This week I am talking to David Stern, MD CEO of Experity (@experityhealth) who is working to change the way urgent care works for patients by rethinking the offerings delivered in this setting. With a focus on medicine and the user experience David looked for a technical solution to help capture, document, and automate the urgent care centers that he worked in but found nothing that matched their needs. He received support from his partners in the centers to set about creating their own solution which has become the leading system in the space.
Their focus was laser-sharp on the user experience and contrary to traditional approaches started out with a paper-based solution when everyone else was focusing on placing technology at the center. Along the way, David immersed himself in coding obtaining certification in this area so he had a better understanding of the back-end business of urgent care
Listen in to hear their bottom-up approach to design that built a user-friendly system that not only captures the information but also introduces important automation and workflow optimization that went through some major pressure testing during the COVID19 pandemic and emerged faster, stronger and better. Their journey mirrors the Azyxxi early success thanks to a design built by doctors for doctors and creating a patient-centric solution that delivers value for everyone involved in delivering and receiving care.
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Raw Transcript
Nick van Terheyden
And today I’m delighted to be joined by Dr. David Stern. He is the CEO of experimente, and an internist. David, thanks for joining me today.
David Stern
Thank you very much, Dr. Neck pleasure to be here.
Nick van Terheyden
So if you would tell us a little bit about your background, you’re obviously a physician, as I highlighted at the beginning, but that’s not the only part of your story. Tell us how you arrived at this point in your career and some of the key moments.
David Stern
Sure, I trained as an internist and thought I was going to practice academic internal medicine, and ended up doing a short stint in some urgent cares. And really enjoyed that type of medicine where I was seeing patients for acute problems developing relationships with with patients, actually, that would come back over over time, as well. But what what was most important for me at that point was it was a lifestyle, I had my I had a wife, who was, who was ill, and took, she was ill for many years. And so it allowed me to work certain hours and then be officer now. But what happened, as time went on, I got I got more involved in the ownership of the business, and the administration, the business. And so whether it was something big coming down the pike, that was the electronic medical record, and that electronic medical record, I said that that’s the secret. That’s the future of medicine, I need to find one for urgent care. So we had six at the time. So we went out and looked at electronic medical records, I will say I looked at over 100. So that gives you an idea of how it sets I was about it. But everything was a square peg in a round hole for our particular industry, everything would slow us down, it would not capture the coding properly. And so I went to my partners and said, what’s out there is just not going to work. EHRs aren’t ready, we’ll have to wait. My partner said, David, you can you can do this. Why don’t we start our own EHR? I thought he was nuts, but put together a business plan. And, sure enough, the electronic medical record that we came up for, for urgent care actually worked tremendously. We we grew really rapidly. And I ended up three years ago growing to a point where we merged with our number one competitor in the space. And we’ve been able to continue growth, as we’ve taken an outside investor and several actually several outside investors. And I’ve gone from me to doctor seeing patients in urgent care to being an advisor, colleague, and CEO. For those for those urgent cares throughout the country, we have almost 60% of the 10,000 urgent cares in the United States using one of our services.
Nick van Terheyden
So little bit of an unusual journey. And as part of your history, you didn’t declare any computing or engineering background as part of your undergraduate, did you have any of that knowledge going into this?
David Stern
I am a very unusual technology CEO I have. I never took a business class. And I never took a computer class. I actually didn’t even touch a computer as an undergraduate. That may give away how old I am. But I will say I thought I would never use a computer, why would I ever take a computer class and just a year outside, outside of medical school, I bought my first PC, I really enjoyed using it. And but I would say I’ve never written a line of code. And I really can’t, I can’t understand the technology more than at a high level. So does give hope for folks who have technology backgrounds to possibly be successful in the technology area.
Nick van Terheyden
But I think that’s an important understanding, you know, central to this, that you know who you are, as a physician, you deeply understand the space you worked in the space. You looked at it from, I would say the clinical perspective and said, let’s see what’s out there and reviewed it. And you know, when you talk about the 100, I fully understand that, you know, we had large numbers. I wasn’t aware that there was six, but I’m not surprised to hear you know, of various offerings. Taking on that direction was a pretty substantial project that must have been a little bit daunting as a clinician, but you know, you’ve got all of your partners and colleagues saying, Great, well, you’ve looked at everything now go do it. How did you approach that?
David Stern
I put together a business plan to make this software company take off and I I was a little fortunate, most people who start technology companies need to take on outside investors, what I had discovered is we were losing about a million dollars of revenue, leaving it on the table in our six urgent care centers, due to poor coding. And we quit. And I had been training, I had become a certified professional coder, I had worked on training providers on coding, and I was a complete failure at training physicians how to do coding, it’s working with physicians, as you know, is like herding cats, as people often say, so as a failure and training them how to do it. And I knew if we could automate this coding process, we could, we could capture that million dollars, right, my partners agreed that I could have that million dollars of extra revenue, which is all profit, I could have that million dollars of extra revenue for three straight years. So I had a $3 million seed fund that I had to generate through this software. And four months after starting the company, we had a rudimentary product that was generating that extra million dollars a year. And we use that extra million for a year when the third year came, came up. My partner’s looked at me say, sorry, Elizabeth, the next year, they said, Nope, we’re on the trajectory here. The the expense slide is going to cross under the revenue line in the next month. And indeed it did. And we have been profitable ever, ever since that, that end of that third year, the beginning of the fourth year. So we’re able to self fund and I never, I didn’t have to take on investors all the way up until about three years ago, where it made sense to do when we merged with our largest competitor.
Nick van Terheyden
i And you know, some critical elements in there. So first of all, the deep understanding of coding, I think one of the things that many physicians would agree, we’re not coders, you clearly are so you took specialist. It’s almost like a specialty in its own right. And there are a few folks, I’ve certainly known a number of folks that have explored that that obviously contributed to the understanding of the finances. But when it came to building this, as you cast your mind back to the process, what were the key elements? What what specifically allowed you to create something that has clearly excelled in the marketplace? And there’s there’s nothing more intolerant than a group of physicians for an experience that takes away from their contribution to the patient and patient time. You got that right. What was it in there that was critical to allow this to be so successful?
David Stern
So I think that you You’re, you’re almost there as to what really made it successful as we looked at it from the user perspective, first, and technology was only secondary technology was the servant of the user experience. So believe it or not, I said, I came up with electronic medical record, but it was extraordinarily rudimentary. What it was was a two sided sheet of paper that had a whole bunch of fields on it, that when you checked certain things, and on the paper, the computer would read what you put there, and then it could code the visit. So to capture, typically, the typical physician was losing, or leaving on the table about $20 per visit on coding. And we were able to capture that $20 And we took two. So it’s a very good 10 to one ratio for the the end user. It’s why we grew so fast. But it’s also I had a fella come up to me said, David, you’re the next Bill Gates, you’re the reason doctors are never going to have to touch a computer. I said, No, no, it’s not the future. This is just this bridge to getting to electronic medical record. But what it did was it it, it did several things, it got our all of our users used to stereotypical documentation, having to fill out certain fields, not and not being optional to fill out certain fields, because our system would actually read that. And it would ticket back if they hadn’t filled out certain fields and said you didn’t fill this out, you’ve got to fill it out. So we and then what we did over time, and it took about five years as we converted that paper interface into a full computer interface that really looked very familiar to the folks that were used to the paper. So the key was if you studied disruptive industries, you don’t disrupt an industry by coming in with the slam dunk. Wow technology, you disrupt usually from the bottom up, and you disrupt you often using technology that everybody else looks at. So that’s ridiculous. Why would anybody use paper, for example, that’s what people said about us. But we were able to capture a large portion of the market that way. And we were able then to move with the revenue we generated to move to a different situation where our our technology really was state of the art
Nick van Terheyden
And, you know, you talk about the paper piece and you know, potentially as a ridiculous concept, but let’s be clear. If we go back in time, I remember the implementation of computers and not just in medicine, but you know, in business, we’re moving to a paperless office. Hello, we didn’t. And I think the concept of starting with that is absolutely foundational in terms of the way that you explore the opportunities for improvements in process and then build technology. And I think, you know, as technology has expanded, it starts to offer even more opportunities and more potential. So fast forward, you’ve built this, you’ve obviously continued to expand, you’re probably seen some incredible innovations that have added to this that have made it better, I have a sense of what might have been significant. But can you recall, inflection points in that innovation process that really started to bring even more value to the interaction and the solution?
David Stern
What we did talk about bringing, bringing the solution to the computer interface, so that the physician is using the computer, we always kept the user experience as a front and center. And it was was fairly common for physicians to start using the system, say I, I didn’t really hardly need any training, I could use this right out of the box, I can tell this is made by a physician. And quite honestly, there’s a physician that had actually worked in this space for many years. So I sort of knew what they needed, what they wanted, and what would get in the way, and that we had to, we had to make the EMR get out of the way. So that would have been the first inflection point, I would say other inflection points came as we started to realize that we needed to become not just physician centric, but patient centric. And so we needed to allow the patient to check in online, we had the first solution to allow patients to just click on a website and say they give them a time to come in. And they could come in to the urgent care and they were already pre registered into the medical record for the folks when they came in. And that that that changes things dramatically. And then at over time, when we started to make that scheduler dynamic, so that it would change if the clinic got busy and somebody walked in. With a laceration, everybody could be bumped out an hour or so people didn’t have to come in and wait in the clinic, they would feel more like the doctor was waiting for them. They were waiting for the doctor and they would come in or when it was time to be seen. So that patient centric journey is where we were moving continuously moving now serving patients after the visit to see how it went. If they were if there were problems, how that was going serving patients with text messages, are you are you feeling any better not starting to have some robotic robotic responses there. So that if they’re not feeling better, they can be encouraged to to either come back in or tell the tell the clinic what their issues are. And that that full circle of patient experience from the time they check in online to the time their visit is completed. And actually until their visits their visitors visit is completely paid for. We we offer that complete experience and but just over the last few years, I would say we’ve gotten to the point where we we say almost everything that the patient or the provider does is now working in our software, all integrated in such a way that it creates a unified and very seamless journey for everyone.
Nick van Terheyden
For those of you just joining I’m Dr. Nick the incrementalist today I’m talking to Dr. David Stern. He’s the CEO of experimente. We were just talking about the history and innovation to the creation of essentially a physician built physician friendly solution. It reminds me a lot of Zixi. If you’re familiar with that tool set that was built in Maryland, I think it was MedStar. It it suffered from a problem when they first put it out on the wards. It was built by clinicians, for clinicians, and they put a sign, you know, saying do not use came back a week later. And there was a line of clinicians lining up to use it because it was so valuable. It had been built, you know, and it was I don’t want to say a victim it was you know, it was a success, even though they were trying to sort of limit access to you know, be careful about the expansion. So, I think it sounds very much like you had similar experiences with that, you know, just laser sharp focus on the user experience as you think about this, so clearly clinicians you know, I’m sure within the organization In all of the elements that support this, what’s the patient experience? How have you focused on that, and what’s their response to this been?
David Stern
So I would say for the most part, the patient doesn’t know where there were white labeled behind the scenes. And so they’re really focused on on the VA health care provider, and the urgent care chain that they’re going to that batsu they have a relationship with. And our job is to get out of the way and just allow them to seamlessly take care of the patient. But it I think, what’s what, what, not just us but every EHR, the country is starting to realize you can’t just be a software for the provider, you need to see the whole patient experience all the way through. And when you when you see that a patient experience all the way through, including even the ability to pay your bill and do everything in one place. It just makes makes it so much easier to be a patient. And I will say I recently had a procedure in a hospital, and they were using the big EHR epic. And it was much more seamless than then when I had used use their functionality 10 years earlier, felt much more patient centric, I was getting a text message or an email every time something was updated. And it it this this sort of revolution, which we say at experimente is our mission statement. Our goal, our purpose is we power the patient centered healthcare revolution, with although we think we’re ahead of of virtually anybody else out there, in seeing it as a patient centric solution. Even the big guys are also seeing that it is about the patient, it is about making that experience seamless, because the healthcare providers that can provide that sort of seamless experience where you walk in the door, the physician is expecting you within five minutes at a time you’re in the in the office, you’re being seen by the physician. And you’re 15 minutes later, you’re you’re out on the street, walking into your car and getting in your car and you had everything you needed in that visit done. That’s an amazing experience. And the healthcare providers that see that use technology to deliver that and you can’t do it. Anybody thinks technology delivers a bad one that’s wrong. It’s always execution. That’s key, you can have the worst technology in the world, and still deliver incredible experience to the patient. And you can have the best technology in the world and deliver a horrible experience to the patient. So the key there is you have to take great technology and put great execution on top of that. And that kind of an experience makes it makes a healthcare provider, really unbeatable in the market. And you know, having experienced this seamless experience, multiple times I went the hospital, multiple studies, surgery, multiple things, everything came off like clockwork, and a large part of that was centered around that medical record. I’m not going to another provider, I’m not going to another health system. This is my this will be my health system until they blow it because they’ve got me. And that’s key when you deliver that kind of service people, people, no matter what you do, and if you’re selling cars, people say I’m a Ford guy. I’m a Chevy guy, I’m a Tesla guy, whatever it is, if you’re getting that kind of service from your local, your local dealer, you’re going to stay with that car, if you know that the healthcare providers delivering that kind of service. Again, you need in most cases, you really do need superb technology to be able to deliver on on top of that. But if you deliver that you’re an unbeatable force in your community, and people will keep using,
Nick van Terheyden
yeah, it makes you super sticky. You know, the the phrase that always resounds in my mind is, you know, people always remember how you may how, how you made them feel not what you did. And this is all about feeling. And the perception of an experience that is just seamless. And you know, we walk into lots of experiences, you know, takeout packages, you name it. And there’s all this technology going on. And it’s always troubled me that healthcare has been so far behind, but it sounds like you’ve really nailed this. And, you know, as you describe, the patient doesn’t even know that you’re there, which I think, you know, perhaps not great news for the company because obviously you want people to know you’re contributing to that. But that is great news for the patient. It really is. Because if they don’t know, then you’re doing a fantastic job. So I think very exciting. You’ve seen growth I mean, it’s almost impossible not to talk about the pandemic although people are trying not to at these points in time, there was clearly a huge expansion, you know, contribution to that, that the numbers were extraordinary. And obviously, it was very significant in the urgent care space, because so many of the other institutions were locked down, you couldn’t even I mean, it was almost like there was a military guard round some places. How did that go for you?
David Stern
Yeah, COVID was a very different situation as the pandemic yet first of all, there was no protective equipment, there’s no testing in the urgent cares. And literally, my clients called me up and said, I think we’re gonna have to close half of our centers. And, in response, what I did is I created a weekly phone call with all the executives in our industry. And basically, it was a please don’t close your centers, because if you close your centers, those employees are never coming back. And there will be protective equipment, there will be testing, and it’s coming soon. And fortunately, I was right, on all fronts. And fortunately, folks decided to wait a little bit to close their centers and very short, urgent care is that we’re seeing 30 patients a day, we’re seeing on average, almost 80 patients a day, and we had urgent cares who were delivering services in parking lot, sometimes seeing over 1000 patients today, that’s stress on our system, because we have a dynamic scheduling system, that when when you get extra busy, it changes things around the stress that our system that was designed to accommodate Self Scheduling of maybe 30 patients a day, 40 patients a day, all of a sudden was being asked to do several 1000 patients in a single senator per day. And these dynamic artificial intelligence protocols that we put behind the scenes, they really didn’t work, they broke, that we saw some horrible things for a couple of weeks until we could revamp the whole system, where people are being giving appointments to come into the urgent care at 4am. And get their coverage just to give us an opening for you.
Nick van Terheyden
I’m willing to bet some people showed up for that.
David Stern
It was a massive problem. And we were we were struggling just like the urgent cares were to deliver this this tremendous care, I was saying we had engineers staying up all night frequently, to to get the get the systems fixed so they could handle it, we have and now we have systems that can handle 1000s of patients a day, but not necessarily not sure we’ll ever have that demand again. But it was a it was a great lesson and almost a military type response to a crisis that we had to work with our clients to deliver. And we were able to do it in such a way that we had tremendous growth, not just in not just in the numbers of patients being seen, but so many urgent cares realized they needed a software that was specifically designed to handle what they were doing. And we were the only ones that really had.
Nick van Terheyden
So fantastic learning opportunity. I’m always terrified to say this, but you know, another silver lining to the pandemic, it’s sort of created more resilience, more opportunity. So as you think about the future, what are you excited about? What do you see happening? And where do you see all of this going?
David Stern
Well, I mean, I’m not just talking near future, I won’t talk the long term future. But the near future, I think one of the big, exciting things, there’s going to be treatments for COVID. urgent cares have established themselves as a place to go get diagnosed. And I think the future is urgent cares will become the place where you not only get diagnosed, but where you get treated, there still are a lot of state laws that don’t allow physicians in certain states to actually dispense medications to the patient. But very hopeful that the government will see this as a time to change that where an urgent care can be a one stop shop, you go in, you not only get tested for COVID. But you can pick up your treatment, we have effective treatments now, they’re not quite ready for everybody to get them not quite ready to give it to everybody who gets COVID. But it’s just a matter of a few months till we get there. And when we get there, urgent cares are really ready and well positioned to be a great place to deliver care. And the good news is that the next future thing if we’re just looking a little further out, it has it’s happening already as more and more integration with health systems and other medical practices so that those medical records and that record of that treatment is just seamlessly traveling throughout, throughout all of the electronic health systems in the US. And we’re we’re getting we’re on the cusp of that happening. And the good news is that not only we’re on the cusp, but we’re seeing so many providers starting to use these solutions to pull in records from other centers, we get pulled events seamlessly and for us to move into a situation where we’re not working in all these different health care silos. But we’re working interconnected ly and cooperatively like medicine should be practiced.
Nick van Terheyden
So I think exciting times I’m going to push the both or in this case, the van or coach or bus out a little bit further and say potentially expanding this into mobile clinics. I think we’ve seen you know the urgent care in New New York. I heard about this where testing and treatment is incorporated into these mobile units into underserved communities. I think, you know, essential and just smart behavior, unfortunately, as we do every week, we’ve run out of time. So it just remains for me to thank you for joining me on the show today. David, thanks for joining me.
David Stern
Thank you very much.
