Eliminate faxing — Not by mandating it away, but by prioritizing the movement to best-in-class data solutions in the FHIR language. This move away from outdating faxing, which communicates health data with no common format or language and hinders the efficient exchange and sharing of critical health data, will enable the second major digital evolution in healthcare — for the better if we are savvy.
Ihad the pleasure to interview Lonnie Rae. Lonnie is an American business executive, strategist, and human rights advocate focused in healthcare and machine learning. She is the CEO, President and Co-Founder of Medal, Inc, a technology company specializing in the extraction and transformation of unstructured clinical data to generate intelligent longitudinal patient profiles and automate the population of thousands of common medical forms for insurers and government entities through state-of-the-art machine learning. She serves as a mentor to Henkel and to Founders Embassy, the world’s first embassy designed for international and immigrant entrepreneurs committed to making a positive impact on the world.
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 career began with a decision to pursue a medical degree. In my third year as a medical student, I encountered a patient in critical condition, without access to his medical history. Though his treatment was ultimately successful, I knew that with access to his data, his care would have been faster, more effective and less costly. Frustrated with the notion that it was easier to order an Uber than it was to gain access to lifesaving information, with only eight months remaining, I decided to take a leave of absence from pursuing my M.D. I had compiled research indicating that the majority of my patient population was dying from information-related errors. I estimated that an eight-month delay in addressing this problem was equivalent to 166,666 preventable deaths. Diverting from the path I’d worked my entire life towards was the hardest decision I’d ever made, but I knew I was and am working towards the best possible future for my patients and peers.
Then, while on track to pursue a tech career as a Chief Medical Officer, I was hit by a bus during a vacation. My record didn’t come with me, and my care cost $10k more than it should have. During my recovery, I had an idea that would lay the foundation to make globally accessible and useful records of health a reality. That’s why I founded Medal, where I serve as CEO, and formally left my program to rededicate my life to breaking down barriers so physicians can easily gain access to critical data that can save a patient’s life.
Can you share the most interesting story that happened to you since you began leading your company?
There are so many stories, so many of which are either take it to the grave or publish anonymously! The HBO show ‘Silicon Valley’ is just a hint of the reality of what the day-to-day process is like. Those who know me closely and know these stories keep encouraging me to write a book, but I can’t seem to find the time. The obvious answer for the most interesting story would be to talk about the challenges of being a female CEO. But the truth is, those things just encourage us to be better founders and to have grit — grit is the stuff good founders are made of. Regardless of the challenge, a good founder has to get things done. What I can say is that these things create exceptional opportunities for investors who are shrewd and able to take advantage of them — female founders have been shown to average 2x the return as a result of receiving fewer investment dollars at lower valuations. Someday this will change, but for now, it’s really good investment practice to invest in women and minorities.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
During one of the very first fundraising calls for Medal, we were calling from a warehouse because we didn’t yet have an office. In the middle of the call, someone outside started banging on the iron walls, screaming and yelling, and then sirens started to wail. The call didn’t last long afterward. I think that company took one look at us and was just done.
However, the key lesson there was, ultimately, prepare the environment around you. Not just the room where your meeting or call is taking place, but take note of all the planning and preparation needed, and take time to lay out the groundwork beforehand. Not being prepared for that call resulted in us not succeeding in raising money from that investor and preparing your environment appropriately can make a big difference.
What do you think makes your company stand out? Can you share a story, even an anonymous one?
The industry is really coalescing, jiving, and rallying around Fast Healthcare Interoperability Resources (FHIR) as a standard. Medal has been working in this standard for years and driving toward developing technology to support the transition onto FHIR. We’re very happy about this development in the market and what we believe it will do for the US healthcare market, and more broadly for the world, as we think about being able to utilize, analyze, and transfer medical data at scale.
We’re proficient in FHIR already, but in healthcare, communicating data is still 75 percent on fax as of December 2018. All that data is unstructured and up to 80 percent of the data in the electronic medical record systems is also unstructured. It’s not easy to utilize unstructured or heterogenous data at scale and people are trying to move into the age of artificial intelligence (AI) and machine learning (ML) — they need a solution. Having committed to FHIR early, we’re prepared. We’re ready and in position to really help and work with large organizations supporting the transition.
Organizations that we’ve been working with for a while have seen good results. There has been an 84 percent time reduction in how long it takes to fill out and complete paperwork regarding patients. Some organizations have such large paperwork files that only two to 16 are completed per day and this means a big wait for the patient and their care. Medal can make a fundamental difference in the speed and quality of patient care at this really important juncture.
What advice would you give to other healthcare leaders to help their team to thrive?
Don’t be afraid to tackle a new area. As care providers, we’ve studied really hard to understand the human body and how to care for it — ultimately these new technologies will be important tools in our toolbelt for providing the best care and it’s important to learn how they can help us. As you’re working, the environment is changing. As the healthcare landscape evolves, the wisdom of how to use these tools effectively is shifting. Medal took the perspective of maintaining a portfolio of industry opportunities and figuring out what across those were most needed. During this time of change, we’re now seeing that catalytic conversion of industry where we’re now positioned to really serve and assist companies that are ready to dive ahead into the next stages of this healthcare revolution.
The impact these developments will have in healthcare cannot be overstated and the laws coming out now on how to use and share data will change the landscape for us all. There’s not a perfect crystalized alignment on behalf of all parties, but in this circumstance, creating a competitive marketplace given this vision of the future is winning. When you’re doing something well and using the standards that will be best for all involved, you will drive toward producing the best possible product to serve stakeholders.
Additionally, if there are things you wish were part of the laws, because you feel they’re important, then make a comment and get involved. Within the guidelines, if there is something more you feel should be there — create it. If you have reason to believe it should exist, build it. Lead by example and build the world you want to live in.
Ok, thank you for that. 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?
Incentives in the US are being evaluated and questioned because of studies like this one. Currently, there’s a lot coming out in new legislation, and in the grassroots approach of how the community addresses these points, such as with interoperability and FHIR. We’re working to make sure we’re not doing double or even triple duty on certain tasks and with data. By understanding what’s happening to patients, we’re improving access to safety monitoring.
Our country has an open and free marketplace, with more than 300 types of medical record systems. Moreover, we have a wide range of insurers to choose from. Because of this, the US healthcare system has had to come up with ways for sharing health data in the best, most scalable, most useful way possible — we’re collectively contributing to and building the standard while we’re working to make it able to be implemented at scale: this is a bit like rowing a boat while you’re finishing building it, but it’s also the fastest way to solve some of the core issues we have in healthcare today. What has posed a unique challenge in the US has led to the birth of innovative solutions that will impact our healthcare delivery systems significantly and in numerous ways that we have and have not yet predicted.
Another challenge the US healthcare market faces is that it’s in the process of evaluating new models of care. There are huge innovation programs at the federal level, and at the consortium level in the US to test, explore, and run experiments on new models of care and payment systems that will incentivize/support good outcomes and improve the performance of the system overall.
In addition, conversations are occurring around the ‘American Way’ and the perception of the free or competitive marketplace. This is leading to new systems of insurance and care delivery, where individuals are more than patients — they are becoming consumers. This will lead to change. Change is never perfectly clean or straight-lined. But as these things happen, we are finding the way that supports the ideals of this nation and will deliver very high-quality care to consumers who have gotten used to being in charge of their own autonomy/lives.
What is more personal than your healthcare? We’re undergoing changes as a country that were necessitated by a unique ecosystem and diverse options. These options necessitated sophisticated and advanced solutions to emerge around models of care delivery and to transition models of consumer/customer empowerment.
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.
1) Eliminate faxing — Not by mandating it away, but by prioritizing the movement to best-in-class data solutions in the FHIR language. This move away from outdating faxing, which communicates health data with no common format or language and hinders the efficient exchange and sharing of critical health data, will enable the second major digital evolution in healthcare — for the better if we are savvy.
2) Support patient access/patient-centered health records — Not having real patient access is like having a bank account that only your banker can see. Despite the fact that we do not all have advanced degrees in finance, we all have full access to our banking accounts. Like with our health, we are ultimately responsible for the outcomes we face in that part of our lives, and therefore should be able to access our own health records as easily as we can access our personal finances.
3) Promote education on modern software principles — Understand what is easy, what is hard, and learn to be selective about our priorities. Hospitals asking for everything at once often get second- or third- tier versions of each feature — and we’ve seen that numerous medical errors, even otherwise preventable deaths, can result from this. The technology industry has evolved to building in what we call an “agile” framework, which means developing one feature at a time and testing it in sequence, but the healthcare industry hasn’t yet caught up to this across the board. The way to think of it is a series of controlled experiments. You wouldn’t put your patient on 10 new medications at once without testing them one at a time and testing the interactions between them in a controlled manner across a population, so why do we still try to do this with software? Moreover, this is a recipe for not having any feature work phenomenally — it’s like being a generalist, jack of all trades, master of none. Instead, it’s important for doctors and hospitals to prioritize understanding best-in-class agile development as opposed to the older-style waterfall models, which mandated building everything at once before getting incremental feedback. We have to be exceptionally savvy consumers of healthcare IT to really understand who is building quality platforms in various areas.
4) Reduce high rates of burnout within the care community — It starts with having empathy for ourselves. Physicians work exceptionally long hours and suffer incredibly high rates of burnout. We need to, as a community, generate more empathy for ourselves — taking care of our own bodies when we are sick, so that we can have true empathy for others. Without a step forward in this direction within the industry, without more compassion and care for our own experiences, it is so hard to have this same high bar for the patients we care for.
5) Encourage more connectivity between leadership and “boots on the ground” — So often I hear leaders of a program have shockingly different views than the workers who are responsible for day-to-day tasks and responsibilities. Case in point: I heard a large system insist that they no longer had any faxing within their national system, but rather there was a great messaging service that all of its doctors use. The doctors, however, disagreed firmly, stating sincere problems with their systems and that they most often resort to faxing or snapping pictures of patient data to collaborate with colleagues and transmit life-saving information. Healthcare leaders must ensure they’re aligned with those who are closely administering the system or using it daily. By prioritizing the end-user about their experience, we can ensure all teams are working together to design tools with empathy for the “power users” of those tools.
Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
Invest in FHIR and invest in tools that are going to leverage FHIR. Invest early and get on the ground floor of this next wave because companies that can take advantage now will reap the benefits moving forward. At this early stage, figure out what impact FHIR and interoperability will have on your organization and get ahead of it. Build a foundation before asking for all the bells and whistles and think about what is the minimum that you need to build or buy to achieve a result before adding on to it. Modern software leverages what’s called an Application Programming Interface (API) that allows different software to interact with the code behind the scenes — this allows us to leverage multiple tools together. Build the foundation first and then think about the beautiful house you want to build on top of that really strong foundation. Build the first floor before trying to build the attic. Remember that the shiny thing you want to use really needs somewhere super strong to sit for it to be as great as it can be.
FHIR will impact all kinds of things at the individual, corporate, community, and leadership levels. Change is always hard and always difficult, but it is very often worthwhile. This is similar to when you undergo a personal change, in figuring out who you are today and who you want to become. It’s never a simple, clean, easy process. The same is true for organizations. The best we can do is to make the most of this change, benefit from it, and figure out how to capitalize on the next wave of health tech innovation.
As a mental health professional, myself, I’m particularly interested in the interplay between the general healthcare system and the mental health system. Right now we have two parallel tracks mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
We need to understand that each individual is just one person — at the end of the day, we aren’t two separate people: the physical and the mental body. We’re starting to understand how physiological health and behavioral health interlace in more detail. For example, the greatest density of serotonin receptors is not in the brain, but in the gut. We are seeing not just an observed intertwining, but the evidence of how/why physical and mental health are related.
The mast cell, which releases histamine and 300 different chemical mediators, is likely to affect everything from autoimmune disorders to allergic reactions and even various parts of chronic illness. It’s been implicated in fibromyalgia and other physical body aches. We are now seeing at a cellular level the impact that serotonin has on the immune system. There’s also evidence that severe emotional distress can make anaphylactic shock more likely.
Essentially, we have evidence that these things are deeply linked. In our nation — particularly in younger generations — there is a deep awareness of meditation and mental wellness, and people understand and want the value that it brings. More apps are gaining a following, such as Simple Habit, Headspace, Calm, etc. We’re seeing in-person meditation studios emerge as well as a greater overall focus on mindfulness. We’ve also known for some time the link between anxiety, stress, and certain diseases/disorders. As healthcare professionals, we have so frequently treated all of mental health with an army of blunt instruments. Of course, there are times when those medications, instruments, and pathways are absolutely the right path at a given time. But, while we’re seeing physical illness benefiting from mindfulness or cognitive behavioral therapy (CBT), we’re also sometimes seeing a developing understanding of very severe mental illness.
As an industry, we are developing evolving views of how to best help people with both the interplay of mental illness and physical health. When we see these people being more empowered, our models will evolve further. Mental wellness should be a front-line treatment for many, many things. That’s going to involve de-stigmatizing mental health challenges, as well as rallying around and understanding the spectrum of normalcy and distress.
How would you define an “excellent healthcare provider”?
Empathic. Someone with a great deal of empathy, and who is really listening.
Doctors are experiencing empathetic burnout in greater numbers. They can’t spend enough time with their patients. Often, they’re sprinting through a checklist that they’re increasingly required to fill out. Checklists can be really helpful because they prevent accidents, but doctors often don’t have time to ask, “Who is this person?”
We have many more providers who do not have the time and support to be as empathetic and excellent as they can be — and they want to be. That’s why we went to medical school — to be excellent healthcare providers. We need to recognize that the provider is the number one person who is impacted by this system, because they are deeply affected when they are unable to deliver patients the level of empathy they wish to. They can be impacted by that lack of empathy twice — not only as a care provider but as a human being and patient themselves.
Providers want to do a good job. We really have to serve, support, and provide them with the kind of care and commitment to delighting them as a user, so they can be as excellent as they want to be.
An excellent provider should also have curiosity. If you are doing one thing after another, it’s hard to be as curious as you would naturally be. Giving providers back the time to be curious will have a huge impact on healthcare delivery. Everyone who goes to medical school wants to be curious and helpful. Our job as technology providers is to enable that reality. As healthcare providers, we have to support and encourage our peers to take care of themselves.
Many physicians are in an impossible situation and are doing the best that they can. Many have found ways to get around that and are able to provide excellent care by getting themselves more time, and changing the way practices work to provide that care. We can help them be excellent by dedicating that support to providing solutions for the individual user — not just organizations.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
At the risk of sounding like a true Millennial, “you only live once.” When you are hit by a bus and have a near death experience, your life really does flash before your eyes. It’s about doing what you can with the life you have. That’s why I’m here.
Are you working on any exciting new projects now? How do you think that will help people?
Medal is constantly looking to be at the forefront of health tech innovation. We recently formally launched our platform to pioneer the creation of a unified, contextual record of health at HIMSS19 in February. The platform extracts medical information from every possible source where data is trapped and applies machine learning and natural language processing to wrap it in a contextual narrative, giving it meaning. We’re always looking for ways to leverage cutting-edge AI technology and data analytics to give health data a purpose, enabling care teams to provide quality patient care, as quickly and cost-effectively as possible. We have some big projects in the works and are excited to share more as we roll out the next phases of that work.
What are your top 3 favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I’m a devout science fiction reader. I also read a lot from world travel and about people. I love traveling and meeting new people — uncovering new perspectives. Science fiction gives us a lot of unique perspectives on how the world could or may play out. It challenges us to think about the assumptions that we’re holding. In healthcare, you need to understand the nature of finite and infinite games. In terms of understanding, you have to have patience and the desire to keep going.
Additionally, I really enjoyed the book, “Emotional Awareness: Overcoming the Obstacles to Psychological Balance and Compassion,” by the Dalai Lama and Paul Ekman, PhD.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger.
In healthcare there are various ways of getting patients involved in their own care, especially with patient empowerment and patient engagement becoming more common. However, anyone familiar with Open Notes, will remember when provider notes were made available to patients — and how they created even more work for already very thinly-stretched care providers.
As a nation, we need to consider that Open Notes was an early version, and this is ultimately going to be a user experience and workflow optimization problem. At the end of the day, no consumer would tolerate having bank accounts they can’t access. It’s hard to be a fully educated, engaged and empowered consumer of healthcare if you don’t have a shared relationship with your own healthcare history.
Personally, I was told after I started having mysterious health symptoms in the wake of my accident that I wouldn’t be able to run a company, work a full-time job, travel, or have a family. Having access to my data enabled and empowered me to be in a position to figure out how to find a better path that enables me to do all of that. Not every patient is empowered to do the legwork or make the change that ends up being necessary in his or her life. The few and most determined patients whose lives and livelihood literally could depend on them figuring out a new answer stand to contribute a great deal to the medical community. Those patients and families who have the resources and various capacities to contribute, will be so incentivized to find answers that it will ultimately help us all to care for one another in this world.
How can our readers follow you on social media?
You can follow me on Twitter at @LonnieRae, or on LinkedIn.