It’s OK to be afraid of failure. You will worry about running out of money, not finding a “fit” for what you’ve built, and many other spectacular ways to fail. Eventually those thoughts will just become background noise. The quicker they do, the better your focus will be. I think in the beginning I was often thinking or worrying about an “exit” — trying to make sure I had my ducks in a row in case our venture went south. While it is good to have a plan, without confidence that “failure is OK, you will land on your feet” — you might miss the “scary fun” of doing a startup.
As a part of my series about “Big Ideas That Might Change The World In The Next Few Years” I had the pleasure of interviewing Dave Ross, Chief Technology Officer, Co-Founder of Twistle. Mr. Ross has spent more than 20 years in health IT, leading software development and deployment in a wide range of technology and product areas; he focuses on mobile applications and interoperability. Prior to Twistle, Mr. Ross served as Director of Information Services for more than eight years at Albany Medical Center in upstate New York. Mr. Ross holds a bachelor’s degree in Information Systems from the State University of New York.
Thank you so much for doing this with us! Before we dig in, our readers would like to get to know you a bit. Can you please tell us a story about what brought you to this specific career path?
I grew up in a physician family — my father, brother, and sister had long careers in medicine by the time I started to think about my own path. There were many formative moments where I witnessed the impact that technology had on both healthcare and education. I saw first-hand that you could create data-driven processes which had a direct, positive impact on human beings. Early on I wanted to improve the daily lives of healthcare workers or educators, but as I began to think bigger, I realized that there was massive power in technology to “reach out” to patients directly, and that’s how Twistle got started.
Can you please share with us the most interesting story that happened to you since you began your career?
The first time we pitched the idea of Twistle’s automated patient pathways to a surgeon we came prepared with a number of bells and whistles ready to go, like a complex series of steps, rules/logic, alerting, etc. The surgeon (who was most concerned about dehydration risk after his patients left the hospital) took one look at what we had and said, “Can this just make sure that my patients drink 6–8 glasses of water every day?” That one simply-stated goal and our ability to effectively adapt on the fly (we changed the pathway during the meeting to target dehydration) really accelerated our growth. It led to our first real contract with a large enterprise and put us on a trajectory that we couldn’t have imagined at the time.
Which principles or philosophies have guided your life? Your career?
I have always valued “meaningfulness” as part of my paycheck. If I feel like I’m helping others in some positive way, many of the day-to-day difficulties don’t seem nearly as difficult. Whenever I’ve thought, “What should I do next?”, I think about how much purpose there would be in it. I wonder if it would lead to a story I would tell my grandkids?
Ok thank you for that. Let’s now move to the main focus of our interview. Can you tell us about your “Big Idea That Might Change The World”?
90% of the world’s population has access to a cell phone. That means that with the right technology and strategy, 90% of the world’s patients can be reached via secure texting with patient education, coaching, and reminders that can fundamentally improve population health.
Simply sending messages, though, is not enough. There is a unique patient at the other end of each communication and the value is ultimately determined by them. Asking questions and responding intelligently is a huge part of achieving meaningful engagement. The ideal solution will:
- Be optimized to meet unique patient needs
- Enable health / quality outcomes analysis
- Help patients achieve goals that are both important to them *and* the healthcare organization
Our big idea is a “navigation” system for health that offers “turn-by-turn” directions to patients throughout their care journey by way of their mobile phone. Additionally, it should reach the masses, and not require specific levels of tech-literacy. It will explore key insights gleaned from years of patient engagement data; a wide array of factors will drive an optimal patient experience ranging from the use of empathy to the technical features of a message delivery method. The future implications of machine learning on our ability to personalize communication pathways in a way that uniquely addresses each patient’s needs will also be explored — but AI/Machine Learning doesn’t have to live front and center to deliver real value.
How do you think this will change the world?
Globally, healthcare delivery is stressed in many ways. Costs are difficult to control, and healthcare providers are often incentivized in multiple competing directions. I think solutions like Twistle will allow measures of health within broad populations to be maintained or improved, while at the same time decreasing overall cost. We are doing the “heavy lifting” of keeping massive numbers of people “on track,” which allows healthcare providers to focus on patients who actually need extra attention. If we can get healthcare costs under control, there will be less financial pressure on all involved parties, and many more people will be happier and healthier overall.
The obvious one here is the use of AI in making clinical decisions, even if it is just “supporting” a human decision maker. The consequences of those decisions may not be what anyone wants to hear at an individual level, e.g., “This computer decided you don’t need an MRI, due to the predictive likelihood of it not finding anything significant.” But we then rejoice in the result at a population-level, e.g., “unnecessary imaging costs are way down this year.” It’s something everyone should think about as they go through their own healthcare journey. I think the risks here can be mitigated through data transparency, e.g., allowing individuals to understand at a deeper level how decisions are made, even when advanced technology is playing a role.
Was there a “tipping point” that led you to this idea? Can you tell us that story?
In the early days of Twistle we were struggling to find product-to-market fit. We knew we wanted to have a positive impact on the broader population(s) of patients, but we were only focused on building asynchronous messaging tools and not thinking about the role of automation in patient engagement. However, I was also exposed to quite a few healthcare technology systems that are deployed to measure quality, specifically as a component of reimbursement. These systems did not support real-time intervention and I thought, “What if we could detect that an individual was at risk of negatively impacting one of these quality measures?” If we did, we could automatically intervene using our messaging technology and actually change that outcome in real-time. That led to us developing a true return-on-investment story and was a real tipping point for us as a company. We could now point to a meaningful change in the bottom line of our customer segment. Framing our solution in this way rapidly took us to new opportunities and successes.
What do you need to lead this idea to widespread adoption?
I consider Twistle to have already achieved widespread adoption in our target market of large healthcare provider systems, who typically have robust processes established for deploying new technology. This becomes more challenging as we move down-market to smaller organizations and freestanding healthcare practice(s). We know we need to improve our product so that it is more approachable and “turnkey” in order to find that same widespread adoption down market. Another battle we fight is one of perception. Many healthcare providers are forced to constantly enter data into systems with poor usability and efficiency. When we try to introduce Twistle, there is a perception that *any* new technology is unwanted due to the burdensome state of healthcare technology today. So there is a hurdle for us to climb in order to change that perception and help our adopters understand that deploying Twistle will not make their problems worse, but it will instead alleviate them.
What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)
- It’s OK to be afraid of failure. You will worry about running out of money, not finding a “fit” for what you’ve built, and many other spectacular ways to fail. Eventually those thoughts will just become background noise. The quicker they do, the better your focus will be. I think in the beginning I was often thinking or worrying about an “exit” — trying to make sure I had my ducks in a row in case our venture went south. While it is good to have a plan, without confidence that “failure is OK, you will land on your feet” — you might miss the “scary fun” of doing a startup.
- Pivot fast, but don’t try to re-invent everything when you do. There were a few times where good ideas were left by the wayside because of the shiny new toy in front of us. At Twistle, the first 1–2 years were spent on an idea(s) that didn’t have great product/market fit — basically a “messaging app” for healthcare. We shifted our focus and core value proposition to automation, but we continued to iterate on what we originally built in order to find our success. By not throwing out what we had built, we gained an advantage that we would not have had if we just “pivoted” and built something new from scratch.
- Be as transparent as possible. When things aren’t going in a direction that you believe will be successful, don’t worry about the career/social harmony aspects of letting other(s) know your thoughts. It can be done respectfully, and others will appreciate knowing where you stand. I think one thing we struggled with in the beginning was being open and honest with ourselves about the business prospects of our solution(s). We had a lot of great ideas coming from opinionated leaders in the room, and while many of those ideas were aspirational and motivating, they were sometimes too idealistic to be successful. We may have waited too long to narrow in on the intersection between idealistic and realistic, and I believe some of that may have been an inherent unwillingness to disrupt the status quo.
- Hire people that scare you. It’s cliche, but it almost always works out in your favor to bring people on-board who could do your job better than you. Elevate those around you, and we all rise together. As a CTO, there’s a mental trap in trying to be the best at everything. The best developer, the best architect, the best agile coach, etc. I think a CTO’s role is to set context for the product development team(s), make sure all the roles glue together successfully. You must make sure that business ideas blend perfectly into an engineering/product organization. It’s important to make meaningful technical contributions to your product, but you should expect to be out-classed by people you hire in many different ways.
- Keep your life outside of your career intact. I think many startup-ers forget that in order to be successful they need to find balance. Working long hours, forgetting about self-care, and ignoring loved-ones are easy things to do when you are trying to get a new company off the ground. In the long run, it will benefit neither you nor the company. This advice is easier to give than to follow. I’ve done a team meeting while simultaneously descending mountain chutes in the backcountry on a snowboard. Letting your work permeate many aspects of your outside life is both easy and sometimes the only option. You might at some point look back and realize that you haven’t truly disconnected from work in months or even years. One key thing to do is to have great operational backup — where you can “disappear” for a few days and have complete confidence that things will generally be OK with your product/service/customers/etc.
Can you share with our readers what you think are the most important “success habits” or “success mindsets”?
Make sure your work reflects your personal values. For me, as I mentioned, work has to be meaningful. I think to some extent we all want this, but maybe in different ways. I’ve adopted a big picture tactic to transform my life and the way I live each day. For example I ask myself everyday, “What did I learn? What could I have done better? Did I make a difference?” This sense of purpose helps keep me focused and moving forward.
Directly related to this is the willingness to grow and change. Change is a constant and being open to it leads to success — you just might not follow the path that you originally thought would get you there.
Some very well known VCs read this column. If you had 60 seconds to make a pitch to a VC, what would you say? He or she might just see this if we tag them 🙂
I would say that Twistle has perfected a broad, platform-based approach to patient engagement that has already achieved significant widespread adoption at many large US-based healthcare institutions. Our own customers have measured the impact our technology has, and have found significant return-on-investment in deploying Twistle. We are continuing to grow organically into new areas that we never dreamed of, and additional capital would only accelerate this growth and broaden our horizons.
How can our readers follow you on social media?
Thank you so much for joining us. This was very inspirational.