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Welcome to this Week in Health it. My name is Bill Russell Healthcare, CIO, coach and creator of this Week in Health. It a set of podcast videos and collaboration events. Dedicated to developing the next generation of health leaders. This episode and every episode since we started the Covid Ovid 19 series has been sponsored by Sirius Healthcare.

Now we're, we've exited that series, but Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show's efforts to develop the next generation of health leaders. Alright, today we are joined by Lucy Eide, PhD, md Dr. Lucy Eide, founder and CEO of Remedy.

Uh, good morning, Lucy. Welcome to the show. Good morning. Thanks for having me. So, uh, remedy, I have Remedy Down as a health tech company focused on bringing personalized management to chronic health conditions. Um, elaborate on that a little bit. What, what is it that you guys do? So we are really focused on the issue of how do we help, you know, clinicians better use data when looking at these chronic diseases and sort of bridging from, you know, protocols and population health type guidance to that individual patient who you're taking care of.

And with the enormous amount of data being thrown at clinicians in their EMR from devices in the home, how do they make sense of that and make that really evidence-based data, uh, driven decision about patient care. So you're bringing evidence-based, uh, guidelines and those kind of things. How do you interact?

I mean, how do you interact with the, are you in the workflow of the EHR or do you have your own digital tool? How does, how do you interact? So early on when I started the company, EHR integration was a huge pain point in the industry, as I'm sure you know very well, as a former CIO. And, um, someone luckily put a bug in my ear about fire, uh, way before fire was a cool thing to talk about.

And we became very early adopters of fire and sort of that concept, right, of a common API and standardized way to interface with EHRs. Um, not just about the data, but about the actual user experience, so sort of the smart on fire piece of that. And how do you basically run an application like ours within the clinician's workflow?

So, you know, from my point of view, if a clinician never really knows that remedies, what's delivering this great product to them, I don't care. Our goal is for them to have the data, you know, analytics and tools they need to deliver better patient care all within that existing workflow. And that's the problem.

We talk about that a lot on the show of the promise of technology fading into the background, right? Mm-Hmm, . So we're just enabling outcomes, enabling, uh, progress. But what, what kind of outcomes are you guys seeing and what kind of things do you measure in terms of the success of your implementations? So, as you mentioned, we're focused on chronic diseases like diabetes, heart failure, hypertension, obesity, et cetera.

So we look at those clinical outcomes, um, but sort of the, the means to the end, right? How do you get to those clinical outcomes? It's where there's been the rub in chronic disease management for, for years, maybe decades, right? If you spend more money getting the better outcome. It becomes sort of a non-scalable, non-sustainable type intervention.

So efficiency of workflow is a big deal. Um, and then I would say most recently with a big focus on remote patient monitoring and new reimbursement models, sort of driving that financial model with the ideal situation being, you know, clinicians and health systems can use technology that generates new revenue streams, drives more efficiency for their end users and also better patient outcomes.

So when, when Covid hit, did you get a lot of requests to do something different than what was your core business? Was that a common thing? You know, not necessarily different from our core business. Remote patient monitoring has been a part of our core business from the beginning. We've always, starting with diabetes, we've always been pulling in the blood glucose data into the workflow.

You know, mashing it up with MR data to help drive this evidence. You know, just like telemedicine, all of a sudden there was this explosion of how do we take care of these highly vulnerable populations remotely because we can't bring 'em into the clinic. So, um, a lot of interest in the RPM capabilities and because of some of the reimbursement changes that have happened under the public health emergency.

Um, a lot more focus on the billing for rrp. M So, I, last question on this, 'cause I'm, I'm. Uh, curious. So, you know, we have a lot of data moving around. You're, you're, uh, providing, um, some, I don't know what's the, what the best word is for this, but you're, you're providing intelligence around that data and you're presenting that data at the, you know, at the right time, at the point of care and whatnot.

Are you doing any, anything with regard to, uh, artificial intelligence, machine learning to, um, either look at the data. During the, uh, the clinical workflow or, or post-clinical workflow to enhance, uh, uh, operation performance outcomes? Yeah, so in the clinical workflow, right, the, one of the challenges with remote patient monitoring is.

The feeling by clinicians of don't just give me more data, right? Don't dump a bunch of patient generated health data into my workflow. Help me know what to do with that. Who do I focus on? Which patients are highest risk of having an, you know, adverse outcome or having an ER visit. Um, so we have a lot built into our rules engine that drives our clinical decision support.

Pathways that really helps clinicians optimize for that efficiency of, you know, who are the highest acuity, highest risk patients who need, um, attention and intervention. And then, as you said, outside of that workflow, we are certainly building, you know, analytics and algorithms to help them understand globally what the implications are.

You know, you know, these protocols, guidelines can be incredibly. They can be conflicted if, you know, many of these patients have multiple chronic diseases. So you have diabetes guidelines, you have heart guidelines, you might have kidney guidelines. That's difficult for human beings to sort of optimize for that intersection.

So we're really interested in that space, sort of optimizing that individual patient decision making in the face of complicated and sometimes conflicting, um, evidence. So. You know, you have the, what the clinician really wants from digital tools and, and digital transformation and what patient really wants from the tools and transformation.

Is it, is it clarity of what I should be doing at this specific time? Um, given the, just the complexity of all the information and the complexity of my chronic condition? Is that what they're looking for? Or, or, or, or how would you describe what the clinician and what the patient are looking for? Yeah. You know, I think the best way a clinician put it to me was make it really easy for me to do the right thing and make it difficult for me to do the wrong thing for this patient.

And you know, I think we as patients, we're all patients at sometime, right? That's what we want. We, we want to go to that trusted advisor of our, you know, physician or other, um, caregiver. Have them make the best decision for us based on our unique circumstances and our characteristics as an individual. So I think those two are aligned.

Yeah, that's fantastic. Easy to do the right thing, hard to do the wrong thing. That is, uh, that's fantastic, especially with all the de of information that's coming at them. Uh, you have a, a phenomenal background. I probably should have started here, but, um, I'd like to get back to it. So you have a phenomenal background, PhD, MD.

So you are, are, would you classify yourself as somebody who's always wanting to learn more? That's why you ended up there, or you just went down one path and decided that there was another path? Give us a little background, a little background on how you end up a PhD, md. Yes. I started my career as a scientist and I would say I, I probably am at, you know, the root of it.

A scientist at at heart, um, is a physicist working for the government. And then went into venture capital for a bit, and we can come back to that. And then really had a plan to, you know, transition into academic medicine. So I did a dual, um, MD PhD program with a goal of, you know, having a career in a large academic medical center and running a research lab and seeing patients and, um.

Once I got into residency and really got a feel for what the actual practice of medicine is like and what actual hospital operations are like, I just became fascinated by all of the opportunity to make that work better. Right. And sort of a systems level analysis of like, why do we do this this way and why haven't we changed in light of evidence?

And sort of that endless why. Yeah. The, the, the PhD in you, the scientist in you came out. You just kept looking. You, you, you looked at the hospital operation and you're like, this, this can be better. So, so, you know, I I I'm curious about, you know, Elon Musk talks a lot about using the scientific method, and is is that essentially your, your approach?

You have a hypothesis, you're like, we could do this better. I think if we do this, this will be better. Is that, how, is that how you approach your, your, uh, your company and your entrepreneurial efforts? It. Yeah. And I, I think, you know, often I get asked about being a physician and becoming an entrepreneur, and I actually think that scientific training, um, is much more preparatory for shifting into entrepreneurship because Exactly.

You see a problem, you create a hypothesis of, you know, what's the underlying that problem? How could you solve that problem? And then you just start to iterate on that. You know, you try something, you gather evidence. Did that work? Did that not work? Okay, let's. Change that little piece to see if we can get it to work better.

Um, and you know, in our journey, when we first launched a platform, it was standalone and we had people who loved it, but said, I, you know, I can't scale this across my organization if it's not integrated to the EMR. So then we start down that pathway. Okay. You know, how do you do that? What is fire? What does that mean?

What's the future? Right? . And so it's sort of this endless peeling back layers of an onion. Yeah. Well, well, when you're hiring now, do you look for people who have a, uh, I mean, have a scientist kind of background or, or pretty broad in terms of who you hire? You know, I think I look for people who are curious, right?

Because at the end of the day, that's what, that's a common trait of a lot of scientists is just fundamental curiosity and a willingness to explore things they may not know a lot about and to sort of continuously learn. Um, and so certainly when people join our team, it's like this is, you know, this is a young, nimble company, and what we're doing today may be different than what we're doing three to six months.

And you want, you need to want to go on that journey with us. I'm, I'm curious about tech debt and, you know, when you're first starting a company out, it's beautiful 'cause it's greenfield and you know, you can set things up and go in a lot of different directions. Um, but as you start to progress, you know, you get asked, uh, your list of things that people are asking you to do gets pretty long.

And then you have some legacy date legacy systems and those kind of things. How do you, how do you determine what you're actually gonna do, I guess is the first question and then the second. How do you handle tech debt as you mature, as a, as an organization? Yeah, that, that is a tough one. And there's sort of what we call a, you know, cage fight that happens on our product roadmap, uh, session where, you know, everybody comes in with their list of requests from clients, the list of requests from the tech team, you know, the strategy requests of what they want on that product roadmap.

And, and we really do have to sort of fight it out, um, figuratively, you know, over what, what ends up on that roadmap. And one of the big issues is, you know, when do you. Invest the time and resources and um, you know. Moving past some of that tech debt. So, um, we really tried to, you know, operate on really modern future facing architecture and stacks and having people who don't come from healthcare is very helpful.

Um, and often when we're talking to IT teams at health systems, there's sort of, you know, crying a few tears of jealousy when we talk about these, you know, modern architectures that we work on. 'cause it's things they don't often get to work on in their day-to-day life. Um. It's hard, right? I mean it's the trade off is do we build the enhancement that the customer right now is asking for, or do we invest, you know, months of dev in moving to, you know, an updated platform and dealing with some of that tech debt.

So it's just a trade off. What about, what about the users? Do you, do you have trade-offs from time to time where you're looking at and you go, Hey, this is gonna be really good for the clinician, but it might, might not be as good for the patient, or this might be really good for the patient, but the clinician is really gonna hate putting this into the workflow.

Do you have those, those kinds of trade-offs? You know, we have over time, um, sort of really work to understand the, the usability and those demands from the patient and the demands from the clinician. And certainly on the patient side. I, I truly believe. You know, none of us want our health issues to dominate our day-to-day life, right?

Just like clinicians want the technology to fade into the background, the patients do too. If I have diabetes or hypertension, I don't wanna spend my day thinking about that. Um, and so, you know, we have scaled back and scaled back in some ways what we try to ask of patients. You know, we love cellular enabled RPM technologies.

Just step on the scale, just take your blood pressure, the data automatically goes into our platform and you don't have to think about it. You don't have to pair to a smartphone with Bluetooth, which is frustrating. And um, so that's been our approach on the patient side of, you know, how do we make this, um, accessible and available.

Um, our team is really committed to sort of the. Community health aspect as well of, you know, years ago I sort of set the expectation if we're not gonna be a technology company that makes healthcare better for the 1%, I wanna be a technology company that makes healthcare better for those who have the hardest time accessing healthcare.

And so that, um, influences a lot of what we think about in terms of accessibility, both price and technology of what we build for patients. Yeah. And the sensors are really going there, right? I mean, you. Uh, the sensors, the cellular technology. I mean, with five, one of the best things about five G coming out is that four G becomes less expensive and three G becomes less expensive.

Right? Right. So we, we can now get these little sensors that we put in these things. Um, I mean, is that what you envision sort of the home of the future where I sit down on a, on a chair and it automatically takes a handful of readings and, and puts it in into some, some sort of, uh. Uh, database. Uh, it's a bad terminology, but anyway, but, but it brings all the data together about my health, uh, passively, uh, over time.

Is that, is that, what, is that what we're envisioning? Yeah, I do think we need to get to a continuous passive model of monitoring, right? And while today the cutting edge is using cellular enabled medical devices, like a glucometer, we all know that's gonna go away at some point in the future. And whether it's, you know, sensors embedded in the home in my clothing, whether it's maybe at the next step, the sensors and smart watches and phones, um.

That, that's where we're going. And in fact, we're doing some cool and exciting work around covid with continuous, non-invasive monitoring, and really the analytics of picking up deviation from personal baseline and flagging people who were displaying early, uh, symptoms and sort of warning signs of covid.

Now, and, and you mentioned this earlier and I, I've been in these meetings where the doctors were like, I, I don't want any more data. I mean like here's all the data. You figure out what it means. I mean, do something to it and just present me, you know, these three data elements. That's all I really wanna see.

I don't wanna see, every time somebody sits on a chair, I don't wanna see, you know, their weight changed by 0.5 ounces. Uh, absolutely. They, they need the technology to distill it down to the actionable information for the physician. And then I think we all also have to continue to think about top of license practicing, right?

What do we need physicians to do because only they can do it through their credentialing and their training. What can the rest of the care team do? And I think that concept is gonna be further advanced as we move more into this continuous virtual model of care. You know, everyone on the care team has a role to play there.

How do you get your best ideas? Is it, is it from your clients? I mean, is it, do you have like an advisory board of clients or is it just by interacting with your clients? Is it help desk calls? I mean, how do you determine, how do you find the next ideas for your product? Yeah, I would say it's mostly client and clinician driven.

So both, you know, clinicians who are at client sites and then sort of you. Formal and informal advisors who we have. Yeah, that would make sense. I, all right, so I wanna go back. I don't know how I ended up where I'm at, but I wanna go back to your background. So you PhD, uh, md you worked in venture capital.

And, uh, let me add, this is a question. I'm, I'm, I'm asked a fair amount is, you know, when's, when's the right time for someone to look at venture capital, pe. Angel investing or bootstrap? No investing at all. If you're, I mean, where do the different strategies really, uh, work the best? Um, you know, I think depending on the stage of the company, what kind of product you're building, you know, if you can bootstrap a technology and start generating early revenue and fund the company through that, I think that's a great mechanism.

Um, that's hard if you're building clinical software that needs to, you know, comply with HIPAA and a lot of other, you know, regulatory, um. Burdens. It's hard to, in the, with the long healthcare sales cycles, to bootstrap something, I would say that's been my experience. But you know, you, you'll see people in healthcare with more consumer facing technologies, less clinical technologies who can take that path.

Um, you know, overall, I think it's just important to get alignment of, you know, the people you raise money from are becoming the long-term part of your team, and know that, and, you know, be aligned with them as to what you're. Goals are, what your values are. And to me that that's much more important than the type of money is that you're raising money from people who are wanting to go on the same journey with you.

Yes. You're not just taking money from somebody who's gonna give you money. You're, you're actually, uh, because that is one of the problems. People are like, you know, I finally found somebody to give me money. And so when you say to 'em, well, are all those things aligned? There's our values, you know, objectives, they're like, they're gonna give me money.

Um, there, that, that's probably a, a path towards destruction, isn't it? You know, there are gonna be bumps in the road, right? And ups and downs and turns, and having people who are willing to go through those times with you and be supportive, um, you know, their role isn't always to be supportive. The role is to question you and help make you better, but you want that fundamental alignment.

At the end of the day, what's the problem we're trying to solve? And are, you know, do we believe in the same thing? Yeah, it's interesting, the podcast, I've, I've mentioned this before on the show, but, uh, redox did a podcast with their, with their VC person and the two founders. 'cause they recently had to do some reductions and it was interesting to see all three of them.

Addressing not only their company, but they addressed the, the entire healthcare community by putting it out on a podcast of why are we making these decisions, how are we focusing? And those kind of things. I think that's a great example of, of really good alignment, um, between the VC and the owner. Uh, there's not a question there, it's just sort of a, a comment, but.

Uh, you've seen a lot of pitches to vc. What would you say is the, the mistake that you see made when people come before a, a venture capital firm and, and pitch for, for a partnership and, and money? You know, I'd say probably the most common pitch mistake is, you know, having a. Technology looking for a problem, you know, and you probably are a solution looking for a problem to solve.

But you know, any of us can fall in love with the ideas we have and the technology we built. But if you don't really understand the problem you're solving, and you know what, what is the market demand that I'm meeting and what's the revenue model for a product, right? Because at the end of the day, we all have to come up with a sustainable business model that's gonna support growth of a company.

So. In general, it's, it's hard, right? Because you're so close to it. Um, but always being able to speak in sort of that, you know, unit economics of, for the client, for the user, this is the problem I'm solving and this is why they must have what I'm building. Not, it's a nice to have. So there's a sense in which I, I, you probably hear a lot if, you know, if we build it, they will come.

There's not really a good model for, Hey, here's how we're gonna help them to be successful. Here's how we're gonna help them drive patient outcomes. Here's the demand that's already been generated around this type of product set and those kind of things, I would assume. Yeah, and you know, the early days of value-based care, I think we're a good example of that.

Um, there are a lot of companies building solutions to help, uh, drive better outcomes for early ACOs and other value-based care models. But the economics weren't necessarily all figured out of what would make those, um, you know, models work for the health system much alone for the supporting technologies.

So there were a lot of cycles around that of, you know, I'm, I'm pitching better outcomes, but how does that tie back to the, the revenue and the savings? Absolutely. So, so, Lucy, why did, so you talked a little bit about how you ended up being an entrepreneur, um, and, and you had the VC background. People might look at it and go, well, that's just a perfect fit, but there's so few female, uh, health tech entrepreneurs.

Um, give, uh, give us a, an idea. Were there any obstacles you had to overcome in order to get to where you're at today? And what would you, what would you say to maybe the next generation in terms of. Uh, doing things today that will prepare them for that role. Yeah. Um, you know, I think when I talk with sometimes clinicians or, or scientists who are interested in being entrepreneurs in healthcare, I do think actually having the clinical experience, you, I'll talk to med students sometime and they'll say, Hey, should I just quit and go start a company?

And I usually advise them, no, you know, actually go out there and really understand. What your colleagues in medicine are experiencing because the ability to be empathetic when you're building technology is incredibly important. And I think that's been very important for us as a company to really, you know, understand the pain points and the priority of those pain points.

And sort of the, you know, schlog of the day-to-Day in medicine. Sometimes you come in, you've got 40 patients to see, and at the end of the day you actually. And so I'll, you know, repeat that to my team over and over. We can't build better technology that adds an hour to their day. We just can't, nobody will use that because over time they actually wanna be able to go home at night.

Um, so I think, you know, coming at it with that perspective of, I'm gonna go get some experience that will help me be. Um, able to better relate to those end users is one approach. Um, you know, raising money, I'm, I'm pretty involved in female entrepreneurship, um, organizations and, you know, there's a big gap in terms of the amount of money that women raise as entrepreneurs versus men.

Um, and while I had worked in venture capital, I really didn't have, you know, connections and to healthcare VCs. So that was a big obstacle to overcome for sure. And you know, you have to just be. Tenacious be okay with being told no dozens, if not hundreds of times. And, you know, be confident in what you believe in and your vision.

And if you're really providing value, somebody else will see that and appreciate it and support you. Yeah. Tell me, talk to me a little bit about, um, networking and mentorship. Right? So. I hear a lot of people say, I can't find a mentor. I, I want, I want a mentor, but I can't find a mentor. That's one thing.

And then the, uh, and just the value of the people that you've interacted with over the years and how they, uh, how they help you maybe today in the role, maybe even get you into the role you're in today. . Yeah. I think one area that's overlooked is peer mentorship. Um, that has been incredibly helpful to me.

One of the, actually the first sort of fund money in was from a group called Village Capital, who has this really unique peer selection process around their investment strategy, which we would luckily lucky to be selected, but it's a group of peers who I have stayed connected with, because while we may be building different companies and different technologies, we're all

To some degree living the same experience. Um, and then later in the company, we were located at Georgia Tech at the technology accelerated fair, and I would have lunch every Friday with the other CEOs. And, um, that was probably the most helpful group of mentors who I have interacted with because, you know, they could be a FinTech company, a marketing tech company, but we all have the same issues, right?

Employee issues, founder issues, investor issues, and sort of knowing it's not unique to you that like, this is hard. Everybody else is going through it. They come out. The other side to me was what was just super helpful in sort of getting up and doing it again the next day. Those, those groups. Um, yeah, it is interesting to me.

There, there have been times where I've sat around with other CIOs and people are like, uh, you know, you get to talk to CIOs all the time. I'm like, yeah, you get to hear a part of the conversation on the podcast. Invariably, the best part of the conversation is the 15 minutes after we stop recording.

Because the guard comes down and we, and they go, oh man, this changed to the, to HHS database from the CDC database has sent my team into a swirl. But, you know, and we end up sharing that stuff, which you're not sharing on the podcast. I don't know. We just, we just don't do it. . I don't know why that is. Yeah.

Um, but yeah, it's the, it's those groups where you can be honest for, uh, you know, people sharing the same kind of problems. You can be honest, non-competitive and just help one another out. Um, how can, uh, you know, how can people get more information about, uh, about your company and how can they follow you?

Uh, so the company is remedy.com, R-I-M-I-D i.com. Um, we are really active on Twitter, on LinkedIn, so, you know, follow us at those two locations and you can follow me on Twitter. Um, just my whole name at Lucien ide, just outta curiosity remedy, uh, how'd you come up with the name? You know, one of those creative uncomfortable branding exercises, but it's a play on the word remedy, but something that we could own and sort of grow into.

Yeah, it's, it's hard to name a company, isn't it? I mean, it's, it sounds like it's easy, but it's, there's so many things that go into it. Absolutely. Yeah. Lucy, thank you again for your time. I really appreciate it. And that's all for this week. Don't forget to sign up for clip notes. Send an email to CliffNotes at this week in health it.com.

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