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Organizing (and Reorganizing) People and Product Teams for Growth


Julie Yoo

Do you know who your doctor is? Chances are you do, even if you only see them once a year. But does your doctor’s hospital or health system know who they are? That may sound like an odd question, but it turns out one of the fundamental problems that health systems have today is understanding who their doctors are, what they do (what kind of patients/conditions they treat), and where they practice? And the problem is not as simple as distinguishing between Dr. J. Smith the cardiologist and Dr. James Smith the gastroenterologist. There’s still the problem of finding the best appointment time. From the physician office’s perspective, it’s not just about finding and filling an open spot on the schedule – it’s about optimizing the schedule by discovering underutilized capacity.

Kyruus has built a provider data management platform that considers billions of data points about physicians from thousands of different data sources to solve what they call the Patient Access Paradox.

Co-Founder and Chief Product Officer Julie Yoo has learned a few things since launching the company with Dr. Graham Gardner back in 2011. Julie and I talked about her background and the challenges of leading a company through significant growth and beyond, including:

  • How they’ve organized their product teams to more closely follow the user’s journey and support continued growth,
  • Deciding what to do and what NOT to do as a Chief Product Officer
  • The future role of EHRs in healthcare

Listen to the interview to hear us discuss her path to product management and running product at Kyruus.

Listen to the Show:

Show notes:

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Podcast Transcript:

Heath: Welcome to the Dirt and the Product Hero.

Julie: Thank you.

Heath: I’m here today with Julie Yoo, who is the Co-Founder and Chief Product Officer at Kyruus. Why don’t we just start by off talking a little bit about your background. What is your journey into product? I notice you move from engineering into product. Tell me a little bit about that transition.

Julie: Absolutely, so for better or for worse I actually started out completely not focused on engineering when I first came to college at MIT.  I was actually a pre-med major thinking that I wanted to be a doctor when I grew up. But happened to be in school during the first dot com boom back in the late nineties. And was just in the mix obviously. In the MIT. tech ecosystem and Kendall square more broadly. And so decided to actually pivot into computer science, but kept my pre-med. So I finished out my pre-med requirements and finished my CS degree and became a software engineer out of college. And I did that for about three years, but it was very obvious both to me and others I worked with that I was very drawn to the customer side of things. So it was spending a ton of time with early customers. So this was at a company called Endeca. And I had joined right about when there were twenty-five total. So early, early phase of the business. And therefore we got just really unfettered access to the early customers who were adopting our solution. And I just fell in love with that notion of being able to translate the business needs of the users and the buyers into technology based solutions.

So I caught that bug sort of early on in my career. I actually did two stints between my engineering career and product management. Which were in the areas of professional services, initially. So Endeca’s model was as a platform technology. And so every customer who bought our product implemented the front end of our solution in their unique ways. So they basically built web apps on top of our platform. And so we had a dedicated engineering team that did application development atop our platform. So that was even more exposure at the time focused on the e-commerce space. And learning about just the fundamentals of how to think about new customer acquisition, conversion funnels. How do you present information in such a way to drive better decision making and ultimately in that case bigger shopping cart sizes. And build a transactional platform that could drive revenue for organizations. So that was my one stint there and as you will hear as I get into the Kyruus story that experience and exposure to the e-commerce base was very inspirational to the vision behind my current business.

And then after that because I again enjoyed that sort of market facing presence. I actually did another stint in sales engineering, where our mandate was to be kind of the tip of the spear of sales. And help understand the solution space that a customer was trying to … A prospect really was trying to address. And translate that into a package solution that our technology could enable. And so I did that for a couple years. And that was probably my formidable experience because it had a bit of that entrepreneurial spirit, right? You’re sort of building a business market in a territory and having to figure out, okay, what vertical are we going to be able to make our name in? And how is that gonna create a flywheel into other customer opportunities. And then what can we codify in the product that enables us to scale this to other customers as well as other industries?

Heath: That was Endeca?

Julie: That was all at Endeca. I was very fortunate to have joined Endeca at a time when I was able to kind of wear all of those hats and scale with that business. And throughout all of that the common thread was in the back of my head. I was always still very enamored by healthcare. And my initial exposure to pre-medicine and what was happening on the macro federal government stage with regards to HITECH, and Meaningful Use, and what not. I was keeping sort of an ear to the ground on what that opportunity set was playing out as. And late in my Endeca career, Endeca decided to start verticalizing their solutions. So initially they made their name in e-commerce. And that was kind of their core business, but we started to look at other verticals. Like financial services, manufacturing, and then of course, healthcare given that it was such a data driven industry. Long story short, we ultimately did not scale the business in the healthcare vertical. But I had the fortunate opportunity to be exposed to some of those early sales opportunities. And just realized what all of us know today which is that healthcare was literally decades behind other industries as far as technology adoption goes. And there just seemed to be some very obvious use cases where technologies like Endeca could be applied to solve comparable problems to what we were seeing in other spaces.

So ultimately that was what triggered my career change. So I actually did my career change by way of grad school. It was basically an MS/MBA program that focused on entrepreneurship within the healthcare industry. And that was really when I kind of declared and said given both my engineering background as well as my interest in the sort of market facing aspects of that. That product management was gonna be the function that I wanted to hang my hat on. My very first product management job was actually a side job in grad school. Where I partnered up with an entrepreneur and Kendall Square who was building a new business in the area of personal genomics. Essentially making accessible to consumers your genetic information and providing both technology as well as services wrapped around that. I sort of partnered with this person as essentially their first employee and product manager to design, build, and bring a new solution to market from scratch and have never looked back since in terms of the product management function.

Heath: So you realized healthcare was screwed up? I mean, sorry. In bad need of solutions from your pre-med days would you say?

Julie: I would say it started with an intellectual curiosity about the healthcare industry. And then my exposure to the actual space at Endeca was what caused me to realize what the business opportunity was.

Heath: Well said, business opportunity.

Julie: Yes. And then I ultimately joined on to another company post-grad school called Generation Health. Which was also in the genetic testing space. We were a benefit management play, and I was basically their head of product at that company.

Heath: And then you left to found Kyruus?

Julie: Correct. That company got acquired by CVS Health and my current Co-founder Graham Gardner was the founder of that company. And so he and I had a chance to work together in that capacity. And we enjoyed it so much that we said let’s do it again.

Heath: And this was when?

Julie: 2010 was when our last company got acquired. And we officially started the business. That Kyruus, the current company in 2011.

Heath: You’re now how big?

Julie: We are now a one hundred twenty person going concern based in Back Bay. And we’re a six and a half … Or seven … Probably seven and a half years now into our journey. Significant growth period as far as stage goes. Venture backed so raised quite a bit of capital to give us the runway to get to where we are today.

Heath: So the name Kyruus. I’ve read a little bit about this on the website. Tell me about the two u’s.

Julie: Yeah, so the idea behind our platform and this is a little bit of insight into our product. We are a patient provider matching platform that helps health systems solve their supply demand mismatch problems. And the fundamental thesis behind the platform is that your ability to match patients to the right provider is only as good as the data that you have about those providers. And it turns out that one of the very fundamental basic problems that health systems have is understanding who their doctors are? What they do? Where they practice? And under what circumstances should this patient be referred to him versus not? And what we’ve built is essentially a provider data management platform that has billions of data points about physicians from thousands of different data sources. And what we’ve found early on when we built this asset was that there are many different personas of doctors represented in the data. And so you could have the clinical view of a physician, what diagnosis they treat, what procedures they do in clinic. But that person might also be an administrator who has a certain role from sort of an executive perspective. And furthermore they might be an academic who does research in certain areas that may or may not be related to their clinical work.

And so as we say all these different faces of the doctor within our platform. We stumbled upon this concept of chirality which if anyone has taken organic chemistry knows that it’s the notion of a mirror image that’s non-superimposable on itself. So like molecular forms can be chiral in nature. We thought that … That was an interesting way to think about physician profiles in a different views. And basically the different u’s that are represented in the data. We came up with the name Kyruus based on chiral forms of nature. And then the double u’s represented the different personas or profiles that physicians had within our database.

Heath: Well, it’s a cool name and all the better that it means something. I have worked in no less than four companies, top of my head, that had to deal with in some form or fashion this mess that is broadly termed provider directories. Provider data is a mess.

Julie: Absolutely.

Heath: And the perception to many I think is that oh you mean physician look up on a hospital’s website. Which is of course is not at all the case. I mean If you just think about looking about at a clinician’s specialty. They may have almost nothing to the lay person to do with what they actually do.

Julie: Exactly.

Heath: Based on whether they’ve headed down this track or that track. Or they’re administrative, or they’re more academic in teaching. And so I can certainly appreciate the fact that this is a hard nut to crack. From my perspective I think the one of the more interesting parts is this notion of optimizing the schedule. Right? And so people in within healthcare maybe familiar with the notion of, it sounds like a crass term, but referral leakage.

Julie: Yes.

Heath: To me it seems that a big component of it is … I don’t know of if you use this term, but patient leakage. Right? You’re filling your schedule suboptimally and by the way half of the schedule that is filled is not ever gonna really show up.

Julie: Exactly. Yeah. So we described this phenomenon as what we call the Patient Access Paradox. This notion that we as patients are waiting weeks for doctor’s appointment. And we assume that … That’s because no one can get into the system and everyone is booked up solid. But when you look at the data it turns out that there’s a significant under utilization of capacity that does exist today. And it happens for what we characterize as really three major reasons. One is just simply empty slots, slots that go completely unused because they’re either not visible. And that’s the majority of the time, it’s that whoever is making the referral or scheduling the appointment doesn’t actually have access to the schedule of the provider to whom they’re referring. And that could be due to literally just limitations of the EHR platforms and practice managements systems. Where you should not take for granted that a PCP who is on, let’s say Epic, can schedule appointments into their colleagues calendars when they’re on the same instance of Epic. That’s not a given. Let alone when you’re in a network where you’ve got dozens or even hundreds of different practice management systems. So that’s one of the fundamental issues that we solve.

A second issue to what you were alluding to is that even when you’re booking appointments and filling up slots it can be with the wrong type of doctor. And this was actually the personal experience of my co-founder when he was a cardiologist. Where he would receive referrals of patients who waited weeks to see him. Only to be told that he was not the right kind of cardiologist. He was an interventional cardiologist and this person had to go see an EP. And therefore had to be re-referred to yet another colleague.  And someone that Graham new off the top of his head. Someone he had trained with, who was down the hall from him.

Heath: I went to med-school with that guy or gal.

Julie: Exactly. And so not knowing at all whether that person had availability, took the insurance, was geographically convenient to the patient, et cetera. So that’s another major issue that we solve for is kind of getting that … Reducing referral misdirection. And then one of the most critical aspects of today’s healthcare landscape is getting to the right level of care. So if you have a headache you don’t necessarily have to go to a neurologist from the get go. There might be a triage path that allows you to get in sooner with a lower acuity care provider. Or maybe go to a walk in clinic that you could go to on your own time, and at your own convenience. And only be referred to a neurologist if you meet the clinical criteria. And therefore save that precious neurologist’s time for the truly high acuity cases that need his specialization.

So those are kind of the ways that we see the problem. And of course access to your point the knowledge of the schedule capacity. What appointments can be used for what. There are very legitimate constraints and rules that need to be placed around that. Whether it be … You know you don’t have certain equipment in certain locations, or you don’t accept that insurance at location a versus location b. Those are all the types of data and business rules that we codify for our platform.

Heath: Yeah. You barely mentioned the insurance thing right?

Julie: Yeah.

Heath: You make it through that gauntlet only to realize that oh my particular form of Blue Cross plan doesn’t accept these patients.

Julie: Correct.

Heath: Or back when I was working in the clinic there was this notion of okay are they a new patient or an old patient? Because new patients require forty-five minutes. Old patients thirty minutes that kind of thing.

Julie: Exactly. Exactly.

Heath: To be able to manually human manage that was complicated enough from just a four physical therapy practice. Four physical therapists practice.   Let alone a cardiology practice, from within a department of medicine, from within an academic medical center that’s downtown but also has satellite offices around one twenty-eight, technology belt what have you … I can remember also thinking back to the days we had a provider directory-ish application. Provider matching was a huge pain. Is that something that your technology and or data accomplishes? Or do you partner for that matching piece of it?

Julie: You’re saying patient provider matching?

Heath: No. Just strip it all away and say we have to have a unique provider even within a hospital. A single hospital … We have to know that this doctor J Smith, is also doctor James Smith, is also Jimmy.

Julie: Absolutely. Yeah. Yes. So the core tech behind our provider data management platform of much inspired by my experience at Endeca is basically entity reconciliation. So that you understand if J Smith, and John Smith, and J.R. Smith are represented ten different ways across seventeen different databases. And he doesn’t have an NPI associated with every instance. How do you know that this is the J Smith who is a cardiologist versus the John Smith who is a gastro? We use machine learning to basically apply semantic analysis of the data that surrounds that reference to that doctor. So we can say okay … We always use Graham’s example G Gardner at Brown.edu who is an author of this article related to atrial fibrillation must be a cardiologist because atrial fibrillation is a cardiology related term. And Brown means that he had some affiliation with Brown. Turns out he went to medical school at Brown. So we use that surrounding metadata to inform the best possible match. And like that is a huge problem that we solve for the health systems. It’s very technical in nature, but the notion of a single source of truth, essentially of who your clinical assets are. Is core value proposition associated with our platform.

Heath: I would expect that piece of it. The capacity to do that would have improved tremendously since I was in that space. So …

Julie: Yeah, I mean the nice thing about this is that we’ve really taken sort of off the shelf technologies and made it domain specific. So we obviously train it on provider centric data. But there’s really nothing novel about how we do it versus I’m sure how Amazon does it in their catalog data. Or other industries. So we’re trying to leverage.

Heath: It’s a commodity right?

Julie: Exactly.

Heath: I mean it’s data matching, right?

Julie: Correct.

Heath: What are your biggest challenges right now at Kyruus?

Julie: I would say there’s an answer with my Chief Product Officer hat on. And then an answer with my Co-founder hat on. And certainly from a CPO perspective I think it’s probably not unique to me and every head of product thinks about the most important thing is making decisions about what to do. And then what not to do, which is the more important thing. Especially now that we’re at a scale where we have very significant customers. All of whom in our go to market strategy was talked down. So we literally work with the largest health systems in the country. Who obviously have an opinion on how their operations should run. And what our products should enable them to do. And balancing that with adhesion to our product vision is perhaps the hardest part of my job. And you know being able to have a conviction of doing something that might not be obvious to people. That might be misunderstood for some period of time. But aligned with the longer term vision at the expense of having to tell a customer face to face tomorrow that … That’s not something we’re going to do. So those trade offs and decisions hit my inbox literally multiple times a day. And making those right decisions on a daily basis is certainly one of the major things that keeps me up at night.

With my Co-founder hat on it’s all about scale these days. All the good and the bad that comes with that. So we in retrospect probably achieved part of the market fit about eighteen months ago or so. And it’s obviously a phenomenal milestone that very few companies get to. So it was a great … A very big deal for us. But at the same there were some really challenging trade offs that we had to make. Certainly on the people side. I read about it, you hear all the time that companies get to a certain scale. And there’s people who got them to where they got to, but are not the people who are gonna scale with the business.  And to actually live that and breathe that first hand was a huge challenge. And something that we’re still managing and trying to paint career paths for the people who we want to stay. But having to have hard conversations with some folks who just realize that they’re not gonna be able to scale with the business.

So I think that aspect of doing that in a human way. And making sure we are staying true to our values, while setting those people up for success no matter where they go. Being grateful for everything that they’ve done to Kyruus. And all of the communication and sort of messaging around that is something that I think our executive team is very thoughtful about. But again just is something that you … We want to be paying a lot of attention to.

Heath: You run product. You also run engineering, am I right? And design? Tell me about the product team. How are your teams organized?

Julie: So related to your last question actually. One of the big decisions and changes that we recently made was yes I have been running everything.

Heath: Okay.

Julie: And as we scaled we recognized that we wanted to bring in a trained professional, so to speak, to actually run day to day operations and the execution arm of our product efforts. And so very recently just last month we brought in an SVP of product development to actually run all of those functions.

And he is a close partner of mine. He’s someone who I have phenomenal respect for. And has just given me a ton of leverage in my ability to then focus on the things I can uniquely bring to the company. And in my mind I kind of always think of a two by two matrix. Of you have strategy versus execution. And then you have kind of internal operations versus external engagement.

And I’m definitely spending today. Much of my time in that upper right hand quadrant of focusing on where do we need to be … not this year, but in five years? And what are the incremental decisions that we need to make now that will allow us to have option value. You know, it might not be a tactical thing that we do today. But at least leave that door open for us in the next several years. While also continuing to the external and maintain our position as a thought leader in the market. We were a category creator when we first started this business. And one of the major reasons why we’ve been able to be successful is that we had to teach the industry how to think about this problem. And to your points about provider data. Nobody really knew how to value that. That use case. And what it costs an organization to not be doing that well. And so we created that whole vocabulary. And so a lot of what I’m spending my time doing is carrying that torch externally at trade shows, engaging with our customers, with other industry thought leaders to make sure that our voice and our vocabularies is what is being used to describe this problem space.

So I’ve now been able to orientate and anchor myself there. And that sort of journey through those four quadrants so to speak has been very dynamic for me personally over the last seven years. That was a decision that we made recently. That obviously I fundamentally think was the right decision for the business.

Heath: So recent it’s not even reflected on your website.

Julie: I know.

Heath: So I was confused by that. I actually was looking the other night and though your verbal description to me I think is a CPO. I was not sure how you could handle that and running product. Especially in what I can imagine can be a pretty gnarly back end, and complex … and with all the different API’s … And I mean you white label at least some of your … Am I right?

Julie: Yeah.

Heath: I mean there’s people using your product that won’t necessary know it’s Kyruus, right?

Julie: Exactly.

Heath: So that can get fairly hairy.

Julie: Oh, yeah. No, it’s a huge behemoth of a machine that I’m glad I had to opportunity to run the entire ship. Because it informs obviously the way I think about how the vision can get executed on and operationalized. But certainly I think we all would agree on my team at least that the best use of my time is not doing that. And that there are people out there who would do it far greater than I.

Heath: We have so many interview series that we do. And it’s run around product innovation and one of the central questions is how do you … not only divide and manage, but protect that innovation component? The answers have run the gamut all of which are centered around this notion that it’s very difficult to do that. And I know as a former product manager I felt like I had almost no time to lift my head up off of the proverbial desk. And turn towards the market to say okay, it’s all well and good to be working in this roadmap.  Which now and years later I realize was really more of a release point than a roadmap. Who is looking out for … six, ten…

Julie: The beyond.

Heath: I struggle with this notion of two years and beyond. Because I think that’s crazy in the tech space.  I think you’re really talking six months and beyond. But there’s just no way you could do that.

Julie: Yeah. Yeah. Unless you have a dedicated … And that’s like I am the embodiment of dedicated resource against that. So that’s been our strategy. And it requires a lot of … I know one of the areas you wanted to discuss was just how we all kind of communicate amongst ourselves from department to department. And we are a product centric company. And so in some ways I view myself as sitting at the intersection of all those functions, and driving that dialogue about … Okay, are mature products here is the go to market strategy for those. Here is what we need to think about with regards to our renewal strategy. A crossword book of business, et cetera. How do we protect our house? I literally have a slide that has the Under Armour logo on it. That’s one kind of pillar of our product strategy. But let me whisper in your ear here are the three things we must be thinking about, because even though it’s not on your radar today. If it’s still something that we have an interest in twelve months then we’re gonna be on our heels. And so there is that you have to invest in that ongoing dialogue. Again things that might not be intuitive. That people might don’t distract me. But you know again we’ve decided to kind of fundamentally invest in having that dedicated function.

Heath: So although perhaps no longer directly your teams per se, how are your product teams organized? Organized around products? Or around Jobs To Be Done? Use cases? How are those teams organized?

Julie: Yeah. We have been pendulum swinging back and forth for the last several years.

Heath: Well, in Venice the market has been changing the way they structure teams.

Julie: Absolutely. So when we started we have a platform that has three major products atop it. That each have their own end users. So we have a call center scheduler facing product. We have a consumer patient facing product. And then a practice facing product. And so it was very intuitive for us at the beginning to orient around that. So we have PM’s kind of aligned that way. The way that our product is utilized is that it’s not that clean. So an organization doesn’t think about it that way. They think about we have a referral management initiative that hits all of three of those stakeholders. And so we need to be thinking about that in a vertical sense. And so now we’re oriented more around the jobs to be done initiative type of orientation. Where, for instance, there’s a team that focuses on enterprise scheduling. And what does it mean to have full unfettered visibility in to all of the schedules. And then allow for anyone to be able to book appointments in. And so that’s one example of how we’re oriented today.

I think because of the scale that we’re at we also have the benefit of having not just a product management team, but a separate product marketing team. And that’s actually where they split. So our product management team is organized around initiative. But our product marketing team cares about who is the buyer. And so those are orthogonal views on the platform. And that’s how we’re able to staff it. Is to have … you know two … essentially … Be covering both but doing it through two different functions.

Heath: And are design and engineering part of these teams? Or are they separate? Or?

Julie: Design rolls up to product. And then engineering is sort of peered to product. But we do have sort of the one to one where obviously we have a product manager dedicated to a engineering team that is focused on one of those initiatives. But we’re a heavy prototype first culture or kind of methodology.

And it’s just fascinating how much of that overhead of discussion and complexity goes away when you have a visual.

When people can actually tangibly see what that work flow could look like. So we value our design function for that reason.

Heath: Well, and when you have someone who can create those prototypes and test those prototypes and gather the feedback on those prototypes. Right?

Julie: Correct.  Exactly.

Heath: In fairness the ability to whip up a prototype back in the day was not so easy. Today so many of these tools out there whether it’s InVision or heck even Keynote these days you can do some pretty crazy ninja things …

Julie: Yeah, yeah, yeah. We’ve used power point, you know, whatever you can get your hands on.

Heath: What is a typical day like for you?

Julie: I’m spending most of my time on strategy. And given the stage that we’re at as a business we have the opportunity to now kind of lift our heads up, and say okay now we’ve got a team dedicated to scaling the core business. And meanwhile me, our co-founder, and our new CFO are kind of involved in additional net new opportunities. One area is business development, obviously a core part of health IT, in particular. Is not just establishing your own core business, but also playing nicely with others so to speak. You have to be a member of an ecosystem and partner with other organizations in this space to be successful. So we have forged a number of formal partnerships. Whether it be tech vendors in our space. Whether it be tech vendors out of our space who are trying to get into healthcare. Whether it be services providers like consulting firms. That’s a lot of where I spend my time. Both building relationship and then obviously developing a value proposition for those organization to think of Kyruus top of mind when patient access is something that their customers bring to their table. So that’s one of the big areas where I’m focused right now.

That’s actually the primary reason I’m going to HIMSS next week is to do some of those announcements. And be not just in the Kyruus booth, but in some of the other booths of the partners.

Heath: You can just go the last day. We call that biz dev day, right?

Julie: Unfortunately, all the presentations are Monday through Wednesday. So I will be there during the thick of it. So that’s one big area. Another is just I spend a lot of time thinking about org. And as we scale we’ve brought on a lot of new folks recently. And I obviously have a big interest in indoctrinating the story of Kyruus and why we’ve made certain decisions the way we have. And why again the non-obvious things are things that are leaders have to be thinking about as they execute on their functions. So a lot of my time is spent with my fellow executives. And then I spend a lot of time doing this kind of thing. And just investing in updating the market on where Kyruus is … We have thought leadership events. We run our own annual conference as well as quarterly webinars. And I’m spending a lot of time external facing. Just sort of being the voice of Kyruus in the market.

Heath: I think the healthcare industry has struggled with user experience, customer engagement over the years. Why do you think that is? Why is it unique? I think it’s unique to healthcare, but others excuse me may disagree.

Julie: I think it’s shifting a bit. I think there’s the EHR era which we’re at the tail end of in terms of what Meaningful Use drove. And the fact that so much of the usability challenges were focused on that product platform. And then now what I would call more the best-of-breed solutions that are trying to fill the gaps that the EHR’s don’t. So in the EHR world I think there was just a fundamental mismatch in some ways between why those systems existed and what the users had to do to get their day to day jobs done. Which is basically the I need to get paid versus I need to care for a patient. And so I think that there’s lots of incremental things that came off of that fundamental disconnect that ultimately lead to a really poor user experience. That was just not optimized for what the end user was trying to do. We have yet to see an EHR that is actually oriented around patient journeys. And I think there’s a whole opportunity set around that some of which Kyruus gets to. In terms of really taking a patient centric view to the appointment booking experience, and making sure that you’re looking at that holistically and longitudinally. So that’s kind of my commentary on the EHR space.

I think there is legitimate reasons why this industry is conservative. I think there are legitimate regulatory concerns, and safety concerns …Patient privacy concerns.  Where culturally the industry is more risk averse than others. And therefore are not gonna just try out apps. Or just spend time testing things out. The bar is higher and that’s something that we certainly had to deal with to get an MVP out there. There almost is no such thing as an MVP in the world that we live in, because you have to hit certain bars for things that start ups and other industries likely don’t have to deal with. That said I think there are also historically lack of efficient market dynamics that incentivize people to use solutions that otherwise make sense or seem rational. But I think that’s changing. Actually one of the most optimistic outlooks that we have is that we do see signs that it is becoming a more competitive market. Competitive meaning health systems are finally realizing that they have to treat their patients like customers. And actually invest in long term relationship, and compete for business.

Heath: Which they wouldn’t even utter those words “customer service” … No, they’re patients.

Julie: Correct. The word revenue was a total …

Heath: They might say client, but they never say customer. And it’s like what’s wrong with the word customer?

Julie: Yeah. And now one of the biggest growing sectors in health IT is CRM. And so people are finally embracing that. I think a lot of it has to do with the fact that most of the leading health systems have brought people in from outside of healthcare.

And many of the customers that we work with who were the early adopters of our platform were not healthcare people. And they didn’t have that … Sort of the burden of historical cultural context. So I am optimistic that it will change, and we’re really just at the beginning of that whole journey.

Heath: I have always been … I guess bearish is the word. The idea that EHR as a formal old school product will ultimately work.

Julie: Mm-hmm.

Heath: I think you mentioned some of it. It’s just too much. Too big. You can’t … There’s too many different users, it can’t possibly serve them all optimally. I’m expecting, hoping, feeling like now the opposite of what we saw around the HITECH Act. Which is killing off of this best of breed idea. We want one throat to choke if I’m the hospital’s CIO. I want to optimize and scale back my vendors, and now we may be going back again to the old best of breed concept.

Julie: Mm-hmm.

Heath: And I just don’t think you can nail the experience well enough unless you do say I’m going for the best experience. For this piece of functionality. And I’ll expect because technology allows it that that piece of functionality will play nice with this other piece of technology.

Julie: Yes, yeah. I definitely fundamentally believe in that model of evolution. And I think some of it is just industry maturity. Where in order to get to that place some fundamentals need to exist. Including things like infrastructure. So at the end of the day I think EHR’s will be relegated to infrastructure layer. And they are the pipes you enter data into, and transact and transmit data back and forth. But they are not gonna be necessarily all of the business logic and the workflow that allows these people to do their jobs so to speak. And so I think that is something that I certainly experience at Endeca. Where same exact dynamic occurred there. We were competing against the Oracle’s and the SAP’s of the world whose ERP platforms they would claim could do what Endeca did.

But ultimately the industry realized that those are your fundamental infrastructures.  And your middle ware like Endeca has to exist to actually address the use case. So I think that’s exactly what’s happening right now is that people have installed the pipes. And now they realize that those pipes don’t solve world hunger. As they were claim to have done. There is still some real dynamics out there in terms of those EHR companies will always say that these things are on their roadmap. And that given the major investments that these organizations have made. There is true inertia to more juice out of that squeeze versus looking at alternative solutions. But I think if you look at other industries and the way that that’s matured. Again I’m optimistic that it is moving in that direction. And that’s why companies like Kyruus have been able to be successful in recent years.

Heath: I think it has to … I think it has and I think it has to.

Julie: Yeah.

Heath: Failures or mistakes. We’ve all made them. Certainly in product. What’s a failure or mistake that either you’ve made or you’ve seen made that you learned from in product?

Julie: Yeah, I’ve made tons. And you know a lot of them have to do with I would say two dimensions. One is timing from the perspective of just making decisions more quickly. And not optimizing for individual customers when doing so. And that gets to some of what I mentioned earlier. Where there is a certain stage of the business where you are highly reliant on individual customers versus not. And then that switches at some point. And so getting that balance right. There’s a whole slew of mistakes that I think we made along the way along those lines. That in retrospect I would of wanted to have wanted to have more conviction around our vision and our road map versus relenting to individual loud voices.

I think, well maybe not related directly to product, but similarly on the people side. It’s always the product and the people. So the people side. I think having a stronger thesis on the value of domain knowledge in this particular space. And I still go back and forth on this. I’d be curious to hear your thoughts. At first we did not optimize for domain knowledge. And like many other companies I was coming into healthcare obviously from another industry. And I wanted that fresh point of view. Sort of that lack of jadedness, so to speak. And I think that probably slowed us down at the beginning because we had to get over certain learning curves. And appreciation, and empathy with people who do things in really unintuitive ways, right?

Any rational human being who comes into a clinic and sees how it’s run…their mind is blown. Because they’re like why do they do it this way? And there’s just that whole learning curve where someone like you who would have walked into that said this is why, and let’s move on. So I think we did probably lose some cycles on that. Now we do have folks who have that do have that domain expertise. Whether it be technical domain expertise or provider domain expertise. And I think there’s a lot of leverage that we get out of it. So that’s maybe an insight that I wish I had had sooner so that we could have optimized.

Heath: It depends on a lot of things. I think it depends on the role they have within the organization, right? Do you want … I do believe that in the healthcare tech space it helps whether it’s … Whether it should help or not is a different question.  But it certainly helps to disarm an audience of clinicians if there is a clinician in the room that’s doing the talking. And that’s more of a sort of upfront sales view.

Julie: Yeah, relationship development view.

Heath: Do I really care if my database managers or engineers have worked in healthcare? I might say I don’t want them to because they’re gonna come at it from a well that’s crazy. Who has those?  Hospitals don’t have those technologies twenty years old you should be using the technology you used in the airliner, or the FinTech … Or something like that.

Julie: Legacy, yeah. Exactly. Right.

Heath: So I think it depends on the role and then obviously the size of your company.  I don’t think you’d need to worry about having it be necessarily the majority of the company has the domain knowledge. But certainly you need it in strategic parts of the company.

Julie: Yeah, exactly.

Heath: I mean … You know … You’ve got an MD founder, right?

Julie: Correct.

Heath: Doesn’t hurt.

Julie: Right. Absolutely.

Heath: But do you need your entire exec team to be MD’s? No.

Julie: No.

Heath: Yeah. Products you admire? What’s a product or product that you admire that’s not your own. Healthcare or not doesn’t matter.

Julie: I definitely admire my own. So I think I’m guessing that a hundred percent of product people who you ask that this question will say Amazon at some point. So Amazon definitely admire them. Specifically for the reason that they enter new markets and are category leaders in those markets.

I think that’s just very rare that a company with that much breath can also be the number one player in that segment. So that’s why from a tech perspective I admire them. On a consumer lens I actually happen to be in my insta pot and sous-vide machine phase. Really what I admire about those is just how they’ve been able to democratize really high class cooking and culinary skills into … I mean I’m the worst chef on the planet and yet I know how to use those things. And I can make these phenomenal meals. I have a little one at home so just the convenience, and the efficiency, and not having to … You know I loved Blue Apron and the concept behind that, but the amount of work necessary to make those meals was just way too much.

Heath: Yeah, I see it.

Julie: The simplicity of the user experience with those products has been pretty exceptional.

Heath: To me like I like the prep work. Like I like using a knife that doesn’t bother me.

Julie: Yeah.

Heath: For me the headache is what should I make tonight? So I guess that solves a little bit of it ’cause it gives you a recipe or a pre-made … But that part doesn’t bother me. So that strikes me as maybe not … Creating or solving the biggest issue.

Julie: Yeah. I don’t know much about their vision. But, certainly it was like first class problems kind of focused on that.

Heath: Yeah.

Julie: I’m intrigued by just more fundamental nutrition issues and food access. How do you solve the whole food desert challenge. And things of that sort …  But yeah, no insta pot and sous-vide simplify a lot of the aspects of the Blue Apron process that were a little bit overwhelming for me.

Heath: So what advice would you give to someone who is looking to jump into product management?

Julie: One is go meet other product people. If solely for the benefit of understanding how varied product management can be. I think one of the things that I’ve definitely taken time out to do during my Kyruus journey is meet other heads of product. And just really appreciate how many different types of ways to run product there are out there. And it’s not necessarily correlated with the industry or whether you’re enterprise or consumer. I think product is such a … It’s a relatively new function and it just means different things to different businesses. So definitely get out there and just learn what that …  Kind of what that landscape looks like. I would also say keep a journal of all the products that you use. And imagine if you’re a product manager. Not just what’s good and bad about the current product. But where would you take that product and …

That when I interview product managers one of the questions I always ask is give me a product. Don’t tell me what you like and don’t like about it. But what would you do with that product and where would you take it? And similarly documenting what companies and product management models you think work and don’t work and in what scenarios. So I’m a big sort of journaling, diary person. So I think keeping track of your product thoughts is a good way to demonstrate that you have a true appreciation for what that function means.

Heath: Interesting idea. Have you ever connected with a Boston Women in Product?

Julie: Not the women. I know BPMA.

Heath: So there’s a subgroup I guess you call it the Boston Women in Product. Turns out it wasn’t intentional but I looked up and realized that two of our product heroes were two of the three founders of the Boston Women in Product.

Julie: Oh, okay.

Heath: So I thought well we got to grab the third person.

Julie: Yeah.

Heath: Brought all three of them in here and did a podcast with them. One of the women on that group. She brought up something you mentioned which is there is all these product organizations for product managers. But what they’re all trying … I said what’s coming this year for Boston Women in Product? They’re trying to create another focus around product leaders for lack of a better term.

Because there’s a very different challenge is. It’s one thing to group a product managers around a table whether they’re senior or director, whatever. But it’s another for the CPO level. Different issues, different challenges.

Julie: Yeah, yeah, yeah.

Heath: So you should connect with them.

Julie: Oh, I should connect with them. We have like a skunk works CPO dinner group.

Heath: Yeah.

Julie: And we get together once a quarter. So we should merge with them.

Heath: I’ll send you their information. They’ll be at UX Fest I’m sure.

Julie: Awesome. Good.

Heath: Anyway.  Well, thanks for coming.

Julie: Yeah. Thank so much this was fun.

Author Heath Umbach

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