This week I am talking to Krishna Kurapati (@krishnaqliq), Founder & CEO of Qliksoft (@QlikSOFT). Krishna started his career in innovation and security and found his way into healthcare like many of us with connections and friends who were struggling with technology not working well to support the delivery of care.
We talk about the early days of communications in healthcare that was replete with pagers and telephone calls and the change brought about by the smartphone and in particular the iPhone back in 2007. Healthcare workers moved en masse to adopt these new mobile technologies as did the rest of the world but healthcare got left behind.
We talk about the early innovation in secure messaging and the importance of integration, the addition of read receipts that users take for granted now, and the opportunity of automation in the messaging systems.
Listen in to hear us discuss the challenges of scheduling and why this is such a complex problem, the solution to which lies in automation that is augmented by the integration of additional capabilities that can include users to resolve the more complex problems not solved by automation
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Raw Transcript
Nick van Terheyden
And today I’m delighted to be joined by Krishna Kurapati. He’s the founder and CEO of Qliksoft. Krishna. Thanks for joining me today.
Krishna Kurapati
Thanks, Nick. Glad to be here. Love to share some ideas.
Nick van Terheyden
That’s so if you would tell us a little bit about your background, it’s not traditional in terms of healthcare, you’ve come at it from a slightly different perspective. Tell us about your journey and how you ended up here.
Krishna Kurapati
Yeah, I think I’m an ad technologist and entrepreneur. I’ve been a technology entrepreneur for over 25 years. The early on startups are more on communication, when the whole industry is looking at Voice over IP as a means of cutting out calling cards and using internet as a means of phone calls. So we got in that space. And early on, we build products in that space before Skype ever was Voice over IP platform. And we exited that company. And then I started another company in security, network security, space application security that brought me into understanding the issue with spamming and intrusions and all those things. So basically, I’ve been at technology, finding gaps in the needs of the market, or, and then bridging those gaps with solutions appropriately. So when 2009 and eight came, I was looking at healthcare more closely because of my diet diaspora where I belong, and a lot, a lot of physician friends are talking to them, but the challenges that they have. And then that got me interested in looking more deeper into the challenges. And at the time, you know, people started adopting smartphones, physician adoption went through the roof and 95% of the physicians have smartphones, but they still use pagers, faxes and such to communicate. So we’re seeing what what’s wrong with it. So why can we have a texting app, but then the challenge is, it has to be secure, HIPAA compliant. So that’s the origins of quick software. We’re looking at the messaging as a means of securely communicating bidirectional between provider to provider with a read receipt, acknowledgement, all the capabilities that make the collaboration much more real time, but asynchronous at the same time, because I’m not holding on my phone, trying to call talk to you, I just send you a message. And we all benefit from using texting in the consumer space. How can physicians and nurses do the same? That’s the origins of Quicksort?
Nick van Terheyden
You know, it’s interesting, you talk about that, and I’m casting my mind back. And I think everybody listening needs to sort of take a step and go, Wow, step back to that period of history. 2008. And you’re right, we were seeing, you know, the wide adoption of phones, I think the iPhone was one of the big jumps in terms of adoption, and it was in large part due to its facile nature, everybody could adopt it. I remember the first one, you know, really quick, but we still had pages, I remember people clinging to them, in fact, you know that the they needed to be reliable. And I’m sure there’s probably some still around in Radiology Departments where they say the signal won’t reach downstairs and so forth. But here you are. You’re at that point, that nexus and you realize that there was a need for this, but it wasn’t being serviced. We had these devices. So how did you go about addressing that? Because it’s hard to imagine at this point, because it is more native, I think more natural and people go yes, but I imagine there was a lot of resistance at that point. What was your experiences?
Krishna Kurapati
Oh, yeah, certainly, I think that was the biggest first few years of learning and the healthcare, the pace of healthcare, how it moves. Coming from the technology, background and enterprise application background coming into healthcare. It was a it was an eye opener for me to know how resistant I was conservative it is for good reason. But then, you know, even though it’s a good idea, a good product will help them It takes months years for them to come to terms it’s many reasons. Resistance to you know, the way they prioritize everything else over New Change Management. This could this doesn’t require a lot of change management because the texting, they already physicians, nurses to texting already, they just have to transition from regular texting to secure texting, which, when we that, so that journey of understanding, okay, how would we make physicians adapt faster, our goal was to make it as easy as it is to use regular texting. And that was the look and feel voice. So we did a lot of iterations on UI user experience, to make sure that it fits. So the physician can get on get get using in minutes, not days. And now, there’s no official training required. So they can just download and use it day one, and it feels and smells like a regular text message. So that was like four to three years of real going back and forth and adapting our technology to use case. So then once, you know, once they once the market also realized that, you know, they can keep using the pagers there and the cost of pagers, but also, it’s not two way communication. And they want more two way communication without relying on a call center and such. So they started coming out there.
Nick van Terheyden
So as I think back to that time, and you know, certainly some of the resistance, I remember, hearing was, you know, we can’t move to texting, it’s not secure. And just for clarity sake, I don’t know if you know this, but the pager system was an entirely public, open text, no encryption, no concealment of any information, you literally just had to put up an aerial and you could receive every text message that was going. So to be clear, that wasn’t secure. But suddenly every became it’s got to be secure, and so forth. How do you go about adapting and creating something, because we’re all used to it? I think, you know, everybody, I don’t want to say loves it. But it’s certainly a very easy form of communication works quickly, people have adopted it worldwide. But that secure issue, and also integration into the existing workflow is critical. Because if you’ve got things going on outside of the general sort of inflammation flow, then you know, there’s risks associated with that with loss of inflammation. How did you go about approaching that?
Krishna Kurapati
It’s mainly educating. I think you have two set of cohorts that you need to address one is clinicians, and then the IT people in the health care organizations, obviously, the physicians don’t care, it’s secure or not, they want to get get something done pretty quickly on now
Nick van Terheyden
study on we’re not quite that dismissive, but okay.
Krishna Kurapati
To some extent, I mean, I think they do care. But they you know, as long as they know that, it is, you can say HIPAA compliant, they’re okay. But then the IT people want to know, make sure that it is truly secure. And that’s when my previous security background came in handy to build a solution that is truly end to end encrypted capability. And every time we went and educated the healthcare organizations, IT teams, they were quite impressed with our technology and our the ability to make it most secure messaging solution, and they kind of quickly came around and started endorsing our solution. And then the clinicians, on the other hand, would love to see they, I mean, you don’t believe it, they’re more impressed by Read Receipt. Okay, somebody, if I send you a message, you know, now everybody takes for granted for the two check marks, one check mark for delivery, another check mark for you read it back then it was not there. So you sent a message, boom, you No, no, no, you I don’t know whether you received it unless you respond to me. But we have the Read Receipt, double check marks in 2010 11 ish timeframe. And then everybody, that’s physicians, oh, well, now I know that my nurse has it. And the nurse will say, Wow, I know that my physician has read my message. And we went for a one for one step forward in the workflow to add ability for acknowledgement, request acknowledgement. So not only that, you read it, but you also explicitly say, Okay, I got it. So that means I understood what you just said, or I understand, I will take care of it. So that says next level of validate validation would be really valuable. For example, if you’re sending a group message, so you send to 10 people in a clinical team, and five of them acknowledged it means they really understood the task, and then they’re ready to do it. And then five did not, then you know what was happening with them. So, so it enhances their workflow, because they just fire and forget that they just see what’s happened to it, right? Because instead of that previously, when you set up page, unless that person calls you back, you don’t know what’s happened to that. So it’s just like putting something in a mailbox and hoping it gets the other end. But here, you have a two way communication in a way going on. Now we can send emojis back and forth, all this stuff, that’s additional enhancement, to express your likeness or unlikeness of message, but back in their receipt was the critical feature of the solution.
Nick van Terheyden
You know, it’s interesting, you bring up that read receipt. And, you know, we tend to take technologies that advances for granted once it’s been embedded. And I’m not sure what the timeframe is, I want to say it’s a relatively short timeframe that we accept that. But you know, that read receipt, I think, important in terms of understanding that somebody received the message, this additional step of acknowledgement, I think, again, important. And you bring up another aspect of this that, you know, historically when that was in a pager, the only way that you could do or acknowledge would have been to call it was a whole separate channel. Now you’ve got an existing channel where you can communicate. So you’ve developed and built on this platform. And obviously, it provides real utility. But now we’ve got the potential to apply more technology and to automate. Tell us a little bit about that.
Krishna Kurapati
Yeah, so I think the question next to begs to, you know, you’ve been sending you we already know the bots and all those in Slack channels, and all those places that we use to automate some workflows. So what if we could use the bots and automation tools to automate some of the processes or workflows that are used in engagement? What are we doing? Okay, so, if you if you see in a clinic, what are they doing, they’re calling somebody, they’re receiving faxes, they’re receiving some emails, they’re sending some text messages. They’re also doing what are they doing for, okay, referral, intake, insurance, update all the mundane tasks, collecting payments. So consent forms, okay, I want to get a consent from from you. So you come into the office waiting room, you sit down, and then sign a paper and give it to me, and I’ll take that scanned paper and then scan it, and then put it into my EMR, that I got the consent from the patient. So if you walk through each of those workflow, it starts with communication, always. So if you start with a communication, or a point of contact for communication, now, if we can take that communication point of contact, take that information, automate it, so that when a patient receives a consent request, and when the patient submits from a smartphone, because, you know, in 92,009 10, it was physicians adopting 100%. iPhones come 2015 16, it’s 95% of consumers, adopted smartphones, you hardly see flip phones, even people with homeless people have adopted iPhones, smartphones, because that’s the only way they can connect to the world, they don’t have computers. So if you think of that, we all have computers. But you know, a lot of people at low income level don’t have computers there, the smartphone is the computer for them. So it’s much more cost effective for them to own a smartphone than and a computer and a smartphone or a flip phone. So they adapted that technology much faster. So now it becomes a democratized way of communicating with the patients using a text secure messaging, because everything has to be HIPAA compliant, but also enable some automation so that you don’t, so let’s say, you know, you send a message to patient in the middle of the night and our patient wants to reach you in the middle of the night. If you don’t have automation, you probably will have a big call center of people waiting to receive those messages, which people some people do that, but it doesn’t scale. So the ability to automate the communication processes back and forth between patient and provider is critical to open up so you know, open up the communication to the patients itself, because a lot of people are afraid of opening communication to the P patients because they don’t know what to do with it. If they come in, they reach out to us. What do I do? How do I take care of them. So, so that’s the crux of 2015 16. If you look at six, seven years from 2010, the shift changed from only providers to the patients having the smartphones. And the ability to reach those patients also, is is valuable to the providers to using text messaging and secure messaging.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Krishna Kurapati, he’s the founder and CEO of Qliksoft, we were just talking about the automation and, you know, the the opportunity to remove some of the tasks and activities that, you know, essentially grind people down. As a result of sort of the repetitive nature, we’ve become accustomed to this outside of healthcare. And you know, I think of restaurants as an example, where, good lord, I get a text notification, you know, maybe three hours before, sometimes an hour before, you know, hey, just confirming, you know, the capacity for me to reply to that. So within that domain, and I’m pretty sure that there is nobody in the restaurant that’s going, oh, gosh, I see Nick is coming into the restaurant, we should send him a text message and remind him that is pure automation, you’re now bringing that in. And I think, in the context of the pandemic, we’ve seen this huge burnout. You know, I just read a report recently that talked about, you know, how to retain staff, and one of the key elements to retaining staff, both the ones that are trying, you know, looking to resign, and those that are, you know, in place, or even recruit, is to remove the drudgery and create some automation in there, that allows for all of these, what I would call scut tasks to be just done, I shouldn’t even have to think about it. So that’s where I think you’re heading. Tell us how you go about that. And what the sort of process because it, it sounds simple in a restaurant, but Is it as simple in the healthcare setting?
Krishna Kurapati
Yeah, I think so, to your point, the drudgery of the staff, and that’s the big attrition, reason for attrition, that doing all the nurses practicing at the level of clerk and clerk is practicing the level of data entry. So you want you want to give them the career growth, that’s what they’re in for. They want to become an MA or somebody like that. So giving them the opportunity to do that means taking out all the manual work from them. And it’s not easy though, in healthcare, because, you know, there’s there’s a integration involved in the EMR and other solutions that you already have in the workflows that you’re setting. So when this is back before COVID, I started this journey in 2017 18. To look at this problem, from ground up, what is required for us to really scale things up in healthcare is obviously when integration integration. Integration, when you say it’s, it’s, uh, two levels, it’s challenging. One is the cost of integration. EMRs are expensive. How do you make sure that you keep the cost low for integrations, then the last one is, the time it takes to integrate is another challenge. So that’s step one problem. The other problem is the the kind of workflows are different in different settings. So primary care, physicians are different from a pediatric pediatric are talking to pitch parents, not patients. So you need to allow those variance variances, restaurants, you have one kind of goal. But here you have a whole set set of different micro verticals, I would say, in healthcare, if you want to build a platform that can serve all of them, got to think through all different workflows and make it flexible. The analogy that you I used is Lego builder. So if you can build Legos in such a way that you could create the architecture, LEGO Architecture, but you know, also you build some tools, some tips, so you could keep that pediatric kit, you could create internists, kit or hospitalist kit or cardiology kit. But then if you got another physician group, they can take these existing kits and then build their own kids, or we can just get a build from scratch to their their needs without just building a style pipe that only serve them.
Nick van Terheyden
Yeah, so I think, you know, tremendous opportunity Unity one of the first places that I think we all least I know I would in my intersection with healthcare as a patient, not as a clinician, and maybe as a clinician it well, actually, I’m sure as a clinician as well, it’s, it’s self scheduling. Why is it that I’m still required to pick up the phone and go through a process? I can’t see appointments? And then, you know, I get actual calls from people saying, No, we can’t do this at work. How do we go about this? What’s been the barrier to this? Yeah,
Krishna Kurapati
I think the scheduling is by far, scheduling by far is the most complex one. The reason it is is that, you know, if you’re, this is why the user you UI. So again, this is the fundamental thought process or axioms, concepts is here, I believe, in conversational based user experience. Because I’m biased, I come from that world. And I believe in it, for a good reason why I say that, if you if you’re a patient, and you’re clicking through through the buttons, let’s say you know, I’m you are you want to address your scheduling, okay, I am a physician, you’re a patient, and you want to be scheduled. You want yourself to be squeezed in for a time that’s most available. So that, you know, you have some impending reason why you want to come and see me sooner than later. But I don’t have slots available now. Okay? To give you that, what do I do, okay, I just can email you back and forth, or I can call you and be on the call, and it’s talking some front desk, front office person, or I can engage with you on a secure message model where I wouldn’t be able to, you know, a lot of it is automated 80% of the time, it is straightforward, okay. 80% of the patients, they want to have a schedule, it’s not like emergency visit, or a general visit, that just want to have somebody to take care of me in a month, even if a month out, it’s fine. But 20 person or the patient wants something squeezed in. So how do they how do you deal with it? So instead of dealing that at 20, we just cannot deal with this 20%. So we just have these calls, shall we go go to the lowest common denominator model? What I see is how can we use the automation in secure messaging with chatbots and other automation tools, so that those people who can get 80%, they can go through the process and get it without human intervention. But those people who need that squeezed in approach, they can talk to somebody in the human in the human in the loop model. And they can talk to somebody asynchronously explain the reasons and concerns and put them into waitlist, so that they can get on to the next available time slot. And without them calling back again, they could send a text message back when the slot is available for them to come in. Could be could be today, tomorrow, whatever. So that’s how I see why the scheduling, if you just give me a user experience, user, you user interface for them to schedule, then you don’t have a communication path. My view is we have to give communication path between back and forth between the scheduler and the patient, but also give some automation along the way. So that the person on the other hand is not overwhelmed by number of calls or messages from the patients.
Nick van Terheyden
So interesting. You know, number one, that scheduling is such a complex area, but I guess anybody that’s tried to organize a meeting with more than two people online in business, let alone in healthcare knows and understands that that’s a challenge. And I think the incremental step is to take the low hanging fruit and fix that with you know, simplicity and automation and then have a pathway that allows for a fallout to a separate process that perhaps includes the manual so that your cases of manual intervention are much reduced. And they’re the ones that need the oversight and the intelligence of humans to be able to contribute and sometimes even the physician, unfortunately, as we do each and every week, we’ve run out of time, I think fascinating areas and tremendous opportunity just remains for me to thank you for joining me on the show. Krishna. Thanks for joining me.
Krishna Kurapati
Yeah, thanks, Nick for giving me opportunity. I think this is an interesting call. I have to pull some of the ideas from deep in my cerebellum to bring to you this is a wonderful conversation. I you asked me some good questions.
