Improving the Healthcare Experience with AI-Powered Solutions

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Saul Marquez:
Hey, everybody! Saul Marquez with the Outcomes Rocket, and thanks for joining me once again today. I am joined by an extraordinary guest. His name is Aaron Patzer. He’s the founder and CEO of Vital.io, an AI-powered patient experience at over 100 hospitals. He’s also was the founder of Mint.com, with over 25 million users, and five other startups. He served as product innovation and officer at Intuit. If you’ve used TurboTax, Quicken, Mint, QuickBooks, you and 200 million other people have used software that he’s designed. Aaron was named by Fortune magazine’s Top 40 executives under 40. He’s won five product design awards and done over 600 press interviews, at one time, appearing as a regular CNBC expert, I’m excited to have him here on the podcast to talk about the groundbreaking work they’re doing at Vital. And with that, Aaron, I want to welcome you to the podcast.

Aaron Patzer:
Thanks for having me, Saul. Appreciate it.

Saul Marquez:
Yeah, it’s a pleasure. And so, look, one of the things that we like to do before we get into the meat and bones, the mechanics of the business, is really dig into what is it that inspires the work. So talk to us about what inspired your work to get into healthcare.

Aaron Patzer:
Yeah, so I think it’s probably not obvious. I’m still probably best known for being the founder of Mint, used, as you said, by 25 million people, most popular personal finance tool in the US, Canada. I was an officer of Intuit when I was way too young to be qualified to do so. Um, but what got me into healthcare was really my family. Most of my family is in healthcare. Um, so my sister is, she’s like quite a famed epidemiologist, she now runs the LOINC Institute. Like, if anybody’s familiar with LOINC codes that do the international lab standards, she runs that institute, the Regenstrief Institute. My dad worked at Bristol-Myers Squibb on pharmaceuticals and nutritional products and then actually started Vital with my brother-in-law, Dr. Justin Schrager, who is a professor of emergency medicine and a practicing emergency doctor. And I don’t know, like, I feel like there’s such an advantage to have people who know medicine in your personal life. I’m always like, just am I going to die from this? Is this is this a problem? And he’s like, You’ll be fine. But, you know, once a month I have a question, and it’s just such a privilege to have somebody who has the time and patience to explain things to you as a human, as somebody who doesn’t know all of the jargon, who doesn’t know that, you know, cerebral infarction means stroke and all of the terminology and abbreviations that they use, and I kind of just wanted to put Justin’s brains, nurses’ brains into software, using AI, using really good product design. We have super high utilization; about 60% of all patients in the emergency room use our software because we make it super easy to use, and just put a doctor accessible, explain things to people like the real humans. We use AI because, it actually sounds weird, but it makes things more personal. You know, doctors are like, hey, I saw your BUN is 26 micrograms per deciliter, and it’s low, and you’re like, what’s BUN? Yeah, what’s a deciliter? And you know, you should be like, listen, this tests your liver function, and this indicates that you might not be processing this well, or this one indicates that you might be dehydrated, and it’s looking low, so you probably are. And it shocks me that there’s just not that kind of, I would say usability or patient experience, or friendliness, or human-centered design are sort of some of the words or phrases that you might categorize as being in healthcare, so solving that is kind of what motivates me.

Saul Marquez:
That’s awesome. I love that. And look, there is a huge opportunity in personalizing experiences. This idea of the consumer, right, instead of the patient. It’s a huge miss. And I think a lot of companies are obviously in the know, and when you walk through these trade shows nowadays, that’s why you see some of these consumer companies in, they have a booth, the Best Buys, the you know, you name them, Instacart, you know, like they’re all in there, Amazon. And somebody like you that has that consumer background with the high adoption tech like Mint, I think there’s a lot of insights you could bring to the field. So really, let’s dive in. When you think about the company that you’ve started here, Vital.io, what would you say is the core offering and the way that you intend and are offering value in the market?

Aaron Patzer:
Sure. So Vital is AI-powered patient experience. And we started out in the emergency room, which is an area that not a lot of people pay attention to, but there’s 145 million emergency visits in the US every year. You know, some people go back repeatedly, but that’s like 40% of the population. It’s a lot. There are about $2,000 visits each, and, you know, we spent $300 billion on emergency medicine, it’s the primary way that people enter hospitals, it’s the primary way that people their experience there is going to set their opinion of your health system and your hospital. So there’s a real advantage to getting it right, and I think nobody’s paid attention to it before because it’s not the moneymaker that, you know, knee replacements and surgeries are. So, we’ve taken a very consumer approach to guiding you through both an emergency and an inpatient hospital stay. So in emergency, we use AI to figure out how long are you going to wait? How long is it going to be before you see a nurse? What do you need to do before you prepare to see them? How long are you going to be back in the waiting room? How long is your CT scan going to take? Today is a Friday, and it’s busy, and it’s more crowded than usual. You’re going to get a different wait time. Two people who walk in at the same time, one with a sprained ankle, one with chest pain, they’re going to see different wait times. So, we use AI to actually personalize it based on the reason for visit, the age. How many rooms you have left? We look at 100 different factors to make these wait times super accurate, and as a result, people are glued to their phones watching their wait time ticked down. That means there’s less stress on the registration staff, there’s less questions for nurses. What am I waiting for? We explain your lab results, not just the example that I gave before, which is talking to you as a human about what each of these means, but if you have like a CT scan, an MRI, an x-ray, you’ll get this radiology report back. And Saul, it says like you have squamous epithelial cells, or your medial malleolus might be fractured. You’re like, I don’t even know what body parts they’re referring to. And so, we wrote this, this AI, it’s generative AI, a large language model like ChatGPT or a Llama or a Med-PaLM 2, what Google has for that. And we put our own proprietary layer on top of that to understand, you know, what type of note it is, and we turn that into patient-centric language. We call it our doctor-to-patient translator.

Saul Marquez:
Nice.

Aaron Patzer:
And so literally it takes, thanks, it takes words like cerebral infarction and turns them into stroke. When we see NPO at midnight, which no human understands what that means, it’s literally an abbreviation of a Latin phrase nil per os, and we just say, the doctor says you shouldn’t eat or drink after midnight because you’re going to have surgery the next morning. And so it turns this jargony, impossible to understand, made only for doctors with PhDs, you know, medical reports into something that a middle schooler can understand, you know, that every person can understand, and we can do it in multiple languages. I can’t imagine anything scarier than, you know, like having a parent who comes from somewhere else, doesn’t speak the language, you’re trying, maybe is a little senile, and you’re like, mom, what did the doctor tell you to do? And it’s impossible. And so the other thing that we do as a value is we build family sharing straight in here. So, people share with an average of 2 or 3 family members during an emergency stay, people can follow along. How are you doing? What are you waiting on? Is it time to pick this family member up? And then, at the end of its stay, we break up your discharge instructions. It’s 2023, and we’re still handing people like 15 pages of dot matrix printed packets. And if you want to see something super sad, look at the trash can outside of the emergency room, outside of a hospital. They just throw these things away, they don’t understand them. And so, because they have a lot of filler and a lot of garbage, like smoking cessation and COVID policies that are two years out of date and just, we break them up into: what are you supposed to do? Saul, the first thing you need to do is you need to call a cardiologist, and you need to get an appointment in the next three days. You need to follow up with your primary care physician a month later. We’ve, you’ve got two new medications; they’ve been sent to this exact pharmacy, which, by the way, closes in 45 minutes, so you should get over there now before it closes. Otherwise, you won’t have them for the long holiday weekend. So all of that is built in, and it’s like AI to make it easy for people. And that’s why we have over a million patients actively using the platform.

Saul Marquez:
That’s awesome.

Aaron Patzer:
Now, in just a just a couple of years, I hope it’s 10 million and a few.

Saul Marquez:
Aaron, I love it, you know, and I was listening to really a podcast yesterday. We’re doing a podcast for a client of ours, and the gentleman said, you know, AI is not about technology. I’m not going to say any names, but he says, but he’s a respected AI person. He says it’s about the promise to the people. And what you’re talking about is the promise to the people, you know, the promise to patients, and you know, making it simple for all of us to understand our care in a way that is, you know, contextualized with our environment. And so, Aaron, you know, I’m just, the thing that I kept thinking about was, is it an app? Is it a portal? Is it a piece of paper? What?

Aaron Patzer:
That’s a great question.

Saul Marquez:
So talk to me about that.

Aaron Patzer:
We, Vital sits on top of any EHR, so Cerner, Epic, Allscripts, Meditech, whatever you have, if it’s got a FHIR interface or an HL7 interface. So we see when a new visit occurs, in your system, we see when a new note is written, when lab results come through, and we have basically a live feed of hospital data, and are calculating everything from that. For the patient, this is a progressive web app, so it’s just going to send you a text message when your visit starts. It’s going to have what looks like a password reset link where you verify your date of birth and last name and some security things, but you don’t have to download anything. You don’t have to set a username and password, that’s where I think a lot of people get it wrong in the industry. You see a lot of people doing apps and people don’t, especially in an emergency situation like it’s one of the worst days of your life. You do not want to download a 100-megabyte app on crappy hospital Wi-Fi that’s in the basement because that’s where a lot of emergency rooms are and set another username and password. So we make this as easy as possible while also having the kind of security that you have to expect from healthcare, and as a result, about 60% of patients actually do this, which is insane. And it’s 60%, we count family members using this. So we noticed that, you know, if you are over 70, 80 years old, I noticed the adoption actually went up, and it turns out people were handing it to their son, their daughter, their spouse to use the web app in the emergency room or an inpatient setting. It’s even higher in inpatient because it tends to be an older population. And so we have like, 50% of 90-year-olds using this. Um, you know, it’s not quite as high as people in the 20s and 30s, but it’s like really, really high. And a lot of that is because it’s ease of use, and we help their family use it on their behalf.

Saul Marquez:
That’s great. Thank you for that. Really good to understand the interface. And it’s simple, it’s a simple web app that you just use, and it works. That’s awesome. And Aaron, so you know, this is something that a lot of hospital systems could benefit from. Is that who you guys are seeking to work with mainly? Or are you also looking to work with payers? Tell us more about that.

Aaron Patzer:
Yeah, we work with, oh gosh, it must be 20-plus hospitals or health systems now. So we have a lot of hospitals with Dignity, CommonSpirit, UPMC, Emory, Avera, Trinity, Allina, I mean, literally all over the country we work with hospitals and health systems. It is a SaaS model. So the product depends on how busy your ED is. We always make exceptions for critical access rural hospitals, people, freestanding EDs that are small, but your medium or your large-sized hospitals are going to be, you know, anywhere from $60,000 to $75,000 a year. And then, because we break down your discharge paperwork, turns out 30% or 40% more people actually follow their instructions. And so, you get about $1 million worth of improved revenue, I suppose, because people are sticking with your health system and actually seeing the specialist you told them to. Fewer readmissions, we tend to have your left without being seen, right, because we tell people about wait times and set expectations, and we also apologize to them. We’re like, hey, Saul, sorry you’ve been waiting for 90 minutes. Is there anything that we can get you? Can somebody bring you a blanket or water, or something if you need it? And that addresses a lot of, you know, through automation, through technology, have that sort of human touch and mass. Um, and then your HCAHPS scores are going to go up. So, your, that’s hospital patient satisfaction scores are going to go way up, particularly in the categories of, I was informed about delays, likelihood to recommend, kept my friends and family informed all the things that you would expect something like this to do. So there’s really tangible results in all of this for hospitals and health systems. If you want to take a look for yourself, you don’t have to take my word for it or anything, just do a Google search for Dignity Chandler Medical Center Emergency Room on Google, or Mercy Gilbert Medical Center Emergency Room. Search for the emergency room, and you’ll notice that those have Google ratings of like 4.2, 4.8, some of the highest in the country. Whereas if you look for most emergency rooms, it’s like a 1.7 to a 2.1. You would never eat at a restaurant that had this kind of rating, right? And so that is people who are so satisfied with the experience and with the software that they’ve gone out and rated it. And it’s not just the software, it’s great nurses at those facilities, … partners that we have here. Um, but that’s the independent proof. You just read what people are writing about it.

Saul Marquez:
That’s awesome. No, thank you. Thank you for that, Aaron, and yeah, there’s a big opportunity here. I mean, you know, one of the biggest problems is burnout. You know, these hospitals, their staff is burning out. Talk to us a little bit about the other side of this, right? The benefits to the patients are clear. Talk to us about the benefits to the caregivers, the quadruple aim.

Aaron Patzer:
I am glad that you asked about this. One of our clients did a study that showed that Vital saves nurses about 2200 hours a year when it’s operating. Well, how does it do that? So one of the ways is that we have these virtual call buttons; we call them service requests, particularly for people in the waiting room or in haul spots that don’t have a big red button. And frankly, you shouldn’t use big red button anyway. But nurses are asked to do everything under the sun, which is why, one of the reasons why they’re burned out. Can you get me a charger for my iPhone? Can you get me a glass of water? The room, you know, is out of paper towels or in an inpatient setting. Hey, can you tell them on my turkey sandwich that I don’t like mustard or whatever it is? Nurses are coordinating with environmental services and food and nutrition, and like, they’re being treated like concierges when they should be treated like caregivers, people who have deep medical knowledge who can save your life. And so, by offloading that to other people, patient care liaisons, people who are not at your $60 or $80 an hour, but are at your $20, $25 an hour, techs who can handle some of the other requests, you can save nurses a ton of time and a ton of burnout. Um, and then just better informed patients means less questions to nurses if you have that doctor-to-patient translator and they actually understand what their medical treatment is, they understand the side effects of their medications. They were prompted to be prepared with their list of home medications or to, in the emergency room, we actually ask people to pee into a cup as soon as they can. That’s literally one of the tips in the app, because otherwise, they’ll have to wait two hours until they can for a urinalysis, which almost everybody does. And so all of these little things add up to helping the nurses do their job better so that they can actually just do the things that software never will be able to. As good as our AI is, it will never, never replace a human. It is there to supplement doctors and nurses.

Saul Marquez:
That’s great. So a lot of, so the actual technology takes in preferences and allows the patient to put them in, even from a like if they’re sitting in a bed in the hospital, they could plug stuff in.

Aaron Patzer:
Absolutely. I mean, the whole point is to provide that personalized experience. Your experience as an elderly person in for hip pain should be very different than someone who is in their 20s and giving birth, and so they have different preferences. The app changes, we ask you to do different things. We’re literally monitoring your vital signs in the app to figure out whether we should ask you to watch another fall risk video or education. Like if you’re really sick, we’ll ask you to do 0 or 1 things a day. If you look like you’re recovering and doing well, we’ll be like, hey, you need to watch these four videos about, you know, new baby stuff or recovering from your C-section or whatever it might be. So literally, the app adapts depending on your health.

Saul Marquez:
Man, that’s awesome.

Aaron Patzer:
That’s the kind of personalization that I don’t think anybody’s ever had in healthcare before, but it totally makes sense when you think about it.

Saul Marquez:
Totally. And look, guys, the thing that’s running through my head, like, first of all, like if you’re intrigued by this, you should be because, frankly, this is where healthcare is going. And I love that Aaron’s here talking to us about how it’s already happening. Um, the quote, you know, the future is here, it’s just not evenly distributed, is very true.

Aaron Patzer:
That’s right.

Saul Marquez:
And so the, like I think about Aaron, I was thinking about like a hotel experience right where I got chat messages from the concierge. I mean, it was so personalized, they would tell me about the s’mores for my son and it was so personalized. And the check-ins, like to have this in my care, I can’t even imagine it, but you’re telling me it’s possible.

Aaron Patzer:
It is, and this is just the start.

Saul Marquez:
So exciting.

Aaron Patzer:
Imagine if, you know, if you’re a patient sitting for a few days in a hospital bed and the nurse comes by every hour or two, and you have a lot of questions that have built up, and you often forget them because you’re in a groggy state by the time they come around. What if you had a, think of a ChatGPT who knew your entire medical history, who knew all of your medications and what their interactions might be that you could ask questions to. Why am I on this anyway? Is it normal for me to feel a tingling in my right arm or constipation, or whatever it might be? That’s a side effect. Is this is a normal side effect? How often does it occur? And just being able to interact with your own data that way.

Saul Marquez:
Huge, just huge. Well, look, Aaron, I love this. You know, I appreciate you. I appreciate you jumping on to let us know more about the work that you and the Vital.io team are up to. I think we’ll definitely have to do a part two to dig in a little bit deeper. I’ve had a ton of fun covering some of these things with you today. If you had to have a closing thought for the listeners today, what would you leave them with, and what’s the best place they could reach out to you and your team to engage?

Aaron Patzer:
Sure. I suppose the closing thought would be to say that patient experience, or consumer experience, is absolutely in its infancy in healthcare. Um. You know, some of the things that we do, I don’t think anybody else has done in healthcare, but I’ve done them before ten years ago in TurboTax, or in Mint, or in some of the other products that I’ve worked at, and I know that they work, and I know that they matter. Um, if you want to get in touch with us, go to Vital.io. If you want to use that doctor-to-patient translator I talked about, you can go to Vital.io/translate. If you do it on your phone, you can take a picture of any medical report, lab report, medical bill, it will explain to you. And it’s just live, just snapshot something that you don’t understand, and it will translate it for free, worldwide. You get five translations a day, and they reset tomorrow, so use them for your caregivers. But check the AI out for yourself and see how good we do.

Saul Marquez:
That’s awesome, Aaron. What a great opportunity. Thank you for that gift, that opportunity for everybody to learn more about what they’re doing in their own language with this translator. I appreciate you jumping on with us, Aaron. Looking forward to staying in touch.

Aaron Patzer:
Appreciate it, Saul.