In this episode, we will answer the following questions:

[01:27] current focus, team consistency and workflow of the CTO

[06:05] how to achieve a win-win situation with your customers: leveraging relationships for controlled testing and successful software launches

[10:41] validation of the key stakeholders’ satisfaction in Briotix Health

[12:20] typical EMR implementation mistakes that healthcare providers make

[17:59] the right time to switch to another EMR/EHR solution

[20:11] overcoming industry conservatism: emerging technologies for healthcare efficiency and safety

[27:40] the lack of proper data analytics in healthcare from the perspective of providers and individual patients

[36:09] custom EHR/EMR solutions and the fragmented healthcare market

[40:26] M&A and the other lines of business at Jcloud

[42:41] speech processing and innovations for data and human genome as promising technology trends in healthcare

[45:14] Rapid Fire Round (3 personal questions)

 

Links:

Russell’s Linkedin: https://www.linkedin.com/in/russhertzberg/

Briotix Health: https://www.briotix.com/

Jcloud: https://jcloudco.com/

 

The links to the episode on different platforms: iTunes, Google Podcasts, SoundCloud, Spotify, YouTube.

Listen to the episode and let us know what you think on the topic.

Russell Herzberg is the CTO of Briotix Health, a company that builds a next-generation data platform for occupational health. Also, Russ runs JCloud, a company that connects development companies with US-based businesses and companies.

And for example, Jсloud has organized and executed the development of a big data analytics platform that was sold twice within four years of the start of the project. Russ, thank you for joining. Let's start with your company, Briotix Health. What is your primary focus at the moment? The company.

[01:27] the current focus, team consistency and workflow of the CTO at Briotix Health

Russell Hertzberg: The company is an occupational health provider, so we send occupational health professionals out into the businesses in the United States to help the employers and the employees be healthier while they're on the job.

Some of our clients are big manufacturers that have employees in demanding positions. There are a lot of physical demands in some of the jobs, and there's a high possibility of accidents and injuries on the job. And in particular, we try to do a lot of preventative consulting and advising before injuries happen.

So we employ a lot of physical trainers, and exercise physiologists in the office environment. We employ what are called agronomists and we help businesses and employees stay fit, healthy, and on the job really. And from there, we get into some specialized businesses as well. There's an area that business we're in, that's involved in after an employee is injured, returning them to work either gradually or on an appropriate schedule based on their injury or accident.

We're also in the pre-offer employment testing space as well. And my role, of course, is in the development of software and the running of the company's IT infrastructure. We're a decent-sized company. We have 450 plus employees right now. And we've built a lot of software over the years to support the occupational health engagement process.

And we are working on a next-generation data platform for better health for sure. That's gonna not only incorporate the structured data from all the encounters that our providers have but also ingest some of the next-generation sensor data and computer vision data that has a lot of promise for improving occupational health. It's a kind of a classic role where I'm building more software, and enhancing some of our current software.

And then there are also all the IT-oriented tasks you would expect from a pretty big healthcare provider. So we're in the middle of SOC 2 Type II compliance effort right now, for example, constantly dealing, as we talked about the other day, with cybersecurity attacks.

Some potentially serious, some turning out to be false positives. So it's a, on the CTO side for me, a very busy time, basically. So that's a bit about Briotix Health and a bit about what I do there.

Ivan Dunskiy: Cool. And how big is your tech team? 

Russell Hertzberg: Right now, between the Eastern Europe development teams that we've added recently and the US-based technology, it's around 30 people.

Ivan Dunskiy: So, do you already have product managers who help you with the project prioritization and so on?

Russell Hertzberg: Yeah, we have a number of people that are in a product management-like role. We're really more of an agile shop, so we have, I would say, two types of product management roles now on our teams. We have a subject matter expert.

Clinical healthcare domain experts, of course, who are product owners on the teams. And then we have people that typically play a scrum master and classical project management type role. And I think that I would describe our product management as split between those two functions if that makes sense.

Ivan Dunskiy: Can you share what is your strategy for delivering projects? When they are ready, how do you deliver that and use it with the real users? 

Russell Hertzberg: Yeah. In a company of our size, I call it “the luxury of having a customer base.” And some of the customer base is engaged with our organization and therefore, we're able to move them onto some of these new platforms in a controlled release, controlled testing cycle.

That I would say a startup or early-stage company often does not have that kind of luxury. Therefore, it's a lot harder for the pre-revenue company and even the early-stage company to get effective testing in the market. We, on the other hand, have these close relationships with some of our biggest customers.

[06:05] how to achieve a win-win situation with your customers: leveraging relationships for controlled testing and successful software launches

We've been working with them for several years. We can share with them where we're at on our roadmap as it evolves and as we get closer to maybe releasing a beta version of the platform. And we can kind of effectively manage and control that release cycle by getting real feedback from some of our biggest customers.

And again, that is a luxury of a more established company. And that's what I want to take advantage of, I mean, the last thing in the world I want to do is try to start five beta tests in later stages of an MVP type release. And wind up with four of them not even using the software or not being a very good fit for the software.

That's not the case here at Briotix Health, as these new software solutions are ready to go to market. We know full well that a couple of our biggest customers really want to use the software, what they're gonna be doing in the software. And we know we're gonna get a lot of use.

In some cases, some of the projects I'm working on, we're refactoring and rewriting a prior system, so we're gonna be migrating all the data from the prior version of the system to the new version that we're developing. And they just get a lot of use during the beta test. So that I think, like I said, is an advantage of being a more established company.

Ivan Dunskiy: Yeah, sure. But do you have kind of a framework of metrics? How do you measure if clients would use the system? 

Russell Hertzberg: Well, that brings up a couple of different methodologies you can think about for sure. You wanna build into your software solution usage analysis, which some people might call clickstream analysis, but you really want to know what parts of your application are being used.

By what users and what roles? Obviously most modern software of service solutions have a fairly elaborate, way of establishing different roles in the system and everything from the kind of a super user admin down to just a casual end user as limited access to a limited amount of data, a limited set of functions.

So you do want to be able to do usage analysis by the user. So that's kind of looking at it from the inside, right? From the inside of your software solution.

Ivan Dunskiy: Do you mean like things like heatmaps? 

Russell Hertzberg: Yeah, right. A heatmap would be taking a step up to the analytic view of all that clickstream data or user usage data, and the heat map might show the most popular area of the application by the number of users that were using it, and the number of clicks they took in that particular area of the application. The heatmap might also show an area of your application that you thought was really important that nobody visits at all.

Or it gets visited once a month for 10 seconds. And so that tells you something. That's the inside view. And a data-driven view and an important view for sure. And that's a mandate throughout our organization to build that kind of analysis into everything we're working on.

I also think, though, you have to be willing to take a completely different view on that question. The perceptions of your key end user or users, your customer executives on how the adoption of your software is going, may have nothing at all to do with the real data that you can see from your inside view of your own platform.

But that might be really important. A key executive from the customer side might have a five-minute conversation with a key user who isn't getting some need met. And you could have a problem. So it's unfortunate, in the real world of adoption, it's not always a nice, neat mathematical data-driven case.

A lot of other things can happen that aren't that organized, and easily analyzed. 

Ivan Dunskiy: You mean adoption within the organization? 

Russell Hertzberg: Yeah. Adoption within the client organization. You might have 20 or 30 users that are banging away at it, but you could still also have two or three key users that aren't getting their needs met.

And, you wouldn't be able to see that necessarily from the heat map of your usage analysis. But that could just as easily, to use an American idiom, sink your battleship at that client.

[10:41] validation of the key stakeholders’ satisfaction in Briotix Health

Ivan Dunskiy: And can you share how you validate that your solutions meet all the pain points, let's say, of all key stakeholders?

Russell Hertzberg: Well, we have a client management organization. A lot of decent size companies have, and the client management organizations kind of constantly probing the key client, constituents, and stakeholders and finding out if they're happy. Again, some of them might be happy based on metrics.

Some of them might have some very narrow, very specific requirement or need they're looking to have fulfilled from the platform, and all they care about is whether you're fulfilling that need or requirement at the level they expect it to be fulfilled at. 

So that's engaged in customer engagement in kind of constantly sampling, the key constituents on the customer and finding out how happy they are.

You can do that in taking them to lunch, everything from taking the person to lunch to electronic survey methods and everything in between. So, that's a little bit of an art form. I mean, I think certain data is good there, getting surveys and also looking at your usage analysis data is good.

But as I said earlier, you also have to be engaged on the qualitative side of that, and the relationship also is very important. Especially when a solution influences different parts of the organization.

[12:20] typical EMR implementation mistakes that healthcare providers make

Ivan Dunskiy: You mentioned also that you worked on many EMR implementations. So what's a typical mistake healthcare providers make when implementing a new EMR solution?

Russell Hertzberg: Oh, lots of typical mistakes. One of the biggest is believing that the EMR, the adoption is done already.

Every EMR solution is going to require ongoing data integration. And some of the EMR platforms are better at it than others. Some of the EMR platforms, for example, are relatively newer technologically and have defined API integration methods exposing their APIs to help companies get data out of their platform, consuming APIs so they can bring data into their platform. And some of those API integration methods are easier to work with than others. And so one of the biggest mistakes, in summary, on the end user client side is to underestimate the effort and the time that's gonna go into the necessary data integrations, whether that's integrating electronic prescriptions for drug order fulfillment or whether that's importing an initial set of users, a bulk import of users to the system. Hundreds of users in a system. You don't want to key enter each one of their information one at a time. So that's another integration that has to happen often at the beginning.

Laboratory management systems and work related to samples of blood, samples of urine. All those kinds of things are often data integrations that need to take place. And typically, the patient that's being tracked in an EMR, EHR, will have had other encounters with your own providers or perhaps other providers, and some of that encounter data you'd really like to have.

So that you have what we call continuity of care. So, there's just really this endlessly long list of data integration, that needs to be done. And that's one big problem.

I'd say, a second general problem area is user training and user adoption. People in the clinical healthcare environment are experts at care, care management, and delivering care to people.

Russell Hertzberg: And the EMR and EHR is shaping how they do their work on a moment to moment, hour basis throughout a work day. And that the shaping process can be bumpy. They may have used a system before, or no system that still runs into that. And now they're being fit into a workflow that's pretty rigid. It's electronic, it's step-by-step. You have to adapt to the way the software works and how it has you work. And practice. Also a common problem is user adoption. 

That's another problem with EMRs and EHRs.

And I think it honestly in the United States, maybe the third problem is that, as a whole, we do have EMR/EHR vendors that have been around since the beginning of electronic medical records, and they may have missed a generation or two or three of technological enhancement to their platform.

So we have a number of pretty well-known EMR companies, both in the acute care segment and then in some of the niche segments like long-term post-acute care, which is the skilled nursing facilities for the elderly in the United States, or the segment I'm in now, occupational health. We have vendors in those segments that are effectively still selling and supporting technology from the 1990s. Client-server technology, I ran into an EMR platform in a project, I'm working on just recently.

It's not based on modern database technology. Everything is stored in files. It's an ISAM, it's an index sequential access method-based EMR. Every user is running a full client and everything is stored on a network file server. So, there are older technologies that ran into a similar situation to that and long-term post-acute care also. 

I did a number of data integration projects for a platform that was very old. And it has 25% of that market, roughly, believe it or not. In the United States, I think there are 17,000 skilled nursing facilities. Think about that. 

Here you have a major provider segment in the United States and a quarter of the electronic medical records implementations are running on a really old technology that has security implications, that has challenges for data integration. And it has the opportunity, obviously, for some of the companies that you and I know really well that are focused on building more modern software solutions for the healthcare market.

That's a challenge for us here in the States. But that's an opportunity for some of the companies that I've been working closely with for the last 10 years in my consulting business. 

[17:59] the right time to switch to another EMR/EHR solution

Ivan Dunskiy: And to you, what are the top reasons why healthcare organization needs to switch to another EMR solution?

Russell Hertzberg: One is frustration with older technology. Not getting enhanced very quickly. Not delivering functionality needed. Another is compliance and security, for sure. Compliance and security can drive a need, a need to make a transition. 

Ivan Dunskiy: Should they have it by default?

Russell Hertzberg: Well, they should have a platform that allows them to achieve the compliance and security mandates and requirements of, of the segment the industry they're in. And if they can't do that, or they can only do part of it, that could expose them to a lot of problems. 

Ivan Dunskiy: You mean not just basic HIPAA compliance, but some specific compliances related to a specific niche. 

Russell Hertzberg: Or a successful attack on them. 

Successful data exfiltration incident for an event that shows that their platform is fundamentally vulnerable and that their vendor doesn't really have a solution for them, and they may, may be mandated to report that publicly. That can cause a pretty big shakeup in a healthcare organization.

And those kinds of things do happen, actually. 

The other scenario, of course, for transitions is mergers and acquisitions. The USA always has a significant amount of M&A activity. It's gone up quite a lot in healthcare over the last 10 years, and so, a smaller organization gets acquired by a bigger organization.

The bigger organization may be unhappy with the solution that they're running, and the smaller organization maybe has something better. And the bigger organization looks at it and goes: "Not only are we getting this company's business and their customers, we're getting a technology implementation that's better than ours. Let's switch to that." And variations on that scenario. So that's another thing, honestly that can be behind a switch or a change.

[20:11] overcoming industry conservatism: emerging technologies for healthcare efficiency and safety

Ivan Dunskiy: Got it. And we all hear that healthcare is a conservative industry to adopt new technology. But like to your mind, what technology solutions could make the most significant difference, let's say, for a mid-size healthcare provider?

Russell Hertzberg: The pandemic, of course, accelerated the deployment and usage of telehealth. And I think that that's largely going to continue even though for the most part, the pandemic is over. Just the convenience and ability for a patient to have a relatively simple engagement with a provider, you know, via a method like you and I are using for this discussion, is extremely attractive.

It's lower cost. There are times when the physician needs to observe the patient physically and be with the patient for 5 -15 minutes and do some hands-on physical assessments, and then develop the soap notes related to that assessment. But that's for more acute or more serious illness, health problems. 

There are a lot of routine situations where getting in your car or getting on a train or getting in an Uber and going to the provider and waiting and having the office visit is just, it's a lot of lost time for you. If you eliminate all of that and just schedule a telehealth session and explain what's going on, and maybe all you really need is a prescription to antibiotics or renewal of some prescription for some topical thing on the skin or whatever. And that's just better practice, you know, that saves time for the provider. It saves time for the patient. It reduces costs of healthcare provision and the system, system-wide. So, telehealth is here to stay.

There are a lot of different ways for the EMR providers, for example, to deliver integrated telehealth. Everything from API-based integrations with platforms like Zoom to open source approaches to integrating all that functionality into a platform. So I think that's here to stay.

There's a lot of work there. There's a lot more work going to go on there. So that would be one.

And then there are interesting nichey things, something that I have discussed now twice actually recently. You're probably familiar with the story of Calendly. That was a small Ukrainian development company that build that little utility that allows you to expose your personal calendar, and other people can essentially self-schedule themselves into your calendar for meetings, and you can expose that.

The same concept is likely to gain popularity with the scheduling of healthcare appointments. And so, the group calendar function supporting a patient population, scheduling themselves for either in-person meetings or telehealth sessions is coming. I'm seeing a number of needs and requirements for that. And companies, EMR companies are either in the process of building that or will be in the near future. And again, that's just a logical next step. That makes things more efficient, and takes some cost out of the healthcare provision system.

The other area that I'm of course very interested in occupational health is tracking the movements of employees who are engaged in everything from moving around between three different office locations on the day and needing to maintain a good upright posture to employees in a manufacturing environment who are doing heavy pushing, heavy lifting, and are at higher risk of different kinds of musculoskeletal injuries.

Using richer data from those kinds of situations to deliver better healthcare to maybe predict increasing the risk of injury. Just a number of different use cases and scenarios for that new rich data that we're starting to be able to get more of.

So that's another future area that I'm pretty excited about. And we're doing some interesting testing with some of the new sensors, wearable sensors. We do have computer vision projects as well that are all in that area. That's another kind of cool next-generation tech area in healthcare.

Ivan Dunskiy: Don't you think that people would be somehow unhappy that they are measured all the time?

Russell Hertzberg: That's an issue, of course. It's an employee and union issue. We have a number of unionized clients right now, and significant parts of American industry are unionized.

So the union has a stakeholder role in determining whether employees should be allowed to be monitored in such a fashion. And the employer, though, and the employee are typically very aligned. unless something goes wrong wanting better health for the workforce. See, if you work for somebody, you don't wanna get injured, presumably. I mean, there's always the “get injured, win a big lawsuit” mindset. We have a little of that in the US too, but for the most part, that's not the way people think. People think: "Hey, I've got a nice job, like working in this job. I do my job well every day." That's a typical scenario. "So I'm pretty happy, I'm pretty fulfilled. I can pay my bills, I can save some money for my kids to go to university or to travel to Ukraine,” whatever. And the employers thinking the same thing, similar to that type of employee.

It's like: "Okay, we've got some great employees here. We want to care for them. We want to nurture them. We want them to remain healthy. We wanna optimize their health because when they're healthy, they do a better job. Consistent job." And so employers and employees are pretty aligned.

If some of this new technology is good for the employer and good for the employee, I think that the regulatory barriers that are potentially there, are gonna be lower. But that's a cutting-edge kind of question. And we are working through some of the regulatory and legal considerations on using some of this new technology right now.

At least in the occupational health space. And all the questions are not answered by any means. But the big picture is if the employer and the employee are aligned, and it's better for employee health, and it's better for the employer to have healthy employees. That's a sufficient alignment, I think, to help us get some of this technology deployed.

Ivan Dunskiy: And of course, I think that's on the employer side to show that alignment to an employee. 

Russell Hertzberg: Yeah, show it to the employee and show it to regulatory bodies and maybe show it to a union too. That's right. And it's not a guarantee that the way you see it as an employer is going to prevail and allow you to still deploy that technology.

There are a lot of potential hurdles there, for sure.

[27:40] the lack of proper data analytics in healthcare from the perspective of providers and individual patients

Ivan Dunskiy: Do you think that lacking proper data analytics is a big problem for healthcare providers?

Russell Hertzberg: Yeah. I think that right now, insight into everything about your provider organization, from how efficient it is operationally to how profitable our individual customers. 

I'm taking one view here. First is I'm a healthcare provider. What analytics would I like to have? We all run on some analytics, but do we have enough, and do we have the right analytics, can it be improved? We don't have enough. We have some of the right analytics, and by all means, there's a huge amount of room for improvement. So that's a provider perspective. 

If you take it to the individual patient perspective, that's a hat I can put on very easily. I had some elderly parents, they both passed, but I went through the process of their declining health fairly recently and got a real perspective on what that's like for an aging elderly person, both from the perspective of my parents, who I was very close to and then the perspective of building software for long-term post-acute care.

And at the end of their lives, both my parents were engaged to some extent with those types of providers. And at that time, I was working on the technology for long-term post-acute care. So from a patient perspective, there's just a huge amount of information that you wish you had that you don't have when you're engaged with the healthcare system.

Over the last five years, let's say you went to two different allergists. Can you look at an integrated view of what the two different allergists learned about you? Or let's say you have a chronic mild skin condition and you've seen four different dermatologists. Three of those dermatologists have three different EMRs, and one didn't have an EMR at all.What chance do you have of getting a consistent set of tests and assessments back from four different dermatologists?

And maybe the latest one is recommending to you a new biologic medication that requires you to get all kinds of strange diagnostic tests before you can even use it. "Well, what is a doctor telling me to do? If he tells me to do X, I'll do X." Some of us have been more engaged in the healthcare system from the patient perspective. And maybe you're thinking it's a little more complex and just listen to one doctor.

Maybe you're thinking that you need to do your own research about the condition. So maybe you're factoring in the doctor's recommendation, another doctor's recommendation, your own research. And uncertainty before you're going: "Okay, cool, I'll take that new biologic."

That was just invented in some labs, using DNA modification technology or whatever. And the analytics or even the gathering of the information that you'd like to do from the patient side to do a highly informed analysis. It doesn't exist. You can't get that, really. 

So you're left with a fragmented, at least in the US healthcare system, you know, which is its own kind of Byzantium, if you will, or its own balkanized situation. When you get older, you have medicare-based healthcare provision. While you're younger, you're typically in a healthcare plan coming from an employer. You have all these different types of specialties, hospitalization when you're seriously ill, but all sorts of unique specialties for unique conditions.

Dermatologists, chiropractors, orthopedics. There are lots of specialized segments. And so over the course of your lifetime, you're in this Byzantine-type system, you don't have an integrated view at all of your various healthcare conditions and, and your health situations.

So that is a challenge for us to do effective analytics. And so there's a huge demand for analytics because with all that confusion and all those different types of providers and all that lack of integration in the individual patient's basic healthcare records, there's an unlimited need to integrate that data and then analyze it.

So the demand for healthcare data integration and analytics, at least in the USA market, where we have this very fragmented system. That's fragmented in terms of how healthcare is paid for. It's fragmented in terms of healthcare provided. In that environment, it's unlimited demand, frankly, for the technology that helps with healthcare data integration and healthcare analytics.

It is a very big ongoing opportunity area. I had to bulk up on healthcare, and data integration software talent right away. I didn't even have to think twice about that. A little less than a year ago, when I started this new role, I knew just from my experience in the last 12 or so years, that the demand on my organization for healthcare data integration was gonna be vast and increasing at all times. It just was inevitable.

Ivan Dunskiy: Is it demand for specific technical skills on how to integrate with specific API systems?

Russell Hertzberg: Certainly, you're looking for experienced engineers in particular technology stacks that have done API integrations. In some cases simply consumed other APIs, so an ability to assess a set of API endpoints and then develop a consumption module for that API.

But there are also cases where you need to design and develop an API to expose your own data. To API consumers coming from other systems. That's also a set of skills and a set of experiences that you wouldn't necessarily find in any software engineer.

And then there are older methods. There's always ETL and ELT, and a lot of people have been doing data integration via that method for a long time. But in healthcare, we also had a period where there were some XML-based formats, I won't even call 'em standards. It's called HL7.

Lots of variations in the HL7 implementations. Very complex implementations. Some compound document standards in healthcare data integration as well that are based on XML. And then, for the insurance-oriented integrations, there's a set of older ANSI x12 standards, which are very kind of old protocols, but they're also still very relevant in the US healthcare market. In modern systems, we're typically more often dealing with RESTful APIs. Hopefully, JSON-type data, which is really easy to work with.

It's very human-readable, so that makes it a lot easier to work with basically. So, just in this little chat we've had here, you see in the US market you have 5, 6, 7 different types of data integration cases and technology standards and so what kind of software engineers can you find to do that?

They're out there, but they do need some specific skills or need to be fast learners or have some similar baseline experience maybe somewhere else and then be able to quickly learn the subject matter and the domain, learn the structures of the data they're trying to consume or build an API for your own platform too. 

And there are a couple of interesting new initiatives that are, maybe not being adopted too quickly. In the rest of the API area for healthcare data integration, there's FHIR, called Fast Healthcare Developability Resources, and they're some interesting third-party companies that have built FHIR platforms that have been adopted by some of the healthcare software companies, but probably not enough, and the adoption hasn't gone all that quickly. So, that's a little bit of a more of a techy deep dive into healthcare data integration in the situation.

[36:09] custom EHR/EMR solutions and the fragmented healthcare market

Ivan Dunskiy: And how do you think could custom software solutions, specifically custom EMR, be more efficient than on-the-shelf products?

Russell Hertzberg: Well, I was doing a little research before our talk, and I was looking at something like a full list of all the different EHR/EMR systems in the United States and how they break down. 

Orthopedic practices have their own flavor of an EMR/EHR. A dermatologist maybe has their own flavor of an EMR/EHR. Chiropractors are not MDs, but chiropractors, if they get to be bigger practice, have their own flavor of something like an EMR/EHR. Where again, some of the concepts are the same. Somebody walks in the door, that's an encounter, and you gather some basic demographic information on an encounter. But then, as far as the treatments go and the treatment workflow and the follow-up, each one of those types of practices are different, right?

Tthose unique provider segments all need a custom solution. Or some element of what they need is very custom. Now, how do you achieve that customization? Do you write unique web forms in JavaScript with Node.js on the backend for each one of those, or do you, for example, build a drag-and-drop form builder that allows a non-programmer to kind of build what's unique and about that platform.

So there's a lot of interesting design and architecture considerations there. It's a good topic and a great question. 

Ivan Dunskiy: But I thought that this, I would say sub industries, they already have of the shelf solutions as well. For example, there are a set of different products for nursing homes or for home health and so on.

Russell Hertzberg: There are, that's right. And each, what I think the opportunity essentially is that each one of those segments has a unique set of vendors. So I don't know what the number is in the United States in terms of specialized healthcare provider segments. It's probably more than 50. It might even be more than a hundred. And everybody knows about the big providers in acute care, which is basically our hospital system. Companies like Epic and, Cerner, Allscripts. 

But if you go into dermatology who are the top EHR/EMR providers for dermatologists, I don't know who they are right now. Because I've been in long-term post-acute care, I know who the two biggest ones are for skilled nursing. I happen to know that off the top of my head. But who are the biggest EMR/EHR providers for chiropractors or physical therapy?

I mean, there's a very great company in Eastern Europe called Raintree that specializes in therapy. But then there are therapy EMR solutions for long-term post-acute care too. So it is really a very fragmented market. On the provider side, and as I said, some of the companies are very much legacy, their solutions are from 25 - 30 years ago, and they're emerging companies. They're early-stage companies. They're companies that have 50 or a hundred customers, and they're a couple of million dollars of revenue. And they need help. They need a lot of new software, basically. 

It's still a very promising opportunity for some of the companies I work with on the JCloud side, some of my partners in Eastern Europe. Some of my partners, Serbian partnership, companies in Poland that I've begun talking to and working with. So, I mean, great opportunity for health tech in the United States. Customize EMR solutions, add-on modules for EMR solutions, and then the data integration and data analytics area for EMR. Those are very good opportunities.

[40:26] M&A and the other lines of business at Jcloud

Ivan Dunskiy: And can you tell more about Jcloud? What specifically did you do there? 

Russell Hertzberg: When I left Softserve in 2014, I began doing some of my own consulting at the same time I started into my first delivery management role in Atlanta. And we've evolved into three main lines of business at Jcloud. We continue to help early-stage companies essentially develop a healthy ecosystem between the founders, investors, and the software development team.

So that's creating alignment there, an orchestration for an early-stage company so that they're really in a position to experience high growth. 

The second part is working with companies like yours, Demigos, and a lot of the other software development services companies in Eastern Europe. And I do connect some of those companies with USA clients who are in need of specialized software engineering resources.

Everything from a database performance optimization expert up to a full team, that's building a next-generation solution and everything in between. Dedicated teams, fractional individuals, and everything in between. It's classic software development service. 

And the third piece, more recently, is M&A.

And M&A focused on software development services companies. As I've been in that market in one way or another for about 12 years. So, I think there are going to be more mergers and acquisitions in the software development services space. Clearly, I've seen a few more deals lately and know who the big buyers are and, we know who a lot of the faster growing emerging companies are.

So I think there's more of that. And, that's an interesting, exciting area for me, that I've been working in now for a little while as well on the Jcloud side. So it's a small partnership. I have a partner. She's not here on the call. Deanna, you've met her. And we're working on those three areas, and it's complimentary to my corporate life and has no conflicts. It's great!

[42:41] speech processing and innovations for data and human genome as promising technology trends in healthcare

Ivan Dunskiy: Thanks for sharing. And we are coming to the end of the interview. What technology trends in healthcare, or let's say specifically in EMR space or beyond that do you see in the next three to five years?

Russell Hertzberg: Well, I think, one we didn't touch on yet is speech processing. And I think that's continuing to get better, continued improvements in related algorithms.

Ivan Dunskiy: Physicians do not like to type, right? 

Russell Hertzberg: Yeah. Why would you wanna type, if you can just dictate? That's especially a physician-friendly technology.

It's been oversold in the past, but you have to wait for the performance and the accuracy of the recognition algorithms to catch up to the vision, and that will happen. That's one very promising area. As I mentioned earlier, I'm pretty optimistic about sensors, wearable sensors. I think that the digital mobile healthcare revolution has started.

It's happening. Things like Fitbits are very, very useful already to people. I'm in a pilot right now on a wearable sensor for my posture. That's generating a lot of very interesting data about the relationship between neck and back health and posture.

I just think that that's going to be a promising area because the data you can get is richer. And it's a matter of you getting enough rich data, you can get a lot of insight. I think AI and machine learning is going to be very transformative in healthcare.

And of course, obviously genetics, human genome is a tremendously promising area for future innovation. I guess a single human's fully sequenced genome is around seven. Terabits of data, it's a lot of data. And there's large portions of that data that we haven't really explored yet, or even know what the meaning of it might be relative to human health.

[45:14] Rapid Fire Round (3 personal questions)

Ivan Dunskiy: I suggest that we end this podcast with the light exercise called Rapid Fire Round. I'll ask you several personal questions, and you can give answers. 

Russell Hertzberg: Okay. I'll be careful, though. 

Ivan Dunskiy: Could you remember some funny moments from your career? 

Russell Hertzberg: Oh yeah, lots of funny moments. Traveling for Softserve with a guy named Harry Propper, who's the president of Softserve. A lot of funny moments, so there you go.

Ivan Dunskiy: Can you share something? 

Russell Hertzberg: Just humorous encounters with Randy. In airports in Europe, and just awkward statements and a lot of laughter.

Ivan Dunskiy: What is your hobby?

Russell Hertzberg: I'm a sportsman. I think some people that I've met in Ukraine know that about me, so, I'm training pretty much year-round to continue to play water polo. I'm a water poloist. And I do love snow skiing. I'm about to be moved to Colorado. And my family's had a place here in Colorado since the early nineties, so I almost definitely an avid snow skier. We've had an unbelievable skiing winter here in the western US. Amounts of snow set, all kinds of records. So I'm excited about snow skiing and living in Colorado. I play a little bit of golf. And I guess I'm casually an observer of sociopolitical trends in the United States, too.

Very interested in the emerging of healthcare and politics that we've seen with Covid-19. So that's a little bit of a hobby. Mostly I'm a sportsman, but on the intellectual side, maybe I'm very interested in the social and political dimensions of healthcare.

Ivan Dunskiy: Cool. And what is the location that's impressed you the most?

Russell Hertzberg: In the world? Lviv. Я люблю Львів! (in Ukrainian meaning “I love Lviv”)

As a city that is kind of beautiful to walk around and has ambiance. To me, it's a lovely, charming city in central Europe and really cool older buildings and lots of outdoor cafes, lots of history, lots of tradition. Lviv is amazing.

Ivan Dunskiy: And what is the piece of advice you would give to your 20-year-old self? 

Russell Hertzberg: Learn to listen better. Shut up more and listen better. 

Ivan Dunskiy: Thank you, Russ, for your time and for sharing so much about about technology in healthcare, and of course, the trends, and the EMR world. Thank you for sharing your unique perspective on that. What is the best way to contact you?

Russell Hertzberg: You can use my Gmail email address. If it's related to Jcloud, that's russellhertzberg@gmail.com. And if it's related to my CTO role in occupational health, that would be Briotix, so russellhertzberg@briotix.com.

Thank you listeners and we'll catch up on next episodes.

Who is behind the HealthTech Beat podcast

We are a team of IT professionals who like sharing technical knowledge with healthcare industry people.

At Demigos, we generate ideas on how to improve product performance, design, and positioning based on our experience building complex health tech solutions.

Check our blog with articles on the related topics, and our cases in healthtech. Also, connect the podcast host and the CEO of Demigos Ivan Dunskiy on Linkedin.