Morris Panner spoke to HCA News about the interoperability landscape and his company's change from DICOM Grid to Ambra Health.
In the second half of our C-Suite Q&A with Morris Panner, the CEO of Ambra Health, artificial intelligence and the future of value-based care dominated discussion, as well as challenges posed by cyber attacks. Also at hand was Ambra’s audacious decision last year to change its name from DICOM Grid last summer. Panner detailed the process of deciding to rebrand a well-known company amidst impressive growth.
Part 1 of the interview can be read here.
AI right now is probably the most interesting topic, it’s on everybody’s mind. Let me talk about how it works in our world.
There’s the nirvana, you could call it, the futuristic scenario where algorithms are going to be able to make clinical judgments. Maybe we’re moving in that direction, and maybe we get there, but today AI functions in one of two ways.
The more common way, the way we use it often, is to make sure that the right patient gets matched with their information as fast as possible, between and among different systems. We have a patient-matching algorithm that allows institutions to cut the amount of time that it takes dramatically. The National Kidney Registry gave us an award because we were able to save them over 1,400 hours per year and cut the matching process from what could be days down to hours. That’s huge, and that today is not diagnostic, that’s under the broad term of AI for workflow, and that’s big.
The second area we’re starting to see is screening. This has been done, but not as well. What you would see in mammography is CAD, computer aided detection, and the idea was to make sure the very busy practitioner would have a heads-up. The algorithms are getting better and better at helping people know what to look for. On top of that, they’re also able to start looking at things in a study that maybe the person hasn’t even thought about yet. That is a little more controversial, because it’s going to generate false positives. There was a movement afoot at one time to do your full body scan, and almost everybody would come up with all sorts of strange indications: you had a module in your lung, is it lung cancer? You had to figure out what to do with those other findings, and we’ll see what to do with all that using AI, but that’s another screening technique that allows hospitals and healthcare providers to be more efficient.
What we haven’t done yet in our system is have an algorithm to look at something and go ‘oh, that looks like this type of tumor so we’re going to route it to this specialist or take this action.’ I think it’s coming, just a little further down the road.
How do you want to see the landscape looking for these processes in, let’s say, 5 years?
I think when I put my hopeful hat on, it’s going to be interoperable, and no different than electronic banking. It’s just a question to me if we have the will. We can do it, will we do it? And then it will be as ubiquitous as looking at your credit card statement online. That to me is what the future should hold.
I also believe that we are better positioned than ever before to have it happen in the next 5 years. Not to get into politics, but in healthcare right now it’s hard not to at least nod at politics. What we’re seeing right now is widespread frustration. I don’t think people have a lot of solutions today. You don’t hear anybody saying, ‘I’ve got the perfect thing and if you just listen to me we’ll get it all done.’ You hear people either being vitriolic or people just like ‘well, you know, we all need to work together to figure this out…’ I think that part of the constructive side in improving the cost of the healthcare equation is going to be interoperability. I think a big piece of that is going to be imaging interoperability. So much of healthcare, and so much of life, is determined by who pays and what they can pay for, I think the systems that are for the first time truly burned in, safe and effective, we’re going to see people avail themselves of it.
I very much hope over the next 5 years we move to an electronic, patient-controlled, open system.
Speaking just for Ambra, what are some of the biggest challenges you face as you grow?
We are learning how to be an innovative software vendor in the enterprise healthcare space, and learning how to achieve innovation and change is no small feat. Our core strategy right now is to align ourselves with the thought leaders and the drives of change in the system. We have something of our ideal customer profile: it’s not a title like CTO or CMO, it’s a description, and the description is “change agent.” At every healthcare system today there are change agents, and they recognize and they share this philosophy around interoperability. Our biggest challenge in a nutshell is to find, and align ourselves, and support the change agents inside healthcare.
It is a very complex world, and it requires collaboration and consensus between the people who are running IT and the people who are providing clinical care. If you find these change agents and you can align yourself with these change agents, you can get some really exciting results. Clayton Christensen, in The Innovator’s Dilemma, says that the paradigm is to find the outlying smaller places that have to make cost-quality tradeoffs, and they buy the smaller tractor because they can’t afford the big tractor and they go from there. In healthcare, it’s sort of interesting. We find that we have change agents at Mayo Clinic, there’s no better healthcare provider in the world, there’s change agents at Stanford Children’s Hospital.... If I can think of a secret sauce, it has been our ability to find those people and give them what they need. They’re looking for this, it’s not because they think we’re charming, it’s because this is a tool to break down the data silos and the barriers to information sharing.
We’ve really had to learn how to bring change to an industry that people say is resistant to it. It’s not in some respects, American healthcare is the best in the world, they diagnose things faster, they find cures faster…but that has not rippled through the infrastructure and IT. We are learning how to do that, it’s an ongoing journey.
We can’t go without asking you if current security concerns and cyberattacks ever keep you up at night.
If you are running a business in America, you should be alert to how to manage those concerns. We’ve seen individuals’ identities stolen, we’ve seen big institutions have attacks, our government’s been attacked and there’s even convert over whether our elections are safe. This has now become part of our risk management. Nothing’s going to be perfect. But what’s the alternative? It may be too late, if you’re on the electric power grid you’re connected to the world. It may just be too late for us to pull back from the world even if we wanted to.
So really the questions are, how do you make appropriate investments, how do you develop appropriate strategies, how do you learn from others so that we don’t get pushed back or scared out of doing the right thing. There’s going to be inevitable bumps and challenges by bad people who are not trying to help the process. That’s not good, and we can’t let those people stop us from advancing. We recognize that we’ve got to do everything we can to anticipate, and in some cases react to challenges.
On the business side, the name Ambra Health gave me pause until I saw “formerly DICOM Grid” and instantly knew who you guys were. That branding change came about a year ago. How did it come about, and what are the difficulties with changing brand names on a pretty known entity?
It’s pretty cool, actually. It was fun. We brought in a wonderful new marketing lead, and she said ‘you know, one of the things about DICOM is that it’s a standard, it’s like being called The PDF Company. But put that aside: are we just moving one format from point A to Point B, or are we doing something larger?’
The truth was, we’re involved in AI for workflow, we’re involved in this, that, and the other thing. We ended up hiring a consultant to go out and interview all of our customers, and the feedback was really fascinating. Our customers said they really wished we could capture all the stuff we do for them, because we were not really a DICOM engine for some, we were so much more. We capture more imaging types, we capture video, we capture other types of healthcare information, and we’re able to handle other types of workflow. We got feedback for a lot of customers that our name did not accurately capture everything we were doing.
At some point, you’ve got to jump. There’s a lot of technical things we did in terms of marketing and branding, to make sure that things redirected from the old name and so forth. We went out to our change agents to spread the word, and so far, by all the statistics…all the things tell us that we’ve really done it at the right time. We did it as we were growing, and since we have done it we’ve probably grown a little over 50% or 60%, I think our compound annual growth rate is right around 70%. Quickly you get to a point where any change is even harder, so we made the leap and really haven’t looked back.
It’s not for the faint of heart, but I think it’s been a really positive step and an investment that will serve us well as we grow forward. I loved it because when we went to our investors and our board, we really had to walk them through all of this and we said, ‘we’re in this for the long term, we’re really building an important company that’s going to have an important mission, and we think it’s the right thing to do,’ and they were emphatically in favor of it. It’s really been a very positive move.
That is quite the decision, especially when you seemed on pace for ubiquity already with the existing name.
One study that you’ll find interesting: a branding company asked 'which brands attract the highest degree of loyalty?' I guessed Apple, or Under Armor, or Chanel, those things. They said ‘No.’ There is no consumer brand even in the top half. The most important and significant brands are all enterprise brands, and the reason for that is simple. If you buy an Apple computer or a Chanel wrap or an Under Armor shirt, that’s a nice thing and it says something about who you are…but when you make an enterprise decision, when you say ‘I believe an interoperability platform is going to change what we do,’ you have invested so much of yourself in that, and your personal brand, and you’ve had to bring your teammates along and get the institution to vote, and then you’re going to live with that decision for a really long time. The most powerful brands in the world, with the highest degree of loyalty, are enterprise brands.
We really wanted our brand to, over time, be that associated with this change and progress, and have people really stake things on it. It’s not a lighthearted decision, we’re asking people to commit to change, and that’s why when we find change agents, they’re thrilled to have a partner to do it.