Soundcloud Meets Rap Genius
This week I am talking to Shiv Rao, MD (@ShivdevRao) is the co-founder and CEO of Abridge (@ABridgeHQ), which uses groundbreaking machine learning to help people understand the details of their care and follow through on their doctors’ advice. He is also a faculty member and practicing cardiologist at UPMC’s Heart and Vascular Institute.
Shiv has a non-traditional background in medicine that included an early interest in history and architecture but was persuaded to pivot to medicine and has not looked back. With some early success building an app designed for residents (and built while Shiv was a resident) along with several start-up companies under his belt led to working at UPMC in their investment and innovation hub as an investor in a range of startups.
You can hear the origin story from his personal experiences with his wife and the healthcare system and the patient from his clinic with a history of Breast Cancer who was very stressed for what was a relatively routine consultation that informed the essential need to “Capture the Story” and democratize access to health information.
Abridge has defined the key drivers for their solution:
- Allow everyone to better understand their health
- Better understand the follow-through necessary
Listen in to hear their journey to through creation of technology, signing up over 50,000 users who are already getting useful details into their health that includes insights and actionable instructions, as he puts it
Doesn’t matter who presses record – everyone benefits
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
Listen along on HealthcareNowRadio or on SoundCloud
Transcript
Nick van Terheyden
Today
I’m delighted to be joined by Dr. Shiv Rayo. He is the CEO and co founder of a
bridge, and also a cardiologist. She have thanks for joining me today. Pleasure
to be here. Thanks, Nick. So, for the benefit of the listeners, as we always
do, I like to sort of dive into a little bit of your background, yours is not a
traditional journey, necessarily to medicine. Tell us a little bit about how
you got to this point in your career.
Shiv Rao
Yeah,
and if I start to tell you too long of a story, just let me know. And I’ll cut
this short. But I’m a cardiologist that said, I’ve been living at the
intersection of healthcare and tech for over a decade. Way back in the day, I
went to Carnegie Mellon for my undergrad. And amazingly enough, I studied
everything I’m not doing today, I was a history major, I wanted to be an
architect, spending too much of my time skateboarding. And then I was convinced
by an architecture professor, that I was rebelling against all the Indian
doctors in the world and in my family, and that I actually wanted to be a
doctor. And he was right, he told me a really inspiring story about an
ophthalmologist who would give an eyesight, you know, hundreds of thousands of
people in India and I made a late pivot, did my pre med requirements, while
making music, and helping, you know, a record label sell records in Japan, believe
it or not, and then went to med school and had a good time initially, but
quickly realized that on, I didn’t see a lot of room for creativity are obvious
places for me to be creative, and have all the respect in the world for basic
science research. But that 13 year bench to bedside feedback loop isn’t for me.
And that’s where sort of tech entered the story I discovered what tech could do
when I helped develop a, an application of sorts for my residency program at
the University of Michigan, and experienced some peasant level of product
market fit when people were using it, but also offered to pay for it. And I
decided then and there that I wanted to really, really double down on on what
software could do for health care over time. So fast forward, you know, many,
many years later. And a couple startups later, ended up being in the right
place at the right time after my cardiology fellowship at UPMC and landed a job
at their corporate venture lab of sorts, it’s called UPMC enterprises. And I
violated Peters principle. And sure, several times over a few years going from
someone who was helping on product teams to being head of strategy and and then
ended up being one of the three check writers, one of the three investors
investing on the provider side of their portfolio. But I quit that job in March
of 2018, to fully focus on this idea. And I think what I realized about this
specific idea about a bridge was that this specific technology has the
potential to help so many more people that I could see in my weekly clinic.
Nick van Terheyden
So I
mean, there’s so much to unpack there, not least of all the sort of pivot do
you think, because one of the conversations I hear repeatedly is, you know, to
get into medical school, you really have to be heads down focus? Do you think
that gave you an additional important perspective that you weren’t focused on
it initially?
Shiv Rao
Yeah, I
like to think so. Um, you know, I do talks about t shaped people people are
really, really deep in one area, but can cross the T with another discipline.
And but that, that being able to cross the T, they say, I think that it gives
the individual a lot more perspective, potentially in a lot lot more ways to
sort of be creative because they can connect the dots across different different
disciplines. And I hope that to some extent, I’m, you know, I’m able to do
that, in that I studied pretty disparate fields, and also was able to spend a
good amount of my my time as an undergrad doing creative things.
Nick van Terheyden
You know,
and it’s interesting, the architectural world is obviously lost a leader in
that space since you came over to the healthcare space instead. And in that
journey, you you talk about multiple startups, ultimately coming to this one,
tell us a little bit about a bridge what it is and how it came about.
Shiv Rao
Yeah,
absolutely. First of all, I don’t want to overstate my contributions to
architecture that really, that journey never really began. Our vision at a
bridge is to bring more compassion and confidence to every step of a person’s
health journey, we help people capture the details of their care, so they can
follow through on their doctor’s recommendations and gain more peace of mind.
And to date, more than 50,000 people have downloaded a bridge across the United
States. And they’re using a bridge for all types of health conversations from
annual examinations to specialist appointments, it helps them understand the
details of their health, from the high level care plan down to the details of
their diagnoses, procedures, and their medications.
Nick van Terheyden
So I’m
in the, the genesis of this, how did you come up with this idea? I mean, it,
you know, resonates with I think patients probably resonates with physicians.
But where did this come from? What was what was going on to sort of drive you
to this concept?
Shiv Rao
Well, I
think there’s, there’s a founding story between myself and my co founder and
our CTO Sandeep, where both of us I think, have personal experiences that
inform our conviction around this idea. There’s there also, I think, kind of
feces around the market that inform our perspective and our conviction on
pursuing this. So from a personal standpoint, or maybe I’ll, I’ll start with a
thesis, I think part of our thesis is that upstream of all the diagnostics and
health care whether it’s a chest X ray or a CT scan, or some blood chemistries,
and upstream of all the therapeutics in healthcare, whether it’s a baby aspirin
or or a pandemic vaccination, or some cutting edge immunotherapy upstream of
everything in healthcare is a conversation. And that is increasingly happening
over telemedicine. But certainly, it will always also happen in person. And in
that conversation, all of us as people, we’re telling the story of our
symptoms, the stories of our families, and and what are clinicians doing,
clinicians are writing histories and physicals that’s the archetypal clinical
document history. And so our thesis is that if we can empower people to
actually capture the details of these stories, as they’re being told, and the
details of their care plans as as they’re being told, and if we can structure
that information, and make sense of it, then we can help people do two things.
And this is really the mission of the company, to number one, help them better
understand their health. And number two, we can help them better follow
through. And if we can do those two things, then over time, our ambition is to
to to move the needle also on not just clinical experiences, but also on
outcomes.
Nick van Terheyden
So tell
us a little bit about the personal stories of you know, how this came about?
Shiv Rao
Yeah,
absolutely. So my co founders, Sandeep would tell you his story about his his
grandmother with breast cancer and accompanying her to the hospital, and
gaining conviction that he wanted to play a part in improving that healthcare
delivery experience for everyone. My personal story is that years ago, my wife
and I found out about a rare disease in our family. And to have a healthy
child, we needed to go through years of IVF. And it’s a happy ending, we have
twin four year old boys who were incredibly credibly privileged. So often, my
wife would come back from a visit. And I’d asked her like so many family
members, what did the doctor say? And so often, she’d say, I don’t know. And
some portion of the time, it’s because they were telling her, but when you’re
going through something and can be in one ear out the other, so hard to
remember what what what’s happening. It can be overwhelming. Also, I think, the
third of the time, I realized some portion of the time they weren’t telling her
some portion of that time, the way the system is designed. You can feel as a
person and like you’re being sort of shuttled through a maze. But also there’s
another third of the time where I realized that she knew exactly what was going
on. But it can be it can feel like death by 1000 paper cuts to have to repeat
your story over and over and over again to everyone from you know, the
radiology technologist to the med student to the consultant to every single
family member. But as a doctor, I saw a patient in March of 2018. The same
month, I quit my job as a cardiologist are mostly walked away from it. I still
see patients from time to time, but certainly walked away from my job as a as
an as an ambassador for for UPMC. I saw a patient in my weekly clinic she had a
10 year history of breast cancer, and she was about to start chemotherapy that
could affect her heart. And she she was coming to see me for cardiac clearance,
because some chemotherapeutics can can affect the heart muscle, and she was
super nervous and anxious, like crawling out of her skin. And so at the end, I
asked her why and if there was something I did, or something I said to make her
feel so uncomfortable. And she told me that for the last 10 years, her husband
had come to every single visit with a with a doctor or a nurse, except this
one, he just couldn’t make it. So I asked, I asked her, What does he do, that’s
not obvious. And she told me that he sits in the corner, he’s quiet, he just
takes notes. She’s an English professor, and incredibly eloquent. But she
taught me She explained to me that when you’re going through something, and it
doesn’t matter how serious it can be very overwhelming. And it can be really
hard to be present and to build a relationship with your doctor, your nurse.
And so him taking notes meant that she could feel liberated to be in the moment
knowing that they could go home and unpack all of those notes and combine them
with their own thoughts, their own research, their own, you know, potential
second opinions from family friends, and they could go to the next clinician,
next doctor, nurse. And armed with this better understanding, they could feel
like the main characters as opposed to someone looking in from the outside. So
in a sense, everything that her husband did in the corner of the room,
everything that they did at home in terms of unpacking those conversations and
better understanding them. And then better following through is what we’re
trying to distribute democratize for everyone out there.
Nick van Terheyden
So for
those of you just joining, I’m Dr. Nick the incrementalist and today I’m
talking to Dr. Shiv Rayo. He is the CEO and co founder of the bridge, and also
a cardiologist we were just talking about the setup and the story behind a
bridge. And what it sounds like is we all need one of those individuals in the
corner of the room. But of course, that’s not easy to do. It’s not a scalable
solution. And here you come and say, well, we can put technology to work at
that. But that’s not a simple task. How did you go about that process to create
something that would allow for this?
Shiv Rao
Yeah,
it’s a great question. And it’s, it’s taken a good amount of time, a good amount
of r&d to get to the point where we could deliver a user experience a
useful user experience in terms of the problem, because I think that maps to
the solution and the RND, we realized very quickly that a few things about
humans actually, and this a lot of this from our own user research. But one is
that people forget the details. We there’s research out there, out of Dartmouth
that suggests that people forget up to 85% of what the doctor said, which is,
you know, a mind blowing statistic. And we also, there’s good research out
there to suggest that lower health literacy is associated with low recall and
that the current solutions out there are either not personalized enough.
They’re way too cookie cutter in terms of patient education, or they’re way too
specific, and not necessarily meeting people where they are. When we asked our
own users about how much they forget, they told us that they forget up to 40
45% of their conversations with doctors. That’s a crazy number in and of
itself. But then the real kind of kicker for me personally as as a clinician
was when we asked them what they actually remember. They said the very
beginning the pleasantries, you know, like, hey, Nick, it’s been six months,
how’s your family, like now soccer practice with the kids, that kind of thing.
And then the very end, where it’s like, Alright, Nick, you’re doing great, I’ll
see you in six months, but all everything in between, where you know, a new
diagnostic a new therapeutic, a drug formulation, you know, how many milligrams
of a pill and when to take it and like with what all of that in one ear out the
other. And that’s mind blowing to me, because we use words that don’t don’t
really make a lot of sense, like compliance in health care, you know, in the
health care system proper. And we also use better words like adherence, but how
can we expect any of us as humans to get here when we don’t remember any of
this? And part of the reason we don’t remember is that people feel very
emotional when they’re in a visit, especially when they’re talking about
something real when they’re talking about their health, and it’d be very
difficult to focus And we also learned from people that they want to take an
active approach to their care, they want to be on the same page with their care
team, but also everyone around them. Something that we learned during the
pandemic was that this problem, everything I just mentioned, is amplified with
telemedicine to some extent, because telemedicine visits the nature of the
medium can make them shorter, more transactional. And that as care gets more
fragmented as I use a consumer app for a certain pill, and then go to an urgent
care for different problem and then go to, you know, an academic health center
for something else. There, it’s very difficult to connect the dots across all
of those conversations, all of that care and understand the bigger picture of
this. So from a technology perspective, we needed to make sure that we could
not only capture the conversation, and so there’s challenges around being able
to capture audio, but also go beyond that and structure the information in the
conversation. So there’s information extraction, some challenges, and also from
a machine learning perspective, there’s abstract extractive summarization
challenges that we’ve been working hard on over the last couple years. And it
took us a great deal of time to get to the point where we felt like we were
there, we had built something that started to approximate, you know, my, my
patients husband in the corner of the room.
Nick van Terheyden
So as
you think back to that journey, I mean, it’s been a an extended period of time,
applying, you know, components of machine learning, natural language
processing, obviously, audio issues, and, you know, technology has improved
over that period of time. But I can’t imagine that the audio has made a big
difference, maybe it has, I don’t know, looking back, were there any sort of
inflection points, you go, Wow, that was a really helpful sort of insight that
made a difference and really changed the trajectory for the better for the
company and what you were trying to put together.
Shiv Rao
But I
think we can also almost map every single one of the inflection insights within
the company to the mission of the company. We want to help people one better
understand their health and number to better follow through. And all of the
technology research that we do all the machine learning all of the app and user
experiences have to map to those two, like aspects of our mission. Because the
four main benefits that we help people with is we help them as we heard from
the our users is that we number one, help them stay on top of their health,
too, we help them see the big picture. Three, we help them all stay on the same
page, which is so important important during the pandemic. And then for we this
is maybe the most profound of all, but we heard from so many people that it it
gives them peace of mind. So in terms of that technology, and how we sort of
grade ourselves and how well we’re helping people so far to date for over
50,000 people, we’ve helped them better understand over 400,000 medical terms
in a conversation. So that point when a clinician might say to you, like use
the word arrhythmia, or might start a new medication called hydrocolloid
hydrochloric biocide, or might talk about a surgical procedure like a
transcatheter, aortic valvuloplasty. So this is medical jargon. And we’re
trying to translate that for people, we’re trying to help them better
understand that. And similarly, there are those moments in the conversation
where the doctor or the nurse or the PA, you know, gives drops, a takeaway,
like a next step, the care plan, like everything from you got to stop smoking,
I can, you know, hear it in, you know, in your voice all the way to see me in
six months, all the way to start this medication or stop this medication. And
one of the key technological challenges that we’ve been working on that, that
is is is key to our mission around helping people follow through is being able
to extract those next steps in a conversation automatically. And then being
able to nudge people being able to remind them of those next steps. And that’s
not like a low hanging challenge. And I think one inflection point was
recognizing realizing, at some point over the last year that we could really
tackle this that we could get to a certain level of accuracy and deliver an
experience that actually helps people after they’ve left the exam room because,
you know, most of the the journey doesn’t happen in the exam room itself.
Nick van Terheyden
Fantastic.
So you know, the application of technology that essentially allows other
individuals who didn’t go to medical school and one of the things I recall very
early on, was being told that it was no different to learning a foreign
language going to medical School, all the terminology. Now, there were some
aspects to it, you know, when you talk about those phrases, what triggers in my
mind is my Latin, because we sort of construct and you know, you can
interpolate terms and phrases that you don’t use. And of course, if you don’t
have any of that background, you’ve got nothing. So you’re applying all of that
improving literacy. And, you know, in the context of COVID-19, of course, we’re
in even worse circumstances with, you know, limits to people being allowed in
it. My sense of this is that this is even more relevant at this point in time,
both for in person, but potentially, for telemedicine, what’s going on in that
space? And you know, where are you sort of providing this? You’ve got the
50,000. But you see this expanding beyond that?
Shiv Rao
Yeah,
absolutely. And you’re, you’re spot on. And now more than ever, this is really
important. Like a quick story. This is, like, amazingly enough, this story
about the first patient I ever saw as a resident at the University of Michigan,
in my first week, I’m about to walk into into her room, and I’m feeling pretty
arrogant about you know, you know, being in Michigan and that I probably know
10 x more than the patient and I can really like deliver a care plan and, and
help them. And little did I know that in Ann Arbor, so much of the patient
population has like a PhD already. And so I walk into the room without doing
too much pre reading. And within a minute, this patient is starting to quiz me
on whether or not she has multiple endocrine neoplasia, type two a or two B.
And you know, for those who don’t know, this is like, this is like a question
you get on your MCAT. You know, this is like a question you memorized and you
forget you’ve forgotten
Nick van Terheyden
never
applicable again. Yes. At this point in time. Exactly.
Shiv Rao
And I
remember feeling like, at first being like, What is this, like, I did not
expect this conversation and this level of discourse, and really quickly,
thankfully, realizing that we should chat about this, and I should be
transparent. And I told her like, okay, great question. Let’s look this up
together. I vaguely remember. But it would be better if we both looked it up
together. And we did. And we had a conversation about it. And I still had
something differentiated to offer. I remember feeling good that I could
translate things in a way that that could be useful. But I walked away thinking
like if this is what healthcare delivery looks like, this is not something I
was prepared for. And what I subsequently realized over the next three years of
residency is that it’s not what healthcare delivery usually looks like. But if
it was what healthcare delivery actually look like, what would relationships
between clinicians and consumers, you know, doctors and patients look like? We
think it would look, you know, really powerful, like if all of us felt like we
were truly building relationships, that that we were both benefiting, that both
parts, you know, of, of, of the story, not only like the patient’s symptoms,
but also the clinicians care plan. You know, these are the bookends of an
archetypal clinical document, the history of present illness comes from the
patient and the assessment and plan from the clinician. They’re both equally
important it takes to to create that healthcare narrative. And so what if like
using a bridge, we can actually thread the needle through both sets of
important end users anchor on the consumer and help people better understand
and follow through. So yeah, I’m sorry if I didn’t answer your question. But I
think you know, when when we pitch our company for seed financing, we use the
metaphor, where we call this SoundCloud meets Rap Genius for healthcare
SoundCloud in that when you record a conversation, you’re creating content in
that sense, but Rap Genius because we can help translate not a rap songs,
lyrics, but we can translate the actual medical conversation and help people
better understand it. So a lot of our mission, you know, at the end of the day
maps to that ambition.
Nick van Terheyden
Fantastic.
So in in the remaining time that we’ve got. Can you share any insights of where
you see this going?
Shiv Rao
Yeah,
absolutely. I think one really quick point about the current pandemic is that
we’ve heard from so many of our users that they’re unable to bring their family
member into their exam room, whether it’s in an urgent care in a hospital, and
they’ve been able to use a bridge to stay on the same page. So that’s like one
important reason why I have now more than ever, there’s so much value in being
able to record these conversations and keep everyone on the same page. And
we’ve heard the same thing from clinicians, that it’s helping their patients do
the same thing. But I think like from from a really high level perspective.
It’s an interesting time in the country, obviously. And while the political of
the future of something like the ACA may be unclear, one aspect of the ACA that
is absolutely here to stay with strong bipartisan support is that the patient
is entitled to an electronic copy of their records, including the clinical
notes, as we’ve seen over just the last few weeks with the information blocking
rule and hospital systems, exposing clinical documents to their patients. So
this is very much aligned with that same idea with the same mission. This is an
arc of history that everyone gets behind, which is that everyone can benefit
when they better understand and, you know, these these medical conversations.
So we’re writing that and I think what we’re really excited to tell you and
everyone else more about over the coming weird weeks, is how we can align
everybody in the system, not just the end users like the patients and the
doctors, but also the hospitals around this idea.
Nick van Terheyden
Fantastic.
Unfortunately, as usual, we’ve run out of time, so it just remains for me to
thank you for joining me on the show today. Thanks for coming on the show.
Shiv Rao
Thank
you so much, Nick. It’s been a privilege.
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