How to Make Healthcare Data Useful and Patient Experience Better with Niko Skievaski, Co-founder and President, Redox (transcribed by Sonix)

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Saul Marquez: And welcome back to the podcast. Today I have a very special guest for you. His name is Niko Skievaski. He is the Co-Founder and President at Redox. At Redox, they’re accelerating the development and distribution of digital health solutions with a full service healthcare integration platform to securely and efficiently exchange data. Health Care Organizations and tech vendors connect once and authorize the data they send and receive across the most extensive interoperable network in healthcare. I had the opportunity to meet him at the DOC S.F. meeting this year. And I was just really inspired and blown away by his deep expertise and knowledge in the field. He was voted in the Forbes 30 Under 30 in Healthcare in 2017. He’s an official member of the Forbes Technology Council, has had experience with partnerships across many different healthcare providers in the United States. Also partnerships with Cisco, he’s been able to bring in his experience that he got while he was at Epic in combination with his Masters and undergrad in economics to make sense out of a lot of nonsense in healthcare especially in technology so it’s a pleasure to invite you to the podcast Niko, would love to hear anything that maybe I left out in the intro that you want to share with listeners. Welcome.

Niko Skievaski: Yeah thanks a lot for having me. I think you nailed the venture pretty well. We start the Redox about five years ago now so that’s been the primary focus. But yeah before that I was in Epic and started a couple of tech companies in that time period. But yeah you pretty much nailed it.

Saul Marquez: Awesome awesome. You know one of the things that I really enjoyed about your presentation was how simple you made the complex and I feel like that’s a differentiator and why you and your company have been successful. I want to just kind of go behind the curtain a little bit and ask you why did you get into the medical sector?

Niko Skievaski: Yeah it was kind of by accident. So I was in graduate school studying economics and was actually looking for a dissertation for a doctoral thesis and had studied healthcare economics a little bit and was really looking around the industry for really like a perverse incentive to study in healthcare is really a hairball of these perverse incentives so that had to be something in here. For instance why is it so inefficient and how can that inefficiency be overcome without policy or technology adoption. That technology question like it got me thinking about how has technology been adopted in the industry and why is healthcare the industry that we saw clipboards and pagers and fax machines and those sorts of things. So that led me down the technology hunt and it led me to Epic so originally started talking to Epic about you know what data they had and of course they wouldn’t want to talk to some student about that. So I applied for a job and thought maybe I could get access through that process.

Saul Marquez: Nice.

Niko Skievaski: My plan was to go there for a year gather data go back to school and keep going but got to Epic and realized that they don’t actually have any data that is distributed in the health systems across the country and the dream of digitizing all these medical records really wasn’t we weren’t able to accomplish the benefits associated with that and because of the distributed nature of how electronics health records were went to market. So you know I became increasingly obsessed with that problem and that’s what a lot of where the inspiration I have behind Redox comes from in that we’re trying to stitch that data back together trying to make it uniform and available to software developers to use to tell you how we stumbled into the space but it was really the inefficiencies in the market that kind of drove me into the healthcare industry.

Saul Marquez: Super cool story Niko and so you went you got a job and you haven’t looked back, you haven’t left.

Niko Skievaski: Yep.

Saul Marquez: And the problems are definitely neck deep and as true entrepreneurs you know we look at those problems as opportunities and just curious what’s on your mind you know what what do you think a hot topic that needs to be on every medical leaders agenda today and how are you and Redox approaching it?

Niko Skievaski: Yeah. So this topic of interoperability it’s hard but it’s really at the heart of many of the underlying challenges in healthcare. For instance you know where there’s a lot of talk about this shift towards value based care and of course how we we change our reimbursement system in the industry and that requires health organizations to better evaluate risk because they’re taking on more risk. They have to look at the population of patients that they care for differently. They use complete information to really figure out how to make value based decisions. So to do that they need access to data. They need to be able to use technology different technologies to drive efficiencies is an organization and the lack of interoperability in healthcare is really preventing that shift from happening by allowing us to use technologies to become more efficient in the way we deliver care. Another big trend that is kind of upheld due to the lack of interoperability is the consumerization of healthcare. We need people to behave more like consumers with self-interest and that requires more complete information as well. In the past, the paternalistic nature of medicine has really shielded this information from patients creating a kind of a dependency on the doctor not only to diagnose but order treatments that will make patients healthy. That blind dependency also creates behavior of disengagement which is so rooted in much of the chronic conditions straining our industry. So that’s kind of an underlying problem. There’s also this notion that patients really can’t shop if they can’t take their data with them and shopping is a really essential to the efficient allocation of any goods and services much less in healthcare. So if you’re stuck with the healthcare organization that you’re working with, you will keep going back there and going to the providers that are referred within that system rather than kind of using your sovereignty as a consumer to move between different organizations and find the best deal find the best value itself. So without the mobility and liquidity of that data, it’s kind of preventing that problem from being resolved.

Saul Marquez: Yeah I know I think you’re bringing up some really great points and Niko and so don’t want to interrupt you had one more. Go ahead.

Niko Skievaski: Yeah. So it’s just the last one. You know it’s one that kids home from the H.R. space but physician burnout is becoming a huge issue in the industry. And you know the strain that our health systems have it kind of passes down to the providers to pressure them to see more patients to do more with less. All while increasing the documentation and data entry burden that electronic health records have brought. So it’s very rare to find a doctor who actually likes to use a manager and it’s heavily cited as one of the main reasons for the increase in physician burnout that we’re seeing across the industry today. If we had an interoperable ecosystem that would mean providers can actually choose whatever tools they want for the job much like me and you choose whatever tools we want to use to do our jobs whatever email client we want whatever chat system we want, calendar system you know all these things you can have a best of breed world where you have API’s and we have free movement of data behind the scenes that enables those technologies to extend what we have are providers who are kind of forced to use the technology that was mandated by the federal government that wasn’t designed for their specific workflow specifically. So yes some of the challenges that I think are exacerbated by this interoperability problem.

Saul Marquez: Yeah I know you good call outs Niko. And so you’ve clearly stated the challenges, the problems, we’d love to hear from you the dream, the Redox dream and maybe some examples in there of how your making a difference today.

Niko Skievaski: Yeah for sure. So our mission at Redox is to make healthcare data useful and that we really look to accomplish that by creating this reusable infrastructure that technology can plug into and utilize the underlying healthcare data to allow that technology to be proliferated to get in the hands of the users and the patients that will actually be able to benefit from it. So the way that we do that is quite simple we just standardize the data within the various health systems that we work with and make it available over an application programming interface an API so developers can create applications on top of it. So the layman’s example I use is that we’re kind of like the plumbing infrastructure and the apps on top of it are like the sink and the shower and the things that actually that are useful to people but we’re the people who are supplying the water and the water treatment facility, you know cleaning up all the data. Yeah. And you know some some examples obviously with this kind of core level infrastructure we work across different different stakeholders in the industry. So one example is on the vendor side. We work with a lot of different technology vendors whether that’s software developers or hardware devices and things like that. So one example is a company called Dexcom. They are probably the number one provider of glucose there’s continuous glucose monitoring systems so public company.

Saul Marquez: Yeah I’m very familiar with them.

Niko Skievaski: Yeah. So what we do with them is when a patient needs to get a recommit or order we received that order from the electronic health record from the provider. So that’s the Dexcom who can drop ship the device to the patient. The patient can on and start using it. And then when it’s appropriate data sent back into that electronic health record so that the provider and care team can be notified if the patient’s know outside of a relevant range or they’re not using it appropriately or things like that so they can intervene on that patient’s care and make sure there’s no complications down the road. So that’s one example we started working with them at Children’s of Los Angeles and have kind of expanded to many other health systems beyond that. And the thing I love about that is the data that we’re seeing come across that is in this case these are these are pediatric patients that have diabetes who are learning how to control their chronic condition to be a part of that process is really kind of fulfilling. Sense on the vendor side we also support like actual electronic health record vendors. So example there is a PointClickCare. They are kind of the leading vendor in post acute space so skilled nursing facilities and nursing homes and groups like that. And so what we do with them is obviously they receive patients from skilled nursing facilities as a place where patients get discharged from the hospital. And so the data generated at the hospital about that patient’s acute visit needs to travel with them and go to that skilled nursing facility or long term care facility or nursing home you know back to wherever the patient is kind of having that longer term care outside of the acute setting. So we’re able to facilitate that transfer of data between those two care settings. And then of course if the patient care has to be readmitted to the hospital bringing the data that was generated at that skilled nursing facility back into that care setting so we’re able to facilitate those exchanges and medical care footprint. It’s about 60% of the skilled nursing facilities across the country. So it creates a lot of density in regions of every geographic region across the country has these types of facilities with PointClickCare software running.

Saul Marquez: Very goal. Now I think it’s impactful the reach you guys have been able to establish in such a short period of time and in healthcare years that is. So I really appreciate you sharing those examples Niko. Talk to us about a time when you had a setback. What did you experience take us to that moment, what did you learn that’s made you better?

Niko Skievaski: Yeah. So it’s a tough question to reflect on. You mentioned healthcare years you know this wasn’t very long ago this was in 2015 wasn’t the first time Redox went live.

Saul Marquez: Yeah.

Niko Skievaski: So about the whole year of 2014 we were just kind of an idea this infrastructure idea and we didn’t actually understand how to bring this to market. But finally we were able to get live in 2015 and get the first applications running at the first health systems and have data flowing through our system. We started to understand what it meant to be responsible for protecting this PHI and then shipping the data from as near real time as possible. And the failure came with our first downtime. So any young software company has has downtimes in their early days and that’s when they got real at Redox, the downtime from our perspective that’s infrastructure really freezes that data into place and things screeched to a halt for the users depending on their technology. So these are really growing pains that come with every software company and we began investing heavily at the time and our infrastructure and monitoring and alerting and hiring the best engineers we could find to help us build this rock solid dependable platform that we knew needed to be mission critical for the applications that we support. So you know fast forward to today in a lot of ways it’s good that we had a downtime really early in our existence when we had two or three applications on the system because it helped us build the infrastructure that we have today that now supports we support about 5 million patient that’s just going through the system a day across 450 different health systems across the country. And I think those early growing pains that we didn’t get serious about infrastructure at the beginning we wouldn’t have been able to build that trust to help us get to where we are today.

Saul Marquez: That’s a great story Niko and you know I’m a firm believer that you can’t control the winds but you can control your sails and by all means you guys took those sails and use that wind to take you guys even further. Tell us about the other side of that coin. What’s one of your proudest experiences that you’ve experienced to date?

Niko Skievaski: Gosh. So the first is literally the first thing I thought I would do that was the proudest moment is likely yet to come. There’s so much more that we need to accomplish. I talked about how interoperability is this huge plague, this problem in our industry that is holding so much back. And although we’ve been you know we’ve been doing this for a few years now we have a pretty decent footprint. We still have not solved the problem. And you know not saying that Redox will solve the problem but we will be a piece in that infrastructure. We’ll be a piece the technology stack that enables the problem to be solved and so I think that myself and our team are super motivated by that quest to solve the problem. And there’s been a lot of proud moments along the way getting the software up and running and starting to scale it and starting to see the network effects in the model grow. Those are all things that are kind of evidence that what we’re doing is working and moving towards that but it still doesn’t feel like we can put a notch on the belt and say hey interoperability assault we’re moving toward closer in that direction and we’re doing it with a market driven approach which I think is a really honorable way to go about it. So you know it’s kind of a cop out. They answered but I think it’s coming still where we’re still working towards it. And you know as an aside another really proud thing that you’re as an entrepreneur we’ve got to kind of see is that Redox has about 80 employees now and for the first year the six of us who were kind of around in the first year we were barely scraping by to survive. And now it’s it’s just phenomenal to look around and see the people that get to create careers in healthcare doing something impactful and we can support them and their families as employees as team members to help do that. So that’s also really proud to just be an employer that can actually provide value not only in an industry but to the people who who take part in that mission.

Saul Marquez: Definitely a lot to be proud of and a lot more to work towards. So could Redox listening to this get to work now and you know I think that positive discontent is a big thing. Being proud of and happy about the progress but still keeping your eye on the overall vision and mission. Some of the best leaders in the world and in healthcare do that. So kudos to you Niko for keeping the motivation up and and paying that vision for the team. Tell us about an exciting project or focus that you’re working on today.

Niko Skievaski: Yeah yeah. So the big things for 2019 you know we just came out with strategic planning as you do in January and I guess some companies probably do it in December. But we’re kind of the procrastinators. So for 2019 the big things that we’re pumped about as I mentioned we’re starting to see these network effects in the business and what I mean by that is we work with a vendor like you know like a Dexcom I mentioned PointClickCare and get them rolling and they start implementing that health system across the country and so you can really start to see this exponential growth through all of these vendors that we work with. Similarly every time that we bring the health system on and we start partnering with the health system to figure out what other vendors that they’re trying to adopt and they become a great kind of referral source for us and bring more technology in and that it’s another it’s in their flywheel that brings growth. So 2019 for us is really about continuing to grow that network as fast as possible because as the network grows the actual cost of providing this infrastructure drops at the margin right. So that…

Saul Marquez: Yep.

Niko Skievaski: Each end point just becomes a on average that much cheaper. Our goal isn’t to make money hand over fist during integration. I think integration should be commodities it should be as close to cost as possible. So by growing the network and seeing these network effects we can actually envision a world where we can start dropping prices and make it so it is so easy and simple to utilize data from these healthcare realizations that we would never make sense free to try to build that infrastructure on your own. As you know a lot of groups do today. So that’s the primary focus. But the other kind of exciting thing that comes from that is what we have a mass is a huge standardized data set of healthcare data going back to that my initial quest in graduate school about trying to figure out who has the data and what we can use that data for to drive efficiencies in the industry. Now that’s Redox. You know we we have created this great data asset that we can start to think about how do we actually draw insight from that. Give that insight back to the health systems or directly to patients to help them figure out how to improve on their on their well-being. And you know from our perspective we don’t see ourselves making application to that but releasing more infrastructure products that would enable the software developers out there and enable the health systems, the clinical from, the pharmacists to be using this data know the researchers to drive that insight and that’s super exciting from my perspective because two years ago we didn’t know we were just moving data from A to B. Now we have this data asset that can really be used for something special industry. So we have a lot of projects in flight around that a lot of kind of RND research that’s going into figuring out what’s going to work there. So you know hopefully 2019, 2020 we’re able to kind of release some really exciting things that wouldn’t be possible without that vast data network that we’ve been able to acquire over the past few years.

Saul Marquez: Nice work Niko and you know just the thought that comes to my head is “hey you went to look for it you didn’t find it. So you built it.”

Niko Skievaski: You know I never I didn’t put it together like that but it’s a concise way of describing the story.

Saul Marquez: And so big kudos to you it’s not easy not easy but somebody has to get it done. You guys are working on it. Getting close to the end here Niko, let’s build a small syllabus for the listeners. It’s going to be the one on one of Niko Skievaski on the basics on interoperability and and getting good outcomes in healthcare so I’ve got five questions for you lightning round style followed by a book for listeners. Ready?

Niko Skievaski: Yep ready?

Saul Marquez: All right. What’s the best way to improve healthcare outcomes?

Niko Skievaski: So for us really healthcare happens at that intersection of patients and providers. And we have to remember that that relationship needs to be an empathetic relationship. And so when we think about creating improving that experience and create outcomes we have to protect that relationship. We need to make sure we understand it’s sacred. And before creating technology make sure that that technology doesn’t take away from the relationship that it improves. And you know the vendors that we’ve worked with over time have done that have seen the best outcomes.

Saul Marquez: What is the biggest mistake or pitfall to avoid?

Niko Skievaski: Selling to health systems. It’s very difficult. It’s a huge bureaucratic machine. And we as I mentioned we’re in 450 health systems. We didn’t have to sell to them. And I feel very grateful that we didn’t have to because all of the vendors that we work with essentially did that for us and kind of brought us in on their backs. But we’ve seen a lot of groups kind of fail in that struggle because as much as health systems want to buy something they are often burdened by the bureaucracy. So if you can figure out how not to sell to them or if you can figure out how to boost your price or you know sell to providers instead sell directly to patients. So to figure out how to make it as small as possible to get it and then expand from there. I think that’s a much better way to go.

Saul Marquez: Good one. How do you stay relevant despite constant change?

Niko Skievaski: I think being a student of the market is really important. And they might come obvious to me as an economics major. But having an outside approach and you know not getting in your bubble it’s very frequent that if there’s a disagreement or you know around strategy or and a process for around you know something we want to do with that within Redox that we pause the conversation we get up we leave the room we talk to customers and having that outside in approach I think is super important to staying on top of what the market is telling you because the market will tell you what they need and if you’re in tune with that you’re not gonna become irrelevant.

Saul Marquez: Love it man, great great great advice. And what’s one area of focus that drives everything in your organization?

Niko Skievaski: Yeah we have the saying that we are all patients. And I think that can hit home for for anyone because you know even if you haven’t been a patient recently probably interacted with loved ones who have. And anytime a patient goes through the healthcare system they see opportunities to make a better agency. Places where patients were left in the dark or processes were wildly inefficient or bills were insanely expensive. So these are all things that I think can hit home for people and relax you know where we’re a couple steps removed from actual patient care right where this infrastructure level and there’s application layer on top of that and the users are finally on top of that. But remember in that end of the day I’m going to go to the doctor and it’s going to be the technology that they use and the information that’s brought to their fingertips. That’s going to could be life or death and a lot of situations. And there’s infrastructure that powers that. So that’s something that I think we hold and we hold really dear.

Saul Marquez: Yeah definitely all patients. And on the fifth one here this is a two part one Niko, first what is your number one health habit? And second what is your number one success habit?

Niko Skievaski: Interesting. So my health habit I would say is having a mindfulness practice. I’m a cyclist by well I guess I did that in college. And so I still ride my bike a lot. And for me riding my bike is very much a mindfulness practice I kind of get into a Zen state either you know mountain biking or road biking. And when I can’t ride my bike either because it’s doing a lot of travel or the weather’s bad like it is right now I replace that with having you know mindfulness meditation practice. So that’s been wildly helpful in staying close to what’s important and being able to let things go. So yeah it’s from a health perspective I think that’s huge. You hear a lot of a lot of people talking about how it’s been transformative in their life. Success practice? One of the things that I try to do every day is picks three things that need to get done that day and then basically make those the three things that I try to do. Today for instance one of the three was doing this podcast. So so…

Saul Marquez: I’m honored.

Niko Skievaski: Literally these aren’t huge important things these are like OK there’s 100 different tasks I have to get through. Let’s pick three that have to get done and make sure that those happen and then the rest as long as I get those three done. I can count today as successful and then anything else is really icing on the cake. And I think that kind of clarity helps to make it so it doesn’t feel less burdened whereas a stressed the importance.

Saul Marquez: Love it, great shares and hey man I’m honored that we made your top three.

Niko Skievaski: Of course.

Saul Marquez: Niko, outcomesrocket made it to his top three. Niko, this has been a blast. Listeners anything that you heard on today’s podcast is available in a transcript. We’ve got the show notes, some good summaries. Just go to outcomesrocket.health in the search bar type in Niko or type in a Redox you’ll be able to find links to the company, everything that we’ve discussed here today. What book would you recommend to the listeners Niko?

Niko Skievaski: One of my favorite books to recommend is The Art of Learning by Joshua Waitzkin and he talks about how we can really continuously be a continuous learner in life and the tactics to kind of getting that flow state where learning really opens up, it’s wildly useful.

Saul Marquez: Awesome love it so we’ll be adding that to the list here. Niko, before we conclude I’d love if you could just share a closing thought and then the best place for the listeners could get in touch with or follow your work.

Niko Skievaski: Yeah. So we talked about a lot today a lot of it’s kind of complex and in the inner trenches of healthcare but I think going back to that what I was saying about us being all patients as a patient you might not have the ability to single handedly disrupt healthcare. But we’re all consumers of it and we can shop and we can demand our data from our providers and we can use our feet in our money to demand more from our payers and employers and providers and our healthcare systems. So we have a lot of power as consumers. And even though the market is broken in many ways we can still make a difference as a consumer, as a patient. So yeah reach out to me you can find me on Twitter at niko_ski and my email address is niko@redoxengine.com. And always happy to reach out and have more conversations.

Saul Marquez: Outstanding so folks take Niko up on connecting. Definitely an individual and company that you guys should keep up with. So be sure to follow them on Twitter and reach out if you’ve got any need. So Niko appreciate you making time and looking forward to staying in touch my man.

Niko Skievaski: Yeah thanks a lot. Have a good one.

Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show note, resources, inspiration, and so much more.

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