An End to Chart Chasing | Carm Huntress, BEE, CEO of Credo

Speech to text:

Mike Koelzer, Host: [00:00:00] Car for those who haven't come across you online, introduce yourself and tell our listeners what we're talking about today.

Carm Huntress: I'm Carm Huntress. I'm the CEO and founder of Credo, which is helping to automate the access to patients' medical records, for a whole host of reasons. My previous background and Mike we've spent some time together as I was the CEO and founder of a company called RX review, which now is called arrive health, which brought real time drug costs to doctors and helped them better rationalize cost issues for patients.

I guess, in some ways now credo is really focused on rationalizing access to medical records, which is a huge challenge today in the us

Mike Koelzer, Host: All right car. When I think about medical records, this is something that my dad, God rest his soul. And I would bitch about, 20 years ago when he passed away and you'd see these big charts and all that stuff, and almost everybody and their uncle has said, this can be done better. Now the average person doesn't see the communication faxes and things like that. But. Why do old cars get to come along and do something about this? When the whole world is probably focused on this, what's the magic potion that credo is bringing to this.

Carm Huntress: Yeah. I think the first thing I'd say is you're absolutely right. This has been a problem that's been around for a very long time and nobody's really solved it. I think the other thing is to just do some stats. So this industry of medical record retrieval is 126 billion of cost on the healthcare system in the us.

It's a massive system. And even today, our stats are about a year old, we're mediating about 9 billion. 9 billion pages of medical records a year still via phone and fax. So it's a highly antiquated industry. And, when I came into it, I was really looking to solve an issue for patients by saying, we're starting to, we did all this work for the last two decades and bringing the electronic health records into the market.

Now we have 80, 90% penetration. There's a lot less actual paper, but you and me as patients don't really have access to our records. That's a very odd thing. And,there's a lot, we can talk about a lot of the reasons why patients,in a lot of ways, don't care until they have to care about their records.

But I think the, probably the statistic that kind of really sets you back in your seat is that we move around 210 million medical records a year in the us. So the aha moment for me was to wait a minute. We're moving around 60% of the US in some way, moving their medical record around every year for a specific reason, yet nobody ends up with ownership of it and they're doing that right for treatment.

Right. I've got a new doctor. I have to go see they're doing that for, you know, malpractice. They're doing that for a second opinion. They're doing that for a clinical trial. They're doing it for all these reasons, but they just get it done and then they move on with their lives. And I said, that's kind of crazy.

we should probably step in there and see if we can enable access for a patient through those means. And I would say that's probably the biggest difference between me and other people. Who've am, I'm not trying to build a PHR. Microsoft tried that Google tried that there's a bunch of people doing it.

Our assessment is, we have not seen a personal health record. That's been tried in the last two decades. Get more than a few tens of thousands of users, nobody in the millions by a long shot. And so it really points to the underlying problem that you, as a patient don't care, or I don't care until I really have to get it right until I need it for a doctor's appointment or I've got a procedure coming up or, and if I do need it, there's a lot of uncertainty, it's like, where is this thing?

I don't know, is it over here? And that I was with this doctor, but he moved over there. and so it's very confusing, it's a high effort today to get your record. And we've had all these experiences with patients lately of, oh, I, I have a CD. And then you say, what do you do with a CD?

and it, and so it's a lot of effort and it's a lot of uncertainty. So we're really trying to step into a system where we can really provide a lot of value to people who really need the records. and I think the one last thing of why this hasn't been solved, which is really the question you asked is that, look, this system isn't built this way.

Let's think about the fee for service for a second. If you just back up and you look at the fee for service.

if I, if you come into a fee for a service hospital and you say, I have all my records, I've already done all my tests. I've got my whole history here. Wait, the fee for service system says, wait a minute.

I, I wanna redo, I don't want that. I wanna do new tests. I want to charge you for this MRI. I wanna recharge you for this. and we've talked to doctors who said, in Colorado here, I brought a patient down from up north. They had an MRI there at two hours ago

Mike Koelzer, Host: and we brought our system and we can't get access to the record.

Carm Huntress: So we just read.

Another thousand dollars out the door of cost. The system likes that cuz that's revenue and so feed for service it [00:05:00] really does not have an incentive model today to say, Hey, we, it's a boy, it would be great for us to have the record. And that's what we've seen.

What's really changed in the last two years is the 21st century cures act. And what that means, to drive interoperability and openness of data in the us.

Mike Koelzer, Host: When you talk about a medical record that somebody wants their medical record, is that symbolic of paper slash CD slash online slash thumb drive? or are we still talking like, like a box that has to get somewhere? how tangible, how physical are we talking?

Carm Huntress: pretty physical. I would say, I've been, we've been at this for seven, eight months now, cuz I just started the company late last year coming into this year. And I think that's probably the most surprising thing about how antiquated this still is. You know, it's 20, 22,

I think about the digital experiences we have on our phone or shopping or traveling.

It's incredible what we can do. and yet we have this extremely antiquated methodology. And so we've seen it all. all the things that you message mentioned from thumb drives to CDs, to paper,and the, just the prevalence of phones and faxing this information is still very high.

We are in, we are still in the early days. I think it's encouraging though. I would say this is what's so encouraging. We are really starting to see digital transitions. We had a small one, we just started up with a new client last week and we were mediating the patient through their portal. So through an EHR portal and we gave it, we sent it out to five patients just to get a test going.

And two patients did it fully digitally. We didn't have to call the hospital. We didn't have to fax a request, a HIPAA request form over. We didn't have to get a release of information. We didn't have to wait days or weeks for that person on the other side to piece the thing together or print it out and put it back on the fax machine and send it.

It was all done digitally.

And so we really are starting to see our belief as we're in the early days of this digital transition to mediating all this data digitally. And that opens up so many exciting possibilities. if I would say anything the last seven months have taught me, we're still in the early days 

and seeing a lot of paper, phone facts, CDs, all the stuff we lament in healthcare about our record.

Mike Koelzer, Host: Carm. Tell me if I'm outside of the norm where I live in my town, Grand Rapids, we have a pretty big health system here, and I don't like it. I'm independent. I don't like the monopoly of it, all that kind of stuff. But there does seem to be a pretty good relationship. It seems like almost every doctor I go to in town is part of this place.

And they've got all of these records and almost every time I turn around, I'm going to one of these places related to this, the people that are not related seem to be in the system. Somehow we're not a pharmacy. I can't look at my stuff in this health system thing. I'm taking it 

other cities are more fragmented than that, or

because I think there is still a problem in grand rapids because there's other people that are not, if I went to a podiatrist or if I

went to some other thing, it's probably not gonna be connected, but how connected are we versus what you are seeing?

Carm Huntress: Yeah, I think it's a good way to think about it in two really separate spheres. There's the hospital inpatient acute care, and then the outpatient care world, right? Where you have internal medicine, primary care and specialists, what you see in the large systems, That are mainly dominated by the large EHR companies in this, in the us.

That would be epic and Cerner. you're seeing really good connectivity. You know, if you look at Epic, they now have over a hundred million patients in their care everywhere, but you've gotta then question, wait, what's the data. That is really hospital care data, that is, I've had an acute event.

I've had a procedure, I've had a surgery. I had a bed, I got in the ICU, right? That's episodic based care and really where the problem starts to emerge is in that second category, which is the outpatient care world. You still have a lot of independent physicians. You still have a lot of EHR supporting that world.

You have a big difference between primary care and then specialists and what the problem is a lot of the people we work with, which are, doing value based care and primary and specialty care, that's where all the high value data is. I want that outpatient data. I want to know what's going on with your endocrinologist.

I wanna know what's going on with your cardiologist,

the fact that you had an ER visit two years ago, Good. Thank you. You broke a bone,

right? But I really need this, this data. And that's really where we see the big gap today. The long tail issue of getting complete longitudinal health history for you as a patient really is [00:10:00] in that long tail of outpatient care, which is still, I think they've done a good job getting EHRs, but those EHRs are custom and one off.

And the access to that data isn't there. and maybe this is a little bit to start to dive into what the 21st century cures act is doing in pulling the strings of interoperability and mandating, starting to mandate access. so that's what we really see in, in, in the acute versus outpatient world.

Mike Koelzer, Host: I got a comment on the epic. I think our hospital uses that, that bigger group I talked about. I think they use that. It kind of looks like a 19. nineties video game. To me, it's kind of a junky. I, I can say that you maybe can't say it's a junky, like lot of different colors graphics, you

Now, it's like someone decided to put a little flower kind of thing over here.

And I mean, if this thing's got like a hundred, how many does they have like a hundred million I wanna go on and see everything kind of like a shade of, you know, tan with nice, you know, it, it's kind of like a video game to me in a bad way.

Carm Huntress: Yeah. So look, a lot of this, I think there's two comments I'd have. One is that a lot of this stuff is pretty age technology. you think about epic it's it was mainly written in a code coding language called mump. So it's a very antiquated system. And my last startup at RX review, now arrived health, the company, we spent a huge amount of time inside these clinical workflows.

These are very antiquated sort of late nineties feel, look and feel right. it's a desktop old school app. and that's just the reality of it. The second thing is that there hasn't been right. If you think about an epic or Cerner or most modern, EHRs, their function is around billing and.

And RCM, right? It is not about the provider and patient experience. And so there just isn't one in those organizations, there isn't that function, like I have a full time UX UI designer on my team, That's not something that they really ever thought about. They just said, Hey engineers, just throw it on a screen and put some checkboxes and, and we'll do it.

And those in those environments aren't like what we're used to today, where you can get a sort of high design and fidelity, like an apple app out of the app store where you can really create a wonderful user experience. Cuz you have so much flexibility. Those are very constrained legacy systems that we're dealing with there.

So it is a sad state of affairs. I expect it to change and get better over time, but it's still very early days. I say to people, sometimes you have to hold healthcare to 1997 standards.

Remember Netscape navigator and

remember like the early Microsoft apps and how 

clunky every, you know, it'sit's just, it's still there.

It's getting better. And I think there's been a big wake up call to these organizations that they really have to start transitioning and you talk to the big systems and they, oh, we want, we care about provider experience. We care about burnout. We care about them having too many clicks.

Mike Koelzer, Host: and there's people with their full job functions trying to solve these issues. So I think we're starting to see a transition, but to your point, it is, it's, it's a bad video game from the late nineties right now. In the early seventies, I had the, uh, the Odyssey game, I think it was called and and everything had a paddle going vertically up and down the right and left side with this

square going back and forth. And then we would take these like cellophane, covers and you'd actually stick it to your TV and that would make the different sports, so you'd have badminton and soccer and, and, uh, tennis and it'd all be the same damn game with just different 

Carm Huntress: different different covers on it. That's not much different, right? If you think about it,we go to these clinics and try to help these providers and it's sticky notes today. They have all their answers to all the things they need, to do this thing, you gotta, here's the way you click over here.

Mike Koelzer, Host: Oh. And if you need that phone number to get that fax, here's that number and, there's sticky notes galore and we see a lot of that. We see that still in, in healthcare today. Car,let me take a guess at this, you call it the care act. Let me take a guess. that was some of the

little guys saying this isn't fair that we're not able to crack into the systems and we should be, or is that not the Genesis of that?

Carm Huntress: there's a lot in the 21st century cures act. Let's just say that first there's a huge amount of legislation that went into that. The most important thing for, I think you and I, as consumers to pay attention to is this rule that's called information blocking. And the government finally said, which it is just, it wrote it down.

We all kind of, I think inherently believe it, but it wrote it down and said, no entity that has your healthcare data has your personal health information. Your Phi can prevent you or block you from gaining access to that data. And. It has to be provided to you in a machine readable format,[00:15:00] 

Mike Koelzer, Host: which means a digital format, which means a structured digital format.

Carm Huntress: And so that is probably the biggest part that a lot of people, maybe missed cuz the big headlines around it, but that was one of the things it did that was so impactful. And so now, these systems there's, there's gonna be fines that you will start to see. I think this is highly likely of patients asking for their information and a system not falling through not giving in a digital format and fines starting to emerge that are gonna be, some people are estimating.

These are gonna be million dollar fines, on these health systems for blocking information, your medical record to you as a patient. and so that's a big part of the transition. The other thing is it created this. framework called the common agreement in its greater form. It's called TECA, which basically is giving rules of the road

it's giving a framework for the us to create a national interoperability system and pieced together all these health information exchanges, which have really struggle to, to deliver on what they're supposed to do, which is, give you structured access or just give you digital access and to all your data from one place.

But TEF is finally saying, Hey, I want to, we need Carm hunters' information. I can reach out with car hunters' information, just his name, first name, last name, date of birth, and pass that out to the national network. And the national network says, oh, here's everything we have on karma hunts. And that could be from all over the country.

I've lived in three different places. I went to a bunch of different hospitals. I have acute care. It's driving that standard access across all systems to that data. And that's a very exciting movement. Now I will say on the ground, the guy doing this in the tactical day to day, we're in, we're in the very early stages.

These are still highly antiquated networks. The data's not that great coming through them. There's still a lot of use cases that aren't covered. You can get decent data for treatment if you're actually treating the patient. But if you're doing it for payment and operations, and trying to get data and not, there's not a lot of data on these networks today for those use cases, but we're in the early phases.

The 21st century cures act is really saying, Hey, Everybody who's we've we just spent, X billion of transitioning everybody to electronic health record. Now let's actually make useful lights, make it interoperable, and connect patients to their data and give it in, in a complete sense.

Mike Koelzer, Host: All right. So what is that TAF KFKA?

Carm Huntress: TECA

Mike Koelzer, Host: Is that an acronym?

Carm Huntress: an, it is an acronym I don't have it off the top of my head. It is the co what you need to know members is the last two letters, which is the common agreement 

TECA, uh, which is the common agreement across health entities to share an exchange of health information.

And that's what it stands for.

Mike Koelzer, Host: all right, Carm. So here's my imagination on this, that all of these people that need this information put out a little, call out and they might be. Sharing it, they might be getting your weight from the people that weighed you last in here and your blood pressure from this person. That would be my hope. Here's why, because we already talked about Microsoft and Google, we're not able to come up with a national database. We had all the information right there.

And I would hate the thought of the government trying to collect everything and have it in one space. So are you saying that Taka is gonna have this in one database?

Carm Huntress: no, I wish I had a better, a really strong analogy here where your data's gonna stay stored, where it's stored,

Mike Koelzer, Host: But what you can do is sort of a call out. 

The first scenario sort of

Carm Huntress: yeah. Yeah. So I make a call out with all your information, your first name and last name, your date of birth, your gender, your zip code.

I take all that information. I make a big request and then the network responds and says, oh, I have Mike in, I have this mic here. It I've data here. It looks like it all matches.

you can get access to that. you could make a copy of it obviously, if you wanted to, but that data stays there.

And then the network just gives you all the data. And then, the challenge, the next factor challenge is how do we merge all that data together and make sense of it. And I think that's part of what credos are trying to do. We're trying to really solve that last mile of, let's say you're going to a new PCP.

They're connected into the national network. They make a request, the data comes back. Now I have three, 400 pages

of clinical data to try to take care of you. And I have seven minutes. in a primary care visit to make sense of all of the hundreds of pages, right? So we first have to create the mechanisms which the 21st century cures act in TECA are doing is to create that national interoperability network to gain access to the data.

And then the second factor is that now we need to [00:20:00] make sense of it. But, to your point, it's really an opening door to go get it from all the different places,

and bring it all together in one place. So it's really helpful for you and to keep people who take care of you.

Mike Koelzer, Host: assuming that is not there yet, that this is relatively new. Do you get to just sit around and play air hockey until this information is available

or what's the timeline on this for you as a company?

Carm Huntress: Yeah. So the way to look at this is that we're in this transitional phase and you're absolutely right, Cuz we've got some people, very sophisticated, have it all digitized and it's even structured and a lot of people are using, I'm sure your listeners have heard of the fire standard, the fast healthcare interoperability resource, which is a standard structured schema to describe a medical record,

There are systems out there that have gotten that far, which is great.

Mike Koelzer, Host: You can get some of this so far.

Carm Huntress: Some of this, right? It's a small percentage, right? Maybe five, 10%. Then let's go to the other side, right? Where there's no connectivity, it's an antiquated EHR. Maybe there's still some paper around the office. You have to, really, the only way to mediate access is through phone and fax.

And so what credo does really well is we'll breath in depth.

We do it all right, because we understand the market's transition. And if a provider comes to us says, Hey, I want the records on this patient. And I'm treating them for acute kidney disease. I don't want them. An acute record over here. I want all their kidney history and what's gone on there.

And that means we might have to phone in fact, but we're willing to take on any use case necessary, to mediate access to the data in our relationships. We typically try to commit to getting two years of complete longitudinal data on patients. And, I think that makes us a little bit more unique opposed to those who are, doing the digital stuff, but, you're only getting partial data back, And that's not helpful if you're a primary care doc or a specialist that really needs that sense of completeness or a specific amount of data that might not be in the national networks 

today. 

Mike Koelzer, Host: I kind of lost my head there for a second car, because I was so excited about this nice little package of this new

Carm Huntress: me too. Me. 

Mike Koelzer, Host: that you could go get everything. I forgot that we started off talking about faxes and phone calls and things like this. Now it's all coming together for me that you're kind of the traffic cop between, uh, you know, self driving and auto driving things.

You're kind of bringing all this together right now.

Carm Huntress: Yeah. And I think it's the right approach. I think. We have to have organizations like Credo in the market today that are helping people make the digital transition. And really think about the last mile. I'll tell you a story.we were in one of the most advanced risk adjusted Medicare advantage providers and probably in the us.

And we were on an onsite with them in one of their clinics. And, we said, what's your current process? we were thinking, oh, it's gonna be some fancy

software system and all this stuff. And the woman says, oh wait, hold on. I have to go to the other room. And she likes it, she has to leave.

Why does she have to leave? So she gets up, she comes back and she walks in with a notebook and she opens up this notebook and it's a beautiful notebook. It's incredibly well done in that it has a name of a provider. And then underneath in a different color ink, the fax number and pages and pages of this.

Mike Koelzer, Host: Oh my gosh.

Carm Huntress: And, you're sitting going, this is one of the most advanced primary care clinics in the us. And we really have to ground ourselves in that. And our team says. We're gonna, we're gonna come here and help you transition that processy that notebook into doing it digitally. And that's a very hard, last mile thing.

When you actually get on the ground in the clinic there, people tend to be stuck in their ways. They're very, operationally, it's very messy. They're dealing with a lot of things coming at them. These organizations clearly need, in my opinion, an organization like credo to help them with that last mile digital transformation, from phone facts, paper, into a fully digital thing.

And then we're not even getting into, let's just say by chance you do do the facts, you get the facts back now, wait, how do I get the facts into the EHR? there are some really fundamental cha challenges and in a way that the provider can actually use.

So there's a lot here to unpack in terms of, making this really a reality, in the US healthcare system.

Mike Koelzer, Host: As we're talking here, it kind of reminds me of almost what Coinbase is doing, the bridge between crypto and dollar, they're the ones that are gonna help buy a S slurpy kind of thing, getting people in there. When you are then dealing with Sally in the office, who's getting her facts out.

And so on. would you say you're offering as, Hey Sally, look, we're making this so simple. We're not gonna use the facts anymore or are part of credo saying no, that's our bread and butter. We're gonna work with them to make this fax mean something

Carm Huntress: it's really about, I'd say it a little bit differently for Sally who's maybe a, an,an admin in a clinic. I [00:25:00] want Sally to say every time I need a patient's record, I'm just gonna send it over to credo and they're gonna just take care of it. 

Mike Koelzer, Host: when they need to do something with it or get something.

Carm Huntress: Get it, when they need that record, that a new patient showed up.

Mike Koelzer, Host: Got it.

Carm Huntress: I need their records. They can send us the patient or it gets sent to us through a form or they email it to us, whatever, they send it over. Our team picks it up, our software picks it up. It does as much as it can digitally. And if it can't, we have op human capital, who's supporting that

to finish. So then Sally gets up the next day and that's not on her list of, her job description anymore on day to day. And that's a huge deal. I really think about this. This is one of, I think the highest, Sort of labor cost to outpatient clinics today, this sort of unforeseen cost where we know, at least in our experience, we're seeing clinical staff, people, nurses, PAs MAs, taking time hours out of their day to do chart chasing, to go get records.

That is really not a very good use of their time. When we have one of the largest clinical shortages in the us today,

they need to be back treating, taking care of patients,helping the patients get into the exam room, doing, the, blood pressure and things that they were trained to do

and not sit around and ch you know, chase charts.

And so that's really where credos are trying to step in and be very thoughtful, about the way we do this and support the clinics we work with. Now, I will also say, we're trying to create a lot of intelligence out of that data. we're not trying to sit here and say, oh, here's 300, best of luck.

Here's 300, PDF pages of clinical data that you gotta sift through. We wanna make sense of it too.

my, my vision is where we've done our work and the doctor clicks into a view. And in 30 seconds, they know the whole history of that patient. And they've got a really good understanding of their procedures, their di diagnoses, their medications,their recent lab results.

All those things are super, super important,for a primary care specialist doctor. And we want to just get that data together as quickly as possible.

Mike Koelzer, Host: Car,

which one of these statements is closer to reality. Sally asks for the information, you get it over to her at 4:00 PM. At 11:00 PM. Is that all cleared out of credo or is credo building a database?

Carm Huntress: we're really building a database. One of the things that's important for us on a missionary basis is that, again, it goes back to my first comment around we're mediating access to 210 million records, but we're not enabling patient access. And so one of our endeavors with our partners who are typically payers and providers, for the most part,

is to open up at the end of our process.

We sit there and we say, God, we just spent. X amount of time could be minutes to days to weeks getting all these records together. We wanna make sure at the end of that process, we're enabling patient access. And I would also say from a regulatory standpoint, you could argue we're mandated to do so because we can't block information from their data.

And so part of what we're trying to do is enable, right? You could think about it as I'm doing it. I'm the provider who is paying me to do this work that they need done to enable me. Patient patience to get an AC access. and I think that really is our underlying mission. The thing I'm so excited about is that if we do our job right, and we can mediate millions of patients, 

access to their records through the prayers and providers we work today will have a dramatic impact on the patient's quality of life. And, them being able to get the appropriate care that they ultimately need. Cuz now they have their record in a centralized location.

and they can then use it.

They can share it with other people. They can look at it, they can get products and services that match their needs. And we might actually support some of that. but what's exciting is we tell this to payers and providers and they go, this is a benefit. This is a great thing for our patients.

This is a great thing for our members

because now, and it's sticky, they wanna stay with us cuz they have all their data and it's here and it's centralized and they can take it with them. And that's really the ultimate goal of credo. And what we're trying to do is enable that patient access.

So we don't want it to end with, Hey, we got the, do you know, date over to your doctor and now it's done because my hope is, we're doing this 210 million times a year.

If I can get 10% of that every year and do it for 20 million Americans, I'm gonna, I'm gonna get up every day thrilled about the impact we've had on the US healthcare system and what we've done for patients.

Mike Koelzer, Host: It seems that you'd have to, with that information to make sure that you're current, you've got the information. It's almost like when someone asks for it, you almost have to ping out and make sure, Mrs.

Jones hasn't gained 30 pounds in the [00:30:00] last couple months and that's over here somewhere. You've got the information, but you almost have to ping it out. Don't you make sure it's still valid.

Carm Huntress: Yeah, there's a couple things that I think are little nuances to this, what we're doing that are pretty big. The first thing is when you open up that digital access. you're getting a continuous update. You can get a continuous update on patients. So if I'm taking some, you know, I love this thought of oh, I'm going to my primary care doc and are we paying, oh, we got the latest car, the data from the cardiologist, 

or vice versa, I'm going to the cardiologist and I'm getting that data instantaneously. And so this ongoing digital connectivity is a big deal versus a fax. It's one and done. I just get that slice of time. So that's one thing to really pay attention to. the second thing that's I think meaningful here is that, we're starting to get the data in digital format

and it's not a PDF, it's not a fax.

And so that little change is really impactful in terms of keeping up with X, Y, Z patients' data. And do we have all the most up to date things?

One of the other things we're working on, which we think is exciting is. to get a sense of completeness. One of the ways we can look at that is your claims data.

So if we're working with a payer and they've had you for two years and we see, oh, we can just look and say, we know you got cured here and here. Did we get the data from all those places?

And if we did, then we have a pretty good sense that we have most of, if not all, of your history in one place.

And so those are some of the exciting things that we're doing that I think are, they may be a little nuanced, but they're really big, right? They're really big in terms of the transition from traditional phone and fax to a digital, digital first ongoing connectivity to structure data on you.

It's searchable that's we can use it for population health. We can do all sorts of really amazing things. Once we have that data in a standard structured format for you.

Mike Koelzer, Host: What's the quality of confidence in OCR? Now, if you get maybe a handwritten fax with some light ink on it, but a dot matrix printer

 I know this is nuts and bolts, but is your system or some system able, how much can you pull out of that? How much confidence do you have in that?

Carm Huntress: So if it's, this is a great question. If it is what we really, we've been looking at this pretty closely, if it's, if it's text, right? If it's actual text, even if it's scan text, that's pretty high accuracy, 90 plus percent. Now you really want to get to 97 plus to be honest. So there's still a bit of a gap.

The real problem today is the hand. handwriting is probably the biggest gap. And you rarely see systems over 80%, in identifying handwriting really well. I think there's gonna be a,I don't want to give away too much here, but, we're pretty, I'm very excited about some of the neural network stuff that's happening, in,advanced AI and machine learning models.

The neural networks now have a real potential to solve these problems in healthcare, in terms of unstructured, hand, handwritten notes, orders, all that stuff. These neural networks should be able to conquer that problem because they understand context.

and I think it'll start to change, the thing that's still, I think is important to say here is I might be able to scan an entire document, but deriving meaning is a secondary issue.

So an example is, let's say I have two columns of data, right? And on the left hand side of the page, I have the name of the lab and I have the results. The machine might be able to abstract all that data out in text format,

but not put it together in a way that makes sense.

And that I, I know that, oh, that line, that test result over here is linked to this test.

That's a secondary, really hard problem to solve in terms of moving FA phone and fax or, unstructured data,

or even text data into derived, meaning of what am I actually looking at here and have I made sense of it? So we're, there's still a lot. This is the whole transition we're going through as a society right now.

But I will tell you, Mike, I am, so I am so freaking excited.

It's so cool. When you think about it, if we really do make the transition here and the demonstrable magnificent, wonderful impact this is gonna have on patients and care. and those systems getting mandated to say, you can't fax the stuff anymore.

Carm Huntress: It's probably in the hundreds of billions of dollars there of duplicate tests that are going on just because we don't have access to the medical records. So it's some of those things that I get excited about, we haven't really seen that bend in the cost curve yet of healthcare.

These could be big things that could happen that could ultimately shift the cost.

Mike Koelzer, Host: The thing about not [00:35:00] having all the records, let's say that people say, we're gonna redo 'em, we have them, we're gonna redo 'em, . Even if you waste some money to redo them, it'd be good to have them to see the trends and things like that. So it's one thing, wasting money on duplicate tests. It's another thing, not even having the damn numbers to compare it, because that would be wasteful, but at least it would be helpful to see those numbers.

Carm Huntress: Yeah, exactly. And so even the comparison is highly valued. Is this, is your cholesterol going up or down? We don't really know. we have a, we have an episodic view of that in a moment in time, but we don't really let's, what's the trend been over the last five years.

this is where this stuff gets really impactful and we kind of brush over it and it looks like an edge case at first, but really it's a huge 

deal. 

Mike Koelzer, Host: it. 

Carm Huntress: it's a huge deal in terms of the transition to care. And then, I think about really exciting opportunities for you and me as consumers where, I do think it's highly likely within the next five or 10 years where, okay, we finally figured it out. We've got full longitudinal access to Mike's record and we can see the last two or three years.

We can see all his conditions. We can see all his lab results. We can see all his procedures. Wow. Wouldn't you love a little agent that looked over all that, and said, Hey Mike, here's the best things you can do for yourself.

Here's products and services that match your conditions and needs that are, and that are a click of a button away.

Opposed to just generally, you know, here's a smoking sensation class. Well, I don't smoke. 

I had this experience because I tried one of these apps, consumer apps, PHR kind of thing, and I'm clicking through everything and it's asking me all the questions and the first offer it gave me was a smoking sensation thing.

 That's not, it doesn't mean anything to me. Those are the things that I get really excited about, around AI, machine learning,and the digital look at the ecosystem of digital products and services we could offer to patients if we understood their medical record, if we could actually peer into it.

And I think there's gonna be apps in the future that really do this extremely well. And I have some aspirations with credo that we could potentially get there as a company.

Mike Koelzer, Host: You talk about handwriting stuff too. A lot of times handwriting is the biggest thing.

Like here's this chart about everything, you know what this person's gonna do for the next three weeks. And the computer's doing all this stuff, but the little handwriting thing up in the top said, she died or something like that. So the handwriting stuff is usually the kind of important stuff that people leave out of the digital part.

Carm Huntress: Yeah. You know, it's funny, I said this to someone the other day, cuz if you look at clinical value. If I take a full medical record, 70% of the value is in the note is in the, and that could be a handwritten note or just a unstructured text note, which is terrible because you can't derive, you don't know, you've gotta deconstruct that thing to actually understand what the doctor's talking about.

and so the thing that's impactful here, one is we move to a digital structured world that will hopefully go away, but it points to the underlying problem here that a lot of this stuff is buried in unstructured clinical notes. That would be highly valued to, to, to you. And this is what I said to somebody.

I said this at a big hospital. I said, how much, care recommendations from doctors about care. Patients should take

is sitting inside those notes.

and I was actually making a fee for service argument. I was saying. one, if they took that advice, that's sitting in that unstructured clinical note, wow.

What an impact that would have because they would be getting ahead of issues most likely. And it would be more preventative, but two, if you're a fee for service system, that's more revenue for you.

You want that patient to take that action. The doctor's recommending, and so you think about to your point, whether it's handwriting or an unstructured clinical note, how much data

and really valuable information is sitting there that's either missed or glossed over.

So it's a really sad state of affairs.

Mike Koelzer, Host: Yeah. I had a, on a previous podcast, a recent one. I forgot the question. Exactly. We were talking though about how much information was available to a pharmacist and pharmacists don't get any care information. And that's not good. And even worse now with all of the vertical PBMs, AMS, forcing specialty drugs to their place and not allowing pharmacists to do this and mail order and things like that. It's like when I fill something in a pharmacy, the best I get is an interaction with maybe one of these specialty drugs or somewhere that I wouldn't know they were getting it unless I have an interaction, but to do any proactive, looking at their charts, something as simple as seeing if, um, know, Trazodone and old [00:40:00] depression medicine, is it being used for depression or is it being used for sleep?

You know, that kind of stuff on the simple terms, we don't know any of that in pharmacy. We don't see any of those care notes 

Carm Huntress: this is the friction, the pharmacy friction that patients experience, is so extreme today. and a lot of it is related to the lack of clinical data. We saw this, wholeheartedly at RX review, when I was running the company because of the lack of data.

When you think about a specialty medication where you have the prior authorization, the specialty, the manufacturer enrollment forms

that typically takes quite a bit of clinical data to actually fill those forms out and the pharmacy or the specialty pharmacy sitting there completely blind, they don't even know.

you think about drug to drug interactions, med history, things like that. There's such a lack of data for pharmacists to really rationalize this. and this is why I'm so excited about some of these patient mediated things where I could see a future where, Hey, maybe we're working with,a specialist and they say, oh, you just got this new,we got a new,prescription for you, sends you a text message says, Hey, the pharmacy needs your medical record click here.

They click, they log in to their patient portal and it just whoop sends the record over to that specialty pharmacy. Now they have a complete view. They do this and today, you know, the sad state affairs is what happens is that specialty pharmacy will call the patient and the patient doesn't know,

they're sitting there saying, we need to know your last A1.

oh,I don't know what that is. We need to know this lab result. I don't know. What do you, you know, what do you gotta call my doctor? And then it's who's your doctor, and then what's their phone number and it's the round Robin we're playing to try to track down clinical data.

When what we really want is an open interoperable system. And I think really patient centered, right where the patient's got that control of moving it around is really where we have to end up in pharmacy, to take out a lot of that friction around prior authorization and specialty drugs and things like that.

It's a big deal. It's a huge pain point.

Mike Koelzer, Host: Yeah. Car,looking at Google who was going to have this basically Google medical or whatever the hell it was called

Google health or something like that. 

Carm Huntress: healthy. Yeah.

Mike Koelzer, Host: I have heard that, one of the reasons for its demise was patients didn't wanna update it. That's one, two is. Maybe another thought I heard was people don't want to, they don't trust Google to have their data. What was true in your opinion? What were the reasons why Microsoft and Google weren't able to make this work?

Carm Huntress: The thing that I feel really, clearly about here is, I'm a big fan of timing.

If you look at statistics of startup success,half of it is timing. You have to time the market. And I think both for Microsoft and Google, it was a decade before their time, in terms of an attempt, there was no real digital mediation at all of records.

They were phone and faxing and stuff like that.

 I think that's the biggest reason for failure. The second one is really the patient problem of uncertainty and, really, uncertainty , effort and value. I don't know where this stuff is, can Microsoft and Google even figure out where this stuff is.

There's a lot of effort involved in going back and forth and releasing information and all this stuff. And I don't want to take a Saturday to do that. and,value where's the value. I've just collated a bunch of PDFs for you. it's not really valuable. I think this is one of the reasons the PHR companies have failed is because just putting your record on your phone doesn't really do anything for you.

I mean, I tell this story when I was talking to some investors, I went and got my digital record. at,one of the big epic systems here in Colorado. I care. And, I had a celiac test done, which is gluten sensitivity.

Now I got the test and I know I'm not gluten sensitive,

But whether it was gluten is yes or no.

You either have the sensitivity or don't. do you know what it said in the medical, the digital medical record, it said 2 72. what is 2 72? and what was crazy is there were no units. It was just the number by 

itself. and so I have no idea what that means as a consumer and a patient.

And so where's the value, where's the value in that? Okay. if you could just say yes or no, you have celiac.

Okay. Now I know not to eat gluten. I can take action. I can derive value.

Those endeavors, we're just not creating value for consumers, and that's really what you have to figure out at the end of the day here.

Mike Koelzer, Host: Who was going to fill that data? Was that the consumer, or were doctors gonna offer that to Google and so on?

Carm Huntress: I've had some conversations. This was pretty manual, there was some technology, but it was a, mainly a, like a phone in fact system that was [00:45:00] just going out and. Trying to go get the records together if you made a request. And I actually remember trying, and it was terrible,

I don't think they got any data back on me.

 It was, you know, a decade before its time, in my opinion, it was just too early. And we've gotta recognize that we're in a different phase of healthcare. I really think so now,

if you go back to when that was, oh seven, we had I don't know, 20%, 30% penetration of electronic health records.

We're now at 80 or 90% and systems aren't focused on that endeavor anymore. And they can think about things like interoperability and digitalization as an endeavor. I mean, you know, when some of this stuff starts to make sense to you, when you think about it like an epic system, that's supposedly they have to have something like a hundred integrations into all the systems, right?

The monitoring systems, the imaging systems, the lab systems, the pharmacy systems, it goes on and on. You know how many integrations you have to do to appropriately stand up that infrastructure. We're finally over that hump.

And, for the most part, obviously there's some that are further behind than others, but I think we're finally there.

The convergence I really seeis three things. We've got penetration of the electronic health record. We've got regulatory mandates coming off the 21st cures act to say, you, you have to do this if you wanna stay compliant. And the third thing is really, I think of fire. and the reason for that is it's finally saying here's a standard structured schema to describe a medical record.

and that is such an impactful thing. When everybody has agreement, everybody raises their hand and says, I shall implement in, this way.

Mike Koelzer, Host: that's the language where all these things talk to each other fire,

Carm Huntress: Yeah, fire's really the St. The, the standard structured schema to describe a medical record. So let's just do a quick example.

Mike Koelzer, Host: The first thing you said of those three was the machines talking to each other.

Carm Huntress: Yeah,

Mike Koelzer, Host: What's the basis of that car? Is there a certain language they're all using now or a certain field they're all using? How are those computers talking to each other better now?

Carm Huntress: it's, this is part of the FCA agreement to say, there's common agreement to say, this is the way I'm connecting into the networks. And then there's, sort of both, 

yeah, that's a little bit lower down first. It's just creating connectivity. I'm connecting into this system in this way, and those aren't as well defined, but they're just saying.

Here's how I connect into my HIE with data. And there's some things like ADT feeds,admission,transfer and discharge,feeds 

that 

Mike Koelzer, Host: keys that are talking to each

Carm Huntress: yeah. That is talking to each other. The thing that's so exciting about fire that you have to see as the big transition is.

If I went to the health system they may. Describe, let's say blood pressure in one way, and then you go to Helston B and they describe it in another way. They do different units of measure, for instance.

Well, now I want to, I want to compare those two things. There's a Delta difference there, what fire says, and what's so important to understand about fire says you cannot, it's rigid.

It says if you're gonna say blood pressure, it's in these specific units. And so if I'm comparing your data from health system a to health system B they're the same. And so they're comparable, so I can put them on a chart and I can show a line of your blood pressure changing over time. HL seven.

it served its purpose, never defined that. And so you end up with data that's digital, but you don't know what it means because it's different everywhere you go. it's got different flavors. And so it's hard to compare and chart and make sense of it. Fire's the first time we've said collectively, we are gonna hold to a specific standard of not only the structure, but the scheme itself, is going to be specific.

 Let's do the pharmacy example. We saw this at the RX review.

We would do nightly polls out of a health, a big health system in let's say epic, epic to epic. We work with two big health systems.

We pull data from one epic system of all the drugs that had been ordered that day.

We wanted to see population health, statistics and stuff. We pull it all. you think about it in Excel spreadsheet, you have, columns of names of what, this column, the first row is, here's the drug name?

Here's the dose, here's the duration, right? We would go to system B, pull the exact same data, And the columns would all be different.

And you go, what? And so now we're now doing it for 10 systems and now trying to map all the data together.

Do you see the problem? Now it's a mess. And so fire is this really great endeavor.

That's taken about 10 years to develop. And it was in the early days, working on the standard with my team at RX review,to try to say, let's stop that. And let's define standard structured ways of describing the data and that way we have ways of comparing and charting it and making sense of it.

that's part of the reason why I think credos more of a viable company today than,it would've been 10 years ago with Microsoft and Google, when they were attempting to do this.[00:50:00] 

Mike Koelzer, Host: I had to factory reset my phone yesterday and don't ask me, it's a sore subject, but I had to factory reset it. And I came upon the Google 

like your, if you get into a crash, it knows. And if you, and it gives you an emergency number and things like that. And I came across the question of blood type.

And again, I'm reminded that I have no idea in hell what my blood type is, so here, if I don't know my blood type and I'm supposed to be a medical kind of person, you can imagine just the trouble that would be with, consumer

input. 

Carm Huntress: Yeah.and this is where I think, so much of this stuff has fallen short. we have to be, this is one of the shames of sort of consumer, care right now is that, we have to be these translators of all our clinical data. we have to become experts of all this stuff, of our medications, of our procedures, of our, it's such a high ask.

And then you think of someone who's elderly. And, all the healthcare that they've had over their decades of life. And it's just an, it's a really untenable thing. And I think this is one of the things that's,I think a bit of a problem from a personal health record perspective for all of us, of 

I was looking at a procedure I had, and I was reading the clinical notes and I said, I don't understand any of this.

and,I just was like, oh man, and I'm no, I'm in the field. I'm looking at this stuff all the time. And the doctor was writing things in the clinical notes that I did not, I didn't know the, I didn't understand what the words meant.

This is again, I always like to ground myself when I'm in, you know, working on a new company or something, what is the reality?

What are the facts that are really the truth right now of where we are today? And we're still in these very early phases and that's why I'm. So at credo, we're so committed to meeting the market where it is. I was like, we got going with some early customers and they were, we realized very quickly to get to that high value data.

We're gonna have to phone in fax sometimes.

Okay, we're gonna set up an operational team. We're gonna support our clinics. We're gonna support our payer partners. We're gonna have that operational team phoning and faxing and I'm building. I'm okay. Building a human, enabled, tech-enabled service company with a bunch of humans.

if that's what it takes to do our job well and really meet our mission, which is enabling that patient with their complete record. and that's what we're committed to.

Mike Koelzer, Host: Carm. Where does the blockchain play out in this? let me ask it this way. 10 years from now, you're not going into these different healthcare places and they're answering your pings and stuff like that. All of this is somehow in the blockchain. no one owns it. Except the person.

And, credo is again like the coin base where you're the person that's making sense of this, nebulous,

blockchain. 

Carm Huntress: Yeah. So, I mean, this is, this is funny, you know, I always laugh sometimes at my investor pitch. It's like an AI driven neural network for understanding unstructured medical records on the blockchain. And what I just heard sounds so cool. Like, 

It sounds amazing.

And I should be able to raise a hundred million 

dollars on that. Um,

we're, we're a long way away from that I spent, I have spent and I still spend, I'm a big fan of crypto and,paid close attention to the NFT markets because I think there's synergies or, 

things relatable, 

to healthcare here. But I'll tell you just examples of why we can't really have a blockchain solution yet. and the first one is the problem with medical record data in that it's very messy,

right? Am I really gonna put someone's handwriting on a blockchain, and the types of data and the way it's coming together, we really need to get to that digital format where you can start to think about this.

The second thing is error. blockchains are IMU. you put something on them, you cannot change them.

if you look at most statistics, and we know this as, and this is a big impact on healthcare. The third leading cause of death is medical errors. and when you look at medical data, about 10% of it is error ridden today.

And of that 10%, 25% of that data is life threatening.

That's wrong.

and so, you know, my viewpoint is I don't really want to endeavor into the blockchain until some of those issues have really been dealt 

with. I just sit there and I go, geez, let's get the errors figured out and get the data cleaned up.

before we think about putting it on a blockchain, I think the other part too, is that, I think there's been endeavors on this. I've studied a lot of them. Some ICO remember the craze and the initial coin offerings that came a few years ago. The challenge, that was really inappropriate, was people were just taking like a, a hundred page medical record and just throwing it onto the blockchain.

That's [00:55:00] not really valuable.

It's just this big PDF locked upon a blockchain,

 In my belief, what the answer here is in the blockchain world is when I can just take a discreet piece of my healthcare record, like a blood pressure, like an A1C, like a procedure.

And that little piece is structured in an NFT like model. then the world becomes really interesting because let's say you had that mic. You could say, Hey, I'm going to see my doctor today. And it's a follow up from this procedure I had over here. I just wanna share the procedure and I wanna share it for one day.

And he only gets access to the procedure

or I'm getting a life insurance policy. And here's the information I wanna share, which may be a more complete record, right? That is starting to get really interesting in terms of privacy control. in a very nuanced, discreet way, which might be a high value use case for using blockchain, in terms of it.

And I'll tell you the far out use case that I just love,

which is you invert the EHR, which means you're in complete control. You know, the EHR doesn't store your data, you have your data and you have complete control.

And so you walk in to your doctor, you tap your phone and you sit, share your doctor then have complete access to your record.

They're adding data to it. They hit it, submit backs. It writes another block on the blockchain. And now you have your record and you walk out with your record and it just goes with you. That for me is really the future of this. But I think in a decade, 

Mike Koelzer, Host: I agree. You can make a to-do list with apps on your phone, the problem is the only people that are gonna end up doing it on the phone correctly are the people that probably already did a pretty good job with to-do list anyways, it's way out there.

Carm Huntress: Yeah. I, and I just look about what we need

and the job today isn't about putting on the blockchain. 

 It's not even really about putting it on the phone. I don't think, I think it's more about, Hey, how do you get this data over to my doctor?

How do we get it in a structured format? How do we get away from using CDs?

 I actually had somebody on my team drive a few weeks ago, driving around New Jersey, physically going to facilities with a scanner in their car, getting medical records. This is for 2022 folks.

This is where the reality is, for getting this data together. And then I'll tell you the client, you're not gonna believe this, the client, we scanned it into our secure HIPAA, in the cloud thing of their record. And then we said, we want to transfer it over to you securely, what do you want us to do?

And you know what the client said,

Mike Koelzer, Host: They said, fax it over.

Carm Huntress: they said, fax it. And I went, God,I wanted to scream. 

I said, this is not the answer guys. that's the job to be done today, 

 That's where you gotta meet him.

Mike Koelzer, Host: Yes. The people that kinda like the to-do list, the people that want the blockchain and all that kind of stuff, they're already doing a pretty decent job with databases and things like that. It's not those people. It's the long tail that you talked about those odds and ends out there that just aren't getting in there. Carm, you mentioned NFT. When I think of NFTs, I'm often thinking of digital image ownership, and we've seen that now with the, the. Board is that board monkeys, board, apes, and the

and the, and different things. That example you brought up there if they had an NFT I'm not familiar with, then talking digitally to something, would it be something that the physician would look at in your example?

Or are they able to take the NFT and do a nearfield, zap or something to put that in their computer?

Carm Huntress: the way to look at it is the physician might have their own wallet, 

right. That they're, they have on their phone, an 

application. And then what you're just is permissioning them into their wallet based on a certain set of rules. 

Right. 

Mike Koelzer, Host: that wallet for 48 hours or something like that.

Carm Huntress: Yeah, so it's just an opening into, an app or, whatever the physician might have their own solution, right.

That they want to use. And it's just opening that up. It's a fun sort of ethereal conversation because the other part that gets really exciting is research. I think about this world where you could have a coin, right? You could have a monetary system, and where researchers could come to you and say, Hey, I'll pay you.

Let's say Bitcoin, I'll pay you some Bitcoin here to give me access for 30 days to your record, cuz I want to do research and they could send that message out to 5 million people. or maybe there's enough visibility on the, on the chain to say, I want to, I'm looking for people with diabetes.

And it just pings all those people and says, Hey, are you open to doing this? Yes. And then you know where it's going, you know, it's being shared and for how. there's some really amazing [01:00:00] stuff you start to think about doing, um, or, you know, I love the idea of, of sharing.

Like, let's say, there's a new digital app, right? A digital, like a diabetes management app. And it just says, Hey, share your blockchain with us so we can better build your program and personalize it for you based on where your A1C is based on where your blood sugar is based on others, where's your weight and all that just shoots over.

so you can use it in the app, right? That's the type of portability we ultimately want. around our records. One of the things you could say is really clunky about the user experience today. I have to log into all my different access points. it's a pretty exhausting endeavor if you've gotten to care at a lot of different places.

The thought of having that centralized on a blockchain NFT type infrastructure is very interesting. But again, I always get back to,let's not get obsessed about technology. Let's talk about the value to the consumer 

and if I could get paid anonymously, share my medical record with researchers.

Hmm that's Yeah.

That's interesting. 

Um, that's maybe in terms of value to consumers and,doing a job that they, they would enjoy, doing and I think for a lot of people with rare diseases who are looking for a cure, gosh, how great would that be? If they could just easily share their data with researchers, to lead to a cure to their disease.

Mike Koelzer, Host: I had a guest on and they were talking about the value of blockchain for research. And they said, right now you might collect research and you're getting it from all over the world. And then, someone's got the damn header wrong on the database, or they got the decimal moved over a thing and it just messes something up like the old telephone game, you know?

And he said with blockchain, it's original data basically on this stuff, he said, it's gonna be a big value for that.

Carm Huntress: Yeah, I, I think we're gonna see, you know, I, I kind of remember, you know, I was born in the, right at the late nineties, there was growing up in high school and things like that. and what I saw, that same thing where we had that sort of iterations of the internet, 

if you read the book technological in, uh, revolutions, that book is incredible at helping you understand. all the things to get technology actually deployed. You have to have this installation phase then, and then you have deployment. And that, I still think we're in this early installation phase of crypto,technology and blockchain technology.

where it's not yet at that deployment phase, it's still, there's clunky. It's like using the internet, the first browser was a mess, It, and then it had to get better and better, and you had to get this sort of installation and then you saw this massive deployment of it everywhere.

I think blockchain is very similar in that way, in that we'll see, I think this third iteration, I think we went through sort of the initial Bitcoin thing. Then we had the whole ICO craze, um, and coin base. And now I think we're onto the third iteration, which is gonna be super interesting that I think will emerge post this sort of technical, if you're following the curve of the market right now on after this downturn, I think we're gonna see some really interesting stuff emerge from it.

all across healthcare and FinTech for that matter.

Mike Koelzer, Host: Besides getting the technology up to snuff, its ability, you've gotta have enough of a network. It's like how valuable was the first fax machine to somebody

Carm Huntress: Yeah, 

Mike Koelzer, Host: It means nothing until there's faxes across the country.

Carm Huntress: Yep. Yep, exactly. That's the thing we've gotta remember. and again, this is like interoperability right now. We've got the first digital fax machine or the first few getting planted around the country. We just need to do a lot more. And we're still doing that installation of national interoperability, through standards, through the common agreement through TECA, that is driving that interoperability and as more access points open up every day, you eventually hit a tipping point where you have massive deployment of those systems.

and we'll see a tipping point from traditional phone and fax to,mediating, all this stuff digitally.

Mike Koelzer, Host: Carm, when we look out 10 years with credo, and even though I'd like to talk about all the cool technology stuff on it, don't go there. What is this going to mean for the average parent, the average person that needs care. What's gonna be really cool in 10 years?

What does that value look like for a customer in 10 years?

Carm Huntress: I think the first thing I would say, before I answer, is that my endeavor is to enable access for a hundred million Americans, on credit and have a relationship with those patients and their records to help them live their healthiest lives. Now I think when we tip to a hundred million users on the platform, I think the things that we're gonna do are gonna be extraordinary, because we've finally done that thing.

We all talk about transitioning the patient to the center of their care. And I think that only becomes true when we've enabled it with their data, because healthcare is an, in the end , one experience. it's about you and your [01:05:00] individual care. And now two patients are alike, but when we have that data, we can really do that personalization and that unique delivery of care.

And so, you know, if I was really pushing the boundaries of my imagination, I would say that we would have a set of AI agents around your data of evaluating everything going on with your life, both from a medical diagnostic lab, qualitative, quantitative data, quantified self data,

feeding into engines, and making recomme and making recommendations to you based on people like you, based on people with your same genetic profile based on you, people in the same age group, in the same socioeconomic 

situation, and then having a marketplace of products and services that are highly personalized to you and your needs of your family.

And then the last thing I say is the door opening to highly personalized care and research.

and that would be the other area where I think we could run synthetic or real time clinical trials. We could help patients get into clinical trials that today have very high abandonment rates or, on enrollment rates.

we could do things about advanced diagnostics, right? looking and saying, Hey, we're watching your data here. We think you have a gen you know, a genetic issue here, and we'd like to run a test on you to check if you have that. if you have a potential genetic issue here, 

 or a genetic disease that has been undiagnosed, those are the types of things that I imagine 10 years out we will be doing.

and I love the idea of having a comparative engine. We can either build people, just like Mike and see their continuum of care and know that this is the best next thing for you to 

do, or I can synthetically build it off the data and basically build almost like a digital twin to you and start to see and start to think about, Hey, what are the best treatment options here for you?

That's the endeavor here of credo long term, and I'm so excited. we're in these very early phases and if you think about really what we're doing, I'm working with payers and providers today to subsidize the high cost today. It takes me to go get your record,

to get to the future where it'll be a commodity, right?

Because it'll be digital, it'll be interoperable. I can get it, a cent on the dollar

and then all these new possibilities open up.

or open up to you as a consumer.

That's what I want to do for patients. And, in terms of my selfishness and the impact I could have, I get inspired, thinking about the impact I could have on patients' lives and the difference we could make as a company and on mission.

And,I, that's what gets me up every day. And, I thought about a lot of different businesses. I wanted to start after doing RX review

and I really want to go do something big and impactful and I care deeply about the US healthcare system. And so I hope we're able to achieve these things and ultimately bend the cost curve on the GDP of healthcare, 

because we have to,we are gonna lose our spot as a world leader.

on the sheer cost of healthcare in these, in this country and we have to fix it. and we've invested a lot and we still have not seen quite enough results in 

terms of changing the cost curve. And so I really hope credos are part of that. And I hope we make that change in the next 10 years.

Mike Koelzer, Host: I picture in

Carm Huntress: 10 years, I'm gonna pick credo up and I'm gonna be so proud of you Calm and, it's gonna be like the Jetson's voice. I forget what her name was on the Jetson's that little robot, Yeah. Rosie, 

Mike Koelzer, Host: Rosie.

and it's gonna be your rosy voice. And it's gonna say Mike we've had this, artificial intelligence, team look at your thing and we've done all this.

And it's gonna say, we recommend not to have, three bowls of, honey bunches of votes at night, and I'm gonna throw it in the drawer. And I'm gonna 

Carm Huntress: You're gonna 

toss it. Yeah. 

Mike Koelzer, Host: damn calm. Carm. good to see you again.

Congratulations on credo. Keep doing what you're doing. The world needs you.

Carm Huntress: Thanks Mike.

Always a pleasure. 

Thanks so much. 

Yep. Bye.