Administrative Inefficiencies — The lack of technology adoption, billing complexity and information/data interoperability have created a perfect storm of administrative inefficiency. Just one example is that different payers cover different procedures and pay different amounts. Both the payers and the providers need an entire back office operation focused on this problem alone. It does not need to be this way.
Asa part of my interview series with leaders in healthcare, I had the pleasure to interview David Niewolny. David is the Director of Market Development for Healthcare at Real-Time Innovations (RTI), the Industrial Internet of Things (IIoT) connectivity company. Previously, he led businesses at Freescale Semiconductor and NXP Semiconductor. David is an expert on healthcare technology with more than 18 years of experience in the embedded technology market and more than 10 years focused on connected healthcare and medical applications.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
My story starts in White Bear Lake, Minn., a suburb of Minneapolis in the heart of the Midwest. The Twin Cities Area of Minnesota was and continues to be the medical technology hub in the center of the U.S. Medtronic, St. Jude Medical (now Abbott), and Boston Scientific were and still are all major employers. Throughout high school, I was fortunate enough to have engineers from these major med-tech organizations come speak to my science classes. It was inspiring to hear them speak about what they were doing. All of them had such passion for helping people. It was that passion in their voices that pushed me to pursue a career path in healthcare and medical technology.
Following high school, I chose to pursue a chemical engineering degree at Iowa State, where I directed my studies for admission into medical school following graduation. In 1999, I graduated at the height of the first tech boom and all of the major semiconductor companies were hiring like crazy and offering very competitive comp packages, so I decided to put my medical school dreams on hold and I took a small detour to Austin, Texas to work with Motorola in their semiconductor division. At Motorola SPS and then Freescale, I held a variety of engineering positions which taught me a lot about semiconductors and more specifically connected embedded systems. Little did I know these embedded systems would soon become the foundation for what is now known as the Internet of Things or simply the IoT.
Following an MBA from the McCombs School at the University of Texas in 2007, I was ready to pursue my passion. My employer at the time, Freescale Semiconductor, was looking at establishing itself in new markets and gave me the opportunity to lead a small team to build a business focused on healthcare and medical technology. I spent the next 10 years leading and growing that business and left in 2017 to move up the technology stack into networking middleware and start the process over again with RTI, where I am leading our growth into healthcare and medical applications.
Every day I feel so fortunate that I have the opportunity to work with great people and cutting edge technology, all working to solve some of the toughest challenges in making the IoT a reality. The work we are doing at RTI is instrumental in providing the foundational infrastructure that powers the digital transformation of healthcare and a variety of other exciting industries.
Can you share the most interesting story that happened to you since you began leading your company?
At RTI, the entire company is aligned on a single mission to make the world run better. We do this by providing the critical infrastructure needed to enable the intelligent, autonomous systems of our future. You really cannot get much more interesting than that. The application spaces we are working in and the problems we are solving alongside our customers will drastically affect the way we live 20 years from now.
Each year in January, we bring the entire company together for a week to discuss strategy, build relationships and align the organization for the year. One of the key portions of this week-long event are the customer presentations. We have been fortunate enough for the last two years to have members from major medical device companies come speak to us about their applications and their use of Connext DDS. At RTI, our core product, Connext DDS, is an embedded connectivity framework based on the OMG Data Distribution Service Standard (DDS). Think of it as the software infrastructure for all of the data running throughout a complex system. That system could be a single product like a medical imaging device or a surgical robot, or that system could be a patient room, a hospital, or an entire hospital system. Connext DDS simply ensures that all of the data within these systems is reliably and securely available in real time (<10us) to any other device or application within that system. The applications have ranged from medical imaging applications using Connext DDS to increase performance in preparation to implement artificial intelligence (AI), to medical robotics designed to be operated remotely, to healthcare IIoT applications designed to aggregate disparate sources of data providing a foundation for real-time clinical decision support and automation. All of these applications have the ability to change healthcare as we know it, providing better detection of diseases, increasing availability of complex medical procedures, providing better surgical outcomes, reducing medical errors and more.
The amazing piece to this story is not in the work we do, but the effect those presentations have on me as well as the entire RTI organization. You can look around the room during those sessions and see a team that is truly honored and humbled to be working with our customers to enable these life changing technologies. We always leave that week inspired and proud of the work we do. It’s something that all organizations should do more frequently, especially those in the healthcare and medical space. I guarantee that you will find your teams more engaged and willing to go the extra mile for your customers.
Can you tell our readers a bit about why you are an authority in the healthcare field?
Healthcare is a very broad term and maintaining expertise in such a broad area is impractical. The key to being an authority in something as broad as healthcare is surrounding yourself with experts in a variety of sub-segments. To stay current, over the course of my career I have worked hard to build a network of contacts in the provider, payer, patient and technology space. My teams and I bring value back to that network by maintaining a level of expertise specifically in new emerging technologies and more specifically, in how to use these technologies to solve real healthcare business problems.
Over the course of my career, my teams and I have had the opportunity to work with some really cool technologies (Ethernet, USB, Bluetooth, Bluetooth Low Energy, WiFi and now DDS). We’ve had the opportunity to work with executives and engineering teams across the globe working to implement disruptive solutions utilizing these technologies. It’s been these interactions that have made my teams and me authorities in the utilization of new technology to create disruptive innovations in the healthcare space. Our teams help healthcare and medical companies embrace and utilize new technology that will help transform their businesses by improving patient care and lowering healthcare costs.
What makes your company stand out? Can you share a story?
There are a variety of things that make RTI stand out. From an internal perspective, we do a fantastic job at hiring people that align with our mission and core values to make the world a better place by providing critical infrastructure for complex and autonomous systems, through customer focus, teamwork, impeccable ethics and an uncompromising drive for excellence.
From an external perspective, we are one of only a handful of companies focused on providing mission-critical connectivity software for distributed edge computing. The IoT is still in its infancy with much of the focus on sending data to the cloud through a message broker. This cloud-centric architecture will soon give way to a more distributed edge-centric architecture, similar to the transition from mainframe computing to personal computing that we saw in the 1980s. RTI and our Connext DDS product is uniquely positioned to help make this transition more seamless for our customers by allowing them to focus on their core competency (i.e. healthcare and medical applications) and leaving the data connectivity component to us.
As a result, our software is designed into thousands of real IIoT systems. This includes systems that we are familiar with as well as the systems of our future, such as CT scanners, naval ships, wind turbines, air traffic control, autonomous vehicles, surgical robotics and underwater drones.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
This is such an exciting time to be in the healthcare space. The opportunities for innovation are as plentiful as they have ever been in history. The areas that I believe we will see the most disruption will be:
- Medical Imaging — We will see the combination of increased computational performance, the capture of higher resolution images, the ability to combine different image types, and the use of AI to support radiologists, which will improve diagnosis and lower the risk of error.
- Medical Robotics — We will see the increased usage of robotics in the OR with an eventual move to remote surgery, giving rural patients better access to care; and finally semi-autonomous surgery where the robot will be doing a majority of the work.
- Healthcare IoT Platforms — We will see a shift to more software-centric, platform-based approach patient management. The hospital will have access to all of the near-patient real-time data in a single platform, which will allow them to better manage patients and their business.
These trends will make our healthcare system safer, lower costs and improve patient care, but not a single application noted above can be done without a highly-performant connectivity framework, such as Connext DDS. Because the technology is standards-based there is also an interoperability component that is key and missing from a large portion of the healthcare market today. Technology like this is a foundational element in creating a fully integrated healthcare ecosystem.
What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)
- Nothing is easy — I am an optimist by nature, a glass half-full type of guy. Early in my career, I was always surprised by the number of challenges and obstacles that were in between me and a particular goal or milestone. Over time, I have come to expect the fact that, nothing is easy and if it were easy then it would not be worth doing because everyone would be doing it. Embrace the hard projects, they will be the most memorable and the ones you are most proud of!
- It’s okay to be wrong — Though I am not a fan of the fail fast, fail often mantra, I have found that it is actually okay to be wrong. In the past I was very hard on myself over making a decision that was inevitably the “wrong” one, and saw these decisions as failures. I don’t think we should celebrate being wrong, but I have found that doing so truly is an opportunity. An opportunity to gain insights that you would not have gotten any other way. As leaders, we need to make the best decision we can with the information we have, knowing some decisions will be wrong, but if we learn from every mistake, over time our decisions will undoubtedly get better.
- Personal relationships are important — Early in my career I led two separate lives, a work life and a personal life. At work, I was more like a machine than a person. I quickly learned that as you gain responsibility and begin taking on leadership roles it’s important to open up, let people in to your personal life and build real relationships at work.
- Spend more time listening — Listen to your peers, listen to your manager, listen to your employees and listen to your customers. You’ll be amazed at the information that you will get from all of these groups of people. Listening will make the small amount of time that you spend talking so much more meaningful to all of these groups.
- Healthcare is complex — I was not at all prepared for the complexity of the healthcare ecosystem. It’s an industry that operates in life or death scenarios so anything new must meet the strictest guidelines and requirements. I cannot say I was not warned, but the warning was not at all a preparation for what I was about to dive into.
Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high-income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
- Fee for Service Reimbursement Business Model — The current business model in the U.S. for healthcare delivery is a key driver of inefficiency. Providers get paid when they supply products and services, incentivizing them to provide products and services. In this scenario, suppliers have the ability to drive potentially unnecessary demand. Some studies have shown this supplier push to be roughly 50% of the total healthcare spend.
- Administrative Inefficiencies — The lack of technology adoption, billing complexity and information/data interoperability have created a perfect storm of administrative inefficiency. Just one example is that different payers cover different procedures and pay different amounts. Both the payers and the providers need an entire back office operation focused on this problem alone. It does not need to be this way.
- Lack of Coordinated Care — The lack of information/data interoperability throughout the healthcare ecosystem makes a coordinated care plan almost impossible. The data silos that now exist between providers, payers, patients, device vendors and EHR vendors is ridiculous. These silos put patient safety at risk and significantly increase cost due to data accessibility. This is the area that RTI has the ability to help drive significant change.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
- New Business Models — The single biggest issue with the U.S. healthcare system is the business model and the value network. Highly paid physicians have little incentive to pass their routine work off to lesser paid practitioners or technology based solutions. New business models should incentivize the use of technology to only utilize costly physicians when they are truly needed.
- Consolidation of Providers — Today, the providers are at the mercy of the payers and the medical device companies as they are all an order of magnitude larger than most all of the providers. We need to have those providing healthcare at the top of the value chain to drive innovation and competition throughout the ecosystem, leading to lower costs and better service.
- Ecosystem Integration — The integration of information and data throughout the entire healthcare ecosystem in instrumental in driving change. It’s hard to change what you can’t see and can’t measure. A complete, comprehensive and most importantly, widely adopted standard for connectivity, like DDS, will provide a view into our healthcare system not seen before, opening doors for innovative disruption. At RTI, we are working with a variety of organizations throughout the healthcare ecosystem to help drive awareness of the benefits of using standards-based connectivity technology.
- Personal Ownership of Healthcare Data — An indirect result of ecosystem integration should be personal ownership of one’s healthcare data. A patient-centric approach to healthcare data will empower patients to get more involved in their care and engage more meaningfully with their providers. Data shows that engaged patients tend to be healthier overall.
- Incentivize/Gamify Healthy Behaviors — The fee for service model is broken and there is currently very little reward for staying healthy. We need to find a way to incentivize our society into living a healthier lifestyle through healthy choices. Personal access and ownership of healthcare data will lay a foundation for this next step.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
- Innovate. Innovate. Innovate. — Healthcare is not the first industry to go down this path of rampant inefficiency. All of the inefficient industries before have eventually been disrupted around the introduction of new technology and a new business model. I believe that an ecosystem of connected devices, applications and systems will be the technological breakthrough to catalyze a healthcare revolution.
- Healthcare Focused Funding — In order to fund this innovative disruption, we need focused incubators, venture funds and growth equity funds that have planned and accounted for investment timelines of 10–20 years as opposed to the <10 year timelines they are used to funding.
- Be Patient — Healthcare moves slowly. This is something that I initially fought but now have accepted. Healthcare will never move at the speed of consumer technology, nor should it. Human life is at stake and we need to always remember that. As leaders in healthcare, we need to stay motivated, committed and continue to inspire the greatest minds to pursue this challenge along with us.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I am still a bit old school in that I have not completely embraced podcasts, but here are a few of the books that I have enjoyed and often refer back to. These books have most definitely influenced my view and approach to leadership and strategy.
- How to Win Friends and Influence People by Dale Carnegie — This book is always a great reminder of how much of the world of business is based on personal relationships. As leaders, whether we are managing up, managing down, or managing our customers, the principles in this book simply work. As our society continues to embrace technology more and more, I am convinced that personal relationships will continue to be increasingly important.
- The Creative Destruction of Medicine by Dr. Eric Topol and The Innovator’s Prescription by Clayton Christensen — These two books provide a lot of context to the complexities of healthcare, specifically the U.S. Healthcare system, and collectively provide a framework for disruption while providing a futuristic picture of how the digital revolution can make a significant impact to the cost and quality of care.
- Escape Velocity by Geoffrey Moore — This book provides an easy-to-follow framework for driving innovation within established organizations both large and small.
- I am currently reading The Leadership Challenge by James Kouzes and Barry Posner and I am looking forward to reading Dr. Eric Topol’s latest book, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again.
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