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🎙 Welcome to Rarified Air: Stories of Inspired Service, a podcast that takes you on a journey into the DNA of InterSystems. I will be your guide as we explore how our unparalleled commitment to customer service fuels limitless human potential.
🤝 Join us as we dive into the culture of InterSystems and share the stories of the people who make it all possible - our customers, partners, and employees. From helping healthcare providers improve patient outcomes to powering the world’s most important institutions, we’ll show you how our dedication to customer service excellence is in rarified air.
Cathy Harris [00:00:00]:
If you compare it to Europe, it's like a tenth of the number of resources of healthcare practitioners to patient care. And there's also a very inequitable distribution of healthcare delivery in the private sector versus the public sector.
Intro/Outro [00:00:20]:
Welcome to Rarified Air. Stories of inspired service. Our host, John Palladino, head of client services at Intersystems, will use his 40 years of experience to show you how to build a successful customer service program and highlight stories of innovation with customers. Join us as we explore the past, present and future of service, from AI's promise to the enduring power of the human touch.
John Paladino [00:00:49]:
In this podcast, we talk about inspired service inspiration from customers I meet, inspiration from people I work with, inspiration from partners, and inspiration from people in my life. And today I'm really honored to have two special guests from a company called trifor. Trifor is T R I F O U R just in case you were curious. And I'm here in South Africa with me today. First, let me introduce Cathy Harris, who's the Chief Operating officer. Welcome, Cathy.
Cathy Harris [00:01:20]:
Thank you very much.
John Paladino [00:01:21]:
Give us a little bit of background for our listeners so they have some context. You've been with Trifor for 20 years?
Cathy Harris [00:01:27]:
No, I've been with Trifor for eight years. I've been in the industry for more than 20 years. I initially the sort of the biggest part of my career within a hospital group, a private hospital group in South Africa, which is really where I was fortunate enough to be exposed to the business of hospitals and healthcare. And that's been a great asset to me in terms of the delivery for and with TRIFOR health.
John Paladino [00:01:54]:
And from what I know about you, you're passionate about healthcare.
Cathy Harris [00:01:58]:
I am, very much, thank you.
John Paladino [00:02:01]:
And also with me is the Trifor CTO, Stephan du Plooy.
Stephan du Plooy [00:02:06]:
So I'm the CTO of the TRIFOR Professional Services unit. So my responsibility is basically to look after the architecture and design of the the systems we build. I've been involved with interSystems since before 2005, started as a cache developer in the early days, and I'm still very much hands on involved in the solutions that we built for both our internal and external clients.
John Paladino [00:02:33]:
Well, it's great to hear both the business aspect about what you're doing and making a difference, making an impact as well as the technological impact as well. Let's start with what's different about South Africa. And before we get into it, Cathy, I was in Indonesia about a month ago and there are 150,000 doCTOrs for 280 million people. So there are a lot of challenges. Private Healthcare is doubling the number of hospitals they have every two years. The government has initiatives to improve healthcare, but health equity is very, very important. How does that compare to what you know, I'm new to South Africa, I've only visited a few times. But how is that different to the market here?
Cathy Harris [00:03:15]:
Well, I think like most countries in the world, and specifically third world countries, there is an incredible shortage of healthcare professionals. I don't know what the ratio of doCTOrs to patients is, but if you compare it to Europe, it's like a tenth of the number of resources of healthcare practitioners to patient care. And there's also a very inequitable distribution of healthcare delivery in the private sector versus the public sector. So I think it is an absolutely inequitable system.
John Paladino [00:03:51]:
There are about 60 million people in South Africa, is that right?
Cathy Harris [00:03:54]:
60 million people, but a very small tax base. So your tax base is around about 8 million.
John Paladino [00:04:01]:
I may have this wrong, but somebody had told me that it was about 80% or a little bit more that don't have access to healthcare in South.
Cathy Harris [00:04:09]:
Africa, don't have access to private healthcare and public healthcare is very limited. There's too little in the way of the delivery of primary care. The hospitals are really poorly maintained. You don't want to see a public hospital in some of the areas. They really are very poorly equipped and maintained and a very low ratio of healthcare practitioners to patients.
John Paladino [00:04:39]:
So big, big challenge. Huge challenges, big demands, a lot of passion and extreme importance. Is there a myth about healthcare in South Africa?
Cathy Harris [00:04:51]:
I think the myth is probably that the delivery of healthcare is poor. Now that is a fact in the public sector purely not because people are not passionate or people don't care, but just because they're overwhelmed. Whereas in the private sector, I think our healthcare is comparable and better, I think, than delivery anywhere in any first world country. It is incredibly good.
John Paladino [00:05:17]:
Stephan, over to you. In terms of technology challenges and opportunities, is there anything that comes to mind and that's top of mind for you?
Stephan du Plooy [00:05:26]:
So I think for the future, integrations is still a challenge for us. We have this platform with all the capabilities to do integrations, but there's many third party systems that don't really support the type of integrations that we still need. So that's definitely an area that I see for the future that will grow to really get more better and full, complete integrations going.
John Paladino [00:05:50]:
So if you had complete integration, if that were possible, you can snap your fingers and it's all there. What do you do with the data?
Stephan du Plooy [00:05:56]:
So that's the other thing to actually use the data and present it in a way that it's usable and it improves patient care at the end. And getting back to myths, I think one of the myths is that an electronic or electronic health system will automatically improve patient care. And that's not true. So you have to tailor the system according to the customer's needs to be sure that you actually improve business functions and at the end then improve patient care.
John Paladino [00:06:25]:
So it's not just what we call electronic medical record system or ehr, electronic health record. It's the whole fabric of healthcare and the diversity of all the different parts of healthcare, pharmacy, payers, government.
Stephan du Plooy [00:06:40]:
Exactly. It's the full package.
John Paladino [00:06:42]:
So what do you see coming in the future? If you have that connectivity, the interoperability, and you have access to data that you can work with, are there any use cases that come to mind, what you would do with that data?
Stephan du Plooy [00:06:53]:
So I think one use case that everybody's looking at is obviously AI and how to get AI built into our systems. So if you have that data available and you can use the data, then how can you use AI to make the user experience better for the users using the system? And we already started playing with things like that, just maybe adding some guidance to the user or advice, just to see how we can incorporate that to improve the user experience.
John Paladino [00:07:22]:
Stephan, there's a view about health information exchanges. So you think if you have all the data, what can you do with it? What are the possibilities? Can you actually wade your way through the data to do something practical? And I want to tell a quick story about a customer that we work with in New York City called healthix. And we've worked with healthix for many years. But the most interesting story, I think is during COVID So during COVID the State of New York Department of Health wanted to understand how many patients were in hospital, how many were discharged, what medications they were on, kind of the routine thing that was happening around the world. The way that we're doing that is through surveillance, daily surveillance reports that every hospital had to feed up to the state. As you might imagine, hospitals were pretty busy. So the surveillance reports were late, they were inaccurate. In the end, they weren't terribly useful, they had some purpose.
John Paladino [00:08:17]:
But the health information exchange, HealthX, had 30 million aggregated patient records that was getting real time feeds from all the hospitals, all the labs, all the pharmacies, all the walk in clinics, everything around New York City, and in fact the lower half of the state of New York. And they were able to provide that daily surveillance to the state of New York. And it had a profound effect in terms of the efficiency and how they reacted as Covid was evolving and the needs were changing, and they had to move nurses and doCTOrs from one region to another to accommodate a tsunami of patients coming in with COVID and related problems. So once you have all the data, there are limitless possibilities. I'm wondering if you can imagine if you had all the data for South Africa, how would that help in terms of providing better care? Can you think of any cases where it might be applicable?
Stephan du Plooy [00:09:18]:
Well, thinking about it, that in South Africa, we really don't have that level of integration, so we don't have that sharing of information between different providers. So I'm sure there will be a real benefit to have it just for different providers to be able to see the history of a patient across the board. Currently, it's all in silos and different providers have their own records for each patient and there's no sharing. So I'm sure there's a lot of opportunities if we can get to that point.
John Paladino [00:09:46]:
Would it help with things like analysis of populations and outbreaks? If there's an outbreak in a certain part of South Africa, could it help with something like that?
Cathy Harris [00:09:56]:
Yeah, I mean, 100% it would. The problem we face in this country is that so much of the public health care specifically is paper based. I'll never forget years ago, myself and one of my colleagues had to go into an area in KwaZulu Natal to a hospital called Prince Moscheni. And at that time, there was a lot of unrest in South Africa. They actually took us in under armed guard.
John Paladino [00:10:24]:
Oh, wow.
Cathy Harris [00:10:26]:
Which was quite an experience. And we got into this hospital and there was just files everywhere. There were paper files in the bins, like on the tables. It was the most unbelievable amount of paper actually doing nothing for anybody. And you think about they create all these paper records. It's just incredible. So the shift has to come starting at the basics. Just capturing admissions in the hospitals is not available in some of our facilities, but in the public sector.
John Paladino [00:11:01]:
So my dream is maybe AI could help with that. Because one thing AI is really good at is taking notes and images and kind of things that aren't typed into a system and putting it into data that could be loaded into a system. So I think there's opportunities for innovation that could help us move from paper to the next level.
Cathy Harris [00:11:22]:
I think that's a huge opportunity. In fact, I think it's almost the silver bullet for bringing that information together and for making it useful for Patient care. And by being able to consolidate that information and start following trends and build patterns, you can start saving on resourcing. You know, you don't have somebody writing in a paper file all the time. And you actually, by using that information, can start actively managing rather than reactively. Because at the moment, what we've got, I think in healthcare in South Africa specifically, is sick care. It's reactive healthcare. We're not proactively managing patient care.
Cathy Harris [00:12:07]:
You know, if you were to look at things like wearables, you could surely integrate or we should be starting to look at integrating. And I know there is some initiative in this way, keeping patients out of the hospitals instead of in the hospitals. If they've got wearables, they can be monitored. So patient discharge from hospital a lot sooner, or maybe not even admitted to hospital, because that data is feeding back to a source that is intelligently consolidating it into something usable for the clinicians.
John Paladino [00:12:40]:
It's interesting you started a health information exchange type of organization here. Its table for the moment. It was in Japan not too long ago, and you would think in Japan, with all the technology they have and how effective things run in Japan, that they have this all figured out. But I had a meeting with the Ministry of Health and they were talking about how to share data, because in Japan in healthcare, nobody shares data. So they're wondering what government policies and incentives or penalties, but mostly incentives do they have to put in place to encourage the sharing of patient data. To do what you were saying, Stephan, to be able to aggregate it and use it for good purposes. And they're at the very beginning of this journey and they're looking at other countries, such as England and the US and other countries to see how they've accomplished it. So it's interesting.
John Paladino [00:13:38]:
I think all countries are in different places in this journey. Even in the us we still have a long way to go, but I think the direction is sound.
Stephan du Plooy [00:13:47]:
Yes, and I think that's what you're saying. So I think the main challenge is to convince the providers to see the value in sharing that information. If we can get private providers to see the value in that, then I'm sure projects like that will take off.
John Paladino [00:14:02]:
So let's talk about partnership, because you're under pressure from your customers and from what's happening in their community and things are changing. AIs come in. And how do you use that? For example, regulations change all the time. I'm sure they change here. And you want to develop your business, you want to continue to innovate and grow your business so you can do more for your customers. So for partners that you work with, and I'm not talking about my company specifically, but for partners you work with, what are your expectations in terms of that partnership today and how do those expectations change, say, over the next five years? Let's start on the busy side, Cathy.
Cathy Harris [00:14:45]:
All right, so if I refer to sort of our biggest business partner, which is Intersystems, obviously if we go back a few years, when I joined trifor, it was Cache at that stage and a very unknown quantity in South Africa, specifically the Intersystem office was new and we first had to sell cachet.
John Paladino [00:15:06]:
Cache is our data platform, which has been superseded with the next generation called iris. Just want to clarify.
Cathy Harris [00:15:13]:
So we first had to sell Cachet and then move on to what we actually do. It was an unknown quantity, but I think over time, as the presence of Intersystems has grown globally as well as locally, it is now an asset for us because people understand the interoperability that we get out of it and the fact that they don't need middleware for a lot of most of what we do because of all of that technology built into the database. And also it's an incredibly supportive partnership, which is what we expect and what we would like of all of our partners. So we, as I said at the beginning of the discussion, we are expanding into different areas because we can't be experts on everything. We're looking into areas like telemedicine, specific nursing care platforms, ICU platforms, and all of those. We expect the same kind of support that we give and that we get from our Intersystems partners.
John Paladino [00:16:18]:
So let me just replay that back and make sure I get that right. So for technology, it's basically staying ahead of what you need so that you have it at the right time. And from a business partnership standpoint, it's understanding what you need today and where you're heading and working with you. And sometimes that means in terms of supporting you and being responsive, sometimes it means understanding where your roadmap is going and your business needs and being there with you shoulder to shoulder. Did I get it right?
Cathy Harris [00:16:50]:
Absolutely, you got it right. Thank you.
John Paladino [00:16:53]:
Thank you very much. And Stephan, from a CTO perspective, what do you expect from a partner today and in the future?
Stephan du Plooy [00:17:00]:
Well, I think to add to support, support is a very important aspect for us since we run mission critical systems. Since we're in South Africa with the challenges we have here, we also have quite a big time zone difference between us and let's say the U.S. where many of the big corporations are. So we do have quite a couple of examples where we needed intersystem support and how the call was then handed over from time zone to time zone to ensure that we can get continuous service. So that is a very important aspect for us also to make sure that you have a partner that will evolve with the times technology change. So you can't stay stagnant. You need to change with times. And it's important to have that in your pocket.
John Paladino [00:17:44]:
Absolutely. Because the world around us changes. Right. I remember mainframes to many computers to PCs to Internet. Now it's AI. I don't know what's next, but you have to evolve together and adapt together and get through each of those transformations.
Stephan du Plooy [00:17:59]:
So to go back to where we started with the time application, when we started back in 2002, it was built on cache database with CSP pages as the user interface. And it was a standalone system. And as things evolved, things like integration became more and more important. So that's the nice thing. We could actually add those integration capabilities into our system and still use the same stack that we've used before. And that's because Intersystems as a partner grew with the features as time went by as well.
John Paladino [00:18:34]:
So, Cathy and Stephan, I want to bring it back to inspired service. That's what this podcast is all about. And let me share with you what I see changing in a couple of different ways within our customer base. And maybe you can then share some of the things you see changing too. It'd be interesting to see the comparison. So what I see changing is people want faster solutions. And it's amazing because we get fewer phone calls, everything is either by email or they log things directly, but even more so they go to other sources. Right.
John Paladino [00:19:08]:
So if I'm working on my car, you know, I go to YouTube, I don't read the manual. So we see that more of that type of behavior. So we're putting a lot more effort into having kind of do it yourself material out there for self help. And then security is the other dimension. Security is top of mind for everybody, not just in our business, but worldwide. So about 20% of our workload is somehow related to security. It's not all ransomware, something like that. It's how do I make my system more secure, what are good security practices, and so forth.
John Paladino [00:19:41]:
And that's caused us to rethink how we're organized, to be able to serve that and actually be much more proactive in working with our customers, in education, about Security, best practices, other customer experiences. And then of course we do have customers. Everybody has customers hit with ransomware. 30% of all businesses in Canada were hit with ransomware last year. They all had a security event which is amazing. And healthcare is being targeted. Lots of markets are, but especially healthcare. So that's what I see changing is, you know, more do it yourself, faster solutions.
John Paladino [00:20:18]:
Security is top of mind. What do you see changing, Cathy? And you run support. So in your business, what do you see? Is there anything that's different?
Cathy Harris [00:20:27]:
As a partner to our hospitals, which is our end users, we actually have to play a consulting role. So when you're going into a business, they need advice. If it's an existing business, there might be some business processes that have been there for 20 years and they're just there because they've been there for 20 years. And then you go and you think, why do you do this like that? Because we're doing like that forever. So we have consciously cherry picked our team from within the industry, so either from other vendors in the same space or people from a hospital background. And it really has paid off because I think it gives our customers a sense of kind of security that when we go in and we meet the executive specifically for the first time, that we understand their business and that needs to be carried over to every level of support within our organization. So when you talk to a customer, you need to understand what it is their business problem is. Don't go to the technical problem first.
Cathy Harris [00:21:37]:
Technical people we can find what we look for. Specifically on the first line support, second line support side are people who understand the industry.
Stephan du Plooy [00:21:48]:
To add to that, specifically from the professional services unit side, we find that customers expect us to be the experts in the domain when they contact us. And since most of our work is actually consulting services, we do see that support as part of the services we provide. So that is really important.
John Paladino [00:22:07]:
So that's one of the reasons I am inspired by trifor. It's one of the reasons I'm inspired by both of you and that's one of the reasons you're here to share this inspiration with all of our listeners. Cathy and Stephan, thank you for being here. This has been fantastic.
Stephan du Plooy [00:22:24]:
Thank you for having us.
Cathy Harris [00:22:25]:
Thank you.
Intro/Outro [00:22:26]:
Thanks for listening today. If you have any questions or want to hear from a specific guest, email us anytime at inspiredservice@innersystems.com and when you're ready to unlock the potential of your data and experience the transformative power of support done differently, go to innersystems.com.