E104: Niko Skievaski, co-Founder and President at Redox – Interview

March 30, 2017


This interview is with Niko Skievaski. Niko is already a legend in Madison, and he just turned 30. He’s the President and co-Founder of Redox, which is the API for electronic health records.

He was also recently named to Forbes 30 under 30 in healthcare. Before Redox he co-Founded 100state which is a co-working, incubator space. It’s original and cool.

Niko is based in Madison so I was lucky enough to do this interview in person.

Here are some other things we talk about:

-Why did you work at Epic? What did you learn there?
-Why did you start 100state?
-What’s the authorization process to gain API access to EHRs across different health networks?
-How easy does Redox make it to connect to EHRs?
-Will you keep Redox’s headquarters in Madison?
-Do you still meditate before meetings at Redox?

Dave Kruse: Hey everyone. Welcome to another episode of Flyover Labs and today we are lucky enough to have Niko Skievaski with us. And Niko is already a legend in Madison and he is not even 30. He is the President and Co-Founder of Redox, which is essential to API for Electronic Health Records which Niko can give a better description of. He was also recently named Forbes Under 30 for healthcare and before Redox he Co-Founded 100state which is a co-working incubator type space in Madison which is quite original and cool. So Niko is actually in Madison as I mentioned. So I am lucky enough to be doing this in person. So yeah, let’s get started. Niko, thanks for coming on the show today.

Niko Skievaski: Yeah, happy to be here.

Dave Kruse: Yeah, so you’re young but you still have a pretty impressive background. Can you tell us kind of how you got to where you are right now?

Niko Skievaski: Sure yeah. So I’m originally from Phoenix, although I was born in Hawaii, which is where I get vague ethnicity from.

Dave Kruse: Your good looks.

Niko Skievaski: Yeah, and I went to Arizona State for economics and while I was doing that I worked at Wells Fargo as an analyst, which is really kind of a cool way to go through school, because I got to apply what I was learning like every day. And I think that’s something in the entrepreneurial sense you have to learn quickly and apply what you learn quickly to get moving in whatever direction you are going and so I got used to doing that really early. So I worked at Wells Fargo for four years as an analyst through undergrad and after graduation and then went to graduate school for more economics at Boston University. I was there for – I thought I would be there for six years going a Ph.D., but after a course, after a year and a half course I decided I didn’t want to be a professor and…

Dave Kruse: Why is that?

Niko Skievaski: I realized that it was too theoretical and I wanted to figure out how to again apply the economics I was learning into the real world and when you get into the academics side of economics, it’s very much like making models up that you hope to describe the way the world works, but you are really just trying to put math into the world, and which almost seems like an artificial way, because you create the mathematical model that you think represents the world and then you stop the model and then you say, if it had been in the real world, this is what we could expect and then you kind of test it and it seemed too out there, a little too metaphor for me. I wanted to figure out how to make change in things in day-to-day life and actually that’s why I found myself in healthcare, because as an economics grad student I started looking at the healthcare industry as an area that was just you know torn up with miscellany incentives. So you have doctors who get paid every time they order meds or procedures, so they want to do more of it. You have payers who want to keep patients out of hospitals and pay for you know, not pay for – essentially the less they pay for the more money they make, so they have this reverse incentive. We have hospitals who get paid the longer you stay in them, which means that you know they keep you another couple of nights and they get paid more, which might not always be right for your health. So there were all these miscellaneous incentives and so I stated looking at first off what causes those incentives to miscellany and then what are the effects of those miscellany incentives and that amounts to just a terrible amount of inefficiency in the healthcare space. And so within that inefficiency there is you know probably a 100 economic dissertations that can be written. The area that I stated looking at was technology and saying, okay, if there is all this inefficiency technology and the adoption of technology, really technology is synonymous with efficiency. We adopt technology in the world so we can become more efficient and so I said well, what technology is becoming adopted or is not being adopted in healthcare and how could that contribute to efficiency gains an that’s what got me looking at electronic medical records. So I first heard about Epic as I was researching technology and healthcare. Epic is one of the largest electronic medical record companies in the world. They supply or they have medical records for something like 60% of the U.S. population and so I started looking into how I can talk to Epic. I thought maybe I could get my hands on their data and go with it, and…

Dave Kruse: Easy. [Laughing]

Niko Skievaski: Yeah, I thought well you know if you have 60% of the U.S. population, maybe we can slice and dice that data and figure out where there are some you know places to have efficiency gains and you know save lives and actually apply some of this looking at analytics and data to improve healthcare. So I started talking to them and Epic is traditionally know for being a closed off kind of private company and I found that the only way to really talk to them was through their recruiting channel. So I ended up talking to someone in HR and they eventually offered me a job as a project manager and anyone who knows me knows that I’d be a terrible project manager. But they offered me a job as the project manager. I turned them down and I was like no, I’m not really looking for a job. I’m an economist I’m trying to figure out you know how we can use some of this data and make the world a better place. And around that same time I was realizing I didn’t want to go into academia at Boston University where I was in grad school and then Epic got back to me a month later and offered me a job as a pricing analyst. So I was like oh pricing, that’s economics; you know we have a market leader in the industry. They need to figure out how to charge the customers and if I’m working there off kind of the inside scoop on how this illusive company works. So I accepted the job and picked up and moved to Madison. I had to…

Dave Kruse: What year was that?

Niko Skievaski: That was 2010, yeah. So I was on the airplane from Boston into Madison and literally looked at the back of the airplane magazine where they have the map of the county and it was like oh that’s where I’m going. I didn’t…

Dave Kruse: Serious.

Niko Skievaski: My Midwest geography is quite poor. So I moved here, worked at Epic, had a blast while I was there, realized in my first month at Epic that probably something I should have realized long before I accepted the job, but realized that Epic doesn’t have that data. They provide the software to house the data, but the data itself is kept in the basements of health systems across the country. So you know Keizer…

Dave Kruse: In stores.

Niko Skievaski: Yeah, all these big health systems who use Epic literally buy the software from Epic and then run their own database in a data center that they manage that doesn’t talk to the health system down the street and it doesn’t talk to the internet. It kind of sits there managed on an Epic server and so that was pretty disheartening, figuring out.

Dave Kruse: Yeah.

Niko Skievaski: You know the data, they talk to each other. But also you know there are other reasons that it made sense to digitize healthcare than to combine the data together and that’s why Epic became successful and other EMRs were adopted and that was because even if we were not combining the data with all the patients in the country, we can still streamline workflows of health systems and say, how can we help a doctor provide care more efficiency to a patient, how can we help multiple providers collaborate around a patient’s care and so that was one of the things that electronic medical records helped with and then there is the backend process of how do we document what we have done with the patient and send that to the insurance company and so I learned all about that while working at Epic. You know I bounced around to six different offices in my couple of years, three years that I was at Epic. So I wasn’t a pricing analyst for long. I found out that another thing that Epic does in a sort of unique way is pricing. They don’t change their price.

Dave Kruse: So what were you analyzing there?

Niko Skievaski: Exactly. So they – and they do this out of fairness. Epic is one of these companies that has this, you know they believe in being fare to all of their customers. Sometimes they work with children’s hospitals, sometimes they work with academics. You know a lot of these guys are non-profits. So they say okay, we are going to charge a certain price for the size of the health system regardless of who they are. We are not going to negotiate. We are not going to change that price because if we raise the price, it’s not fair for the person who pays the higher price that we sold it to someone last year for a lower price and if we lower the price, it’s not fair to the people who paid the higher price last year. So they have this sort of mindset of our price is our price, take it out leave it, which meant that as an analyst there is not really much to change once the price is set. And setting a price only happens every time a new product comes out, which is you know not very often. So we had a team of seven people as pricing analysts who are basically reading prices and calculating how big a health system is and giving a price to the sales team, which was a pretty. It was a job that you got and you could say you know we had this price list; we can just kind of automate this. So I did a lot of automation work and essentially automated myself out of the job in my first month there and you know we built a better way to get a price of that. It was not rocket science, but that landed me in a job where I worked with Epic’s kind of number three. Sometimes in the press they call their CTO, but I basically worked with him as he started managing the consulting arm of Epic. There are people who are in aero planes every week flying out to health systems. So I worked with him probably 2.5 years in that job kind of on special projects, different things that both from a strategic level, as well as like the tactical level and just getting the job done and in that process got to work on a lot of really kind of the innovative projects that were happening within the company. That’s where I met Luke and James, my Co-Founder for Redox.

Dave Kruse: What was one of those projects or what was one of those special things that you…

Niko Skievaski: So the first project was one that actually led me to leave Epic and it was data information sharing software. So one of the challenges was Epic has hundreds of customers across the country and for the most part they are all trying to configure the software to do the similar things like you know the check in work flow or the putting a patient in a room workflow, like what are all these work flows and Epic is really customizable, so you can get creative on how you do it and each healthy system was kind of recreating these new ways to do it. And so I wanted to figure out a way for us to share that information across all the different projects that were going on. So I did some Googling and found myself on stock overflow as you typically do when you Google technical problems and realize that stock overflows are beautiful solution to solve this problem of what are the ten different ways you can do one thing and people can, if you are having a stock overflow most developers will probably find themselves in that website a couple of times a day whenever they Google like ‘how do I use Java Script to transform a yada yada…’ a bunch of other developers can answer that question before and they contribute and say, well you can do it this way and someone else will say, well that way is okay, but I’ve tried it this way and essentially the community works up and down answers. So I thought this is a brilliant solution. It’s kind of like a modern forum, it’s like core all right where you can ask whatever you want and you’ll get great answers from the community. So I rolled that out of that pick. We found an open source version of that software and I rolled it out you know without asking anyone’s permission or without any resources. I was teaching healthcare economics at that time and instead of bringing the new hires in and teaching them health care economics, I said everyone log into this platform and ask whatever question you want. And someone asked a typical new hire question at Epic which was why doesn’t Epic have a gym, like a typical question that new hires ask. Someone else ask the question, well answered the question and said I think it doesn’t have a gym because try and probably support the local gyms in our community and so it they had a gym it might take business away from those guys, which is an answer that you know I’ve heard before and is a viable answer. And so that started the strand of people that I picked using the software and within six months we had most of the company like as users asking and answering people’s questions online. And so I was – clearly was working with the demographic of people that worked within that organization and I eventually left Epic because I wanted to bring that software directly to Epic’s customers, which is not something that I thought I could do internally. Oh! And you originally asked this, as to how I found these Co-Founders. Through that project I actually met both Luke and James. I met James, because James was rewriting the search engine for Epic that indexed all of the files that Epic had in its internal serves and all of the resources and he wrote a – he literally replaced Google and Epic with an open search engine that he stood up there and I was meeting with him, because I was like hey you have to index this question and answer platform, because we have a lot of knowledge here, so let’s get this on your search engine. So I met him through that and then met Luke because Luke was running kind of an innovation group in the implementation team and we met as the team was talking about like what are the different ways that different people within the implementation team could and should be using this question and answer platform. So kind of got to know both of them through projects that really you know 90% of their day job is working with customers or like their co-working and these were their side projects, like how do we actually innovate and make the company better. And so I really like that about them that they are spending their kind of extra time, which you don’t have a lot of working on you know outside projects that weren’t part of the scope of their typical job, which I think is common among entrepreneurs. You always find them tinkering at things that…

Dave Kruse: You’re curious about it, yeah.

Niko Skievaski: Yeah exactly.

Dave Kruse: Did you guys all leave at the same time?

Niko Skievaski: No so what happened was, I left in March of 2013, yeah. March of 2013 I left Epic to start a company called Breadcrumbs, which is that question and answer platform on the outside. So I left and we rebuilt the platform and started talking to health systems and it was interesting because now I wasn’t working at Epic, but I was in Madison and it was my first time where I was downtown on a week day, and I say all the people and like people walking around the square and the vibrancy of the talent and I was this is amazing. It’s a great city to live and work in, because before that every day I was going out to Epic’s campus in Verona. So I started seeing all these great things that were going on in Madison and trying to find other people to work on things with, because I was doing my company and we had three people and our start up, but it can get really cozy working with a couple of people all day. Like you need a community to help support new ventures and I found we had a start up, like a meet up going on with capital entrepreneurs that had been going on for years before. I had become an entrepreneur but that was something where once a month everyone drink beers together and everyone share their stories and networked around their problems and their companies and I through that was awesome and I said like why isn’t there a place where we can do this every day, like have a place where you can go and work on your startup, have a table and sit down and do whatever you are going to do but be a part of a community. So simultaneously while we were doing Breadcrumbs, we tried to figure out like how can we create a space where you have that and at Epic I think one of the things I loved about Epic was the people you got to work with on the diversity of different projects. I think a lot of people on college have a similar experience where you know college is half about the people you meet and you relationships you build, may be more than half right, and you know that’s so much part of the learning process too is collaborating. So you know Madison is a college town. The second biggest thing people do in Madison is Epic and we thought, well what if we built a place where people who were graduating from the university, people who were leaving Epic and looking for that next thing to do could go and just hang out and work on whatever they are working on, but find other people to do it with. And that was the original idea behind the 100State was you know I had my startup, I knew a couple of other people who had startups and we said look, why don’t we share an office and open it up to the general community and say, come and share this office with us. I don’t care if you are a lawyer or a if you are graphic designer, photographer or starting a company or a student and just want a different place to study, like come and hang out with us here and we’ll go to lunch to together, we’ll throw events, we’ll drink beer, but we’ll be friends and that was, yeah, that was in the sort of summer of 2013, because we first were in a train car, so we have this weird train car parked on West Washington there. It’s like…

Dave Kruse: That’s where you started. I remember going to the Blue Tree, that’s a space that…

Niko Skievaski: Yeah, so before that we were at Train Car. Yeah so we – Breadcrumbs as a company, you know we were looking for place to have our office and we didn’t have any money, we never raised money and there is another company called WHOS-IN, which was Michael Gazzaniga and some other folks and they are like hey, let’s get this Train Car. Its only $700 a month and it was the caboose of the train, the last car. It was a terrible little office space, you know couple of 100 square feet, but $700 bucks a month and we can get internet in it and so we are like okay, we are in, so we paid a couple of 100 bucks, they paid a couple 100 and then we started trying to get other people. So we got a photographer to come join us, we got a marketing guy who is like a marketing consultant and they just rented the space for $50 bucks a month and we covered the rent and had probably 10 people in there and that’s when George from Blue Tree came to the office and he said hey, I’m with you know a slightly larger startup. We are thinking about getting a new office space, but its way too big for us. Would you want to move your whole caboose co-working experience into our office with us. So we went and looked at it and that was the 100State office. So half of it was Blue Tree, which is an Epic focused consulting company. The other half was this hodgepodge of startups.

Dave Kruse: Is that when 100State become more official?

Niko Skievaski: Yeah, that’s when 100State become 100State.

Dave Kruse: Yeah, that’s…

Niko Skievaski: Before that we were just like people on a Train Car and we threw like radios on this Train Car and it was so fun and we are like okay, now we can go bigger and take this to an office space that at the time seemed just ginormous. I think it was – I don’t know the square footage but it was way bigger, you know 15 offices, like a main co-working area. So we moved in there, one of the first things we did at our 100State was we threw TEDx Madison. So the folks who were involved in organizing 100States had like what sort of event can we draw the innovation community in with and so we put on TEDx Madison and we got 10 speakers from around town talking about innovation in Madison and it was at that event where I met James again, who I met from Epic but I was like oh! You are not working at Epic anymore, what are you doing? He is like, I don’t know. I just quit like last week.

Dave Kruse: So this was not coordinated.

Niko Skievaski: No.

Dave Kruse: Wow!

Niko Skievaski: Yes.

Dave Kruse: That’s serendipity you got going there.

Niko Skievaski: Well and that’s the point of these innovation communities, is to create moments of serendipity. So James was at TEDx. He came to the after party that we had at the 100State. He was like, what is this space? I got to get involved. So James became an active member and eventually on the board on a 100State as the co-working space group from you know the kind of 10 of us plus the consulting company that was in there to probably go to maybe a 100 people in that year we were in that space, to fast-forward to our 100Sates story, eventually moved across the street to a space that was like twice as big and that was just a 100States. Blue Tree had moved on their own office by then and that co-work community grew to about 200 people and we started doing designated offices and designated desks, kind of building the pipeline of like you start as an individual, kind of in the main area going to events and hanging out and networking. Once you get an idea and you team you move to a table you can call it yours, you can start collaborating with your team, maybe you are talking to investors and things like that, you need to pop out into an office every now and then once you become even more established, maybe have a couple of people on your team now, you can move into an office and close the door, start focusing, but still have a community there to support you and then eventually if your company starts taking off and you need your own space and your own conference room, then you kind of graduate and move into sort of commercial real-estate community, getting your own place and that was sort of early stage pipeline that you know 100Sate was there to support. And I went through that process because Redox did that exactly. So as I was sitting at 100State with James and we are seeing all these great people come through, a lot of them were former Epic employees; a lot of them know a whole lot about healthcare and technology because of their experience at Epic. They were becoming members of 100State and getting involved in projects that a lot of times had nothing to do with healthcare and we saw that as a – it was unfortunate because these people have such experience and talent in this space where essentially leaving the industry and not because they don’t like the industry, but because the opportunities that were in front them where you know working on some App, some housing App or some like calendar app of something like that. So originally James and I put our heads together and said well, we are having 100State, how do we help people here to learn more and care more about healthcare and that’s where 100Helath came from. So we took a little corner of a 100State and said this is now 100Helath. This is where we are talking about healthcare.

Dave Kruse: Nothing else.

Niko Skievaski: And nothing else. So what we did is we started – we had these healthcare breakfasts. So we would cook eggs and then invite 15 people to come in and we would talk about problems in healthcare and brainstorm on them. So we had these like brainstorms over breakfast about healthcare.

Dave Kruse: It was whose idea it was essentially like to help incubate ideas and then essentially take equity for that and then roll them out into…

Niko Skievaski: Yeah, that’s what – at the beginning we didn’t have an idea of what the business model would be, but eventually we needed to figure that out. So that’s when Luke got involved. James and I were looking at each other and James and I were really good at brainstorming, but we were like we need someone who can crack the whip and make sure that we get ship done on and at the time I was like that guy Luke that I know from Epic would be amazing at this. So I called Luke up and it just so happened that he was trying to think of what the next thing he wanted to do and he had been thinking a lot about innovation in healthcare and in technology and just loved this, fell in love with this right away. It was very quick – was very quick to quit Epic and jump ship and join us and you know I think he was in the transitionary period anyway. But he came in it was like okay, this is awesome, but so far everything we are doing is kind of non-profit. Like how do we turn this into something that can scale or we can actually provide value to more people than just the couple of people that are in front of us. Meanwhile James and I are both doing odd jobs on the side just to like make ends meet. So we started thinking about you know what’s a compelling business model here that we can gain some traction on and raise some money. So we said okay, we have all these people who are interested in healthcare; we have ideas being generated from it; we created a panel of mentors like 50 mentors from health systems across the country, just people that we knew from our days working in healthcare and essentially said okay, this is some really cool raw ingredients to help incubate companies. But we didn’t have a fund, so we couldn’t do like a traditional tax service model where we invest a little bit and then follow on. We didn’t know anything about VC funds, so like I guess we could have thought about raising a fund, but no one even like brought that idea up, because we had no idea. So we said okay, well what if we like incubate and work with these companies and the longer we work with them, the more actively we can gain and so we came up with this really weird accelerator model that you know eventually we started seven companies like with this model, with you know a bunch of different groups and we learned a couple of things in this process.

Dave Kruse: Alright, any of those still going on?

Niko Skievaski: Yeah, a couple of them actually. Well, so actually two of them exactly. One of them is a book company that I started. So this was a collaboration with a bunch of members at 100State, but this was around ICD-10, so ICD-10 was coming out and ICD-10 is a medical billing coding language, basically health systems will send these codes to insurers so that way they know that they are talking about the same ways people have injured themselves. And with version 10 of the system ICD-10 there are more and more codes out there that were seemingly ridicules to anyone. So there were codes like burned due to water skies on fire or struck by orka or all sorts of different, like sucked into jet engine subsequent encounter, so it’s happened more than once. So this is just weird ways to that you could possible injure yourself and so anytime any health tech nerd talked about ICD-10, they always pulled out the weird ones, like struck by duck or other contact with shark, like some really obscure scares specific things. So what we decided to do is build a – like an illustrated book on this. So we reach out to all the artists we knew in the community, put it up on Facebook and said we are looking for artist who want to illustrate weird medical billing codes and actually got a lot of people saying like, I’ll take one of those. Those are some weird codes like, I’ll take the other contact with shark and draw like an artist with rendition of what that had. So we put that in a book and starting selling the book off our website and it started selling really well and so literally for the next two years I think most of my income came from that book, yeah, but it was huge collaboration with all of the artists and people in the community. We shared profits with the artists and literally to this day my dad’s full time job is to ship books from home. So he is still everyday shipping books. You can still buy them they are on Amazon. Yeah, it’s fun. And in the industry a lot of – I’ll go to meetings at health systems like to this day and see the book on the conference room table.

Dave Kruse: It’s good for a conversation starter.

Niko Skievaski: Yeah, and I’m like Oh! You guys have this. And they are like, oh yeah we love it, it’s funny. Have you see it, and I’m like, did you notice the name on it, that’s me. So that’s one company that survived the 100Health days. Most of the other companies in there we realized would need – most of them were technology companies. They would need to exchange data with electronic medical records to scale and so that was a core understanding that we got with 100Health and so the seventh company was Redox and that was how do we actually help this ecosystem of healthcare technology, like new emerging technology, innovate in a scalable way with the legacy systems EMRs that are user health systems.

Dave Kruse: And maybe that was it, but just what’s the overview of Redox is that – just make sure everyone understands.

Niko Skievaski: Yeah. So that’s kind of how the idea was born, is that we realized there is a common problem when you are bringing new technology to market and healthcare and that’s any health system you sell to is going to ask you, this is great, you know I love the value propositions you are offering, but how do you actually work with the behemoth electronic medical record that’s in my basement that I spent $50 million last year on and if you don’t have a good answer to that it’s hard to move forward in the sales process. So obviously with our background coming from the EMR space, James specifically was a developer who worked on a lot of that. He said well, we can build a platform. We can build an API platform that modern developers will know how to use. So it’s a typical API that you know any developer who is integrated with Facebook or Google or LinkedIn has used APIs like this, its rest base JSON. Modern web developers know how to use this stuff. If we can create a standardized API experience, Redox can do the hard work on the other end of connecting up to the district customized legacy systems that are out there and this isn’t a new business model all right. Like there has been companies in other industries that have done this really successfully. So Twilio is a good example where you know if you want to send an SMS its – you are going to use Twilio to do it, because they have a single, very simple API to use and Twilio goes and figures out how to integrate with version and Sprint and TMobile and all the other sort of weird middle men you have to do it to actually send an SMS over a phone. There is also other in the financial industry. Mind.com was an early sort of person trying to aggregate all your financial data from different bank accounts and before an API Mind.com actually stood screen scraping, where they would make you log into our Bank of America account through their portal and then they would go in and screen scrip it in the browser. And eventually they moved to using APIs to do this, so there is a company called Yodlee, who came out in the financial industry and they worked with all the big banks to get all of that data into a consistent API that developers can build on top of. And so we are definitely in that vein of following the footsteps of these great integration companies, but no one was really doing it in healthcare yet. So we have a very much a developer first approach. We’re trying to support the people who are you know at the edge of innovation, pushing the needle, who are moving the needle, pushing the envelope. They are pushing the envelope in innovation. The ones developing these solutions, we give them a consistent API experience, so they know what data to get and when a health system asked them how they can integrated, they have a solid answer to that question that helps them get through that process. And so the 100Health experience helped us realized that was a big problem. It also helped us realize that our team was uniquely positioned to solve that problem, which our team was not uniquely positioned to start an incubator, because we had never stated a company really before other than these things I mentioned, but we are by no means experts in it. But we are experts in healthcare technology and you know modern web develop and how those two things need to merged together for new innovations to happen.

Dave Kruse: And can you just give us kind of the stats on Redox; like how much money you raised, the number of employees, any other fun facts.

Niko Skievaski: Yeah, yeah. So we, at that time when we figured out we wanted to do Redox, it was just like the three of us when we had an idea. At that time we were able to surprisingly raise an amount around of $350 K and so with that we hired our first two developers, some more friends that we had made at Epic and started the journey there. And since then we’ve grown to – I think we are at 30 employees now and that was – I guess it was two and a half years that we are doing this. So right 30 employees. We raised a couple of rounds of investment after that, so we are at I think $13 million in total money in. What’s great about this developer first approach is that we focused on building this developer community and so now we have this community of I think its 2,600 developers that have created accounts on Redox. So these are people who are creating like new innovative apps and they want to find you know the API to work with and the platform to build that on top of, so that’s the developer community, and once those developers get an application that’s market ready, they’ll – they bring us into the conversations of health systems and so we’ve been integrated with more than two dozen electronic medical record systems, spanning across 70 different health systems around the country and we have one in the Netherlands now too, so internationally. And the things that makes us kind of unique in this is that people have done healthcare integration in the past, but no one’s ever done it in the cloud based multi tenant system. So we, all of the data we are processing around 1 million clinical messages around day, all of that goes to the exact same engine and the cool thing here is that, two health systems that are plugged into Redox, they might be integrating with two different applications, but because it’s all going through that exact same hub, they are technically interoperable, which means we can flip the switch and share the area between health systems if and when they might need to do that. So as we are growing, we are essentially building a network where every note that we are adding to it makes the whole thing so much more valuable to everyone that’s a part of it.

Dave Kruse: And so what’s the process? If you had like five networks, hospital networks saying hey, we want to share data around this certain area; how – yeah, how does that work. Do you need permission from all the health networks or what’s the process to…

Niko Skievaski: Yeah, yeah so whenever we share data between two parties, both parties need to agree and say yes. Typically before every new engagement, like for each new app or every new node we add to the network, if they want to data, they have to get permission from the healthy system. Typically that relation comes from the form of Business Associate Agreement. So what this is the health system is saying we are associated with this technology provider and we need to use them to provide care for patients and therefore they get access to this data and that’s how we currently today are getting data from A to B. And so if A and B actually need data and C comes along they need to get permission from the source from A to get – to be added into that chain. Technically we can just flip a switch, but legally they need that permission. Where I think we want to get to, like where I think the industry needs to get to is a point where a patient themselves – so in this, you know in this sort of A and B’s I’ve been talking about, the patient hasn’t been discussed at all. It’s really just health systems who is providing care, application who is providing software, agree that they should work together. But what’s missing from this equation is the patient has never – there is not a mechanism right now as a patient for you to say I have an application and I want all my clinical data to go into it, and I think that’s where we need to get to, because right now if you look at “consumer health” and I used air quotes because consumer health applications are really kind of fitness apps right now, like there are things like Strava or like even Apple’s Health Kit and apps have been great with that, you know your FitBit and those sorts of things. Those are applications that are using the fitness capacity, but they are not really applications that are used in the clinical care setting and there is divide. You can look at that as the end of two spectrums. If the spectrum of healthcare technology on one end is your fitness like you are feeling good, you are eating well you are remembering to drink, like those types of apps, on the other end it is you had a knee replacement and need to track your recovery and your meds and make sure that you don’t need another knee replacement in five years. So like the very acute clinical care are all the way through the preventative sort of fitness style care and I think right now like hardcore healthcare technology in the clinical setting happens without the patient’s input and then when the patient’s engaged its more in the fitness side and for clinical – I mean for healthcare technology to become mainstream and actually reach consumer health, we need to bridge that gap and we are not going to get there until a patient, a patient can actually tell our health system I need my data to come down in an API format and I need to be able to authorize any app that I want to use that data.

Dave Kruse: That would be awesome. So how do you think that will happen, because I’m ready.

Niko Skievaski: Yeah it’s a chicken or the egg problem.

Dave Kruse: Is it much political as anything or – I mean technology wise it seems like it could be quite possible.

Niko Skievaski: Well, so technology wise we have a connectivity problem. So most people out there have been to multiple doctors over their lifetime, and even a lot of people who have prank diseases will go to multiple doctors you know within a given year just because they are all specialist and maybe you are hospitalized and a lot of times those systems don’t talk to each other because they are not connected. So first we need that network can connect the systems, that’s what Redox is doing today. Then we need a network that allows the patient authorization and that’s where I think Redox is going, is a place where we have the developer community, we are building a network that’s connected and then how can we help the developers build tools that patients or consumers will actually want to download. Because consumers don’t have a demand for APIs, most of the people don’t know what an API is. They have a demand for applications that can help them turn data into information, but those applications need to be powered by API to pull the data down.

Dave Kruse: Okay, and I know we are almost out, do you still have a little time or…

Niko Skievaski: Yeah.

Dave Kruse: All right, I’ll just keep – we’ll just keep firing though these questions here. So then what’s the process for somebody connected to their eHRs without Redox. Like someone, they want to connect to the University of Wisconsin Hospital and I like I don’t want to go to you guys, which is probably not – I’m curious how that would even work.

Niko Skievaski: You can totally do that. You can totally, you can totally connect to any health system without Redox, but what you are doing is basically connecting point to point. You are connecting A to B and that means you need to connect A to C and A to D and A to E and A to F as you grow and each one of those projects is a pain and it takes time and it takes effort and you are not – what you are not doing is solving an industry wide problem. So when we talk to customers who are trying to figure out, do I work with Redox or do I connect directly, what we way is, if you connect to Redox and we are already plugged into a health system, like that’s going to make – it’s not a project any more, it’s just turning you on. So you are connecting to network that will enable you to move a lot of faster and eventually what we hope is that integrations of commodity where it’s not something that you differentiate and say like oh, my apps great because I can integrate with the legacy system. That should be a given that all apps integrate with legacy systems because they need to, because legacy system is the backbone, a source of truth and hopefully if integration is a commodity, then everyone is like using a network to do that. And I don’t think that Redox needs to be the one and only network. Like we’ll connect to other people’s networks, but it needs to be a network to be able to.

Dave Kruse: Yeah, that makes sense. Okay and do you have any interesting case studies or like that a company is doing something interesting because of Redox.

Niko Skievaski: Yeah, yeah so one of my favorites that I think is a real cool technology example is this company called Gauss Surgical. They were actually the first one that we went live with, so it has a special place in our hearts, but they, their start ups out of Palo Alto. They have an iPad app that is used in the operating room and a nurse will use this app to document any blood loss the patient’s had. So if you imagine any operation, it gets a little messy, blood gets on the floor, in canisters, on the gown and sponges and they need to document how much blood the patient lost to figure out if the patient needs a blood transfusion or other complications that happen with blood loss. So right now current state without their app, people are kind of guessing, they are say oh, we lost a couple ounces on the floor there. I don’t know how much that is and the canister you know has a 100 cc in it and so they try to document that into the medical record. What the app does is it uses a special analysis in machine leaning and blood lab values to – they take pictures of blood and it measures, it uses the pictures to measure like okay, if the blood is that red and its covering this area, so they can determine how much blood the patient’s lost and its FDA cleared to do that.

Dave Kruse: Really.

Niko Skievaski: Way more accurately than you know weighing sponges. So like mind blowing technology and that’s what those guys are amazing at, is that experience of figuring out how much blood a patient’s lost and what we help them, like we just take the number, they say the patient lost 200 milliliters of blood and we just put that in the right sport in the medical recorded, because once it’s in the medical record it aligns with the source of truth and they can figure out okay, the patient has all these other diagnosis or has you know other complications that we need to get a blood transfusion or we don’t need to. So we went live with them a couple of years ago at Hackensack University Medical Center. All of the C-sections that happened in their birthing suites used this technology, because blood loss in a C-section can get really complicated for the baby and the month and it’s kind of cool that you know the first thing, the technology that we did, we used it in life or death situations at a major economic health system and its just like such cool Start Trek type technology. That’s pretty similar when they just have the Hollow Lens on and they can just look around and build…

Dave Kruse: All right, and let’s see, we’ll try to run through these. So I mean you are doing a lot of interesting stuff. Like where do you want to take Redox technology and we probably already talked about it. Can you talk – well do you kind of have the patient verification. I mean is that the main…

Niko Skievaski: Well yeah, that’s kind of the aspiration area. Like we want to get to a point where we power consumer applicants in the same way that we power enterprise applications, but really there is a lot of work that we are doing right now in the next year on the enterprise site. So things around analytics and giving health systems tools that they need to better utilize the data, so there is a lot of stuff in the short term that we are putting effort into and so when we look at how we are spending this investment that we recently raised, it’s really about improving our product to meet the needs of the ever changing healthcare enterprise and that’s everything from adopting new innovative technologies to developing their own technologies on top of their electronic medical record.

Dave Kruse: Interesting, okay. So you’re actually providing, building analytical tool.

Niko Skievaski: Yeah, right now we have kind of some analytics that come out of the box as far as kind of medi data round the message that are being processed. But what we don’t have are like clinical analytics and I think that’s an area where we are interested in moving into or giving people that ability to ask questions of the data, rather than us just telling you every time a patient’s discharged. We need to allow you to ask, tell me all the patient’s who had been discharged and who have congestive heart failure or something like that and so that’s the sort of slight change in the API functionality that actually requires a lot of engineering, but it’s something that we think needs to happen in this healthcare API space.

Dave Kruse: Okay, and if I had an app and I wanted to connect like 25 different health networks, what’s like the price. You don’t have to tell the exact pricing, but more like is it per site or is it like the volume…

Niko Skievaski: It’s not volume based because a lot of times the health systems – well as an app developer you are not dictating the volume that comes out a health system. Whereas like with Twilio you can do volume based, because they determine how many SMS they are going to send. So that’s a slight difference. We do it on a per connection basis. So if you are connecting to 25 health systems, each one of those health systems is like a license that you purchase from us and then depending on how much, like the scope of the data that you are connecting with, it determines the exact license price.

Dave Kruse: Got you, okay, all right. And I think we have about three or four more – I mean I was curious, so this is moving a little beyond Redox because more, a little outside Redox that is kind of associated with it, because you were an entrepreneurial resident at the Cisco.

Niko Skievaski: Oh! Yeah.

Dave Kruse: I was definitely curious how was the experience?

Niko Skievaski: It was awesome. We actually did that through Redox, so well yeah.

Dave Kruse: Oh! Yeah, I know through Redox, but it’s not necessary what you guys are doing…

Niko Skievaski: Yeah. So we were working with a big health system out in the bay area and the health system said well, this is really interesting. You guys are doing, solving a really cool problem. We’ve actually been working with Cisco on this problem and for us immediately we were like Oh! Shit, like they are working with Cisco, one of the biggest software and hardware companies in the world. Like if they are going to solve this problem, like you know they are someone who can actually take a crack out of this problem. So we were initially intimidated, but they introduced us to our contacts at Cisco and Cisco was really an amazing company to work with. You know they are a huge company, but they have the means to work with startups and they said okay, if we are going to work with you, there is a number of ways we can do it, but if you do entrepreneur and residence program what it does is it essentially brings you into the family. It says like okay, now you are part of Cisco and we can figure out and be much more transparent in figuring out how we can partner and work together. So we did that program. It was a six month thing, so it wrapped up I think last month, but we are still working with Cisco and still figuring out the exact ways that we are working on that deal and we can’t publically talk about it yet, but I think you know eventually we will be able to make an announcement and say you know…

Dave Kruse: Did you spend a lot of time out there or were you here? What does it mean you’re on-sight?

Niko Skievaski: Yeah, so we just out of the nature of our business we spend a lot of time in the bay area’s anyways and whenever we were there we are always meeting with Cisco and the health system we are working with there and so it was – you know we are probably out there at least once a month during that time period.

Dave Kruse: And you’re at Madison which is awesome, do you – first off do you plan on staying here? Like keeping the headquarters here at least and what type of resistance have you done from like investors or like even health networks. Health network is probably used it as well, but has there been any resistance or is it…

Niko Skievaski: No, you know we love being in Madison. Its home, we are going to stay here. We let our employees live wherever they want. So we have probably 10 employees who are kind of scattered around the country, but we bring everyone to Madison every quarter at least to hang out, to make sure we still see each other in person and go out to dinner and hang out with the team for a week. But we let our employees live wherever they want and even the employees who could leave Madison, they choose to stay here because they – well, a lot of them choose to stay because they like the town and its low cost of living so your money goes further, great community, lots of support, you know flying out of here isn’t the easiest thing to do but we drive to Milwaukee a lot, so we have gotten used to that a little, but no Madison’s going to the home for Redox. I love it here, we see a bright future.

Dave Kruse: Well, I expect peep-in’s and couple more last questions around personal. So I was – well first off, I remember reading, I don’t know if you still do this, but you used to mediate before meetings. You guys still do that?

Niko Skievaski: No, it got a little disruptive, because that’s the team…

Dave Kruse: That’s disruptive.

Niko Skievaski: Yeah, it did, because we finally got everyone together like in old times, like a big company when meeting and then it would be like okay, three minutes of silence. And people are like oh! Damn, like I’m ready to go. Yeah and I think that’s unfortunate because it’s something that I think is important to take time to gather yourself. So I know a lot of us do it still independently. We stopped doing it as a team. It’s something that we’ve had people on the team say like we wish we would do more of that. I think it’s something that hopefully we can get to a point where we can find more outlets for it, yeah. Wherever we had week meets and bring everyone to town we try to do something kind of more in the mindfulness sight together. So we’ve had yoga teachers come in and lead us through, kinds of mediations and stuff, but we stopped doing it.

Dave Kruse: All right, and the last question is so how – it’s kind of goes along the lines of meditation. How do you deal with the kind of the stress? How do you get away, because you know it’s awesome what you are doing, but it’s not all roses and daisies and lollypops. So how do you, when you are stressed like how do you relax and get away?

Niko Skievaski: So I just had a baby and so when I – yeah, when I get home from work like you know I know that unit the baby goes to bed I am not looking at any work. Even if people call me then I don’t answer it, because that’s the little time I get to spend with him and it’s a total stress relief and he can be crying his head off and it’s still super energizing for me to just be hanging out with him and you know I do bedtime routine and everything and then put him down and after dinner I typically have a couple of hours of just like quite work time where I can typically catch up on everything that I needed to do for the day. So I got into a pretty good rhythm of doing that. Travel definitely throws into all of that, but just having that time to unplug and you know spend time with family has been really important.

Dave Kruse: Got you, okay. Well that’s a good answer and I love how little baby is not stressful, its – maybe – for people who knows Niko, he is pretty laid back guy, so.

Niko Skievaski: My wife does a lot of the stressful with the babies. So she does the hard job. Yeah exactly. And he is an amazing baby. He sleeps through the night and stuff, so we have been lucky with him.

Dave Kruse: Well, awesome. All right, we went over time but this is awesome. So Niko, thanks for telling us your story and telling us about Redox and when you have some big announcements in the future maybe I’ll come back and we’ll do another one down the road. And thanks everyone for listening to another episode of Flyover Labs. As always, I definitely appreciate it. Bye everyone.