Agile Businesses: David Lareau Of Medicomp Systems On How Businesses Pivot and Stay Relevant In The Face of Disruptive Technologies
An Interview With Fotis Georgiadis
Don’t fall in love with the latest new thing. Every couple of years something new emerges in our industry. It becomes the latest fashion, and you get pushed to adopt it. Early adopters of new technology can become evangelical and insist that everything that came before is inferior. Focusing on tools, rather than on the problem you are trying to solve, can lead to “designing yourself into a corner.” There are pros and cons to every technology so you need to focus on things that will be around for a while and are general and flexible, and adaptable enough to evolve, since nothing in technology remains static.
As a part of my series about the “How Businesses Pivot and Stay Relevant In The Face of Disruptive Technologies”, I had the pleasure of interviewing David Lareau.
David Lareau is Chief Executive Officer of Medicomp. Lareau joined Medicomp in 1995 and has responsibility for operations and product management, including customer relations and marketing. Prior to joining Medicomp, Lareau founded a company that installed management communication networks in large enterprises such as The World Bank, DuPont and Sinai Hospital in Baltimore. The Sinai Hospital project, one of the first PC-based LAN systems using email and groupware, was widely acknowledged as one of the largest and most successful implementations of this technology.
Lareau’s work at Sinai led to the founding of a medical billing company that led, in turn, to his partnership with Medicomp. Realizing that the healthcare industry made less use of information technology than almost any other industry, particularly in the area of clinical care, Lareau immediately saw the potential for Medicomp’s powerful technologies and joined the company to operationalize Peter Goltra’s vision.
Thank you so much for joining us in this interview series. Our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?
I was working for a company whose CEO was the Chairman of the Board of Trustees of a local hospital. He asked me to help the hospital upgrade their internal communications and management systems, and in doing so, I met a surgeon at the hospital who was having problems with his billing. He asked me if I could help him find a billing system and, after doing a bit of research, I saw an opportunity to start a medical billing and service business. A few years later one of my billing clients wanted to find what was then called an electronic medical record (EMR). My research on that led me to Medicomp Systems, where I have been for the last 26 years.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lessons or ‘take aways’ you learned from that?
That first billing client was having problems because the person who handled his billing — let’s call him Sam — was committing Medicare billing fraud and embezzling from the practice. Unfortunately, for me, Sam was a relative of the managing partner of the practice. So, to avoid confrontation, the managing partner had me inform Sam that my company was taking over the billing. That did not go well, and the next day Sam called my office to speak with me and was put on hold. I was told that he was on hold and before picking up the phone I let loose with a stream of ill thoughts, crudely expressed, about what I thought of Sam. But Sam was not on hold — he was on speakerphone and heard every word I said. Later that day, the doctor called me at home, my wife picked up the phone, turned a new color I had never seen, and handed me the phone saying, “I don’t know what he is trying to say, but he’s using a lot of really bad words.” It’s funny now, as I managed to keep the customer, but I learned two things: make sure you know the difference between hold and speaker on the phone (the modern version is “mute” on a video call) and, more importantly, keep ill thoughts about others to yourself, as it’s a small world and you tend to run into the same people over-and-over again. I now try to remember the concept of the “karma bank” when I am tempted to respond to situations in irritation or anger.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story?
Twice in my career I started new companies which could not pay me for as long as three years. During those periods my wife supported us financially and gave me the emotional backing I needed to persevere in some tough times. If not for her support, I would not have been able to take the chances I did. At one point we were going through our apartment looking for loose change so we could get something to eat. A frozen cheese pizza never tasted so good.
From a business perspective, one of my first managers noticed I was working very late but never seemed to get anything finished. I had developed a reputation for being willing to help anyone with just about anything, so I ended up accepting a lot of responsibility for things that I had no business doing. I was unable to say “no” and kept working harder but always falling further behind. My manager told me I should always have a list of priorities, not just in my head, but on a whiteboard in my office so that I, and anyone who came into my office could see them. If something came up as a new project, he said it had to either replace something on the priority list or should go on one of two other lists: “later” or “probably never” — and I should update it whenever a new request came in, or if priorities did change. This introduced me to the concept of opportunity cost, which in software and business development I think of as “if you are working on something, you are NOT working on something else, so be sure you are working on what is most important.”
Extensive research suggests that “purpose driven businesses” are more successful in many areas. When your company started, what was its vision, what was its purpose?
Our company was founded in 1978 by Peter Goltra, who saw that computers could be used to empower medical professionals by presenting clinically relevant information to them at the point of care. He says that doctors and nurses are among the most highly trained knowledge workers and that technology could support their decision making and workflows if it can pull information together diagnostically based on each patient’s clinical situation. That has been our focus ever since and has resulted in our clinical relevancy engine, which has tens of millions of links between more than 400,000 clinical data concepts. It is the core of everything we do.
Thank you for all that. Let’s now turn to the main focus of our discussion. Can you tell our readers a bit about what your business does? How do you help people?
A problem in the healthcare industry is that clinically relevant information based on a patient’s condition is not always readily available because information is stored in multiple systems and in different formats. Even within a single system, patient information is scattered. Our business is focused on providing tools so that relevant clinical data can be presented instantly to a medical provider when they need it. It is the solution that satisfies clinicians’ demands to “show me what I want to see, when I want to see it, without making me specify what I need.” We provide those tools, which can be integrated with existing clinical systems.
Which technological innovation has encroached or disrupted your industry? Can you explain why this has been disruptive?
In healthcare, several technological, as well as regulatory changes are reshaping the industry
On the regulatory front, the 21st Century Cures Act, passed in 2016, requires that medical information be shared with patients. This is a huge shift from the days when doctors and hospitals talked about “our charts” and were able to block information sharing with patients. Another big change is the development and widespread adoption of the data-sharing standard Fast Health Interoperability Resources (FHIR), which defines how healthcare information can be exchanged between different computer systems, regardless of how the data is stored. A third development is the adoption of the Trusted Exchange Framework and Common Agreement (TEFCA) which outlines a common set of principles, terms, and conditions to enable the nationwide exchange of electronic health information (EHI) across disparate health information networks (HINs). The regulatory changes are all driven by the federal government’s desire to move from a fee-for-service medical reimbursement model that pays clinicians for every transaction to a value-based care model that holds medical providers accountable for their patients’ overall health. The combination of expanded clinical data sharing and reimbursements based on patient outcomes is resulting in significant disruption in our industry.
On the technology front, the industry is experiencing disruption from the shifting of software from “big iron” and client/server solutions to web-based ‘software-as-a-service,’ as well as from the accelerated movement to API-based interoperability. This will be disruptive to the incumbent vendors as it will make it easier for enterprises to turn to new entrants into the market as systems start to shift from monolithic system architectures to more nimble, best-of-breed modular solutions.
What did you do to pivot as a result of this disruption?
With the shift to value-based reimbursement models, we have made changes to our relevancy engine to address evolving industry regulations and provider requirements. The Medicare Advantage program, which is grounded in value-based care, was rolled out between 1997 and 2003. In 2003, the government first declared a set of clinical reference terminology standards for health data, and we began mapping the new terminology standards to the clinical data concepts in our relevancy engine. This has enabled us to provide diagnostically filtered views of healthcare information regardless of the source of the data, making it easier for users to manage patient conditions.
In 2005, as the industry was shifting to technology to host software-as-a-service “in the cloud,” we also began migrating from “big iron” and client/server implementations to web-based deployments — even though the technology was still somewhat primitive. Now, the shift is to what the industry calls “API-based interoperability,” so we are pivoting again to make it easier for existing systems to integrate our products.
Was there a specific “Aha moment” that gave you the idea to start this new path? If yes, we’d love to hear the story.
As a middleware vendor, aha moments and new paths happen all the time and are an essential part of doing business. The ability to adapt quickly is critical because our partners rely on us to anticipate where the industry will be in five to ten years and provide solutions that can updated to meet future needs. A major turning point for us was the realization that the industry was about to move away from the “one size fits all” products offered by the dominant systems vendors in our space to the notion that the core systems should serve as a platform which can be augmented by newer technologies.
For example, in 2005 we started working on a new product named Clinitalk, which used a desktop or client/server architecture to speech-enable our clinical documentation tools so a physician could use our software “hands-free” in the exam room. We made it the centerpiece of our booth at HIMSS (one of the healthcare industry’s biggest annual conferences), and everyone who came by raved about how cool it was and what a great job we did. However, nobody wanted to buy the solution because that was the year that the industry decided that everything had to be moved to the web — and our speech technology was not yet ready for deployment on the web.
When we got back from HIMSS, I congratulated the staff on a great show and thanked them for their two years of work on the speech product. Then I said we had to move on and strip the speech capability from our solution and move everything to the web.
That pivot led us to develop our current product, Quippe, which now, twelve years later is deployed on hosted platforms such as Microsoft Azure and AWS. And, incidentally, we are now taking another shot at speech-enabling it, but this time it will be “in the cloud.”
So, how are things going with this new direction?
We cannot be more pleased with how things are developing. The industry is being forced to open up, share patient data using FHIR, support API-based interoperability, and make it possible for our solutions to be more easily added to existing systems. Data sharing has increased the need for healthcare providers to be able to quickly find clinically relevant information related to specific patient problems and concerns — exactly what our main focus and vision has been since 1978.
Can you share the most interesting story that happened to you since you started this pivot?
In the summer of 2019, we were contacted by Holy Name Medical Center in Teaneck, New Jersey. Holy Name is an independent health system that was looking for a new information system to manage its 361-bed hospital and hundreds of ambulatory providers. After meeting with the dominant system vendors, they decided that none could support their vision of a modern, cloud-hosted community health infrastructure. They approached us and said they wanted to develop their own system and were considering using our tools as the clinical core.
I told them that I thought they were crazy to believe a single hospital could build their own system. I was wrong.
Holy Name began working with our latest tools in late 2019. In early 2020 they were getting ready to go live in their emergency department when COVID hit the New York metro area. Holy Name was at the epicenter of the outbreak and were even featured on the cover of Time magazine with the headline “The Eye of the Storm.”
Despite this, their team continued development and completed their project in 2021. Now Holy Name is expanding its implementation across the organization and making plans to commercialize their solution. Starting in 2023, they intend to offer the system to other independent health systems.
Holy Name shows what can be accomplished when enterprise leaders embrace change and face challenges with a clear vision and a focused team. We are thrilled to be part of their journey.
What would you say is the most critical role of a leader during a disruptive period?
The most critical role for a leader during disruptive times is to keep people informed by engaging directly with them and asking them to share their thoughts and concerns. You cannot pretend that you have all the answers. People get uneasy during disruptive periods, so leaders must let their teams know that you are all in this together. Outline the challenges and the opportunities and let them know that disruption requires adaptation. Help them see the situation as an opportunity and not just as an unpleasant change. If you see disruption coming, share your perspective on it with your team. You will often discover more resilience than you expected.
When the future seems so uncertain, what is the best way to boost morale? What can a leader do to inspire, motivate, and engage their team?
It starts with continuity and engagement — though if you have not been open and collaborative with your team, it will be seen as disingenuous to begin suddenly. As for continuity, a leader must find the right people and keep them, particularly in a knowledge-driven business such as software and clinical development. We pride ourselves on having a turnover rate of less than 3% per year, which is what it takes to maintain high quality in what you produce.
Is there a “number one principle” that can help guide a company through the ups and downs of turbulent times?
Stay lean, keep the right people doing the right work, and stay focused on your core priorities.
Can you share 3 or 4 of the most common mistakes you have seen other businesses make when faced with a disruptive technology? What should one keep in mind to avoid that?
- Denial, and hoping it goes away. We once had a technical development manager who did not want to learn anything new and insisted that the internet was a “fad” and would go away. To avoid this, you must be willing to listen to people who will tell you what you do not want to hear. That development manager did not want to admit that his skills had to be updated and that things that worked for him in the past would not work in the future. Always be willing to ask yourself how you need to adapt.
- Hoping there is some magical solution that will save the day. Today we are seeing some of what I call “magical thinking” in terms of artificial intelligence and machine learning being able to solve the problem of EHR (electronic health record) usability. Approaching change with an open, but questioning mind, is the key to determining what is real from what might be false hopes.
- Changing people when you should change vision, focus, or process. Changing people during times of disruption can result in loss of institutional memory and in organizations making repeated attempts to do something that didn’t work the first time. It reminds me of Einstein’s parable of quantum insanity: “Insanity is doing the same thing over-and-over and expecting different results.” You can avoid this by remembering that almost everyone wants to do good work, feel like what they are doing is valuable, and to be part of something that gives them satisfaction. If you build your approach around that, to make everyone feel valued and involved, you can build a team that gets through tough times and comes out stronger because of it. If you are not getting what you need out of your team, it is a fault of leadership and vision, so fix that before you go about changing team members.
- Waiting for perfection. Don’t do it. Determine what your priorities are and move quickly with incremental improvements instead of waiting for everything to be “just right.”
Ok. Thank you. Here is the primary question of our discussion. Based on your experience and success, what are the five most important things a business leader should do to pivot and stay relevant in the face of disruptive technologies? Please share a story or an example for each.
- Listen to the people using your products and ask what worries them about the future. Our Chief Medical Officer, Dr. Jay Anders, was originally a customer. While still a customer, he came to our office and said that the doctors using our software were complaining that it required too many “clicks” and that the screens did not adapt to reflect the patient’s condition. He said we needed to create a documentation engine that would dynamically change the information displayed on the screen as the doctor questioned and examined the patient. At the time, the industry standard was to use fixed lists rather than clinically dynamic views as Dr. Anders suggested. He said the system needed to “show me what I want, when I want it, without me having to tell you what it is that I want.” I thought he was out of his mind, but he had some ideas on how to do it. That led to a breakthrough in how we proceeded to build our next generation of tools.
- Talk to people outside your typical contacts who you know believe you are on the wrong track. At trade shows people often come up to your booth and ask what you do. When you show them, some will say, “Well, that’s never going to work.” Instead of dismissing them, ask them why and listen to what they tell you. As clinical terminology standards started to evolve in the late 90s, a clinical informaticist came to our exhibit at a trade show and said we were destined to fail if we did not adopt a specific terminology as the core of our clinical relevancy engine. I followed up with several other people, who said the same thing. We knew that we could not use the standard they were proposing, so we did not change our core data model. But we realized that if that many people in the industry share the same thinking, we had to at least accommodate it. That led us to develop a new tool, which is widely used today.
- Take chances on new entrants into the business, but carefully vet the leadership. In any industry new players are constantly emerging, making it difficult to decide with whom to cast your lot. It is easy to get excited about new technology, but it is hard to pick the right partners for your business. When vetting new partners, I have found it useful to examine the background of the leaders to understand what they have done previously, including the success of their ventures and how their vision has evolved over the years. Treat each partnership as a relationship like a marriage, and not just like a casual date.
- Do a lot of reading and talking with people “swimming against the current.” Every industry has gadflies, which are generally defined as “an annoying person, especially one who provokes others into action by criticism.” They can be vocal and prolific and can sometimes seem a bit unhinged. Like the person who comes up to you and says, “You don’t know what you are doing,” be willing to consider that they might be onto something and don’t dismiss them out-of-hand.
- Don’t fall in love with the latest new thing. Every couple of years something new emerges in our industry. It becomes the latest fashion, and you get pushed to adopt it. Early adopters of new technology can become evangelical and insist that everything that came before is inferior. Focusing on tools, rather than on the problem you are trying to solve, can lead to “designing yourself into a corner.” There are pros and cons to every technology so you need to focus on things that will be around for a while and are general and flexible, and adaptable enough to evolve, since nothing in technology remains static.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“What goes around, comes around.” This is related to the concept of the karma bank. Every industry is small, the same people are in it for years, they move around and, sooner or later, you will probably see them again. Even if you strongly disagree with someone and have no reason to do business with them, you should treat them with respect, hear them out, explain your position, and try to part with mutual goodwill toward each other.
How can our readers further follow your work?
To learn more about Medicomp Systems, visit http://www.medicomp.com. Our company blog discusses many of the trends and issues we’ve discussed here today, and also provides summaries of a podcast hosted by our chief medical officer. We’re also fairly active on social media, and post regular updates to both LinkedIn and Twitter.
Thank you so much for sharing these important insights. We wish you continued success and good health!
Agile Businesses: David Lareau Of Medicomp Systems On How Businesses Pivot and Stay Relevant In The… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.
