HIStalk Interviews Ashwini Zenooz, MD, CEO, Commure

Ashwini Zenooz, MD is president and CEO of Commure of San Francisco, CA.

Tell me about yourself and the company.

I’m a radiologist by background. I’ve been a practicing physician for most of my professional career. I made the switch a few years ago, officially, to government and policy. I worked on Capitol Hill and then moved on to continue my work in government at the Department of Veterans Affairs as an executive, then continued my work from there into tech.

Throughout that entire process, I’ve been an avid lover of what technology can bring to healthcare. From my first days as an attending or fellow, I remember all of the things that you could do to have more efficiencies in healthcare, and technology is at the core of it. I believe in the power of technology and I think we are at a great time at the intersection of tech and healthcare, so I’m excited to be here.

I joined this company because the single theme that I’ve been seeing throughout my career is that we have a lot of point solutions and they are continuing to increase. COVID just blew that out of the water. That’s great, because it brought a lot of access to patients and a lot of great solutions, but it became an even more disconnected system. The premise of this company is, how do we bring all of that health tech disconnect to make it work and empower the healthcare workforce? I love that idea, so I wanted to come here. 

We are building the first health tech operating system. Our goal is to bring in and unify multiple data sets and data services so that it is meaningful for the clinicians during those micro moments of care, help with the performance of the organization through these applications; innovate; and give the tools for the systems that are using us to have a platform for innovation that is unifying. I love that concept. We always talk about interoperability from a technology perspective, not from, how does it impact users and how do we make it work for them?  I love that we are actually bringing action to interoperability.

Who are the company’s competitors in data aggregation and API services?

The first thing I would say is that I don’t view data aggregators and API companies as competitors. In order for us to be a functional platform and operating system, it’s important that we bring multiple vendors and last-mile integration companies together. That’s important for us so we can have the data unified in a single place. That’s the first component.

When you reference data integration and APIs, some of that, especially the data integration, has different components. We don’t do the last mile of data integration. It’s once the data is coming together with all these different sources, how do we provide that unification and the unified view? For those, I would say that you could have platform companies as competitors that are out there, anything from a Microsoft or one of the other companies, but they are also partners for us because we build on top of them. Microsoft, Google, Amazon, et cetera.

I don’t think we are yet in a space where we have a competitor because we are the first health tech operating system that is actually bringing FHIR and non-FHIR data together. We are enabling different data structures and sources, and we have a solution where you can actually build on top. I don’t think that solution exists in the market as a whole. If you break down the individual components that we could have for each category, there’s a competitor.

I’m still not getting a picture of exactly what you sell and to whom. Can you give me an example?

We predominantly work with healthcare systems today. If you think of the healthcare system, they have on average somewhere between 10 to 16 electronic medical records or systems of record. They have radiology, laboratory, their main clinical EHR, and they have other data sources. They also work with multiple third-party point solution vendors. 

A lot of times, the healthcare system has to do the work of continually doing point-to-point integration with these third parties to make them effective with the vendors. By bringing in an operating system in the middle, they have found that they can scale those applications across the board by a single plugin. Once you integrate with Commure or you build a solution on Commure, the data automatically flows to anything that is connected with the Commure operating system.

Think of a switchboard, where multiple plugs are connected in. If you are connected into each other, then the data is set up in a way, structured in a way, where it has a common architecture, where you are able to communicate and have data. You have a clinician who has an EHR, they have patient data coming in from the glucose monitor, and you have third-party data that’s coming in. The system has built an algorithm, let’s say on top of Google Cloud for analytics. We can connect the dots and have a system of action. We can bring the algorithm to life and bring it to the forefront for that provider to make the decisions at that moment of care. We’re a transactional system. It’s not retroactive review of analytics. That’s who’s using us, and that’s one example for clinical.

Another example on the platform is using location services. Think about a nurse who is delivering care where there is violence in the workplace. All she has to do is push a button on the badge and we do the work on the back end, where we connect the dots between her to security and nearby employees so we can say, “Here’s the person that needs help.” We can engage. And all of this happens on the back end on the platform, whereas before, you would have to go to a nursing station, pick up the phone, call somebody, et cetera. We are able to connect the dots between clinical, operational, and financial through any app that is connected into the platform.

How do you bring EHR vendors to the table to make their data available?

For the operating system to be functional, you have to work with partners. EHRs are part of the partner ecosystem. It’s not going to work without working with the EHR partners. We have to be able to bring the data together and we have to make it useful. For us to bring the data sources together and for it to be meaningful, we have to work with the developer ecosystem that is building these incredible point solutions in the digital health market. We have to work with the existing laboratory and pathology systems that a health system might use. We have to work with the EHRs and the HIEs that are out there so that we can actually have this data come and for it to be meaningful.

With the PatientKeeper acquisition, we inherited two decades of great clinical experience and workflows that are adding to our vault of solutions. But the overall Commure operating system is going to require PatientKeeper solutions, other vendor solutions, and Epic and Cerner solutions to come together. To me, it’s all about figuring out how to collaborate and not remove these systems that are in existence and bring more cost to the healthcare system. I don’t think we should be kicking out the EHR because the services and functionality that Commure provides are additive and should be enhancing the EHR and enhancing the operational efficiency of the company.

There are a lot of things that the EHRs don’t do that a health system needs, and that a clinician needs. Those are the areas that we are providing a platform for innovation, where you can say, “You have this data. We have these templates for you.” You as a health system can work with your own team or you can work with third-party developers. You should be able to use a low-code or a no-code platform that we have to spin up the workflow that you need within a matter of weeks that it is integrated and connected to the EHR. You have an enhancement of your EHR. I don’t think we should be dislodging them. They do a great job at what they do, which is being the electronic recordkeeping system.

What will the industry look like in five years as startups build products that use existing health system data?

I think it’s fabulous. No one company can be the end-all, be-all in healthcare. If you have a monopoly in healthcare or you think that the EHR is going to be the source of all of your clinical workflows, all of your operational workflows, and all of your financial workflows, one, that’s going to be difficult.

Two, it’s not going to give the system any flexibility to think about new ways to innovate and work faster. COVID has opened up the ecosystem and has allowed for innovation. Health systems in particular realized that there is so much more that they need for a more efficient, better way to engage their patients and their providers. They saw that when we started shutting down and going to a virtual environment or hybrid environment with healthcare. That accelerated the innovation in healthcare, and I think that’s fabulous.

The only issue with that is that with so many point solutions, the healthcare system has to do the job of integrating all of those to make it meaningful for them to use it. We’re working with a healthcare system now that has over a 100 third-party vendors who provide point solutions, and some redundant solutions are being used across departments. That adds to the cost of the healthcare system, which goes against what we should be trying to do.

This is simplistic example, but if you think about the IOS or the Android ecosystem, they create a way for seamless consumer experience through this core data integration platform. Then they enable an easy app development platform and a robust suite of pre-built, ready-to-launch apps. Apple comes with Apple Maps, Apple Calendar, and Apple Mail, but that doesn’t mean that you can’t download one of the new innovative maps or scheduling apps or Waze or whatever that you want to use as a consumer. It is auto integrated. Just because you use Apple Calendar and Gmail for your email does not mean that those two don’t work together. 

I’d like to see that simplicity. That’s where we are going to head with a platform approach in healthcare, where you can have the best-of-breed solutions available to these health systems. But there’s not going to be the issue where interoperability and tech is a blocker. They will function together to reduce the friction for the user.

Has consolidation into bigger health systems enhanced demand for services like yours, as tech-savvy corporate offices connect systems that came with acquisitions?

The short answer is yes. It’s not just the EHRs when you see system consolidation. As we are moving into a new model of work, you’re going to have a lot of non-health system parties that work with the inpatient system. For example, you’re going to have multiple cardiology practices that refer patients and take care of patients inside of a central healthcare system. They are now part of the system. They don’t use the same EHR or billing or operational systems, but you need to give them the flexibility to work with each other. Solutions where you’re able to help with the network of innovation to bring all of this together so that the patient isn’t bothered when they’re going from their external cardiologist into an internal vendor — that’s where I see a lot of change.

It’s not just at the level of the EHR. It’s between the inpatient systems. How do you provide these seamless experiences for these providers, not just the patients, as they are caring for patients and they are traveling between these outpatient systems that are part of a network into the inpatient system? How do you provide the same flexibility as those providers are interfacing with the insurance companies? How do digital health companies refer in and out of a health system where they don’t belong?

That’s the new age of healthcare. It’s this hybrid model of care, the “click and mortar” system. That’s where the platform innovation is going, and we are going to see a lot more of it. It’s great for us because we truly believe that patients should have the flexibility and clinicians should have the data available when they need it without having friction from technology, which is what we enable.

What are the company’s priorities over the next few years?

Right now, we are really, really focused. You probably don’t see a lot of info from us because we are hyper-focused on working with some of our lighthouse customers. We have defined a few focused customers and we want to make sure that we are learning from them and partnering with them to come up with the best solutions. I don’t foresee us changing much from that course, because we are learning a lot and it’s helping us build our product roadmap and introduce new solutions to the market. I would say that we’re going to continue along that path.

We are seeing a lot of requests for payer-provider collaboration and how we can enable that, so we will think about how to extend our platform and the operating system to help connect the dots, as clinicians are working not only across other healthcare systems or across their networks, but also with the payers in the ecosystem.

I don’t think that there’s a silver bullet in healthcare, “one size fits all” solutions. We have to be open to the approach of collaborating and working together, including multiple EHRs working together and multiple competitive companies working together, to help provide the best care for patients and the best experience for providers.