Over the past year I have been following the success of Redox and I have read many articles about the entrepreneurial journey of their President and Co-Founder, Niko Skievaski. I recently had the chance to sit down with him at the MGMA18 conference in Boston.
Rather than revisit the same questions that have been covered in dozens of other articles, I wanted to go in a different direction. I wanted to learn more about Skievaski- the-person rather than Skievaski-the-entrepreneur and I wanted to hear Skievaski’s opinion on the state of the healthcare as an ecosystem.
The latter is something that we have been investigating here at Healthcare Scene. For more details, see John Lynn’s recent post about MEDITECH’s app development environment (Greenfield) and my article exploring whether EHR companies are difficult to work with.
Skievaski and I had a wide-ranging conversation. I hope you enjoy it.
You and I met briefly at the Redox party at HIMSS18 earlier this year. I just want to thank you for your hospitality.
You’re welcome. We love our taco parties at Redox. I’m glad you enjoyed the fiesta.
I understand that you recently moved from Madison, WI to Boulder, Colorado. Why the move?
I lived in Madison for 10 years. I was working for EPIC during that time so it made sense to be there. But I recently decided that I needed a few more mountains in my life so I moved to Boulder.
All through college I raced mountain bikes and I wanted to get back to that. Madison does have a few rolling hills which are fun to ride down, but there’s no comparison to biking down a mountain. So I moved to Boulder for the mountain biking.
You’re from Canada right? [Yes] I was up in British Columbia for two months in the summer last year just mountain biking the trails up there. That was my first real experience being in Canada for an extended period of time. It was fun. You guys are really chill up there in Vancouver.
There are many players in the data integration space. Some have been in the business for decades. Why has Redox succeed in capturing the buzz while others haven’t?
We do things fundamentally differently than existing vendors in the integration space.
In the status quo, you implement an EHR and you need upwards of 400 interfaces to connect it to various other systems in your hospital. So you go out and hire 5-20 interface analysts to sit around all day and code the interfaces you need. You do that a few times, like we did at Epic, and you realize that you are building the same interface over and over again for different health systems. It is literally is the same interface.
Redox is based on the premise that you only should have to build the interface once for all healthcare systems. Once it’s built, others can leverage that work too. For example, we connect Brigham and Women’s ADT feed to Redox. We mapped it. We know where all the fields are. And we’ve done the same with hundreds of other health systems. So if there is any reason that Brigham wants to share their info with any of those other health systems we can facilitate it very easily.
Legacy players didn’t grow up in the cloud so they don’t think like we do. They come from a world of on-premise integration and at a time when healthcare organizations wanted to do all the interface work themselves. It’s a different world now.
I guess you can say that we’re getting the attention because we are solving the problem so differently than everyone else.
One of the interesting things about Redox is that you don’t sell to healthcare organizations. Instead you focus exclusively on HealthIT vendors. Why is that?
We started by working with HealthIT startups that knew how to build in the cloud but didn’t know anything about HL7 and didn’t want to. Yet these companies needed to connect to their customers’ EHR systems.
Without that integration, healthcare organizations wouldn’t buy these amazing cloud apps because of the lack of easy connectivity to their existing systems. In that equation, the incentive lies with the HealthIT company. They are the ones that want to solve the issue of connectivity more than the healthcare organization does. So we target companies that need this help and we go to their customers, get connected to the data and make It easy for the new company to focus on what they do best – which isn’t data integration.
The first project we do with a health system is very much like a standard integration project. The second project is where things get excited because we use that exact same interface we built the first time. There’s really no work to be done by the organization. That’s how we scale.
Is there an ideal type of HealthIT company that Redox likes to work with?
With certain vendors who have the right multi-tenant architecture, like PointClickCare, we can just connect with them once and they can then provision to their customers with a flip of a switch. Any PointClickCare location that wants integration, they can just click and make it happen. Together we make it very easy for a PointClickCare customer to connect with HIEs and the healthcare organizations that they work with.
Basically any HealthIT vendor that is truly cloud-based and that has embraced the concept of having a single platform for everyone is an ideal fit for Redox. Of course, we’re willing to talk to anyone to try and find a solution, but if you are cloud-based HealthIT vendor we should really be talking.
Can you give me an example of an advantage Redox enjoys because you are cloud-based?
By being in the cloud we essentially become the cloud interface for health systems to connect to cloud apps. Vendors come to us because we make it easy for them to get the data they need. Healthcare organizations push cloud vendors they want to work with to us because they won’t have to do any work to connect that new app if that vendor signs on with Redox.
Where things get really interesting, and exciting for Redox, is when we can use our cloud platform to facilitate conversations between vendors and their common customers without the need to go all the way back to that customer’s EHR as the focal point of integration.
For example, say there is a cloud-based scheduling app that allows patients to see and book appointments online. Let’s say they are a Redox customer. Now let’s say there is a telemedicine app that allows healthcare organizations to offer telehealth visits and it reads/writes appointment data directly into the organization’s EHR. Say this telemedicine company is a Redox customer too. So if the healthcare org wants to offer Telemedicine appointments through that scheduling app, the two companies can just integrate through Redox rather than use the EHR as the point of integration because we have all the necessary information running through our platform. This would speed up the transaction and make the patient experience more seamless.
This level of integration is just not possible without being in the cloud.
One of the topics we have explored recently at Healthcare Scene is how difficult it is (or isn’t) to work with EHR companies like Epic, Cerner and Allscripts. What are your thoughts on this? Are EHR companies hard to work with?
I would say, in general, EHR companies get a bad rap. I worked at Epic and I have to say that being inside Epic you don’t realize that people outside think you are difficult to work with. We worked hard to give our customers good service. Epic supports their customers, which are health systems. If a system wants to integrate with an application, then Epic people are more than happy to make it happen. They will put together a project team to support that initiative.
I think that as long as the health system is driving the conversation, EHR companies can be easy to work with.
The challenging part is when there is no customer in between. Say you are a HealthIT vendor and you want to go strike up a deal with an EHR company, like Epic. You have to realize that it’s nearly impossible for that EHR company to assess you as HealthIT vendor. They can’t tell if you are a good vendor or a bad one. If you are an established player or someone with an idea on the back of a napkin. The only way they can tell is if they go ask their customers – the health systems. Because of this, their traditional response has been: “Yes, happy to work with you, but we need to have one of our customers on board to prove this will work.” This can be perceived as being difficult to work with.
When we started Redox we didn’t go immediately knocking on Epic’s door and asking our friends to partner with us. Instead we went out and found a mutual customer to work with so that we would have a proof point when we did approach them.
I actually think it is easier to work with large EHR companies versus smaller ones. The larger companies have more invested in each of their customers and are more apt to work on projects that their customers want to do. Smaller EHR companies are constrained by resources and often don’t have the infrastructure to support integration projects in a timely manner. The good news is that things are changing. We’re seeing a lot more of the small EHR companies come out with developer programs, APIs and partner exchanges. I think they understand the need for their systems to be open.
Is the lack of interoperability a technological issue or is it simply an unwillingness to collaborate?
Neither. It’s a business model problem.
There is no business model that drives healthcare organizations to share their data. No one bats an eye about the lack of interoperability in the consumer world. Walmart doesn’t share their customer data with Target even though there are many people buy from both retailers. If they did share data, they would just be stealing each other’s customers. Healthcare organizations are in competition with each other so they aren’t really incentivized to share data with each other, but give them a useful app in between and all of a sudden they will open up their data.
Interoperability is the right thing to do, but it’s a hard thing to do.
What do you wish you could do with an EHR company that you cannot do today?
The user interface (UI) of EHRs are locked down. I wish EHR companies were more open to change workflow or add buttons to their UIs to make things a more seamless.
I totally understand why they don’t allow it. The workflow in an EHR has an impact on patient safety as well as on outcomes, so you wouldn’t want just any vendor to be able to make UI changes on a whim. But it would be great if there was a way to do something with the UI to make it easier for the end user.
For example, if you are doing something in the workflow, it would be fantastic if you could add a button to the UI that launched a 3rd party app from within the EHR. Say a clinician is doing a chart review and they want to be able to see the latest data from a remote patient monitoring tool. Imagine if that clinician could click a button and launch the actual monitoring app rather than that app having to ship its data to the EHR and have it stored/rendered in a poor format – like a table of numbers or a rudimentary chart. Why not let the native app show the data in all it’s glory using an interface designed specifically for it?
What’s next for Redox?
We want to push the healthcare industry to a point where we don’t even think about integration anymore. We want to see an end to integration projects. Think about all the time and resources that would be saved if you don’t have to use a custom interface each time. If we can do that we can drive down the cost of healthcare for everyone. To do that we just have to keep growing the nodes on our network and be a good partner to everyone.
This may sound like a tall order, but maybe not for someone who rolls over mountains on a bike for fun.
[Update: Niko Skievaski’s title which was incorrectly reported as CEO. Skievaski is Redox’s President and Co-Founder]