Thought Leaders in Healthcare IT: Abraham Gutman, CEO of AG Mednet (Part 7)

Sramana Mitra: My next question is from an industry point of view. What are the trends and where do you see open problems that are perhaps not in your product roadmap but are things that you are seeing just because of your deep penetration and insight of the space? Where do you see the problems that need to be solved by new entrepreneurs?

Abraham Gutman: First of all, there need to be ways to reduce or slow down the growing cost of clinical trials. That’s a very big problem. A billion dollars in 10 years is becoming unacceptable. >>>

Thought Leaders in Healthcare IT: Abraham Gutman, CEO of AG Mednet (Part 6)

Abraham Gutman: Another level of quality analysis that we do is on the meta data in the images. You know how JPEGs have some meta data. It has a little bit of GPS stuff. In a JPEG, you may have a few dozen meta tags, so to speak. In a medical image, you have several thousand meta tags. The equivalent of aperture and so forth but multiplied by a thousand. Those things are very well-defined in the imaging charter because you need consistency, step by step, as they are being sent. Otherwise, you may introduce noise into data that is already pretty fuzzy to figure out whether a drug is working. We are now able to check all of these things around these images prior to the images being sent, which reduces the number of queries by over 75% in imaging trials.

Sramana Mitra; It sounds like that’s where you’ve done a huge amount of innovation and thinking to really optimize the process of pre-sending.

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Thought Leaders in Healthcare IT: Abraham Gutman, CEO of AG Mednet (Part 5)

Abrahama Gutman: You have to check the sub-assemblies where they are being assembled and put together into a data submission, which occurs typically every six weeks for a period of three to four years. You should also check that the submission meets the requirements of the charter of the clinical trial. It’s important and is typically done after the data has been sent. What we have been doing is developing more and more functionality that checks the quality of that data before the data leaves the clinical site. Think of it as a hospital somewhere in Southern China, Northern India, or Russia. It checks that quality.

Sramana Mitra: When you say it checks the quality, can you illustrate what that involves. Are we talking about metadata? >>>

Thought Leaders in Healthcare IT: Abraham Gutman, CEO of AG Mednet (Part 4)

Abraham Gutman: We needed to figure out a way of using our infrastructure. It was the same infrastructure as for the eBay of radiology, but I needed to have a way of enabling people to send these images using just a software front-end. There were a number of things that you needed to be able to do. One of them was being able to de-identify the images because unlike care environment where it’s very important that a patient record always has the patient name, it is exactly the opposite in clinical trials. Any subject record should not have the patient name because these are blind trials. So, we developed a front-end and we released it on October 31, 2008. I always remember that date because it was Halloween.

Again, luck struck because as we had been developing this, a pharmaceutical company called Glaxo Smith Kline somehow heard about what we were doing. >>>

Thought Leaders in Healthcare IT: Abraham Gutman, CEO of AG Mednet (Part 3)

Abraham Gutman: Pretty soon, I realized that that’s not how medicine works. It’s not arbitrage. This whole notion that people have that most radiology images are leaving the United States and going to India to be read, is absolutely wrong. In the United States, you are required to have three things in order to be able to do a final diagnosis. The final diagnosis is what you need to have in order to be reimbursed by Medicare or insurance companies. The three things are the following. You need to have board certification in the United States. You can have this if you’re a foreign doctor. You need to have a license in the State where the images were taken. That’s also manageable. But, you also have to be on US soil to do the reading.

Sramana Mitra: That rules out all this off-shore business.

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Bootstrapping Using Services: Robin Wiener, CEO of Get Real Health (Part 7)

Sramana Mitra: What about the team? Tell me a bit about the three best at the Maryland Incubator. How did that all play out?

Robin Wiener: We started out with three people. One of the guys we worked with early on was Raj. He is kind of our fourth partner and a phenomenal one. He moved back to Bangalore where he started our Indian office, which is not the typical Indian office. They’re part of our company. He has built a phenomenal team. We have two offices. We’ve 34 people in India. Here in Maryland, we’ve 33. Then we’ve three people in Texas.

My Vice President came out of our first client, American Heart Association. She really wanted to try something different. She lives in Dallas and wanted to stay in Dallas. If you’re talented, I want you to work on my team, but you don’t have to sit next to me. You can work wherever you want. Then, we also have two people in England. We’re about 71 right now. We went from four or five of us to this. I have the most phenomenal team. They’re just really fantastic.

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Thought Leaders in Healthcare IT: Abraham Gutman, CEO of AG Mednet (Part 2)

Sramana Mitra: Moving big images is no big deal.

Abraham Gutman: I said, “I won’t compress images. Who cares about compressing? There’s a lot of capacity in the ground already. Tell me how big a pipe I need and I’ll just make or lease a pipe. I can move truck loads of images very fast and efficiently.” Now I had a solution for the problem but I was wondering if the problem that he had suggested was a real problem. So I got in my car and started going to little hospitals in the New England area. >>>

Bootstrapping Using Services: Robin Wiener, CEO of Get Real Health (Part 6)

Robin Wiener: US is also starting to think about that a little bit. The other place where we’ve launched is Australia. It’s the same model of telehealth. We’ve partnered with Telstra Health, which is the largest telecommunications company in Australia. We’re rolling out our first application there. A new region that is very interesting is the Middle East. The population is getting sick. They’re very interested in trying to work with their population to keep them healthy. Since we can do the product in Arabic, they’re very interested in what we can do. >>>