Ep. 3 - Jonathon Feit: Beyond Lucid Technologies

Today we are speaking with Jonathon Feit. Jonathon is the Co-Founder & Chief Executive Officer of Beyond Lucid Technologies, an organization focused on building the infrastructure to share critical health information with first responders. Enjoy the show!

Episode Transcript

(00:09):
Thank you for visiting the Medi Apps show brought to you by the Medical Logistics and Transportation Organization,
Medi Apps.
I'm your host,
Ryland Stone.
Today we are speaking with Jonathan Feight.
Jonathan is the co founder and chief executive Officer of Beyond Lucid Technologies,
an organization focused on building the infrastructure to share critical health information with first responders.

(00:31):
I hope you enjoy the show.
Hello,
Jonathan.
Thank you so much for joining us on the podcast today.
Really appreciate your time.
Appreciate it,
man.
Thank you so much for having me and I appreciate it.
Yeah,
of course.
So to just really jump right into it,
let's kind of go back in,
in your story and we'll go back to your childhood.
Tell me if there's ever any time when you have like that,
that entrepreneurial spark as you're growing up.

(00:52):
And I personally,
I had some small businesses kind of growing up.
But yeah,
give me some background there.
Oh man.
Uh so you,
you're about to rip off a bunch of scar issue then.
Um So,
so Beyond Lucid Technologies is not my first company.
Uh It is,
it is the one that I have worked with,
uh and uh helmed,

(01:14):
I suppose the longest uh before this,
I,
I had a,
a publishing company,
believe it or not.
Um We,
we published the world's first all digital magazine that was called Citizen Culture Magazine.
Way back when we can talk about it if you'd like.
Uh But since you asked about,
you know,
we,
we're laying down on the couch here and sort of laying bare the,

(01:34):
the psychotherapy.
Um I come from a family of entrepreneurs.
Um So if any of your uh listeners have shopped at Costco,
for example,
and buy those,
those twisty light bulbs,
uh that's actually my uncle's company um Fight Electric.
So,
you know,
I,
I come from AAA lineage of folks when,

(01:56):
when my great grandparents were in Poland.
Um My family's uh religious history is Jewish uh and the Jewish community in parts of Europe for a long time were not allowed to own the land,
for example,
that was a uh a way of,
sort of,
it was a,
it was a persecutor thing probably beyond the scope for today.

(02:17):
But um they got clever and they said,
well,
they can't own land.
So they bought the trees that were on the land which they were allowed to buy and they opened a paper mill.
Uh and,
and that was actually how they earned their living until they left Europe during World War two.
Then,
uh my,
my dad and so now we,
you know,
we've got a lot of a,
we've got lawyers and doctors and got all those things.

(02:38):
Um,
I wasn't planning on going that path but I did want another way to serve,
uh,
and,
uh,
you know,
that I can,
I can certainly talk to you about how I got to where I am now if you wanted.
But,
um,
I think I've always been surrounded by the idea that if,
if you see a problem in the world and you have a way of a clever way of addressing it,
then,
you know,
go forth and go for us and do it.

(03:00):
Yeah,
for sure,
for the publishing company that you guys were doing.
What was the,
the main target or industry you were in.
So,
uh I appreciate you asking about it.
Uh It was my,
my first love and it'll break your heart every day and twice on Sunday publishing business.
Um But it was actually,
we were,
we were seeking to create essentially a young New Yorker.

(03:20):
Uh And we actually got,
we were once described as a New Yorker for a New generation.
It was a,
a very,
a very nice point of pride.
But uh actually the,
the long and short of the story is I had wanted to break into the publishing business.
I had wanted to be a journalist and it's really hard uh to start out without a lot of experience.
It's very similar to entrepreneuring actually,
right?

(03:40):
How do you raise the money if you don't have any track record,
how do you get track record if you don't raise the money?
So I,
I sought to break the chicken egg cycle.
Um And one of the biggest points of pride is over the course of our publishing history.
We,
we introduced 86 new authors and artists to the world who had never had a previous clip.
And many of them went on to write books and do some other really wonderful things in their careers and they literally got their start in our publication.

(04:06):
Um A couple of years later,
I,
I put together what it did.
It didn't launch,
the timing was wrong.
But um it would,
it was the,
the first all inclusive weddings magazine.
Uh So focus on uh interracial interfaith and same sex weddings.
Um for better and worse.
Our,
our,
our country was not quite uh in the liberal minded position that it was at the time that I was writing it.

(04:28):
So market was not exactly there.
If it had been a couple of years later,
it,
it would have been Gangbusters and,
and it really,
actually to me underscored an enormous uh the enormous value of the timing it,
uh and that's been really important now as well,
sort of finding a way to,
to survive,
finding a way to,
to serve your market because sometimes it takes time for the market to catch up.

(04:51):
Uh You mentioned that,
of course.
Right.
Before we started that,
you know,
digital health and health I t I think are uh you know,
case study in that,
that you may have a wonderful idea.
That's,
that's out of sync with where the market is.
Um And uh a couple of years later,
so now a couple of years ago,
I got quoted by the San Francisco Chronicle in an article about entrepreneurship tied at the JP Morgan Health Care conference.

(05:13):
And you know,
when you talk to a reporter,
you're never sure what's gonna come out of your mouth or what they're gonna quote.
Um But in this case,
it actually worked out really well and they quoted me saying that my definition of entrepreneurship was finding a way to survive until the market wants what you have to offer.
Um And I think that is something where,
you know,
COVID-19 as an example was catalytic.
Um And so many ideas that had been ahead of their time were now perfectly timed.

(05:37):
Um And some things that maybe were no longer as relevant got weeded out.
And so you have,
when you have a market shot,
uh it kind of gets people to say,
what,
what do we have around here that we weren't paying attention to and now we now we need it.
And so it,
to me that's kind of been the theme of my career is,
is sometimes being ahead of the curve and now it's finding ways to,
to,
to better align that with the demand and,

(05:58):
and,
and bring the economics to bear for sure.
And I,
I think that'll definitely,
we can get into your company beyond Lucid technologies in a little bit.
Uh But so after you had that,
the publishing business,
it looks like just looking over your linkedin,
you went to Carnegie Mellon.
Is that correct?
I did.
Yeah.
So I uh I didn't want to be in the advertising business.
I mean,
that was,
that was really not my uh I wanted to be a publisher.

(06:18):
I wanted to be a,
you know,
a magazine editor and a writer and uh I was,
I was passionate about the words and,
but the idea of,
of selling ads was really not what I wanted to do.
Um It turns out because some of my work now overlaps with that.
It,
it wasn't really the advertising that I had an issue with.
It was the idea that selling,
selling portions of a page.

(06:41):
It is not really passion inspiring,
right?
People like the creativity of the publishing business,
the medium isn't media business wonderful,
by the way.
Um I mean,
it's hard for sure,
but it's fun,
right?
I mean,
you get to talk to a lot of interesting people and go places and tell stories.
It's,
it's really enjoyable.
Um But,
you know,
buy a quarter page in a magazine that I hope someone might potentially pick off the nude stand.

(07:03):
And if they do,
I hope they might potentially,
you know,
uh,
turn to that page.
That,
that's a hard business to do.
Um,
yeah,
so I didn't wanna,
I didn't wanna do it anymore.
I,
uh,
I,
I,
my,
my passion was in health care.
Um,
I have a disability so I don't know if you're seeing it yet but,
uh,
I'm,
I have Tourette Syndrome so I'm a twitchy guy.
If,
if I seem a little twitchy on your screen here,

(07:23):
don't adjust your monitor.
It's me,
not you.
Um And,
and,
you know,
I,
I had a lot of history even before being in publishing,
I joined the army on September 11th.
Um,
I enlisted,
uh,
that Tourette Syndrome in the United States army don't really see eye to eye,
uh,
because my eyes move all over the place.
So,

(07:43):
um,
so,
you know,
that was,
that was where my heart was,
you know,
going in and,
and working in a public service capacity where there were folks who were soldiers and sailors and,
and airmen and medics and firefighters and folks who had put themselves in harming police officers.
And I,
and I really wanted to be able to help them,
um using technology and innovation and health care and it sort of close some of the gaps both about their own patients and about themselves,

(08:07):
you know,
the things that they were exposed to.
Um,
and so I left and I,
I,
I thought I was gonna go be a doctor and kind of go that route through the medical business.
Uh And then I ran into the immovable object that was organic chemistry.
We too did not see eye to eye.
Uh And so the,
you know,
as a friend of mine says,
long story,
less long,
um I had a professor who basically suggested if I wanted to be in the medical business,

(08:30):
maybe go,
go to business school.
Uh and,
and go that route and,
and link up with clinicians as opposed to having to be a clinician.
So that's how I ended up in business school,
met my business partner there.
Um And we founded our company six months in uh to Carnegie Mellon's credit and I really think it's due um because we're the only company that was created in our year that still exists.

(08:51):
It's actually a point of pride for us.
And,
and you guys were founded in 2009.
Wow.
Yep.
Yep.
Ja,
in uh 2009,
we Chris and I got together in 2009 and January founded the company in May.
Um And uh Carnegie Mellon is an investor in us.
So we're certainly grateful to them for that.
Um But,
but they did a wonderful thing.

(09:11):
It took some convincing,
but they let us bend almost our entire curriculum around this work.
So we actually had about 18 months or so of protected deep dive market research stuff,
the stuff that's really expensive to do to try to understand and,
and interview and do all the things that,
you know,
you tell people to do when you're on a start a venture.

(09:33):
Um,
and the only class that I don't think we were able to do that for was corporate finance because,
you know,
you're studying public companies but marketing presentations,
finance,
modeling,
design,
all these things that C M U does wonderfully well at a really deep level and we bent it all around beyond Lucid.
And,
um,
basically came out with a plan,

(09:54):
we had still had to build the product and sort of do all the things there,
but at least we understood some of what the market need was.
Um,
and we've bootstrapped,
I mean,
our company has raised less than a million dollars in external financing.
Uh,
and I,
I don't,
I don't think if we hadn't had,
if we hadn't had that,
you know,
that was kind of an extended incubator,
you know,
when you think about what so many incubators do and we did it in school.

(10:16):
Um,
and,
uh,
so that credit,
you know,
I don't get a chance to say it often but,
but credit really goes to them for,
for letting us do that and,
and it,
it launched us in a way that would have potentially been very expensive either in cash or in equity to do once if we were doing it without the protection of being in school.
For sure.
And so what was the first iteration of Beyond Lucid.

(10:36):
Were you guys doing consulting for,
um,
health care organizations?
Fire Ems?
Well,
actually,
if you,
if you look,
if you look back,
uh,
almost a direct line back from where we are now,
we were doing the same work just took a while to get in the market.
Um,
you know,
we've done some consulting work along the way.
Obviously,
that can be a great way to help pay the bills of.
But we,

(10:56):
we came,
we came out of school in 2010.
It took a couple of years to build the product and we did a lot of,
uh,
you know,
talking with,
um,
fire ems agencies,
uh hospital systems,
public health systems trying to understand what this market space was and how we were seeing some really big problems that I'm happy to tell you about if you want to know.
But we,
we were looking at the incumbencies and we saw what was there and we basically said how the hell are these problems still exist if,

(11:22):
if you've got these big companies,
I mean,
clearly somebody's missing the boat somewhere.
Um,
and,
or,
or these problems should have been solved,
but we're talking about multibillion dollar problems.
Um,
actual cash money,
not like potential tan,
but money being left on the table in the billions of.
And so we looked at that and thought,
well,
there's gotta be something here.
Um,
emergency medical services and medical transportation.

(11:44):
As,
you know,
I is extremely complicated from a regulatory perspective.
Um,
it's one of the,
it is triple regulated just at the federal level.
Uh,
let alone state local rules,
uh,
you know,
medical directors and their,
their views on things.
So,
we needed to understand all of that and we went through a compliance process that took us to 2013.
So,

(12:05):
uh,
we were the first,
uh,
company in the space to achieve nemesis three compliance,
which is the National Ems Information System.
We were the very first company to do it.
Um And,
and before we get too much into that,
how about you?
Give us like a little elevator pitch on what you guys do at beyond Lucid.
So for my little research,
I believe you're like a,
an E PC R and you guys do a whole bunch of other stuff too.
But yeah,

(12:25):
give me like a 32nd elevator pitch.
Well,
and that's kind of where I was actually just about to touch,
touch you.
So I guess I'm not,
I'm,
I'm glad I'm kind of in line with your question.
Um But it,
it all started with the documentation system.
So our,
our valley,
our,
our focus is to connect the dots between the responders in the field and the care ecosystems in which they operate.
Uh It,
it all started really by,

(12:45):
by having a record system that was high integrity of easy enough to complete that you could get it done without having to spend hours doing your documentation.
Uh We really focused on those those human computer interface aspects that Carnegie Mellon you know does so very well from a software perspective of.
And then it,
it quickly became clear that just capturing the data and just the electronic patient care record was not enough.

(13:10):
Um People were starting to ask for that information to be moved.
Interoperability was really coming into its early iterations right around then with the Affordable Care Act as a a tailwind to it.
Um So we started focusing on interoperability.
We got some funding in the,
you know,
from the California Health Care Foundation in 2014.
So right after we,

(13:31):
uh we just came into the market as a compliant system,
we got our first couple of agencies on board,
but then we got this funding and the funding was around what is now called community para medicine,
which is essentially keeping people in their homes,
right?
And,
and not necessarily transporting them.
But in order to do that,
you need visibility on the data,
you need to understand who's being cared for and where and why and why this time versus last time,

(13:56):
sort of that longitudinal view.
Um So the California Health Care Foundation because of the way their charger structure,
they're not allowed to fund uh ems and,
and fire agencies,
but they are allowed to fund municipalities and hospitals and health systems.
But it turns out that when you look at community para medicine,
they're all involved,
right?
So they were able to fund this and,
and so they gave us some money to essentially create a an interface engine that would let hospitals and health information exchanges absorb and ingest and use the data from outside the hospital.

(14:28):
Um And we deployed that in 2015.
So that was we,
we sort of focused on these pipes that we call the prehospital pipes and everything really flowed from that.
Um Because we realized again,
if,
if that benefit of interoperability only worked with our system,
we'd have to take everybody off of whatever charting system they already had.
That's not gonna work at scale for a small company.

(14:49):
Um I mean,
the conversion times alone would knock your socks off.
So we detach the pieces and that's really what we focus on.
That's our,
our,
you know,
I describe our as quill for emergency medical services or for emergency medical services.
We,
we are the companies behind the guys that sort of detach these pieces that allow you to take your Zole E S O image Trend intermedics,

(15:12):
uh sano charting system and move it and,
and have the receiver on the hie side,
the E E hr side,
et cetera ingest the data and then be able to do things like ana analytics and tracking um for community paramedic and specialty care registries that kind of marry up with the records.
So it's really all these pipes behind the scenes and that's what we do.

(15:34):
Um It turns out those holes in this ecosystem are massive and there are huge amounts of cost and,
and mortality and morbid morbidity on the line if you can't get it right.
And so our focus has really been on making sure the responders have all the information they need and then they can convey that to whoever's gonna take custody of the patient.
Next.

(15:55):
Very good,
very good.
So just to like clarify my understanding for any of the listeners that may or may not know I was a E M A while back uh doing ambulances,
you're running emergencies,
all that good stuff.
Um So yeah,
of course.
Um And then just to make sure I kind of understand.
So we used image trend was the,
the software that we were familiar with.
So if I'm an E M T,

(16:16):
I'm I'm on scene of a patient,
I'm putting in information and then that's getting transferred directly to the E D in lifetime.
So they know that incoming patient before my like call in report or is I understand that?
Yeah,
that's,
that's the idea.
Um But,
but it goes further.
So uh it's funny,
I just published an article or a,
I just conducted an interview that got turned into an article for health leaders media.

(16:37):
Uh I'll be happy to send you the link if you want to post it with the article,
the pod um I did an interview with Image Trend and Epic uh the big E hr vendor uh at hymns a couple weeks ago.
Um So this is him 23 for posterity.
And I asked them some pretty hard questions and I,
I had a video on it 72 72 minutes of recorded video of,

(17:00):
of them walking me through exactly what happens and what doesn't happen when image trend itself sends data over to the hospital.
And in,
in image trends,
you know,
corner,
there are some things they do very well.
Um They,
they can send alerts and so on and so forth um around who's coming in if that information has been captured,

(17:21):
problem is as they demonstrated and we have epic talking about this,
they don't take the raw data.
So image trend is essentially giving them a PDF uh and the PDF attaches to something,
but you can't really mine it.
So if you're looking at trying to uh understand what Rylands needs are and how those have evolved over time,

(17:46):
uh And who you're gonna need to talk to next and who we're gonna refer you to and how we're gonna do the follow up.
And you know,
are we seeing sparks of communicable disease and infection?
And you know,
all of that stuff's really tough if all you have is PDF.
So our goal is to say,
if you want to use image trend in the field,

(18:06):
awesome,
knock yourself out I mean,
there are whole states like Maryland and Delaware where you don't have a choice.
So you're really gonna have to knock yourself out.
Um But that doesn't mean that Johns Hopkins can take their data and put it into the E hr that doesn't mean that the E H the,
the hie in the region can share the data and if you cross over a state line into DC,

(18:27):
all of that goes dark,
right?
So that's a huge problem when you think about how many people live in Baltimore have their information in an infrastructure in Maryland and then go down to the nation's capital,
a 45 minute trip away and all their information is missing.
So for us,
it's about liberating those data so that they can cross those lines securely,

(18:48):
right?
That you're maintaining compliance and doing all the stuff.
Um but the data are discrete so they can flow much more easily and you can send them to different places and you can pull in alerts from apps of people on their phone and you,
you can merge them with an E PC R or even on the backside.
So when someone has the E PC R from image trend and then they have a an alert coming through pulse or something they can meet in the middle,

(19:13):
right?
There's all kinds of cool stuff that we can do as long as you break out the zeros and the ones and they're not bounded within that system,
the,
the real shame.
And it's fascinating to me but the,
the,
the mobile medical business ems fire community premise and critical care,
et cetera is about 5 to 6 years behind the rest of the electronic health records ecosystem in this.

(19:34):
And,
and I have been one for many years who's been trying to get the whole ecosystem to say,
we know what this is gonna do,
know the direction it's going,
right?
Can we avoid the,
the lag and the delay and,
and,
and sort of the screwing around?
Um And we haven't avoided it,
we've run headlong into it.
Um So,
so now it provides an opportunity to say,
right,
we've seen what it looks like when interoperability doesn't go the distance.

(19:58):
Are we about done?
Like can we can we,
can we go in and now say,
all right,
we now we know that the goal is for you Ryland to be able to do exactly what you just said,
which is I've got my paycheck.
I'm gonna land the data over there.
I've got my charging system in the field.
That's great.
Who else needs to know about this?
Where does it need to go?
Why is the health information exchange not receiving it?
What if it could?
And you know,

(20:19):
could you ping a registry of special health needs?
Could you ping a registry of uh you know,
critical medical wishes?
Could you ping a registry that says this person has an implant or a transplant.
You know,
there's all these different things you can do once the data are discrete.
And so that's what our focus is on,
is on moving those pieces around and sort of crawling through the ecosystem to say,

(20:39):
what is that,
ems professional in the field going to need.
Because right now as,
you know,
they show up and they don't have a,
they don't have much at all.
Um And so they make do and,
and I don't think they should have to make do.
I think there's enormous risk to the patient.
I think there's enormous risk to the provider.
We are spending huge amounts of money on people going to the wrong places,
uh staying longer,
waiting to be seen for hours.

(21:01):
Uh All of that can be solved if we liberate the data.
And so our focus has been pulling it out of its shelves.
Um And uh it seems to be working.
Gotcha.
Very.
That's really,
really interesting.
It's,
it's,
it's cool coming from a,
a clinical background,
seeing the progress that's hopefully gonna be there.
And it sounds like what you were mentioning on the end there.
You're transitioning from that E PC R the transmission and kind of getting that raw data to honestly more of like a,

(21:26):
a predictive or more informed response from that Ems crew.
So you guys are telling them like,
hey,
ems crew,
you're dispatched on this,
you're dispatched to a 23 year old female in a car.
She's currently,
uh,
do not resuscitate and she's on blood thinners and they would have all that info prior to that dispatch.
There's your bingo.
That's very,
very cool.
Yeah,
that,

(21:46):
that would definitely increase patient care.
And,
uh,
just to what you spoke to there,
there's,
there's a cost aspect to patients to the,
the correct centers and where they need to go.
Um,
and there is a revenue opportunity too,
by the way,
right?
I mean,
getting,
getting,
getting the whole process moving faster,
right?
I remember,
I mean,
this is one of the things you learn in business school.
It's not rocket science,
but you know,

(22:07):
a negative loss is a gain,
right?
So,
so speed is speed is revenue,
right?
The ability to not be wasting time is revenue because you can be doing other things or streamline your operation,
reduce less waste and nutrition and grind and you know,
that sort of thing.
But at the same time,
if you're able to match the patient with the best location,

(22:28):
there's value created.
Um that value can be measured.
Uh I just I this is what I give presentations on to a lot of places is the economics beyond a mileage rate.
I mean,
a mileage rate is kind of a crappy way of measuring what,
what medics do.
Um And,
and so,
you know,
I I just posted something about this funny just last night on linkedin,

(22:48):
which I,
I can,
you know,
ring up if you want or you can go find it.
But um it was just about that people talking about how,
you know what the role of A I is going to be.
Uh for example,
in this space,
I have a lot of feelings on that,
which I'm happy to address to you.
But,
but ultimately,
it was,
you know,
A I is a data driven enterprise,
it's a data driven concept.
So if,

(23:10):
if people are going to ask for raises and they're gonna want to be described as essential and they,
and all of these things that mobile medical professionals want and deserve.
They've got to be able to prove the value and,
and the problem is if your documentation,
if your data systems are so riddled with errors and part of the reason they're riddled with errors is because they're complicated,
they're not very well designed and,
and then they just kind of haven't kept up with modernity,

(23:33):
but people aren't gonna want to put their data in that becomes a self perpetuating crisis because,
you know,
I I know of fire departments that have been involved in major saves.
I mean,
if you remember those,
those fires we had here in California a couple years ago and I had some fire departments come to me and say we are being asked by our city council,
what we did,
what was our involvement?

(23:55):
What do you mean involvement?
You still have a town like literally your involvement is evident all around you,
right?
But it turned out that another service in their jurisdiction had a really,
really good handle on their data.
And they understood how to say this is what we did for who and where and this is where they ended up.
And this is how they performed.
And this was the outcome and this is,
you know what the basically the downstream value of everything we did.

(24:17):
And the fire department kind of looked around and said,
we saved some buildings.
Uh and we pulled some people out and that's great.
True.
I mean,
they no knock in what they did,
but they really undersold their value.
And so I come in and sort of say,
if,
if I can help you realize that the quality of what you put into these systems is going to indicate what you did all of a sudden,

(24:38):
it's not a charting system anymore.
It's a compendium of your knowledge and expertise.
And if you're good at what you do and you did good work,
you deserve to be compensated for it.
Um That,
that has a lot of value.
It has value to the,
to the providers,
it has value to the patients,
the ecosystem,
there's less waste.
Uh but not a lot of folks in our industry think like this.

(24:58):
And,
you know,
you mentioned sort of moving from the E PC R.
The reason why I always start with the E PC R and I'm glad you did too.
Is,
is you have to have a solid data structure underneath this.
If,
if,
if you're floppy,
floppy with an F as in Frank,
not sloppy,
right?
But if you're,
if you're floppy,
you don't have a rigid economic structure.

(25:19):
You,
you know,
this is what they teach you in business school,
right?
You have to learn how to do the math.
And if you don't have the math,
you,
you can't very well say this is what you should be paying me because I can't measure it that way.
But if we start with the E PC R,
then you've got plenty of data to work with.
Um And so it really becomes a matter of,
of,
of translating that value proposition to the payer,

(25:42):
whoever that payer is going to be,
whether that is an insurance company or a government entity or a patient and their family,
right?
What did I do for you as a patient?
Maybe you want pay for,
maybe you're a self insured patient.
There's lots of reasons why we want to have that conversation.
But if you don't have any data,
you can't progress past a heartstring story.
And that may be a wonderful thing and it gets,
you know,
word and a pat on the back,

(26:03):
but it's not gonna get you,
you know,
people to open their wallets.
Yeah.
Yeah.
Very,
very interesting.
I do think as data continues to develop and A I is continuing to advance a lot of different industries.
It'll be really interesting and exciting to see how it impacts health care for.
Just kind of going back.
Just overview questions as you were going through and building beyond Lucid.
What were some of your early challenges?

(26:24):
Obviously,
you're,
you're a software company and kind of working on that.
But yeah,
what were some early challenges you were experiencing?
Actually,
it's funny you mentioned that that actually turned out to be a very important challenge at the beginning of hardware was not available.
Um A lot of places that we first approached.
Uh uh again,
going back like 10 or 12 years,
we're actually using software or excuse me,

(26:46):
hardware.
Now,
we're in some cases,
four or five,
even more years older than that.
So you,
you,
our was actually a real issue of and,
and it changed significantly.
Um We have had some partnerships over the years with folks like Dell of and they were great partnerships,
but we actually were introducing to this sector,

(27:09):
some of the high,
higher power,
rugged,
even non rugged devices and saying,
look,
you may think that you need.
In fact,
this is an actual conversation.
I had the rugged P CS that folks were using.
Once upon a time cost about $4000 you probably use some of those.
And well,
if you've got an $800 tablet and you could put a 25 $30 case on it.

(27:32):
And you could teach your people not to use them as Frisbees if you can get five of those for every one of the other one.
Right.
Well,
on top of the fact that it's cheaper,
it also doesn't weigh £15.
And if you're carrying that in addition to the EKG monitor,
in addition to the pack and the pot and the person that's a lot of grind on a person's bodies.

(27:53):
So we actually had to teach people to,
to even go away from some of the hardware that they were using,
that it was worth looking at other form factors.
Um So,
you know,
that,
that was an interesting one and I think that's probably the single biggest thing.
And I remember when,
when we were in b school and some of these lessons,
I'm really glad that I remember.
But,
you know,
when people talk about what your competitors are and,

(28:15):
and it's really tempting,
especially with someone with a big idea to say that,
you know,
we're the first to do something and as if that matters and sometimes it does and sometimes it's marketing and sometimes it's not great to be the guy who built the first digital magazine and then lost a bunch of money doing it.
So,
but uh if I knew then what I know now.
So,

(28:36):
um but,
you know,
inertia is always a competitor and that's something that often gets forgotten.
So the idea that you know,
if someone is used to using a pencil and paper or they're used to using their tough book,
they don't know how a,
a modern E PC R is different than the one that I have.
Well,
it's,
it's called an E PC R.

(28:57):
Right.
It,
it's gotta kind of be the same thing.
Well,
no,
we,
we,
we,
we've run out of words,
we've run out of,
you know,
acronyms or whatever,
but you should try to,
to see the difference.
Um,
and so people being used to something is always a competitor and I think that took a while.
Um,
the sea change,

(29:17):
I actually feel very personally because I'm not a medic and I'm not a firefighter.
Um,
I'm a technologist.
I'm a data geek.
Uh,
you know,
I was a publisher but I do all these different things,
but I can't claim to be a clinician and for probably the 1st 10 years of my career in this business,
that was a problem.
Uh,
there were a lot of people who would say things like,
what do you know,
you've never ridden on the truck?

(29:38):
Well,
have,
I,
I've spent a lot of time on the truck and I've,
I've spent a lot of time being with people who are dealing with a lot and,
you know,
I didn't show up and decided I was going to do this in five minutes.
But,
you know,
four years to deploy a product means I did something in that time.
But,
but the reality is that sense of do you even get what we're doing was a real problem.

(30:01):
And then the market started to shift or data and economics and some of that has to do with,
you know,
sort of macro business discussions and inflation and you know,
people,
you know,
clamping down on municipal budgets of all kinds of stuff.
But um basically,
it became a question of accountability and it turns out that being the only company,

(30:25):
we are the only company in this space that was founded by two non clinician M B A s.
Uh And the point is that was at one point a real Achilles heel and it has turned out to be probably the best gift we could have asked for because the industry has plenty of people who can say I rode on a truck.
I was a firefighter.
I was a medic just like you and I can say I wasn't that,
but I can tell you how to get paid and if your problem is getting paid,

(30:48):
not finding a clinician,
I'm your guy.
If you want somebody who can say that they've taken care of patients at two o'clock in the morning,
I'm not that guy.
Um And,
and so there's an interesting bifurcation happening now where,
you know,
some people are still all about the club and that's OK.
Uh And so the empathy of that,
but there are other people who are saying empathy is great,

(31:08):
but I'm gonna shut down my service or I'm not gonna be able to continue to fund my community para medicine program unless I figure out how to get some money behind this.
And it turns out being the guy with,
you know,
a different three letters after my name,
not E M T P.
Uh but M B A turns out to be really helpful.
Very,
very interesting.
So you right.
It is.
What,
what was the Achilles heel turned out to be great?

(31:30):
And we,
we,
you know,
Lord knows we've tightened the belt to get here.
But uh it's really fascinating as we started talking about before to sort of watch the market catch up.
Uh because we like to think that we saw where it was going and wanted to be where the fuck was going.
Not where it was.
Yeah.
No,
for sure.
So I,
you spoke a lot to kind of just market trends changing.

(31:52):
What would you say were some of the biggest wins?
Was it some of those macro levels just adjusting and departments saying,
hey,
we actually are losing our budget here.
We need to make this profitable.
Hey,
you might have a solution.
Would you talk to us,
Jonathan and go down that route?
What were your biggest wins?
I,
I think that's,
I think that's sort of a,
a way where things ended up.
Um I don't know if it,
it was that direct I think,

(32:15):
and,
and I,
I will say even from our earliest days in Pittsburgh,
I,
I discovered what I'm about to say,
which is that every market,
every community has its early adopters,
right?
And that,
and that may sound,
you know,
both obvious,
either obvious or not obvious,
depending on who you are,
I guess.
But if you think about adoption curves,
right?
And the idea that someone has to be first and someone's gonna take longer,

(32:38):
but some places make that a part of their culture of and,
and,
and some places are just,
you know,
I'm the first to hear about it because I tend to go to conferences more and it doesn't,
doesn't really matter,
but we really,
we really focused on those early adopters.
The early adopters are a fascinating group and like I say,
every community has them,
some of them are,
you know,

(32:58):
the first agency in Pittsburgh or the first agency in Colorado that wants to do something.
Um some of it are just the ones that are kind of on their own.
So they don't really have a choice and they have to sort of figure out or die,
right?
A lot of rural services face that.
So by focusing on the early adopters,
we tend to find folks who realize that something better should be doable.

(33:24):
They kind of have ideas,
but they don't necessarily know where the dividing line is between a pipe dream and something feasible,
right.
Now we started to see more of that.
Right.
That was the shift.
So,
you know,
I,
I think it coincided with a few different things.
One is,
you know,
the mood chord,
things like iphones and ipads and,

(33:45):
you know,
I don't really,
I don't really need a tough book anymore.
If I'm gonna buy new,
you know,
new hardware.
Is there something else I should be looking at or should I take the same now,
10 year old software and just put it on my new device?
That,
that doesn't make a ton of sense.
Um I'll tell you one really interesting example that comes to mind on this was speech to text.
So we were the first company to put speech to text and a camera in a patient care record system.

(34:09):
Neither of which is rocket science,
by the way.
Well,
I mean,
if you think about what you're doing,
freeing up hands and,
and being able to,
you know,
the picture is worth 1000 words.
Well,
what's a video worth?
I mean,
these are,
these are real,
they're cliche,
but they totally apply when you're talking about,
you know,
the time to write a narrative uh or convey something in 30 seconds,
you know,
you were doing this,
you're conveying something to someone who may or may not be paying attention to you.

(34:31):
And if I can give you a snip in a video,
I mean,
that's even better.
So,
so really quite fascinating we introduced the speech to text,
uh,
in 2012,
um,
so long time ago now,
but check them into got 11 years ago.
Um,
and there's a cool story that led up to it,
but I'll,
I'll tell you that if you want to hear it,
otherwise it's,
it's worth another conversation sometimes.

(34:53):
But the bottom line is,
I went across the country and I asked people,
would you love,
would you want speech to text?
No one wants to hunt and peck for keys,
right?
No one,
no one really wanted to be spending the time writing their narrative.
They all loved the idea.
And I said,
well,
would you use it?
And they said,
no,
that what you just said,
you right?
You want,

(35:13):
you want this piece of text but you wouldn't use it is when it turns out the the problem was at the time we needed you to wear a headset,
right?
The un directional microphones and other things weren't as good so on and so forth on,
on computers.
So they,
we need you to wear a headset.
You've got a Jabra,
you've got the jawbone like the different ones that you could have.
You have like the boom microphone,

(35:33):
all these different things that people like?
No way I said,
but is it more worth it to you to wear the microphone or to have the speech to text?
And we got some really cool responses.
I mean,
some people were just afraid of looking stupid.
Other people were afraid they'd lose it or forget to charge it,
which is a legit concern.
And then of course,
there were some who had a very wise view of,
you know,
you could end up with fluids on there and from the patient,

(35:56):
maybe you don't want to have their blood,
you know,
even a couple of drops near your mouth.
Right.
So all of these were really cool points that basically got people to say thanks.
But no,
thanks.
Well,
ok,
but the fellow who had turned me on to,
that was the now uh retired chief of Pittsburgh,
Ems Bob mccaw.
And,
and he had this prediction back in like 2020 2010,
that the whole industry was gonna go hand,

(36:17):
you know,
without hands,
so hands free and voice and other sort of powered interfaces.
So I really believed that he was on to something.
And a couple of years later we noticed that speech to text became a requirement for a lot of places.
So I found myself asking what changed,
right?
I mean,
how do you get from people saying?
No,
no,
no.
Who absolutely need to have this?

(36:38):
I totally love it.
I want to be able to dictate my stuff.
Can you let me navigate a whole chart with my voice?
What do you think changed?
I have,
I don't know.
So,
so I did a lot of digging on this because this is the kind of stuff they teach you to do at a quant school.
Um And,
and we have some tools like conjoint analysis that are kind of an amazing thing.

(36:58):
If any of your listeners are interested,
it's very geeky,
but it's very important.
It's the way that companies like Starbucks have won in their business sectors.
It's one of the few things I remember from business school specifically.
Um So conduit analysis helps you understand features and so understand which feature really rises,
which is the one that really makes a difference.
Uh And so we applied that concept to this and it turns out that the the difference between then and now were hands-free laws.

(37:24):
So back in 2010 and 2012,
you could still drive around in some jurisdictions with your cell phone in your hand.
By 2018 2019 2020 there's pretty much nowhere in the United States that you can do that.
So people got used to the idea that I'm gonna wear a headset or I'm gonna have a microphone that's good enough that I don't need it because it'll pick up my voice,

(37:45):
right?
And,
and so,
you know,
when you ask the question,
kind of what,
what you know,
surrounding context that allowed us to advance.
It really was that focus on interoperability that I talked about before,
but really a modernizing of the expectations of what technology should be able to do,
you should be able to do speech to text,

(38:06):
you should be able to have a camera and,
and take that image and hype it through to the hospital in real time.
I shouldn't have to wait to get back to my station to do my documentation because when I get my to my station,
I wanna have dinner,
right?
I wanna take a nap.
Right?
So I I or I might have to go take care of another patient or clean my my rig.
Right.
Sure.
Do whatever I need to do.

(38:27):
I don't really want to sit down and start charting.
Why can't I do that in the field?
Well,
if my software system frankly isn't well designed for that,
it's a nice way of putting it.
But if the software system is not well designed,
I don't really have a choice.
But if you start to expect those types of things,
which is what modern technology is enabling folks to do.
And I don't think this has to do with age.

(38:48):
By the way,
there's a lot of people who would say that this has to do with the aging of our industry and like younger people coming up.
But I don't think that's true.
I think some of the most sophisticated technology folks in our industry are people who've been there for 20 and 30 years and they've seen those before,
they realized it wasn't great if you were using tape on the leg or the back of the glove.
And,
and the fact that I had to learn something OK.

(39:10):
The way that I tell people is,
it's a whole lot easier to learn how to do documentation efficiently than to learn to shove a tube down somebody's throat and bring them back to life or rip apart a car and pull them out.
So we,
we had to take it on ourselves.
And I don't just mean us as a company,
but as an industry,
this idea that if you are building tools that are designed to be used at the patient in real time,

(39:32):
to facilitate interoperability to,
to know who Ryland is and what his needs are.
You have to change the design.
And there are still so many people complaining about things like nemesis and H L seven and the underlying guts of the thing and they don't realize the problem is not there.
The problem is on what you,
what you have in your pan.
And if you haven't made investments in modernizing,

(39:52):
you know,
you can't expect your,
your car to go 0 to 60 if it's 15 years old and you get its oil change every,
you know,
every 18 months,
right?
So if you want performance and if you want efficiency and if you want all those things,
you wouldn't modernize yourself.
But if I'm going and teaching you that you need to do that and you just think I'm gonna,
I'm trying to sell you something.

(40:13):
You don't necessarily believe me,
what we're finding now is that there's all these external factors like the hands free laws and the availability of,
you know,
computer in your pocket right now.
All of a sudden people have an expectation.
Why can't I check my patient in to the hospital on the way in?
Like I check myself in to the,
to the air,
you know,
to the flight on the way to the airport.

(40:34):
Uh that was brought to me by chief Mike Metro,
who's the now retired chief paramedic of Los Los Angeles County fire many years ago because he was pissed off at the idea that he could do all these things,
just not in health care,
not in emergency medicine.
I said,
well,
then let's rock and roll.
Very,
very interesting.
So it's very cool to see how you guys have progressed.

(40:55):
I mean,
clearly when you guys started,
you didn't have the devices that you touched on.
You didn't have aws to go build on.
Uh you didn't have any of these new features.
So it'll be really cool kind of watching you guys continue to grow.
What are your goals over the next five years or so?
For beyond Lucid on your team?
What are you guys focusing on more?
Uh Yeah,
look,

(41:15):
uh I,
I,
I get to say it,
it is a privilege of Anna Burton to be able to say we are one of the,
one of the very few,
if not,
I can say one of the only consistently profitable digital health ventures anywhere.
Um That is a responsibility on us,
right?
We,
we,
the,
the idea that we are presenting value that our partners are willing to pay for,

(41:42):
um is something that puts an everyday responsibility on us.
I am of the belief that software should never be considered finished.
You're always adding to it.
So,
you know,
as I mentioned,
interoperability um is a thing,
it's an expectation.
There are a lot of people choking on the lack of interoperability right now.
And even worse,

(42:02):
there are whole regions kind of banging their heads thinking they have to use one particular company or another because they don't realize that there are necessarily other ways of doing things,
um even things that can keep those companies in place but help to connect the missing doc that we've talked about before of you mentioned the vehicle aspect.
Um You know,
so I I'm really glad that you did and I don't know if you saw this on the website,

(42:25):
but um Hal on post crash intelligence is a very important part of our future.
So,
uh this is a,
a patented technology that we have uh that we've created that essentially will inform responders uh en route to the scene about who was likely impacted by a crash of.
Do I think that is a massive driver of our future?

(42:48):
Um No pun intended,
I guess,
uh because because it doesn't have a choice,
right?
Uh in 2021 our country had 43,000 deaths on roadways um for all of the smart and that's according to the National Highway Traffic Safety Administration of,
you know,
because of all of the safety technologies and automated driving and just all of the things that are getting introduced to increase safety on the roads,

(43:17):
our 22 death rate was 10% higher.
So in 46,000 deaths last year,
as opposed to 43 the previous year.
Um That's a tragedy,
right?
And,
and,
and so to the degree that we are,
I'm,
I'm often asked it in the way of,
are,
you know,
if we're spending effort on making cars smarter and faster and lighter and cheaper and automated,

(43:40):
are we also making them safer?
And the answer is clearly not.
Um But it turns out that there's a lot of infrastructure that goes into that.
So when we,
for example,
talk about interoperability and we have a registry system that we deployed uh in Oregon first and uh next on deck is Virginia.
Uh We just,
now I'll make some news on your pod here.

(44:01):
Uh We just got given an eta for deployment of the start of the next school year.
So,
uh Congrats,
September 23.
Thank you.
There's still some pieces to put in place,
but we have a,
it's a publicly announced eta um that uh you know,
these,
these pipes,
these prehospital pipes serve up information for instance about uh a,

(44:22):
a pediatric patient,
special health needs,
right?
Do they have medical equipment?
Do they have uh uh you know,
an underlying uh disease or disability that,
that someone may not know when they just show up?
Right.
Does a patient have an end of life,
medical order or some other critical wish that needs to get addressed?
Well,
guess what all of those also apply in the vehicular space?

(44:44):
Right?
What if it turns out that in the back seat as a kid with or autism or sickle cell or cystic fibrosis?
And mom is passed out on the front seat because she was involved in a crash and she can't tell you what's going on with the kid in the back or she's going to be get this 36 a half million epilepsy patients who drive,
right.

(45:04):
So if you've got almost 37 million people with epilepsy,
someone has an issue,
but that issue may not be related to the epilepsy,
the crew shows up with the lights going and that puts you into a photosensitive seizure.
Now you have a second problem,
right?
So these pieces of information are massive markets and they're completely wide open and,

(45:24):
and not that I want people to go into them other than me,
we got this.
Um but you know,
our,
our goal is to continue putting in place the infrastructure that allows these things to go,
that allows them to lessen the wall times,
you know,
get the patients out of the inpatient bed so that the E D patient can go into the inpatient bed and the crew can get the patient off the pot.

(45:45):
And,
and those efficiencies are simply not being deployed at scale by incumbents for reasons that quite frankly,
I don't understand.
I don't think it's because the markets aren't real,
they're very real,
uh,
they're lucrative,
they're painful and they're massive.
But I think people are so head down focused on maintaining the business they've had and the joy of the,

(46:08):
of the,
the smaller agile company.
Um My business partner says I can't call ourselves a startup anymore because we've been around for a minute.
But,
but the joy of being agile is,
you know,
Clay Christensen.
And when,
you know,
the,
the,
the Harvard professor,
uh late Harvard professor who studied disruptive innovation talked about this,
you know,
as the dinosaurs get bigger,

(46:28):
they,
they leave shot and those shadows get bigger.
Um Now we have the,
the Harvard business Review actually just published a podcast a couple of weeks ago about something called nondestructive Creativity.
And it was,
it,
it was something that truly inspired me.
It was really this idea that instead of changing everything about the status quo,
like so much innovation has been focused on.

(46:48):
What if we focus on collaborating with the status quo and filling in those gaps.
And now now all of a sudden,
you don't have to rip out anything people have invested in instead you do the opposite,
you make it better,
right?
And so you,
you're squeezing more juice out of that orange rather than saying I'm gonna give you a lemon and you're gonna like it.
Uh And I think that's what a lot of people have been used to.

(47:10):
So we are gonna focus on closing those gaps um making sure we're sustainable and doing that and,
you know,
growing up into the right.
Uh But,
but it's really not just about lipstick on a pig,
it's about being able to say,
what is the measurement that,
that shows that these are bringing value so that folks who are sort of done not having a sustainable model can say there's an option out there and I don't have to uninstall replacement.

(47:45):
It's an augmentation.
Um So you end up with an augmented reality to use the cliche uh as opposed to something that is,
uh you know,
either vaporous uh or so expensive and invest,
you know,
invasive that you can't afford to get it.
Um And,
and that's a,
those are big spaces.
So we're gonna be pretty busy,

(48:06):
but we're pretty excited.
Very cool.
Well,
I'll definitely be sure to kind of keep watching as you guys continue on.
Uh just for,
for a couple of other questions before we wrap up for anyone in your team.
What do you look for in personality and character traits in a new member joining your team?
Oh,
that's a great question.
Um,
funny.
I,
I used to,
well,
I used to talk about this a lot internally.

(48:27):
It was never externally.
Um,
the higher ranked your school,
the less interested in you.
I probably am.
Um,
and,
and,
and I think that's a weird thing.
It's a weird perspective when it comes to Silicon Valley.
Right?
Is,
you know,
the,
the Stanford,
the Berkeley's,
the Harvard Penns,
et cetera.
I have,
I've got no interest in that.
Um I,
I used to,
I mean,
it's not to say that I have nothing but love for those folks.

(48:49):
I do.
I have nothing but love for him.
But,
but mobile medicine is a hard business.
This is not,
this is not shiny Wall Street work.
Um I,
I used to say that the people that I want on my team are the ones who can talk about football or some other sport thereof.
Uh,
guys or girls,
depending on your persuasion and how much work sucks because that's what people talk about.

(49:13):
Right?
It,
it,
you know,
our,
our profession is relationship based.
It's trust based.
You gotta know the medicine again.
Ryland,
you know,
this,
you know,
as well as anybody could.
So you gotta know the skills,
you know,
and you gotta have the goods and be able to show up and perform on whatever the task is.
But it,
it's,
it's really about if,
if I'm gonna be at an event and I'm standing at the bar,

(49:36):
can I,
can I have a relationship with this person and build trust there?
So that's number 12 and three for me is,
you know,
we,
we have a team that is in many ways so bizarre.
Um,
you know,
my,
my engineers are the best in the business 100%.
Um,
there is nobody who can touch them from an engineering perspective,

(49:57):
especially when you consider the,
the size of our team and what we have managed to accomplish.
Um And so the dedication,
the recognition that this industry is 24 73 65 yet those sort of come with the territory,
right?
You're,
you're uh again,
you,
you were a medic.
So you understand or use an E M T,
right?
So,
you know,
you,
you understand that like the worst days of the year for,

(50:19):
for folks in our industry are Thanksgiving after nine,
uh New Year's Eve,
July 4th,
right?
Labor Day.
So any of those holidays where people decide to go,
either get really stupid or put things into holes they don't belong.
And so,
and I like them on fire because for just,
you know,
for added added power.
Well,
you know,
this is a 3 65 a day,

(50:41):
you know,
a year business.
Um,
we don't have an off switch.
So you've got to be willing to work and you're willing to serve.
But,
um,
it,
it,
it really is about building a relationship with the end user such that they know that when they pick up the phone that they get us.
Um,
and,
and that's something that all of our partner clients have ever.

(51:03):
Uh,
uh,
they,
they write about in,
in testimonials.
It's,
it's a wonderful compliment that when they need us,
they pick up the phone and they call and they know they're gonna get someone who cares.
Um,
so that's what I look for.
It,
it,
it's,
it's hard to quantify that,
but I know it's the opposite of entitlement.
And so to the degree that there are places that believe that just because you have a certain ranking,

(51:23):
I mean,
Carnegie Mellon is a pretty good school.
So is Boston University.
I mean,
spent time at M I T,
I've,
I've got the credentials but,
you know,
I would,
I don't work in an ecosystem where that's gonna get you in the door.
Uh You know,
if you,
if you have a Harvard degree and you can't pass your,
your,
your exams,
you,
you're not gonna get a patch,
right?
And so I want to know that the folks that we work with are gonna appreciate the fact that this,

(51:46):
this work is hard,
but it's rewarding,
it's mission driven.
Um If you have a great education,
that's great.
But,
but ultimately can you build the trust of the people you're in trust,
you,
you know,
you,
you're working with whether it's patients or colleagues or,
or whoever.
Yeah,
I wholeheartedly agree that relationships,
especially in health care,
the most valuable ones.
Um As long as you connect with people that Yeah,

(52:07):
for sure.
And very,
very important.
So just to my last question for you,
looking back on your life,
now,
what advice would you give your 21 year old self?
So as an entrepreneur,
that's just starting one little piece of advice that you would say,
hey,
oh,
entrepreneurial advice.
OK.
Uh Because I'll tell you and I'm like,
I've never said this on record.
But if I was going to give my 21 year old self advice because I went to school in Boston and I swear to God,

(52:29):
I'm not entirely sure what I did for my five years that I was in school.
Uh I had a blast.
I studied a lot.
I got two degrees out of it,
but I never went to Cape Cod.
And if I'm gonna be living in Boston,
I never went to the cape.
I'm not really sure what I was doing.
So I would tell my 20 year old self.
Get ye down to the cape,
find someone cool to drive with.
It's a long drive and bring a jacket but go to the caps.

(52:49):
Um What,
you know,
that's a great question.
I,
I'll uh let me end on a high point then because this is something I learned from my dad and it's funny he doesn't remember.
I'm gonna get all emotional.
Um He,
he actually doesn't remember this.
He told me,
but he had a poster in his office for years.
I actually have this on my Facebook page.
Uh If you wanted to,
to check it out.

(53:10):
Um um The poster was of a guy walking with his back toward you down a road.
Um And I would say this is,
this is what I would tell a,
an,
an entrepreneur starting out.
This is it,
the quote on the poster was the most dangerous customer.
Isn't the one who complains.
It's the one who doesn't ask the damn question.

(53:34):
So,
you know,
as a journalist,
probably my single biggest superpower.
And it's ironic because I,
I always feel a little uncomfortable in interviews like this,
I'm,
I'm more comfortable interviewing people than I am being interviewed.
Um I like to ask the question and let it ride and actually it kind of like you're just gonna let me go wherever I go,

(53:54):
right?
But you learned things about what people are thinking that you wouldn't necessarily think to ask them,
right?
My favorite question as an interviewer always was,
tell me something.
You thought I was going to ask you or you were hoping I asked you,
but I didn't,
right?
And then all of us like whoa I didn't expect that.
And then something pops to mind and that's what you're gonna tell me.

(54:17):
So when,
when someone tells you,
they like your stuff,
ask why,
but ask them what they hate about it too.
Right?
If someone tells you that you're,
you know,
nobody keeps every,
every client forever.
Uh I have to explain that to my guys because as I mentioned,
they,
we build those relationships and they take it very seriously.
And so if someone chooses to go in another direction,
we feel those.

(54:38):
Um But I ask them,
right.
I,
I can't expect that if you know,
someone's gonna stay with us their entire life.
But,
but if somebody saw something in somebody else and somebody didn't see something over here,
I'm gonna learn from that.
And,
and so,
you know,
we have only ever,
rarely had somebody.
We don't,
we don't turn a lot anyway.

(54:58):
But um when we,
I mean,
90 plus percent retention so big up to,
we're really proud of that.
Uh But when somebody goes,
I try whatever I can to get them to explain to me.
Did we drop the ball?
Right.
Was it a feature that we,
that you needed?
Was it a matter of pricing?

(55:18):
Did someone and,
and,
and oftentimes it may be an external factor right?
There may be a new regulatory,
something that we don't know about.
It had nothing to do with us.
Um It may be that,
uh they had a,
a,
an issue between,
you know,
management and union and they,
and there was some internal politics thing and,
or someone left the department and so someone else is coming in and they want to bring their things that they know their systems.

(55:39):
Um,
so we try to take very,
very seriously when someone picks up the phone and says I need this or I'm frustrated or I'm curious or I'm whatever.
Right.
That's gold man.
Uh,
and I think the worst thing that people can do and I've known people who've done this and sort of puff themselves up and try to make themselves look bigger than they were.

(56:01):
Especially at the beginning.
I think that's lethal,
but it can be,
it can be useful if you're trying to make yourself seem bigger.
But,
but then you may turn out to be a house of cards and I think we're past that.
I hope we're past that as an industry,
at least for a while.
But I if,
if somebody's willing to take the time to tell you their insights,

(56:22):
man,
that,
that stuff is just wonderful.
So you should not be going for the ones who are gonna tell you what's awesome.
Listen to the ones who are gonna tell you what sucks and then fix everything,
take care of the ones who like you that's important.
But one of the best pieces of advice that I ever got was focus on the happy clients,
focus on the unit economics that was from Lisa Sunan,

(56:44):
who's an extremely well known health care investor and advisor and leader and uh you know,
also executive,
she's amazing and,
and she said,
votes will take care of itself.
Let people tell you what they like,
make sure that the unit economics are in the black.
And then,
and then once people are happy,
let them tell the story to their friends because that is more valuable than anything I would ever be able to tell them.

(57:08):
Um That's it,
that's what I would say.
So when they're willing to tell you what you need to improve,
man,
put stars next to that and then make sure you follow up with them and show them what you did and say,
hey,
look,
you inspired this.
Uh And then they take a sense of ownership of the fact that they made you better.
If you're gonna work in an industry like health care man,
there are easier ways to make a book.
So if you know that you can have a tangible return by your knowledge helped make something better.

(57:31):
It doesn't guarantee that you're gonna get that person to use your stuff,
but they're certainly not gonna forget the fact that you came back to them and said that they made an impact.
Uh And so that that goes back to the relationships.
Very,
very true,
very,
very true.
Well,
thank you so much for your time,
Jonathan.
I really appreciate our conversation and I hope you have a great rest of your week.
My pleasure.
I appreciate it.
Thank you so much for your interest and for letting me ramble at you.

(57:54):
Thank you Jonathan.
Take care.
Mm.