…Improving access to medical records — for healthcare professional and patients, alike. If healthcare providers can’t access the records, or the information is inadequately displayed, its value is limited. In a high-tech world where we can access WIFI in an underground train, there is absolutely no reason this technology should fail healthcare providers trying to do their jobs.
Thomas Charlton is Chairman and CEO Goliath Technologies, a company that provides proactive IT operations software to address the challenges associated with managing a hybrid cloud infrastructure, particularly among healthcare organizations.
Thomas is a leader in the high-tech space, heading-up U.S. and internationally-based software companies across multiple industries. He has an extensive track record as an executive of guiding companies through growth, profitability and acquisition.
Prior to Goliath Technologies, Thomas orchestrated the turnaround at PHD Virtual as Chairman and CEO, and led the company through seven record quarters of growth. Charlton also served as President and CEO of Shunra Software. He assumed control in 2007 and, after nine record quarters of revenue growth, returned the company to profitability in 2009.
Prior to Shunra Software, Thomas led a successful venture as the CEO of VoiceGenie Technologies in Toronto, Canada which received numerous sales and technology awards and recognitions. VoiceGenie Technologies was acquired by Alcatel. He was also CEO of Trailblazer Systems in Atlanta, where he doubled revenues in 12 months, which led to acquisition by Nu Bridges in 2004. His first executive role was with Tidal Software in Palo Alto, California where he joined the team initially as VP of Sales and became CEO 18 months later. Tidal Software received a number of awards including Silicon Valley Hot 100, Gartner Visionary.
Thomas Charlton has been featured on Fox Business Network, and in Inc. Magazine, CEO Magazine, New York Times, Businessweek, Philadelphia Inquirer, Philadelphia Business Journal, Silicon Valley Business News, San Jose Mercury News, and CEO Intronet. His full bio is available here.
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 path has certainly not been straight. I actually started out in the medical field, then got into high tech and eventually found a way to fuse the two!
Early in my career I was an executive at a medical company, U.S. Surgical, running a large sales division. I made my way up the ranks through sales in a model that required in-depth healthcare knowledge — in fact, we were gowned and gloved in the operating theater to help surgeons use our products. And, our products improved patient outcomes by dramatically reducing time spend in surgery, recovery, and reducing relapses and re-admittances. So, I really felt part of the patient care delivery process for my customers and took a great deal of pride in the work I was doing to help improve care.
That organization began a ‘fast track’ program that pushed executives to get an MBA to be considered for Corporate Vice President positions. This would first require me to complete my college education, and I decided not to put my career on hold. I believed, and still believe, that education is important. I was certainly learning and building my professional experience — continuing my education in the real world. I believed this approach could get me to Vice President faster than going back into the classroom and set out to prove it.
From there, I moved to an opportunity in the software industry, this was in 1998 in Silicon Valley and the height of the dot.com boom. So, I became very interested in the tech industry. I became a regional manager with Legato Systems leading a team of 5 people with only $15 million in revenue. I immersed myself in the tech industry and software, specifically. The team I hired increased that to $25m in 12 months at which time I was recruited to become a VP of Sales at Tidal Software. The company was unprofitable and had downward trending revenues in the trailing 24 months. I attracted a new team and, while we doubled revenues very quickly, the company suffered high operating losses. 18 months later, I was promoted by the board to President on a conditional basis. 6 months after that I was moved to the position of CEO. I’ve carried this lesson throughout my career: I firmly believe that building the strongest teams comes down to hiring individuals based on personal characteristics and success — so I look deeper than just degrees and academic credentials.
While I continued to build knowledge and experience, I really missed the emotional connection I had when I knew my medical devices positively impacted patient outcomes. While I was in the technology field, I always missed the human element — the intersection of the patient, product and the clinical staff. I started Goliath Technologies to provide proactive IT operations software to address the challenges associated with managing a hybrid cloud IT infrastructure. We keep systems running smoothly for a range of industries — airlines, financial institutions, government organizations, educational institutions, energy & utility companies, retail companies and others — and I know this makes life better for millions of people (workers and customers), but I wanted to feel the connection with patients again. In the medical surgical device field, there is a direct link, when it comes to software, it’s harder to see … until, I started to learn more about the new reliance that health systems have on EHR’s. The potential of digitizing medical records is massive in terms of improving patient care, but they must be readily accessible by the clinicians at the point of care. This is where I felt Goliath could get involved.
It’s been 10 years since the federal government invested $36 billion to facilitate the digitization of patient records and now 96% of non-federal acute care hospitals have adopted an EHR system. Like any industry that evolves so quickly challenges are to be expected. When we are on the phone with hospital CIO’s they tell us that they have spent millions on EHR’s but lack the tools to support application: EHR’s are where the rubber meets the road; where patients and doctors are face-to-face. If the doctor cannot get the patient’s records, the impact delivery of patient care is real and significant. The executive team saw this as an opportunity for innovation and we invested heavily in the healthcare space. Our software helps Health IT insure that physicians and clinicians have seamless access to patient records at the point of care. We quite literally identify issues before they happen and give IT the time to fix issues before patients and clinicians are impacted. Our own technical brand of preventive care.
So, that’s how I found a way to fuse my work in high tech with my passion for improving healthcare. I truly feel that I am part of driving Next Gen healthcare.
Can you share the most interesting story that happened to you since you began leading your company?
We sell software and very often it is hard to connect “technology” with the human element. How do we connect the value of our technology with the people who it positively impacts? And, are the people who derive value just the people we sell to, or are there others downstream who might be touched by what we do? It’s hard to see that in day-to-day operations. But, one evening I got a clear picture. I was out in Washington DC with a technical person I was hiring, and a doctor who I knew in the area. We were talking about what Goliath does and the technical person was explaining to the doctor how valuable the technology is to him as a user of the product. I noticed the doctor’s eyes glazing over so I injected, “so if you’ve ever attempted to use medical records while talking with a patient, and had trouble accessing the records, we have technology that helps avoid that situation.” The doctor immediately became animated and told us a story about a time when he was telling a couple that the husband was terminal and, while trying to get into this conversation, he couldn’t find the patient’s electronic lab reports that would have formed the basis for the discussion. His frustration was palpable … you could almost see the pain registering in his cloudy eyes. The experience helped me to clearly see the human element of what we do in healthcare: It is all about patient care. And, this is what gets me up every morning; what is driving me to do what I can to raise awareness for this technology.
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?
I’ve made many mistakes — none are funny because they cost me so much money! Business is all about taking risks and learning as you go. I’ve turned around several companies and that has involved acquiring other companies. I do have a few funny stories about integrating companies. Here is one:
When I joined Tidal Software, I noticed that the office was siloed. The VP’s sat in their offices apart from the sales team. There wasn’t much interaction and, more importantly, there wasn’t knowledge sharing. For companies to grow, it’s important to develop talent and that can’t happen when those with experience are closed off from those with less experience. As CEO, I told the VP’s do keep their doors open. I wanted to create an office culture that encouraged interaction between different levels. The VP’s continued to keep their doors closed. So, one night I just removed all of the doors. Viola! I instituted an open-door policy, literally. I guess you could say I was a visionary for open floor office designs!
What do you think makes your company stand out? Can you share a story?
Boldness, grit and compassion.
We were working with a large for-profit healthcare system on a very difficult problem. It turns out we had to develop a new product to solve the issues that they were experiencing that prevented clinicians and physicians from accessing the patient medical records in a consistently seamless manner. We knew that when we developed this technology it would be very successful. And, we would be the only ones with it.
So, we agreed to build this working prototype within 60 days even though 6-man months was the estimate from development (Bold). The development team moved resources to the project and worked 7 days a week, three weeks of the month and 6 days the other week (Grit). We delivered the product and it was the success we expected. We have sold 1000’s of licenses.
Shortly after we released the product, we encountered a small community medical center that needed the product in the worst way, but they literally had no budget. They were also so small that no one would really care that they were a customer so that had no currency for credibility. I talked to the person that managed IT and gave them free licenses and consulting so they could enjoy the value that this product provided to both the IT department and patients (Compassion).
But all of this is underpinned by an exceptional team. Goliath takes a different approach to hiring and developing talent. We look for self-motivated people and create an environment where they can really drive their own careers and thrive. I look for people who will “tip the grit scale” — someone with determination, discipline and mental toughness; It is really the most rewarding part of the job and always has been to see people build their careers and their confidence; and have repeated successes. They get what we call the “swagger” and that is something everyone should feel at some point in their lives. I’ve built repeatedly built strong, profitable companies using this approach to hiring. (And other top companies have started to do this too!)
Seeing people develop and advance their careers is one of my greatest joys. My office door (which is always open) is covered with photos of people who have come into the company at one level and moved-up. The ability to transfer knowledge and develop skills is the hallmark of a leader and of strong companies. Bringing people up within the company — promoting within — is a practice I firmly believe works … and, I have the pictures to prove it!
What advice would you give to other healthcare leaders to help their team to thrive?
For any team to thrive or be successful, it must have clear, meaningful goals for both the company or organization, and for the team members themselves. Each team member must have a common understanding of what each one will contribute and how the collective contributions will result in the goal being fulfilled. If you want to motivate people as a health are leader, specifically, you need to drive the mission back to impact on the patient and the healthcare provider. Keep talking about how the technology is improving patient care and the ability of doctors and nurses to deliver that care — show them through real-life examples. These stories must stay at the forefront of the company’s work and is the primary motivator for the most effective teams.
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?
This study was commissioned by the Commonwealth Fund, one of hundreds of organizations that conduct healthcare research. When it comes to studies like this, the criteria, the questions asked, and the POV of the analysis coming out of the findings have an influence on the conclusions. I can’t speak to this organization’s goals and this study, specifically, but I can speak from my own experience and industry knowledge to the state of healthcare in the US compared to other countries, and some steps we could take to improve what is already one of, if not the best places in the world to get injured or sick.
I have run companies in Canada, Israel and the UK. In Canada, often held out as the ideal model of a single payer or government run system, we actually had cash stipends for employees so they could afford out-of-system care — cash care. One vice president working for me traveled to Rochester, NY to have his mother’s hip replaced after waiting two years in Canada. In Israel, anyone with a serious illness came to the US for quicker and more efficient treatments. So, regardless of the Commonwealth Fund conclusions, the reality is that people are coming from all over the world to get healthcare here in the US. In fact, according to Patients Without Borders, nearly 300,000 people travel to the U.S. each year for specialty care or high acuity cases. The U.S. healthcare system ranks highest in preemptive cancer screening and cancer survival and the best treatment of chronic disease — so we’re clearly doing something right!
Nevertheless, looking at the Commonwealth Fund study’s areas: care process, access, administrative efficiency, equity and healthcare outcomes, I can say that we do need improvements in care process and administrative efficiency. As an entrepreneur, I see this as an opportunity for innovation, and I like to focus on how I can be part of solutions. Goliath is addressing some of these shortcomings in a few different ways:
- Improving access to medical records — for healthcare professional and patients, alike. If healthcare providers can’t access the records, or the information is inadequately displayed, its value is limited. In a high-tech world where we can access WIFI in an underground train, there is absolutely no reason this technology should fail healthcare providers trying to do their jobs.
- Administrative efficiency: Doctors are crunched for time. Any time they waste tinkering with slow or down systems, is time is taken away from patients. Face-to-face time is cut short or distracted.
- Better care: Access to a patient’s health records (current treatments, medicine and history) is critical information that nurses and doctors need to have in real time in order to provide the best possible treatment to the patient sitting in from of them.
- Reducing costs: Furthermore, the high cost of healthcare is a problem and there are many contributing factors. Goliath Technologies is helping to reduce administrative costs by improving interoperability between health IT software platforms
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. Improve tech systems. EHR’s are the future of medical care. Immediate, comprehensive access to a patient’s health information is critical for doctors and nurses to deliver the best quality care to patients. And, digital records empower patients to manage their health by giving them quick and easy access to their information. Hospitals have spent millions on EHR systems but not the support — we are often on the phone with CIOs from companies in this situation. They have invested heavily in the technology but lack the tools to support application and to troubleshoot. Where the rubber meets the road is where patient and doctors are face-to-face. These organizations are large-scale end users of these technologies, so the stakes are extremely high. One troublesome glitch can result in an outage impacting 40,000 end users. When doctors cannot access the records that they need, it impacts the delivery of patient care.
2. Reduce Physician Burn out. Our nation’s healthcare providers are increasingly strapped for time as they work to deliver the best care for patients. According to one report, the cost of unplanned downtime has escalated rapidly, rising an estimated 30% in the past seven years to more than $634 per physician per hour. Technology should ease the burden on physicians, not add to it. We need to provide reliable, consistent and seamless access to the digital tools that physicians need so they can focus on the patient in front of them. Please refer to the story (above) of about my dinner conversation with the doctor in DC.
3. Cost: EHRs are the Future. There will be no return to paper, hand-scribbled medical records, so we need to continue looking ahead to digitization and all that it offers and find ways to improve technologies and APIs so they can talk to one another. One local Healthcare CIO recently mentioned that he tells his team that the job of healthcare IT is to provide access to needed information at the time care is given — not 10 minutes later due to IT issues. As technology, software and interoperability improve, physicians will spend less time staring at stalled screens and more time visiting with patients; patients will spend less time in waiting rooms; information will be shared more quickly between physicians, patients and insurers; and costs will go down significantly all around.
4. Encourage Individual Accountability into the Healthcare: As preventable diseases and conditions continue to drive-up healthcare costs, there are increasing efforts to empower individuals to take control of their health through preventative care and wellness programs, encouraging patient accountability and promoting good decisions in post-hospital healthcare. There are also new programs like Blue Button API 2.0 that is showing promise as a standardized digital format — it empowers patients by giving them better access to their personal health information in a secure manner right from their smartphones. Technology has a role to play here as well, as seen in the rise in popularity of various fitness trackers, the Apple watch, and other tools that not only provide individuals with data to make informed choices, but the ability to easily share that data with their healthcare providers. Medical histories can be easily shared with their doctors and across health systems. These types of programs empower the patient and also help reduce costs.
5. Increase Competition by Rolling Back Regulations: We need to open-up competition between insurance companies across state lines. It is nuts that I can only get a few insurers within my state to compete for my business. Mergers between large providers are limiting options and raising rates for patients that are bound by state lines with few choices. This has to change. Our daily lives are filled with choices, we deserve the same when it comes to our health.
Ok, its 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?
We have to begin a real conversation about what is wrong with healthcare — specifically wrong. And then, put plans in place to fix it. In the US, the conversation has to begin with a general agreement on what is outstanding about the US healthcare system. Look, this is just a general gauge of quality. Consumer travel patterns are a good litmus test — some would say the best arbiters of quality when it comes to getting healthcare for loved ones. We should measure how many people are coming to the US for healthcare versus going to Canada, UK, France or the Netherlands. Let’s stop being distracted by an international body picking a metric or two and using them to assign a quality score to the entire US healthcare system. We should be scoring ourselves.
From here — from this common understanding — we can stop trying to tear down this system and make it more innovative and all inclusive. There are 329M people in the US and only 12% don’t have healthcare and 6% of those are young people who opt-out. So, let’s find a plan for those other 6%. EHR’s are almost ubiquitous at this point and there are tremendous upsides if we can improve usability, uptime and interoperability. So, let’s find innovative ways to accomplish this in the market that already exists. By the way, this is happening now with Goliath and all the major EHR vendors.
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?
Mental health is reimbursed at substantially lower rates and the coverages are substantially lower than general health. We see this in overall IT spend. For example, mental health facilities are largely still on paper medical records in part because the HITECH Act didn’t reimburse mental health providers for upgrading systems like they did healthcare systems. I heard this from a CIO who has both health care systems and mental facilities in the same network. He purchased only for the health care facilities.
How would you define an “excellent healthcare provider”?
An ‘excellent healthcare provider’ is someone who always puts the patient first and is focused on the best possible outcome for that patient. There are great technologies and tools available, including the EHR systems used today, that give providers the information needed to understand the patient and how to best provide care. The danger comes, I believe, when healthcare providers find themselves forced to focus primarily on the regulations, process, and paperwork, and not the patient.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.” — Teddy Roosevelt
WHY: High tech innovation is a tough field to be in — there are always hiccups and there are no guarantees that the solution will be adopted. Nevertheless, bold technological innovations have transformed our lives — you can reach people instantly with a text message now, whereas just 50 years ago we were dependent on telephone landlines. And in the early 20th century, we communicated by written letter.
Improving healthcare is not an easy endeavor, and there are plenty of naysayers who want to throw in the towel on EHR’s saying it’s too complicated to get all the technology to work together. I reject that. It may take a little more grit, but we’re not settling for antiquated approaches to healthcare.
Are you working on any exciting new projects now? How do you think that will help people?
So much of IT is fundamentally reactive — it responds to issues after they have already occurred. At Goliath we flip the paradigm to help IT be proactive and warn of approaching issues, so corrective action can be taken before users are impacted. Goliath does this today with the completed Phase One of our embedded intelligence and automation features. We’ve used this already, to give just one example, to proactively identify an issue that would have created a major outage for over 40,000 healthcare workers for one of our clients. Thanks to Goliath Technologies, that major outage never happened. In Phase Two we will continue to advance the predictive capabilities of our software to alert IT to 99% of performance issues before users are impacted. We’re driving our product to be the ultimate solution with the embedded intelligence and automation to predict, identify root cause, and remediate issues pre-emptively, making end user complaints and dissatisfaction obsolete.
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 enjoy both books and podcasts, but I think in this case there’s an even better source: the healthcare providers themselves. When you talk to doctors about their experiences, you get real world intelligence directly from the source. The top CIOs understand this and use a variety of formal and informal opportunities to get real insights from the people on the front lines of healthcare delivery. Maintaining a connection to patient care and the patients themselves is critical.
- In terms of blogs I think HISTalk has a valuable perspective as an anonymous professional that brings a much-needed frankness and openness.
- From a more formal perspective I think the work done by Chilmark Research is valuable.
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.
I think we’ve become obsessed with degrees in this country and we need to re-focus on accomplishments and personal characteristics. I want to tell young people and their parents — getting into an Ivy League or other very expensive school is not “the” ticket to success. Your life isn’t over if you don’t attend one of these top schools and you don’t need to accumulate $35k in debt by the time your 22 in order to set yourself up for success. As CEO, I try to lead the way in seeing candidates as individuals and considering their personality traits rather than just focusing on their academic backgrounds.
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