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Building a User-Friendly EHR: A conversation with CareCloud CEO Ken Comée

Ken Comée is the CEO of CareCloud, a cloud-based electronic health record (EHR) and physician practice management company. Their open platform is intended to help providers maximize the efficiency and effectiveness of their practices, while connecting and collaborating directly with patients in support of better care.

Mr. Comée joins CareCloud following a successful track record of helping cloud-based technology innovators to secure and extend market leadership. He brings more than 20 years of executive management experience in both private and public companies.

Previously, Ken was CEO of Cast Iron Systems, growing the company into the #1 brand in cloud integration.

Zach: Hi Ken! Thanks for talking to me today. Mind telling us a bit about your background?

Ken: Well, I go back further than that. I made the move into startups in the early 2000s, right when the ‘.com Boom’ was over and the bust was on us, which really forced my entrance into the cloud space with the right business fundamentals. The days of throwing up a website and selling dog food were gone and you really had to get down to building a repeatable and scalable business on the web.

I’ve been doing that for the last 18 years and have been very fortunate to be associated with some of the best venture guys in the Valley: Norwest, Sequoia, Tenaya, Adams Street, and Benchmark and have been able to work with some prominent, patient long-term investors at those firms. That helps immensely to get an idea shaped and ready to take to market. You have to have a tremendous syndicate that believes in the vision and will be supportive during the bumps and hiccups along the way because you’re going to experience them.

And you joined CareCloud 3 years ago, is that right?

6 years ago, actually almost 7, Norwest asked me to take a board seat at CareCloud. I then took the CEO role three and a half years ago. So about half my time was with the original founding team, and then it was the classic situation where the founder gets to a certain size and scale they’re no longer quite so effective, so they wanted to bring on a professional management team.

I moved out here in a moment’s notice. They said ‘Do you want to do this job’ and I said ‘Hell yes.’ It was a massive market that needs disruption in the early stage of that disruption. I came out here with the idea that we could really build a big legacy company because all of our competitors were 20-30 years old and were going to struggle getting to pure cloud and all the interoperability and scalability benefits we all know about.

We’re right there, and the market is moving towards us. It’s not even just one or two waves we’re riding, there are multiple waves. We’re riding the modernization of healthcare and systems moving up into the cloud.

We’re riding this really compelling wave of physician practices that are rolling up. Physicians aren’t thinking how do I build a 10-doctor practice but a multi-hundred doctor practice by through acquisitions and mergers and building a massive scale effect. That plays right to the cloud because you can’t have brick and mortar servers on premises.

"We found that previously it took a patient on average twenty minutes to check in, with CareCloud its taking less than nine"

Another wave is that of rising health costs. Patients are being pushed to pay for more out of pocket so physicians have to start thinking about a changing demographic of patients that are expecting the tools and technologies to interface with their doctor with a consumer retail feel and a good patient face.

Then there’s medicine moving from the fee for service world to value-based care. Physicians are on the hook for driving patient-based outcomes and having population analytics to show that their patients are getting better and staying better over time. We sit right in the middle of all four of those vectors.

You mentioned the switch to value-based care — What are your plans for better supporting doctors to understand their patient’s health and even intervene?

I think at the core is the fact that we’re a platform. We have the ability to aggregate the efficiency and excellence of workflows. Medicine is all about workflows: how do you engage them and then track them, for example, a patient being referred out to additional tests or care from affiliate practices. Our goal is giving a holistic end-to-end view of the patient to the doctor.

Because we have a platform and we believe in core cloud principals, it’s all open. The open API structure of our platform allows us to plug into population health vendors, and telemedicine vendors and even Google, as shown with our latest announcement as an interoperability partner in the FHIR API. We want to surface all the necessary contact points within the patient’s flow for that physician as well as get access to that data to produce analytics the doctor needs to see for that patient or cohort of patients.

How do you decide to build something in-house as opposed to enabling that ecosystem you were describing and allowing someone else to build it? Traditionally, EHR vendors have tried to keep everything in-house so your take is interesting.

Absolutely. That’s where the big disruption comes. It’s old-style thinking that says ‘We just want to own it all and protect ourselves.’ You can’t do that now you’ve got to be open and realize that you don’t want to do it all because you’ll never be able to manage all the endpoints.

Our philosophy is that we’ll choose to build some things that are core to our platform, like the EHR and the patient experience and the practice management revenue cycle. But I don’t want to build everything so we partner with best-of-breed to give more efficiency and productivity tooling to physicians.

One of the big things that helps us with is reducing the number of ticks and clicks and swivel chairing physicians need to do in order to input or find data. Our platform is really driving to be the next generation of easy-to-use and highly intuitive, and we’re developing machine-learning to know what the most common pathways are. We want the system to help guide the physician, not force them to go find everything. Then, when the patient is in front of the physician it’s a much more productive and effective relationship between the two.

Have you been able to calculate the time physicians save with these new tools?

Absolutely. We launched something called the Breeze platform about a year ago. It’s a patient engagement solution in conjunction with the Clover Kiosk First Data (think Square). It’s not just a payments vehicle but it also helps patients make appointments online rather than calling the doctor's office, fill forms before the patient is even in the office, give ratings and reviews to their doctor. What we’re finding is significant value with phones ringing significantly less and admin staff that don’t have to answer questions patients can solve online.

We found that previously it took a patient on average twenty minutes to check in, with CareCloud its taking less than nine. For an existing patient it took 12-15 minutes and now with CareCloud it’s 2-4. So it’s a significant improvement of the administrative check-in time allowing the front-office staff to focus on the patient experience and giving more time for the doctor to be with the patient.

The other thing we’re seeing from the ROI perspective is the ability to collect cash from the patient. Physicians would see on average about ⅓ of their patient obligations go to bad debt because they wouldn’t chase patients for outstanding bills. But with the rising cost of those patients, you can’t write off it off. So, allowing the system to show the bill to the patient right away creates a 10% increase in the amount of cash collected which can mean a lot of money, especially at the larger practices.

You mentioned how these independent practices are aggregating. Can you talk about how you’ve been working to service larger practices?

Great question — we came into the market 8-9 years ago from the bottom up, selling to 1-3 doctor practices in massive amounts. I made the shift 3.5 years ago to move up-market. We saw the changing landscape with physicians under pressure from a cost standpoint. The payers were ceding less and it was getting harder from a compliance standpoint. Physicians just wanted to practice medicine and so would sell the practice to a larger entity.

"I think we’re going to see some productive, high-growth companies in the coming years."

We considered the needs for multi-location and maybe even multi-state practices. We considered revenue reporting and thought ‘Well, we can set up our billing algorithm by state.’

Another thing about us is that with those brick and mortar practice can’t have servers on site. They’ve got to get in the cloud and they’ve got to use technology via the browser, so we’ve really worked on a best-of-breed infrastructure using Amazon, Google, ML and AI to improve the speed, accessibility, uptime and the open connectivity with our API.

You mentioned the Google partnership; how are you using next-generation analytics to drive new insights?

It’s an amazing partnership. I always get the question ‘Who else are they working with’ and the answer is really ‘Nobody.’

It really started out with them saying we’d love to have you guys on our cloud (we’d been with Amazon). We said ‘Ok what do you have’ and we started to see what they were doing, organizing healthcare data and putting billions of dollars to create a healthcare unit inside of Google.

They were really coming at it with a lot of digital recognition capability and advancement within the FHIR API and interoperability. We saw it was really core to where we wanted to take our platform. What they saw within us was cutting-edge thinking on how to create an open environment, and our holistic end-to-end data that enabled us to do analytics for the physician practice as well as for the patient. We really do have two companies one mind on using data aggregation across multiple surface-points to deliver the most value.

We’re working together to put our technology in their cloud and use their technology for the FHIR API, but we’re also working very closely with them to leverage their recognition technology.

Imagine applying image recognition to faxes, to the millions and millions of faxes that go back and forth between patients and a physician or a referring physician. It’s been a manual practice, but we’re automating it and putting it up into the cloud with Google. We really think we’re just scratching the surface on this partnership, though.

There are some worries that some of the evaluations we’re seeing in health-tech are a little high. What’s your opinion on that, especially being a little separated from it in Miami?

That’s a timely question because I was on the phone with our lead investor last week. You’re right that we’re going to see a lot of activity in the coming year. I think 2019 will start to see more healthcare IT companies start to hit the public markets. They’re at the starting line, growing and trying to get their margins up so that the market is comfortable with them. I look at the evaluations and say ‘You don’t know until you know’. But I definitely don’t think it’s a bubble.

"We want to be the central, best-of-breed technology that’s at the center of the physician's world"

I think this is real and I think it’s going to be an avalanche. There’s so much out there that’s really making healthcare better. I think we’re going to see some productive, high-growth companies in the coming years.

It’s a space to stay. Health IT is still in the early stage of disruption, and like anything, technology will push disruption and the market will start to pull it. I think next year will definitely be a pull year as physicians, payers, and administrative staff gets more access to technology to make healthcare better, easier, and more profitable.

You mentioned Google and Amazon’s work within healthcare. It seems like Apple may be making a play to get more involved in health data, do you see that as potentially competitive to an EHR vendor like yourself?

Ultimately I think the companies that are going to win are the ones who are going to be most open. Apple is going to come at it from a consumer standpoint. They just announced that the Apple watch can monitor your EKG, and I think it’s fascinating and it’s necessary. It’s going to start to make patients aware that they have the opportunity and even the responsibility to access their healthcare data. They’ll have to learn how to take it with them to live their lives and interact with physicians.

Will Apple ever get into the EHR game? It’s possible. But we want to stay focused on having the physician in the mix, and the tooling that we give physicians to allow them to be more productive and more engaging and more precise in an easy-to-interact way. We’re not going to go away.

I think the point you’re making is that the big boys are going to come in and figure it out. The smaller ones will advance the disruption and the bigger ones will figure out what to build and what to buy, but I love it. You look at Amazon and their acquisition of Whole Foods, getting the consumer shopping for groceries, before buying Pill Pack and disrupting the prescription game. You have new companies like Forward and One Medical making it easier to see their doctor in the course of our everyday activities. I think these are great things, but we want to be the central, best-of-breed technology that’s at the center of the physician's world.

Do you have thoughts on approaching an IPO or getting more investment?

This isn’t my first rodeo, I’ve had multiple exits but I really came down here to build a legacy company that stands the test of time. The companies that we compete with have had their runs, but it’s our turn and it’s our time in the marketplace, so I’ll take the necessary investment to build something that goes public in the next two-to-three years. It’s in the cards and I think you’re going to see significant growth out of ourselves and anybody else that has a similar type of approach of giving doctors better tools and technologies to provide care. The market is littered with companies trying to build the right technology solutions in healthcare without having healthcare expertise and we’ve flipped it.

What other space within healthcare do you find most exciting right now?

Great question. What’s happening in the hospital space will be very exciting. We sit in ambulatory and specialized medicine, but you have to see the change in the role of the hospital going forward. Hospitals have had such a hold on massive costs that have plagued healthcare and so over the next couple of years, I think you’ll see a reconciliation of that role. They’ve got to change their cost profile, they can’t continue to execute and spend as much as they have. It works for us because anything that’s not going to the hospitals is coming out into the ambulatory space.

What advice would you have for someone else that’s entering into healthcare?

My advice is get in fast.

It’s changing so rapidly and what I love about it is if you can bring newness of energy and thought you can do amazing things. I think more colleges need to focus on demonstrating what a career in healthcare IT could look like because you have to focus on disrupting the end-to-end 30-year-old anchor and lack of innovation. I would say get an IT background and then bring it to healthcare.

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