HIStalk Interviews Bill Grana, CEO, HCTec

Bill Grana, JD, MBA is CEO of HCTec.

Tell me about yourself and the company.

I have been in tech for nearly 30 years as an entrepreneur and business operator, beginning in the first dot-com era. A lot of my experience over that time has been in the healthcare provider arena.

HCtec is an IT services firm that is focused exclusively on health systems and other healthcare specialty providers. Our reason for existing is to improve the health of the communities that our clients serve by optimizing and making their IT functions better.

What health tech trends are you seeing?

AI is obviously capturing a lot of media attention. That is probably followed somewhat closely by cybersecurity issues, where we saw some significant events just this year. But AI is capturing a lot of the buzz. Although I usually believe that things tend to unfold from a technology perspective a little bit more slowly than what people often think, my general instincts in this case are going to be wrong. AI is here, and its impact — not just in healthcare, but in many other industries — is going to be real.

We have a significant call center offering. Health systems outsource their call center and their service desk to us, Clearly that will be impacted by automation and AI. That also extends to other aspects of IT and to the EHR. You can see scenarios where EHR analysts, whether they be Epic or otherwise, will have much of the work that they do become automated over time. I’m typically not one to believe that there will be a major landslide in technology adoption, but I think it will come more quickly than many people think.

I’m also a big believer in robotics and the coupling of AI with robotics. That will have impact not just within healthcare, but in lots of other industries. When I say robotics, my vision is humanoid-like robots, not factory assembly line robots. I hope to see that within my lifetime, and I think that it’s just a matter of time before that becomes a reality in the business world and in our personal lives as well.

What kind of AI help do health systems ask for?

We don’t necessarily have a defined practice in that area. We have done a fair amount of work in the data and analytics arena. What we are seeing is that health systems are pouring the foundation, from a data management and data architecture perspective, so that they can take advantage of some of the promise of what AI has to offer. I’ll call it preliminary foundation work as opposed to actually helping to support and implement AI systems.

Will health systems buy off-the-shelf robots or hospital-specific ones, and will they require a services component?

They will be functional or use case specific. When I show up for my annual visit with my primary care doctor and I check in, much of that whole process has already become automated. But then the time that I spend with the medical assistant who weighs me — which is always a little bit of a scary proposition — takes my blood pressure, and asks me about all the medications or supplements that I’ve been taking and my general health since my last visit, you certainly could imagine that a humanoid-like robot could be doing all that work. From just a technology perspective, I don’t think we are that far away from those use cases being presented.

Is consumer-facing technology such as the digital front door still on the front burner of health systems?

That absolutely remains a focus for the clients that we work with. Making it easy for their patients, their customers if you will, to interact with the health system. That could be making appointment sand much of the interaction. The foundation is the patient portal to ask questions of their providers and receive reminders about upcoming appointments or health screenings that are needed. That first phase is already in place for many systems. When I interact with the various providers that I see, much of it is digital.

Will use of that technology be evenly distributed?

I think it will become fairly ubiquitous. Virtually everyone has a smartphone in some form or fashion today, and the cost of the technologies too has been driven down as they have matured. I don’t necessarily see a world from a technology perspective relative to healthcare where you have a division between have and have nots. Now that’s a totally separate issue when you’re talking about just access to care. That that remains a real challenge in many parts of our country that are significantly underserved from a healthcare perspective.

What expected and actual benefits have health systems seen from shifting technology to the cloud?

There’s one recent example that comes to my mind. We supported a client who was moving their Epic instance to AWS, one of maybe five or six examples of Epic on the AWS cloud. They are getting the benefit of not having to support all the overhead and infrastructure that comes with physical data centers, but there’s also a big security benefit. Taking your applications and infrastructure to cloud doesn’t mean that you are completely immune to cyber risks, but it definitely makes it easier to manage those risks.

How will the availability of technology expertise change from the shift to cloud as well as return-to-office mandates?

We are seeing a lot of flexibility, including in our own business. In some cases, fully remote teams and maybe leadership that comes into the office on a periodic basis. In almost all cases, some sort of hybrid system where people are expected to show up in the office two or three days a week and then work from home the remainder of the time. 

I have very mixed feelings about that. I guess I’m some somewhat old school and in the latter stages of my career, but I’m still a huge believer in the power and the value that comes from people getting together in a room and working through problems. Not that it can’t happen through tools like Zoom that we’re on today, but it’s more challenging. But I also leave open the possibility that maybe generationally, I’m beyond being able to see how you do that effectively.

Do customers ask specifically for remote help for go-live support and major projects to reduce travel costs? Or do you convince them that their chance of success is better if you’re allowed to send resources to their location?

It’s still limited in terms of the requirements, and clearly it depends upon the type of work that’s being done. You still see a lot of at-the-elbow support being provided in person, although we also do a fair amount of remote backup support. That has made our business easier, because pre -COVID, we typically needed to find consultants who were either in physical proximity to the clients or willing to get on a plane every week to go see those clients. Now that that has become less of a requirement, it makes finding that talent somewhat easier than it was previously.

Will return-to-work mandates change the available pool of consulting talent?

To me, it’s just such a personal thing. Some people desire interaction with their work colleagues more than others and will seek out opportunities that are either exclusively in office or some sort of hybrid arrangement. Others are fully comfortable working in a remote environment and as a virtual team member.

I have a son who will be 25 years old here shortly who is a software engineer for a health tech company. He really enjoys his job, but two years into it, he is craving the ability to actually work in an office. The company that he works for is fully remote. It’s located in a place that, for a single 25-year-old, is not the most attractive geography to move into. He has realized that there are probably some things that he’s missing, especially early in his career, from a mentorship perspective and observation perspective, that he just can’t get working fully remote. I think about my own career and how different it would have been if I hadn’t had the relationships and the mentors in a face-to face manner that I did when I was his age.

Will people who work remotely find themselves not promotable or not experienced in the right areas compared to their in-office co-workers?

That’s a really interesting question for people who want to move onward and upward. Will they find themselves limited by the fact that they are working remotely? Time will tell. It probably depends on the organization and the culture of that business as well. Plenty of very successful companies are working fully remote, and people have the same sorts of opportunities to advance their careers as they otherwise would if they have to come into the office in a more traditional way.

What are the new challenges and opportunities for health tech companies as broad business conditions change?

Many product companies missed the mark, but were able to get going when money was free and everyone was a genius. Irrespective of industry, those that don’t have clear product market in this financing environment are going to have a hard time taking it to the next level. Those that maybe haven’t demonstrated a ton of market penetration or revenue success, but do have strong product market fit, will be able to access capital and be successful in the markets that they’re focused on. Another way to say it is that good companies are not going to have any problem continuing to grow and do good things, and those that were able to get started because of the low interest rate environment that we were in are going to fall to the wayside.

What factors will be important in the company’s next few years?

We are excited about our positioning, even with the advent of AI and maybe certain aspects of what we do being fully automated. As we look into the future, technology is only going to play a greater role in healthcare than what it does today. We equate that to opportunity in our business. 

The key theme for us is growth, whether that is revenue growth or the number of clients. Growth is something that we talk about constantly. Our vision is to be the recognized leader in the healthcare IT services market as measured by three things — client satisfaction, client retention, and the financial performance of our business. We think that we will get there, first and foremost, by working to deeply understand the needs the IT services needs of our clients, their challenges, and their key strategic initiatives. That starts with relationship building and establishing credibility and trust. In a pure services business, that’s even more important than in a product or software business. 

We will work then to address our clients’ needs through our own service capability or the capabilities of our partners, We have never set out to be all things to the market from an IT services perspective. We believe in strategic partnerships. We have strong delivery practices, definitely a culture and commitment to high quality service. By doing that, we’ll see improvement in our client organizations, whether it be from an operational perspective, clinical perspective, or, in financial performance, which is critical for many of our health system clients. You read that half of all health systems today are still in the red at an operating level. Bringing them back to the black is part of what we’re trying to help them do. If we do those things well, we ought to thrive and continue to see meaningful growth in our business.

We feel very blessed — and I don’t typically like to use that word – and excited for the opportunity that we have to help our clients leverage and improve their technology environments in a way that helps them. Most of our clients are not-for-profit organizations. Technology could be a part of helping them realize their mission and their reason for being.