When Digital is Not Enough: Smarter Software, Better Patient Care

Scheduled for: January 4th, 2022, 12:00 pm PT / Category: Interviews

How can AI and software help patients, providers, and the healthcare system as a whole?

Pamela Singh, CEO & Co-founder of CaseCTRL, has a background in Systems Engineering and Operations Research. A fierce patient advocate, Pamela is working to modernize the delivery of personalized surgical care!

Podcast

 

Transcript

Tullio Siragusa:
Good afternoon, everyone. Welcome to the first dojo.live of 2022. I am Tullio Siragusa and today is Tuesday, January 4th, 2022. I’m joined today by Kim Lantis, who is in Hermosillo, Mexico. Hi, Kim. Welcome back.

Kim Lantis:
Thank you. Happy new year! And we’ll see how long I keep saying 2021 instead of 2022. <laugh>

Tullio Siragusa:
Yeah, right?

Kim Lantis:
But at least you don’t have to write out checks anymore. You remember that?

Tullio Siragusa:
Yeah, no. <laugh> People used to put the wrong date on them all the time. And we’re joined today by Pamela Singh who is the Co-founder and CEO at CaseCTRL. Who’s joining us from Northern Virginia. Hi, Pamela. Welcome to dojo.live.

Pamela Singh:
Hi! How are you? Thanks for having me.

Tullio Siragusa:
Very good. Thank you. So today we’re talking about patient care, better patient care, and we’re talking about software and AI. How do these all go together? So that’s what we’re are going to unpack in our conversation with Pamela today. But before we dive into that and see what we can learn, let’s get to know our guest a little bit. Pamela, if you don’t mind, please tell us a little bit about yourself.

Pamela Singh:
Yeah, of course. My name’s Pamela Singh. I am CEO and Co-founder of CaseCTRL, but my background is in systems engineering and operations research, which is the science of efficiency. And I’m originally from Northern Virginia, but now we are based in good old Houston, Texas. So I’ll probably be saying “y’all” a lot during this conversation.

Tullio Siragusa:
<laugh> Yeah, it’s amazing how many people in Texas don’t say “y’all” but it’s mostly like East Texas, but it could happen. So thanks for joining us. So tell us about CaseCTRL. What’s the company all about? What gave birth to this idea? What was that moment like? “Hey, we should create this company.” Tell us a little bit about that.

Pamela Singh:
Great question. So CaseCTRL is a software that uses AI and automation to streamline the surgery, scheduling workflows and coordination. We actually started from an organic need. So my husband is a practicing orthopedic surgeon and there are a couple things in play. You know, one, especially now with the COVID, this started a few years ago, but, in the healthcare industry, especially with surgeons, they go to school to do surgery, but we bog them down with so much documentation and it makes already stressful job, even more stressful. So I would see him come home every day, late, exhausted. And so we already had that burnout factor in there, but another thing that happened was at work. He noticed that he had a patient come in crying one day, who said, you know,

“Hey, Dr. Dewan, I signed up for a surgery with you. I finally got over my anxiety to have surgery in the first place, got my son to fly in, take a week off to take care of me, got to the hospital, just to be told that, ‘Oh, Hey, due to an admin oversight I was missing a cardiology clearance and my surgery was canceled.'” So, not only do we burden surgeons and healthcare workers with the administrative work, but now there’s also an emotional component to it where they have to take care of these patients and deal with these patients to really give them a better experience. And we have all these high tech surgeries, but they are supported by low tech processes, such as coordination for surgery is done with paper, fax, scans and email. And it’s really harming patient care and it’s harming staff as well. So, mm-hmm? <Affirmative>

Tullio Siragusa:
Yeah, please go ahead.

Pamela Singh:
Yeah. So we threw together a MVP just to help his own practice and we noticed a 20% decrease in case cancellations, which was great! But it wasn’t until a year later when his hospital administrators actually came to us and said, “What are you guys doing differently here than all the other surgeons? Because we’ve noticed your practice is much more efficient.” And that’s how CaseCTRL was born. Really, I was happy with just him doing less paperwork, having less cancellations and being home early so he could do the dishes and put the kids to bed. That was really good enough for me, but then when we found out this is a larger problem, with my background in efficiency, it was something that we just couldn’t ignore.

Tullio Siragusa:
I love it. Okay. So what started out is your desire to make your life easier, and better, turned out to be a great solution for a lot of other people as well. All right. Let’s see what we can learn. This is something we can certainly unpack and learn a lot today. Kim, if you could please introduce the topic and kick it off.

Kim Lantis:
Of course, thank you Tullio and thank you for being here, Pamela. So the topic as chosen by you is “When Digital is Not Enough: Smarter Software, Better Patient Care.” And as we already touched on, really talking about how AI and software can help patients, the whole caboodle, right? Providers and the healthcare system as a whole. So tapping into this, what is the AI component? I mean, I think I can, I imagine this – we have to set up, let’s say, coordinate a meeting across just five different teammates trying to coordinate our Outlook calendars or whatever, and it’s a nightmare. <laugh> So I can’t imagine having to do that across an entire hospital or network. How does AI help you with this? What other processes, other than scheduling, can you help with?

Pamela Singh:
Great question. So, you know, it’s not just about scheduling the surgery, but it’s also about making sure you have all of the right equipment during the surgery and making sure that you have the right processes and plans in place after the surgery as well. So not just about scheduling, but really if you plan up front, the entire episode of care is improved. For example, when we start with the surgeon, so currently, a lot of surgeons have to write eight pages per surgery of their complex surgery preferences, such as special implants they want or tools they want to use. And it can take up to 25 minutes or 20 minutes per surgery to write all this information. Plus it’s just exhausting. What we found is a lot of surgeons just put in the bare minimum and hand it off to their surgery scheduler.

And then there is a lot of back and forth or some of the supplies don’t arrive on time. It impacts the surgery. So what we do with the AI portion is we abstract historical data from that surgeon’s previous cases, as well as other surgeons’ cases, and we autofill – prefill – all of the, there’s a lot of coding that needs to be done on this paperwork. A lot of the surgeons preferences, a lot of the tools that need to be there. And by doing that, we’ve actually been able to save surgeons about 250 hours per year. That’s the AI component for the surgeons. And for patients, what we’ve been able to do is, you know, they might have a lot of questions and anxiety during their surgery or before their surgery. And one thing that we’ve been able to do is, “Hey, why don’t we provide them with more information and literacy where they don’t have to hunt down a scheduler or anyone.” You know, if I’m having surgery, I want to know what it is, what to expect.

I just want to have the facts; that’ll really help me with my anxiety. So based on the type of surgery, and also based on that specific patient – specific surgery and that specific surgeon’s preferences – that is the type of information that we give them in email format, text format, however they want to receive it. And the reason why we don’t just do a one-size-fits-all is because even if you have two surgeons in the same practice who do the same type of surgery, they have completely different preferences. They’ve trained on different tools. And, as you can tell, it just gets exponentially more difficult to do this. So if you’re a human trying to process all this information, you know, we found that surgery schedulers are really overwhelmed and overworked at the moment, especially in COVID when you have surgeries being canceled left and right, or rescheduled. So they have to redo all of this manual work. So that’s kind of where the AI component comes into play.

Kim Lantis:
Great. So it sort of just takes this standard of what they’re used to having happen, and then all you really have to do is just review it, check it and say, “That looks good!” Is there any post op care as well? I mean, or in the actual operating room, like, I don’t know, a checklist? I think they have to – what do I know? I’m not a surgeon! But I have the understanding that they have to check and make sure that every tool is correct that there’s no missing screws or anything. Are you doing that as well? Or is that coming up?

Pamela Singh:
Mm-hm. <Affirmative> Yeah. So one thing that we have actually received feedback on is from the OR teams that the doctors who used CaseCTRL, it was much easier for the staff to pull the right equipment instead of pulling everything and the kitchen sink, because someone didn’t fill out a form specific enough with what they want. So, you know, if you pull out all these tools, they still have to be sanitized and it costs a lot of money per surgical tray. So by only pulling what we need, not only are we saving money, but we’re also making the jobs easier of the surgical staff as well. And then postop, we have just started postop care pathways where, based on how the surgery went and based on a patient’s health, we are able to provide them with a step-by-step guidance and documentation of how to recover.
Kim Lantis:
Very cool. And specific to what it is that they have in their body.

Pamela Singh:
Mm-hmm. <Affirmative> Exactly.

Tullio Siragusa:
So, I’m curious. How do you get everyone to work and participate? It sounds as though there’s a lot of people involved, a lot of different departments involved. And the coordination of all these things, certainly having a platform where you can do all that facilitates it and enables everyone to not end up doing double effort or showing up without what’s needed or having a situation where a surgery needs to be canceled because of some admin oversight, or what have you. How do you get everybody to be trained to change their current processes? I mean, this is a disruption to the current processes, as inadequate as it is today, right?

Pamela Singh:
Mm-hmm. <Affirmative>

Tullio Siragusa:
So what’s that been like to get these multiple disciplinary teams to participate in one CaseCTRL platform?

Pamela Singh:
Great question. So one thing I’ve learned is, it doesn’t matter how good your technology is. If people don’t adopt it and use it, it’s going nowhere. So change management is definitely a huge part of us and the way we have implemented it is we decided to make the software flexible. So, from the beginning we understand that it’s not one-size-fits-all in terms of processes. So what we’ve been able to do is, you know, when we do a preliminary in-depth workflow analysis, we’re able to see, you know, you have some surgeons who are tech savvy. We have some who I like to call “tech averse”. And surgeons do not like disruption to their processes. So one, we have our users, our investors, even people on our board, are surgeons. So we understand how to talk to them.

Pamela Singh:
And another is, we are able to tailor the process to match some of their workflows. And then we come in and we make suggestions to process improvement after we have enough data. So 90 days of data to suggest process improvement. So we don’t just come in say, “Hey, this is how you should do things.” We make those recommendations. We have the system set up to go with their workflow, as best as we can, as much as they’re willing to change. And then we’ve been able to slowly convert them based on showing them real data from their own practice as to why they should change and what changes they should make. And that’s been, you know, much easier when they have that data in front of them.

Tullio Siragusa:
So currently, the way you’re doing it is you’re facilitating the process just the way, you know, any major software implementation, whether it’s a bank or what have you, they would have the company or hire either an outside consultant to help them adapt the technology to their current workflows. You guys are doing something similar. Are you, how are you doing that today? You have like ex-nurses or doctors that are practitioners in this process? How challenging has that been to find people that want to play in this technology to help their constituents? Is that something that’s been a challenge for you, and if not, how are you guys going about it?

Pamela Singh:
So right now it hasn’t been a challenge yet because COVID actually, the silver lining of COVID is, now people are more open to digital solutions. So, we started during, we decided to launch during COVID because great planners that way. But people are more open to digital solutions. And now there’s also market forces that are requiring them to change, such as the CARES Act. There’s also government mandates which make, which are mandating more interoperability. And now another thing you’re seeing, especially in orthopedic surgery, is smaller practices are joining together to make big super practices. So they all have these different processes and they need a way to standardize this as one huge conglomerate. And they can be at different locations doing clinic, they can be at different locations doing surgeries. So now there’s a real need for this type of platform. And in terms of who actually uses our platform, we have three people who log in, which is the administrators, the schedulers, and the surgeons. And with everyone else, we interact either by sending or pulling information in the type of packet that they would like to receive the information in.

Tullio Siragusa:
I’m curious to understand, as people use this and adopt this, we get the workflow efficiency. There’s definitely value in that. There’s also the value to the patient in terms of less risk of things going wrong, or things getting canceled or rescheduled, or what have you. All that is incredibly valuable and important. Is there also a benefit financially to the institutions that are adopting this? i.e. Better processes, more efficiency, more effective coordination – does it impact for example, their cost of insurance? I know cost of insurance for a surgeon is extremely high. How has this been perceived by the insurance carriers? Are they behind it? Are they supportive? What’s that been like?

Pamela Singh:
So with insurance carriers we are in dialogues with them about launching another feature, which will be coming out this year. But right now, the most of the cost benefit is to the actual surgeon or the practicing surgical revenue, the clinic or the hospital. And the way we did this is, we actually have one case study where one hospital thought that, you know, “Out of all of the patients who were being offered a surgery, only 6% weren’t making it to the operating table.” But because CaseCTRL tracks patients from the very beginning, even undecided patients, we found that, “Hey, actually, 30% of patients who you’re offering surgery to aren’t making it to the operating table.” So that’s a lot of revenue that’s left on the table. So we’re able to recapture some of those surgeries, we’re able to decrease case cancellations. And we found that results in about $200 to $300K more in surgical revenue per surgeon per year.

Tullio Siragusa:
I have to admit I’m one of those 30%. I’ve been calling off on something since August. Go ahead, Kim. You got a question.

Kim Lantis:
Well, I think there’s also just the financial benefit, I’m imagining, of just having happier employees, right? Your surgeons, their schedulers, everyone’s just, “It’s working nicer for me. I like to be here.” But going back to that validation of your personal story of the genesis of CaseCTRL with the actual clinic, the hospital, coming to your husband and saying, “What’s happening?” I want to talk to you about just from the business standpoint, first of all, what did that validation feel like? Were you surprised, taken aback? And then also, what were the steps then with that “aha moment” of how you transitioned into being this entrepreneur and saying, “Let’s do this!”

Pamela Singh:
Great question. Well, one, when the hospital came to us, you know, they dug through all their records. They manually went through records and then compared it to, you know, CaseCTRL being implemented. And so that was eyeopening. For somebody who loves process improvement, I didn’t have a lot of insight into the surgery scheduling process and how much inefficiency goes on. It was kind of scary to see that, “Hey, if I’m having high tech surgery, the person coordinating it is literally using post-it notes. So I’m not sure how safe I feel about that.” But it also came the validation from my husband’s surgery scheduler. And one of them said, “You know, now I just don’t feel as stressed anymore.” And this is something that we’ve been able to see, even in our implementations, where it reduces administrative burden by 75%.

Pamela Singh:
So technically, we also reduce the amount of full-time employees you need by 0.33. But, we’re not here to just replace them. We are here to help them. So now they can actually do more customer facing roles or patient facing roles, which you really need employees to cultivate those rewarding relationships with patients now. And aside from 75% less administrative burden, we have found that patients are just happier and not as angry when they feel like they’re being respected. And when they feel like they have information, there’s some level of control. So, actually the patient who came in crying for my husband, whose surgery was canceled, she came back and she had knee surgery on her other knee, and it was with CaseCTRL. And she said she had a much better experience. So that the validation that we really needed to say, “Hey, let’s do something bigger.”

Pamela Singh:
In terms of being an entrepreneur, I never thought I would be an entrepreneur. And at one point I was like, “Even if you pay me, I wouldn’t be an entrepreneur.” I like to know what’s going on. I am a control freak, and, you know, I need to know everything. But you know, life throws curve balls at you and I had some health issues pop up. So being an entrepreneur would actually allow me to do my work, but have some more flexibility. So I decided, “You know, why not?” And it has created a great work-life balance. I can have a meeting, go play with my daughter for a couple minutes, have her spill cranberry juice all over me, but it’s okay because I’m on Zoom so nobody sees the pajamas and cranberry juice pants, you know? But it’s been a very rewarding experience for sure. Personally and professionally.

Tullio Siragusa:
Amazing. You said something really interesting that I think is important to highlight for anyone who’s watching this that’s in the healthcare space. You said that this also reduces the dependency on staff by 33%, which means if I’m reading this correctly, which means people are already working probably 12 – 15 hours as it is now, they’re overworked. Let’s face it. So you’re basically saying that if you adopt this, your staff will have a bit of a normal life.

Pamela Singh:
Yeah. Maybe they can actually go on vacation without everybody just losing their minds.

Tullio Siragusa:
Or get home without being exhausted by the end of the day. Okay. So this is, you know, definitely improving the lives of the practitioners who are, who probably spend a lot of time, like you said, administratively working through things. What about the patient? Let’s connect the patient into this process. Do they participate in this software? Are they invited into the workflow? How does the patient participate in this?

Pamela Singh:
Well, it depends on what the clinical practice wants. Some surgery centers want their patients to be able to interact, let’s say, select their top three surgery dates. Or, you know, if they have a wound that looks like it’s getting an infection, they want to be able to chat with the office about it. But so far, most of our implementations are providing that educational material to patients and receiving feedback of, “Hey,” you know, “just a reminder, please don’t eat 12 hours before your surgery.” “Hey,” we’re kind of handholding them through the entire surgical process, “we wanted to double check, are you on blood thinners or are you not?” That can also lead to canceled surgery. So right now we’re really handholding them and increasing their confidence in not just the process, but their team as well. Having been a surgical patient who felt like I was just completely in the dark – I was just not supposed to eat anything. And nobody asked me about my medications and I just showed up and I had surgery on my foot. I can tell you that when I’m provided information about what to expect and what to do, I have a much higher regard of the surgeon because I feel like they actually care about me instead of just being an assembly line patient.

Tullio Siragusa:
Nice.

Kim Lantis:
Yeah. I mean, it’s interesting when you think about it. Like, in a way, you feel like technology is replacing the human, because now there’s not a person doing this. But allows for the human to actually be more human, which I think is a beautiful thing. So let’s talk again, let’s shift it back to CaseCTRL. Where are you at with your company? You already mentioned you personally getting to enjoy this flexibility and your cranberry juice pants <laugh>.

Pamela Singh:
<laugh> Whoops. I shouldn’t have mentioned that.

Kim Lantis:
What works for you? What other things, aside from flexibility, are you building into your company culture as you’re growing and what’s that shift gonna look like for you?

Pamela Singh:
Mm-hmm <affirmative> Yeah, so we just closed out our oversubscribed pre-seed round of $1.5 million. And so now we are doing a hiring push. Just today we finalized with one of our fullstack engineers. And by the way, we are looking for more fullstack engineers, if anybody is interersted.

Kim Lantis:
Congratulations.

Pamela Singh:
The way we are bringing people on is, it’s not just about their qualifications on paper. It’s also about the number one most important thing in our company culture: communication. So that means we’re not just telling you what’s going on, we’re telling you what’s expected, but we are, each of us, is open to taking constructive criticism from another. And each of us feels responsible for giving feedback and constructive criticism to each team member as well, because we feel like that de-risks a lot of situations that, you know, hey, as a CEO, I want to know every possible thing that can go wrong with my software, right? So if the software team is open and vocal to me about, “Hey, here are the priorities, you know, based on your decision that we made. We think this would be better.” It’s good to have that have that knowledge and have the software team feel comfortable enough to come and talk to me because if one of us rises, it lifts everybody else up. Right? So I feel like everybody should have a voice in which direction we’re going as a company.

Kim Lantis:
Yeah. Yeah.

Tullio Siragusa:
That’s amazing.

Kim Lantis:
Pushback is really important.

Pamela Singh:
Mm-hmm. <Affirmative>

Tullio Siragusa:
I remember 15, 10 – 15 years ago that would’ve been a Series A round and things have dramatically changed today. Right? <laugh>

Pamela Singh:
They’ve changed a lot over the last three years, actually. Two years. It’s only been two years.

Tullio Siragusa:
Wow! I mean, that’s amazing. Well, congratulations. So what’s the day in the life of someone who comes and joins the organization? It seems like a very open, transparent culture, challenging each other is the norm. And, so, what’s the day in the life in terms of why would someone want to be part of this organization?

Pamela Singh:
Yeah. Well, one, we are a hybrid. So we’re not just in-person, although we do like to meet in person, especially for white boarding sessions and workshop sessions. We found that to be very useful. But the hybrid kind of role that we have opened up for a lot of software engineers, we feel kind of gives the best both worlds. And a lot of companies are doing that now, but, we are a startup, but we’re still offering some of the higher level salaries that you might not usually see because we value our software engineers and we’re confident that we’re going to be growing. And we’re confident that, you know, we’re going to be able to raise more and grow fast. But one of the most important things they can expect is a lot of sarcasm from everybody, and open culture. I also like to bribe people with baked goods that I don’t bake. So nobody needs to be scared. <laugh> But we’re a very open, fun, I would say, pretty laid back in terms of, you know, having our meetings. But we all have high standards for ourselves.

Tullio Siragusa:
Amazing. Well, we wish you a lot of success. Congratulations. We’re coming up on time, but we have one final question for you. What’s this journey been like for you as an entrepreneur? What have you learned about yourself through this journey?

Pamela Singh:
Deep question. I’ve learned that, I’ve learned to reframe the word “failure.” So like I mentioned before, I was, you know, always wanted to do things, right. I always wanted to get things done efficiently and quickly. And I’ve learned not to be a perfectionist and I’ve learned you can get more done when you’re not a perfectionist. So redefining failure and looking at it as a learning opportunity has actually helped me grow the business faster. Instead of having, receiving a “no,” or having a hiccup, and instead of seeing it as a failure, learn your lesson, give yourself five minutes to mope, grab a cup of coffee and then move on. So it’s actually changed my view on life as well. I’m not as picky about the dishes anymore either.

Tullio Siragusa:
Nice. Nice.

Kim Lantis:
Yeah. Especially now that your husband gets to wash them. <laugh>

Tullio Siragusa:
<laugh> Well, you know, it’s been said that one of the great ways to achieve self realization is to become an entrepreneur because you really face everything that you need to work on about yourself. So it sounds like it’s been a rewarding journey personally as well as professionally. Thanks for being with us. We enjoyed having you with us. Just stay on the air as we, just stay with us as we go off the air in a second. Kim, what do we got coming up for the rest of the week?

Kim Lantis:
Yeah, the rest of the week is a full house. So tomorrow we’re going to be speaking with Gary Saarenvirta the founder and CEO of Daisy Intelligence. We’ll be talking about AI that delivers explainable decisions as a service. And then finally on Thursday, we will be speaking with Prasanth Nair, CEO and product architect at Double Gemini: “Ending Email Overwhelm: Why is email making you less productive and what to do about it?” So, yeah. Join us here on dojo.live, 12:00 pacific. Thank you!

Tullio Siragusa:
12:00 pacific. Kim is breaking up, but you got it all in. <laugh> Thanks for being with us. We’ll see you back tomorrow at 12 o’clock. Thanks guys. Bye!

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