In this week’s C-Suite Q&A, Healthcare Analytics News spoke with Morris Panner, the CEO of Ambra Health, for a ranging and rewarding discussion about interoperability, artificial intelligence, value-based care, and the business of running a health tech company. Ambra changed its name from DICOM Grid last summer to more accurately portray the breadth of work they do, and they have not looked back.
Panner’s passion for the industry stems from a family situation in which better patient record sharing systems could have helped, and he responded to HCA News’s questions at length and great detail. As such, the interview is split into two parts. This is the first.
First off, just give us a rundown of what AMBRA Health provides and it what its mission is.
Ambra Health makes it possible for you to put x-rays and other medical images in the cloud securely, so you can say goodbye to CDs and faxes and use the cloud safely for medical information that you might want to share with family members or usually, more importantly, other physicians or other care providers.
The mission is to achieve true interoperability in healthcare to improve the quality of care. Right now, there’s so many silos in healthcare, it really hurts patients and makes it harder for people to obtain the best care possible. We want to break down those barriers.
You mention making records more accessible to patients-in what respect are they able to access them, and why is that important?
Look at the recent examples that have come out about Apple and about other consumer tech companies moving into healthcare…the age of consumerism in healthcare is here. And I think that’s going to be a positive trend.
One of the important things that we do is we give patients access to their x-rays, CAT scans, and MRI studies. Why is that so revolutionary? Just a few years back, it was almost impossible to even view these kinds of diagnostic studies unless you had an expensive, very specific and technical set of equipment. And now, we’ve made it possible with nothing more than a web browser and access to the internet, you can look at the most sophisticated images or send them to another provider to get a second opinion. They don’t need any special equipment, they don’t have to worry if they have the same brand of equipment that was used to take the study. We make it vendor-neutral, so anybody can look at any study at any time. We’ve had neurosurgeons make evaluations from their iPad while they’re waiting for the plane door to close.
Can you speak briefly about, in your words, the relationships you have with health systems and the importance of collaboration and interoperability?
To give you a perspective on it, we right now have touchpoints on over 900 institutions in the United States. We see more than a million studies uploaded to our cloud in any given month. What we’re able to do is give world-class institutions the ability to partner with providers and patients no matter where they are. If you think about any healthcare provider, one of their biggest challenges is making sure they can get access to patients, and paradoxically patients will say one of their biggest challenges is getting access to the right healthcare provider. And then, once you have access to that person, making sure you have the right care team so that you can get somebody the best quality care.
In our system today there are different places that are better at different things. Take, for example, the Mayo Clinic network. That’s a network throughout the country that is designed to let regional institutions to collaborate with the Mayo Clinic, and to let you as a patient access a care team that is an exponential multiplier of the local presence. And that’s really what we’re getting at: you want to be able to have your doctor, but you want to be sure that your doctors have access to the experts. That’s not any different than what you see in a medical school setting, it’s a familiar model to make sure you’re bringing the right expertise to bear. As a patient, you want your physician to be able to do that easily and rapidly.
We hear a lot of the people in various corners of health tech speak about medicine kind of being a late adopter to various new-age tech concepts. I hear you speak of medicine getting beaten to the punch on the move to cloud computing, maintaining CDs and paper records for a while. Is there a reason in your mind that the medical community might move more slowly to modernizing?
I think two things have held healthcare back. One is concerns about privacy. Let’s face it, healthcare information is just different, and people are pretty reluctant to share information because if you share with the wrong person, the consequences of that can be devastating. I hear that, our privacy is really important. We’ve kind of moved beyond privacy in some crazy way, with Facebook and other social media applications, but people aren’t comfortable doing that in healthcare. One of the things we had to do was develop some patented technology to safeguard the transmission of patient information, so that it actually splits patient information away from some of the healthcare data so you are less likely to reunite that information behind the firewalls, it’s a safer way to do it.
The good news is, with people like Mayo and Stanford and Massachusetts General Hospital…they’ve already gone through the security checks now and they are creating the momentum for this change. People trust them, as you should, you trust them when they talk about other developments in healthcare. We can trust those leaders, we’re affiliated with them and we feel good.
The second reason why I think healthcare is behind is a little bit less of a positive one. Healthcare business models up until now have really been based on the idea that you “acquire” a patient. If you could get a patient and they were yours, you didn’t want to “lose” the patient. You hear healthcare systems talk about “revenue leakage,” which means a patient will not avail themselves of all your services. But that too is changing, because consumers are driving it, people are taking more control of their healthcare. And we’re also starting to see people looking at value-based care models. You really want to start keeping people healthy, and you want to make sure you’re not duplicating studies that aren’t necessary, and you want to be able to collaborate so that if you have a patient that’s not very sick, you want them in an environment that’s low acuity. If they are very sick, you want them brought to a high-acuity environment more rapidly.
We start to see, even in the business models between hospitals, we no longer see them talking to each other as a zero-sum game of ‘that’s my patient, that’s your patient…’.
The lack of interoperability has really been what I would call an illegitimate stumbling block that we’re now getting past, thanks to a lot of the pressures that have come about around quality. These aren’t political concerns, but they’re things that the average consumer now, thanks to Dr. Google, thinks of. If I give you access to your imaging, once you have it on our system, you can take that study and share it with any physician you want and they want to be part of the process to navigate you through a care pathway that makes the most sense.
How about you personally-what brought you into the field, and what do you like about it?
My background is in software, and I understood what the possibilities were for cloud software.And then I had a personal experience as a parent that really drove me to get excited about this business, and in some ways that excitement has never stopped. My son is fine, but when he was younger, he had some health problems. And one of the critical pieces of information always is diagnostic imaging x-rays, and it was very hard to get those to the right expert. I thought to myself ‘This is ridiculous, there’s no other type of information that is so siloed. This is so important to share, why is this happening?’ When the opportunity came to join a group of physicians that had this idea and were looking to commercialize it, it really struck home.
In my neighborhood I’m known as the guy for when you have a problem and need to share medical information: ‘that’s the guy who built that system that can do that.’ It really is a very nice way to kind of pay it forward as I look back on what we went through as a family and the frustrations we had in trying to share critical medical information with experts. We really lived it.
In the second half of our C-Suite Q&A with Morris Panner, the CEO of Ambra Health, artificial intelligence and the future of value-based care dominated discussion, as well as challenges posed by cyber attacks. Also at hand was Ambra’s audacious decision last year to change its name from DICOM Grid last summer. Panner detailed the process of deciding to rebrand a well-known company amidst impressive growth.
Within the value-based decision-making process, what role does AI play?
AI right now is probably the most interesting topic, it’s on everybody’s mind. Let me talk about how it works in our world.
There’s the nirvana, you could call it, the futuristic scenario where algorithms are going to be able to make clinical judgments. Maybe we’re moving in that direction, and maybe we get there, but today AI functions in one of two ways.
The more common way, the way we use it often, is to make sure that the right patient gets matched with their information as fast as possible, between and among different systems. We have a patient-matching algorithm that allows institutions to cut the amount of time that it takes dramatically. The National Kidney Registry gave us an award because we were able to save them over 1,400 hours per year and cut the matching process from what could be days down to hours. That’s huge, and that today is not diagnostic, that’s under the broad term of AI for workflow, and that’s big.
The second area we’re starting to see is screening. This has been done, but not as well. What you would see in mammography is CAD, computer aided detection, and the idea was to make sure the very busy practitioner would have a heads-up. The algorithms are getting better and better at helping people know what to look for. On top of that, they’re also able to start looking at things in a study that maybe the person hasn’t even thought about yet. That is a little more controversial, because it’s going to generate false positives. There was a movement afoot at one time to do your full body scan, and almost everybody would come up with all sorts of strange indications: you had a module in your lung, is it lung cancer? You had to figure out what to do with those other findings, and we’ll see what to do with all that using AI, but that’s another screening technique that allows hospitals and healthcare providers to be more efficient.
What we haven’t done yet in our system is have an algorithm to look at something and go ‘oh, that looks like this type of tumor so we’re going to route it to this specialist or take this action.’ I think it’s coming, just a little further down the road.
How do you want to see the landscape looking for these processes in, let’s say, 5 years?
I think when I put my hopeful hat on, it’s going to be interoperable, and no different than electronic banking. It’s just a question to me if we have the will. We can do it, will we do it? And then it will be as ubiquitous as looking at your credit card statement online. That to me is what the future should hold.
I also believe that we are better positioned than ever before to have it happen in the next 5 years. Not to get into politics, but in healthcare right now it’s hard not to at least nod at politics. What we’re seeing right now is widespread frustration. I don’t think people have a lot of solutions today. You don’t hear anybody saying, ‘I’ve got the perfect thing and if you just listen to me we’ll get it all done.’ You hear people either being vitriolic or people just like ‘well, you know, we all need to work together to figure this out…’ I think that part of the constructive side in improving the cost of the healthcare equation is going to be interoperability. I think a big piece of that is going to be imaging interoperability. So much of healthcare, and so much of life, is determined by who pays and what they can pay for, I think the systems that are for the first time truly burned in, safe and effective, we’re going to see people avail themselves of it.
I very much hope over the next 5 years we move to an electronic, patient-controlled, open system.
Speaking just for Ambra, what are some of the biggest challenges you face as you grow?
We are learning how to be an innovative software vendor in the enterprise healthcare space, and learning how to achieve innovation and change is no small feat. Our core strategy right now is to align ourselves with the thought leaders and the drives of change in the system. We have something of our ideal customer profile: it’s not a title like CTO or CMO, it’s a description, and the description is “change agent.” At every healthcare system today there are change agents, and they recognize and they share this philosophy around interoperability. Our biggest challenge in a nutshell is to find, and align ourselves, and support the change agents inside healthcare.
It is a very complex world, and it requires collaboration and consensus between the people who are running IT and the people who are providing clinical care. If you find these change agents and you can align yourself with these change agents, you can get some really exciting results. Clayton Christensen, in The Innovator’s Dilemma, says that the paradigm is to find the outlying smaller places that have to make cost-quality tradeoffs, and they buy the smaller tractor because they can’t afford the big tractor and they go from there. In healthcare, it’s sort of interesting. We find that we have change agents at Mayo Clinic, there’s no better healthcare provider in the world, there’s change agents at Stanford Children’s Hospital…. If I can think of a secret sauce, it has been our ability to find those people and give them what they need. They’re looking for this, it’s not because they think we’re charming, it’s because this is a tool to break down the data silos and the barriers to information sharing.
We’ve really had to learn how to bring change to an industry that people say is resistant to it. It’s not in some respects, American healthcare is the best in the world, they diagnose things faster, they find cures faster…but that has not rippled through the infrastructure and IT. We are learning how to do that, it’s an ongoing journey.
We can’t go without asking you if current security concerns and cyberattacks ever keep you up at night.
If you are running a business in America, you should be alert to how to manage those concerns. We’ve seen individuals’ identities stolen, we’ve seen big institutions have attacks, our government’s been attacked and there’s even convert over whether our elections are safe. This has now become part of our risk management. Nothing’s going to be perfect. But what’s the alternative? It may be too late, if you’re on the electric power grid you’re connected to the world. It may just be too late for us to pull back from the world even if we wanted to.
So really the questions are, how do you make appropriate investments, how do you develop appropriate strategies, how do you learn from others so that we don’t get pushed back or scared out of doing the right thing. There’s going to be inevitable bumps and challenges by bad people who are not trying to help the process. That’s not good, and we can’t let those people stop us from advancing. We recognize that we’ve got to do everything we can to anticipate, and in some cases react to challenges.
On the business side, the name Ambra Health gave me pause until I saw “formerly DICOM Grid” and instantly knew who you guys were. That branding change came about a year ago. How did it come about, and what are the difficulties with changing brand names on a pretty known entity?
It’s pretty cool, actually. It was fun. We brought in a wonderful new marketing lead, and she said ‘you know, one of the things about DICOM is that it’s a standard, it’s like being called The PDF Company. But put that aside: are we just moving one format from point A to Point B, or are we doing something larger?’
The truth was, we’re involved in AI for workflow, we’re involved in this, that, and the other thing. We ended up hiring a consultant to go out and interview all of our customers, and the feedback was really fascinating. Our customers said they really wished we could capture all the stuff we do for them, because we were not really a DICOM engine for some, we were so much more. We capture more imaging types, we capture video, we capture other types of healthcare information, and we’re able to handle other types of workflow. We got feedback for a lot of customers that our name did not accurately capture everything we were doing.
At some point, you’ve got to jump. There’s a lot of technical things we did in terms of marketing and branding, to make sure that things redirected from the old name and so forth. We went out to our change agents to spread the word, and so far, by all the statistics…all the things tell us that we’ve really done it at the right time. We did it as we were growing, and since we have done it we’ve probably grown a little over 50% or 60%, I think our compound annual growth rate is right around 70%. Quickly you get to a point where any change is even harder, so we made the leap and really haven’t looked back.
It’s not for the faint of heart, but I think it’s been a really positive step and an investment that will serve us well as we grow forward. I loved it because when we went to our investors and our board, we really had to walk them through all of this and we said, ‘we’re in this for the long term, we’re really building an important company that’s going to have an important mission, and we think it’s the right thing to do,’ and they were emphatically in favor of it. It’s really been a very positive move.
That is quite the decision, especially when you seemed on pace for ubiquity already with the existing name.
One study that you’ll find interesting: a branding company asked ‘which brands attract the highest degree of loyalty?’ I guessed Apple, or Under Armor, or Chanel, those things. They said ‘No.’ There is no consumer brand even in the top half. The most important and significant brands are all enterprise brands, and the reason for that is simple. If you buy an Apple computer or a Chanel wrap or an Under Armor shirt, that’s a nice thing and it says something about who you are…but when you make an enterprise decision, when you say ‘I believe an interoperability platform is going to change what we do,’ you have invested so much of yourself in that, and your personal brand, and you’ve had to bring your teammates along and get the institution to vote, and then you’re going to live with that decision for a really long time. The most powerful brands in the world, with the highest degree of loyalty, are enterprise brands.
We really wanted our brand to, over time, be that associated with this change and progress, and have people really stake things on it. It’s not a lighthearted decision, we’re asking people to commit to change, and that’s why when we find change agents, they’re thrilled to have a partner to do it.