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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.
Dimitri Fane [00:00:00]:
What they need are solutions that are easy to understand, easy to implement and easy to use. We hear all the time one of our customers in the UK whos a doctor, I speak to him often and he always talks to me about what he calls the 04:00 a.m. test and thats I need to be able to use the system at 04:00 a.m. when I havent slept for 24 hours and ive got a sick child in front of me. Thats a really eye opening way to think about product design actually, that you need to build a product that you can use in that situation without causing further harm.
Speaker B [00:00:31]:
Welcome to Rarefied Air. Stories of inspired service our host, John Paladino, head of client services at Inner Systems, 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 [00:01:00]:
Welcome again to Rarefied AiR. I always bring in people who inspire me to these podcasts and today I have a very inspiring person, Dimitri Fane, who I've known for quite a long time. Dimitri inspires me in so many different ways. He's adaptable, he deals with challenges. Yeah, head on. He knows a lot, knows a lot more than me, that's for sure. And today we're going to talk about supporting really, really complex customers and we'll also talk a bit about, hey, how AI can help. Welcome Dimitri.
John Paladino [00:01:35]:
Tell us a little bit about yourself.
Dimitri Fane [00:01:36]:
Thanks. That was quite an introduction. You've been inspiring me for 25 years now. Just for the record, the feeling is absolutely mutual.
John Paladino [00:01:43]:
I think, well, you should start a podcast.
Dimitri Fane [00:01:46]:
Maybe I will. I started working for you, I think 25 years ago, and much of what I've learned, I learned from you. So thank you for that. But so, yes, these days I actually live in Australia and I run arth track care product business, which is our international EHR. We support in 29 different countries.
John Paladino [00:02:04]:
So tell us about supporting complex customers. We're supporting an EHR and Dimitri, by support I don't mean product support. We can talk a little bit about that, but the customer doesn't care about a department. They care about the partner that they pick and how that partner works with them. So what are some of the challenges? And maybe you can characterize the customers too, because I think they're pretty diverse in size and specialties and so forth.
Dimitri Fane [00:02:30]:
Yeah. So the customer base is diverse in all kinds of ways, both geographically and by size and complexity. But we do tend to skew. I think healthcare in general is just a complex business, and we skew towards the complex customers in healthcare. I do think what you said at the beginning is very true, that customers want to work with a company. They don't. And I'm constantly reminding our teams that whether you're in support or product or development doesn't really matter. You're there to represent inner systems, and you need to represent that view and represent what the company does.
Dimitri Fane [00:03:02]:
We span, really, the gamut from entire countries down to chains of private hospitals across regions of countries.
John Paladino [00:03:10]:
And what are customer expectations? Do you see a common theme in terms of what customers would like?
Dimitri Fane [00:03:15]:
The customers expect us to be the experts to take them on the journey to lead them. They're the experts in providing healthcare. We're the experts in technology. We have lots of healthcare expertise as well. I think probably about 60 70% of my team are clinical, actually, and not technical. So we bring plenty of clinical expertise. But it's not direct patient care clinical. It's how do you translate the technology to solve the problems for the hospital?
John Paladino [00:03:41]:
And do you see expectations different in different countries?
Dimitri Fane [00:03:45]:
I would say that there's different levels of digital maturity. So in some countries, like the UAE, comes to mind. It's an incredibly digitally mature environment, and everything happens on people's phones. They're similar in China.
John Paladino [00:03:58]:
All.
Dimitri Fane [00:03:59]:
There's no cash anymore, all payments are electronic, and that sort of translates through the whole culture. So there's definitely areas that are more digitally mature than others. But I think the expectations of a solution that solves their really complex healthcare problems is pretty uniform across different countries.
John Paladino [00:04:16]:
What pressures do you see on the customer organizations? Yeah, healthcare complex is complex. The profits for those that are private are very low, extremely low. So they have all kinds of pressures. How would you characterize the pressures?
Dimitri Fane [00:04:31]:
So the pressures are huge, actually, and particularly coming off of the high point of the pandemic. We're still feeling the impacts of the pandemic. It's absolutely not over. And I see, particularly in public healthcare systems, there's this tremendous backlog of waiting lists of people who need procedures. They still haven't gotten through that waiting list. So the NHS talks about this concept of a care deficit, which is like a financial deficit. They have both, as it turns out. Yeah, I'm really fascinated by that term.
Dimitri Fane [00:05:00]:
And they think in terms of the same way you think about a financial deficit and the things you need to do to make up that deficit. There's a care deficit and pretty much uniformly across public and private. I think we're seeing a care deficit and lots of effort to make up that deficit.
John Paladino [00:05:14]:
So I recently read that turnover for clinicians, it's pretty much worldwide, is about 30%, which seems really high. Our turnover is about 6%. So maybe im a bit biased, but 30% sounds like a huge challenge in itself.
Dimitri Fane [00:05:29]:
Trey, I think, again, the pandemic made all of that worse. Its the combination of its actually both the care deficit and the financial deficit. I think were hearing a lot about clinician burnout, both with doctors and nurses. Its really bad in some cases, and theyre almost sort of traumatized. Theyre just completely overwhelmed and unable to keep up with the task. And I think thats one of the things that really drives us to try and build systems that help them.
John Paladino [00:05:53]:
I'm sure they don't welcome new technology while they're busy just trying to get things done. Sure. They don't see the benefit of it. So is that a challenge for you and for others?
Dimitri Fane [00:06:05]:
Yeah, absolutely. I mean, it's a challenge for me in terms of supporting with our technology. It's not as much of a, it's a challenge for our implementation teams who are directly in there. And that's sort of the classic thing where you're too busy to pay attention to the thing that's coming along that's actually going to help you. I think it's our job to lead them down that path.
John Paladino [00:06:23]:
So the customer is complex, as healthcare is complex. They're incredibly busy. Technology is probably not at the top of their list of things they want to do today. So how do we navigate through that to really make them successful and happy?
Dimitri Fane [00:06:40]:
To me, executive involvement and focus on change management are really the keys because these projects are done to achieve an organizational goal which ultimately supports the users. But they, we don't necessarily address the individual pain point for every user. And so that leaves this gap between what the organization's trying to accomplish and what the people on the front lines are dealing with every day. And it's incredibly complex. It's not an easy thing to work through.
John Paladino [00:07:08]:
So what are some of the, I was going to say demands, but it's probably the wrong word. What do customers need from us?
Dimitri Fane [00:07:15]:
What they need are solutions that are easy to understand, easy to implement, and easy to use. We hear all the time. One of our customers in the UK who's a doctor, I speak to him often and he always talks to me about what he calls the 04:00 a.m. test. And that's I need to be able to use the system at 04:00 a.m. when I haven't slept for 24 hours and I've got a sick child in front of me. Wow, that's a really eye opening way to think about product design, actually, that you need to build a product that you can use in that situation without causing further harm.
John Paladino [00:07:45]:
Dimitri, every podcast we have to talk about AI at least a little bit. So with all the complexity and the customer's dealing with, without any type of technology or EHR, and then the challenge to make it really simple for them to use the four Em test is a great analogy. I love that. How do you see AI fitting into a future roadmap of possibilities?
Dimitri Fane [00:08:09]:
I think those of us who work in technology are used to these trends that come. And every year there's a new buzzword, whether it's blockchain or whatever else. I would say AI in general, and generative AI in particular to me is the first one of these things that I find incredibly compelling. And I think it's going to actually change everything we do.
John Paladino [00:08:29]:
Wow. Do you have any examples? Do you have a vision of what's possible?
Dimitri Fane [00:08:33]:
Yeah. So I think what we're really focusing on right now is its impact on the user experience, its ability to make complex things simple. And the way I think about this in terms of the clinicians is for years now, the EHR industry in general, nothing to do with us in particular, has kind of forced them to work in a particular way to get the data into the system that we need to drive downstream systems. So you need that data for revenue cycle, you need it to send orders out to your pharmacy and so forth. And historically, we've forced the users to think like a computer. We build these screens that have drop downs and radio buttons and workflows, and click, next, next. And I'm really proud of what we do, and I think our application is as intuitive as any of them, but it doesn't really match the way the real world works. And I think that's where generative AI is going to change the world for us.
Dimitri Fane [00:09:23]:
I think it enables us to build solutions where the users can just speak naturally and ask questions and say things, and we can capture all of that. And our job as an EHR then becomes taking that messy reality of life that can include photographs and video and handwriting and anything else, and turning it into those structures invisibly under the covers that then drive those downstream operations.
John Paladino [00:09:46]:
Those are great examples. Speaking of that, I have a friend who's an emergency doc and his workflow is he'll write down vitals and problems and all the things a doctor cares about on a napkin.
Dimitri Fane [00:09:57]:
Right.
John Paladino [00:09:58]:
And then at the end of the shift collects all the napkins and puts it in the system. And AI could help with that, right?
Dimitri Fane [00:10:04]:
Absolutely. I mean, I think we're really seeing almost like a democratizing trend here because there have been very highly specialized optical character recognition systems and things like that for years. But it's becoming much easier to implement with generative AI. So that's a great example. That doctor ought to be able to just continue doing what he or she does and then take a picture of that paper towel. And then the Behr should be able to unpick that and figure out, this is an order, this is an allergy, this is a lab test and tee that all up. Not automatically. You always need the human in charge.
Dimitri Fane [00:10:37]:
Really? We heard that earlier today, this concept of human in charge, or human in the lead rather than human in the loop, but you always need to validate it. But I think we can make it much, much easier.
John Paladino [00:10:47]:
So there's also the counter side to AI. I'll give you a quick example. So a while ago I had Malano, they dealt with it fine. I went for a follow up and I asked the doctor who was young, I said, whats the possibility its going to come back in, say, seven years? He pulled out a book and he started telling me the statistics. I was like, forget it. So I can imagine AI could do the same thing and give a little bit too much information thats going to make the patient or the patients family really worry. So how do you balance that?
Dimitri Fane [00:11:20]:
So I think that's a general issue that the whole industry is kind of struggling with now. So we're defining use cases and how do you keep the system working along those use cases. So if you build a chatbot into an EHR, for example, your first thought isn't necessarily how do you prevent the user from asking certain questions? But actually we don't want to provide a system that tells doctors how to treat patients. That's not our job. Our job is to optimize the system they're using and provide them with the answers. So we're looking at ways of building, probably also using AI, maybe a second channel of AI, monitoring the conversation and certain kinds of questions. You redirect that to a different service. It might still be AI, but there's clinical content companies out there that are building AI around validated sets of medical papers, for example.
Dimitri Fane [00:12:08]:
So we're not the ones who are going to answer your medical questions. But there are companies out there we can partner with who will be able to answer medical questions.
John Paladino [00:12:15]:
Interesting. So what I see with complex customers, not just in healthcare, the top two things they want from us is adaptability, whether it's adapting to help them train their staff, or adapt them with new features in a product or different way of doing things, or simplifying that type of adaptability and responsiveness. Do you see AI assisting in those areas?
Dimitri Fane [00:12:39]:
Yeah, I do. I mean, one of the things that we demonstrated this week with the health share product was this idea of composable screens built by generative AI. This is a user saying, build me a table that shows these columns and we can dynamically, the AI can build that table and produce really nicely formatted output. I think that leads you down a really interesting path. There's a lot of research that personalization from an EHR point of view is incredibly important and one of the leading indicators of user satisfaction. The more personalized the system is, the more it matches your workflow, the more satisfied you are using it. I think there's a future where users can really design their own screens, in a sense using some of the tools we've seen from generative AI.
John Paladino [00:13:23]:
Well that sounds great, and also a bit risky too.
Dimitri Fane [00:13:26]:
It depends what your system's doing. In terms of the system, I work on track care. We do have to be very, very careful in how we present data because there's regulatory things you don't want to show lab tests without reference ranges and things like that. For us it's more about assembling pre existing building blocks, not necessarily writing UI from scratch, but saying when I select a patient id, like to see the problem list and the lab results, and maybe I dont really care about this other piece of the record because of my particular clinical specialty. So its more of like putting the puzzle together in a custom way for each user.
John Paladino [00:13:58]:
Thats great. From a product support standpoint, were using machine learning and a little bit of AI at this point to try to be more responsive and were measuring how that's improving and it's helping. So an incoming issue comes in, we can find similar issues immediately. So whoever's assigned to that issue might have a shortcut to be able to get to the answer faster. We're also doing that with documentation and training and trying to bring all three of those together. So yeah, I think it's going to be an interesting journey and efficiency, not cutting staff, but just making staff more effective and responsive and happier staff too, is always good.
Dimitri Fane [00:14:38]:
No, absolutely. I mean, I think that's the general road we're going. And think back to that phrase of the care deficit. It's not about eliminating staff, it's about freeing the staff up from the non clinical work they're doing to allow them to focus on that care deficit.
John Paladino [00:14:51]:
Yeah. At the end of the day, what matters is, does the system help them do their job better and safely? So, Dimitri, the complex customers we're talking about, and again, this is not just in healthcare. We have a lot of others, supply chain, financial services, customers that are large and complex. You can't just have a customer success manager and expect everything to be okay. So in your experience, what would you recommend for the type of engagement, both in terms of people and process of engagement with a large, complex customer?
Dimitri Fane [00:15:24]:
Yeah. So you absolutely need to match the right people on the vendor side with the right people on the customer side so that you can share information openly and lead the customer. So in our world, in the EHR world, I'm very big on our clinical executives. We have these teams around the world, and we have them in each of our regions who are experienced clinicians, but also experts in our products. And their job is to build relationships with the chief medical officer, the chief nursing officer, the people who are really running the clinical side of the hospital and help them translate our products into the way they work. And it's really a key role because it's not particularly technical, but it focuses on clinical adoption. And one of the things that we find, and I think the whole industry finds is deeper. Clinical adoption also leads to better user satisfaction and better outcomes for patients.
Dimitri Fane [00:16:12]:
So actually using the system that, the way it was designed in the right way, and that's really key for us.
John Paladino [00:16:17]:
An it to clinician, I would imagine, is probably friendly, but not very effective.
Dimitri Fane [00:16:22]:
Yeah, I mean, it can be, but you can also. Part of the problem with that is if the it person just does whatever the clinician asks without questioning it, because they wouldn't, because they're not clinical, you wind up with a custom solution that maybe doesn't solve the problem in the right way. Whereas if you're approaching it from a clinician to clinician conversation, you can solve the problem in the right way.
John Paladino [00:16:42]:
It's an example of understanding what the customer needs rather than what they want.
Dimitri Fane [00:16:46]:
Absolutely. Oh, that's so key. That's the key to everything, is to solve their real problem, not necessarily what they ask for. On any given day, are there any.
John Paladino [00:16:54]:
Stories about, are people engaging with customers?
Dimitri Fane [00:16:57]:
Yeah, I'm very big on our product teams getting directly involved with customers. It's an unnatural thing in some ways, interestingly enough, because we have implementation teams, support teams, customer service teams. So sometimes I have to actually push our own people quite hard to jump over all of those hoops. But it's incredible how much you can accomplish by a 1 hour face to face conversation and you really get to the real problem very quickly.
John Paladino [00:17:22]:
Yeah, I'm a strong proponent of putting a developer on site with a customer when there's some complex problem or need or something's just not working right, developer's going to figure it out and maybe you need a clinician there to give it context. But direct developer engagement, I think is key.
Dimitri Fane [00:17:39]:
Yeah, absolutely. And it's even important when it's a problem we can't solve because let's face it, sometimes you can't fix everything. Healthcare is incredibly complex and there's some things that just are just sort of beyond the nature of what we do. And having those conversations in person makes all the difference, rather than just an email coming back saying, no, we can't do that.
John Paladino [00:17:59]:
So to sum it up, it's tricky because it's really opposing forces. You have the customers complexity, all the pressures on them to serve patients, us coming in with technology, trying to help, and you have to make sure things get aligned.
Dimitri Fane [00:18:15]:
That alignment, change management leadership on both the customer side and the vendor side is absolutely key.
John Paladino [00:18:22]:
So just how would you summarize a strong partnership? Maybe you have examples without naming customer names, but maybe you have examples of where strong partnerships are really working and why.
Dimitri Fane [00:18:35]:
Yeah, I think it comes down to trust, really. Trust is the key where we have, and I'm incredibly lucky, I suppose, to have a number of really strong partners amongst our customers and its trust that builds up over time. They need to learn that we will deliver. Were not going to nickel and dime them on everything. What im always saying to customers is their success is actually the thing thats most important to me on a short term basis. If it costs us a little bit of money to solve a problem, thats okay. Their long term success means theyre going to tell their friends, tell the market, and its going to eventually be a good thing for us in the long run. So building up that trust that were going to actually solve their problem that well listen to them is really the key.
John Paladino [00:19:14]:
Trey, and you touch on something. So were not transactional.
Dimitri Fane [00:19:17]:
We try very hard not to be transactional. When I see that happening, which its a natural thing, I really try and get involved and stop that.
John Paladino [00:19:24]:
Yeah. Nickel and diming does not cultivate trust.
Dimitri Fane [00:19:28]:
Absolutely not. And in the long run, its not going to move the needle for us either. It destroys the relationship.
John Paladino [00:19:33]:
I'm going to put you on the spot, Dimitri. What do you see a future customer, say a complex customer in five years as compared to today? What has changed in their world?
Dimitri Fane [00:19:44]:
I think the world is getting more and more complex, and so their world is going to be more complex. We're going to get much more specific medical treatments based on genetic data. That's a huge part of healthcare that we're going to see evolve rapidly with AI, much more targeted treatments. We're going to have to find new ways of supporting that. The volumes are not going to get any less. So the systems we build need to be smoother, easier to implement, easier to use, less implementation effort. We're really trying to reduce all of that friction so that we can get things deployed and get the customers to get value out of the systems they're investing in earlier.
John Paladino [00:20:20]:
Now you can see why I'm so inspired. Bonus question, Dimitri. Okay, so the relationship relies on trust, as you said, but you need leadership in the relationship. So what attributes for a leader in this complex type of relationship thats highly dependent on us? What type of leader do you think is going to be a successful leader?
Dimitri Fane [00:20:42]:
My answer may sound a little bit surprising, but one of the key things to me is the ability to say no in the right way. What I found in many, many years of working with customers is its actually okay to say no to them bad things if you say no quickly, not a year later, and you explain the reasons why, and I think customers will respect you and trust you more if you're better able to manage those conversations, because hopefully 99 out of 100 times we're saying yes. But it's those times where you actually need to say no because it's not the right thing for the customer, that you really need leaders who can do that.
John Paladino [00:21:15]:
So, Dimitri, I'm going to come back to the first point you made when you gave us a little bit of background. You said, we're in how many countries? 23 countries, 29 countries. So with the dependency on this relationship, the complexity of the customer, the alignment we have to have with people, having the right people, working with the customer, the right type of leadership, how do you scale that up?
Dimitri Fane [00:21:38]:
It's really difficult. And I guess the short answer is carefully and not quickly. We've seen this in the past with our company where we've tried to scale too quickly and we get into trouble so we're not actively, necessarily looking for new countries to operate, and we're very, very careful. We won't work with local implementation partners initially anyway. We'll use them to support our efforts, but we need to be there on the ground leading and managing the project. So we're very careful about entering new countries and we try and focus on controlled growth. You build some small success and then build on top of that, and by then you've got the local leadership team trained up to a point where you can expand. So honestly, sometimes it means youve got to say no.
Dimitri Fane [00:22:19]:
Theres one country were in now where were seeing really explosive growth and we could say yes to a lot more deals than were saying yes to, but were sort of keeping a lid on the number of deals until we build that solid base, because growing too fast can be a recipe for disaster.
John Paladino [00:22:34]:
Yeah, its a good point to add onto that. You never give up on optimizing too, right. You have to continuously get more efficient. When we started releasing software in smaller bytes, it really made a great impact because it freed us and the customer up from as compared to having a big, big bang type of release. So a continuous stream of improvements, that's.
Dimitri Fane [00:22:58]:
One of the big changes I'm most proud of, actually. We went with our track gear product from once a year, big monolithic releases that customers would adopt every two or three years to now we release every eight weeks. And so there's always not every, they're all cumulative, so you don't have to take every one. But it gives the customer the flexibility to keep up with our rapid pace of development if they like, or take a breather and let things stabilize. But they're dividing things into smaller chunks, makes it much easier for the customers to consume them.
John Paladino [00:23:26]:
Okay, summarize this part of the discussion. So don't over commit yourself where you can't deliver it to existing customers. Have the right alignment of people to support the partnership and make sure it's a vibrant, trustworthy relationship. And optimize, optimize, optimize.
Dimitri Fane [00:23:44]:
Absolutely. I would agree with all of that.
John Paladino [00:23:46]:
That's great. Dimitri, I love sitting down and talking to you in any context. And I knew having you on the podcast would give all the listeners the same type of experience I have. When I sit down, just chat with you, I learn a lot. You really inspire me.
Dimitri Fane [00:24:03]:
That's very nice of you today. This has been wonderful. It's been very natural and easy to talk, and it's really an honor to be here.
John Paladino [00:24:10]:
Oh, thank you so much for being here. I'm sure this was interesting to our listeners. Please give us feedback. Tell us what you like. Tell us what we could do differently. We enjoy feedback of all types. Dimitri Fane thank you.
Speaker B [00:24:23]:
Thanks for listening today. If you have any questions or want to hear from a specific guest, email us in anytime at inspired servicenorsystems.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.