We have you back. So last time we talked about the, I don't know, like the state of what's going on in the healthcare world as regards with technological opportunities, what companies are interested in, the opportunities they have, things that they're, I guess you could say worried about, but stuff they want to pursue. I thought it'd be good to have a second episode where we talk about, so in our world of doing software better and the oldest, as we say, sometimes the, the build, run and manage phases of figuring out your software and building it and running it and managing it like all up and down our Tanzu stack. I thought it'd be fun to talk about. So picking out some of those things, like what, what are some things that healthcare companies are doing or could be doing specifically with that. It'd be fun to talk more about stuff in the more custom software development space. Last time we drew a distinction between in healthcare, like patient outcomes, which is the point of healthcare to keep people healthy. It's right there in the name. And then, you know, what I would call efficiency and productivity or removing costs, making things financially run better, which is fine as well. I think what we do, there's a lot that they can, the, the, like the software world that we work in can fit into both of those buckets. Absolutely. And I think the healthcare space, you've got things from the practical, how do we do this to your point, efficiently and securely get more widgets per buck and stay compliant and stay secure. We've got, how do we leverage things at the edge? We think about hospital at home and devices and things like that. And then there's really a real opportunity coming up to really change that patient or member from an insurance perspective experience. When I think about the transparency regulations that are coming out, which right now everybody's in the, we just got to deal with government regulation. But that's really mandating this whole API based world, leveraging fire, FHIR protocol out there. And which is great because now once everybody is talking that I think we're starting to get into that world of where people are going, I had to do this anyway. What can I do with it? Like, how can I take advantage of it? How can I now leverage the fact that I know hospitals and labs and doctors are all going to be talking that this fire language insurance companies that have a whole lot of information are talking this fire language.
2:12When you start to think about what digital experiences you can bring to life as a hospital or as an insurance company, or frankly, as a startup that we haven't even thought of yet, it starts to get really exciting from that aspect. What is fire? What are the details of it as far as what data it is? It's basically your medical records at the simplest form that you went to your doctor today and had a physical and here was all your lab results and your vitals and doctor's notes and things like that. It's also what the insurance company did with that, what claim was paid, how much it cost, how much your insurance company paid or didn't pay or that kind of stuff. Oh, that's interesting. It also makes out this mandate of freedom of information so not only is it this but the rules are this particular HL7 fire protocol, but which is just a language, right? English, French, Italian fire. It's just a common language we're all going to use to talk that the words that mean the same thing, but it's also a right. So you as a patient have the right to say, if I have a device that speaks this, and by the way, iPhones do, and the health background and the health app stuff, I can go and say, give me my medical record. And you have that. And so what is that experience when now I can start to look and explore that information myself? That kind of openness and transparency reminds me of like European banking, which they have a, I forget what it's called, but they, I think it's the EU passed like this law ordinance. I don't know what you call it. But requirement a couple of years ago that banks have to be open. Have you ever used mint.com? It's a similar thing, except you don't have to like use mint. Like in theory, all of the, there's open APIs for stuff and you have a right to that banking data. And so you can integrate it into your one thing. So it seems like a similar thing of, Hey, I own my healthcare records. The other side of that, which is as technologists, you understand is that there's a big difference between owning some chunk of data and being able to actually get it. Mint, I think is a good example of what is that generation of things that are going to come out as this protocol gets established, right?
4:12That's going to be really exciting. And if I am an insurance company or a medical device maker or a large hospital system, how do I get ahead of that? How do I be the one that does the disrupting instead of being disrupted? And that's healthcare has lagged in this disruption cycle, right? You've got the infamous Netflix blockbuster that I think we all overuse. You have disruption in the travel industry, disruption in banking and all of this. Healthcare has turned into that world. And not only with all the consolidation happening from an industry perspective, but now you have this common technology foundation of who's going to innovate on that. And what is that going to look like? And what demands, frankly, for those that aren't doing the disrupting, what demands is that put on everybody else to plug into it? If somebody develops this new widget around healthcare, it's going to be expected that the insurance companies and the labs and the hospitals and everybody participate in that. The customers are just going to demand it. And so if I'm a CIO or a CTO, I'm starting to think this way. How can I change the experience directly, whether it's my app that I'm giving them, if I'm a hospital, that particular experience I'm giving somebody, maybe while they're in the hospital or out. But also, how do I be ready to plug in to take advantage of whatever somebody else has to do? Both of those aspects are critical. What are some things people are doing in this fire world? Obviously, access is something, right? So there's APIs and then there's also there's the opportunity, like you're saying, when you're in a clinic or a hospital, I don't know, using an app somehow. Like what are people dreaming up or actually putting into practice? I want to say problem opportunity might be a better word. What we're trying to solve is how to make this digestive. Just because I give you all this information, what are you going to do with it? How do you translate it and how do you translate it in a healthy way? How do you not see an anomalous lab result and go make some change in your lifestyle that might not be a good thing? With information comes responsibility. I'm sure I've been butchering some phrase out there. But that seems to be a lot of it right now. We are starting to see shopping services.
6:13I mentioned the turquoise blue out there on the price transparency angle of, all right, where can you go so that it's cheaper from that aspect? So we're starting to see a lot of that. I would say most of the activity right now is just almost this blinders, how do I get compliant? That seems to be what a lot of things are happening at the moment. We're just starting to think about from that aspect. But as somebody who participates in the healthcare system for various reasons, I really want that mid experience to use what you did it before. I see this specialist from this doctor. I've got a general practitioner over here. I've got a lab over here. Look, it's easier to describe. But if I say this, look, I'm a cancer survivor, right? And in good shape and healthy and lucky and all of that good stuff. But I want my whole world in one there. And when I was going through that, luckily I'm not going through that now, I want to be able to navigate that. I want to know that I've got to go see my oncologist on Tuesday. I've got a pre-op appointment on Wednesday. All of this kind of stuff. Today, I can do like appointment management. Great. We have calendars. But there's prep that goes with that, right? Oh, if I am going to have surgery 12 hours before I got to do this or 24 hours, I got to stop taking this medicine before I get into this one. You can start to bring that experience together. And that removes such a large level of anxiety. When you're going through something like that, you've got the anxiety of somebody said the awful C word to you. And now you've got to navigate this experience. And I think if you can digitally bring all of that together, not only what has happened, but what is happening, that's where it starts to get exciting. And look, the healthcare system is not efficient. I think we talked about it last time about how much facts is involved. And hopefully this really is the thing that puts a nail in that coffin. Seriously, it drives me nuts. But it's crazy. But then I can also take my records from one thing to the other. I don't have to count on hospital system A that I had to go to for one particular procedure because they were a specialist in it. Getting that information within 36 hours over to hospital B or doctor B is probably more accurate that I have to go see.
8:15I can bring it myself or I know the digital pipeline is there. It's pulling back to like IT stuff or analogously. There is it's sometimes hard to predict when you standardize and open up like a system, like the data and the system records, like you were saying. But also, and you're getting to this, also like the process of a system, right? Essentially, when you work in a big complex system, not work, but when you are in, especially as a patient, like you were just saying, a big complex system, like you basically have to project manage it. And I think that's like what a lot of people don't anticipate and then definitely don't do well. And I'm a terrible project manager, but like it's that it's almost like, you know how, like in school, they sometimes have a class to teach you how to like budget. There's some life skills that I think that people have to learn the hard way. And one of them is that you're going to have to project manage a lot of stuff. It may seem like you've got all these high paid people who are taking care of you, but really they're not. They're not taking care of the big picture. So you're in charge of everything. And I hadn't really thought of that, but that's a huge thing that a programmer always has this perspective. But that'd be pretty easy to solve if the records are standardized. And if you just introduce a little bit of changing some habits, like I would imagine you would have to do a thing. If you had this app on your phone that connected to whatever backend so that you could interface with everything, you probably, it probably would be best if like right there, if you're in the room, I don't know, you touch phones together or whatever, and you sync all this stuff. Because I get, I feel like whenever the patient and whatever they call them, the caregiver leave the room, you've introduced wait times of days. There's just, you've got to do it like right then. And then it's probably, and the handoff, obviously you have much more unfortunate experience than I do, but it seems like most of what you're handing off is usually like a page, right? Like it's not really that much and yet it can take forever and be really weird. Yeah, it can. And it's important for accuracy. And fire isn't this magic protocol that has all the medical appointment, your future appointments in it or anything.
10:16It's a layer cake like everything else. But just getting all of these parties to talk digitally, I think really changes. And we'll also see all the dynamics, right? There are those companies that will lean into disruption. There'll be those that try to resist it and put up walls and don't share some of that information. And I think we saw that with banking, frankly, for some of it. Not everybody leaned into the open banking experience right away and it took a while. But I think we'll get there, right? And I think we'll see some EMR providers really lean into this open world and we'll see others that try to go the walled garden approach. And I think the customers of those EMR systems, the hospital systems themselves or insurance companies or customers of those two, that don't really buy how this goes. Yeah, it's a bit of an overstatement, but it seems like opening up, standardizing and opening up data always helps the industry, like whatever industry that's happening in. And like you're saying, there can be some closed proprietary business models that have to evolve. But usually there's way more opportunity, like to do new things. And it's also, and I'm, again, analogizing to the tech world, right? I think what is that holding, holding data closed and holding it close, like runs out. It becomes, it becomes an excuse to not try, right? To be decadent and you don't have to worry about it because it's defensible. Whereas if you give yourself motivation to actually have to try new things, then you come up with interesting new stuff and like you evolve and come up with a much better business instead of just stagnating on what you have. It's transformation, it's change. Hey, I know somebody who wrote a book about that recently and the mindset of change, but insert your plug here. But there's just that human aspect of it too, but also business models, right? If I'm going to take a risk, where do I place that risk? And for some organizations and some companies are really comfortable with that and good with that. Others resist that, right? They need to have such a 95 level percent level of confidence and they're going to lag as a result of that. Okay. So there's this openness of record portability and kind of as a patient, it gets you close to having that dashboard, right?
12:16Like that dashboard. And also to some extent, it would be nice to have a digital assistant for stuff, not to get fixated on. But like one example I can think of is just refilling prescriptions seems almost ridiculous. It seems like that should just be incredibly automated at this point, which it can be, but it takes a lot of effort to get that set up and whatever. But so then on- What is here for you in all seriousness, right? That is a place that they are leaning in very hard and I think will be exciting for the industry. Yeah. It seemed like a great leap forward when you didn't have to take a piece of paper to the pharmacy and instead the doctor, whoever could just type on their keyboard and then the prescription sent off. That's so nice. Just imagine if they didn't even have to do, that would be, well. How do you get it delivered? I'll go for a personal kind of rant. We take people who are sick. You have cold, a flu, right? Something like that. We'll be careful at a doctor's office and isolate you and bring you in a back door. If it's like flu season, that's pretty traditional here in the state. Hey, we'll come, we'll give you the flu test to make sure we do that. Hey, I'm going to prescribe you Tamiflu or one of those things. What do we do? We make you go stand in the middle of a pharmacy around a whole other pizza. I never thought of that. That is funny. How do you get the Uber, Lyft, whatever, and I want to put a brand in it to deliver that? Non-narcotics, so we don't have to worry about that. But how do you close that ecosystem? I think that's where we've got to get to because Amazon can't fulfill that at the moment. Maybe they're going to tomorrow because that's real time. I can't wait 24 or 48 hours for that. But how do I, how do we establish that? I think that's coming. There's my free startup idea for somebody. That's right. Prescription logistics. Okay, so we've got that. Now, what are some other areas that you're seeing? Again, whether it's providers or the actual like hospital systems or clinics or the company? Yeah, just trying to figure out how to live in this API world. So how do we put in API gateways, whether that's our Spring Cloud gateway or things like that? You've got to really free your information from your core legacy systems to be able to do this. Whether it's responding to the transparency, the interoperability rules, or just frankly doing new cool stuff. There's a lot of energy in, I've got these closed lock systems.
14:17How do I free the information? How do I do that? So we're seeing a lot of work from there. How do I get to centralized data stores that I can then, at the pace and the speed and the reliability consistency I need to do, shuffle that information back and forth, whether it's to an end customer or my own internal world or whatever the case may be. So a lot of work around that traditional modernizing of operations is still going on, right, in the healthcare world. How do I get more efficient in my operations side of my house or frankly any side? But really, how do I get from business idea to implementation to see if it works? How do I do that? I talked, we were talking earlier that I said, there's so many of these older businesses that need such a high level of confidence before they'll place a bet. How do you remove that risk so that they can just try stuff? And that's about rebuilding that software supply chain. And how do I get from idea to MVP into production to see if this idea is really valuable rather than this big bang, right? How do we make it so you're not making multi-million dollar, multi-quarter bets on something before you actually see if it works? How do I get that into thousands of dollars in a couple of weeks? Yeah, there's a good, there's a good, I don't know if it's a pyramid because I don't know if it gets narrow, but there's a good buildup of, so if we open up all this, if we open up things and we standardize the way that you get access to it, then that implies that you can start to try out a bunch of new things. Whether that's app, we'll just call them apps. Like you can try out different, you can, it's not only that you can try out, make up different apps, like we were talking about, like a dashboard or things like that. But that also means you can start to even change how you're doing healthcare because you have, you're no longer limited by the lack of tools for things, right? Like you actually have new, new tools and technologies that you can use to change the process of how things are done and delivered. In the same way that like a digital scale, I'm sure is better than a scale with some rocks where you're trying to measure the weight of someone. Like you can do a lot more interesting things. And with that, what that means is I would imagine that in a lot of the healthcare world, like you were, as you were going over, there's probably not a lot of architectural think about how you do APIs, right?
16:26And more importantly, how you have, let's say a long-term commitment to public APIs. Because it's one thing to just release some APIs and it's a slightly different thing to be able to run them and scale them. But then like you have to evolve them. How do you migrate your customers and incent them to go from version to version so that you don't just cut them off and leave them on the side of the road on your way, right? Yeah. And then the other thing you're going over, which is interesting, we talk with people a lot about is the, to allude again, like changing your mindset around like risk. And even that word risk is always security. People try to reown it as like risk is just a type of analysis. But I think when normal people hear risk, what they hear is catastrophe, right? There isn't the concept in risk of sometimes it doesn't work out and that's fine. Like risk is always bad. And I think there's a lot of, and we see this across all industries, but I would imagine in healthcare, it's even more so. You shouldn't consider that you're taking on risk so much, but that you're putting in place a process that allows you to learn and figure things out. Which means even the phrasing is troublesome. It's not that things will go wrong. It's just that some of your ideas won't work. And obviously you scope it so that there's not catastrophic failure and you build up the confidence and things, but you shouldn't let yourself never take on risk or learning, which I imagine is a habit that a lot of people in healthcare have to, I don't even know if it's relearned. They have to learn this habit of experimenting. It's all about what are all the good ideas that you never got to take advantage of because you were nervous about, would we get a return for the dollar? Because the dollars, right, in the old way of developing were so big. It costs so much money and time and opportunity just to see if this would work. Well, if you can take away a good chunk of that, you can't get it to zero. But if I can say, you know what, we're going to get the first version of this in the market in six weeks instead of six quarters, that's a very different conversation. And then it really frees you up to experiment and try. And we just talked about how we're getting into a disruptive world of healthcare.
18:26You're going to have to be able to be agile and react and you're going to have new ideas in this space or you're going to get left behind. So what are some other things that people are thinking of doing? Let's say they've got to the space where they are trying out new things. Because I think there's a similar pattern in all industries here where like, one, you like open things up. And then two, you make sure you can support that basically, right? So you have APIs basically. And then the next phase is like doing something with it, like building apps on top of it. A lot of places that we're having conversations now is really on the secure software supply chain side of that. How do I get my internal factory in shape that I can, again, go from idea to production in a rapid way, but do it securely? Do it in a way that I know what's in production? Do it in a way that meets all the compliance framework around that? And do it in a way, again, back to I know what's out there so that if there are CVEs and faults, et cetera, discovered that I know what I know, A, what I have to patch rapidly in some cases, and B, actually try to set that up in an automated fashion. A good piece of this is the recent executive order that came out of the White House around cybersecurity. Now, it's very targeted at federal governments and federal suppliers, but I think as the particular, I fully expect, as the particular implementation regulations come from NIST on that over the next few months, actually six to 12 months, look, HITRUST and all those other healthcare-specific compliance frameworks are just going to suck those up. And they're generally good ideas, right? I have my questions about regulation like I think a lot of people do. Reading this executive order, it really fit like, oh, no, this is generally a good thing. These are all really good things that people should do. So how do I efficiently do things? So how do I do it automatically? How am I confident about if I have created this environment where we can try 100 different ideas as CIO or CISO or CTO? I want to know what people are putting into production, what open source libraries are using, what versions of things you're using and all of that. Really establishing that ecosystem is just critical.
20:29Yeah, building up the full internal capabilities to do software, to start to develop your own software. And now, like you're saying, I think it's almost, I don't know if this is true, but I come across every now and then this notion that when it comes to writing software, like the actual development is usually one of the smaller parts of the whole process. And it's more thinking about it and planning and that's a large part, but then building out the infrastructure and testing, like there's all these other things that consume. It's again, like we were talking about last time, as long as you take the kind of end-to-end view of everything that happens, you realize like how small the actual development phase is. And like you're saying, like the tooling you use around all of that becomes another thing to worry about. The impression that I keep getting is there's, in healthcare, there's a lot of foundation to be laid when it comes to, to use the word fully digitizing everything, right? Getting to the point where there's plenty of innovation going on, like where things can happen fast enough and things are open enough. And you have all that infrastructure needed where you can just like meaningfully put new features out in software or put new APIs out that you can do something with. Because otherwise it's just the same static system. And do it in a way that's efficient, right? Keep dollars under control and that you have strong confidence in what's out there from a security perspective. So if we look at the people who would be doing all this activity in the healthcare world, like who are the, what are the types of organizations that you think would be actually like doing the work of setting up APIs? We're seeing people look at things like Spring Cloud Gateway or the Tanzu Advanced Ecosystem a lot in the payer space right now. They're bigger and generally have existing software development organizations today. The providers, it's really anyone, larger ones that have large or not even large, but dedicated application development firms. We're seeing them lean into this. Smaller providers are primarily leveraging COTS products, right? Just off the shelf type products. At this point, we're not seeing a lot of development from them, but we'll see, again, as we lean into this new world, it may become imperative for them to do that.
22:29Medical device makers, when you start thinking about things on the edge and hospital at home and some of that perspective, we're seeing a ton of activity in that space. And that's an area really ripe for innovation, especially like the device people are already in the technology business. So they understand that more closely, even if it's three-dimensional instead of two-dimensional things. They're usually not in the data business and that's different for them, right? So yeah, they know how to make the electronic widget to send home with you, but now what do you do with the information? And how do you get it to the hospital or the doctor or the, like whoever is the consumer of this? And there's multiples. That's, there's a very interesting time happening in that space. The worst place for you to be when you're sick is in a hospital because of infection controls. And there's other people that are sick and all of that. How do we send people home with devices where normally they would have had to stay in a hospital for observation and let them be a more comfortable just in their own stuff, but be out of that hospital. All right. Well, great. This has been a good, like I said, after we talked last time, I wanted to get an idea of just in general, what are some interesting new things people could do in the healthcare space? And I think, yeah, definitely having the open data like requirements mandated. That's a huge, like that's a huge impetus to do things. So tell people what your, what your Twitter handle is. Circle JTP. All right, great. Well, thanks. Thanks. Thanks again for being on. We'll have to, we'll have to have this discussion sometime in the future as well. I think we'll also have an industry panel at SpringOne Platform, September 3rd and 4th. There you go. People want to get it. And as always, if you want to get the show notes or the archives for this, you can go to tonsitalk.com slash videos, or you can just go to tonsitalk.com and click on the video link and you can find everything there. And with that, we'll see everyone next time. Bye-bye.