487: OtisHealth with Marc Mar-Yohana

Introducing thoughtbot's ongoing maintenance service. Need reliable support and maintenance for your software? Look no further. Our expert team handles upgrades, bug fixes, UI adjustments, and new feature development. And the best part? Our maintenance packages start at just 5k per month for companies of all sizes. From Ruby on Rails to Node, React, and, yes, even PHP, we've got you covered. Trust thoughtbot for top-notch support and optimized performance. To receive a custom quote, contact [email protected]. Marc Mar-Yohana is the CEO and Founder of OtisHealth, a personal health application and platform for patient-caregiver engagement, population health, and clinical research. The conversation revolves around the origin and working principles of OtisHealth, a healthcare app designed to consolidate health information. Marc was motivated to start the app following the tragic death of his eight-year-old daughter, Constance, from an undiagnosed brain tumor. Despite being under the care of multiple health providers, the fragmentation of her medical data meant they missed the signs of her condition. Marc has dedicated his life to developing better tools for families and caregivers to manage their loved one's health. He aimed to create a unified system where all health data could be gathered, enabling caregivers, patients, and medical providers to see the whole picture. OtisHealth allows patients to integrate data from different sources, including wearable devices, and capture information outside clinical settings. The initial outreach strategy of OtisHealth through consumer channels was slow to get traction. The company switched to recruiting through organizations with health interests, such as health insurers or "payers," leading to a significant increase in users. Although not everyone uses the app daily, it is a crucial health management tool for those with chronic illnesses or emergencies. The trustworthiness of OtisHealth is demonstrated through accreditation from the Electronic Healthcare Network Accreditation Commission, indicating that their practices meet or exceed federal regulatory requirements and industry guidelines. This, along with community outreach and educational content, helped build trust with users. Marc's diverse corporate background gave him the skill set to lead OtisHealth, emphasizing the importance of team development and collaboration with other organizations, even competitors, to move the mission forward. __ OtisHealth Follow OtisHealth on Facebook, LinkedIn, Instagram, or YouTube Follow Marc Mar-Yohana on LinkedIn. Follow thoughtbot on Twitter or LinkedIn. Become a Sponsor of Giant Robots! Transcript: VICTORIA: This is the Giant Robots Smashing Into Other Giant Robots Podcast, where we explore the design, development, and business of great products. I'm your host, Victoria Guido. And with me today is Marc Mar-Yohana, CEO and Founder of OtisHealth, a personal health application and a platform for patient-caregiver engagement, population health, and clinical research. Marc, thank you for joining me. MARC: Victoria, I'm honored to be here. Thank you so much for inviting me to join you on this podcast. VICTORIA: You're welcome. I'm excited to have you. So, why don't you just tell me a little bit about what's going on in your world right now? MARC: Well, OtisHealth is keeping me pretty busy. So, I live in Northern California. My team is mostly in California, a little bit in Illinois. And we're busy every day, both supporting our members and working with clients. And so, it's exciting times, especially on our advocacy front. We work with organizations across the country to advocate for patient access to their health records and also for individuals themselves to improve their access to quality healthcare wherever they reside in the United States. The advocacy, the work with our clients, and the work with our members keeps us super busy. Although I do still try to make time to hike in the beautiful scenery out here. I'm new to California. I'm originally from Illinois, so it's great to just be able to get out every once in a while for a hike in the area. VICTORIA: That's wonderful. Have you made it to any redwood forest out there? MARC: Yeah, Muir Woods, which is just north of us, north of the San Francisco Bay Area. Most of the time, we like to walk the coastline. So just north of Santa Cruz is a great state park known as Wilder State Ranch. And they have amazing views of the coastline, wonderful views of birds, as well as occasionally spotting whales, and dolphins, and sea otters along the coast. VICTORIA: That's so cool. I had a friend, actually, who just went up there and went kayaking with the otters, and I'm very jealous. [laughter] It sounds beautiful. MARC: Yeah, that can be fun. Otters are really cute creatures. And they can be aggressive too. There's a concern right now. There's one female otter that likes to grab people's surfboards. And I saw a video of a sea lion jumping on top of a sea kayak to steal a fish from a fisherman. VICTORIA: I think if a sea otter or a sea lion wanted my vessel, a kayak or surfboard, I mean, you can have it. [laughter] You worked this hard. [laughs] MARC: Yeah, they're pretty aggressive. They're more comfortable in the water than we are, so they [laughs] pretty much are in charge in the environment. VICTORIA: That's right. We're in their house, right? So, I'm, like, okay, [laughs] you can have it. That's great. Oh, wonderful. I'm glad you still have time to get outside and enjoy hiking with your family, even though you're a very busy founder [chuckles] and very active advocate for your community. So, why don't you tell me how everything with OtisHealth got started? MARC: So, it started with a tragedy, a horrible tragedy in my life. My daughter, Constance, who was eight years old at the time and had been previously diagnosed with autism, apraxia of speech, and epilepsy, died from an undiagnosed brain tumor. She had great healthcare. She had a neurologist, a pediatrician. She had therapists that saw her five days a week and, of course, her parents watching over her. Yet, we all missed the symptoms, the major illness that claimed her life. And so, because all of her healthcare providers were on different systems, and as parents, we didn't have a system, there wasn't a place to put our observations together. And everyone attributed their observations of her changing condition to other medical concerns. And so, after she passed, I started to spend a couple of years trying to understand what happened. And I realized a big part of it was the information was in front of us. It was just in different people's hands. And when we put it together, we could have seen the whole picture that would have shown that she had a more serious illness. And so I chose a new mission in my life: to abandon my corporate career and move into this role of developing a better set of tools for families and caregivers to manage their loved one's health. And so, our mission today is to work with families, caregivers, and people with chronic illness to give them better tools to manage their everyday health and the health of their loved ones, and thereby also improving lives in the community. VICTORIA: Well, I love that out of the tragedy, you were able to find direction and purpose to solve this major problem, which I can relate to having moved across the country. Your medical records don't come with you. You have to basically kind of start all over, or they have to go get them from your past patients. It's not unified as a system, as you might think that is. [laughs] MARC: That's absolutely right. Our data is spread out across different clinical sources. Just in the time I moved out here to California from Chicago, I saw five different providers just because I wanted to get some tests done. So, I had to go to a few different locations to do a normal battery of tests. And so, I had at least five different health records created just when I moved out here. And they're all in different systems, and they're not even on the same type of application. So, to bring them together, I had to basically download them and put them in files on my desktop computer. With OtisHealth, I'm able to retrieve that data and put it onto one continuous record and watch it. But that's still just our clinical data, meaning data collected in clinical settings. We have more data to share of things that you and I observe as regular people or our families observe. And so, the part that's missing in the record is all the observations in the time that we're not in the physician, in a physician's office, or in the presence of a clinician. We can; with our tools today, such as wearable watches, or blood pressure cuffs that are Bluetooth-connected, we can get a lot more data and share that back into our records so that we have a true baseline, not the once-a-year that I go to see a physician, and they say my blood pressure is high. And the next time I go, it's low. It's because we only have two data points over two years. Where today, with our technology and our capabilities, we can have a baseline of true data continuously throughout the year that will give the physician or care team more insights into how we're doing in terms of our health. VICTORIA: That's so interesting. And it makes a lot of sense to me why someone would want to use this or why doctors would want to use this. And I'm curious, once you had this idea, how did you get that initial traction to get started with OtisHealth? MARC: Initially, it was a little difficult. And this is kind of part of our lessons learned when we started the company. We started advertising on Facebook. This is after we launched the product. So, we launched in 2021. We had the idea that we were going to make this available to a lot of people. We knew a lot of folks that needed it. It was okay to get the first 100 or so people because there were folks that we knew needed the application or folks that were curious about it and wanted to try it. And we started advertising through consumer channels such as Facebook, and LinkedIn, and other magazines to people that we knew had the need for the app. Yet, it was a very slow uptake. And the part of what we learned and we started applying to our marketing or our membership development or recruitment thesis is that the health records are kind of like an umbrella. We don't think about the umbrella or going out to get an umbrella until it's raining, and for most people, it doesn't rain very often. And so, it's not something that people would use every day. In most cases, they use it only when they have an emergency or when they're managing their chronic illness or the chronic illness of a loved one. And so, we eventually changed the way we were recruiting and started recruiting through other organizations, such as clients where we're able to get thousands of users through the client that has members. And then, slowly, over time, teach them the importance of managing their everyday health, and taking their own vitals, and recording that, and they record for themselves and their family. VICTORIA: Right. So, you were able to offer the app for free for daily users because you found another group that was interested in having access to the data and having this app, right? MARC: Yeah. So, anybody today can go to the Apple Store or the Google Play Store and they could download the app for free. And they can use the web version also. And they could share it with friends and family, which I always encourage people to do. So, if you have an emergency contact, invite them to your medical records; at least they have your basic medications, and allergies, and other key information in case of an emergency. What we did in terms of our change of strategy early on is we started going to organizations that also had an interest in improving the health of their population and, in particular, health insurers or what we call in the industry payers. And so, payer organizations could be Medicaid, Medicare, or it could be employee health plan, one of the big health insurance companies like Blue Cross or UnitedHealthcare. They have an interest in people managing their everyday health. And so, one of our clients right now, everyone that enrolls in one of their plans automatically gets enrolled in a version of OtisHealth specifically for their members. And those members could still invite people to join them on the platform, and those people can get on with OtisHealth. But the nice thing is now this payer has a way to both encourage healthier activity or healthier practices for their population and monitor if there's a problem. So, if somebody is missing medications, or not taking their medications on time, or has vitals that are tracking poorly, this gives the payer an opportunity to reach out and ask them if they need help managing their health. VICTORIA: So, how does that dynamic affect how you measure successful engagement on the platform, like, a successful rate of engagement? MARC: So, for us, most people don't use the app every day. Most of us don't even think about our health [laughs] on a daily basis from a standpoint of our medical health or clinical health. Sometimes those of us that exercise regularly think about it in those terms or eating healthy. But we don't think about keeping a record or using an app to maintain our health. And so, for us, an active user is anybody that's logging in at least once a month to update their information. Our really great users are the ones who are using the reminder features to take supplements or take their medications. And so, I would say of the few thousand users that we have—we're approaching 10,000 right now active users—only a small percentage of those, maybe 10%, are actually using it on a daily basis for themselves or their family. And so, for us, a good engagement and good practice is folks setting reminders on at least a weekly basis to take vitals, weigh themselves—something that would help them track their health over time—and if they're taking medications, to set daily reminders for the medications that they take. And so, we currently have far more people enrolled in OtisHealth and that, you know, 5,000, 6000 I mentioned that are active. But they basically bought the umbrella, and they just put it in their closet. They're waiting for that rainy day that they have to pull it out and start using it. VICTORIA: That makes sense. And I'm already in my head going through the people in my family who would benefit from this where, you know, I have family members who have a learning and a physical disability, and tracking everything that they're supposed to be doing to maintain their health is quite difficult. So, I can definitely see the value in that and why people would want to use it. And I think for, you know, healthcare apps, you have to build this high level of trust. You know, people are giving you all this data about their health information. So, how do you go about building a product that people can trust from the beginning? MARC: One of the things we sort early in the life of OtisHealth is an accreditation. An accreditation is not required by law. It's not required by any institution necessarily. It's a third party that reviews our practices and our systems to see if we're actually following good privacy and security standards and practices. And so we went live in November of 2021, and by the end of December of 2021, we already had our full accreditation in what's called a comprehensive level from a national established organization known as The Electronic Healthcare Network Accreditation Commission. And so, that was the first step of making sure that folks understood that we took their privacy and security seriously. That accreditation means that our practices and our technology meets or exceeds federal regulatory requirements and industry guidelines. And that's just the first step. Then after that, it's really a matter of people gain their trust because an accreditation itself doesn't necessarily mean that we trust that brand. That's just a basic starting point for us. After that, we publish articles about maintaining health. We have launched some videos about different aspects of our advocacy, such as with autism for caregivers. And we participate in community activities at the national level to improve patient access and to talk about how important it is to manage our own health and the health of our loved ones. And so, it's a combination of both basic accreditations that show that we made the investment, and we provided a third party to critique us and to review us. And we actively maintain that accreditation is not a one-time stamp. And then, the second part is continuous outreach, and letting the community know what we're working on, what's important to us, so that, over time, they start to look at what we do and start to trust it and invite other people to trust it as well. VICTORIA: That makes a lot of sense. And I'm curious if there were experiences from your corporate career that informed how you acted as a founder and what you prioritized. MARC: I've had an odd corporate career. [laughs] So, I started my career as an engineer in manufacturing operations and in product development and then went down to as a consultant strategy in ops and market management, and then, later, investment management and private equity, and then, later, for a safety science company where I was managing global capital investments in technology and new operations. And so, I've been fortunate that I've had a breadth of experience, from marketing to sales, to product and technology development, and infrastructure management. So, I had some basic skills that helped me understand what...well, the endeavor before I jumped into it because I spent a couple of years thinking about whether or not I even wanted to do something like this. And then, I would say probably the most important part of my previous experience that I apply every day at OtisHealth is developing teams and developing collaboration with different organizations. You know, aside from the team that I have, our own staff, we also work very closely with other organizations, even competitors, to make sure that we're all successful. And so, that collaboration across organizations that don't even have a necessarily contractual relationship is something that I brought over from my previous work and seeing how working across the industry, we can help each other and serve the mission. So, I think that was probably the most important part of my previous work experience that I apply today is this: building a team and building a coalition of organizations that want to move forward together. VICTORIA: That's great. And I'm wondering if there was anything that surprised you in that early phase of building collaboration with other companies and understanding your users that changed the strategic direction you were going with in the app. MARC: So, one of the things that I was really just in awe of was how willing people in the healthcare industry were to jump in and help out when we started talking. And so, many of the organizations that we work with, the founders or the senior staff within the nonprofits we work with, all have a story of why they're doing what they're doing. Many are brilliant people who could have taken their careers in many different directions, not in healthcare. And they chose to move forward in healthcare because of some personal experience in their life. And so, as I learned about the people I was working with, I was surprised how quickly they just took me under their wing and said, "Hey, let's get you started marketing. Let's move OtisHealth forward." And so, we have organizations like Onyx and Invitae [SP] that are giving us support in data access. There's another organization that I can't mention yet; that's another private entity that has offered their support, and we hope to launch with them in the next couple of weeks. And so, we're forming these data access bridges to help get patients more access to their data, their loved ones' data. And then, there's the nonprofits in the advocacy and standards organizations we work with, such as HL7, which is an international health technology standards organization, and DirectTrust, which is an organization that establishes trust networks in ecosystems, as well as the technology infrastructure behind how those systems communicate. And we work also with EHNAC, the accreditation commission. So, we not only are using the accreditation from EHNAC, we're on committees to advise them on future criteria for accreditation. VICTORIA: That's really cool. I love that there's that collaboration and just openness and willingness to try to make things better and to invest in solutions together. Mid-Roll Ad: VICTORIA: Introducing thoughtbot's ongoing maintenance service. Need reliable support and maintenance for your software? Look no further. Our expert team handles upgrades, bug fixes, UI adjustments, and new feature development. And the best part? Our maintenance packages start at just 5K per month for companies of all sizes. From Ruby on Rails to Node, React, and, yes, even PHP, we've got you covered. Trust thoughtbot for top-notch support and optimized performance. To receive a custom quote, contact [email protected]. VICTORIA: And with me here, I have Richard Newman, who is the Development Director on our Boost Team, to talk to me a little bit more about what maintenance actually looks like once you've built your software application, right? RICHARD: Hi, Victoria. VICTORIA: Hi, Richard. You have experience building applications. I wonder if you could describe to a founder who's considering to build an application, like, what should they consider for their long-term maintenance? RICHARD: Well, like you said earlier, part of what you're going for with that long-term maintenance is making sure the health of your project, of your application, is always there. And you don't want to be surprised as you're continuing to work with your users and so forth. And so, a number of things that we pay attention to in maintenance are, we're paying attention to keeping the application secure, providing security updates. We want to make sure that the ecosystem, basically, all of the tools and third-party services that are tied to your application that, we're responding to those sorts of changes as we go along. And then part of it is, occasionally, you're going to find some smaller issues or bugs or so forth as your user group continues to grow or as needs continue to change. You want to be able to respond to those quickly as well. And so, a lot of what goes into maintenance is making sure that you're paying attention and you're ahead of those things before they surprise you. VICTORIA: Because what can happen? Like, what are the consequences if you don't do that ongoing maintenance? RICHARD: Well, the security updates those happen across gems and in the platform sort of tools that are there. And so, if you're not keeping those up to date, your exposure, your vulnerability to being hacked, or having a bad actor come into your application start growing on you if you're not doing the maintenance. The other ones that can come up is there's new interfaces that these third-party services...they may be updating their APIs. They may be updating how you're supposed to work with their tool. And so, those can occasionally break if you're not paying attention to what's going on or you're suddenly surprised by an upgrade that you have to make. And then, finally, there's this long-term sort of code change that just builds up over time if you're not keeping it refactored for the changes that are upcoming in a language or the gems that you work with. And then, suddenly, after a while, it suddenly gets to the point where you have a lot of work that you might have to do to rehabilitate the application to take on some of the newer features that are being released. And so, that makes it that much more difficult, that much more friction about being able to deliver updates for your users or to be able to respond to changes that are happening out there in your application. VICTORIA: Right. So, if you don't have that ongoing maintenance, you could run into a situation where, suddenly, you need to make a very large investment and fixing whatever is broken. RICHARD: Absolutely. It's going to be very tough to plan for if you weren't keeping up all the way along and, yes, absolutely ends up being much slower if you have to remediate it. VICTORIA: That makes sense. I wonder if you have any examples of a project you've walked into and said, "Wow, I wish we had been doing a little bit more maintenance." [laughs] And maybe you can share some details. RICHARD: Yeah. We had a fairly large application that involved a number of clinic services. So, we had an application that users were going in every day and counting on our fast response. And, over time, we've got surprised by a database upgrade that had to happen. Basically, the database was going to be changed by our third-party hosting service, and that hadn't been tested. There hadn't been procedures in place when we discovered this need. And there was a very hard date that that change had to be done or else the entire application was going to go down. And it came at a very inconvenient time, at the end of the year around Christmas, that we had to respond to all of that. And had we been in front of it and just updated it every quarter and staying current with it, it wouldn't have been nearly the lift that it turned out to be. We were facing a pretty hard deadline [laughs] there to keep things going. It was very, very stressful and disruptive for the team and potentially for the clinics. VICTORIA: Right. And it always happens around a big holiday or something like that, right? When it all comes to a head. So... [laughter] RICHARD: Absolutely. You want to be in control of the timeframe and not have the timeframe be in control of you. VICTORIA: Right. And if you have a team like thoughtbot supporting you, you can go on your vacation with a little bit more knowledge that if something breaks, there's someone there who can respond and fix things, and you don't have to interrupt your very valuable time off. So... RICHARD: [chuckles] Absolutely. VICTORIA: Yeah. Well, thank you so much, Richard, for joining me today. I appreciate you coming here to talk with us. And we'll talk to you again soon. RICHARD: Yeah, it was a pleasure. Thank you. VICTORIA: You mentioned advocacy. And I'm curious if you could say more about what advocacy are you doing or how does that blend into your business model and what you're doing with OtisHealth? MARC: I'll give you an example. One of the organizations we belong to and I participate in personally is the Health Information Management System Society. And so, this is a professional society of healthcare IT professionals. And in Northern California, there's an advocacy committee that works directly with the state legislature to promote legislation that will improve the quality of healthcare for people in California. We actively talk to members of the legislature to tell them what bills we think are important. The ones we focus on and the ones I personally focus on are the ones that improve access to our data and also improve our privacy. So, there's a legislation in California, as an example, that will prohibit access to people's healthcare data without proper legal warrant. So, it's basically extending HIPAA protections across any health app launched in California. And we, of course, are already HIPAA-compliant, so that's very easy for us. There's also advocacy specific to certain health conditions. So, my daughter had autism. I work with the Autism Society here in California and also Achieve Tahoe, which is an organization that teaches skiing and other skills to people with disabilities in particular. This past season was my first season. I work primarily with children and young adults with autism and other developmental disorders. And then we also partner with organizations when we think that they're aligned with some of our mission. And so we work with the Caregiver Action Network. We also will work with AARP and other organizations regarding caregiver rights and also teaching caregivers how to access the healthcare data of their loved ones and how to take care of themselves personally. VICTORIA: That's wonderful. And I guess it's not really a question, but I saw that autism service dogs are a thing, and I just thought that was really cool. [laughs] MARC: Yeah, OtisHealth is named after Constance's autism service dog, Otis. And so, service dogs are extraordinary animals. They're highly trained. Otis had been trained for two years before we received him. He was trained specifically for Constance's needs, and he kept her safe. And that was the primary interest in Otis is observing things that she...because of her cognitive limitations, wasn't always aware of her surroundings and wasn't always safe. And so, the dog maintained her safety and her boundaries and kept her focused, as well as just basically blocked her if she was going to do something that was unsafe. So, there are many different kinds of service dogs, and I'm talking specifically about ADA, the Americans with Disability Act type service dogs. These aren't, like, companion dogs or therapy dogs. These are truly highly trained animals that are focused on specific tasks to help an individual be safer, more free, or have more abilities than their disabilities may allow. VICTORIA: Well, I love that. And I like that the app is named after her dog as well. That's just very sweet. And I love that that's how that worked. And I'm curious, what's on the horizon? What are you most excited about for OtisHealth in the next year? MARC: Like all startups, we have [laughs] a lot of plans. And we've been invited to speak at some conferences. I spoke at two already this year. And I have another one coming up in Washington, D.C., where we're going to advocate, again, for patient access. And this is primarily talking to the health systems themselves in adopting technology that makes it easier for patients to securely access their health records. And so, we're excited about that movement in the industry to recognize and start to act on that need for patients to be able to access their health records. And we work with our partners to promote that and also with the federal government. We work with the health and human services to promote this access. And we were published in a report earlier this year because of our technology demonstration with health and human services. And it sounds like it's finally getting some real traction in hospital systems. And members of the Federal Congress are also saying that this is something we need to move forward with in a more aggressive manner. On a more direct path, we're excited our membership's growing. We've had tens of thousands of people register to use the app, with thousands actively using it today. We're working on some new programs right now for payers and for providers that will improve health outcomes and within their populations, as well as bring on hundreds of thousands of other people on the app. We're really excited to know that we're getting both recognized for the work that we're doing and that people are starting to understand the importance of managing everyday health, whether it's with OtisHealth or another application. VICTORIA: Well, I love being excited for these opportunities to advocate for your product and for the mission behind the product. I'm not going to recommend being excited about going to D.C. during the summer. [laughs] Last time I was there when I landed at 9:00 p.m., it was 90 degrees outside [chuckles] and humid, like, 90% humidity. But it's great to have access to people who care and are trying to make things better and have that voice. I'm excited to see you grow. And then, it's been two years since you started the app. I wonder, if you could go back in time to when you first were getting started, what advice would you give yourself? MARC: So, this is a really hard thing for anybody to look back and say that they'd like to change a few things. There are things I would change. I have a lot of experience managing large, sophisticated programs. Because in the past I had large budgets, it was really easy to maintain strict discipline around the implementation. And I think I was too loose in the implementation process at the onset of OtisHealth. I would have been more disciplined around my program management and the accountability that I had to developers I was using. As a startup, I didn't have a large development team in-house. I needed to use external parties. And I should have been a little more closely on top of that process. The other things that we experienced were primarily a result of pivots. We were constantly pivoting as we were learning. I think having a team to review our process and pivot more quickly is really critical. You don't want to pivot 20 times a week. You need to stay focused for a while, but also having friends or advisors or members of your team that can help you assess when a pivot is necessary, or a new opportunity presents itself, I think, is critical. And so, we all know, as founders, the team is key. And I think the earlier you engage a team and not be bashful by asking for advice, the better. VICTORIA: I love that. And I'm curious if you have any advice from your program or from your startup career now on choosing the right development teams. And how do you find those right partners to actually build the app and have that accountability? MARC: So, I would say the number one thing that I've learned, that I knew previously, but I really appreciate it more now as a founder of a small company, is you need mission alignment, not just company to company, but person to person. And I took my time picking advisors to join us, and I took my time getting people on board to OtisHealth. We pick folks that we believe understand what we're doing, and we take our time and make sure that they appreciate it and that we're comfortable with them. Our startup is too small to make a bad hire or to have the wrong perspective because somebody has other motives, such as just making money. If I was providing advice in terms of picking teams or picking vendors to work with, I would say take it slow. Don't rush, even though you may be in a rush, or we may be in a rush to get moving, either for financial reasons or personal reasons. It's important just to feel comfortable. Get to know folks. Meet them in person if you can and spend a few hours with them at a time [laughs], just to make sure that they believe in you, and you believe in them, and that you have a common vision. Because when things get rough or tough, financially or otherwise, you need people that are going to be able to stick through it and work with you. VICTORIA: That makes a lot of sense. There's a lot of pivots happening. You want everyone to be on the same page. And you don't want to have to be corralling everyone all the time if they have competing priorities, so that makes a lot of sense. MARC: Absolutely. Just to be clearer on that, we all run into challenges. So, in some cases, we had to make some financial sacrifices, and everyone did it together. You really need people that are that committed that say, "Okay, I understand where we are, and so, I'm willing to take a pay cut for a while or not get paid for a while until we can get this spec started again." Even vendors I work with today that are strategic vendors understand that and have helped us financially when we need some time to get more revenue in. VICTORIA: Great. And so, when you were building a healthcare app, was there people you needed to have on your team who had that exact specialty in either patient care, or medical records, or something like that? MARC: Yes, yeah, you need experts. So, I'm a quick read. I mean, I spent a couple of years learning the industry and understanding the technology. But the person that's our IT director he has over 25 years of experience in healthcare IT systems, so he is the expert in-house. We also have advisors on our team that are experts in payer services and payer systems, launching healthcare apps, managing standards, and managing SaaS services. We have a data and an AI expert, and a clinical research specialist. We also have physicians we refer to. [laughs] So, we have a pretty big entourage of individuals that we go to for very specific advice and work. VICTORIA: That makes a lot of sense. Let's see, what question should I be asking that I haven't asked yet? MARC: You know, I think most of the people listening to this podcast are technical founders. And it was surprising to me, and I had some founders contact me, asked for some free advice, which I'm happy to do, but they didn't seem sincere in their interest in being in healthcare. And one thing I told them, and I would say to anybody that's interested in being a healthcare technology developer, is you have to have a reason to do it besides the money. It will be a really hard battle to move forward with a technology if the only motivation is a financial opportunity. That isn't going to sustain the pivots or the development. You'll run into a lot of walls, primarily because everyone will see it. Everyone in the industry sees those players come in that just have a financial interest, and the consumers see it, and they don't like it. So, my advice to anybody that wants to develop technology in healthcare is you have to be a little sincere about it and have a real reason to do it beyond just making money, and I think you'll find it more rewarding. There's so much need for healthcare technology and better technology out there. So, I welcome folks to join the fight, the battle, or the opportunities. But I would say that just come in with the idea that you're helping people, not just making money. VICTORIA: I think that rings true for any business you're in, right? But especially in healthcare because it is this big target. Even in consulting, if you're doing business development and you're thinking of working on health IT projects, there's just a huge market that you have to narrow down and figure out where you're going to be. So, if you don't have that intrinsic motivation, it can be overwhelming and scattered, and then people won't connect with you, right? Because everybody is going after the same thing. MARC: That's exactly right. One of the conferences I went to earlier this year, a speaker got up and said, "People invest in people, or people make deals with other people." We talk about companies signing a deal with another company, but it's really one person trusting another person. Whether it's in healthcare or another industry, obviously, that trust needs to happen. At some point, if I don't trust the individual I'm talking to, I'm less likely to have a deal with that company. VICTORIA: Right. It's like; I don't know how, you know, it doesn't really matter how impressive your credentials are. If there's not a basic level of trust, you might not move forward with it, so that makes a lot of sense to me. MARC: Yeah, that's absolutely right, Victoria. VICTORIA: Absolutely. Is there anything else that you'd like to promote at the end of this podcast? MARC: I'd love for folks to try OtisHealth. If you have family that have chronic medical needs or need help managing their medical information, please download OtisHealth, help them join. There are videos on YouTube that explain how to use it if you need some guidance, but we believe most of it is self-explanatory. We are continuously adding data access points. We're going to be launching this week new versions of OtisHealth that have access privileges for people in New York and Nevada and parts of California and Colorado. And so that means that with the app, once you're ID-proofed on the app, you can use it to get your medical records from different sources without having to log into all these different patient portals. So please try it. Use it for yourself but especially use it for your family or anybody who you care for. We'd love to get your feedback as you use the app too. VICTORIA: That's great. And I'm actually already thinking about...next week; I'm going to be going to The San Diego Annual Veterans Stand Down, where anyone who is experiencing homelessness can come in and get access to all the services that they might need, whether it's legal, or healthcare, or dentistry, showers, food, all of these things. And I'm curious if that organization might benefit from having a tool like that for their users. So, I'll be talking about it. [laughs] MARC: Oh, thank you so much. That'd be wonderful. Thank you. VICTORIA: That's great. Well, thank you so much, Marc, for joining us. MARC: My pleasure. Thank you, Victoria, for having me on the show. VICTORIA: Excellent. You can subscribe to the show and find notes along with a complete transcript for this episode at giantrobots.fm. If you have questions or comments, email us at [email protected]. And you can find me on Twitter @victori_ousg. This podcast is brought to you by thoughtbot and produced and edited by Mandy Moore. Thank you for listening. See you next time. ANNOUNCER: This podcast is brought to you by thoughtbot, your expert strategy, design, development, and product management partner. We bring digital products from idea to success and teach you how because we care. Learn more at thoughtbot.com.Special Guest: Marc Mar-Yohana.Support Giant Robots Smashing Into Other Giant Robots