Healthcare Data in the Cloud - Luke Bonney, CEO of Redox

SHIV GAGLANI:Hi, I'm Shiv Gaglani and today on Raise the Line I'm really happy to be joined by Luke Bonney, who's the co-founder and CEO of Redox, a cloud-based platform that makes it easy for digital health companies to integrate with electronic health records at hospitals and clinics.

Redox has integrations with more than 500 independent software vendors and is connected with providers serving over a third of all of America's patients. Earlier in his career, Luke worked at Epic, the leading EHR vendor in the United States. I wanted to do a quick shout out to the partners at Flybridge, including Chip Hazard and Jeff Bussgang, who are both investors in Redox and in Osmosis. Luke, thanks so much for taking the time to be with us today.

LUKE BONNEY:Yes, it's great to be here, super excited to chat.

SHIV GAGLANI:I know a lot about your background, but for our audience's benefit, do you mind telling us a bit about yourself? What led you to your interest in healthcare data and digital health in general?

LUKE BONNEY:Yes, of course. So like a lot of people, I graduated high school knowing that I wanted to work in healthcare IT. No, I'm just kidding. So--

SHIV GAGLANI:I don't know many people. Who are your friends?

LUKE BONNEY:I went to school and was a biology major, expecting to be a doctor and graduated in 2008 and kind of all at the same time, recognized that I wasn't ready to commit myself to medical school, but was very interested in healthcare and very interested in software. So graduating in 2008, similar to what's happened in 2020, there was significant impact to the jobs market. What ended up working for me was getting started out at Epic, which back then that was before the Affordable Care Act.

I remember my parents saying – I'm from New York, and my parents saying, "What's this EHR thing and where is Madison, Wisconsin?" And my response was, "You've got to trust me. It's going to work out." The journey to Redox really started first with Epic. Me and Nico and James, the two other co-founders, that's where we met and really cut our teeth, started to really understand technology and healthcare and the role they play. Redox really got started when all three of us left and Nico and James actually left first, each to start their own startup in Madison. I got involved about a year later and really the first idea that we came together around, kind of the first project was a project we called 100 Health. 100 Health, the tagline was we are going to start 100 digital health companies in Madison in the next five years.

This was in 2013. And of course that was crazy. That was kind of the point. But the whole idea was, we thought digital health and healthcare IT was about to explode because of the impact of meaningful use. We thought Madison was a super unique situation because of the unique mix of talent. And while we didn't start 100 digital health companies with 100 Health, we did get seven started and Redox was born as we witnessed firsthand how difficult it was to scale each of those seven cloud-based technologies. The unique problem that all seven of them were running into that really impacted their ability to scale was how to integrate data with provider organizations.

So that's where the inspiration for Redox was born. We quickly came to understand that what the world needed was a platform that served providers on one side and served developers on the other side and made it easy to facilitate data exchange at scale.

SHIV GAGLANI:That's a really cool backstory and clearly you've gone from those seven to now over 500 software vendors. Can you tell us a bit about what the secrets of your success and scale have been? I'm sure, just like any platform play, there's probably a couple of killer apps or killer integrations that have really led to your adoption.

LUKE BONNEY:Well, I would say the first secret is the willingness to bang our head against a really hard wall for a long period of time, which I think is any successful company; that's at least a key part of the story. For us, the first real big question to answer was, which of the two sides of the network do we start with? We immediately understood that Redox was going to be a platform that sat between providers and cloud-based vendors. The question was, how do you build a network? It's the classic chicken and egg. So the way we went about that, think about this. This is late 2013, early 2014. We basically pitched the idea to a whole bunch of CIOs who we had met and known through our time at Epic and pitched a whole bunch of CTOs at digital health startups.

You could imagine the kind of difference in response, the CIOs were like, "You're built in the cloud and you're talking about a platform. Both of these things make me really nervous." On the other side, we had CTOs at digital health startups saying, "Wait, you're telling me you want to build a single platform where we could connect once and integrate anywhere. I'll buy that right now." So that was kind of the first experiment we ran. It was also the experiment we ran to help us build conviction that Redox was worth pursuing, but that's what really got us started. So our core focus right now is how does Redox provide a wonderful developer experience to cloud-based applications? They're our core customers and core users, and they bring us into the providers who want to use our technology and stand up reusable integration for them that can be used by any other application. That really helped us understand that the way we were going to build our network was by servicing and engaging directly with the technology vendors first.

SHIV GAGLANI:That makes a lot of sense. Definitely forming developer communities is the heart of success of other large companies like Twilio and Stripe. Redox kept coming up as I was doing research into this space. What are some of the example integrations that you're most proud of? Can you give us a bit of a sense of that? You transmit millions of patient records a day. We'd love to hear where the value is being created.

LUKE BONNEY:Yes. To put some numbers, we've done a couple of billion transactions in 2020, and I only say that because I've never been associated with anything with a “b” in front of it. It's really kind of crazy to think about. But obviously, 2020, so much happened to healthcare, so much happened to all of us. I think some of the things that we are most proud of as a company are some of the things that we were able to support in response to COVID.

One of our customers is this amazing company, Curative. Curative is today a COVID-19 testing company. They do everything from drive-through testing facilities, working with municipalities and states all the way through to servicing entire states. When they started, and at this time in 2020, they were something like 10 employees and their CIO came and talked to us this summer and they were at 900 employees. We've helped them process over 10 million COVID results. Our role in all of that has been to provide the infrastructure back and to help them report and exchange those COVID-19 results with state level public health agencies across the country. So today we're now connected and can report COVID results to all 50 states and working on the ability to report and track vaccinations.

All of that is infrastructure that we built in order to support so much of the critical work that went on this year. This time last year, if you said, "Hey, Luke, you're going to be exchanging millions of messages with state level public health agencies." I would have said, "You're crazy. Why would we ever do that?" And here we are now having built out mission critical infrastructure. The way we look at that is, that's our role. That's what we had to do. It's the least we could do in support of our country and our response to COVID-19.

SHIV GAGLANI:That's a pretty amazing example. It actually is a good transition into my next question, which is, what are some of the lasting changes you think COVID will have, not only on Redox? Maybe that infrastructure you built can be recycled for other public health testing, not just pandemics, but maybe other kinds of reporting, but then also for healthcare in general. What are some lasting changes that you think will come out of COVID?

LUKE BONNEY:Yes. As incredibly painful and as terrible as COVID-19 has been, and all the people, both patients and providers and kind of everybody who's been hurt by it, just like everybody, we're trying to look at what are some of the positive things that have come out of this. I'd say the top line and general takeaway is that COVID has drastically accelerated the role of technology in healthcare. And it was because all of us, providers, patients, payers, anybody who touches the healthcare space, understood. We didn't have a choice. In March, April, May, June. We had to embrace technology. So the biggest thing I've seen is we've probably taken five years worth of technology adoption, we jammed it all into 2020.

Some of the specific things that I think have shifted and are here to stay, the first is just virtual care. What we were forced to figure out is, how do we care for patients that we don't see in person? Whether that be telephonic visits, video visits, whether that be remote patient monitoring, how do we care for a patient at home and keep track of them? What we found is that patients, something like 84% of patients who engaged in virtual care when surveyed said, "I would prefer that. Not only is that equivalent, but it is better. It is so much more convenient and in line with how I run the rest of my life. Why would I do anything else?" So I think virtual care and the way we engage patients and the way providers engage patients, that's here to stay. I think the other big shift, two other shifts I'll talk about, the other is a significant acceleration in what I would call the direct to consumer healthcare market.

When I say direct to consumer, I mean engaging, not through a provider, but directly with a patient from a business model standpoint. The two examples here are the necessary explosion in home diagnostics. How can we test, how can we get a test and take a test and send it back in, all at home, from a mail-in standpoint? And then the second is, all the direct-to-consumer prescription work. Whether that be GoodRX, Roman, those sorts of groups, that's the beginning and has accelerated what will be this direct-to-consumer business model and approach. I think over time, that has the greatest opportunity to disrupt healthcare.

The last big thing I would just say is, the regulatory landscape has forever changed. I think most of it's for the good. We've seen reimbursement for virtual care visits get introduced universally. We've seen the ability for physicians to practice across state lines put in place. And overall, we're seeing the reduction in barriers when it comes to technology adoption and access to care. I think healthcare will be a better place for technology innovation in 2021 because of the regulatory changes that were accelerated in 2020.

SHIV GAGLANI:That's great to hear. Two other things that, independent of COVID, I know our audience would be very interested in, and given that you worked at Epic and obviously you integrate with a lot of health records. One is privacy, patient privacy. Actually when I was at Hopkins Med and I co-founded Osmosis there, Robert Lorde and Nick Culbertson also were Hopkins med students and they co-founded Protenus, which does cybersecurity. I'm sure you know them, too.

LUKE BONNEY:Of course. I know those guys well.

SHIV GAGLANI:What are your thoughts and how do you respond to the CIOs at these different health systems to mitigate their fears given that there's a lot of questions around security, around patient privacy and data?

LUKE BONNEY:I have a couple of answers to this question. The first is, one should always recognize that regardless of what technology you bring, when we talk about healthcare, we're talking about some of the most sensitive data that you could imagine. So by the very nature of it, describing very sensitive parts of your experience and my experience and who we are and the fact that it's non-reversible and unchanging, the stakes are just higher. I just want to start there. If you're going to do work in healthcare, you just have to understand that security is paramount no matter what. So for us, what that means is both, we need to invest in that appropriately when we think about our own infrastructure and then make that transparent to the people we work with, and we need outside parties to stamp that, to verify that what we do is secure.

So for us, as we were directly engaging with the CIOs, what that meant was being able to talk through what we do in terms of the controls we have in place, and being able to share things like our high trust certification or our SOC 2 Type 2 letter. That's really critical.

My second response goes back to the question you asked earlier. At the end of the day, the data belongs to the patient, and what really gets lost – everybody's trying to do the right thing so this is not a blame at all -- but at the end of the day, everybody should be asking, “What does the patient want? Where should that data go in order for that patient to get the most value, to receive the best care?” And this is where I get really excited. Today, healthcare is primarily a direct business to business market. Because of that, there's business to business agreements that dictate the use of healthcare data. What I'm really excited about in line with that emergence of the direct to consumer market is to really give more voice to patients to say, "Here's where I want my data to be used." An example of where we're really seeing that today that's super exciting is the emergence of whole new models as it comes to clinical studies, how to match research studies and the patients suited to be enrolled in them.

What we find out is that when patients are able to educate themselves to learn and then to opt in, they're much more willing to do that than probably many people would expect. So overall, I just think there's a whole bunch of momentum in really elevating the patient's voice. And I think as technologists, that's really where we're headed, that's where the puck's going. That's how we think about our work at Redox as well.

SHIV GAGLANI:That's a theme that's come up multiple on the Raise the Line podcast. We had Eric Topple on the podcast a couple of weeks back and one of his many books was The Patient Will See You Now, about bringing that power to the patient so they can be, as Vivian Lee and other guests on our podcast said, co-producers of their own health, which they really should be. It's good to hear that you all are providing that, making that a little more seamless as well for the patient.

LUKE BONNEY:Can I just put one point on this one?

SHIV GAGLANI:Absolutely.

LUKE BONNEY:The one point I would add here and I'm so happy you brought up Dr. Topple. So right now versus when Dr. Topple wrote his book, this is the perpetual question in healthcare, is what enables change over time. The reason we are so excited is because our relationship to our healthcare data has fundamentally shifted because of COVID. We think about our health care data, think about whether we've been tested, what is the outcome of that test? Our relationship as Americans to our healthcare data has shifted and has become much more present than it ever has been before. That's not going to go away anytime soon. In my mind, that is the main reason why I'm so hopeful that the voice of the patient is going to be elevated because patients are going to demand it in a way that they haven't before.

SHIV GAGLANI:Yes. I think that's a really nuanced and important point. Something we believe a lot at Osmosis, too, because we've seen a fundamental shift, not only in the way society views training healthcare professionals now that we know we've reached shortages that are very acutely felt across the country, especially in Southern California, for example, but also understanding your own health. It's one thing to raise the line and improve health care capacity and strengthen the healthcare system. It's another thing to convince people to wear masks and socially distance and actually get the vaccine so they can flatten the curves, so we don't need as much healthcare. I think it's a really important point.

Our audience are primarily healthcare professionals who have a love-hate relationship with electronic health records. Clearly the things you're doing are helping to make that more of a love relationship because it's easier to transfer data and get what you need. What are your hopes for the EHR market and industry so that they aren't leading or contributing to so much burnout among our healthcare providers?

LUKE BONNEY:The first thing I will say is, the role of electronic health records and the government's choice to incentivize their adoption, I think was the right decision. That might not be a popular opinion. But as a patient, as somebody who's receiving care, thinking that as recently as 2009, there's a good chance that my care was documented on paper and therefore, not at all available to a second doctor or a second nurse or a second PA, is crazy. The role of the EHR, which, the way I've always thought about it, is the system of record for any healthcare institution, is critical. The federal government's decision to incentivize their adoption, I think is an interesting and impactful decision that at the end of the day, while very painful, I think is pushing the country and healthcare in the right direction.

The second thing I will say is that, having worked with large healthcare organizations, change at the scale and pace necessary to adopt electronic health records is crazy, having lived through it. Being in my twenties and stepping in to work with clinicians who have been doing their jobs for 30 plus years, and basically asking them, or being a part of the asset to change some of the fundamental ways they go about their work. That is going to be painful, no matter what way you cut it. All I can say is that I'm empathetic. I understand. I was in front of the room as people were dealing with that amount of change and definitely felt myself trying to voice and empathize with both sides of it. But I do think it's the right thing and the necessary thing.

In terms of the relationship between clinicians and technology, the thing that's really clear is that over time, as people get used to and adopt and reestablish routines, there is definitely a higher level of productivity. The ability to share meaningful information about a patient with a core clinical team is absolutely necessary. If you were to ask people after a couple of years of having adopted an electronic health record, "Would I go back? Should we remove it?" The vast majority of them will say, "Heck no. There's no way we could go back." So the only way is to keep going forward and to continue to iterate and improve. And in a lot of places, it might take a couple years, but you end up in a much better spot. That might not be true for everybody. I'm not saying that's true for a hundred percent, but that's true for most people.

SHIV GAGLANI:My last question is, what advice would you give people right now, considering careers in healthcare, digital health? You were pre-med you then wound up improving and innovating in healthcare in a different way than you had originally thought. What advice would you give to the younger students in our audience?

LUKE BONNEY:Totally. Honestly, the fact that this is your core audience is one of the reasons I was so excited to chat with you directly. At the core, I see the folks in medical school and recently out of medical school as the most necessary change agents for healthcare. When we look at the things that slow down technology adoption in healthcare, a huge part of it, there's obviously technical hurdles, but a huge part of it is cultural. So the three roles that I think folks can specifically look at it is first, be a user who's going to provide meaningful feedback to any of the technology you use, whether it's your EHR vendor or telemedicine vendor or anything else you use to do your work. The second is to be vocal where you see a gap, where there's an opportunity for a tool that you struggle with today. You are all in a unique position to understand that gap and to understand how technology could support it.

The last thing I would say is, there's a clear trend of folks with clinical backgrounds being wonderful founders and co-founders for digital health and healthcare IT companies. For me, and I think for a lot of folks, the reason we work in healthcare isn't because it's easy, because it's certainly not. We do it because it's impactful and we can bring about positive change and that's no different. You're in a position where you can be the founder of some really amazing technology startups, if you wanted to do that too.

SHIV GAGLANI:That's some awesome advice. Luke, thanks so much for taking the time to be with us today, and more importantly, for the work that you do at Redox to raise the line and improve healthcare, the way it functions and capacity as a whole.

LUKE BONNEY:Awesome. It was great to be here. Thank you so much for inviting me.

SHIV GAGLANI: With that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show and remember to do your part to flatten the curve and raise the line. We're all in this together. Take care.