28. Mike Docktor: ‘’There has to be a better way for clinicians to interact with patients"

Have you ever wondered how to maintain HIPAA compliance within your task management platforms? In this episode, that's what you are going to find out and a whole lot more. Whether you are in IT, a physician, or on the administrative side, this podcast is for you.

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Mike Docktor: Thank you very much for having me.

Mike: It's been quite the journey. Dock Health, in many ways, is the embodiment of all the things I learned in trying to implement technology for clinicians at a major institution like Boston Children's. 

I long held the belief that clinicians would benefit from the tools of mobile technology and all the great user experiences that I can offer. I’ve spent the better part of 10 years of Dock Health and at Children’s trying to bring those tools to clinicians and other providers. I learned a lot along the way and had my challenges managing all the clinical to do's. 

That was the beginning of Dock Health. 

Mike: That's a great question. One of the first realizations I had was that clinicians’ user experience, in general, is this painful process of logging into an electronic health record, which is a user interface built in the 90s. 

We spent our days clicking through the electronic health record, and that was an incredible frustration to me—that point number one. There has to be a better way for clinicians to interact with their patients and a better user experience. We spend so much of our time in the electronic health record clicking away and not focused on what's important, which is the patient. 

Couple that with all the things that come out of good clinical care, which is all the to-do’s when I see a patient in a clinic. There may be two, three, even half a dozen tasks or to-dos that I have to remember somehow. My challenge is that I can barely read my chicken scratch in the back of my clinic note, and that doesn't scale very well. 

Over time, I became increasingly stressed and anxious that I would forget one of those things, or I was going to drop the ball. I couldn't possibly hand these things off to my team.

That's what you hear about the clinician’s burnout; the burnout sort of trickles down to the clinicians, physicians, nurse practitioners, nurses, the admins, and the staff there to help. 

I'm always amazed that we just don't have an excellent way to collaborate securely and help those to do’s get done. 

At the end of the day, I have three little kids; I want to go home and deal with them. I don't want to be managing all to-dos, and I certainly don't want to be managing all this stress. 

I would leave on a Friday afternoon before Dock Health was around, and I would be certain that I was going to forget something. I was certain that something over the week would get dropped, and I would forget something. Then, Monday morning, I learned that one of my patients was in the emergency room because I forgot to fill something out or call something in. 

I disappoint someone, or I wouldn't take as good care of my patient as I wanted to.

With Dock Health, what we were able to do is simply create a task, assign it to the right person on the team with patient context, and suddenly, I may not have been able to do all the things I needed to do, but I knew what had to be done. I knew who was responsible for doing it. 

That sort of clarity of purpose, process, and structure was this magical thing that completely lifted the weight of me leaving work on a Friday afternoon. So this Friday, I will leave work, whether it's a podcast or clinical care, and know what has to be done and know who's responsible for it, and hopefully, fewer balls get dropped, and we're more efficient and taking good care of patients. 

Mike: Absolutely. I consider myself very lucky. I spent a good part of my time at Boston Children's in technology. I worked in software teams. I worked in our innovation program; I was the clinical director there. 

We worked with several startups, and we managed a lot of projects in software development. Engineers had these great tools like JIRA, Trello, and Asana, and all these excellent project management or task management tools where people could collaborate. They could work together for a unified purpose of creating software or managing a project. 

It amazed me that we didn't have that for something as essential as patient care. 

I had the good fortune of meeting a great user experience designer and co-founder, Keather Roemhildt. She has spent  20 years in consumer tech and offered to help me with the project.

I had an excellent technology team led by making Nitin Gujral, our CTO. He helped build the technology. 

It's incredible that we are the first and only HIPAA compliant task management platform built for healthcare. 

Mike: Healthcare is incredibly nuanced. There are many HIPAA compliant solutions out there. In fact, there are now HIPAA compliant versions of Trello or Asana. To me, that does not mean it's built for healthcare. Those at Paubox probably feel similarly. HIPAA compliance does not equal made for healthcare. 

Of course, it's crucial and essential to manage patient protected information or protected health information appropriately. We make HIPAA compliance, with regard to the management of data, super easy. What I think is essential and critical for us is our laser focus on healthcare, and I believe Paubox feels the same way. 

We are focused on the nuances, the workflows, and the needs of the healthcare environment. We have patient contacts as part of every task. We have the workflows built-in healthcare, team management, and process management that happens in healthcare. We are foundationally and fundamentally HIPAA compliant; that’s where we work from the start. We didn't slap on a HIPAA compliant layer afterward and did our best and manage that process. It is in our DNA. 

On top of that, we're built to serve the healthcare ecosystem and build something that's not just for pediatric GIs like me. We have dentists, mental health providers, internists, and other healthcare startups that simply need a tool to manage all their to-dos with patient context. 

It's exciting, but HIPAA compliance is complicated.

Mike: We are on a mission to make it easier to take good care of patients by taking care of the providers. 

To step on the soapbox for a moment, providers are traditionally thought of as physicians, nurses, and nurse practitioners. We think of providers in more of a holistic sense that providers are anyone that's helping in the provision of care for patients. That could be the person at the front desk, the scheduler, the person on the phone with the insurance company making sure your stuff gets done and taken care of. 

We are trying to bring the providers together on the same page. What invariably happens is that people have their own system. They have posted notes with little checkboxes on it. They have Excel files that are on one person's desktop. They have a paper checklist on another person's desk, and we use email as the way to “collaborate” in healthcare. For those that are just listening, I'm using air quotes because email is not a collaboration tool. It's not a way to manage tasks or processes. 

We’ve created a straightforward tool that allows a clinical and administrative team to work together in the context of taking care of patients. You can create a task, assign it to a person on the team, or assign it to yourself. The task could be on your to-do list, which I use quite often. You can add patient context to know all their appropriate demographic and contact information and have it accessible.

Then you can add all the other bells and whistles and metadata. We allow you to add attachments. If there's a PDF, you can attach that. You can set due dates, and you can tag or label things. You can add comments; you can call out your colleagues to nudge them so that you can check in on a process. 

It’s beyond just merely creating a task.

With all this structure, you can start creating protocols and templates for the mundane tasks that we get bogged down with that are error-prone. We help practices with their new patient onboarding. That typically is a process that is handled by five or six different people. Each of them has a different part in the puzzle, and invariably, they double back and duplicate efforts. The patient gets called twice to find the medical records, but it turns out they already had it. Someone else called to schedule an appointment, but it had already been made. 

Then everyone looks like they're not doing their job well. “Why aren't you guys talking to each other,” that's what I hear from my patients all the time. “How come you guys don't talk to each other?” 

We intend to get everyone on the same page with a unified purpose of helping the providers take better care of the patients and ultimately making it easier to do so. 

Mike: It's amazing. For those that are in healthcare, we often are amazed at how often things go right. The reality is we've all done it for so long. We know the system. We know the process. Generally speaking, things go right, and we all have the best intentions. 

The truth of the matter is that plenty of balls get dropped. As a practice or as a provider, we put so much emphasis on the patient to make sure that they're staying on top of the process. That's wrong. It’s not good patient care for me to say, “make sure you call my admin in three days,” because that's when this process will probably need some nudging. We should have that down. 

To me, it was a frustration. It's why I'm so passionate about this. I'm really on a mission to help providers take better care of their practice themselves and, ultimately, the patient.

Mike: We learned in med school about the importance of communication, but we don't have useful communication tools. Being on the same page and collaborating is essential, especially with the complexity of patient care. 

We are simply not given the right tools to do this stuff. Every other industry has benefited from these valuable tools, which is why I found it amazing that healthcare didn't have a Trello or Asana equivalent. It’s precisely why we're focused on building this. 

What I think is essential to notice is the electronic health record does not manage tasks. It's good at documenting the clinical record and is good at billing. Many of the common EHRs have inboxes. They don't manage all the administrative tasks that have to occur downstream of the clinical event.

If I placed an order for a patient, all these things have to get put together by the rest of the team. Items that are not necessarily even in the electronic health record. Those are things found elsewhere, like on desktops with post-it notes or checklists on someone's desk. No one else has transparency. 

Because you started talking about visibility, having accountability, having the ability to close a loop, and get everyone on the same page with the clarity of purpose and structure is a compelling thing that healthcare has not seen yet. 

That gets to one of the challenges of what we're doing. We're creating a new space in healthcare. We're challenged with a need to educate the market on what task management is.

It's great that there are other players in the space that are helping us. Asana is now a publicly-traded company. It's great that they're educating the masses on what task management can do. It's a wonderful tool, and they're doing great work. 

We're hoping to benefit from that and introduce this concept to healthcare because it's needed more than anything.

Mike: There's the short version and the long version. 

The short version is were HIPAA compliant. We make it easy to sign a business associate agreement for a small practice that doesn't have IT and security committees and compliance folks. We make it simple.

We also make it easy to upload your patient profile. If I want to upload all my patients in our panel in Dock to create patient contacts with tasks easily, we can do that seamlessly and in a self-service manner. 

We will be increasingly working with the enterprises where we're going to be deeply embedded in the electronic health record to pull patient demographics easy. 

Without giving too much away about where we're going in the future, we hope to build increasingly automated processes.

All these things are very manual and very painful for the clinician and the administrative staff. How do we create that connective tissue in an automated way so that all the downstream things can now be done in an automated fashion when I place an order for this? Then we can start giving practices and enterprises insights into where the bottlenecks are.

Where are we dropping balls more often? Where are the efficiencies and inefficiencies? How do we help add resources where necessary and perhaps scale back resources where they're redundant? How do we refine that process? Again, we’re laser-focused on healthcare. 

Mike: That’s a fantastic question. It is quite a struggle. I'm thrilled that we have a 25 year plus user experience veteran that has helped us navigate these waters.

We’ve learned many times in healthcare over time, we are given the one size fits all solution, or what we're told is a one size fits all. It's jammed down our throats by the IT enterprise. It doesn't work for anyone because it was built for an N of one, and it's trying to serve everyone’s needs. 

We've very much taken that and tried not to do that and created what I described as a very agnostic system. It's being used by dentistry, mental health providers, and pediatricians alike. 

It's meant to be very flexible and customizable while at the same time giving enough structure and guidance.

First and foremost, we're an early-stage company. I am at the elbow and on the phone with folks all the time trying to make it as easy for them as possible. We talked to them about their workflows, their challenges, and where balls are getting dropped. We try and help them create structure and process. As much as we're an excellent technology, this is a lot of cultural shifting and change management that practices are struggling with right now. 

COVID has made all this stuff more difficult. Right now, teams are more distributed. They're thinner, in some cases, because they had to be furloughed or fired. Everyone's working in a distributed fashion. Collaboration and coordination are more challenging than ever.

We're happy to work with teams to identify workflows and how we build structure and process around them. Then help kind of nudge and push the boulder up the hill to manage the necessary change. Invariably, what we hear is, “we're just too busy; we can't do this.” We kind of scoff at that. We chuckle a bit. We're throwing someone a life raft. "I know, I'm too busy treading water; I just can't do it."

It takes inertia; we understand that. We're trying to educate folks on the little bit of effort it takes to get on, and it will pay dividends.

Mike: We have only ever been a remote company. My co-founder lives in California. I was in Boston; I’ve recently moved to New Jersey during a pandemic. We have team members in Denver and Boston, and increasingly all over the country. We've been on Zoom since before Zoom was publicly traded. I wish I had invested in that a lot earlier. 

We've been a remote company from the get-go. So for us, that's easy. At a macro level, COVID and the impact of that on healthcare have changed how we sell. Instead of going to a hospital and having a big fancy meeting in a boardroom, we're on Zoom with people. It's allowed scaling a company and getting meetings. I think it's a lot easier than it probably was pre-COVID.

Mike: We hope to make it easier for teams in an organization to get on the same page, to reduce friction, and to reduce redundancy. The first step is getting the team on the same page for the patients. What we're technologically able to do today is we can start inviting outside organizations or members, other stakeholders in a patient's care into that system. 

Now we can connect the dots of the disparate challenges of healthcare and then coordinate efforts across enterprises. 

To make something up, if a pediatrician has their team on a given set of tasks and wants to bring in the therapists that they often refer patients to, they can now invite that therapist into this list. They can co-manage patients and all the tasks. The to-dos go back and forth. 

The same is true if we're working with a specialty pharmacy that compounds all of our pediatric medicines. That begins to expand and grow. 

We're excited about the network effect and the opportunity to use something essential and straightforward tasks that connect folks across healthcare enterprises. Not only within the small team but ultimately, we bring the patients into the fray and assign tasks to them and be in the loop altogether. 

Mike: That's down the road. First, we need to get a solid foundation of clinicians, administrators, and practices using it. The future includes bringing the patient into the picture, which is where they belong. Making patients a member of the team, assigning tasks relevant to them, and then having a window on where their care is, with some transparency. 

It's an exciting “pie in the sky” at the moment, but there's nothing technologically limiting that. 

Mike: Absolutely. There's tons of data coming out of the care integration work done at Boston Children's. Bringing the patient and the family into the care for clarity is better patient care, as far as understanding what the things that they need to be responsible for are, what are the things that their team is responsible for, etc. That's been clinically validated. 

Our hope is, over time, to be a digital tool that allows patients to be part of that again. We're still a ways away from that. We first want to nail the clinical team and administrative team to get their act together. It is an exciting feature to work toward. It's a big undertaking. We're happy to do it; we’re excited to do it.

This is a mission-oriented endeavor. I left my full-time role at a fantastic children's hospital because I felt like I needed to help other clinicians and administrative folks take good care of patients. The system is not helping us.

We can be a little tool in their toolbox to ultimately help providers get home to their families and enjoy their time and help them take better care of patients. That's what it's all about.

Mike: Hopefully, there's no more pandemic. Hopefully, our political system is a little bit more clear. 

When I went into medicine, it was about the patient's right. It was about taking care of patients, looking them in the eye, making the right diagnosis, and prescribing the right solution for their problem. What healthcare has turned into is a bunch of administrative tasks from one person to the next. It is not a fun thing. I'm on a mission to help bring that back to healthcare. 

My hope is ten years, maybe 15, I think it's possible that with all the cool technologies that we have out there, we ought just to be able to get back to the essential good stuff. This is that doctors, nurses, nurse practitioners, and providers want to take care of patients. All this paperwork and nonsense has gotten in the way. How do we get back to that? 

Any sort of proposal that AI is going to put doctors out of practice is nonsense. It's going to make them better doctors; it’s going to make their decisions more informed. It's not going to get rid of them. The "human to human" thing is what it's all about. My hope for healthcare is to get back to good patient care basics, from provider to patient. All the administrative stuff that we're bogged down with right now is managed by Dock and other systems that just make it happen.

Mike: I am a real lover of technology. I'm constantly reading. I'm a huge Apple fanboy. That opened up the world of technology to me. I'm constantly reading various Mac Rumors and Nine-to-Five Mac, Engadget, and Ars Technica. I am very technology-focused. 

Then I get a bunch of newsletters. I'm a huge fan of Twitter. For better or worse, I put a lot of my thoughts out there. 

I certainly am on the receiving end of a lot of brilliant technologists. I'm a much more technology-focused physician. I'm looking to consumer technology to inform what we ought to be doing in healthcare. We have this thing in healthcare that we always have to do it our way. 

There are people, companies, and industries that have spent trillions of dollars figuring out how to do it the right way. Why do we learn from them instead of trying to do it our way? That is very much the space that I operate in. I'm a student of consumer tech. The overlap in the Venn diagram is greater than people want to believe it is.

Mike: I'm a big fan of food and family. So, to the extent that we can get together as a family during these challenging times, we do that. I’ve become one of those typical sourdough fanatics. I've become quite the baker, and my kids love bread. They request bread over cakes for their birthdays now. I wouldn’t say I've perfected the sourdough, but I've certainly gotten good at it. It's a fun blend of science and food and family.