HIStalk Interviews Rizwan Koita, CEO, CitiusTech

Rizwan Koita is CEO of CitiusTech of Princeton, NJ.

Tell me about yourself and the company.

I’m the founder and chief executive officer of CitiusTech. We founded the company in 2005. This is my second company — I started a tech support company. Before that, I spent about five years with McKinsey & Company.

When you and I spoke last in 2015, CitiusTech was about 1,600 or 1,700 people strong. We are now at 3,200 people. It’s been a fairly strong growth year this past year and over the last few years. We do a whole bunch of stuff in healthcare technology for our customers across what we call the Clinical Value Chain.

What is driving the company’s strong growth?

From the revenue perspective, we are now part of the Healthcare Informatics Top 100. Our revenue was $127 million last year and are on track for close to $150 million this year. We also made a strategic investment in a company called FluidEdge Consulting, which is at about $25 to $30 million. We are hoping that, on a consolidated basis, we will end this year with revenue of about $175 million. As you can see, that’s a very significant jump from where we were last year.

The growth of the company is essentially coming in a couple of areas. We do a lot of work with payer organizations in the US market. We do a lot of work with provider organizations. Both of those markets have accepted CitiusTech solutions and our services very nicely. We also work with some of the medical software and technology companies and support their growth. That business is actually doing quite well. It’s a fairly homogeneous growth across our offering with providers and tech companies as well as with payer organizations. To a smaller extent, we work with pharma organizations as well.

There is a tremendous shift toward data management, a tremendous shift toward analytics, and now a significant shift toward data science and machine learning. We at CitiusTech have a significant amount of expertise in these areas. We’ve been able to do value-added work for our customers.

How will artificial intelligence and machine learning affect healthcare in the next five to 10 years?

I’m going to talk about history a little bit. Ten years back, the emphasis was on deploying what I would call foundational applications, such EMRs, health information exchanges, and connectivity software. A lot of big problems in data integration still remain and are getting solved. Steadily the focus of the industry has moved towards, what do we do with all the patient data, clinical data, financial data, and operational data that is getting generated? What’s the best way to manage that data? That could be on-premise, cloud, or a more traditional enterprise data warehouse versus big data solutions.

After the data management problem starts to get solved, the next logical question is, how do we start to use more analytics? Increasingly there is a lot of focus on what I would call the standard analytics, like regulatory reporting and and Level 1 analytics. But as the industry is maturing, we see a tremendous focus towards a slightly more advanced analytics. How do you take this massive amount of data that is now getting captured — EMR, lab, pharmacy, or claims — and put it together to be able to solve more complex problems? These are often not possible to solve using traditional analytics, But some large healthcare entities are using machine learning and AI tools to use that information to drive their problem solving.

If you look at the market, there are a lot of smaller proofs of concept and very interesting pilots going on. But the number of real-life deployed applications at scale is still small. You have lots of tools and utilities, but a small number are actually being used for inpatient care at scale. We are trying to help our customers solve that problem.

There is a dichotomy between what’s happening in pilots, research, or academic settings but little of it in production. In the next five to 10 years, we are going to see a tremendous number of successful models getting deployed in the real world for improving patient care, improving efficiency, and reducing cost, all of which are critical for healthcare.

Will use of AI and machine learning create a competitive advantage for health systems that deploy them more quickly or skillfully?

There will be a clear stratification of the types of organizations that can use machine learning and AI. At a simple level, if you take the provider market and hospital systems, a very large entity — Mayo Clinic, Cleveland Clinic, New York Presbyterian, Baylor Scott & White, and other large health systems — will be able to gather that information, and for research purposes or otherwise, build and create their own models.

The bulk of the healthcare ecosystem will largely be dependent on the vendor community to facilitate the use of such advanced tools. If I had to fast-forward five to 10 years, I would say that a lot of the deployment of these tools will be driven by the vendor community — EMR vendors, medical imaging vendors, lab services companies, or some of the other guys who have the financial, intellectual, and technical horsepower. They can aggregate large data sets, build models, and then test those models and get them through the FDA approval process and other barriers that are required before deploying these models in the real world. I see a greater likelihood of that happening. Some of the very large health systems also have a strong R&D inclination and have the ability to drive innovation, but that would be much harder for mid-tier and small hospital systems.

Thousands of models are being created today in healthcare using machine learning and AI. These models can be created in hospital research centers, academic institutions, or by five guys in a garage who have deep clinical insight. If you look at thousands of these models and then look on the production side, you find that the number of real-life applications in production is low.

The reason for that is that customers are getting bombarded by a lot of models — created internally or externally — but they don’t necessarily have the skills required for model validation. Imagine that I’m a large medical imaging company. Tons of folks are coming to me and saying they have great algorithms for medical imaging. I as a medical imaging company must have the horsepower to be able to put together a team that can independently take clinical data, run it through the models, validate the efficacy of the models, and fine-tune the models before I can validate whether the model is effective or not. Model validation is a huge pain area for the industry.

The second area is model operationalization. If you have a validated model, the task of integrating it with the clinical workflow is reasonably complex. Say, for example, that I have a model in medical imaging. Knowing that it’s a validated model, I still must be able to incorporate that model into the workflow of a radiologist. If it’s a colon cancer detection algorithm, then the characteristics of the colon cancer patient’s image needs to then fire up this AI or machine learning algorithm. The algorithm should be able to give back a response that is clearly visible to that radiologist or specialist who is looking at the colon cancer image. The radiologist should be able to either accept or reject the proposition or the findings of the machine, the AI algorithm. Once they accept it, that information should get fed back into the algorithm to incrementally optimize and enhance the algorithm. The result should be presented back as part of the report or to the patient or what have you.

It requires a certain degree of engineering effort to incorporate the model into the clinical workflow in addition to meeting the data science capability. To operationalize the model, you need a bundle of different skill sets — data sciences, product development, QA and validations, and perhaps FDA certification.

We find that technology companies and hospital systems that are trying to operationalize their data science models often don’t have that blend of capabilities that is required for them to truly operationalize the model. We end up with a scenario in which there are a lot of pilot models, the number of models that are validated are fewer, and the number of models that are operationalized is really, really small. Obviously these things will change in the next five years, so we’re at a very exciting juncture, but it will require a serious level of thought on the part of the stakeholders to be able to actually achieve the validation operationalization, which is one of CitiusTech’s core value-add to our customers.

Do you have any final thoughts?

Our company is on an interesting trajectory where are helping our customers drive innovation in healthcare. We are also seeing tremendous growth from a business perspective. I’m really excited about the kind of work that we are doing for the segments that I described. We are setting up a very strong advisory board that we will announce in the next two or three weeks. We’re doing other things to drive the growth of the company both organically and inorganically, actively engaging with other companies that may have complementary skills and solutions to ours. I’m really excited about the growth part of the company and looking forward to the next five years.