger analogies. Amazing. Providence. It's great. Um, so we'll get, I'm sorry, I've lost, I've lost track now. That's okay.
The next bit I wanted to ask about, and this is where the health data and health interoperability really, um, really comes to life or really gets created into something real and, you know, for a long time, for decades now, health software has made great impacts into the healthcare system. As you mentioned, there's been, um, across the board, there's been a good shift towards digital systems and that's wonderful for reproducibility and sharing in certain circumstances and durability, uh, instead of instead of having paper. Um, but what we've ended up with is a healthcare market, which has lots of different software systems built by lots of different companies, um, with no real interest or, or incentives in many cases apart from, um, some, uh, countries like the U S and the UK.
Um, no real incentives to make those disparate software systems talk to each other. So hospitals don't talk to general practice, general practice, these poorly connected to allied or different parts of, of care. And obviously as a single human, we need care generally from lots of different parts of the healthcare system. Um, and so this kind of, uh, this legacy software, um, ecosystem is fairly poorly connected. And so something that's been really exciting has been the evolution of, uh, how we standardized data so that it can flow around. Um, and where that's got to now is something affectionately or very excitingly called FHIR. Um, which we talk about sometimes and maybe it's a good place to start with what is FHIR and how do you spell it?
Yeah, it's something burning. Yeah, that's a very basic question. Thank you. Um, I, I wanted to touch, sorry, just briefly on what you said there. You know, when you're talking about systems all talking to each other and I feel like, you know, if I look at, uh, a company like Zapier and you may not know them as zapier.com, like they will a whole bunch of these systems that existed that were not talking to each other. And you had a company like SAP that came along and connected, you know, email to Salesforce, Salesforce to MailChimp, MailChimp to whatever else did it, Xero, whatever. Right? And so now we've got systems talk to each other and medicals ready for this anyway. And the way that they're going to do this as FHIR as you mentioned, and it is spelled F, H I R, um, which you know your assistant for.
Well, it stands for fast healthcare interoperability resources. Um, so a big acronym, which doesn't, I don't think it really helps FHIR a standard more exciting. Yeah. Um, and then it leads you to a whole bunch of ponds on the word and you can get really FHIRed up. Sure. Oh, of course. Yeah. Brilliant. So what does it mean? Could be on fire? FHIR? Yeah. What does it mean? Um, so what does it, what does it mean or I guess, um, why do we care? Why do we care about FHIR? Um, so I think in the tech world we have standards, right? Um, and standards for being able to talk to one another, right? And these, these fires or these FHIR, these standards have existed for a long time in the tech world to be able to pass data between two parties and for both those parties to understand one another.
like speaking the same language.
Correct. Yeah. So I've noticed we've had a natural world for many years. Um, and so some of those standards have been things like JSON prior to that XML. Um, and so, uh, really what FHIR is, is, is as kind of an extension of that. So it's a, it's a language that, um, it allows two parties to understand each other within the healthcare world. And so, um, you know, when we talk about a patient, for instance, right FHIR defines what a patient should look like. So it says, right, you know, you might have 30 different healthcare systems, but that patient will consist of, um, you know, a name or, or a series of names or a telephone number or a series of, um, communication, uh, I guess mediums such as email or, um, yeah, I guess that's about it really. But you know, and it's, it's kind of a bunch of properties that define various elements inside, uh, inside the healthcare space. And it goes, cool, uh, this is what we're, you know, these are the standards. Um, and it also allows you to extend those standards too.
And how has that, what you described there, how's that different from, uh, how Alex, myself as a patient might be stored in, uh, my GPs practice now or a hospital system now has FHIR different to how I exist already in the healthcare system as a data entity.
Um, I think, I think FHIR just defines a standard right. So you know, you have a number of properties so that your, that exist for you in, you know, a hospital. Let's say Gordon hospital has, um, you know, your stored in, in some EHR somewhere. And then they defined say, you know, first name, last name, um, medications, um, allergies, all those kinds of things. Right? And so if we were to pass that data to say, Hornsby hospital, you have to say, well, how do we know that those two fields are equal to one another right? Like, how do I get your first name from Gordon into first name?
Cause it could be stored in a different type of technology. It could be still in a different system. It could be stolen. The variable could be called something else. So those two will struggle to talk to each other, if at all.
Yeah, that's right. And I suppose the important part here is that if, if Gordon hospital can go well, cool, we can put it into the standard and go, Hey here, we'll Alex's details in the standard and Holden's Viga, we'll hear all the standard, you know, fields and here's Alex, it's details in the standard. Then we have two systems. I can talk to one another.
It's just like having an interpreter between tightly disparate people who don't speak the same language. That's right.
Yeah. Um, yeah. And what, you know,
this has been a journey for you for the past couple of months. I'm learning about FHIR and its implications and how it works and then a lot of the technical elements of it. Um, as a developer, how do you get,
how do you get started with FHIR? I mean, yeah. What does that look like?
Um, well I mean for me, I guess I can just talk about it from my point of view and how I did it. Um, best part. So I wasn't really sure if, if FHIR was something that somebody was just punting to us to go, Hey, use my technology, um, because it is born in Australia. And I thought, well, is this just an Australian thing? Am I building a global healthcare company? What are the impacts of that? And I realized that FHIR is the standard, um, came out of Australia, but it's been used across the world. Um, and that's the most important thing to note is that it's worth knowing it's worth knowing FHIR. Right. Um, and so once I, once I realized that, I was like, okay, well where do I find out more?
And, um, just got into, uh, you know, went onto Google, fond the documentation, which is well documented and thanks to um, the organization that runs FHIR. Um, and so yeah, I'm FHIRed up. There we go. Run it out there again. I'm fired up and open source FHIR server, um, pyro, which is, um, you know, graciously been, uh, open sourced by Angus Miller of, um, ADHA show. So, uh, and we, we're, I'm very thankful to the work that a lot of people have done in this industry already to set the basics up. Um, you know, just set these frameworks and yeah, we've got a great springboard to go on and that's really helped me learn, um, a lot more about FHIR because there's a lot of resources out there already. Um, and so once I understood the basics that, you know, this was a framework to define entities within the healthcare sector, um, I just got to understand the basics, which is really what does a patient entity look like? What does an appointment, what is a, an encounter or a visit, what does a medication, what is, you know, what are all these entities and what are the properties that are made up and make these up? Um, so yeah, I don't know if that's helpful at all.
Well, it sounds like FHIR ends up being another kind of framework that as a developer you're familiar with understanding frameworks and working through them. And really the first great step is to look at a FHIR server, which is a, what is a FHIR server?
So a FHIR server really just is a, um, I mean that's a great, that's a great question. Really. It's, it's something that understands from an API point of view or from an interface point of view. It understands being able to read and write the entities that make up FHIR, right? So it would understand the way to take in a patient in a certain format, right. To its database or if you, if you execute a read, it can read the patient from the database back out. Um, and most importantly, it's again, putting it in a standard format so that everybody else, can you, yeah.
Yeah. And some probably surprising to, uh, experienced web developers. Um, FHIR is really the first, uh, framework that has brought restful APIs to healthcare. That's, that's been, uh, a long overdue. But, uh, yeah, watershed evolution of the types of API as that developers know and love how to use already, um, with the standards
which then discharge, right. I mean there's nothing like making an a developer feel sick by saying here's a soap service or you know, awesome nonstandard something. Oh yeah. I mean people just, I don't know, ask me personally, I just lose interest immediately. But you know, once I knew it was rare space, once I knew there was the packages out there, like you know, some of the guys and um, uh, that have written amazing packages already to be able to query FHIR service to be able to write to FHIR as soon as, I mean just makes life so easy. And because of that rest based in face, um, we can all pass data around very, very easily. So it's super easy to get started.
Yeah. And that, that's what excites me because it sounds like that's the, the building blocks of the bare bones, the base, the base layer, the infrastructure that we need to build a whole bunch of rich application school. Suddenly the data around patients and healthcare organizations is in a, a standardized format. And I mean, that's what the company that, that Courtney and I are building vibrance, that's all we're doing. We're transforming data from all different sources, legacy and cloud, um, into FHIR so that, um, developers can much more easily build applications for, for health and organizations can start to consolidate their infrastructure because really what, what the exciting part is, is the applications that are coming. And, you know, we want developers to look at healthcare and go, actually, it's not terrifying. It's super exciting. It's, it's got some, you know, some nuance and security first and a few other bits and pieces, but it's, it's doable and it's, it's accessible and, um, there's wide open.
So I mean, even the most hipster hipster developer today can actually go, well, we're in, we're in 2019 with healthcare standards. I'm talking about from a tech point of view. And so, yeah, it's very accessible to me. Um, whether I'm an old school developer or, you know, hip stuff. Um, yeah. And then I think, yeah, I mean, it's worth pointing out. It's worth mentioning guys, like, um, uh, you know, Graham Grieve, who came up with a framework, um, and then obviously the millions of people around the world, which I haven't even got to know yet, but lovely people that I've met so far that had been just amazingly helpful in this area. Um, guys like Angus Miller, guys like Brett Esler, um, from Orisadhi being super helpful. Um, and you know, just people in sorrow that have invited us down to work in groups and, you know, the whole community's super friendly. Um, Kate Evrill you're awesome. I'm Brian Postlethwait. Yeah. So, you know, these are all people that have helped me understand it more and I hope to meet more people in the tech space, tech healthcare space
and the, the, the FHIR a community in health reminds me of some other really rich open source communities where there's a lot of people who have been putting in work for a long time and feel very passionately about this. So, uh, I do love the analogy of standing on the shoulders of giants. And I think there's, you know, a bunch of the names that you've mentioned have been at this for a long time and we're really excited to, to join, join the, the conversation. Um, both literally and, and, and philosophically. And we plan to have a couple of those names on the podcast in the coming episodes.
Yeah, I really hope so. I mean, we're getting, we're getting hundreds of players every week. Right.
That's it. So if you've heard your name in the spoken about in this episode, you can expect us to come and come and find you should name drop some others potentially. We'll save some out for another episode. Yeah. Anything else you wanted to touch on about FHIR or
no, I mean I'm looking forward to next week, maybe not being the center of the debate here and getting somebody else abouard. Yeah, that's it. Yeah.
Okay. Stay tuned guys. Next episode, coming up within the next fortnight and please get in touch if you share optimism for the innovation, um, the impact that innovation is having in, in healthcare, uh, specifically around data, um, and new applications. See next time
and share us. Share us on LinkedIn, Facebook, Twitter, wherever you can make it happen. Bye guys. See ya.