Subscribe
Share
Share
Embed
The Scopewell Podcast features candid conversations with leaders transforming how organizations think, operate, and grow. Hosted by James Leuthe, CEO of Scopewell Solutions, the podcast explores leadership, AI, digital transformation, and the operational realities of turning ideas into measurable impact. Each season goes deep into a different industry and the challenges of driving meaningful change inside complex organizations.
Hello, and welcome to the Scopewell Podcast. My name is James Leuthe. Today, we're gonna talk about one of the most important challenges in healthcare. It's not just about diagnosis, it's about making sure patients actually get to the next step in their care. Angela Adams is the founder and CEO of Inflow Health.
Speaker 1:She started by tackling missed follow ups in radiology, but what emerged was a much bigger opportunity around how care actually gets coordinated across the system. Angela, welcome to the show.
Speaker 2:Thank you so much, James, for having me.
Speaker 1:Well, to get us started, can you please share a bit about yourself and why you started with radiology?
Speaker 2:I'm an ICU nurse by background, so never really had intentions of being a CEO one day, but here we all are. Why radiology for this company? I had a dear friend that struggled with a missed follow-up that ended up costing her her life. And as a nurse by background, I don't want this to happen to anybody. And I don't think it has to.
Speaker 2:It's a 100% preventable thing. And so we started in radiology because if you think about it, radiology is the tip of the spear a lot of times for patients within the health system. You go to the ER, what do they do? They do imaging to figure out what's wrong. You go to the doctor, what does he do?
Speaker 2:She, he, she. They go back and order imaging to figure out what's going on. You go to the orthopedic surgeon because your knee hurts, what happens? They order imaging. So radiology is so important to your medical journey and yet there's just tons of data within those reports, much of which is not being tracked, identified, and orchestrated within the system.
Speaker 2:So we chose that first because of a personal story of mine with a dear friend, And then second, it really is the tip of the spear for patients navigating the health system.
Speaker 1:Thank you for that context. Coming from the clinical side originally, how has that shaped the way you approach this problem?
Speaker 2:I think what it taught me is that healthcare, not, it doesn't struggle with knowing what to do, it struggles with actually getting it done. And as a bedside clinician, many times, like when something negative happened with a patient and we were all sitting in a root cause analysis on figuring out what went wrong, it was that the systems were designed to fail and right now our entire health care system was designed to fail and so it's a scary place to be as a patient and as a caregiver. And so coming from the nursing world, when I translated kind of my background into the technology world, it was how much of that burden can I take off of the clinical staff and make this and design these systems so that they're not failing, but they're actually supporting the clinician? Because there's no, there's no worse day for a clinician who went into this to save patient lives and to make sure that patients had a great experience. There's no worse day than sitting in a room and knowing that something that you did or didn't do contributed to a negative outcome for a patient.
Speaker 2:So me coming from that background, number one, I understand the entire healthcare system and like how it goes day to day and what that feels like. And I know that technology has a place in that and understanding where does technology fit, where do the humans fit, and how do we bring those together to create these hybrid systems to prevent medical errors from occurring and bolster up the clinical staff and make basically their jobs better while protecting the patients that are within their care.
Speaker 1:When you say that the system was designed to fail, could you share a bit more about what you mean?
Speaker 2:Even if you go back to meaningful use and basically high trust and us developing, digitalizing the medical record and creating an electronic health system, there was lots of pieces and parts in there in which we now have documentation in a data repository and we have a great billing system through most of our EHRs, but the system was never designed to promote quality of care to help a clinician be able to access data in a meaningful way quickly so that they know, okay, this ER patient is being seen by me for the very first time in my life and their life. Like how do I know everything that's relevant about their sixty years on this earth and be able to give them good care? That was not how our electronic health record was designed and it doesn't matter which one you're talking about, it's all of them. Because of that, we have this massive care gap within clinical where it's not that we're missing documentation because that's all being auto documented over here and the bills are going out. It's everything in the middle.
Speaker 2:That's the quality and the care that we give and the data that is just lost to us as clinicians because nobody is bridging that gap and bringing that quality of care together in one place.
Speaker 1:What I hear you describing is the breakdown between identifying something and actually getting the patient to care. A lot of companies start with one use case and stay there. When did you realize this was bigger than radiology?
Speaker 2:I've been involved in several startups before this one and I have been around startups for now a decade and I feel like there are people that get very attached to what they first designed and they don't really want to leave that course. And you really have to like punch them in the face with something in order for them to be like, oh, okay, great. So that's not really working or that's not got great product market fit or we can't get this going and they're not like willing to pivot. I'm the exact opposite of that. Every single like month I'm looking at is the value of what we give to our clients the thing that we think it is or is the value over here?
Speaker 2:And so I think staying in close connection with your clients is key to that. In staying in close connection with our clients, radiology, of course, like we talked about was a huge problem. But the gap that we identified as we went through this journey with our clients was that radiology is just one point of care that has that care gap. I would say that the system doesn't fail at detection, it fails at what happens next. And so we kept hearing this over and over and clients were coming to us and kind of pushing us in a direction, which I love.
Speaker 2:You'd rather be pushed in a direction or pulled along in a direction, than to create something in your mind and then have to go to market and test it. And so where clients were pushing us is, oh great, this same radiology problem where there's an abnormal result and you have multiple care members that need to be notified and you have a patient in the middle and this all has to be navigated together, we have that same exact problem in cardiology with heart failure and with AAA management and with coronary artery calcification. And then we have that same exact problem laboratory which the patient comes into the ER, gets labs done or microbiology and then days later sometimes those labs come back and now we have to do something with that information especially if it's abnormal. We have the same problem with pathology. Pathology is very similar in how the radiology report is dictated by a radiologist, the pathology report is dictated by a pathologist.
Speaker 2:So it could use all different sentence structure, all different words, they're all saying the same thing, but it needs a different guided and directed path. And so once we realized that last mile care orchestration was really the gap, we realized that this isn't a radiology problem, this is a systems problem And can we be the platform that solves this at a system level and a platform that really takes what we've learned in radiology and now applies it towards all of the different places where patients are falling through the cracks within the health system. And that's really how we got to where we are today.
Speaker 1:Founders and operators get pulled in a lot of directions. You mentioned customers ask for things, the market is moving, and now with AI, it's easier than ever to just go build. But not everything's worth building. How do you decide what actually makes it onto your roadmap?
Speaker 2:Yeah, I had a mentor a long time ago that said to me, like deciding what not to build is the more important thing and takes the most discipline. And that's where most companies get lost. It's taking client feedback is really important but not doing everything that they ask you to do, if that makes sense. A lot of times clients don't start with the problem, they start with the solution and they come to you and they're like, here's what we want you to build. And I always take them back and I've taught our client success team to take them back.
Speaker 2:And really what we only want to know from them is what are the problems? What are we trying to solve? And then asking those why, why, why, why, why questions until we get to the point where we truly understand the problem. Then we can look at it from a technology lens and apply things like, is this a pattern? Do all of our clients face this?
Speaker 2:Is this commercializable? Does this solve to our four value pillars? Our four value pillars that we have like, like staked the claim on are number one, it has to solve a massive patient safety gap. Number two, it has to mitigate health system liability and help clinicians better take care of patients. Number three, it has to drive its own ROI.
Speaker 2:There's too many red tape scenarios in which people are waiting for reimbursement or waiting for the FDA or waiting for I'm like, no, it has to drive its own ROI. We can't be asking them for money and basically being a drain on a system that's already drained. And number four, it has to be staff neutral, meaning I can't require any more staff than they already have today to do what we're asking them to do with the new, with the new data. And so when I look at client feedback, we look at it in those lenses. We look at it from all of those different perspectives to decide what are the patterns, does it hit all four of our marks, and how closely aligned to our product roadmap is it.
Speaker 2:It would have to take pretty substantial effort to to pivot us off of that.
Speaker 1:That's a very strong framework. I'm curious. Is there something you chose not to build that was actually tempting but not quite aligned with your framework?
Speaker 2:So there was a ton of companies out there. There was client feedback that like the translation of a radiology report into patient language was a feature and functionality that multiple of our clients asked for. But the way that they asked for it, they sent us other companies that were doing it and they basically were like, do this. And I looked at that and I was like, but is that really what you want? The problem that you're trying to solve is that number one, the twenty first Century Cures Act back in 2021 dictated that a patient result had to be put into their MyChart, their patient record within twenty four hours for the patient to be able to view.
Speaker 2:The data was theirs, right? That was the parameter for that. What that ended up doing is a lot of health systems are now dropping medical reports like a radiology report that's written by a radiologist for another doctor to read and it's all in medical jargon. And a lot of it looks super scary and it's not even saying a scary thing, it's saying that you have a completely normal read, but all of the words look very scary to a patient. Everything that they sent to me was just translating one report into basically another readable report.
Speaker 2:And I was like, but that's not really how we consume data now as people. How do you consume data, James? You go to social media, you watch videos, you go to LinkedIn and you watch little segments and like little clips and everything is very interactive and it's either in a 30 segment video on Instagram or it's on a 60 segment video or it's in, you know, we're in these time crunches, right? And that's how our brains now are wired. So I was like, what if we could create these like real style videos that explained with video, with interaction to a patient in real time what their results were?
Speaker 2:Like isn't that better than reading a report? And so I didn't design what they wanted me to design. I didn't just copy what else was out there on the market. I rethought how we as consumers are doing things and applied that towards the problem that they were really trying to get at. And then right under that video is now a quick LLM based like system where they can ask questions like, Oh, blood nodule, that sounds super scary, do I have cancer?
Speaker 2:And you can interact and now with your relevant information, you're now interacting with a tool that's helping you understand your own care. I think something like one in four chattypt threads from people is on their health care. That should say something big to this nation That they're not going to their doctor anymore. They're not going to Google anymore. They're going to LLMs.
Speaker 2:So the more we can create a guardrailed LLM system that deals specifically with this personalized care from their report and their information, the more interaction and engagement we're going to get with patients within the health system. And then the next layer down is them interacting to schedule whatever their next step is. So create that action, create that plan, and engage the patient in their own healthcare system. So it's not that I said no to it. I just said no to what they were asking me to build and I designed it in a way that I felt like the market really needed.
Speaker 1:From the outside, healthcare looks like a massive opportunity. From the inside, it's a very hard system to change. What's been harder than expected when it comes to adoption?
Speaker 2:I think that selling into health systems, yeah, you're right. Investors and in general, everybody looks at the total addressable market, the TAM of healthcare, and they're like, it's a billion, billion, billion, gazillion dollar industry like that. We just need to produce products that go into that. So then why is it such a hard market to sell into? And I think selling into health systems isn't hard because people don't see the value.
Speaker 2:It's hard because nobody owns the problem end to end and there's so much siloed like pieces and process within the system and there's so very little governance right now in the health system that it is really a challenge to number one get attention and just have them understand your product. Number two, once you have the attention, get prioritized, right? Because they're like a squirrel. The little tools and widgets that are passing them by on the daily, they're like, oh, squirrel, squirrel, squirrel. So how do you get prioritized within a system that is just bombarded with tech and AI and noise and you need this, you need this, you need this.
Speaker 2:And at the same time, they're just trying to take care of patients and like do what they're made to do. So like getting prioritized is number two. Then you get prioritized at number three, you have to go through this very limited or what I'm going to call congested governance where it's like you could go through 16 committees, everyone could say yes and you get to committee number seventeen, one person says no and it shuts down the whole thing. And it's like what? What?
Speaker 2:What just happened? Like out of all of these people everyone said yes and one person said no and it shut down. So that's just like poor governance, decision making. And then at the end of the day, driving value to the health system has had a lot of dependence on getting attention from medical staff to do the thing to drive the value, which we know is a problem. Staffing in hospitals is a problem no matter where you are in the health system.
Speaker 2:So those four or five core challenges are really why healthcare is tough. They're notoriously a decade behind.
Speaker 1:Another place where things are behind is care coordination. There's a lot of talk about coordination and workflows. When you say care orchestration, what do you mean?
Speaker 2:Yeah, so when you go to the health system today, let's say that you go in through the ER, something's wrong, you're in an emergency situation, you go in there, they do labs, they do imaging, they figure out like, oh, James, you have acute appendicitis and we gotta take you to the Operating Room right now. So now that ER team is handing you off to surgical team, right? And now you're going in hospital. That's your first transition. And transitions are where information is lost, it's where mistakes made, and it's where basically you have your highest risk within the health system.
Speaker 2:So now you've had surgery, your surgical team is like, you're doing great, James. Now we're gonna discharge you out. Now on discharge, now you're going back to your primary care doctor. Your primary care doctor might not even know that you were in the hospital, right? So now you might have a surgical appointment post op, but let's say now you have another issue.
Speaker 2:You don't know if it's related to the original surgery or you don't know if it's a new issue. So now you go back to your primary care doctor. You've just made like three transitions in there. All of which if you ask any one of those care team members, do you own the care for James? They're going to be like, no.
Speaker 2:The ER handed you off to surgery, surgery handed off to primary care, primary care fell out of the loop because they weren't in your last care setting. They might not even be associated with your hospital. And so who's owning James? Like who owns what we call care orchestration for James? Which is why this is one of the biggest struggle in the whole system today is transitions of care.
Speaker 2:You have a lot of integrated care and delivery networks that have been popularized over the last three decades but still nobody like owns James care and so therein lies like the problem. When I say care orchestration, I mean is there somebody looking out for James? Like think of like the old world like community based doctor that like would come to your house and like knew everything about you, your family, your living situation. Like we just don't have that continuity of care anymore. So we have to create it, right?
Speaker 2:We have to create it with tech, we have to create it with layers, and we have to use the humans in the loop at the right time and make sure that all of the knowledge is transferred at the same time. That's a really difficult thing to do. Transfer the knowledge from ER to surgical, surgical to PCP, PCP back to orthopedic surgeon, orthopedic surgeon back to somebody else that's on your care team. Those are the care orchestration layers that all kind of demand attention right now. And that's why Inflow feels like that's our value edge right there to help the patient through that and help the providers have the right information at the right time.
Speaker 1:And you're doing that beyond radiology now. Let's talk about that.
Speaker 2:Yeah. So the second I'd say ology that we launched was cardiology because in cardiology, it's a very similar path. It's like, well, you have some kind of imaging, maybe an echocardiogram done. You have different levels of heart failure, whether it's new, existing, worsening, and you need to go, let's, you need to go somewhere within the healthcare system. Where do you need to go at that moment?
Speaker 2:As you know, if you've ever gone to one of our ERs in The United States, the ER is definitely not the place that you want to go, right? So then what did we do? We created urgent cares and urgent cares were to try to take some of the burden off of the ER. And so within heart failure, now we've created what's called a heart failure clinic so that we don't have our heart failure patients going to the urgent care or the ER, which hospitals get negatively pinged for based on CMS and reimbursement. So basically, and then you go back one more layer and you have the cardiologist.
Speaker 2:So where does that patient need to go within the health system, another care orchestration use case based on what their finding is and if it's new, existing or worsening. We do the same for AAA management. So if you have an abdominal aneurysm, a lot of times it's stable, it's not causing any harm or symptoms, but it can be deadly. And so watching that over time to make sure that it's not progressing and that symptomology is not associated with it is something that we do across the longevity for that patient. And then coronary artery calcification, which is a super cool use case.
Speaker 2:In imaging today, you can actually have a coronary artery calcification score done. So let's say that your doctor wants you to go in because he's trying to rule out pneumonia. On that CT, you can now have a coronary artery calcification score done at the same time. And they're like, James, great news. You don't have pneumonia, but you do have a lot of calcification that we're concerned about and we think that you should run this additional test.
Speaker 2:That's wonderful, right? You're exposing me to radiation, you're doing a test anyway, give me more information. So what we do is we combine that score with what we know about the patient from the medical record and then we help navigate that patient in the right direction, whether it's back to the PCP or whether it's to a new cardiology consult or whether it's to interventional cardiology. So again, it's all about that care orchestration layer and making sure that because of a result, patient is getting to the right level of care for what their needs are at that moment.
Speaker 1:And healthcare problems can sit in the system for a long time before they get addressed. How do leaders know when a coordination problem has gotten too big to ignore?
Speaker 2:Oh gosh. I feel like they all know that the coordination issue has gotten too big to ignore. I'll tell it an example from one of our health systems. When we were in, basically, contracting with one of our health systems, they told us what their annual volume of imaging was. And it was about 3,000,000 images per year that they were doing in all of their different care settings across all of their different hospitals.
Speaker 2:And so they looked at a staffing model to see could we just solve this with humans? Like do we just need to hire more people? And basically they decided we would need to hire 19 people in order to do this with a human model. 19 people for them, as you can imagine, was millions of dollars when you do all in expenses on 19 people plus a management team plus all of the structure and organization. So they came to us and they were like, can you beat this?
Speaker 2:Can you do this with minimal resources so we don't have to rely on the humans for this? So they knew what the problem was, right? The problem had become so big that they knew they had to solve it. They tried to solve it with people, they couldn't. That number was so exorbitant plus they told me, we can't even hire those people, they're not even there.
Speaker 2:So that's when a problem becomes so big was when they literally looked at the problem, they realized they needed to solve it, they realized they couldn't solve it with humans alone, and they decided to do a hybrid model between tech and human.
Speaker 1:A lot of organizations are trying to do more with less. Technology can enable that, but in my opinion, it needs to be done responsibly and with humans in the loop.
Speaker 2:Anyone who says that they're out there doing autonomous AI for healthcare, I'm like, really? Isn't that what we want? Do I wanna walk into a room with a computer and talk about my healthcare? Like, no. I really don't.
Speaker 2:I want a human interaction. So knowing where you need to use your humans and your empathetic care and knowing where you you can use technology is really, I think, the brilliance of organizations today that are doing it successfully.
Speaker 1:Angela, thank you for coming on and sharing. We appreciate you joining us on The Scopewell Podcast.
Speaker 2:Thank you so much, James. It was a pleasure.