May 9, 2023
Rick LeMoine: Hello everyone and welcome to another episode of day Zero. It is my great pleasure today to introduce Jim Jameson and Dr. Brian Fler from Evidencecare. Jim, let’s start with you. Folks love to hear a bit about your background before we get into the nitty gritty.
Jim Jamieson: Sure. Absolutely. Thank you Dr. Lemoyne. I appreciate you making time for us today. Again, Jim Jameson. I’m co-founder and Chief Rev Officer at Evidencecare. Met Brian probably nine years ago when we kicked around the idea of starting the company based off of, wonderful idea innovative technology and healthcare that Brian had. Started my career off as a Marine. When I got the Marine Corps, I was a defense contractor on and off for about 12 years doing it consulting, enterprise architecture. Moved from Washington DC to Nashville, Tennessee in around June of oh six. That’s when I jumped into tip my toe in healthcare. My mom and stepfather were in healthcare, physician and nurse respectively, and. Was on the revenue cycle side for many years. Large companies, small companies, took a few small companies to successful transactions and along that journey through my stepfather’s physician, who I’m sure we’ll get into today was one of the first check writers in Evidencecare. Is where I met Brian along the journey and Brian met him. So ever since I met Brian, it’s just been a long ride ever since. And here we are.
Rick LeMoine: Wow. Brian, what’s your story?
Brian Fengler: First off, Rick, thank you so much for giving us the opportunity to chat with you today. Always good to see you. Yeah, so my background I grew up in Syracuse, New York. My mother was a nurse. My father was a teacher. But spent a lot of time at the hospital as a young boy. And so always contemplated a career in medicine. Ended up going to medical school in Syracuse and then did my residency in emergency medicine at the University of Virginia. When I finished my residency, I moved to Nashville and started practicing for community hospital here in Nashville. In the emergency room a few years later actually ended up opening up some urgent care clinics here in Nashville that were staffed by emergency physicians. And just through my practice of medicine in the emergency room and urgent care saw the market need and the physician need for a tool like Evidencecare. And that’s where the idea for it originally came from.
Rick LeMoine: Good. Thanks for that, both of you. So let’s jump right into it. What is Evidencecare?
Brian Fengler: So Evidencecare is a platform that is EHR agnostic with the purpose of helping to enable better care decisions. I think everyone was excited about EHRs 10 years ago when Meaningful Use first came out. We thought, wow, this is gonna be great. We’re gonna have all this data, we’re gonna have all this information at the physician’s fingertips. And I think early on, and I think it still persists that, they really are documentation and coding and billing tools and Evidencecare exists to fill that void of bringing clinical insights and nudges into the physician’s workflow in a way that we can help deliver better care to the patients and also create value for the health system in terms of efficiencies and clinical outcomes. And that’s really the purpose of our platform.
Rick LeMoine: And why would a healthcare provi. Be interested or should be interested in your company.
Jim Jamieson: When I was on the revenue cycle side for many years like many non I’ll say clinicians, right? Non nurses, non-doctors, everyone wants to complain about doctors, not spending enough time with them, not doing their job, getting paid too much money, and then on their side of the fence, physician walks in, they spend half the time looking at the computer, and they’re not even looking at me in the face as a patient. And when I met Brian and started getting into the clinical side of it and started spending. Many hours raising capital from physicians in partnering with the large medical societies out there and different specialties. You learn very fast that, the EMRs, the government, different mandates are shoved down, physicians and nurses throats every day, the time necessary to do their job. It gets diminished significantly. And they’re spending less and less time with their patient, more and more time just trying to document so the hospital can get paid for the services they provide. So as we started going down this journey I, we realize if we don’t help physicians do their jobs better, these problems are just gonna persist. So at the core of what we do, and one of the reasons I love the passion for what Brian had initially was. We doctors, they’re people, they’ve got family and kids and houses and lives and mortgages, and they can’t keep up with the literature and the content, and it’s just tough. And they’re working 12, 15 hour days, not getting lunch breaks and getting more put on them. From, from every angle under the sun. So the reason that someone should look to consider using our platform is to really what Brian mentioned earlier, help them do their jobs better. And we believe at the core of who we are as a company, if we can help physicians do their jobs, I e treat patients and get some of that noise out of their face every day. A lot of the problems, systemic problems we see in healthcare, especially when it comes to the financial situation in healthcare. Not everything, but a lot of it will take care of itself.
Rick LeMoine: Brian, you said earlier that. Evidencecare is agnostic to the emr, I presume. We’re actually in my organization in the process of making a switch to the big E like many other organizations are. Tell us what’s the difference between having really good order sets and then having Evidencecare, I presume, either layered on top or off to the side.
Brian Fengler: A lot of health systems have put a lot of time and energy trying to optimize their ehr. They’ve spent hundreds of millions of dollars on it. So there’s a perception of we’ve spent so much on this, we should just be able to do everything right within that native system. But the problem with order sets, specifically Rick, that you mentioned is. An order set doesn’t help me take better care of a specific patient. If we have an order set for pneumonia or C O P D, okay, here’s the library of options for meds and imaging in labs that I may want to consider for this patient, but it’s really not helping the physician get to what is the best for this patient that I’m treating right now. And that’s where our system is a little different in that, we’re pulling data from the ehr recognizing what clinical condition and severity and risk factors that patient has and allowing the physician to get a very simple view of what is evidence-based for this particular patient.
Rick LeMoine: How many people work for you now,
Jim Jamieson: 40. Brian, I think we’re just hovering under 40. Rick.
Rick LeMoine: and so there must be a business side and a clinical side, and then an in between. So how do you know besides there’s still money in the bank, a, that you’re successful, B, that there’s a growth path, and then what to do next?
Jim Jamieson: When you think you’re successful life, some action in the face. First thing in the morning, you wake up and you got about two weeks of cash in the bank and 20 people to pay which has happened. Many times, and you just you just have to have that drive and passion for what you do every day. And we started off with a web-based version of Clinical Pathways and we had a great user base around the world at emergency medicine. But then we realized quickly that you’ve gotta get in the emr, otherwise it’s just not gonna, it’s not gonna work. So everything we did just got. Lack of better word, sunsetted. And then we went in the EMR and then you get certified by the big EMRs and their app models and app stores and all that. So that’s a win. And then you get an innovative healthcare system as a partner and that’s a win. But then you run outta cash, you gotta raise more money. So you’re like, we start over. So it’s, claiming one thing, Brian, I did, I think I’ll speak for Brian. One thing we didn’t do well along the journey was celebrate wins, right? And everything in a small company. Needs to be celebrated, just like in a good relationship in general. And we didn’t do enough of that. We just kept grinding and raising capital and building product. And Brian’s got just some of the best, most amazing ideas for ways to help physicians do their jobs better, quicker, easier, faster. But in a world we live in. You gotta stop and do something. And we were very fortunate to bring on our current coo Amy Eaton, who, when she came on, Brian and I were doing, I know Brian 17 things. And we came down and we said let’s just do these three things and do them very well. And then through Covid Brian and I made a decision and I give, run a ton of credit to bring in a CEO to help us grow the company to the next level. Cuz even though two people, business and clinical are good at what they do, We’re good at what we do right? And there are things we just don’t know cause we haven’t done it before. And we’re blessed to bring on A C E O who not only has been amazing for the company, but just a good process and culture person. We haven’t lost a person in years. People really are dying to come work for the company. And one thing he makes us do every week as we celebrate wins.
Rick LeMoine: Brian.
Brian Fengler: When we first started it, we’d already mentioned, this is our kitchen tables, this was coffee shops. We had our first, five, six employees. We were a small team and we were, everybody was wearing every hat. Everybody was doing everything. And then it’s just been interesting to see that evolution as we’ve grown as a company. Back to your question, Rick, we now have a product team, an implementation team, an engineering team, a client success team, a marketing team, a sales team and now, Boes brought such great processes to operating the business, to the point where every employee has milestones every quarter. That if you execute on these two or three milestones, these will be big wins over the next quarter. That’s 40 people in the company that all have those two or three things. And that’s where now, over the last 18 months we’ve just grown in, in, in efficiency and scale and impact in every area of the business.
Rick LeMoine: What do you see for the future? And tell me where you think AI and things like chat, G P T, those kinds of things are gonna fit.
Brian Fengler: I think our biggest challenge, Jim, might be interesting to hear your perspective here is just the headwinds in healthcare. And it’s a challenging market right now. Every health system is struggling. Every health system has major initiatives in terms of, whether it’s a, an EHR conversion, an E H R upgrade implementation of an E R P system or c R m. And so there’s a lot going on. And so as a digital health company, you have to make sure that you’re positioning yourself to bubble up to the top as a priority, and that’s challenging. We have health systems that. Love our tools, love the value it delivers, but they’re, Hey, we just can’t do this for a year. And as a small company to say, Hey, we’re just gonna send our hands and wait for a year for a health system that we know could be a great client. That’s hard. And I think everybody recognizes that just those head headwinds are gonna continue, probably as maybe a little market downturn. Hospital margins are tight. Workforce challenges. It’s gonna take probably a few years to help for healthcare to stabilize coming out of Covid, and I think that’s probably our biggest challenge. I dunno, Jim, if you have anything to add there?
Jim Jamieson: The only thing I would add to that, Rick, is I think the biggest headwind for us as a company specifically to address that question is getting everything Brian mentioned. But then at the end of the day you have a solution that are for physicians or nurses to take better care of their patients. But when healthcare systems are just sucking the demand of their time all day, every day and everywhere, but actual patient care, anything you put in front of the physician is gonna be met with resistance. Even though it adds value to you or it adds value to your patient or to the financial bottom line of the healthcare system, our job is to find ways to continue doing what we’re doing, but to make it even easier for those physicians, if we help them make a better care decision or reduce the amount of utilization than providing for a patient cuz it’s not necessary. Or find a financial value proposition should the patient be put in the hospital or sent home or going somewhere else. Those are all great, but if it’s, even if it saves you 15, 20, 30 minutes after that, not talking to five other people or calling your peers, it’s still one or two things you have to do now on the front end. So how do we help a, as a company and I think, I believe as an industry, but for Evidencecare specifically, how do we help the how do we help those that help us every day make their jobs easier and that it just, even though we get more innovative and have better solutions and automate more for the physician and their workflow, They’re still getting a hundred different things thrown at them every day. They’re short-staffed, they’re burnt out, they’re frustrated. I think Brian told me about a year ago, a came out around covid. 80% of his peers in emergency medicine wouldn’t recommend their specialty to their family and friends. That’s a tragedy in healthcare. That’s really unfortunate. How do we solve that problem? And the only way to do that is help them do their jobs better.
Rick LeMoine: Yep. So AI.
Brian Fengler: Yeah, we’re I would say Cautiously bullish on ai and by cautiously meaning obviously in healthcare you’re working in a special environment where you gotta worry about P H I security. And I think there’s some hurdles that AI needs to get over there. F d a clearance. We know everybody’s waiting for the FDA to come out with some they say they’re coming out with some new guidelines pretty soon on this topic. So I think everybody’s gonna start dabbling in it. Everybody’s gonna start seeing, what can we do with our tooling and apply AI to come up with whether it’s better insights, whether it’s automation of certain things that can be automated. We’re starting to look at that on our platform. But I think right now it’s just a little early cuz there’s a little uncertainty around, those concerns. But once we get over the hump with. Assuring that we have those security P H I F D A compliant tooling that, and that tooling can be applied. Then I think it’s off to the races cuz there’s so many different use cases where it could be helpful for physicians in their workflow and helping to automate things.
Jim Jamieson: Yeah, my, my take on the whole thing and this is just from a business perspective, not a clinical. I think there’s a lot of use cases from machine learning. I think there’s a lot of things you can automate. And I, that can speak for herself and on the ai, especially the chat G P T thing. I think I am a little concerned about that. You look at what a lot of the big tech experts around the world are signing petitions right now to slow down a bit, right? Cuz there, there are things that I think there’s harm that, that can cause You look at even Zuckerberg and Facebook over the years of we’ve pulled away from society by having people on their phones all day, every day. And when it comes to clinical practice, one thing I learned from Brian early on, No matter how vire technology is, no matter how much you can automate stuff, no matter how much you can make documentation easier, at the end of the day the physician should be the captain of the ship. There are things you can just look at a patient with clinical dalt and see that, that, I don’t care what your documentation that, clinical pathway tells me. If there’s something wrong with this patient, I need to fix it. So there’s gotta be a fine line, someone in there to allow physicians to always be the captain of the ship, but using technology to do some of the automation, clinical documentation, things that shouldn’t be bothered, they shouldn’t be bothered with. That’s fine. I think that’s a great way to go forward. But, to have if we say we can fly a plane with never having somebody in a cockpit, no matter what, that’s gonna concern me, right? And that’s where I see things going clinically. To Brian’s point, cautiously optimistic is a great way to say it.
Rick LeMoine: Great analogy, Jim. Brian, it’s always puzzled me why? Diagnosis hasn’t been on the table in digital health. There’s Isabella, there’s been a couple of very niche attempts, but it, is it fear of malpractice? Is it fear of litigation or is it just too complicated and is AI. AI should be great at pattern recognition. That’s a big part of making a diagnosis. Why do you think it, it hasn’t taken off? And is are we getting to an inflection point?
Brian Fengler: I, I think that’s probably the area that is is furthest away and why should I say that? And next week something will change, but It is my belief as a physician that the assessment and diagnosis of a patient is where the human element of the art of medicine comes in. I think so much can be automated on the backend of that. And as Jim mentioned, the administrative burden of documentation and all those kinds of things are perfect applications for ai. But I’m gonna steal I interviewed Stan Huff. Former C M I O at Intermountain on our podcast about a month ago. And he really answering the same question had a great perspective on it, which is, I think if we get to the point where AI is really helping physicians in their workflow in healthcare, that then makes the art of physical exam patient assessment even more important and allows physicians to then. Spend more time on that human element of medicine. If all those other things are then being taken care of on the backend, it makes that diagnosis so essential.
Rick LeMoine: We’re getting to the end of our time. I’d like each of you to give a brief summary of the important things of a start a startup should be aware of and how you guys approach that.
Brian Fengler: In terms of lesson learned I would tell early entrepreneurs you’re gonna need five to 10 times the capital that you think you need. I can remember, where we thought, geez, if we could just raise a million dollars, this would be all we would ever need to grow this company. And we’ve now raised more than 20 times that. And building a company the right way in a way, in an industry that has as much complexity as healthcare has takes good people, takes time. And you need the capital to, in the runway to be able to do that.
Jim Jamieson: Yeah there’s not much I can add at the end of the day, Rick, I think the number one thing a founder needs is grit. There’s just there’s, it’s gonna suck. Days are gonna be horrible. You’re gonna hate it, but you have to wake up the next day and be excited and motivated. And Brian, and I’ve raised capital from. Pretty much everyone in Nashville, ton of healthcare systems, like I don’t think we have a family or a friend. We can go to dinner and can’t see someone like, Hey, hell’s business. And then you always gotta be on like you, you’re never off. And then you gotta come home and try to be on for your family and your friends. And it’s tough because you, one thing I learned a long time ago from an entrepreneur or fellow entrepreneur is, when somebody asks you a question on how to solve something, an entrepreneur never tells an entrepreneur how to solve a problem. They say, Hey, here’s something that happened to me and here’s how I handle it. You don’t you people wanna always give you advice. And unless they’re a mentor, unless they’ve been there, it’s hard to really receive that well because you’re like, okay, I’ve tried it 80 times and it just doesn’t work. So something different. But it really does come down truly 100% to grit in the people. That you employ. And I don’t think Brian and I had enough experience early on to realize how valuable people are. Cuz no matter how good your technology is, no matter how great your marketing and sales team is, if you don’t have, at the end of the day, the people are building it. The people are selling it, the people are integrating it. And it’s just hard. That’s all there is to it. And you just gotta love it and you have to have a passion for it. Every single. Day. And I think one of the things I would also add is early on, Brian and I did not do a good job of is leveraging our mentors, investors, and board members for help. When you’re focused in the business, you’re not looking, you’re not focused on the business. And when you’re just trying to be, raise capital to build a product or release something or do something, you know your board and investors are there to help. They’ve got networks, they’ve got people, they’ve got money, they’ve got friends, they got. Relationships, use them, hold them accountable, especially if they have equity in the company, they’re incentivized to help you be successful. And we just got so buried in trying to do it ourself that I think we missed a few opportunities early on to, to get some really insightful knowledge and understanding of how we can do something better. There’s always a better way to do it. But if you don’t lift your head up from the business long enough to just ask the question, people want to help, right? We’re all here to help people, and that’s why we’re in this phone here. We want in this call podcast, we want to help others do something better for the industry, for themselves, for the family, for their friends. And Brian, I’ve been extremely fortunate to have some of most amazing friends and investors in healthcare we could ever ask for. But we didn’t do a good job early on. We’re doing it now, but we didn’t do a good job early on in leveraging that network.
Rick LeMoine: This has been absolutely terrific. Thank you. If Gary were still around, he’d be patting me on the head saying good job picking these guys. Thanks for that and again, just absolutely terrific.
Jim Jamieson: Thank you, sir. I appreciate your time. Good seeing you, sir.