Veterinary Medical Records

Shawn: You are listening to the Veterinary Innovation Podcast. My name is Shawn Wilkie and along with my awesome co-host, we interview the innovators in the veterinary space every week. Ivan, why don’t you go and introduce today’s guest.

Ivan: Hi, my name is Ivan Zak, and I’m happy to introduce Emily Dong. She is the founder of Pawprint, which digitized medical records to ease communication and improve clinical efficiency. Today’s topic is going to be around medical records and their management, and sort of innovation in that space. Previous organizations that Emily worked in, was LearnSprout, which was acquired by Apple, which is pretty cool. And then she holds a degree of bachelor of science from the University of Southern California, with specialties in accounting and entrepreneurship. On a personal side of things, she’s an advisor with Miracle Messages, and non-profit seeking to end relational poverty and homelessness. She also misses eating crispy M&Ms. They don’t make those anymore? 

Emily: I think that they might have brought them back. 

Ivan: So very nice to meet you. I know that I was kind of following the Pawprints since I think they’re an exception. Cause I was in various shapes of forms in the client communication space, prior to IDEXX, in IDEXX, and I know a couple of initiatives in that. And I thought that you had a pretty cool idea with Pawprint, and then I know that you’ve pivoted, cause we chatted recently. So it would be really interesting to hear the initial idea of Pawprint, and then what would be interesting is to hear how you pivoted into what you do now, and we will probably develop from there. 

Being Inspired by a Personal Problem

Emily: So I started out as, from my perspective, as a pet owner. I have never been in a veterinary space before, but as a pet owner, I was trying to book a boarding appointment for my dog, they asked me for proof of vaccination. So I called the next person. And after I called five different reporters, they all wanted the records. I called my vet to get the information. And they offered to fax it to me. So I said I don’t have a fax machine. Is there any way to send it digitally? They said “No, you have to come to pick it up”, which was very ridiculous to me. So I just wanted a way, as a pet owner, I could have to manage my own information. So we know when vaccines are due, and you know, be able to book services like this. So that was a start-up pop right. We built an app where pet owners could request their records from any vet, no matter what that vet’s workflow is, whether they use paper, or whether they use a digital system. We’re fully compatible. And then, over the years realized that one of the times when you need this information the most is when you go in for your next vet appointment, and that vet has no contacts on your pet’s history. So we leveraged the same technology to help them get records, and have that available for the appointment.

Shawn: It’s so interesting, Emily, to hear another idea born out of frustration. And I think that that is oftentimes, where some of the best business ideas come from, you know, personal passion to solve the problem that you’ve experienced. Often makes for a really interesting business journey. But I’d like to dive into that a little bit more. You must’ve been awfully frustrated in order to go and create a company around this. When you had that frustration, what made you see the opportunity? You know, why were you so passionate about it that you wanted to solve it?

Emily: The first thing is that the story is longer than what I told you. So I tried to book the boarding appointment. It took me you know about a week to get the records. Then, I realized that the vaccines were overdue, wait three weeks for the vet appointment, wait three weeks post that for the boarding appointment. And so it took so long that it was crazy to me, and I couldn’t imagine, you know, having this dog for hopefully, 15 or 20 more years, and having to deal with this all the time. And the second thing is the problem was very similar to what we worked with at LearnSprout, which was data accessibility. And so I was personally very passionate about that area of the space as well and saw that if we could just give access to the data to the right people, that it would make everyone’s lives infinitely easier.

Ivan: So data is a great question to kind of tap into as well. So, you know, a lot of people are soling for this in the space, and so, then you come with the idea to access the data and provide the information to the clients. Was that journey easy? To get data from the PIMs and medical records, and just transfer them to the owners? Or did you bump into any roadblocks? 

The Challenges of Working With PIMS

Emily: I bet you know that it is never easy when it comes to working with the PIMs systems. And we learned that the hard way. So we’ve done everything from fax, emails, taking verbal, records over the phone, to building integration with the PIM systems. We even found a patent for using machine learning to standardize the data that comes out of these management systems. And one of the things we learned is that no matter what integrator you build, you will never electronically be able to get 100% of the information in the way that you want. And that’s why we have built a lot of process around it. 

Ivan: So that’s super interesting. Can you talk a little more about machine learning using standardized records? Were you trying to get the actual medical records themselves, and normalize them, or was it just around other pieces of data? Because there’s a lot of normalization that’s going on right now around the transactional and operational data, but I don’t think that an innovative app or nothing I know into trying to read medical records. So what that around actual medical information?

Emily: Yes, it was about looking at all of the medical histories, whether that is at the reminder table, or the medical history, and then mapping that to some sort of code. So there’s actually a great team out of Stanford working on that now, called Detag, and they wrote a paper about it. But yeah, it’s being able to look at a lot of information and distill it to some key points is what’s important. 

Ivan: That’s super interesting. So did you get any, you said that you were filling a pattern on that. But did you get anywhere further with that, or the Stanford group is sort of the opinion leader in that right now?

Emily: Yeah, we discussed with them for a little bit, but then the trouble we run into is not all of the records are digital. So even if you go into a practice, and you can use this technology to map all of their data, a lot of times, you know, they still have bloodwork in a separate system. Or they still have some file cabinet with a lot of records in it, and they’re kind of 50/50. So, there are very few practices that are fully digital, and so we didn’t invest further in that area for that reason. 

Ivan: And some of them also, when they are digital, and look digital, but also they’re flat file when you get into that. So (indistinct speech) and all of that fun stuff. So that’s great. So, so then, I know you were providing medical records to the pet owners, and you know, I feel like there is a certain niche of clients that would require that. You always see them as a veterinarian, in the appointment, and then people come in, a little folder where there it’s like, there are every receipt and every visit to the veteran. So it would really utilize that, but then at some point, you decided to pivot. And you focused more on providing the medical records to actual practitioners rather than to the client. So in my experience, the pivot comes to the organization, usually not from a good point. It’s something that you go from in one direction, and you make a hard decision and say “Okay. We need to think outside of the box, and then we need to turn”. So if it’s not information, what was that experience like? And I think that this would be very valuable to innovators and entrepreneurs in the space because some of them don’t stop. Some people go in one direction, and that’s where they kind of go off the cliff, and into the grave of the startup. So it really (indistinct) implementing and making that turn, and try something else. But if you could walk us a little bit through experience, that would be great.

Emily: Yeah, so, the app actually did really well. First, it ranked for us pet health in an AppStore, and we get great ratings, and people really loved the service. The challenge with it is volume. So as a pet owner, you need your record once, maybe twice a year, when they’re initially setting up with these services, and when you need to get your reminders. But you don’t need them all of the time. So we try to look for where there is most value to be gained, and once or twice a year, it’s just difficult to build a company of it. But with veterinarians, what we realized is they get flex of new patients consistently every day, every week, every month. And so they are needing the service multiple times a day, and maybe tens of times a day if they’re a larger practice. So the value to them and the time it saves them to have the system is much higher. 

Ivan: So you redefined if I’m understanding you correctly. So you redefine the value proposition and the different customers, which is even a harder pivot. So you changed the customer and the value that you deliver to them. So what are the main value points that you are not delivering to the clinics, so I understand the service a little better?

Emily: Yeah, the main value is to fold one is time savings. So if you think about when you first enter the vet practice, they say “Please come in 15 minutes early”. You get a bunch of paper forms, you fill them out, then someone at the front desk has to call your past hospitals. The past hospitals are gonna give them a hard time and ask them to send the consent forms that you are actually their client. And hopefully, that receptionist takes up and actually sends the records, and now you are about 30 or 40 minutes into your appointment, which is essentially the entire appointment slack. So the first thing is time savings. And the second thing is despite doing all of that work, most of the time it is unsuccessful. And the vet have to operate without records anyway. And so it’s very easy to quantify the value we bring with time savings, but it’s much harder to quantify the value of giving vets information to actually operate off of. 

Shawn: Interesting. So with the pivot, Emily, have you changed the service so it doesn’t provide the solution to the initial problem? Or you’ve just changed your focus, and you still do provide that service to the pet owner as well?

Emily: We still do provide the service. It is still live in the App Store, and you can still get your records that way. So our focus has shifted a bit, but it’s leveraging the same technology. So we still get records very quickly to steal that information whether you are a pet owner or a veterinarian.

Ivan: Okay, so you are in the business of transferring records. There are couple startups that I can think of, startups, and the companies that are actually been acquired in the space, so there is, I think that vet has a component of that. And it sounds like there is a link to some of that functionality. So are you competing with those companies, or do you have anything that is augmenting services, or are you just better, which is always something that I do? So you can say that.

Pivoting Your Organization

Emily: Yeah, I do like to think that we are just better, just simply better. The way we are better is in our success rate. So getting records is our number one focus. I think with the companies you mentioned, I think they do a lot of other things. And so records is the secondary concern. Much like it is for the receptionist which is why it doesn’t always get there. Because they focused on checking in the dog or taking their weight. We find that both services are more about sharing records that the vet practice already has verses we are focused on getting records from other places into your practice so that in the end you have more information.

Shawn: One question comes to my mind that I think that would be really helpful for our listeners is to describe the experience of interacting with your app as a veterinarian, what value do they extract out of it, what does that experience look like?

Emily: So I think for the veterinarian it is barely noticeable. And that’s really important to us because we want to integrate into the workflow as much as possible. So you get more information without having to make a ton of changes. The biggest change you’re gonna see is that you no longer have to have people do paperwork when they come in. There is a lot less work in that sense, and then you end up with a lot more information, and then things just run more smoothly. And the only thing we do in training rather than teaching people to use the software is mostly telling them to stop doing things. So stop calling other hospitals for records. Stop giving paper forms. But there is no actual work that we should have to be doing because of using our system. 

Ivan: What is the workflow? Can you walk us through? What happens? Like when do they use it, how do they use it, what the client does, and how does it come back to like.. Just the workflow

Shawn: Yeah, and how do they use it, the platform? Let’s get right into it. 

Emily: Yeah, we’ll get into it. So we integrate with the practice management system or your calendar system so that anytime somebody books an appointment, they will either get an email or a text message from us saying you know, please check-in for your appointment, and that experience we like to acquire with checking with your flight online. So you no longer go to a ticket counter, you just, you know, click a couple of buttons on your phone, and you’re in. So the pet owner will get that form, they will confirm the information and let us know which of that we’ve seen in the past, which is a common question on the new client form. And then they will give a signature. And they are done. From there, our team will take it over, we will get the information from all the other practices, and we will also to steal that information into a one-page format so the vet in the end prior to the appointment will get an email, or be able to login to our portal and see a one-page summary of all the records, plus all of the original files. 

Ivan: That’s so awesome. As an emergency veterinarian, there is, you know, there is two opposite sides of the spectrum here that I experienced. Once – you have clients coming in with zero information. So, basically, you’re hitting a client, they don’t remember, they know that shots been done someday, and, you know, you’re lucky if it’s the owner, not the boyfriend, or something, like. You get zero information. That’s one side. The other side you get those nerdy owners that have everything in the book, and then they tell you about cancer that their neighbor used to have while he ate chocolate, that’s when he developed this, and, you know, how he’s on to have the same. And now they think their dog has it. And you’re trying just to sit through the range of information so you guys are condensing that into digestible format into one page, and then you’re presenting that to the vets, so they can just quickly scroll it down to the business. Is that what it is?

Emily: Yes, exactly. So my own record is 70 pages. No one has time to read that. And so in our 1-page format, we highlight the vaccines, last day, the recommended next day that should be done. The lab work, when that was last done, and then any prescriptions and conditions, just one line about each that we find in the record. 

Shawn: And so the next obvious question for me after pet adequate explanation, thank you for that. Is how do you get paid?

Emily: We get paid a monthly fee by the veterinarian for all the time we save them and the actual work that we’re doing. And we charge a fee based on the number of appointments that they have.

Shawn: So, Emily, the next question that comes to my from me, what are people saying about your software?

Emily: Yeah, so the hospital managers are telling us how each member of the team is really loving it. So one quote I have is “We love the summary page, it really helps the technician.” And another hospital manager says receptionist love it, it makes it really easy to make one kick-in and update everything. And I think the biggest surprise to us, and something that was really delightful to me as a product person, is that people really love the photos. So that’s part of the form. The pet owner can upload their photo, and that is now a part of their medical record. And the technicians and the vets can see the image before the pet actually walks in. So it’s a really cool thing to have. 

Ivan: That’s awesome. So, I want to talk a little more about the sort of the, you know, the startup and entrepreneurial part of it. So when I developed SmartFlow, the most kind of irritating thing was when you talk to the vets, they’re like “Oh, that’s the cool feature that should be in the practice management system” And then you go “Yes, it should be. Nobody made it, so that’s why we’re here”. So the, but the challenge is, then when you’re designing it, one of the things that entrepreneurs envision for is to solve problems, but another one is the exit strategy. So is this to your envision yourself as a separate product, do you see yourself as the potential module that others can use? And what is sort of the future of this application? Is it developing into its own kind of product? I’ve seen what’s happening right now in this dynamic market of apps, and you know, affordability of being on the service and not building complex solutions. So is it an app that can live on its own and then being plugged in into multiple systems? Or is it something that you ideally would have built-in and it just sort of white label and lives inside of other applications?

Emily: That is a good question. So I can’t predict the future. However, I think that our system works very well with many other systems. And I think it will continue to live as moderate because it is so difficult to have a vet completely change their system. So that’s why we’ve designed to fit in with whatever they’re working with. So I actually think of it less as an app, and more as an extension of your front desk. And we wanna take away any of the work that they do not have to do physically in the practice. Because they already have 30 or 40 jobs with checking in the patient, and taking care of things, and cleaning up after the pets, and doing paperwork, that anything that can be done remotely we have…