Latest / CareTalk: Healthcare. Unfiltered. / Building a Smarter Healthcare Ecosystem w/ Vim CEO, Oron Afek

Transcript

Building a Smarter Healthcare Ecosystem w/ Vim CEO, Oron Afek · CareTalk: Healthcare. Unfiltered.

• 0:07
  John: Welcome to Care Talk, America's home for incisive insights into healthcare policy and technology.
• 0:13
  John: And we have a particularly exciting guest today to talk to about his healthcare journey, the journey of his company and what he's doing to improve healthcare outcomes.
• 0:24
  John: Through technology and through engaging some of the most, most, some of the most important caregivers and care practitioners caring for some of the most vulnerable people in our healthcare system Oron Afek welcome to care talk,
• 0:38
  Oron: John.
• 0:38
  Oron: Thanks for having me very excited to be here.
• 0:41
  John: So Oron, maybe it would be helpful just for our audience to understand a little bit about your entrepreneur.
• 0:46
  John: Well, tell, tell us, tell us a little bit about your company, but also maybe start with the entrepreneur after that.
• 0:52
  John: Tell it, talk to us a little bit about your entrepreneurial journey.
• 0:55
  John: Can you describe what your company does so people can understand what the promise of technology in healthcare really means?
• 1:03
  Oron: Yeah, sounds good.
• 1:05
  Oron: Vim is um, Vim is creating a marketplace.
• 1:08
  Oron: First of its kind marketplace for applications in healthcare.
• 1:11
  Oron: Um, simply put.
• 1:14
  Oron: Think about.
• 1:15
  Oron: The abundance of innovation Apple brought to the world with the app store and how easy it is for us to download an app that does something that is single point and very focused and solve a problem for us.
• 1:28
  Oron: Healthcare is more complex than that, right?
• 1:30
  Oron: A lot of single point solutions have failed to scale, uh, failed to get a critical mass, but also failed to be comprehensive enough.
• 1:38
  Oron: Uh, and so there's some sort of a bias in healthcare where, you know, I've been seeing this for the last 11 years.
• 1:45
  Oron: Only certain companies are able to break through and get to meaningful scale.
• 1:48
  Oron: And, and we're trying to create a world where, uh, we allow innovation to accelerate and democratize innovation further.
• 1:56
  Oron: So it's easier for people to build companies at scale.
• 1:59
  Oron: So what Vim does, it's been 11 years in the making.
• 2:03
  Oron: Um, we been able to figure out a way to put a hook.
• 2:09
  Oron: And to externalize and to obstruct all the different constituents that make a difference in healthcare for app builders.
• 2:18
  Oron: So we have pair connectivity, very robust one.
• 2:20
  Oron: We are connected with all day.
• 2:22
  John: I can try to, maybe you could describe how Vim is integrated into what doctors do every day.
• 2:29
  Oron: Yeah.
• 2:30
  Oron: And as you said, that's maybe an awesome piece.
• 2:33
  Oron: In order to influence healthcare decision, you have to be in workflow inside an EMR where providers are making decisions.
• 2:41
  Oron: They're seeing dozens of patients on a daily basis.
• 2:45
  Oron: That's for, that's for decisions that are being made, uh, versus let's be patient only kind of facing tools.
• 2:51
  Oron: So we had to figure out a way to meaningfully integrate into EMRs in a deep way that allows for bidirectional data exchange and application surfacing and do this across all EMRs because the market is, is, you know, below epic is pretty fragmented.
• 3:07
  John: And just for folks to understand, electronic medical records are the essential workflow tool for doctors and nurses.
• 3:15
  John: To actually manage initially really billing, I think financial finances, financials are kind of what drove it initially and then standardization from the federal government and now it's, it's an essential part of workflow, but it's really isn't.
• 3:30
  John: Wasn't originally designed to enhance what doctors and nurses and caregivers do in the clinical setting.
• 3:37
  John: It was really a billing, uh, a billing and documentation tool.
• 3:42
  John: And I think what's exciting about what you're doing at Vim, which your ambitions are, is you want to take that up a different level and really, uh, not just improve the technology, but enhance.
• 3:55
  John: That, that clinical experience.
• 3:57
  John: I mean, that's what I, I, I think about when I think about the promise of what, what, what Vim represents.
• 4:04
  Oron: Definitely, John.
• 4:04
  Oron: And I'd like to double click on what just said.
• 4:06
  Oron: There were designers building systems in a fee for service world.
• 4:09
  Oron: There was not been designed as a tool for value based care where there is interesting long term patient health in population health, uh, they were not designed as AI.
• 4:20
  Oron: Platforms or AI operating systems that were not designed, um, as purpose platforms that can integrate with third party solutions and to collaborate more broadly and, and we bring all of that into those clinical workflows.
• 4:38
  Oron: And so there is, again, there, there is a way to accelerate innovation.
• 4:42
  John: And how did you originally, like, what's the entrepreneurial journey that got you to founding and leading this company?
• 4:50
  Oron: Yeah, you know, back, back in the day, I was.
• 4:53
  Oron: Working on building a plot that my, my first, my first professional experience was special forces back in the Israeli military.
• 5:01
  Oron: And then coming out of that, starting a company is trying to build a way to allow developers to build once and deploy everywhere, uh, mobile apps.
• 5:13
  Oron: This is the pre that predates iPhone, Android, uh, you know, there's a very fragmented environment of operating systems, Symbian, Java, and so on and so forth.
• 5:23
  Oron: You may remember that.
• 5:24
  Oron: Um, so it was really tough to build an app across all those different devices.
• 5:28
  Oron: And, and we've been able to find, find a way to do it, um, in a scalable fashion across many different devices.
• 5:35
  Oron: Um, you know, I saw how our customers been using the platform and I remember the, the other year of being able to take 10 developers off the ground on the platform, a large mobile operator bought the company.
• 5:49
  Oron: And Steve Jobs announces the 000 developers kind of go off the ground in the first year.
• 5:55
  Oron: And you could see the power of, you know, not having huge middlemen in our case, it was large mobile operators, but, but having a direct connection between developers and, and consumers.
• 6:10
  Oron: And I think that was really powerful.
• 6:11
  John: Just to draw the through line there, you were looking to create platforms to simplify.
• 6:18
  John: And connect mobile devices, mobile phones were getting more and more powerful.
• 6:24
  John: The, the, the promise of the Apple ecosystem and honestly, the Android ecosystem is, well, we're going to, we're going to build, we're going to set, create a framework where then you, you can almost to your point about a market, a market of innovation that creates a, a, a clearer path that if you've got it right, you'd then be able to scale it across.
• 6:48
  John: Those platforms.
• 6:49
  John: And I think that the other thing that insight Oron that I think is not everybody had is that mobile was going to dominate that it was not just a, you know, a two way walkie talkie that you have a connected, you know, a loosely digitally connected or analog connected device in the military, you'd actually have, uh, a computer in your hand, but also a, you know, a, a, a sort of a most a, um, a connection factory.
• 7:18
  John: Uh, and I think that insight led you to kind of build what is, uh, hopeful, what is hopefully working as a connection factory, one of the most complex ecosystems in the industry, which is healthcare.
• 7:30
  John: And I think that insight that mobile was the future, because I think at that time, a lot of healthcare technology vendors were still kind of focusing on PCs and enterprise.
• 7:40
  John: And you were, you were, you were very focused on mobile.
• 7:43
  John: What do you think drove that insight?
• 7:46
  Oron: I think that similarly on the mobile side and what we are experiencing right now on the AI side, there's certain trends in the marketplace that just make you feel the world is about to change.
• 7:58
  Oron: You know, I think being where Where I'm at right now, you know, not the 20 year old anymore.
• 8:05
  Oron: I feel like I'm starting to have this pattern, more pattern recognition of like, you know, things are going to meaningfully change in a dramatic way.
• 8:12
  Oron: And the world's going to be the same and try to reimagine the world and how it's going to look like.
• 8:17
  Oron: But obviously, John, as, as you, as you know, better than me, healthcare has its own nuances.
• 8:22
  Oron: So, you know, we couldn't just apply Apple.
• 8:26
  Oron: In healthcare, we had to think about who are the real consumers, who makes the decisions of where the cost is going to be driven.
• 8:33
  Oron: It's, is it the patient or the physician?
• 8:35
  Oron: It's the physician.
• 8:36
  Oron: Um, that was one thing who is paying for healthcare.
• 8:39
  Oron: Is this the patient or insurance companies?
• 8:42
  Oron: Okay.
• 8:43
  Oron: It's insurance companies.
• 8:44
  Oron: So you have to bring all of these into the same sandbox to play together.
• 8:49
  Oron: And to some extent, I think.
• 8:51
  Oron: The 11 year in the making journey is, is all about trying to solve this chicken and egg and make sure everyone is playing in the same sandbox so we can actually provide developers with good value that, that was a, that was a big area of focus for us.
• 9:06
  John: And so, so maybe context to contextualize this, you've got this insight about mobile.
• 9:10
  John: You've got this insight about kind of distributed technology.
• 9:14
  John: You understand.
• 9:15
  John: The silos, if you will, of information and I'd say connectivity, but they're not of, of, of the way clinical workflow happens.
• 9:25
  John: And frankly, interactions happen in healthcare.
• 9:27
  John: If you think again, stepping back, looking at it digitally, it doesn't really make sense.
• 9:32
  John: If you looked at conventional supply chains or you looked at, um, normal distributions or workflow in a lot of other workplaces.
• 9:41
  John: You'd have standard information, connected devices, wouldn't really matter whether they're cloud, on prem, or mobile, uh, healthcare is much more fragmented, not, you, you've mentioned the different constituencies, maybe talk, maybe give a couple of examples of, okay, you've established this view of a platform, you understand the complexity of the system, you want to be connected, you want to be relevant and high impact.
• 10:07
  John: What is Vim actually, how does Vim actually impact a doctor or a doctor's practice today, a patient and a patient's care journey today?
• 10:17
  Oron: Definitely.
• 10:18
  Oron: So what, what we've done and what it allows us to do, and again, I don't think it solved the entire problem.
• 10:24
  Oron: I think either the government or local states will need to weigh in and solve another huge break, which I'm happy to talk about for just a second.
• 10:33
  Oron: But let's start with the technology.
• 10:34
  Oron: Think.
• 10:36
  Oron: We, we've been able to integrate with all those different payers and other risk bearing entities.
• 10:40
  Oron: So we can get access to patient data, also HIEs and other, other elements that allows us to get patient data to the point of care.
• 10:48
  Oron: And then we also been able to, um, normalize and understand different clinical workflows.
• 10:54
  Oron: And we put all of that into an SDK software layer that developers of all sorts, large and small companies.
• 11:02
  Oron: Can build on top and the promises, just like we did in mobile, it was built once and deploy everywhere.
• 11:08
  Oron: So this is now in turn, allowing developers to build applications, um, that were, I would say either impossible or really, really hard or expensive to build before.
• 11:18
  Oron: For example, surfacing open heat is gaps in care.
• 11:25
  Oron: At the point of care, allowing provider to take action, closing the loop for reporting with a payer, allowing the provider to get paid, allowing the vendor to get paid, and really have a closed loop ecosystem without the vendor need to figure out a 10 year journey into contracting payers, providers, EMRs, and building something that
• 11:43
  John: By the way, I'd almost, by the way, I'd almost say it slightly differently, the, the power of just providing all of the information at the point of care is not a small thing.
• 11:53
  John: The average patient wouldn't realize that their, their doctors are constantly doing rework except for the fact that they have to respond to the same questions every time they meet from a hall.
• 12:01
  John: And so that actually is a major gap that you are solving for.
• 12:07
  John: The SDK is the software development kit.
• 12:09
  John: What that means is by standardizing that platform and that access to information.
• 12:14
  John: You can actually create the opportunity for applications to be written and to solve basic problems like doc, getting the documentation, automating that, getting paid, and, but also as important for me, what's powerful is you've actually found a way to, to, to be part of the, of, of what the whereby workflow, what a doctor and a caregiver does every day, that's actually a much, again, another big, to your point about the 11 year journey gap.
• 12:41
  John: Yeah.
• 12:42
  John: In the way most applications and application developers think about that they, they, they solve for the problem, but not how to actually engage with where the problem is sort of emerges.
• 12:54
  John: And so they're adding a connection problem or a more complexity to a doctor's doctor's workflow.
• 12:59
  John: Um, and, and, and by helping a doctor, I think you're, you're eventually helping patients.
• 13:04
  John: I just wanted to connect it.
• 13:04
  John: In fact, I would almost say.
• 13:07
  John: You're, you're almost solving for the closed looplets that are, that are throughout the healthcare system.
• 13:12
  John: You're actually opening them up and connecting them.
• 13:15
  John: And that's a, a bigger problem for actually practitioners than probably most caregivers understand.
• 13:22
  Oron: Yeah, I agreed.
• 13:24
  Oron: And I think this will not be complete until payment folder is going to change and incentivize and pay physicians for taking action that is in line with patient longterm interests.
• 13:37
  Oron: Uh, and again, like I think technology can only get us, you know, to a certain extent, but, you know, just using companies you you've built personally built in the past, you have to get to a state of, uh, and, you know, Vim is not a MSO or a risk bearing entity, but, you know, we, we want to see more risk bearing entities, leveraging the technology to truly align incentive between provided and long term patient health and, and do this, not just for Medicare, do this for the entire.
• 14:07
  Oron: commercially, you know, commercial patients.
• 14:10
  John: And by risk, what you're talking about is healthcare on a budget, whether it's by disease state or a transaction or a bundle.
• 14:18
  John: And so But, but tell us a little bit about how's Vim doing right now.
• 14:23
  John: How, how have you done it, it's scaling and connecting the dots for practitioners.
• 14:28
  John: One of the things that impressed me early on with your company is you saw the whole system.
• 14:32
  John: You weren't just creating a, you know, an app for an individual diabetic or a, or an orthopedic surgeon's practice or how a health insurance company could bill and, and, and get documentation.
• 14:45
  John: You were actually looking at and connecting to all the different pieces.
• 14:49
  John: Um, That was great.
• 14:51
  John: It's 11 years.
• 14:52
  John: How are you doing?
• 14:54
  Oron: Yeah.
• 14:54
  Oron: You know, it's, uh, the last couple of years has been, um, very exciting for us.
• 14:59
  Oron: Um, after a long, and, uh, I would say up, up, kind of up and down type of journey.
• 15:05
  Oron: Um, we are installed today close to 50, 000, um, medical practitioners at the point of care.
• 15:13
  Oron: We're seeing around 23, 000, 000 patients in a given year.
• 15:16
  Oron: So 23, 000, 000 patient unique patient encounters.
• 15:19
  Oron: Um, and and we have something to say for most of those encounters.
• 15:22
  Oron: Uh, so close to 150, 000, 000 Americans are covered by the pairs that we work with.
• 15:28
  Oron: So there's.
• 15:29
  Oron: Good chance.
• 15:30
  Oron: We have something to say about a certain, a given patient, a given encounter.
• 15:34
  Oron: And we have close to 40 or so developers building on our platform right now.
• 15:38
  Oron: We only publicly published our SDK, our software developer kit, as you said, John, um, less than a year ago.
• 15:45
  Oron: So we are seeing some nice, nice uplift and kind of developers coming in building.
• 15:49
  Oron: And, and we, we have all sorts of companies.
• 15:51
  Oron: It could be a two people person building an AI scribe company, uh, you know, or, or a larger team, or even one of the largest, you know, Fortunate 20 companies building, building, uh, applications to, to influence provided decision
• 16:07
  John: making.
• 16:08
  John: So you're getting there on the platform piece.
• 16:10
  John: Uh, let me go a slightly different direction on what do you think the advantages are of being an Israeli American company that there's, there's been this, uh, really emergence over the last decade of great entrepreneurs coming from.
• 16:26
  John: Israel and attacking different aspects of the healthcare system.
• 16:29
  John: You're one of the leading ones that you were early on.
• 16:32
  John: And in this, in this, this, uh, kind of productive diaspora or connected community between kind of, uh, uh, Tel Aviv and Palo Alto, uh, that you're, I'm seeing more and more entrepreneurs who have similar.
• 16:47
  John: Backgrounds, uh, but are part of this incredibly productive ecosystem in Israel around technology in general and healthcare technology in specific, what do you think the advantages are and, and, and how would your, how, how, how do you, how do you think about that?
• 17:02
  John: It's a really good question.
• 17:03
  John: I think,
• 17:04
  Oron: I think there are a couple of advantages.
• 17:06
  Oron: The first advantage is.
• 17:08
  Oron: The way Israelis understand health care is a very streamlined single payer system.
• 17:14
  Oron: So, you know, I think you and I would agree.
• 17:17
  Oron: That's what, that's what good looks like from a patient outcome and population health standpoint may not be the most absolute perfect thing for the economy or no, but from, from a,
• 17:28
  John: and from a technology perspective.
• 17:31
  John: That's one clean connected system where everybody is using the same level of information is complete information in the same format is remarkable.
• 17:42
  John: And it's one of the reasons why when Pfizer wanted to try out the mRNA vaccine, There you go.
• 17:47
  John: Here's Israel as a partner because they would have complete transparent information in real time to make sure it was safe and effective.
• 17:54
  John: And people were wondering like, why, why Israel when, when, when Pfizer is an international company, and it's because of the integrity.
• 18:02
  John: And the compliant and, and, and sort of the, the connectedness of the system in Israel and
• 18:09
  Oron: the longterm view of the patients, right?
• 18:11
  Oron: I've been with my HMO for 25 years now, so they know everything about me.
• 18:16
  Oron: I'm still keeping my HMO subscription in place.
• 18:18
  Oron: So that was the, that was the first reason, John.
• 18:20
  Oron: And the second thing that I think is kind of culturally very ingrained.
• 18:26
  Oron: The healthcare is very complex and sometimes overthinking and, you know, this could be expensive and long.
• 18:35
  Oron: So you need to bring different cultural, I would say motivation that, you know, Israelis are very, I think, known and the quick and dirty, you know, let's get something done, let's see what's happening and you're going to do before you think they may not be as we are, may not be as.
• 18:53
  Oron: You know, efficiently scaling companies, you know, the, but then zero to one is something I think we're doing pretty well culturally, given our short tenure and, and being, being in a constant state of war, you need to act quickly and improvise and be resourceful.
• 19:08
  Oron: But a lot of the U S Israeli, um, uh, combination, which allow you to be both kind of good in the zero to one and iterate quickly and fail quickly, but also benefit from the American kind of one to two and how do you.
• 19:20
  Oron: Now standardize and scale and build a large company.
• 19:23
  Oron: Something Israelis at least originally were not really good at.
• 19:27
  Oron: So,
• 19:28
  John: yeah.
• 19:28
  John: And, and, and is it, is it, is it, um, section 8400, 8200?
• 19:32
  John: That is the, the, the, the hard and soft technology part of the Israeli military.
• 19:38
  John: Maybe talk a little bit about how important that unit has been in terms of creating again, another generation of health tech and tech entrepreneurs.
• 19:47
  Oron: Yeah, I actually want to, uh, when I take this question and, um, and actually slightly.
• 19:54
  Oron: 8200 is the very sexy, the very, uh, uh,
• 19:58
  John: everybody apparently when they're raising their says they're from 8200, everybody.
• 20:02
  Oron: Yeah.
• 20:03
  Oron: This is the largest unit in the Israeli military.
• 20:06
  Oron: It's intelligence forces.
• 20:08
  Oron: Uh, this is all the SIGINTs and, and HUMINT and, and COMETs, uh, intelligence gathering at the Israeli military.
• 20:15
  Oron: And the entire security apparatus is based on this unit.
• 20:19
  Oron: Uh, they've been very successful and, and also been attracting amazing talent.
• 20:22
  Oron: And so a lot of the cybersecurity innovation, a lot of that, um, uh, hardware innovation is coming out of this unit.
• 20:28
  Oron: Uh, at the same time, I want to give a shout out to my co founder, Saf David is in Tel Aviv right now.
• 20:34
  Oron: He came from the technology arm of the Israeli air force.
• 20:38
  Oron: And if you think about what Vim does, which is integrated legacy software, which is EMRs, um, in a way that allows for modern day software architecture, that's what they've done in the Air Force.
• 20:48
  Oron: And that's the learnings we brought into healthcare.
• 20:50
  Oron: So think about a lot of the platform Israel been buying from the U. S. over the years, receiving, buying, I mean, depends on you asking, uh, F 15, F 16 to Namefu, those were created back in the eighties.
• 21:02
  Oron: But still there are more than only flying today and communicating with modern day software architecture, like real time drone assignment, target designation, all those kinds of things.
• 21:09
  Oron: So the innovation for VimS specifically came from the air force, even though majority, as you said, of the innovation out of Israel is coming out of 8200.
• 21:18
  John: And maybe, maybe you could talk a little bit about, Oron, where you think the opportunities and the risks are in AI.
• 21:26
  John: There's a, you know, there's as much, uh, intelligent information about.
• 21:31
  John: Um, the promise and the risks of AI as there is artificial and inaccurate information about AI, you're in the midst of, of, of this as we all, we all are in this, the waves hitting the beach, either in the right places or the wrong places of applying, um, to computational intelligence at a different level.
• 21:50
  John: But maybe from your perspective, what do you see as the promise and the risk of AI right now?
• 21:55
  Oron: Yeah, I'm going to paraphrase a dear friend and advisor, Vijay Patel.
• 22:02
  Oron: What we are seeing, and he said it like a year and a half ago, almost two years ago.
• 22:06
  Oron: What we're seeing, and that's, that's where I think the opportunities are in the short term, a lot of quote unquote defense and offense, um, which is basically either making the provider to be more productive, um, in, in the way they work.
• 22:20
  Oron: And it's not just ambient scribe, but, uh, you know, even beyond that, like order automation, workflow automation, data sanitization, uh, summaries, uh, I think, and, and at the same time also.
• 22:32
  Oron: Preventing providers from doing mistakes, uh, or at least highlighting potential issues when such are not being noticed.
• 22:41
  Oron: So that's kind of how I think defense and offense.
• 22:43
  Oron: And I think that's where the opportunity is.
• 22:44
  Oron: Risks are obviously moving to a more autonomous state where you're going to have a bunch of companies doing direct to consumer, uh, and, and, and those I think LLMs that think in a more average state and may not have access to clinical, deep clinical data, they may.
• 23:01
  Oron: End up determining average decisions that may end up risking patients that are in a state where they, they might need something more, more of an intervention, deeper intervention, and I'll, you know, without a human eye looking at them with experience and public recognition, I think that's going to be that could be pretty risky.
• 23:20
  Oron: So I think there's definitely more opportunities and risks.
• 23:24
  Oron: Um, I, I think we need to have guardrails.
• 23:26
  Oron: We need to have the FDA thinking about it, like they think about any other drug.
• 23:30
  Oron: Um, and, uh, yeah, I'm, I'm very excited about the future.
• 23:33
  Oron: I haven't been so excited before.
• 23:36
  Oron: Yeah.
• 23:36
  John: I'm, I'm, I'm glad that you're as excited now as you were a few years ago and you've continued to build this great company.
• 23:42
  John: Um, I think we'll wrap there Oron.
• 23:43
  John: Thank you so much for joining and really appreciate it.
• 23:47
  John: Um, that's it for another interesting discussion at care.
• 23:50
  John: Talk.
• 23:50
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