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Raphael: /Hey folks, and welcome
to this latest episode of

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the Small Tech Podcast by EC.

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And today we have another amazing guest.

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He is the co founder and director of
Firstline, a platform used by over

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150, 000 healthcare providers in over
400 hospitals around the world to make

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clinical guidance on infectious diseases
easily accessible at the point of care.

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He is Cyrus Greenall.

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Hi, Cyrus.

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Cyrus Greenall: Hi, Raphael.

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How are you?

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Raphael: I'm doing well.

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How are you?

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Cyrus Greenall: I'm good.

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Thank you.

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Raphael: Well, yeah, welcome to the
podcast and I would love to learn more

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about how you got to where you are.

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So what was your journey?

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How did you get to Firstline?

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I know you did some stuff in game
development before, so I'm just

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curious to poke around at that.

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Cyrus Greenall: Yeah, I can share
like I, yeah, my dream when I

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was a kid, probably from the age
12, was to work in video games.

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And when I was 13, I wrote a letter
to the president of Electronic Arts,

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Raphael: I love it

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Cyrus Greenall: Making a claim of what I
thought about the future of video games.

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And, why I thought they should give me a
job, which, of course, they could never

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do it But what was amazing is that they
that fellow, Don Matrick, invited me to

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their office in Vancouver, gave me a tour,
and just showed me, exposed me to, video

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games and software development and it was
so exciting to me and it was amazing that

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he took time out of his busy schedule
to, entertain a 13 year old, but that

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really started my path and everything was
really focused on software development

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and video games, so that's what I learned
throughout high school and university

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ended up starting my own video game
company and worked at Electronic Arts.

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And and other video game companies.

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But after some time there, as, you get
older, became, I say my goals shifted and

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I realized there's a lot more to life and
my career than just video games alone.

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It's a difficult industry and it has a
lot of value, but at the same time, like

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I was looking for something a little
bit more and started building apps and

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doing different kind of projects and
I collaborated with a friend of mine

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who's brilliant self taught programmer
who was also a teacher and had taught

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himself to code and had ended up
publishing several apps on his own.

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And this is This is like early
in the days of the App Store.

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So when it was less
accessible than it is today.

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And I was just amazed that someone,
it's very rare actually for people

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to, at the A later stage in life to
teach themselves software development

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and actually self publish apps
themselves again at that stage.

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So I, I feel like I have
to work with this guy.

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Like he was just brilliant.

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And and so, his brother and sister in
law were infectious disease physicians

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and and he was beginning to develop
a prototype pilot at their hospitals.

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And and this is really to try
to tackle this global health

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issue of antibiotic resistance.

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So that's where this story starts.

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Raphael: Okay.

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And so from how did you
fit into this picture?

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What was your role when you
first started working together?

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Cyrus Greenall: Yeah.

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Well, I mean, it was really just
a, like a pilot and an idea.

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And it wasn't really a business.

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So the idea was to come in With my
business acumen, if you can call it

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that and really help turn it into
something that would, that take it

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from a pile into something that we
could scale and actually, create

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a business around it and grow it.

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And it was so exciting to me to
work on something that had such a

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potentially tangible benefit on people.

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And again, as much as I love
video games and there's a role

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for entertainment in this role.

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It's, it doesn't have the same direct
effect on people's lives as, software

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and something like healthcare can.

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So yeah, so my role was really, I mean,
as in a startup, it's like wearing every

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hat, but it was a big part of was just
building the business, even doing some

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Android development but and sales and
really anything and everything that

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was needed, including building content
for hospitals when we first began.

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Raphael: Oh, wow.

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How was that?

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I feel like that must be like,
hospitals must have a special

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kind of way of operating.

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I feel like anything medical
and anything tied to government

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always feels a little onerous.

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So yeah.

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How's that?

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I mean, both in content and,
the rest of the work that you've

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been doing over the years.

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Cyrus Greenall: Yeah.

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I mean, it's different from business,
of course, because the business is

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primarily governed by profit, and
if they see, if a business sees

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something that will, show a return
on investment, they'll likely invest.

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But with healthcare, of course, there's
so many different factors to consider.

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And it's not always just about the money.

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It's also about the quality.

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And it's also about the time, too, that
physicians and pharmacists and nurses

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and administrators are all burned out.

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So there's a limited ability to
take on, new technologies, new

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innovations, even if it's something
that may, might make a difference.

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Raphael: So are the people who would be
using the technologies, are they resistant

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or is it the structure that's resistant?

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Cyrus Greenall: So the folks that we
work with the closest are are experts

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in infectious diseases and antibiotics.

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And they're physicians, they're
pharmacists, they're nurses, and they have

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their daily work, their clinical work.

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So.

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When it comes to adopting new
technology to really start to try

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to transform their work, of course,
it's very exciting, but it comes

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at the expense of their daily work.

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So, that's always a challenge
for us is, working within

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their kind of priority matrix.

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Raphael: Actually, so I realized that,
I had my little blurb at the beginning

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about Firstline, but maybe you can
tell us what's your 30 second pitch?

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What is Firstline?

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Cyrus Greenall: Taking a huge step
back, the big challenge is that,

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medicine is really difficult and
no, person, no provider alone has

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all the knowledge necessary to
make the best possible decisions.

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Just impossible.

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And I think there's more and more
recognition that it's just not reasonable

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to expect everyone to be up to date on all
evidence on all specialties in healthcare.

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So with that recognition, the realization
that we need adjunct tools to help us,

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either people or technology or both.

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So the idea of our tool is, a decision
support tool that a physician or

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pharmacist or nurse can reference when
they're making a treatment decision.

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And so when it comes to infectious
diseases and the treatment the treatment

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of them in Canada and the United States
and elsewhere in the world, up to 50

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percent of treatment decisions are
considered inappropriate or unnecessary.

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So, almost half of the time when
antibiotics are are prescribed, there may

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not be needed or it's the wrong drug or
the wrong duration of therapy and so on.

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And that's a relatively
high rate of error.

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And the consequences you
can imagine are enormous.

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There's an impact on the patient.

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There's an impact on the organization
because they're spending more money.

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And there's an effect
on the globe because.

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The excess use of antibiotics is leading
towards the resistance to antibiotics.

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So, so our tool is really helping
guide the providers, the physicians

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and pharmacists and so on, make
more appropriate decisions.

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So we've had, studies where
you know people using our tool

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have seen a 90 percent level.

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of appropriateness of prescribing.

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So far above that benchmark of, 50 to 70%.

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Raphael: Yeah.

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That's a huge Delta.

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Also like the 50 percent
number was stunning to hear.

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I didn't realize it was that high.

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Wild.

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Cyrus Greenall: Yeah it's extraordinary
and I think we're really just at the

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beginning of this like new age of clinical
guidance and really development of

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standardizing care across an organization
where you move away from like individuals

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making decisions, based on their own
personal knowledge and preferences, and

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moving towards a standardization of care.

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And to do that, of course,
you need a clear standard.

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You need to express it and you
need to make it easy for people

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to adhere to that standard.

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That's essentially what our tool does.

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And of course We do that
through mobile and desktop.

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So, a physician can download Firstline
on their phones or access it on

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the web through their organization
to access, trusted guidance.

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Raphael: And mechanically
how does it work?

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I guess from a user perspective,
like what is it that they're doing

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when they interact with the app?

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But I'm also curious in part because
of the whole, the explosion of LLMs,

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and I feel like this is one of those
things that comes up in the discussion

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about LLMs oh no, like the doctor can
just  ask the AI here's some symptoms,

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here's some things give me a diagnosis.

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Yeah, how does all of that
fit into your product?

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Cyrus Greenall: Yeah, well, I mean,
so first of all, We're different from

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most apps because of course most apps,
most software is trying to keep you in

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the tool as long as possible, right?

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You want as much attention as you can.

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Ours is the opposite.

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We want to get you out as quickly
as possible because if we create too

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much friction, people won't use it.

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So there's a lot of aversion
to technology in healthcare.

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And that's largely because
most technology is not really

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designed with the user in mind.

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It's I would never just, I would
rarely describe it as user friendly.

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So our tool, the average someone
spends is about 60 seconds.

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And that's a reasonable amount of time for
someone to, turn their attention towards

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the app to help them make a decision.

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So the way that it works is we customize.

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The tool for every
organization that we work with.

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The old state was generic
resources that were nationally

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or internationally applicable.

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Raphael: Yeah.

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Cyrus Greenall: With the, again, the
nature of medicine and particularly

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infectious diseases, there's a high degree
of local, variation So, what you prescribe

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in Vancouver may be very different from
Toronto or Los angeles or New Delhi.

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And even in Vancouver, there
are differences in what

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a hospital may recommend.

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So our software allows an organization to
tailor it specific to their local context.

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So we have a, kinda proprietary
backend that essentially is a no code

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platform for creating clinical guidance
that is standardized but at the same

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time it's you know locally specific

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Raphael: interesting.

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So you have this no code tool.

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Which also very cool.

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I always find like platforms that
offer that kind of flexibility are

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really interesting to poke around at.

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And yeah, I feel like
they're interesting systems.

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But I'm curious, like from a technology
perspective, is it doing anything machine

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learning or is it all is it rules based?

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Like you put in X, you can
guarantee you're going to get Y out.

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Just sorting system or
do you use anything?

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Cyrus Greenall: Yeah so thing with a tool
like our is we want to be as  discrete

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and black and white as possible, at
least at this stage, so there is there

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is the ability to incorporate like
calculators can become more complex

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decision support, but it's all very
transparent parent to the end user.

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These are things that they
would be calculating already.

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But you can imagine, I don't even know how
they are doing it at the moment on paper.

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So using the app, it makes
it far more efficient.

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In fact, I mean, most cases are
probably not calculating it.

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But there are things
that they likely should.

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As far as like large language models and
so on, yeah, there's enormous opportunity

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but in healthcare, of course, there's
a lot of, a lot of risks involved.

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We now have one of the largest
databases of clinical guidance for

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infectious diseases in the world.

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We have one of the largest
databases of resistance data in

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the world, among other things.

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So in this kind of new chapter of
like technology where, everyone

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is thinking about Gen AI data
is a huge part of that moat.

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And so we're fortunate that There is a
lot of, content but it's being mindful

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of how it can be used in a way that's
really bringing value to the community.

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Our customers and not ever compromising
the quality of the service.

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Raphael: Yeah.

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It makes sense.

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Is there a way for you to track outcomes
from the decisions made using your system?

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Cyrus Greenall: Like use in terms
of how the platform is used.

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We don't track the actual
like healthcare outcomes.

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So we get that from the organizations
that we work with, that we partner with.

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They're always interested
in really understanding the

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impact of a tool like ours.

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And so they do that, they publish studies
and posters and so on in presentations.

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That talk about the impact of
Firstline in their organization.

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Raphael: Cool.

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Yeah, no, I was curious.

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I was thinking like, if you have these
complex decision trees that give you

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some, like some tangible output that
you can then apply to like a medical

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decision, like it'd be really neat to
then correlate that back and see like

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where they could like tweak, tweak their
own inputs to improve it over time or

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something like that, I think that would be

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Cyrus Greenall: Absolutely.

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And it's really it's an area that there's
a lot of opportunity, I think, to learn

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because no one really knows exactly
what type of guidelines work the best.

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A lot of it is based on subjective
preferences, which is fine,

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but I think there's an enormous
opportunity to incorporate data into

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how we develop clinical guidance.

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Raphael: That's fascinating.

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So just a thought that I had was,
I imagine there's all of these

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kind of structures around how you
build for this medical system.

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That is significantly different
from the game development.

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And I'm curious, like even just
like learning the language of the

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medical system and how they operate,
like even just those things, like

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how, what has that learning been
like for you in that transition?

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Cyrus Greenall: Yeah, it's
really interesting, actually.

00:13:43.971 --> 00:13:46.521
And it's so different in many ways.

00:13:46.791 --> 00:13:49.251
First of all, I find it way easier.

00:13:49.631 --> 00:13:53.791
I don't, I mean, I've been, involved
in quite a few different areas of

00:13:53.791 --> 00:13:57.781
software development, and video games
is by far the most difficult that I've

00:13:57.791 --> 00:14:02.571
experienced, because it touches on almost
every area of software engineering from

00:14:02.661 --> 00:14:07.014
AI to rendering to physics and so on
you have to have someone that's good

00:14:07.014 --> 00:14:11.901
at almost everything on your team not
to mention the incorporation of arts.

00:14:12.184 --> 00:14:15.328
but just from a software engineering
perspective it's incredibly complex and

00:14:15.328 --> 00:14:20.417
the team size and the most difficult
thing is that the goal is entertainment

00:14:20.467 --> 00:14:24.547
and fun is very difficult to predict.

00:14:24.947 --> 00:14:28.287
As I became more experienced in
the industry, I started to realize

00:14:28.287 --> 00:14:31.587
that, even the best designers that
I'd ever worked with, there was a

00:14:31.587 --> 00:14:32.277
high degree of unpredictability.

00:14:33.151 --> 00:14:37.191
There was things that we thought would
be amazing and fun, and they weren't.

00:14:37.251 --> 00:14:40.291
And they just didn't work, and we'd have
to scrap it and start all over again.

00:14:40.291 --> 00:14:44.031
So there's that prototyping aspect
in video games that's so crucial,

00:14:44.361 --> 00:14:48.341
and the best designers in the
world lean on that methodology.

00:14:49.011 --> 00:14:54.061
In this world it's much better because
I find, because it's intuitive.

00:14:54.501 --> 00:14:58.731
There's not, I mean, there's a degree of
prototyping, but the goal is very clear.

00:14:58.781 --> 00:15:01.911
It's make the experience better
for the end user, which is usually,

00:15:01.911 --> 00:15:04.951
I mean, we can follow like best
industry, best practices for that.

00:15:05.421 --> 00:15:06.991
And it's really all for
these clinical issues.

00:15:08.301 --> 00:15:12.651
So we're constantly listening to
our customers and particularly

00:15:12.651 --> 00:15:15.831
those infectious disease experts to
understand what are the problems that

00:15:15.831 --> 00:15:16.921
they're experiencing in the hospital.

00:15:17.111 --> 00:15:22.551
We really try to dive into the
specific clinical issues because often

00:15:22.891 --> 00:15:26.021
when people come to us, they say,
oh, no one looks at our guidelines.

00:15:26.021 --> 00:15:26.841
We'd love to use an app.

00:15:27.671 --> 00:15:28.291
And that's great.

00:15:28.291 --> 00:15:32.351
But there's a deeper level of challenges,
and the problem space is much more

00:15:32.351 --> 00:15:36.081
complex when you dive into, well, why is
it that you want people to use guidance?

00:15:36.101 --> 00:15:38.881
Where are they, where are their
opportunities for improvement

00:15:38.881 --> 00:15:39.851
in terms of clinical care.

00:15:39.851 --> 00:15:43.901
So we try to drive at those
issues and then think about

00:15:43.901 --> 00:15:45.071
what's the best way to solve it.

00:15:45.511 --> 00:15:50.681
So I find that process much more intuitive
because there's always an answer.

00:15:50.731 --> 00:15:54.401
It's just about, really finding
the, most efficient way.

00:15:54.401 --> 00:15:57.291
And of course, making sure that problem
is actually a problem worth solving.

00:15:57.901 --> 00:15:57.921
Yeah.

00:15:58.511 --> 00:16:02.571
And then in terms of yeah, obviously
space that I have no background in and

00:16:02.581 --> 00:16:06.931
many of my colleagues were, yeah, we're
blessed like the folks that we work with,

00:16:06.941 --> 00:16:10.081
they're so happy to share and teach us.

00:16:10.241 --> 00:16:15.126
So, from the day that I started, It was
really immersing myself in this world.

00:16:15.176 --> 00:16:16.366
And I love doing that.

00:16:16.366 --> 00:16:18.546
Love getting into a space
that I know nothing about.

00:16:18.956 --> 00:16:24.356
And I still know very little, but
we talk to our customers constantly.

00:16:24.356 --> 00:16:26.956
I would say we have really
great relationships.

00:16:27.356 --> 00:16:31.856
Many of them I've now called my
friends because we chat so often and

00:16:31.856 --> 00:16:33.016
and it's a lot of learning from them.

00:16:33.016 --> 00:16:37.601
And in fact I think the fact that we
don't have a background in healthcare

00:16:37.601 --> 00:16:41.691
has actually benefited us because we
come at it from a different perspective.

00:16:42.121 --> 00:16:44.891
Our competency is really
in technology and design.

00:16:45.251 --> 00:16:49.381
I mean, we have some competency in
healthcare and in, some clinical

00:16:49.381 --> 00:16:52.931
expertise, but really we bring software
and design, which is, like I said,

00:16:52.931 --> 00:16:54.781
is often lacking in the industry.

00:16:55.086 --> 00:16:55.516
Raphael: Yeah.

00:16:55.786 --> 00:16:57.746
That makes a lot of sense.

00:16:57.782 --> 00:17:01.852
I feel like that's a thing that I also
enjoy with the type of work that we do

00:17:01.852 --> 00:17:05.832
is just being able to dig into a whole
new problem set, a whole new industry.

00:17:05.932 --> 00:17:07.222
Yeah, it's really rewarding.

00:17:07.752 --> 00:17:12.146
I'm curious also, again, from this
transition from games, was there

00:17:12.156 --> 00:17:17.302
anything that you found was perhaps
oddly useful knowledge to transfer

00:17:17.302 --> 00:17:19.262
from game development into this field?

00:17:19.262 --> 00:17:21.132
Cyrus Greenall: Yeah, I mean, absolutely.

00:17:21.172 --> 00:17:26.492
I think, gamification is, I mean, it's
a term that's overused and I think

00:17:26.492 --> 00:17:31.182
misunderstood, but I think understanding
the importance of engagement, right?

00:17:31.202 --> 00:17:36.202
And the user experience, obviously that's
paramount in games and it's no different

00:17:36.212 --> 00:17:39.352
in any, software that's user centered.

00:17:39.812 --> 00:17:44.462
And like I said before, we've really come
at it with this approach of, how do we

00:17:44.462 --> 00:17:46.982
create a tool that providers want to use?

00:17:47.342 --> 00:17:50.372
That they'll go out of their way to
use, even if it's just 60 seconds.

00:17:51.132 --> 00:17:54.672
So there's a lot of those concepts,
I think, brought into the tool

00:17:54.672 --> 00:17:58.482
that really lean on user experience
design that that we would often

00:17:58.482 --> 00:17:59.922
leverage, of course, in video games.

00:18:00.362 --> 00:18:03.982
Raphael: I feel like that gives
you such a step up when you find

00:18:03.982 --> 00:18:05.742
people who don't care about that.

00:18:05.752 --> 00:18:07.502
They think, well, no,
here's the functionality.

00:18:07.502 --> 00:18:08.742
The functionality exists.

00:18:08.742 --> 00:18:09.632
It should take off.

00:18:09.632 --> 00:18:11.022
People should use this, right?

00:18:11.052 --> 00:18:15.062
But they forget that if it's not
pleasant to use, if it's not fun

00:18:15.062 --> 00:18:18.462
to use, if it's not smooth to
use, then people won't use it.

00:18:19.387 --> 00:18:19.837
Cyrus Greenall: Yes.

00:18:20.002 --> 00:18:20.332
Raphael: Yeah.

00:18:20.802 --> 00:18:21.092
Cool.

00:18:21.092 --> 00:18:24.702
Well, I last sort of question that
I've got is do you have any things

00:18:24.702 --> 00:18:28.682
that like, if you would, if you could
go back, do I understand correctly

00:18:28.682 --> 00:18:30.492
that you started this in 2014?

00:18:30.502 --> 00:18:31.162
Is that what you said?

00:18:31.162 --> 00:18:32.222
Or what I read?

00:18:32.297 --> 00:18:35.637
Cyrus Greenall: Yeah, 2015 is
when the company was incorporated.

00:18:35.717 --> 00:18:35.847
Oh

00:18:36.012 --> 00:18:36.422
Raphael: cool.

00:18:36.452 --> 00:18:36.852
Yeah.

00:18:37.222 --> 00:18:41.652
If if you had to tell yourself
a couple pieces of advice you

00:18:41.662 --> 00:18:43.572
back in 2015 what would it be?

00:18:43.622 --> 00:18:44.402
Cyrus Greenall: My gosh.

00:18:44.702 --> 00:18:47.932
I, yeah, that's, that, that
would be a whole other episode, I

00:18:48.272 --> 00:18:48.552
Raphael: Okay.

00:18:48.552 --> 00:18:49.932
Then just one thing, one thing,

00:18:50.182 --> 00:18:51.142
Cyrus Greenall: just one thing

00:18:51.152 --> 00:18:51.562
Raphael: change.

00:18:52.292 --> 00:18:55.142
Cyrus Greenall: Yeah, well, actually, I
think, I would say the biggest thing was

00:18:55.142 --> 00:19:00.232
really understanding what a sales led
versus product led business looks like.

00:19:00.272 --> 00:19:01.422
I'm a product person.

00:19:01.442 --> 00:19:04.102
I think about product led,
and we have the best product.

00:19:04.552 --> 00:19:08.583
In the marketplace, which is amazing but
I've really more and more understood the

00:19:08.663 --> 00:19:14.793
power of sales and how product alone is
not going to, especially in a complex

00:19:14.793 --> 00:19:16.383
organization a health care system.

00:19:16.473 --> 00:19:21.293
The product alone is not going to
necessarily move people when you're

00:19:21.293 --> 00:19:27.293
talking to the CEO of a very large
health care organization they don't care.

00:19:27.613 --> 00:19:31.073
about your app and its cool features.

00:19:31.103 --> 00:19:34.863
Now the physicians and pharmacists
that use the tool, they may, but those

00:19:34.863 --> 00:19:36.913
who are actually paying for it don't.

00:19:37.153 --> 00:19:39.353
So you really have to
understand what matters to them.

00:19:39.983 --> 00:19:43.543
And we've gotten a lot of coaching and
I think it's had a huge effect because

00:19:43.543 --> 00:19:49.163
we've really shifted our orientation to
really helping the teams that we work

00:19:49.163 --> 00:19:53.943
with, the clinical teams and ourselves to
learn how to sell this to an organization.

00:19:54.353 --> 00:19:58.033
So how do we position our tool
as a product that solves problems

00:19:58.113 --> 00:20:02.393
that the administration of a
hospital organization cares about?

00:20:02.713 --> 00:20:06.773
So that may be saving money, it might
be improving their hospital acquired

00:20:06.773 --> 00:20:08.703
infection rates things like that.

00:20:08.773 --> 00:20:10.533
So, so we're doing that now.

00:20:10.603 --> 00:20:11.582
I wish we had done that earlier.

00:20:11.743 --> 00:20:16.683
When we started it took us, it, I think
it took a long time of really trying

00:20:16.683 --> 00:20:21.013
to like hitting walls in in terms of
getting approval at an administrative

00:20:21.043 --> 00:20:24.433
level to really understand like,
what's the right way to sell this.

00:20:24.628 --> 00:20:25.308
Raphael: That makes sense.

00:20:25.411 --> 00:20:27.631
Well, this is the small tech podcast.

00:20:27.701 --> 00:20:31.381
So do you have a small tech
product to share with us?

00:20:32.111 --> 00:20:32.421
Cyrus Greenall: Yeah.

00:20:32.431 --> 00:20:33.271
I was thinking a lot.

00:20:33.601 --> 00:20:37.641
Well, Oh yeah, there it's hard to choose,
but one that just came to mind, cause you

00:20:37.641 --> 00:20:41.491
mentioned that's had a positive experience
and I was thinking about Kiva and I

00:20:41.491 --> 00:20:43.191
don't know if you're familiar with Kiva.

00:20:43.226 --> 00:20:43.946
Raphael: Yeah.

00:20:44.546 --> 00:20:45.186
Kiva.org

00:20:45.546 --> 00:20:48.756
Cyrus Greenall: And they have a mobile
app now, which, and I was asking them

00:20:48.756 --> 00:20:52.836
for 10 years ago and they finally made
one and it's really well designed.

00:20:53.236 --> 00:20:57.516
And I just, yeah, it's such a great
concept and I just, I love it.

00:20:57.606 --> 00:21:00.696
And I've done it with different
kids that I've worked with and such.

00:21:00.726 --> 00:21:06.886
We, my wife has done it in her classroom
and it's a micro financing platform that

00:21:06.936 --> 00:21:11.566
It helps you give it makes it easy to
give small loans, interest free loans,

00:21:11.646 --> 00:21:17.566
to people around the world, and and so
you can fund projects like building a

00:21:17.786 --> 00:21:24.556
home, or a farm, or some educational So,
structure and you choose the projects and

00:21:24.556 --> 00:21:28.296
people that you want to give the loan to,
and then they pay it back over time and

00:21:28.296 --> 00:21:30.706
then you can relend it to other projects.

00:21:31.086 --> 00:21:35.096
So and it's, it has a bit of
gamification to it, which is fun.

00:21:35.116 --> 00:21:39.816
And so I'm always like, I'm obsessed
with trying to have as many countries as

00:21:39.816 --> 00:21:43.686
possible that I've connected with, but
it's really nice because you actually

00:21:43.716 --> 00:21:46.416
feel a small amount of connection.

00:21:46.426 --> 00:21:51.506
You get to see the story of the
folks that you're giving a loan to.

00:21:51.506 --> 00:21:52.656
And it's a very small amount.

00:21:52.686 --> 00:21:55.836
Often it's like 25 dollars
nothing special but it's cool

00:21:55.836 --> 00:21:57.786
to see the effects that it has.

00:21:58.281 --> 00:21:58.881
Raphael: Amazing.

00:21:58.901 --> 00:21:59.461
I love that.

00:21:59.471 --> 00:22:00.851
That is such a good suggestion.

00:22:00.881 --> 00:22:05.711
It's, I think Kiva is a wonderful platform
I also, I love like the updates that

00:22:05.721 --> 00:22:10.661
you get from people when you  give some
money to a project . Well, Cyrus, thank

00:22:10.661 --> 00:22:12.521
you so much for coming on the podcast.

00:22:12.677 --> 00:22:13.287
Cyrus Greenall: My pleasure.

00:22:13.712 --> 00:22:14.752
Raphael: yeah, I really appreciate it.

00:22:14.852 --> 00:22:18.627
It was, Wonderful to learn about
your journey and everything you've

00:22:18.697 --> 00:22:21.117
learned and that you've been
putting together with Firstline.

00:22:21.177 --> 00:22:21.487
Yeah.

00:22:21.537 --> 00:22:22.307
Thank you so much.

00:22:23.497 --> 00:22:24.187
Cyrus Greenall: My pleasure.

00:22:24.387 --> 00:22:24.727
Raphael: Cool.

00:22:24.827 --> 00:22:25.397
All right.

00:22:25.397 --> 00:22:28.457
RaphaÃ«l: After Cyrus and I stopped
recording, he told me about a couple

00:22:28.487 --> 00:22:31.727
more stories that made a lot of
sense to bring back into the podcast.

00:22:31.757 --> 00:22:33.557
So we started recording again.

00:22:33.937 --> 00:22:34.967
Here are those stories.

00:22:35.087 --> 00:22:35.507
Enjoy.

00:22:35.507 --> 00:22:37.647
Raphael: And in my past startups,

00:22:37.945 --> 00:22:38.485
Yeah,

00:22:38.687 --> 00:22:40.397
Cyrus Greenall: there, we have
some, when we did video games,

00:22:40.397 --> 00:22:42.027
we have some crazy stories.

00:22:42.137 --> 00:22:46.977
And, I was thinking, I was like, what like
crazy stories we have from our company?

00:22:47.397 --> 00:22:51.807
Things where it's like taking that bold,
leap as an entrepreneur, like doing things

00:22:51.817 --> 00:22:53.817
that are a little bit crazy sometimes.

00:22:54.317 --> 00:22:57.217
And so, I don't know, I was I find those,
there's those moments where I'm like,

00:22:57.837 --> 00:22:59.587
that they're real, a big test for me.

00:22:59.777 --> 00:23:02.877
And it's so cool when it actually
comes out and you actually survive.

00:23:03.245 --> 00:23:05.365
So anyway, I can share a
little bit about that, but.

00:23:05.593 --> 00:23:06.053
Raphael: yeah, go for

00:23:06.179 --> 00:23:07.079
Cyrus Greenall: There's actually two.

00:23:07.193 --> 00:23:10.373
yeah the first one was, so we as I
mentioned, like we're really steeped in

00:23:10.373 --> 00:23:15.823
this world of antimicrobial stewardship
and in late 2019, early 2020, we

00:23:15.823 --> 00:23:20.073
started, hearing about this Wuhan
virus that was, later called COVID.

00:23:20.073 --> 00:23:23.443
It hadn't reached North America yet.

00:23:23.553 --> 00:23:29.410
And honestly I did not anticipate, I think
few did, but I really did not anticipate

00:23:29.650 --> 00:23:35.440
the effect it would have on the globe
and on the Western world and our business

00:23:35.540 --> 00:23:40.510
while it was focused on antimicrobials
or antibiotics the folks that we work

00:23:40.510 --> 00:23:42.780
with are infectious disease experts.

00:23:43.130 --> 00:23:49.000
So they were affected and they essentially
became preoccupied with Covid and I was

00:23:49.000 --> 00:23:50.770
on a trip to New York and I was visiting.

00:23:50.780 --> 00:23:54.170
The New York City Department of
Health is a customer of ours and we

00:23:54.170 --> 00:23:56.330
were potentially gonna be working
with some hospitals in New York.

00:23:56.330 --> 00:23:59.575
So I went on a trip to, try to
strengthen that relationship and

00:23:59.625 --> 00:24:02.375
meet new hospitals and I was.

00:24:02.960 --> 00:24:09.310
I was alarmed when I saw how much had,
it was affecting their attention even.

00:24:09.680 --> 00:24:13.920
So at the, at a department of health,
they were, activated, which meant like

00:24:14.010 --> 00:24:18.100
every single person in the department
of health had shifted their energy

00:24:18.100 --> 00:24:21.890
towards the preparation, this was
before any cases had reached New York

00:24:22.240 --> 00:24:26.230
but they were anticipating the arrival
of cases and how to respond to it.

00:24:26.670 --> 00:24:28.590
And so much so that no one
was able to meet with me.

00:24:28.590 --> 00:24:29.600
I met with one person.

00:24:29.990 --> 00:24:33.950
And and then I went to go visit
hospitals again, I could see how much

00:24:33.950 --> 00:24:35.340
it was occupying their attention.

00:24:35.950 --> 00:24:39.820
And, um, and so I, I got on the
phone with my partners and I said

00:24:39.820 --> 00:24:41.300
this is this is a huge thing.

00:24:41.300 --> 00:24:44.080
And if not, forget the global
health impact, but just the impact

00:24:44.080 --> 00:24:45.725
on our business like we are.

00:24:46.480 --> 00:24:49.870
We're going to lose like the attention
of every single person we work with if we

00:24:49.870 --> 00:24:52.190
don't find a way to somehow support them.

00:24:52.230 --> 00:24:55.240
And at this stage, remember
there was no treatment.

00:24:55.620 --> 00:25:00.150
There was little knowledge about the
disease and and we had absolutely no idea.

00:25:00.180 --> 00:25:04.720
We're still, I would say, pretty ignorant
to like what, how we could support

00:25:04.750 --> 00:25:06.770
outside of antibiotic prescribing.

00:25:07.230 --> 00:25:10.510
So we got on the phone and talked to
as many people as we could talk to

00:25:10.510 --> 00:25:13.650
our customers and really trying to
understand like, how could Firstline,

00:25:13.960 --> 00:25:15.320
we were called Spectrum at that point.

00:25:15.330 --> 00:25:16.630
How could we help with this?

00:25:17.240 --> 00:25:19.460
Cause  we had people were talking
to potential customers who were

00:25:19.460 --> 00:25:22.710
basically saying, hey, we can't talk
anymore because I'm focused on COVID.

00:25:23.540 --> 00:25:28.480
So we ended up really trying to understand
how we could solve that problem.

00:25:28.480 --> 00:25:31.260
We found like, Hey, maybe
this is something we could do.

00:25:31.640 --> 00:25:36.190
In terms of helping hospitals
identify, does a patient have COVID,

00:25:36.240 --> 00:25:38.220
If they have COVID, what
do you do with them?

00:25:38.520 --> 00:25:39.570
Where do you admit them to?

00:25:39.570 --> 00:25:40.740
What tests do you give them?

00:25:40.740 --> 00:25:40.910
Right?

00:25:40.910 --> 00:25:44.190
There was all these questions that
our customers were dealing with.

00:25:44.200 --> 00:25:47.340
We said, well, Hey, we have a platform
that helps people make decisions.

00:25:47.350 --> 00:25:48.030
Can't we help?

00:25:48.365 --> 00:25:49.475
With this problem too.

00:25:50.065 --> 00:25:52.425
And sure enough, like a few
people said yeah, I think

00:25:52.495 --> 00:25:54.125
actually this might be helpful.

00:25:54.135 --> 00:25:55.725
Let me see if we can get funding for it.

00:25:55.855 --> 00:25:56.525
And they did.

00:25:56.895 --> 00:26:00.315
And and so what became potentially
like a perilous moment for the

00:26:00.315 --> 00:26:04.245
company, honestly, like it might have
it might have destroyed the company.

00:26:04.255 --> 00:26:06.245
I don't know what effect it
would have had we not pivoted.

00:26:06.795 --> 00:26:10.235
It ended up becoming one of our biggest
years and an incredible inflection point.

00:26:10.865 --> 00:26:12.835
We ended up getting support
from the Canadian federal

00:26:12.835 --> 00:26:14.855
government to expand our platform.

00:26:15.335 --> 00:26:18.205
We signed up provinces across Canada.

00:26:18.285 --> 00:26:24.095
We became one of the most widely used
clinical decision support tools in Canada.

00:26:24.585 --> 00:26:29.785
We were helping hospitals across the
country share the first protocols

00:26:29.785 --> 00:26:30.925
for the treatment of COVID.

00:26:31.325 --> 00:26:35.675
And honestly had it not been for
that conversation in New York, and

00:26:35.715 --> 00:26:40.015
we would have been much slower to
respond, maybe too slow, to be honest.

00:26:40.393 --> 00:26:41.073
Raphael: Wild.

00:26:41.353 --> 00:26:45.139
I feel like that's also such a good
story to highlight these moments where

00:26:45.139 --> 00:26:46.669
you're just got to figure something out.

00:26:46.729 --> 00:26:47.339
This feels

00:26:47.391 --> 00:26:47.861
Cyrus Greenall: Yeah, honestly,

00:26:47.889 --> 00:26:48.329
Raphael: break.

00:26:48.379 --> 00:26:51.159
Cyrus Greenall: It really felt like that
it was like 24 hours around the clock.

00:26:51.169 --> 00:26:55.929
We were working on prototypes, if you
will, to show people like, hey, is

00:26:55.929 --> 00:26:57.229
this something that would be helpful?

00:26:57.569 --> 00:27:00.729
With no idea if it actually
was something of value.

00:27:01.329 --> 00:27:05.079
And I can share briefly as a shorter
story, but this is a continuation.

00:27:05.079 --> 00:27:09.409
So we were doing a pilot in a
number of countries in Europe.

00:27:09.949 --> 00:27:14.249
And And it was during COVID, and it
really disrupted that pilot, but we

00:27:14.249 --> 00:27:18.349
were launching at a major university
teaching center in the Netherlands,

00:27:18.919 --> 00:27:21.029
and we were launching on a Saturday.

00:27:21.179 --> 00:27:25.459
In hindsight, I don't know why they
chose a Saturday to launch, but this

00:27:25.459 --> 00:27:30.468
was shortly after we had pivoted
and expanded the app to support all

00:27:30.468 --> 00:27:32.464
infectious diseases, including COVID.

00:27:33.184 --> 00:27:35.624
And on Friday at 5 p.

00:27:35.624 --> 00:27:35.984
m.

00:27:36.304 --> 00:27:41.224
Google took down our app off the Play
Store as I can't remember under their

00:27:41.224 --> 00:27:46.454
policy because there were so many
fraudulent apps around on the app

00:27:46.454 --> 00:27:48.134
store and Play Store at that time.

00:27:48.674 --> 00:27:52.294
And so they basically anything
that I think mentioned COVID in

00:27:52.294 --> 00:27:53.844
its description was taken offline.

00:27:54.384 --> 00:27:57.984
Thankfully Apple didn't do that but
Google did and so our app couldn't be

00:27:57.984 --> 00:28:01.994
download or accessed, and we were going
to be launching in the hospital the

00:28:01.994 --> 00:28:07.304
next day with a mission critical tool
that their providers wanted to use for

00:28:07.304 --> 00:28:10.184
the treatment and management of COVID,
and they couldn't access the app.

00:28:10.184 --> 00:28:10.542
Raphael: No.

00:28:10.552 --> 00:28:11.132
Oh

00:28:11.569 --> 00:28:13.319
Cyrus Greenall: this was horrifying.

00:28:13.359 --> 00:28:17.659
And of course with Google, it was just
an automated email with no support.

00:28:17.939 --> 00:28:20.289
The moment I responded and
received the email was already

00:28:20.289 --> 00:28:21.349
close of business for them.

00:28:21.912 --> 00:28:22.442
Raphael: man.

00:28:22.839 --> 00:28:24.119
Cyrus Greenall: I'm in a panic.

00:28:24.659 --> 00:28:25.349
And with.

00:28:25.519 --> 00:28:27.379
with really no idea of what to do.

00:28:27.379 --> 00:28:30.919
And I start calling every single
phone number I can think of.

00:28:30.919 --> 00:28:36.269
I called Google Cloud and who
had an office in Philippines and

00:28:36.269 --> 00:28:40.319
had nothing to do with we were
Please connect me with someone,

00:28:40.329 --> 00:28:41.499
someone's got to be able to help me.

00:28:41.499 --> 00:28:46.559
And I was just, shouting, critical
that this is a critical, access tool.

00:28:46.929 --> 00:28:49.359
For like healthcare
and for patient safety,

00:28:49.512 --> 00:28:49.972
Raphael: Yeah.

00:28:50.369 --> 00:28:53.539
and none of these numbers I
called, I left messages, I tweeted,

00:28:53.759 --> 00:28:59.089
At Google, of course, nobody is
responding, and I am like in a full on

00:28:59.109 --> 00:29:04.279
panic, and I start Emailing people and
then scouring LinkedIn, and I was just

00:29:04.279 --> 00:29:07.099
starting to put my I started to think, I
got to think outside the box here because

00:29:07.109 --> 00:29:11.199
this is a disaster if we launch and
half the people can't download the app.

00:29:11.599 --> 00:29:16.389
So I start going on LinkedIn and I
start searching people who maybe have

00:29:16.389 --> 00:29:20.859
some, say in like turning our app back
online and I realized, of course, like

00:29:20.859 --> 00:29:24.499
now it's like Friday at 9 PM, who is
going to be checking their LinkedIn.

00:29:24.519 --> 00:29:27.219
So I think, okay, I need to contact
people who are based in Europe.

00:29:27.769 --> 00:29:32.889
So I found VPs and product managers
of the Google Play, of Google Play in

00:29:32.889 --> 00:29:37.199
Europe, and ended up and sent probably
about, I don't know, 50 connection

00:29:37.199 --> 00:29:39.399
requests the same, similar message.

00:29:39.809 --> 00:29:46.899
And finally, the VP of the Play Store
of Google Europe responded and said,

00:29:47.279 --> 00:29:49.579
And connected me with someone and
said, okay, we're going to fix this.

00:29:49.619 --> 00:29:51.469
And within an hour it was fixed.

00:29:51.469 --> 00:29:54.399
This was now Saturday,
like four in the morning.

00:29:54.869 --> 00:29:57.849
So I had been going, I think for
12 hours trying to figure this out.

00:29:57.889 --> 00:30:00.209
I finally fell asleep
at five in the morning.

00:30:00.209 --> 00:30:04.769
The app was back online and then the
crisis was averted, but it was yeah,

00:30:04.809 --> 00:30:06.029
it's like these kinds of moments.

00:30:06.029 --> 00:30:09.869
There's that happened once, once in
a while in the business where You,

00:30:09.909 --> 00:30:13.859
yeah, as an entrepreneur, you have
to think outside the box and kind of

00:30:13.859 --> 00:30:15.909
do anything to keep things running.

00:30:16.352 --> 00:30:16.752
Yep.

00:30:17.042 --> 00:30:19.212
That is wild.

00:30:19.552 --> 00:30:22.702
Both that they just automatically
shut down everything related to

00:30:22.702 --> 00:30:25.862
COVID with the word COVID is,

00:30:26.079 --> 00:30:27.069
Cyrus Greenall: a very Google approach.

00:30:27.069 --> 00:30:30.019
I'm sorry to say, I love Google, but
it's a very Google approach to just,

00:30:30.569 --> 00:30:32.259
automatically turn off everything.

00:30:32.782 --> 00:30:35.072
Raphael: but also amazing that
you actually, that you managed

00:30:35.072 --> 00:30:36.172
to connect with someone who,

00:30:37.369 --> 00:30:37.869
Cyrus Greenall: yeah.

00:30:37.889 --> 00:30:40.119
Credit to them that someone
actually responded onto a

00:30:40.119 --> 00:30:41.569
LinkedIn connection request.

00:30:41.682 --> 00:30:42.022
Raphael: Yeah.

00:30:42.342 --> 00:30:42.884
Amazing.

00:30:42.884 --> 00:30:47.864
Folks that was my interview
with the awesome Cyrus Greenall

00:30:47.954 --> 00:30:50.234
co-founder of Firstline.

00:30:50.234 --> 00:30:52.814
I hope you enjoy the
conversation as much as I did.

00:30:52.814 --> 00:30:54.044
I thought it was amazing.

00:30:54.234 --> 00:30:58.254
You can go find Cyrus and
Firstline at firstline.org.

00:30:58.254 --> 00:31:02.044
You can find the small tech
podcast at smalltechpodcast.com.

00:31:02.064 --> 00:31:05.084
And if you happen to need help building
digital products, you can go find

00:31:05.114 --> 00:31:10.704
us at goec.io that is G O E C .io.

00:31:10.754 --> 00:31:14.414
We are a small team and we can
take all the help we can get.

00:31:14.594 --> 00:31:18.357
So if you can liken subscribe on
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00:31:18.387 --> 00:31:20.157
on your podcast app of choice.

00:31:20.227 --> 00:31:22.027
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00:31:22.027 --> 00:31:23.617
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00:31:23.617 --> 00:31:26.137
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00:31:26.137 --> 00:31:29.707
Preferably people with podcast
apps, though, that would be better.

00:31:29.707 --> 00:31:30.517
In the meantime.

00:31:30.564 --> 00:31:32.424
We all want to do something
good in the world.

00:31:32.484 --> 00:31:36.174
So go out there and build
something good folks.

00:31:36.174 --> 00:31:37.914
I will see you in the next one.

00:31:38.244 --> 00:31:38.844
See ya.