Who says you have to give up quality for convenience? In the health technology space, you can have the best of both worlds. Joining us in this episode to dive deep into the future of consumer healthcare technology is the CEO of Gozio Health, Joshua Titus. At Gozio, they have cracked the code on getting patients and visitors to engage with their health system on mobile. Joshua tells us all about how they made this possible, creating a revolutionary solution. He also talks about the current trends in healthcare technology and where the growth of mobile can take us. From processing and computing powers to AI and innovation, Joshua gives a great view of the exciting world ahead for our health systems. Tune in to learn more about the things to look forward to and how they can impact our lives in the future.
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Quality Vs. Convenience: The Future Of Consumer Healthcare Technology With Joshua Titus
We’re here with Joshua Titus who’s the CEO of Gozio Health. He is a leader in the health technology space, which is something near and dear to my heart because I’m also in the health technology space. When I found Joshua Titus, I was interested in some interesting things that he’s doing because he’s taking what I use on a daily basis to the next level. Without further ado, I want Josh to tell us in his words what is Gozio Health and how is it revolutionary.
Dr. Awesome, thank you for having me on. You said in the intro here that we’re here to have a conversation. I’m genuinely looking forward to having that. Fundamentally, what we have done is we have cracked the code at Gozio Health to figure out how to get patients and visitors to engage with their health system on mobile, not 1 or 2 users a day but thousands of users a day.
That’s what we have done. We have done it primarily by looking at what happens in all the other fields and the other ways that we use our mobile devices and then applying that to healthcare. It’s not pure genius. We’re not sitting on the couch, scratching our chins, and thinking about these amazing things. We already know what we want the phone to do. It’s the same thing that it does with OpenTable or all these other experiences that are low-friction. We’re bringing that to healthcare.
When I think of OpenTable, I think, “I want to book a restaurant. Let’s go ahead, look at OpenTable, and do that.” Can you do that with a physician? The booking of an appointment for a physician is something interesting but I’ve never gotten the leap to telehealth. There’s a certain amount of patient interaction that I like to have with my patients in face-to-face settings. What are you trying to accomplish here? Is it more like booking doctors? Are you trying to supplant the doctor-patient experience? Tell me a little bit more about that.
As far as the doctor-patient experience in COVID and the rise of telehealth, 25% of all visits waned more or less depending on what specialty we’re talking about but in general, you can’t beat face-to-face. With that said, anyone who has ever had a routine script filled over a Zoom call is not going to want to go back, “That’s awesome. I feel great, doc. It’s the same thing we have been doing.” I get that bump or that refill quickly. That’s pretty nice but if I’m not feeling well, I want to be sitting in front of you. I want to be face-to-face and have that human interaction.
Let’s say it’s going to be a long time before we get around that if we ever do. I do think that there’s a place, and we’re not supplanting that human component. More so, if you think about searching for a doctor, some of the ideas that we’re hearing and some of our clients are rolling out that are interesting is, “I tend to look for my doctor. I know my doctor, Dr. Foote. He’s amazing. If I don’t feel well, I’m going to try to get some time on his schedule, call his front desk, and see if I can get some time with him whenever that is,” but some of our clients are approaching it.
Let’s take Piedmont for example, “I want a Piedmont physician to see me. I’m thinking of ear, nose, and throat. If they could speak Spanish, that would be great. Near my house is awesome. If I could do that later this afternoon, I would book it. All those avenues of care are open to me. Is it urgent care? Is it quick care? Is it a primary care physician? There’s primary care at 3:00. I’ll take that slot. It’s a Piedmont doc. I know they’re great. His name is this.” That’s almost the last step in the journey. It’s choosing the actual physician.
I wasn’t sure that was going to work because that’s not how I did it but I will tell you the analytics that are coming back from it and the number of users who are quickly joining this platform. People want it that way. They want to feel like they have a hand in selecting when and where they receive care and who they receive it from. That flexibility is true. If you go to OpenTable, you pick the restaurant. You pick the time that’s available based on what they’re offering you. Why not do something similar with seeing a physician for something that a primary care doc could take care of or maybe even urgent care?
People want to feel like they have a hand in selecting when and where they receive care and who they receive it from.
I can see the benefit of that. I would hope that we, as a medical specialty or whatever specialty that you’re in, whether you’re in dentistry, podiatry, or whatever it is, have some way to establish ourselves for our personality because then you’re limited by the location that you’re in or the amount of marketing that you’re able to do.
When I look at healthcare apps that separate based on those types of factors, I worry the patients are looking, “I want a doctor that’s the closest person to me.” It needs to accept Cigna health insurance. That might not be the best doctor for them but then on the same token, if this person has gone to medical school and they have passed their boards and everything, theoretically from a patient care perspective like the access to care, it would be good but from my personal career trajectory, I would worry that there’s no way to distinguish yourself.
In the same way that dating has become a mixed bag, some people think it’s better that people are on apps, and some people think that it’s less personal. I worry that we don’t know what the social changes are going to be like with that. What have you seen in your metrics? Have you seen any differences in patient retention? Are patients still seeing those same doctors on a regular basis? Are they hopping around because they can’t find somebody they like? What have you seen in the trends? You’ve been at this for almost a decade now.
Some of this is anecdotal as much as it is backed up by analytics but you’re not wrong. The slight difference is that if you think of healthcare in general as a funnel, at the top, it’s very broad and low-acuity, “I’ve got an earache. I need to see someone. They’re going to assign some antibiotics. I’m going to get the script filled.” As the acuity grows and things become more serious, now you are talking, “I want the best doc I can possibly find.” The way the systems are viewing it is if I can make a low lip to that funnel so that the entrance into my system is very low-friction, easy, close by, convenient, and all those things that we get out of interaction with mobile, I’ve got you in then.
You see that primary care guy. He takes a look at you and says, “You need to see this.” There’s the referral happening. You’re coming down the funnel. The level of acuity is going up. You’re going to be pickier about who you see but likely, and this is our hope and the data that we see, when you do that search for additional care or search for that specialist, you remain within the system that originally saw you because it was so easy and frictionless to get into it. That’s how our clients have learned to see it. I don’t disagree with you. If you or I have a big procedure coming up, we want the best work and doc we can find. Insurance folds into it. It needs to be paid for but we want the best care we can find.
If it’s something relatively minor, we want convenience. Here’s what’s interesting in general, and this is zooming way out for a second. At every turn, we have traded quality for convenience. MP3s are not as good as a CD. However, we happily switched them out. The videos that stream to your TVs are not as good as Blu-ray but they sure are convenient. You click on it, and there it is. For the low-acuity stuff, convenience trumps the overall skill level, assuming that you meet a minimum bar. I’ve passed my boards. I’m qualified. There may be people slightly better than I am in this particular area but I’m good enough to get done what needs to be done, to start with.
That’s an interesting concept that we have passed quality for convenience because I do feel like that’s what I’m working on. I’m working day-to-day to become a higher quality surgeon year by year and day by day but convenience might be something that as a macro trend I’m going to be affected by regardless of my focus.
Maybe that’s something that all those physicians should also focus on if they’re trying to build their businesses. I do think that there needs to be some driving factor. That’s an internal thing. That responsibility comes on the medical school to drive this into each physician but quality always needs to be a focus. Honestly, I don’t think that quality and convenience are mutually exclusive.
One of the things I thought was interesting about your app is the idea that it has geolocation. I looked at your case study with Baptist Hospital in Jacksonville. I trained in Jacksonville. I know Baptist and how difficult it is to navigate that particular hospital. I thought that was so genius when you had the ability to park, and it shows you the directions from the parking lot to the patient. That is convenience but that’s also quality because that’s a quality of experience that patients might not have. Even though that doctor might be equivalent to the doctor next door that does not have this app, that’s a higher quality experience. It’s tough to draw that line.
That’s one of the things I want to talk about with you more in general about because I know that you have some patents out for geolocation in general. That’s such an interesting technology for the future that we have already tapped into at a very superficial level. When is this going to be available in the grocery stores? When I have a grocery list, and it directs me to my favorite cereal, when is it going to be available for my assistants so that they know which room to go in after one surgery is complete? What is that geolocation technology on the micro-scale? Will it be available to us the same way that it is for GPS and all these other things?
We are in our infancy there still. Our technology is patented. We can locate a device indoors with accuracy. The last time we measured closely, it was about 4.25 feet. Call it roundup 6 feet or 2 meters. It’s extremely accurate, much more accurate than GPS, especially given that GPS doesn’t work indoors. We can find people. You can imagine a lab probably out in Santa Clara somewhere when they first integrated GPS into a smartphone. You mash these two things together. You know that it probably printed out latitude and longitude on the screen.
The engineers were high-fiving, “The job is done. Look at that. It printed out this text here. I can’t imagine it being any cooler than this.” Those folks, even though it was such an achievement, couldn’t have fathomed how we use location now with Google, Waze, and Tinder. They weren’t thinking about the fact that I know where I am, where other people are, and the things that I can do with that location as a filter to say, “I want to see stuff around me.” They were high-fiving because they got a blue dot in the right place. We are pretty much right there on the indoor mapping or wayfinding thing.
I can pull out a blue dot within four feet of where you are. I can do navigation. I can understand where you should go. I know that you can’t go straight to X-ray, which is called imaging. I helped you out there when you searched for it but we have to go to registration, and then we get to go down to imaging. I can understand a level above in terms of wayfinding and navigation but that’s about it.
Likewise, the folks who couldn’t imagine what you could possibly do beyond the blue dot will equally be surprised at what we do over the next year, 3 years, and 5 years when your phone knows a lot about what’s around you in a way that brings context and can make personalized recommendations or give you advice. Imagine the stuff that’s going on with ChatGPT now combined with location information. It was your Brainiac tour guide that was with you if that’s what you wanted.
There’s a ton of stuff that we’re going to be able to do in this space. Mobile in general is going to continue to grow toward more personalization. The fact that when I launch something as simple as Spotify plays songs that I like and then say, “Other people who like the stuff that you’re playing also like these. Maybe you would like those,” is a pretty cool way to do recommendations. You take those good ideas and fold them in toward personalization. That happens across the mobile spectrum. You move into healthcare, which is now beginning to adopt mobile as a proper interface to our healthcare experience.
Mobile, in general, is going to continue to grow towards more personalization.
That is right for personalization as well, maybe even more so than some of these other pieces. We’re excited about that. You asked when will it come to the grocery stores and the sports stadiums. To be honest with you, it could have if we had focused on that but our heart is in healthcare. We feel like that’s where the most acute pain is. We think that we can solve that directly. As much as it may be lucrative as a company for us to tell you there’s a half-priced latte every time you walk past a Starbucks, we’re not interested in that. Our heart is not in it. Would it be awesome in the grocery store? It would.
There are several times when I’ve been at a grocery store that I wish I had it but by and large, with the engineering talent that we have, we feel like focusing our abilities on helping people who are likely having a crappy day otherwise or worried about a clinical outcome of the day or for a loved one, if you have a kid, you’re going to a children’s hospital. If we can make that day a little bit better through our engineering effort, then that’s where we should be spending it. That’s where we focus. There’s nothing stopping a grocery store from doing it but we’re focused on healthcare.
Specifically, in regards to healthcare, the majority of technological innovation is focused on either the electronic medical record component, the interaction of a patient with that, or making a patient’s experience more accessible, similar to what you’re doing, or you have this very focused cutting-edge technology for specific things.
If you have a surgery that is complicated, you add artificial intelligence or augmented reality to that to make it safer or something like that but then, there are a lot of low-hanging fruit that I don’t see a lot of innovation in, for example, sensor technology. My Apple Watch takes my heart rate, my movements, and all of that stuff. I don’t see a lot of integration. Maybe that’s because I’m not looking but as someone a little bit more in the industry, how much of that type of sensor technology is now being incorporated into healthcare?
What we see that is interesting is a lot of times when we meet with clients or prospects, even more importantly, and they’re not clients yet, they have these huge dreams, “When I pull up, I’m going to greet you, welcome you to the building, and tell you you’re already registered. You go hang out in the healing garden until it’s time to be seen.” They have these big dreams. We’re like, “That’s awesome. It sounds like a great experience. Can you do any of that?” They’re like, “We can’t do any of that.” “Can I grab some time on my doctor’s calendar?” “We’re still working on that piece.”
In other words, we’re still screwing up the easy stuff. What it comes down to is, “What can that hospital system operationalize on their side?” We can bring in technology but can you operationalize it? It’s shifting and thinking about the IoT, the wearables, and that sort of thing. Your watch has incredibly rich data about you, how you’re doing, and how you’re sleeping. To pipe that over into the hospital from a technology standpoint is a piece of cake. What do you do with it then? Who’s going to look at this stuff?
If I package this up and mail a gigabyte file to my primary care physician, he’s going to write, “Nerd,” on my chart and keep moving. What can we operationalize on the hospital side that drives the adoption? The technology is there being used elsewhere but what can we operationalize? That’s the piece that needs to be solved. What are we going to do with this data? Where does it live? Does it live inside your EHR? Is it a separate data lake that everyone can poke into who needs it? What does that look like? Who has access to it? That’s the hard part. The easy part is the tech.
That’s where the big hope is for AI. It’s to sift through all this data because humans don’t have the ability to devote the time necessary for that.
If I say, “Dr. Foote, can you spend an hour and a half sifting through all this raw data dumped on you and let me know if I look okay?” and he said, “I can do it. It’s going to be $1,000,” I’m not going to do that but if he said, “I got two flags out of that data that you sent in. I zoomed in on them. It looks like something is going on early morning. Why don’t you come in and see me? We will do A, B, and C,” that’s how it should work.
How do you want to process this data? Who handles it? Whose job is it to handle it? Who has access to it? These are all excellent questions. It’s nothing we’re focused on necessarily at Gozio but I share your interest in how that plays out because it is a key component in how we change to being able to adopt and put to use some of these newer technologies that are bubbling up.
I hope that we do use that more significantly in the future because as an industry, we’re not so much healthcare as we are sick care, which is this term that everybody uses but it’s accurate. We’re very reactive to problems. We’re only addressing them when patients have symptoms. The idea of anticipating disease is only going to happen when we have that vast amount of data and the ability to track things and longitudinal projected outcomes from it. We never had the manpower before.
Let me give you an example. I live in Cambridge, Massachusetts. At MIT, they have this study. They created this device. It’s almost like a necklace that they wear. Through Wi-Fi, they’re able to tell the location based on inches. For Parkinson’s patients, they have the ability to monitor their movement. If their movement is more erratic, they know that they need to up their meds. If it’s more erratic at certain times, they can tailor their meds to give them a more equal metabolism so that the meds affect them on a more consistent basis.
That’s where the future is, especially for primary care and managing these kinds of chronic diseases. That’s something that would be interesting but there’s so much left to do with the stupid stuff. I can’t tell you how many patients on a regular basis call me because they got lost in the parking lot. When I read that about your company, I was like, “That’s genius.” That is such low-hanging fruit. That’s something that we needed to fix years ago but we still have it.
Our platform does a whole bunch of things. You plug in wait times and physician databases in your EHR. All that plugs in but not the wayfinding component. When I ask the UNCs, the Yales, and the Prismas of the world, “What is the value of my platform to you of pulling together all these disparate data sources and making them available or the wayfinding and the handholding component?” the number comes back. It’s always within a couple of percentage points but roughly 25% of the value of the overall platform is still that hand-holding component or that wayfinding piece.
It’s a big part of it. It’s a big stressor. If a nurse of twenty years says, “Dr. Awesome, I’m going to jump in with you for this next visit to the big hospital downtown. I used to work there. I know everything there is to know about it. Let’s go. I’m going to show you where to park. I’m going to remember where you park. I’m going to take you in and help you navigate this,” your stress level dropped by 30% at least.
You’re still worried about the clinical outcome. Don’t get me wrong. However, you’re not worried about finding your car when you come back out. You’re not worried about being late because you parked on the South deck, not the North deck. All these types of things fall away from you. Even though it is simple, that handholding or wayfinding component is 25% of a visit.
I don’t think it’s simple. It’s an elegant solution to a problem that I don’t think anybody has identified before. Every single large hospital system is difficult to navigate. If you go to an academic medical institution like Tufts University where I work as a faculty member, it takes me about twenty minutes to get from the parking lot to the clinic where I work. I have to park, take this elevator, go down this way, and then go on this other elevator. Most of it is because the majority of hospital systems were built piecemeal.
They grew organically over time.
They’re not well-thought-out. Even if you have the best advantages as I do where I have a faculty parking pass and a badge that gets me through all of these places where you can’t badge through, you even have difficulty. I can’t even imagine how difficult it is for patients. If I was a patient, I wouldn’t want to go there. I want to make sure that I go to a clinic where I could have easy parking and walk right up.
You’re doing this, and you’re not that stressed. You’re 157 IQ isn’t 97 that day because you’re worried about the outcome of a lot of papers that your primary care guy handed you and said, “Make sure you bring this with you.” You’ve got so much going on in your head, let alone navigating. That makes it even more difficult than what you’re experiencing.
We would consider you to be a power user. You’re there 3 or 4 days a week. We tell ourselves this all the time, “We don’t have power users. They’re going to use our app 6 to 9 times probably. They’re likely in this building for the 1st or 2nd time in their lives. We have to make this easy, accessible, and intuitive.” That’s a challenge for us but it’s also something that we’re up for and we enjoy.
I’m going to ask you to take off your healthcare hat for a second. You used to work for Nvidia. I’m a big gamer myself. Nvidia graphic cards are the gold standard when it comes to gaming. I want to talk about processing power in general. We’re on this exponential growth curve. How much processing power is necessary for photorealistic experiences?
Part of the way that we’re talking to each other is based on the engine that you create. The most significant engine out there is the Unreal Engine. It’s close but it’s still not quite there. It gets close. How much processing power is required? Can you give me a timeline of when I will be able to experience a virtual setting very similar, at least from a visual perspective, to what we’re experiencing?
We’re close to that piece. Once you’re able to enable ray tracing, which mimics light itself, and you get all the things that come along with that in terms of how smoke, reflections, and refractions work, and you’re modeling that, you’re going to be there. There are demos that you would have a hard time with other than this uncanny part, “That didn’t move like a human move. That’s a little off,” but as far as how it looks, it could completely fool you. It’s a matter of getting the frame rate up for that type of thing.
Honestly, I wouldn’t be surprised if the next generation is able to do it. In three years or something like that, you will have a hard time telling what was rendered on the fly and what wasn’t. The way that we got there was by learning how to do things in massively parallel. The old analogy that we used to talk about is you have a delivery service. You can keep souping up that delivery truck. You’ve got the biggest engine you can find. It will do 90 miles an hour of the red light, or you can buy another truck.
In three years, you will have a hard time telling what was rendered on the fly and what wasn’t.
It’s much better to have parallel pipelines, 512 pipelines, or whatever we are, break the image up, and do it in parallel. Being able to do massive numbers of things or thousands of things at once and then combine them at the end was the real key to the breakthrough for getting to photorealistic rendering and doing it quick enough that when you get into the 30 to 60 frames a second rate, you’re now into gaming territory as long as you keep the latency down.
There’s that piece. Going in parallel is key. It turns out that the same approach is exactly what you need to train neural networks for AI. It’s the reason that the GPUs are used. A friend of mine came up with CUDA. It takes things that would have been done one at a time in the past years and realizes that if you turn that sideways and look at it, you could break this into multiple parallel things. Instead of one at a time, you do 512 at a time. Suddenly, you’re cooking.
That idea for being able to train these models and then have them execute more quickly is why Nvidia as we’re talking about is still a major player in full self-driving and training AI models and computer vision. They’re big players there because of what they developed for the graphics chip. They found that it had a side benefit of being good for AI. They ran with it once they discovered that but it is interesting how the pretty clear path forward is doing parallel.
Parallel thinking is something that organically in the brain is happening. That’s why they say a lot of AI is gaining a lot of insight from these neuron-based models.
There’s deep learning. There are neural nets. There are those types of things, which does their best to mimic how the brain learns and does pattern matching.
First off, the reason why I wanted to talk about visualization is because, from a layperson’s perspective, that’s the highest amount of computing power. When you’re recreating something like that, you’re recreating an environment. That takes a lot of calculations and computing power but is the transition the same when you’re talking about geolocation? Is the computing power the same? Is it different because you have a ton of users?
The reason why I ask is because what I would love to know is this. We have all of these advances in computing power solely for entertainment purposes. Is that going to be an easy transition for computing power for making EMR work better? Is that going to be an easy transition for people to have better CT scans? Is it a one-to-one thing? Is it different things that we’re talking about?
The key to making those things better is the introduction of AI and filtering so that by the time a human looks at it, all the clearly wrong answers have been removed, and now I can get down to the core of what I need to look at. The computing power will be used to quickly train those models, and then you can have a complex model if you have a powerful engine to make use of it. That’s going to happen.
The other thing to keep in mind though is that when you increase the computing power, that allows you to do more things with a certain amount of power but it also allows you to do the same thing you used to do at lower power, which means that now this slides into and lives on a mobile device. You might have to have a desktop to run the MRI processing power that you need to visualize and spot certain tumors or whatnot. Maybe that happens on your smartphone in ten years. It’s the same thing we’re doing now but with a lot lower power and more muscle.
That’s interesting. Does AI require more computing power than renderings and stuff like that? The algorithm becomes more elegant, and then the computing power comes down.
In general, training the models that are used by AI is incredibly power-intensive. If you think about Bitcoin mining, it’s a similar thing to that where people will build these farms in Iceland because they’re going to be powered by cheap geothermal because that makes monetary sense. The amount of power that you’re pulling can be measured in thousands of homes to train an AI model.
The annual power requirements for a neighborhood would be used to train a model for a week or something like that. It’s incredibly power-intensive. Once you understand the model and you have the model created, you can use the model with much less power out of it but the initial creation of it and the training of the model are incredibly power-intensive.
AI aside, we’re sifting through data on a regular basis. You’re probably sifting through tons of data for your program. Are you doing the majority of this with computing power that’s available to you on your desktop? Are you outsourcing this to Amazon Web Services? How are you sifting through your data? AI is not ubiquitously available. It’s still something we’re talking about.
Pretty much anytime you need heavy-duty compute power, it’s not going to be what we call the on-premises or on-prem. That would be the nerd-speaking years gone by. Everything is cloud-based now. How much of Amazon computing power do you want to buy? You have that punch on your model for you. It’s fundamentally outsourced to other people’s machines that are cloud-based.
What are you looking at in your healthcare data other than the user experience for making sure that your business gets better? What are some novel insights that people might want to know about from the massive amounts of healthcare data that you were able to sift through? Having millions of users that are going to a doctor on a regular basis, you probably have insight that I or any of my colleagues might not have.
We are beginning to dig into that to get the 2nd, 3rd, and 4th order effects that are in the data. We get about 15 million interactions a month. That’s plenty to have some insight into. A lot of it is driven by what our clients want to know. The first thing they want to know is, “Is anyone using this damn thing?” It’s a simple number, “How many installed users do I have? How many do I have using it a day?” It’s that thing but somewhere between the 1st and the 2nd year, especially if we can connect with their business intelligence team, you start looking at things.
There are low-level data that you could look at, “Where’s everyone searching for parking while they’re standing in your building? That’s where my parking sign should go. That’s neat but let’s zoom out a level. Where’s everyone in the Atlanta metro area standing when they search for urgent care? There’s a big red spot up here on the heat map next to Johns Creek. That’s where urgent care is going next.” We’re making rational decisions. We’re making those larger operational decisions.
Where we want to go is to move that data into more predictive analytics. We don’t know why but we have had a 20% jump in people looking for urgent care. Your ERs are going to get hammered in twelve hours. Heads up, you better get staffing rolling. This is what’s going to happen. You can look at macro trends and let the hospital system know what to expect, or you can look at personalized trends, “People who did this and then this often expected to do this next.” That’s what’s presented to them on their dashboard. We think you’re likely going to want to do 1 of these 2 or 3 next things.
It feels like the sensation that the user will have is, “The system gets me. Here I am. It’s time for me to go back to my car. I finished up my visit. Look at that right on the top. Are you ready to go back to your car? I am.” That feels very personalized and cool but it’s all driven by analytics of what other people did. You can do lookalikes. All these things that we use in other fields can apply to the visit and the experience of the patient while they’re on-site and while they’re offsite at home. We’re excited about those pieces. We’re now getting into those 2nd and 3rd degrees of insight based on the data we have.
That’s cool. One of the things that I look forward to is when you can communicate with all of the EMR. We can learn about macro trends like where the healthcare deserts are. Let’s say a new pandemic breaks out, and all of the symptoms are coming up the way that Google was used as a resource because people were searching about particular symptoms with Coronavirus and things like that. The era of Big Data is here but we don’t know what to do with the data. That’s something that I look forward to in the future but it’s also something scary. That’s why I want to put an optimistic spin on it.
One of the things that I want to do with this show is make sure that when people think about the future, they think about it in a positive light but many people would be hesitant to think that all of these interactions and data collection pieces are a good thing. They worry that this is going to be used in a negative fashion. What would you say to those people? On the one hand, it might make for a more convenient life as we have talked about but on the same token, it almost lends itself to less freedom, more directed by these large entities.
We talked about macro trends earlier. The one that we chatted about was that people have historically traded quality for convenience. The other thing they traded is privacy. I don’t agree with it. I’m not on social media. I tend to be a very private person but if you talk to my daughter’s generation, privacy is way down on the list as long as it’s convenient and fun. There’s a general shift away from the way that you and I think. I’m not going to claim that’s a good thing but it is real.
People have traded privacy for convenience.
I also think that there are ways that you can do and treat privacy that keeps it relatively compartmentalized. Here’s an example of how we have approached it. You have an appointment reminder, or let’s say you’re using an EHR. We will say it’s an Epic EHR. You’re in my chart. My chart can say to Gozio, my company, “Take the holder of this phone to this department.”
We will merrily take that phone and navigate it to an infusion appointment. We don’t know who you are though. I don’t need to know. Epic may know who you are. We don’t want to know. By keeping data that we would consider to be PHI behind the authenticator firewall and doing everything else we can possibly do outside of that, then let’s do it that way.
That is one of our secret sauces in terms of driving lots of users. If I had you authenticate as soon as you logged into or opened the app, that’s how you get uninstalled instantly. Let’s do everything else that we can do. The things that are more private or should be more private are often more private. Let’s have those behind your authenticated piece, keep them somewhat separate, and be very clear that we’re keeping them separate.
We have had clients in the past who thought about combining these things and pulling in a Salesforce style, “I know everything about this person. I’m pulling it all into this 360-view of the individual,” but that’s pretty creepy. If the story were written, not that this hospital system wants to embrace you and give you the best possible experience but this hospital system tracks you, that’s bad. Good luck getting that stink to wash off. That’s not going to be easy.
The privacy thing is real, especially at the intersection of technology and medical privacy, which is near and dear to our hearts. This is something very personal. I have to go through chemo. That’s a personal thing. It’s best to keep that compartmentalized for people despite the trends toward being less private. Healthcare may be an exception to that rule.
The privacy thing is real, especially at the intersection of technology and medical privacy.
I hear what you’re saying. I want to look at the idea of privacy. When we’re talking about how people are giving it up, is it as big of a problem? Let’s say, God forbid, my electronic medical information gets out there. When people think about the idea of giving up their privacy versus having this information out there, what is so bad about it? Explain that to people who might not understand that.
I’ve seen demos. There are companies that wanted to work with us. They were showing off their technology. They said, “We can combine together. We will have this amazing view of people.” I said, “Give me an example.” They said, “You know what driveway people leave from when they come into the hospital.” I said, “We do.” He’s like, “Give me the address.” We opened up Google Maps. I spun it to a house and clicked on it. Up pops the address.
He opens his laptop and types in the address. You got a dad and a mom. They got three kids. The dad is suffering from this. The wife is suffering from this. We had this much left on their mortgage. Their kids go to this school. They liked a boat. They’ve got a boat and two cars. They know everything about you based on your address. You start folding in detailed medical information. They may know you better than you know yourself. That gives me the heebie-jeebies.
I don’t want that out there as a model for anyone they want to sell it to, anyone who wants to market to me, or anyone who wants to not sell me insurance because I have a certain lifestyle or whatever it is. Maybe I’m showing my age here but there should be a certain degree of privacy, especially when those things all come together into a complete picture of an individual. That’s scary to me.
We’re getting a little negative.
It’s a cautionary tale.
It can be used for good though. To put a positive spin on it, when I think about my Apple Watch telling me, “You need to stand and do something,” I hope that there’s some beneficence that’s associated, especially the healthcare industry, that says, “I see that you’re at McDonald’s. Is this a good decision for you?” I don’t think that this is something that would be so terrible but on the same token, I see what you’re saying. I hope that we can gain more benefits than detriments from the era of Big Data.
We can. Let me give an example of something that we’re working on. We blend the privacy where there’s an exchange that takes place. You tell me a little bit about you, and because of that, I’m going to be able to give you a much better experience. You open up the mobile app for your favorite hospital and self-declare, “I’m here for labor and delivery.”
Now that I know you’re here for labor and delivery, you probably want a different color scheme. The educational content that I want to present to you is different. I want to let you know that we have firefighters who will verify that your car seat is installed correctly before you leave with your baby. You’re going to need that. There’s 25% off Babies R Us.
In other words, this is an awesome experience. You don’t know who I am yet but I’ve told you a little bit about me and why I’m here. Contrast that with someone who’s there for end-of-life, or if I’m an oncology patient coming back as a frequent flyer, getting my infusions. It’s going to be a little bit different experience. It’s a little more somber. I don’t want to see ads. Maybe we go a little more neutral on the cheery stuff and the bright color scheme.
We can customize and give these personalized experiences. Even though I don’t know who you are, you’ve told me a little bit about you. Based on that, I can take you and get you 90% of the value of knowing who you are. Those are the trade-offs that we’re seeing. We went a little negative earlier, “What happens if we go 100% to the left?” If you tell me a little bit, I can do a lot with it. That’s where we will end up.
I hope that tailored experience is something that happens. When my wife became pregnant, we started getting a lot of these baby ads in the mail and things for formula and stuff like that. I appreciated that. I don’t know how it happened. I know that it did happen but I appreciated the fact that I was getting all this stuff because it’s not a field that I was interested in before we had the baby. When we’re talking about a tailored experience, I look at that as a positive spin on the future.
Even when I buy something on Amazon, and it makes me interested in other things, I don’t think that’s a bad thing. The goal is for Amazon to sell more products. I get that but on the same token, sometimes it’s nice to know that this is something that I didn’t know that was out there that I would appreciate. I look at that as a benefit. There is a lot of detriment to having all of this information available. If people wanted to do bad stuff with it, that is out there but I do think that there’s a lot of good. I do believe in the free market. I do think that it does tend to bring out the best in society.
I look at the way that I’m living now. It’s more convenient. I love the fact that I can have something delivered the next day with Amazon. I don’t look at that as a bad thing. It’s very easy to spin it as a bad thing but I personally don’t see it as a bad thing. There’s always this nostalgic viewpoint from the past about how everything was better. It’s a common philosophy to say that things are becoming worse but in general, they are becoming better.
One of the biggest components that I have to deal with on a daily basis is electronic medical records. There are so many people that come in and have this different idea of what is possible. I can’t tell you how many people come in and tell me they don’t have their medical information. They don’t have anything with them. They’re like, “It’s all in the computer,” as if my computer is linked with every other computer that’s out there. I appreciate the fact that you have a mobile platform where they can pull it up on their phone. I can see all their labs without having to call this, that, and the other person.
I look at that as a benefit. It’s more convenient. It does provide for a more quality experience. We’re coming to the end of our time. I want to thank you for coming on. I do want to leave with one thing, which is something that I always leave every guest with. When you think about the future, what are you most excited about? When you’re thinking, “That’s an exciting technology coming out. I can’t wait for that to happen,” what sparks it for you?
This answer is not going to light your hair on fire but it is the part that I’m excited about. It’s not the exponential change in technology necessarily but for healthcare specifically, it’s the exponential adoption and the adaptation of what we’re doing everywhere else from the experience I have on the delta. I’m on the run. Everything is on my phone. I get my seat upgraded. I know it. They changed the game. That entire experience is so nice but to cherry-pick the things that we love in technology from all other aspects of our life and watch those get adopted and applied to healthcare is what delights me.
I enjoy seeing that happen. Quite honestly, you already have the proof of concept out there. We’re already doing these things everywhere else. It’s not surprising when you bring that into healthcare, and people are blown away that we can do this. I am happy to see where I used to be out there. I’ve been in this thing for a decade, evangelizing the need for this, whereas now my phone rings, “We want to do this. How can you help us do it?”
There’s this drive behind it. What is desired from the market is well understood now. We have been trained on all these other apps. How do we bring that into the healthcare setting so that it’s most impactful? That’s what I’m excited about. That’s what inoculates me against the day-to-day grind of running a technology company. We will use it and be delighted when they’re like, “I didn’t even know this was possible to do in a hospital. This is amazing.”
That’s a very steep point. When I think about Web1 when I have a GeoCities website, which was text-only, now everything is on our phones. We have this interesting interaction with technology that makes our life more convenient for sure but also easier and more livable. That’s something that I’m excited about also. Thank you so much, Josh. It’s nice to meet you. Hopefully, we will talk soon.
It’s very nice to meet you. Thank you for having me on. Anytime.
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About Joshua Titus
Joshua Titus, CEO at Gozio Health, is passionate about creating mobile technology that informs and delights users. This passion led him to co-found Gozio after spending two decades in the left lane of high-growth silicon valley technology companies like NVIDIA. He has authored 11 patents and holds an electrical and computer engineering degree from the University of Illinois at Urbana Champaign.
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