HIStalk Interviews Brent Lang, CEO, Vocera

Brent Lang, MBA is chairman and CEO of Vocera of San Jose, CA.

Tell me about yourself and the company.

I’ve been with Vocera for 19 years. I was brought in by the founders, initially as the VP of marketing back when it was just a few guys in a dark lab trying to figure out if they could make our product work. My wife used to tease me that I was the VP of business, as opposed to the VP of marketing, since I was trying to figure out our go-to-market strategy, our pricing strategy, and our target customer.

The company was not originally created as a healthcare-focused company. The founder’s vision was to enable wearable communication across multiple markets. One of my first jobs as a VP of marketing was to go out and interview a bunch of potential customers about the idea of wearable, hands-free communication. We started talking to some hospitals and nurses were so excited. I remember one hospital nurse saying to me, “You’re going to change the way nursing is practiced around the world.” At that time, I had no idea what she was talking about because I had not come from a healthcare background. I was more of a technologist, having made my way through Silicon Valley tech companies with an interest in technology and business strategy.

I fell in love with the impact that technology could have on hospitals and healthcare workflows. I was an industrial engineer back in school and never really thought about too much how I would use that until I started thinking about the role that communication can have on improving workflow and operations within a healthcare setting. I tell people all the time, just learn what you can, because you never know what knowledge you’re going to pick up along the way that will be relevant to you at some point in your future career, even though it may not seem particularly relevant at that particular moment in time.

Cell phones, apps, and phone-based texting were not around when the company was started. How have they changed the appeal or the marketing of healthcare-specific communications?

People forget that we created the company before Siri, Alexa, and the IPhone. Vocera revolutionized the idea of communication using voice as a user interface and thinking about mobility. We built the original Vocera badge because there weren’t any other appropriate devices. The closest ting might have been a Palm III, Palm V, or later, the Treo. Hands-free is critical in a hospital, so we built the device mainly because there was nothing else that would work. We have learned over the years just how essential the hands-free capability is.

We have embraced a range of different devices. Our strategy is very much about being device of choice, and our software platform supports iPhones, Android devices, tablets, and desktop interfaces. But we find that the closer a clinician is to direct frontline care, the more important it is to have that hands-free capability, and it’s even more relevant during COVID. But what has been important for us was to figure out ways to bring in those other modes of communication that you mentioned — text messaging, alerting, alarming, and other forms of media — into the platform and into the devices that we support.

The new Smart Badge recognizes a “wake word” to make everything hands-free. How important is that to clinicians?

We introduced the wake word earlier this year. You can say “OK, Vocera” to wake up the Smart Badge and allow you to issue a voice command, such as, “call the nurse for room 101” or “call a respiratory therapist.” You don’t have to have any interaction with a button on the badge at all. In this era where people are wearing personal protective equipment, or PPE, a lot of people are excited about the wake word functionality, because they are able to wear their Smart Badge underneath their gowns and maintain an entirely hands-free environment.

Could you integrate your system with inexpensive consumer voice assistants that could be placed in patient rooms, which would allow patients and nurses a simple, hands-free way to communicate, either along with or instead of a call system?

This is actually an area that we are really excited about. We are building a Vocera skill for Alexa that will allow you to put an Alexa device, like an Amazon Echo, in the patient’s room and enable the patient to issue voice commands. Those messages are then routed to the appropriate caregiver. We can leverage our software platform and routing intelligence so that we know who to notify if the patient asks for a blanket, but if the patient says that they are in pain, it can go directly to their nurse to take immediate action. 

It’s really combining, as you said, the consumer devices that are becoming so available and the prevalence of using voice as a user interface and speech recognition as a user interface, combined with the intelligence and routing capabilities of our software, and then the connectivity that we have out to the employees of the hospital. We’ve shipped over a million Vocera badges out into the marketplace. There are hundreds of thousands of people using them every day. That gives you an instant connection to nurses, transport techs, housekeepers, and food services. A patient can get immediate access to all those people, rather than it just being a hardwired connection back to the nurse station, where someone then has to figure out how to deal with that patient’s request. We are seeing a convergence of technologies that people have become used to and comfortable with in their personal lives and in their homes, merging with hospital-specific workflows and hospital-specific solutions that leverage the sophistication that we can build within software.

How has COVID affected the use of your products and the trajectory of the company?

The pandemic has raised the awareness for our company, our solutions, and the value proposition of what we offer, in particular, the hands-free capability. Every time a care team member removes or replaces their PPE, there’s a risk of contamination. Minimizing the number of times PPE is removed reduces the risk of infection and helps preserve these valuable resources. Whether that’s in a triage tent, an ICU room, or an isolation room, the hands-free capability of our solution has been really valuable, because it can be worn underneath the personal protective equipment.

We have seen the product being used in temporary tents being set up to triage patients. We’ve seen the Vocera badge being used connected to the bedrail, to allow patients to reach care team members and for nurses to do virtual rounding, where they can call a patient’s room instead of going in and out for a quick conversation, which keeps them safer and reduces the amount of PPE used. It allows them to reach out to family members. It has been exciting to see the role that that communication can play.

For our employees, our connection to our mission has never been stronger. Our mission is to improve the lives of caregivers, patients, and family members. While the pandemic has been tragic in many regards, it has been inspiring for the employees. Our level of employee engagement is higher than it has ever been because we have been part of the solution. It has been inspiring for employees to feel like they are doing something that is having a direct impact on patients, caregivers, and family members.

What sales and marketing changes have you made given travel limitations and the cancellation of HIMSS20?

We were one of the first companies to drop out of HIMSS when we saw the pandemic rising. Maybe it was the benefit of being out here on the West Coast and seeing what was happening in Washington. But we very quickly started transforming the company to being virtually oriented in our sales, services, and marketing efforts.

Just to give you an example, within 30 days of this all coming about, about 90% of our professional services had been transitioned to remote work using Zoom or other virtual technologies. Our sales team quickly embraced reaching out and working with customers on a virtual basis. Our marketing team did a really good job of creating new use cases and case studies talking about COVID-specific workflows and how the product could be utilized in these environments. We used it as an opportunity to support our customers. We issued several thousand free, temporary license keys for our software to customers who needed to increase their capacity to respond to COVID surge situations.

I’ve been incredibly proud of the response by the company and by the employees to support our customers and do the right thing during these really challenging times.

How do you position your offerings in rounding, patient experience, pre-arrival, and patient monitoring software within the framework of enterprise communications?

Our vision is around enabling the real-time health system across the care continuum. That is more than just voice communication. It is more than just communication broadly. It is all about eliminating the friction points in a patient’s journey and making sure that the right data is delivered to the right person, on the right device, at the right time, with the right level of urgency.

Take as an example our recent acquisition of Ease, which is a patient and family communication application. It enables caregivers to give updates to family members when a loved one is in the hospital for surgery, COVID, or other situations that prevent family members from visiting them. This speaks to our desire to expand to enable this real-time health system.

The company has its roots in the Star Trek communicator kind of mindset, but our software platform is much broader than that now. We have had to evolve as the industry’s has evolved. In the old days, a lot of actions in a hospital were triggered by a nurse walking into a patient’s room and noticing a change in their condition. The workflow started by the nurse needing to reach out to get the appropriate help. More and more today, patient monitors, physiologic monitors, smart beds, and the electronic health record are becoming expert systems. They can, in many cases, notice a change in the patient status quicker than the nurse who is walking into the room. The event that needs to be triggered from that, and the people who need to be activated as a result of that change in patient status, can be coming from lots of different sources beyond just the initial human interaction with the patient.

As a company, we focus on evolving what we do to be able to incorporate all this data coming from these expert systems, route it through our workflow engine, and more importantly, prioritize it and triage it so that we aren’t creating cognitive overload or cognitive burden on the clinician, so that they’re receiving just the most critical information. and know the most important activity to act on next.

You are at a blurred line between what you’ve traditionally done and new technologies that are gaining in popularity, such as chatbots, artificial intelligence-powered population health management, asynchronous text-based provider chatting, and patient-reported outcomes, all of which are usually offered by a standalone startup company. Do you see Vocera getting more involved in either these specific technologies or with those companies that offer them?

You’re absolutely right. Hospitals tell us all the time that they are looking to consolidate the number of vendors that they are working with. They are looking to build platforms that are unified and fully integrated.

We try to create as much of an open platform as we can. We want to be interoperable with data from a range of different systems. Whether it’s a piece of technology that we develop ourselves, creating an interoperability relationship or some sort of partnership, or a potential acquisition — those are all ways of building up a platform that is easy to use and is delivering the right information to the caregiver.

I love to see the innovation that is occurring in the space, because the more information and the more data that gets generated, the more of an opportunity there is for us to analyze that data, route that information, and provide better patient context. When a call or message comes in, it’s not just an interruption, it’s actually patient context-aware events that provide the caregiver with situational awareness that allows them to decide what the next action is.

Our strategy is to say that we are going to do a lot of this ourselves, but we’re also going to create open APIs and open standards that allow us to bring data in from other organizations. One of my favorite examples is sepsis alert technologies, those sophisticated algorithms that can  predict when a particular patient might be headed towards sepsis. The challenge with those is that often that the algorithm can identify the patient who is at risk, but it may not do a good job of notifying somebody who can take action. In that case, we do a simple integration with them, they send us that alert, and we route that to the appropriate caregiver. They can take action much more quickly than if we were just waiting for the clinician to go log into the electronic health record or some other expert system that has identified that the patient is at risk.

Do you have any final thoughts?

Technology vendors have an important role to play in transforming healthcare, whether it’s providing improved safety for clinicians and for patients, reducing the cognitive burden, our doing a better job of protecting our frontline caregivers. Technology must be part of the answer to bridge the gap between where we are and where we need to go. Vocera is really excited to have an opportunity to participate in that.