Outcomes Rocket Podcast_Carm Huntress: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Saul Marquez:
Hey everybody, welcome back to the Outcomes Rocket. Saul Marquez here, and thank you so much for tuning back in. You’re in for a treat. Today I have the amazing Carm Huntress. He’s the founder and CEO of Credo, and they’re bringing an end to the chart-chasing era of healthcare. So the name sounds familiar, that’s because Carm’s been on our podcast before, about a year and a half, two years ago with the work he was doing at RxRevu. Just incredible work there in that space, and continuing to innovate in healthcare, Carm’s an entrepreneur and a strategic leader with over 20 years of experience in startups focused around consumer and enterprise technology. I’m excited to hear and share with you what Carm is up to at Credo. With that Carm, I want to welcome you back to the Rocket, my friend!
Carm Huntress:
Well, Saul, thank you so much for having me and always a pleasure to be here and talk about healthcare.
Saul Marquez:
Hey, man, it’s great, and the opportunities are huge. So, look, man, if the listeners haven’t listened to your episode, you guys got to listen to it, just look it up in the search bar. But Carm in a nutshell, what inspires your work in this business?
Carm Huntress:
Well, you know, I think we’re in a really interesting inflection point right now in healthcare and digital healthcare in that we’ve had a convergence of a couple of big, meaningful things in terms of enabling patient access to their medical record data. The first thing is really a little bit of my history. When at RxRevu, we worked with a lot of the new standards that were enabling patient access to a machine-readable format of their medical record, a particular standard called FHIR, Fast Healthcare Interoperability Resource. And that really enables patients to exchange their medical record data and providers, for that matter, in a standard structured way. And that has now proliferated over the last decade. It’s gotten to most healthcare institutions, and it’s much more widely available, and that was a big deal. And then a few years ago, we had the 21st Century Cures Act, which really opened up the door and said, hey, look, we know no healthcare organization can block a patient’s access to their medical record data. And we have to, if they request it for themselves or they want to share it with a third party application, they should be able to do that in a machine-readable format. And then I think really the last thing that’s happened is the pandemic. And what happened in the pandemic is we went from a sort of in-person entry point into healthcare to a virtual or digital-first front door. And everybody, kind of, now has a MyChart and they’ve done digital interactions and telehealth and all this stuff during the pandemic. And I really looked at that convergence and I said, my gosh, you know, there’s a high probability in the next ten years every patient is going to have full longitudinal access to their medical record. But how is that going to come to be? Because if you look at the patient health record market and if you look at Microsoft’s attempts and Google’s attempts and other attempts, we’re not seeing broad-based adoption of sort of PHRs, and the reason is, is a couple of things. One is that patients, there’s a lot of uncertainty and effort required to sort of go get your records today. It’s not a pleasant experience and it’s not like you want to take a Saturday to do that, right Saul? It’s such a pain. And so we really looked at the medical record exchange process in the United States, which involves a release of information where you go into your doctor, you sign a HIPPA release, and then they call your other doctors and get their records. We do that 210 million times a year in the United States. So 60% of the US population is moving some amount of their medical record data around for some reason, and isn’t it odd that they don’t end up with any of that, those records?
Saul Marquez:
Right, yeah.
Carm Huntress:
So it’s a really interesting problem. So we ended up going to providers and saying, wait a minute, you’ve got this function of chart chasing, which is a known term, taking your providers, taking your nurses, take your MAs and PAs, which we don’t have enough of in this country, and telling them that their job is to go chart chase records for their patients. And so what we really try to do at Credo and where we’re starting is with at-risk providers who are doing value-based care, who today tend to manually through phone and fax, and remember, in the United States, we’re still faxing 9 billion pages of medical record data a year, right? So, Saul, when was the last time you when did you when was the last time you used a fax machine?
Saul Marquez:
I can’t even, I faxed something to the IRS like four years ago.
Carm Huntress:
You know, it’s the IRS and probably healthcare are the last bastion.
Saul Marquez:
Exactly.
Carm Huntress:
And so we’re really trying to help those at-risk organizations through a tech-enabled service. So we have both people and technology to come over and take that function out of those organizations and really support a thoughtful process of going and getting the records. But we’re doing it with a digital-first mentality, not a phone-and-fax mentality. And that’s really ultimately why we want to end chart chasing and digitalize this process and in that process enable patients with access. So even though their provider wants it, we want to make sure they have access too.
Saul Marquez:
Well Carm, that’s, I’m sure music to the ears of a lot of people.
Carm Huntress:
I hope so.
Saul Marquez:
Listening to it and I’m sure, you know, the feeling is, oh my God, this would be great. But then the next question is, but how? You know, like, but how? So how would you answer that?
Carm Huntress:
Yeah, So we’re really looking at and engaging with the interoperability networks that have been established over the last decade through regulation. So there’s a lot of work that’s been done through CMS and the OMC around patient access to data through these APIs, patient-facing APIs coming off the EHRs, that’s an access point to data that’s structured that the patient can mediate, and we’re supporting that. That’s one channel to get data, opposed to traditional phone-and-fax. There’s also been a lot of work in the evolution of what was traditionally called the eHealth exchange, and that was sort of the national interoperability that was established, is now evolving into this thing called TEFCA, which is really creating a common agreement for entities to share medical record information in a standard structured way and say, okay, I’ve got a patient request, I’m a provider taking care of somebody, I want to go out and get all their data and these networks are getting enabled to start to do that. We’re still in the beginning phases. We’re still starting to transition from sort of siloed data stores into having these open and connected networks of HIEs and other entities coming together to pull the data. And so we’re network, I say this to our customers, we’re network-agnostic. We don’t really care where the data comes from, we’ll go over the patient-facing APIs, we’ll look at the national networks and the HIEs or the existing eHealth exchange as access points to data, but we really want to solve the last mile, and that really involves helping these staff members inside these clinics move from their current workflow, which is phone-and-fax into, okay, what does that digital-first work look like? And when you’re at risk and doing value-based care, completeness really matters.
Saul Marquez:
Yeah.
Carm Huntress:
Right? Like if a patient, we don’t get a record of a heart attack and they had a heart attack, or are at high risk of a heart attack, and that apparently is missing from these networks or this data, it’s a big deal if I’m doing value-based care, I need to know that, right, to take care of my patients. And so we really want to give that sense of completeness back to the provider, we use both patient interview plus, looking at claims data and historical data to understand that sense of completeness. But we won’t stop until we have that completeness for that provider. And that’s something that’s very different, right? Where we’re really trying to make sure everything is there so they can do a good assessment, so they can better take care of the patient and not do silly things that happen today, which is three of every ten tests is duplicated because we don’t get the records. You know, that’s a huge amount of waste on the patient to spend the money and the at-risk entity, right, to redo all those tests and spend that money and time. So that’s really the how for us of how we’re going out being this last-mile solution, and, but being agnostic in the way we do it. And to be honest, our team falls back to phone-and-fax if there’s not an electronic method. And that’s, it happens all the time. You know, it’s a pretty common thing still today in terms of having to use that methodology to go get records.
Saul Marquez:
Well, it’s very real, and I appreciate you diving into the how. You know, as we, and basically, you get people what they need on the patient they’re taking care of without having to chart chase. How cool is that? I mean if you can have that, that’s just incredible. I think about this whole interoperability plaque, like man, we’re paving roads, we’re building trains, it’s not there yet, but we’re starting to get that infrastructure, like you mentioned, some governance with TEFCA, got the APIs with FHIR, the opportunity is here. What would you say is the biggest obstacle to getting there today?
Carm Huntress:
Yeah, I mean, we really, I think a lot of people overestimate the amount of data and where it’s stored and how much is out there. You know, we’re talking zettabytes of data and even for an individual patient, their data can be stored across 100 different systems. And so we’ve got an incredibly long way to go in terms of the installation of these technologies like FHIR and accessing into these systems to make sure that this data is accessible in a digital format. And so that’s really, people just don’t understand, there’s just so many access points into this data, and if you think about the years of history of a normal patient, you know, how much data we’re talking about over how many different systems, we are getting there. I mean, the good news is, like, if you look at the patient-facing APIs, there’s now 10,000 access points, right, into patient data, that’s a lot of access points. And so we really fundamentally believe, like we’re at a tipping point and this will come together in the next ten years and hopefully get to a place where it’s relatively a commodity-based cost to go acquire this data where you don’t need a lot of human capital to go chart chase records, it’s basically done all digitally, and that means the marginal cost will be very low to get the data either into providers hands or patients hands, and the practice of duplicate testing and phone and faxing will really go away. And so I really think we’re, we’ve got still a long way to go. We’ve got good regulation now driving the market forward and we’ve got standards like FHIR helping everybody understand, hey, this is where we’re going. We now have a mandated, regulated thing that we can all agree on, like, let’s use this. And that’s going to create that interoperable, connected world where we can all understand the data that’s going around. And I really think we’re at that tipping point. I think it’s very likely, if you kind of extrapolate this out over five or ten years, that within that time horizon, patients should get to a point where the vast majority of their data is available to them across many years of history in a machine-readable format that they can share with any third party for any reason, right? I think we’re on that trajectory in a really good way. It just took us a decade to get enough of this infrastructure, regulation, and technology installed into healthcare, which is just massive to start to reach to this tipping point. And so I think we’re on a good trajectory right now.
Saul Marquez:
That’s beautiful, and awesome that you’re working on this, Carm. You and your team are taking some big swings at this huge problem. You know, and as we think about it, where does it end up? You know, and this is kind of like the age-old debate. Does this end up with the patient so they could show up where they go get care or does it end up with the providers? What are your thoughts there? Or does it matter?
Carm Huntress:
Look, I think it does matter. I think really the patient has to be, again, we’ve been trying to shift, we talk about everything getting shifted to a patient-centric world, and that’s ultimately where we need to be. If we can shift the data to patients and give them a patient-centric view of their health, that is going to open a door to enablement like we’ve never seen before. If you think about the corollaries, step back and think about the financial industry. And it wasn’t until we introduced technologies that could peer into your financial history and actually do something that this world exploded of the Mint.coms, and the Credit Karmas, and the NerdWallets that we’re, that have enabled us to peer into that financial data and say, hey, we can help you find a new mortgage, we can help you get a car loan, we can help you get better life insurance, right? The list goes on and on of financial products and services that we can enable patients with once we understand their personal experience with their finances and their financial health. And it’s no different in healthcare, I would say, I’d argue it’s more complex and more personal, right? Your health journey is incredibly personal and unique to you and what’s happened to you. And until we unlock the data to really create that personalized experience for you, that end of one, you know, nothing’s going to happen. I will tell you, when I started researching this, I played with all the patient apps out there where you can connect your data, but some of them go through questionnaires and I won’t say who I went through because I think it would be disparaging, but I like went through this huge questionnaire and asked to answer all the stuff, and the first thing they offered me in the app was a smoking cessation class. And I said, well, I don’t smoke. This is, this has nothing to do with me. How does that even make sense? And so, look, we’ve got to get these engines orders of magnitude more intelligent than they are today to make sense of the data and then make recommendations. The other thing is that you can understand your financial data, right, pretty well. You understand transactions.
Saul Marquez:
Yeah.
Carm Huntress:
The problem with consumers and healthcare data is it’s very hard to understand. We’re probably both pretty intelligent people. I’ll tell you, one of the first times I pulled my record, I looked at a celiac test I had, which is my gluten sensitivity. All they put in the record was that my result was 272. There was no unit measure, it just said 272. Well, isn’t that a yes or no, right?
Saul Marquez:
Yeah.
Carm Huntress:
And that’s a celiac test. That’s a simple thing, right? And I still know what 272 means. Someone will eventually tell me who’s smarter than me. But this is the point, is that, like, look, healthcare data is high, highly, you know, you have to be highly trained, right? Years of training to actually interpret and make sense of it. Now, computers will get better at that and we’ve shown they can be, especially in AI and ML in specific domains. But we’ve got to get again, unlock the data in a way computers and even clinicians can look at it in a, so a patient can get in the center of their care and then have personalization driven off that data. That’s the future that we really have to thoughtfully work towards. You know, my goal is that we can amass, in the next decade, 100 million patients with their records on our platform. And if we can enable that, then we can able an ecosystem to then take that data and do incredible things that we can’t even fathom right now. And that’s really my intention here, and we’ve got to unlock that. The question here is how are we going to create massive access for patients and their data across tens or hundreds of millions of people? And once we do that, I think we’re going to see a massive shift in terms of how patients will access care and the quality of care they can get, and them really empowered with their data to improve their health and also do things like save money and time, which is really important and which we waste a lot of around healthcare these days.
Saul Marquez:
Awesome. Well, listen, I completely agree this digital access to patient data is a must. The duplicate testing is an issue, let’s make it better and improve not only clinician but also patient experience across the board. Let’s stop chart chasing.
Carm Huntress:
Yeah.
Saul Marquez:
Exactly. It’s credohealth.com. Carm, you know, where can they get a hold of you if they want to talk to you or anybody on your team about exploring this?
Carm Huntress:
Yeah, well, I’m on LinkedIn as Carm Huntress, obviously that’s a great business avenue. I’m also on Twitter pretty actively at @CarmHuntress, and that’s the easiest way on our website. Please reach out if this is an area of interest for you and let’s end chart chasing together and empower patients to live their healthiest lives.
Saul Marquez:
Love it Carm, appreciate you jumping on here. Again folks it’s credohealth.com and we’ll leave Carm’s LinkedIn and Twitter links in the show notes so you could get in touch with them if something today resonated with you, which I hope it did, because it’s a big issue. Thanks, Carm. I appreciate you jumping on.
Carm Huntress:
Thanks so much. Thanks, Saul. Thanks for having me.
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