Technology evangelist John Sung Kim has his ear to the ground in Silicon Valley, and he offers some answers that may surprise you regarding why health IT interoperability is still at an early stage. In this candid and insightful interview, learn the effects of failing to hire and retain talented software engineers, providers not making group purchasing decisions, failing to gain actionable insights from data, the need for more open APIs, and unlocking the potential of wearables and other hardware.
Air Date: February 24, 2016
Guest: John Sung Kim, technology evangelist at Kareo
“Hacking an old Peachtree database so your software can talk to an independent doctor’s legacy EHR system probably isn’t the exciting kind of work that a UC Berkeley computer science graduate wants to work on. So it’s a double challenge. You have to find engineers that are passionate about the end result and why the integration is so important, even though it’s not necessarily going to be fun work for them.”
|1:47||Full transcripts now available for select episodes|
|2:20||Introducing John Sung Kim|
|3:50||John’s “must-attend” digital health conferences|
|6:18||Respect for Theranos|
|9:30||What providers and health IT companies can do to achieve interoperability|
|13:41||The appeal of an open API ecosystem|
|16:02||Bearish on wearables|
|22:12||Bullish on Validic|
|24:30||What will help health IT marketers in 2016?|
|25:26||Bonus question: If you could join a rock band or music artist for a day, who would it be?|
About John Sung Kim
John Sung Kim is a B2B software designer by trade. He started the company Five9 that had a “ten-year overnight success story” from cocktail napkins to IPO on the Nasdaq. His second company, DoctorBase, is a patient engagement platform for independent medical offices. John became the technology evangelist at Kareo when DoctorBase was acquired by Kareo in March 2015. He writes and speaks around the country regarding the “state of the union” of digital health. He convenes with digital health startups and is a contributing member of the digital health ecosystem.
You can reach him on Twitter at @JohnSongKim.
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Jared Johnson: Hello, my friends, and welcome to the Health IT Marketer podcast, the podcast for the heartbeat of healthcare. My name is Jared Johnson. I’m founder and principal of Ultera Digital and your tour guide this week. This is the first and only podcast dedicated to the health IT marketing community. Welcome aboard.
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This program is also all about connecting you with the resources and information to help you achieve your goals in health IT and healthcare marketing. So I want to point you to two of those resources, I may have mentioned them before, the HITMC LinkedIn community and the HITMC.com blog. Some great posts are happening in both communities right now, leading up to the Health IT Marketing and PR Conference, April 6-8 in Atlanta, Georgia. You can register at HealthITMarketingConference.com.
Well, I’ve been known to be persistent when asking you to leave a review on iTunes, but hopefully I’m not on that level of annoyance just yet. I don’t want you thinking that I’m like that paper boy from “Better Off Dead” who keeps showing up and saying, “I want my two dollars.” So if I’m reaching that level of annoyance, just let me know. In fact, you could mention that when you leave your review on iTunes. Do you see what I just did there?
Well anyway, I also wanted to let you know that there are full transcripts now available for several episodes from my interviews with e-Patient Dave, Christophe Trappe, Seattle Mama Doc and Aaron Watkins, in addition to the transcripts that are previously available for Joe Pulizzi and TheDocSmitty, Dr. Justin Smith.
So those transcripts are the top item that you requested from this program, so I hope you enjoy those. You can find all of those recapped posts at UlteraBlog.com. That’s U-L-T-E-R-A blog.com.
Well I’d like to welcome my guest. On the program this week, it’s John Sung Kim. He’s the technology evangelist at Kareo. John, how are you doing?
John Sung Kim: Hi, Jared.
Jared Johnson: Great to have you on the program. And I know we’ve been on several of the same tweet chats and things in various places. Our paths have crossed virtually a number of times here. For our listeners, do you want to let them know a little bit more about your background and where you are now? And tell us a little bit more about what you’re doing for Kareo.
John Sung Kim: Yes. I may B2B software designer by trade. I started a company called Five9, which had a 10-year overnight success story, from cocktail napkin to IPO on the NASDAQ market. And my second company was called DoctorBase, and we were a patient engagement platform for independent medical offices.
DoctorBase was acquired by Kareo in March 2015, so now I’ve taken on the technology evangelist role for Kareo, which basically means I write a lot of articles and give a lot of talks about the state of the union of digital health. I convene with other digital health startups in the San Francisco and Silicon Valley area. And generally I try to be a good member of the ecosystem here.
Jared Johnson: Very nice. So you mentioned conferences and speaking engagements that you have. Are there some that are always on your hit list, some that you say, “Hey, I’ve got to attend these events every year?”
John Sung Kim: Yeah. You know, HIMSS is always a big one. Health 2.0, I think Matthew Holt and Company have done a great job of really growing that as a global meeting place for people in digital health, and certainly the digital health startup community. And then here in San Francisco, it does have a bit of a rarefied air since it is invite-only, but the J.P. Morgan Healthcare Conference really shouldn’t be missed.
Jared Johnson: Oh, yeah. Absolutely. Absolutely. So it sounds like you attended that this last year, or this last month?
John Sung Kim: Oh, yeah. There were a lot of black suits in San Francisco, which was unusual for our city.
Jared Johnson: It really is. What were your takeaways from that conference, if you don’t mind me asking?
John Sung Kim: As always, there’s a concentration on biotech and pharma, but I think the one thing that I took away from the conference this year was that digital health startups are a little bit more desperate than they were last year, because there is a financing crunch that is starting to happen. In the timeframe between 2008 and 2012, let’s call it President Obama’s first term, there was a lot of activity as far as angel and seed investments in digital healthcare companies.
A lot of these companies had business models that were not as strong as they could be or, quite frankly, just didn’t mesh with the realities of the American healthcare system. So a lot of these folks now are looking for their next round of financing, but without demonstrating clear interesting traction to investors, there is a little bit more of a scampering attitude towards, “How are we going to get our next round of financing?”
Jared Johnson: So let’s talk about the effects of that in a moment. I’ve heard it referred to as everything from the “Theranos effect” to other things. Do you see that as being . . . we have these high-profile companies like Theranos out there. Is that one reason that the environment is the way it is right now?
John Sung Kim: Well, as far as Theranos goes, I’m a bit of a contrarian on that. I think there is some schadenfreude about Elizabeth and her team. I have a great deal of respect for Theranos and Elizabeth. I think they’re potentially onto some really game-changing stuff. But certainly the negative press doesn’t help.
At the same time, I do believe, for digital health entrepreneurs, if you can demonstrate traction, it is still a giant industry. There’s tons of room for innovation and change, but we are kind of coming into an economy of haves and have-nots. Certainly, there are companies like Omada Health, which is funded by a venerable VC firm called Andreessen Horowitz. They are reportedly doing very well.
So if you can demonstrate traction, there’s no shortage of investors that want to come and invest in you, but if you haven’t been able to get out of that pilot stage yet, or you’re still trying to pivot, to figure out where the product market fit is, and I see this with a lot of companies that have a great idea, and maybe even a useful product. But the unit economics aren’t there.
It’s a useful product as say, for example, a text message reminder to take your pills, but a lot of these companies are struggling to figure out a business model in terms of, “Well, who’s going to pay for this service?” And they unfortunately are turning into the have-nots.
Jared Johnson: That makes sense. Yeah, and for what it’s worth, I remember a few months ago I decided to try, you know, being here in Arizona, I’m able to actually use Theranos to do my blood work. For whatever it’s worth, I did find it extremely convenient, transparent, and I love the fact that I got my results emailed to me within 48 hours.
So the experience itself, I think they’ve created an entirely new experience when it comes to lab work, so that’s why I’m always interested. And I like to throw that example out there, to see what people think from a lot of different sides, because it is quite polarizing now in the last few months with the negative press. But then there’s this core of what Theranos is actually doing, and it is quite revolutionary. That’s led to some good discussions in the past. So yeah, thanks for sharing that.
Well, one other thing I know that you’ve said, it probably was a tweet chat that you and I have both been on, it was probably the Kareo chat, I want to say it was this last week or two, where the topic was the consumerization of healthcare and health IT, and you’ve mentioned, I believe that’s where it was that just the lack of interoperability really is that number-one obstacle for health IT seeing more of a consumerization. We talk about it lot, but we’re not quite seeing it may be at the pace that some people like to think.
So I guess when we talk about the lack of interoperability, there are a lot of different sides of healthcare involved in that. What if we take two of those audiences, if we take providers, themselves, and we take health IT companies? What do you think those two audiences can do to help make interoperability happen?
John Sung Kim: Great question, Jared. My gosh. This is, I guess, the billion-dollar question. My first TechCrunch article talked about interoperability as what’s really killing digital health startups, and I was pleasantly shocked to see the velocity of how widely read this article was in our community.
And I got so many comments, Jared, from other digital health entrepreneurs that said, “You know, I’m gaining good traction, but this lack of interoperability is killing me. I did a pilot at UCSF, and it took us nine months to integrate into their, say, online scheduling system. But now that I’m trying to sign up Sutter, they have a completely different system, and we are literally losing money on each deal because integration is so painful.”
So from a vendor side, it’s really about hiring engineers that can do these integrations. The dirty secret is that . . . my engineers roll their eyes when I say this, but US engineers are largely, and rightly so, because we are a great center of innovation, are somewhat spoiled in the sense that hacking an old Peachtree database so your software can talk to independent doctor’s legacy EHR system, probably isn’t the exciting kind of work that a UC Berkeley computer science graduate wants to work on.
So it’s a double challenge there. You have to find engineers that are passionate about the end result and why the integration is important, even though it’s not necessarily going to be fun work for them.
Now, there’s also the option of going to what I call “data plumbers,” and this has been an interesting new field or some vertical emerging in digital health. They are startups that have done the integrations for you, and they charge you a certain fee for each integration.
The challenge with this right now is that each integration is priced so it’s only slightly cheaper than hiring your own engineer. So the economics just haven’t reached that 10-to-1 order of magnitude benefit yet for startups, and a lot of startups are getting priced out of a lot of data plumbing products or services and kind of still stuck with the age-old question, “Do I do the integration myself, or do I pay someone that’s done the integration for me?”
From the provider side, I often find providers have the most power in numbers, but no power as an individual entity. Right? So for example, if my PCP said, “I am not going to buy any EHR that doesn’t have an open API, or at least an API partner program.” It’s probably not going to make that much of an impact for, say, an EHR company to change their policies.
Now, the ACO that that doctor is a part of, and say, for example, here in Northern California we have one of the larger IPO, Hill Physicians, let’s say Hill Physicians went to an EHR vendor and said, “We are not going to select your system when our current EHR goes end-of-life unless you have an API partner program.” Then I think you would start to see change.
One of the reasons my engineers and I really liked the idea of being acquired by Kareo and being part of Kareo culture was, at the time, DoctorBase had become quite popular as an acquisition target. We had a growing amount of customers and patient users, and we were approaching profitability. But for me as the chief executive, the most important thing was we find a culture in an acquiring obviously much larger company that shared our common beliefs.
Our belief was that we’re all racing towards a future of data interoperability, and that’s when true innovation digital health is going to start. And Kareo was one of the few companies at the time that had API documents that they just published, and our engineers were shocked. They just started reading it. We started integrating to it.
And Kareo today has a growing partner program, and some of our partners at Kareo are DoctorBase direct competitors. But I think the end goal and the philosophy is, “Whatever is best for our users, is what we’re going to do as a company.” So today we see DoctorBase, Zocdoc, Demandforce. They’re all Kareo partners that can integrate to Kareo products. And for us, that’s the future.
But as far as how providers can help enact that future or accelerate that reality, I think it’s really making group buying decisions and not purchasing a vendor that has vendor lock-in. Right? And we all know who those vendors are. But we certainly think that large provider groups putting pressure on them through their buying choices will have the biggest impact.
Jared Johnson: Well, that makes sense, and I think you just described the exact model that really can lead to interoperability, is that partner program that you’re talking about, and all being based on an open API, and the message that that sends. So I don’t think we can overstate that, how important that is to be part of the digital health innovation itself.
So I know one other place that a lot of people are looking right now for that type of innovation is with wearables, and when we look at, right now . . . I mean, from the clinical and health IT side, I get this sense, and I know some people have published on it, but I get this sense that we understand that today’s wearables really don’t fit into care patterns right now. They just don’t.
At the same time, there’s this promise of tomorrow’s wearables, next generations of either current wearable devices or new devices, they have this promise with them, “Hey, one day they’ll be this way to integrate my patient-generated health data into an actual clinical workflow, because without that, there really isn’t any long-term point to it.” So in your opinion, what is that going to take for wearables to really provide some kind of meaningful value in health care?
John Sung Kim: Oh, gosh. Jared, that’s the 10-billion-dollar question. Right? I’m actually quite bearish on wearables, and I’m bearish for three reasons. I think the biggest is provider time. The PCP is still going to be the point person for ingesting this data. And as we all know, PCPs are just crushed for time right now, so I think there’s a reality mismatch between what men and women such as myself are creating as far as the next brave new world of healthcare and what PCPs have bandwidth for. So I think that’s the primary hurdle there.
And until wearables can start amassing data and turn it into something meaningful . . . For example, if it’s recording my sleep patterns, my PCP isn’t going to have time to really read any part of that report, even if I send it to him or her in an email or show them my phone the next time I’m in the office.
But if it can take that data and it says your risk of having some type of sleeping disorder has gone up X%, or since you started taking this sleep medication, let’s say it’s Zolpidem, your sleep has improved or not improved by Y%, then I think that short burst of data, and let’s not even call it “data,” let’s just call it a “fragment sentence statement” that is a conclusion of all of that data, then I think PCPs will start to look at it.
I still think it’s going to take some time and some brand-building for PCPs to trust that that data is accurate, is backed by any science or is even relevant and not dangerous to bring up as part of the patient-doctor encounter. So that’s one. I think PCPs aren’t there yet, and we need them there for the future wearables to actually be realized today.
The second reason I’m bearish on wearables is just consumer behavior. Yes, Fitbit has been selling in record numbers, but the fact of the matter is most of the patient population that is at risk is still not wearing a Fitbit, and while I haven’t seen a recent study on the health breakdown demographics of the Fitbit buyer, I would venture to guess that more than half of the new Fitbit purchasers are actually people that run on a regular basis.
Meaning, healthy people like wearables today, and until consumer behavior and consumption patterns change, where it’s an unhealthy, overweight chain smoker that decides to buy a Fitbit, I’m still bearish on the needle-moving impact that wearables can have.
And then the third reason I’m bearish on wearables is accuracy. A friend of mine here in San Francisco, Charles Yim, has a Mark Cuban-backed startup called Breathometer. Tons of potential. It’s basically a small device that you can carry in your pocket or on your keychain, and when you blow into it, it will tell you if you’re over the blood-alcohol limit and it’s safe or not safe to drive.
And actually, it’s been quite popular here in the Bay Area. If you go to a restaurant where people are drinking, it is not uncommon here in San Francisco to see someone pull it out of their pocket and read into it.
But the accuracy right now isn’t there enough for folks to say with 100% confidence, “Okay. If I get pulled over and I actually blow into a real breathalyzer made by Siemens or the like, that it’s going to have a great deal of accuracy.” Right? And I think that’s not just a software problem. That’s the hardware problem, and it could also be a battery problem. So the technology isn’t quite there as far as wearables.
And I’ll say one last thing about that. I got to go to Morocco this last holiday season with a group of Apple engineers, and I asked them, “Why do you think the Apple watch hasn’t taken off as far as healthcare?” and they said, “The battery.” I thought they were going to say, “There’s no killer app yet,” but they said it’s the battery. It’s hard for a wearable to be accurate unless you can wear it 24/7, but if you have to take it off at night to recharge it, is it really a digital health device? It’s a great point they had.
Jared Johnson: I want to wrap up here in a few minutes, but I’d love your thoughts still on other digital health tools. I know one that you and I have mentioned before have been tools like Validic, like the type of data solutions that they provide for healthcare delivery. Do you get a sense that there is potential with a tool like that? Is there value there?
John Sung Kim: Oh, absolutely. Now, I’m a little biased because Validic’s counterpart to me, their technology evangelist, Akhsar Kharebox, is a good friend of mine. But someone has to unlock this data, and that’s the first step. And if this data is sitting in a blood glucose monitor and it only lives inside there and the USB cable and a laptop computer of the concerned mother that it’s connected to, I mean, talk about a silo of information.
And I think what Validic is doing is hugely important, because they’re not just unlocking this data. They’re doing it on a massive level. They’re signing up large Fortune 500 companies, large device makers, large telecommunications companies.
So while it may be that someone else actually turns this ocean, probably will soon be petabytes of data, into something that’s meaningful, right now someone has to do the hard plumbing work of actually unlocking it. And I think the way there attacking the market by going after medium-to-large size enterprises and just getting large swarms of information and data, I think they’re onto something potentially huge.
And again, Validic, to me, isn’t just a company, potentially. It’s a platform where other digital health entrepreneurs like myself and others come, and we can grab that data and start to model out things like, “Well, hey, me and four engineers have an idea for how we’re going to treat some type of pediatric disease. Well, let’s test out and model our assumptions by using Validic.” I think their opportunities are near endless. Really bullish on Validic.
Jared Johnson: Well, in closing here, is there anything else you’d like to share with health IT marketers about . . . I’ll just totally open that up. Anything else you’d like to share with our audience?
John Sung Kim: Well, you have such a smart audience that knows the digital healthcare marketing landscape. Gosh. When we started DoctorBase, I’m dating myself, almost six years ago, we didn’t know how consumer reviews would really affect the revenues of both independent medical providers and large provider organizations, and now we see reviews affecting even hospitals. So I think in 2016, marketing agencies that can help accelerate the reputation and review economy for provider groups will continue to see growing businesses.
Jared Johnson: In closing, I’ll throw our bonus question at you here, and that is, if you could join any rock band or music artist for a day, who would that be?
John Sung Kim: This is going to be a tongue-in-cheek answer, and again, it’s going to date me because I’m 40. In the ’80s, there was a famous punk band called The Dead Kennedys, and they had an album, which at the time seemed like a really gloomy prediction of how consumers in America would behave. But it has, for better or for worse, come true. The name of this album and the band that I would like to be a part of for a day is The Dead Kennedys, and the album was called “Give Me Convenience or Give Me Death.”
Jared Johnson: Awesome. Great answer. First punk band to be listed as an answer to that question. Well, John, I appreciate your time on the program today. Do you want to let our listeners know how they can reach you?
John Sung Kim: Yes. I’m at John.Kim@Kareo.com. Let me spell that for you. It’s J-O-H-N.K-I-M at Kareo, K-A-R-E-O.com. I do respond to every email, so please feel free to write. And I’m just John Sung Kim, J-O-H-N S-U-N-G K-I-M at Twitter.
Jared Johnson: Awesome. Well, thanks for being on the program, and we look forward to keeping in touch.
John Sung Kim: Thank you, Jared.
Jared Johnson: Well, that wraps up the program this week. Let me know what you thought about this week’s program by reaching out on Twitter at JaredPiano. That’s J-A-R-E-D P-I-A-N-O. You can also subscribe and leave a review on iTunes, listen on Stitcher Radio or any other favorite podcasting app.
Until next time, I’m Jared Johnson, and you’ve been listening to the Health IT Marketer podcast. This program is sponsored by Ultera Digital Marketing Consulting. Take your content further.
For a full archive, go to HealthITMarketer.com. That’s HealthITMarketer.com. Thanks again, and I’ll talk to you next time.