Designing for Health: Interview with Josh Liu, MD [Podcast]

The pathway to a great patient experience is filled with potential hurdles, potholes, and unexpected twists. Connecting patients and their data with their multi-pronged care team is an essential task for a modern health system. In this endeavor, thoughtful, human-centered design that keeps both the patient and clinician in mind can lead to positive outcomes for every stakeholder in the healthcare ecosystem. More often than not, a simply designed solution can lead to a smooth and streamlined patient journey.

On today’s episode of In Network's Designing for Health podcast feature, Nordic Chief Medical Officer Craig Joseph, MD, talks with Josh Liu, MD, co-founder of SeamlessMD, a technology platform designed to digitize patient care journeys. Their conversation centers around Dr. Liu’s background, his completion of medical school but not residency, and how he got bit by the startup bug. They also discuss the importance of clinician buy-in, the power of simple solutions, and the secret sauce to create engaging social media content.

Listen here:



In Network's Designing for Health podcast feature is available on all major podcasting platforms, including Apple PodcastsAmazon MusiciHeartPandoraSpotify, and more. Search for 'In Network' and subscribe for updates on future episodes. Like what you hear? Make sure to leave a 5-star rating and write a review to help others find the podcast.

Want to hear more from Dr. Joseph? Order a copy of his book, Designing for Health.

Show Notes:

[00:00] Intros

[01:49] Dr. Liu’s background

[06:55] How he got bit by the startup bug

[11:35] The goal of SeamlessMD

[21:55] Gaining insights by simply walking around a hospital

[23:34] The value of harnessing real-world experience in design.

[31:50] Clinician input on Seamless implementation

[34:54] Secrets of social media success

[39:32] Dr. Liu’s favorite well-designed things

[44:04] Outros



Dr. Craig Joseph: Welcome, Josh Liu.

Dr. Josh Liu: Craig, good to see you.

Dr. Craig Joseph: I am so excited to have you on the pod. You are a famous podcaster. You are a famous social media maven; I believe is your title. You are a physician. You are an entrepreneur. You have done many things. And I'm excited to talk with you about all of those things.

Dr. Josh Liu: Me too. It's an honor to be here and I'm excited to dig into it.

Dr. Craig Joseph: All right. Let's start at the beginning. You went to medical school. Where'd you go to medical school?

Dr. Josh Liu: At the University of Toronto.

Dr. Craig Joseph: The University of Toronto. I've heard of it. And your intention was to become what, sort of a doctor? What was your plan for your life as you were finishing up undergrad and going to medical?

Dr. Josh Liu: It's funny. So, when I started medical school, I thought I wanted to be a neurologist, and then I shadowed some neurologists in my first year, and then immediately I knew it wasn't for me. So, I was back to the drawing board. But throughout medical school, I was kind of lost. A lot of folks, I think, go into it knowing what they want to do. I didn’t. And what happened was I had this great mentor who said, you know what, Josh, come work with us at this innovation lab and learn about quality and safety and patient experience. Like all these topics I knew nothing about. And I ended up doing some really exciting work on preventing readmissions, and that got me hooked on the quality and safety bug, the tech bug came later. But it started to plant that seed that like, okay, maybe there's something else meant for me in healthcare.

Dr. Craig Joseph: Okay. And so, you were, kind of your plans were kind of going off the rails, right? Right at that point where you saw all the other things that you could do. So, it wasn't so much that you were unhappy with thinking about becoming a neurologist and having an office and shocking people with tiny little needles, that's my interpretation of what a neurologist does. But you saw all these other opportunities and kind of wanted to explore some of those.

Dr. Josh Liu: Yeah. And I don't remember exactly what happened, but this is back in 2010 when this was going on. So, the iPhone came out three years before, cloud computing and mobile started becoming a big thing. And then startups in general started to emerge as a hot topic around me. So, I started getting into that, just like on the peripheries. Actually, in my third year of med school, I tried starting a totally different healthcare tech venture with two buddies from med school. We were all kind of bit by the startup bug, but that idea actually we quit. We quit on; slash gave up on within 4 to 5 months. And the challenge we had was we were all clinical people, so none of us actually had the skillset to go to product or start a business. And so when I thought about maybe doing this again in the future, I knew I would need probably a different team that had skills that I didn't have, and that eventually led to how we started Seamless. But just know that like these are the stories that people don't hear about, like the failures, the unknown losses, they happen, we just don't talk about them publicly as much as like the wins and the successes.

Dr. Craig Joseph: Well, let's talk about them. Let me just get, let me go back just a little bit. So, this idea of, you know, we've tried starting this company in our third year of medical school, let me emphasize, for those non-physicians who are listening to this podcast, it is not typical to think about starting a company in the middle of medical school. You’re generally, especially third year, like you're in clinicals, right? You are in the hospital, you're at doctor's offices and yet you were still thinking about starting. So, did you were you in high school with starting companies and charging? Were you one of those kids in elementary school charging your friends for candy that your mother bought at the bulk food store?

Dr. Josh Liu: No, I wasn't quite the businessman when I was in kindergarten or anything, but I've always loved being a builder. So, when I was in high school, I was really big on projects and starting school clubs and just kind of going from 0 to 1 on just random projects in general. And then when I got to undergrad, actually in my last year of undergrad, long story short, my university went on strike for a few months, so I had nothing to do. And I actually just started a blog where I just started writing articles about helping kids get into university and applying for scholarships and things like that. It actually originally it was meant to help me chronicle applying to med school. I decided I wanted to blog that, but then when my school went on strike, I needed to spend more time writing because I had nothing to do. The strike, we didn't know it was going to end. It could end at literally any point in time. And so, I had all this free time to write and basically this blog blew up and a lot of students started reading it. And then eventually when I got into med school, I sort of like commercialized the blog in that I ended up I actually ended up starting a med school admission consulting business. Because I was being all this traffic to the blog and it's asking me, hey, could you help me? You know, read my essays and whatnot and help me learn about getting into med school. So, I had a little of an entrepreneurial background with projects and like this really small admissions consulting side business. So I’ve always had that sort of entrepreneurial sense, but I never started an actual, like formal company before.

Dr. Craig Joseph: Okay. All right. Well, that's fair. So, it sounds like you did kind of buildup. It wasn't just out of the blue. All right. So, you're looking to it's now fourth year of medical school. You're looking to graduate. And what were you doing? Did you interview for residencies or were you like, I want to do something else for a bit.

Dr. Josh Liu: So, the plan was to go actually to a family medicine residency, partially because I think I just realized I was more of a generalist. But the second reason was I figured I would do something like be an entrepreneur somewhere, somewhere down the line and having sort of a shorter residency with more flexibility in the work life balance would make it easier for me to pursue other side ventures or projects. So, family medicine was a really good fit for me. And what happened was around the fall of my fourth year, I ended up actually on a whim applying to the startup incubator, and it was through that incubator that I actually met who ended up being my co-founders for my company SeamlessMD. And basically, I brought the problem that I was studying on preventing readmissions and said, hey, wouldn’t it be great if we could build something to engage and monitor patients to prevent something like a readmission? And so, we had an idea that I was passionate about. I had two co-founders who came from the tech and engineering side, and so finally felt we had complementary skill sets to go and do something. So, we started SeamlessMD through the incubator. The incubator actually ran on the side throughout the end of my last year of med school. So basically, we were all finishing school while doing the startup on the side with the incubator and then with the way the incubator works is when the summer hits, you come for a few months in person to finish the program. And so initially, even though I'd gotten into Family Medicine residency, I asked my program director for a few months of postponing of it to just finish the incubator and then start residency in the fall. And he was like, that's cool, go for it. And then as the incubator finished up in August and I had to decide whether I was going back to residency or whether I would do 50/50 time between SeamlessMD and residency, I decided that I wanted to do one thing really well and go all in on just one path. I didn't think I could do two things well. And so, I said, okay, well can I do the startup thing for a year? It's probably going to fail and I'll be back starting residency a year later begging for you to let me through the door again. And they said, okay, sure, take a year, do this, come back. And then every year for five years I would go back and see my program director and he'd say, hey, Josh, are you coming back to start residency this year? And every year I would say no, I kind of want to see where the startup thing goes. We're still alive, as it turns out. And then, long story short, after five years of this back and forth, my program director stepped down from the position. A new person takes over and he says, you know, Josh, this is great. This is really, really neat, but I'm kind of cleaning house. You know, you were his problem. I don't want you to be my problem. So, if you don't come back next year, year six, that’s it we're not going to keep this back and forth going. And frankly, like I was surprised they let me do this this long. I was so grateful and so it basically became my full-time gig and I never did residency and yeah never looked back.

Dr. Craig Joseph: So, it sounds like your future as a practicing family doc is is quite limited, although you could still you know, when you if/when this company that you expect to fail which hasn't failed now for a long time if you do really poorly, you can always go back and find a different residency.

Dr. Josh Liu: You know I probably need a reference letter from you, because I'll tell you when, when I was talking on this topic with that new program director, he said, honestly, Josh, the challenge is imagine you applied back here and I had to pick between you who’s been out of clinical for years and this other applicant. Yes, maybe earlier in their career but literally has been doing clinical things constantly for the past few years. Why would I ever pick you?

Dr. Craig Joseph: Oh my goodness. I would come up with a thousand reasons why why someone would pick you over someone who's just graduated from medical school because you've been interacting in the healthcare space, in, you know, in multiple different ways. And you would bring so much to their residency program. So, I will happily write you a letter of recommendation and help you find someone who's a little bit more open than that residency coordinator. Be that as it may, unfortunately for you, SeamlessMD. is successful despite all of your attempts to run it into the ground, you're doing well. So, what is, first of all, what is SeamlessMD? It sounds like you do something to help minimize readmissions, at least that was your goal at the beginning. Tell us more.

Dr. Josh Liu: Yeah. So, the analogy I like to use is, is travel. So, imagine you're traveling from point A to point B. In the past you had paper maps and now we use ships and everyone knows GPS is faster, safer, better, and no one would ever go back to paper maps. When you think about a patient care journey, whether that's going through surgery or cancer, maternity care or something else, that's a far more complicated journey than travel. And yet we still mostly rely on paper and verbal instructions to guide patients and patients will tell us that they forget these instructions, they lose them, they're hard to follow. And then healthcare providers will tell us that they often feel like they're sending a patient into a black hole between visits or after hospital discharge. And if only there was an easy way to keep patients on track and monitor them to catch things earlier, wouldn't life be better for the patient and for the healthcare system? And so what SeamlessMD does is essentially provide a GPS to a patient to go through these complex care journeys. So as a patient, you get Seamless on your phone, your tablet or desktop computer, and we guide and monitor you step by step throughout those journeys. So, for example Craig, let's say you were getting major heart surgery. With Seamless you would get reminders a week before surgery to stop your blood thinners on time or the night before surgery would prompt you to stop eating on time. The day after surgery, we'd nudge you and educate you on how to do your rehab and recovery exercises. When you go home, we ping you to start tracking your symptoms and how you're feeling. You tell us, Here's my pain level. Every day you take photos of your surgical incision and other important data, and then we send that data back to the healthcare team on dashboards that can also be embedded in the EHR so they can get alerted, they can monitor you and catch things earlier. We've done this across dozens and dozens of clinical specialties with health systems across North America. And we've seen in over 40 studies or evaluations, really major benefits on lower length of stay, readmissions, ED visits, costs, even mortality. And so the impact on not just the patient experience, but the outcome has been pretty, pretty amazing.

Dr. Craig Joseph: Yeah, that is amazing. And it's amazing to me. I think for those who are not in healthcare, how many surgeries, how many major surgeries are postponed or delayed in some way because patients are not properly prepared. And you mentioned a couple of easy ones, right? Hey, stop taking your blood thinner however many days prior. Because if you accidentally take that pill the night before, you are not having an operation the next day and that might push you out weeks or months sometimes. And it's certainly not good for the patient. It's also really not good for the healthcare system or for the surgeon who now, they have a free OR, which is not something that anyone wants, it’s a precious resource.

Dr. Craig Joseph: You want to be using it all the time. So that you're you know, improving the lot of many different groups here. That's great. So where did you come up with the name Seamless? I mean, it seems pretty cool. Where'd you get that name?

Dr. Josh Liu: I'll tell you a funny story. So, way back when it was a much more complicated path to getting to Seamless. MD So the very first name formally we had was Seamless Mobile Health. So it was a three word name, we liked the word seamless because at the time at least I think it's still true, There was a lot of excitement around the idea of seamless care, seamless transitions of care. So, we loved the word seamless. And at the time, mobile health was this exciting new emerging field. So, we put two and two together. The problem with that name was people would butcher the name all the time, so we'd have organizations, the providers call us Seamless Mobile or Seamless Health or Seamless Health mobile. So just like even like the wrong order of words. And that started to frustrate me a little bit. But the moment I knew we had to change the name was one day we were meeting with an organization and my co-founder and chief technology officer was also there, and then he got the name of the company wrong in the meeting and I said, okay, if my co-founder is even having trouble with our company name, it is way, way too complicated. So, at that time, a lot of companies in digital health were using the MD term. I think that was just a hot thing. You actually, we still have it. You get dot MD domain. So we said, okay, let's just copy what people are doing. Call it SeamlessMD. And to be honest, I probably wouldn't pick that name today. I’d probably go with, I don't know, Seamless Health or just Seamless itself. But yeah, it was a worse name before. It's a little bit better now, and it's kind of stuck.

Dr. Craig Joseph: Well, I think if you were to rename yourselves now, you certainly shouldn't spell Seamless the correct way. That's I mean, that's a given for any sort of startup, right? So maybe S-E-E-M or something like that. I'm going to copyright that. But, you know, just think about, you know, purposeful misspellings. That would be great.

Dr. Josh Liu: You got it.

Dr. Craig Joseph: So this is a podcast where we like to talk to people about design and its overlap with healthcare. And so certainly this is something that you must have been concerned with. I'm assuming that you don't just kind of sit down and start coding and saying, well, this is how people are going to use our, app and, and how physicians are going to interpret the information of the care team in general. So talk to us a little bit about how design works at SeamlessMD.

Dr. Josh Liu: Yeah, I think from the very beginning we had this patient-centered design approach. And so throughout the entire process, whether it was even just ideating the solution or even just prototyping and testing it, we'd always make sure that patients were involved in different ways. And I think it's very important, which is recognizing that it's not just about age or demographics of patients. It's very obvious, I think, to most people that, yes, you want to test your product on folks in their 60s, 70s, 80s, 90s for accessibility and usability. But even down to the clinical specialty level we found to be important. So, whenever we, let's say, design a digital program for a brand new clinical area, we always make sure to actually interview, let's say, patients who have gone or are going through that health condition or surgery type and ask them questions such as What are you most worried about in this journey? What information did you wish you knew at the beginning of this journey? What questions did you have? What fears did you have? And that information on top of the actual literature, clinically, that gets infused to how we design the experiences. So, I think just being very laser focused on the patient is key. Probably one story that comes to mind that I think helped me really understand the value of working with patients is, you know, initially we did a lot of work on just the mobile platform. So, smartphones and tablets. And I remember, you know, we used to very often just go into the hospital and actually sit next to the patients and show them prototypes of the application and just watch how they would interact with the program, what buttons would they press was it intuitive, and because we wouldn't be there when they were using it, right. So that had to be pretty intuitive. And I remember there was this elderly patient that I was sitting next to, and this hospital was going to be using Seamless for her hip or knee replacement. And so, she was going to have her hip or knee replaced and she pulls out her iPad from her purse and I'm like, great. She has a tablet she can access. It's going to be wonderful. And then she tries to download the application and she can't because she doesn't know her app store password. And so, I ask her, I'm like, well, what do you use your iPad for? If it's not to download apps and use them? She's like, I use it for email and I love surfing the web. And I was like, boy, you know, like if I just looked at the device she had, I would have made this huge assumption that, of course she can use a mobile app. That was not true for her at all. And so that was actually a very important driver for us to eventually have a Web based platform as well, because we find even today, there are a lot of folks, especially older folks, who have devices, but they actually prefer the Web based version of the product. And so meeting patients where they are is such a huge learning for us. And we only would have known that if we had actually sat next to patients and just watched them.

Dr. Craig Joseph: Yeah, the story I've heard over and over yet startups, I think even established companies forget this regularly. We had another interviewee on this, on this podcast who mentioned that a program at her hospital wasn't working well and people weren't leveraging the technology that they were creating and no one could understand why. And so she decided to, like you actually go to the clinic, hang out in the waiting room, try to understand what was going on, and quickly learned that almost everyone in the clinic spoke Spanish and that the directions for how to download the app were solely in English. And it was that little change that made all the difference by saying, well, the app didn't really need any work. It was just the instructions on how to access the app, putting it in the language of your audience or your group of patients is essential. Also reminds me of a Jack Welch. I think one of the things he talked about was management by walking around. I mean, he felt it was very important to actually get down on the factory floor. And so, he didn't have to listen to what information that he got that kind of went up through the through the ranks, actually hearing from the folks that are doing the work and what their ideas are and what their frustrations are.

Dr. Josh Liu: I think that's a great point in the sense that I think a lot of times people think about the product experience starting once you're in the product, but you're absolutely right, that experience starts during the onboarding or even just during the educational process because if they can't even get to the product, there's no product experience.

Dr. Craig Joseph: Yeah, and I have to admit, I would never, I would have done the same thing that you were doing. I would have said, here's this great app that you cannot download because you just don't know how to and you're not interested in that. And you know how to use the web browser and you're super happy to do that. And it should all just work that way. So yeah, you got to meet, you got to meet people where they're where they're at. So how big is SeamlessMD? How many how many employees do you have?

Dr. Josh Liu: Yeah. So, we have 33 full time right now and we work with 50 different hospitals and health systems across North America.

Dr. Craig Joseph: Okay. And when we were preparing for this, you had mentioned to me that you thought some of your secret sauce. I asked you for all of your secret sauce but you'd only give me, wisely so, you’d only give me a small part of your secret sauce was having clinicians in the company. You said a big chunk of your folks have real world clinical experience and you thought it made a difference. Tell me how.

Dr. Josh Liu: Yeah. So when I think people talk about healthcare companies having clinical DNA, they often think it starts and stops with having like a chief medical officer. And to me that's just one person. I think clinical DNA has to be a lot more widespread for clinical views to have an impact on how you design the product and how you work with your end users. So we actually have over 20% of the company coming from the clinical world in some way. So we have folks who let's say are pharmacists or dieticians or health communications specialists. And that's really important because even though on the outside it looks like we just had more of a patient-facing consumer solution, we actually provide very much, I call it a clinical solution.

Dr. Josh Liu: So when we guide patients through these healthcare journeys, all the content, the workflows, the algorithms have to actually be aligned with and signed off on by the frontline clinical staff. Because if what we're educating and telling a patient to do does not match what their clinical teams want them to do, they're not going to be promoting the solution to their patients. It has to match; it has to fit the workflow. And so when we implement, so number one, our clinical teams actually design all our evidence based digital programs. And when we actually implement it with frontline providers and departments because it's such a high-quality evidence-based program, they typically say, wow, this oncology care journey, we love 80% of it. We have to tweak 20% because our health system does things slightly differently. At least we're 80% the way there. And that last 20%, our team actually does the heavy lifting on configuring and customizing it based on what the clinical teams want. And so, the clinical teams are like editors, and our clinical team is like the ghostwriter because again, like, you know, as a clinician, your time as so, so short. Right? You're so busy with patients and other things going on. So, if you could just tell us, change this, change that, but we understand what you're talking about. We know the clinical lingo that makes a huge difference in making it easier for your team to implement our solution. I can tell you we have all kinds of partners who said when we first heard that the hospital was bringing in a technology solution, you're like, oh my gosh, yet another vendor who doesn't understand what we need as a clinical team and how we speak. And how we write, but when we met Seamless, we got to work with actual clinical people. They understood what we needed and what we wanted, it was so much easier and I think people often under-invest on the clinical side when it comes to healthcare tech. But I think now it's actually pretty integral to doing it well.

Dr. Craig Joseph: Yeah. I mean, my only disagreement with you is saying that Chief Medical Officer is not the most important by far, since that's the title I have. I want to say once again for my boss who may be listening, that Chief Medical Officer is the most important position. However. Thank you, Josh, for clarifying that. Don, if you're listening, Josh, just clarified.

However you're so I mean, I've experienced that so many times. In fact, I, I used to work for a big EHR vendor and one of the things that I saw firsthand was physicians who were in mandatory training who did not want to be in mandatory training. That's just a given. Whatever it was you're training them on, they're not that interested in it. They'd rather be doing their job. Would be looking for reasons to kind of discount the trainer. Right. And so, here's a very specific example that I saw happen. A trainer's trying to explain to a physician who has never really used an electronic health record before or has never entered an order. And they just want to show them how to enter an order. So, they say, well, you go to this box and let's say your patient has a cold and so you want to prescribe an antibiotic. So you go into this box and boom, we're done, right? I'm like, you’re done. Well, why? Because you just said to the doctor that the patient had a cold, which we're going to presume is a viral upper respiratory tract infection, for which an antibiotic would not be indicated. And you've just told me that you know me, the doctor, that you don't understand healthcare. You don't understand basic science, right. And if you don't understand those things, why would I trust you to tell me how to admit a patient using your tool? Your tool can't be that well designed or useful to me because you don't even understand what I do. You don't even understand that I wouldn't order an antibiotic. And again, from the trainer's perspective, a non-clinician, but someone who is very good at adult learning and explaining how that works, just thought, well, it doesn't matter. I'm just ordering a medicine. I'm just trying to show you how to order any medicine. But it does matter. And those, those clinical experiences are like gold, and you have to pay for them with gold, I guess. But you know, you find over and over, especially with doctors, I think others are a little bit more understanding. Doctors have a chip on their shoulders. I think I can say that as a physician, you know.

Dr. Josh Liu: It's such a good point. I think, you know, when you come from the pure tech world, you think you're just selling features. And so in your mind, it's while the feature worked as intended, you click the button, the button did something. But when you talk to clinicians, you realize that the context, the scenario, the use case really matters because even if the features work. If the clinical algorithms, the workflows are wrong, the results can either at best just be frustrating, at worst could be devastating. And to your point, like if you break that trust early with the clinician, why would they trust you in anything else? It's very rational if you come from the clinical world to understand that for sure.

Dr. Craig Joseph: Yeah. It got to the point where when we were selling essentially selling software, but to your point, it's clinical software. I saw people get into arguments about what antibiotic. I would never choose that antibiotic for community acquired pneumonia. And I was like, now we've gone a little too far. So let's figure out an example where we don't have an infectious disease specialist arguing over what the best antibiotic is for the kind of bacteria that we're seeing in our community, because that does get a little bit much

Dr. Josh Liu: Even with us in the past, like there were times where we were showcasing, we call it just an example, but the clinicians will be like, no, wait, hold on. But that doesn't make sense because I would not do it that way. And as a vendor, you're like was just an example for you. But it's like, no, but then you gravitate towards the clinical side. So, we’ve also gotten smarter about, okay, let's just not use examples that may be, there may be disputes about.

Dr. Craig Joseph: Anything that's even remotely controversial. I don't want to go down that path because again, and I said this to a CIO once who said after I told her this, she's like, you must now speak to my entire department. And I said, kind of just offhandedly. Generally, we know that (I say we physicians). Our attitude is that you guys from IT don't know what you're doing. We just can't prove it yet. You know, our starting position is that you don't understand us. You probably don't even understand your own tech. And that's just my, you know, my personal that's just mine. But I think it's a commonly held belief. And now we're just looking for data points to support our theory. Right. And so when you say things that make me question reasonably that you understand what I do, then I'm like, I was right. This person doesn't know it exactly. So let's talk about selling. So you have to sell your technology, your platform into hospitals and healthcare systems and sometimes the audience doesn't include clinicians or physicians specifically. And you've told me that there's a good story about kind of going down the wrong path when you thought you were going down the right path.

Dr. Josh Liu: Yeah. So I think for a long time we always tried to find the fastest way to get into an organization because as everyone knows, sales cycles in healthcare can be very, very long. And so one time, many, many years ago, we were actually able to sell Seamless to a hospital without having to talk to any physicians. There was a quality leader in the organization who saw the value in the solution, convinced the executives to buy the product. They bought the product, and we're like, Great, this was one of the fastest sales cycles in the history of the company. And then when we started implementing the solution, we had to actually start working with the physicians and the frontline nurses to get this going. That's when all the trouble started, because the physicians and the nurses, very understandably so, were saying, what is the solution? We didn't know about this, we didn't agree to this. We don't know why we have to do this. And long story short, it was a very unsuccessful implementation. Clinicians were not engaged to promote it to patients and use it. And soon after, unfortunately, we lost them as a customer and from there we learned that actually, you know what? When it comes to clinical solutions, you can't skip steps. Clinician buy-in-in is so critical because they're the ones who actually need to be engaged with the product, who need to promote it to patients and use it. And so now whenever we go through the sales process, even if we meet a health system who says, hey, you know what, we don't have to engage the physicians, you have our buy-in in top down, let's just go ahead and do it. We'll say, no, no, no, like we need to engage them now, because what we don't want to happen is you sign up for this, implementation fails because your clinicians don't buy-into it and then you've wasted your time and money. And so did we. And I don't care if the CEO of this health system wants this. If the frontline staff aren't bought in and aren't educated, it's not going to work. It's just a waste of time and money. And so I think we learned the hard way that that buy-in cannot be skipped. And in fact, it's actually better if they buy-in early because then they feel like they own the initiative and then they're far more engaged for the lifetime of the partnership. So, it's a little bit of obviously extended time at the beginning, but it pays in dividends over the long haul.

Dr. Craig Joseph: And there are there are things you didn't learn in medical school and you didn't learn in your start up courses or innovation centers. And just it’s the school of hard knocks where yeah, it's important to make sure that you know the right audience even when the right audience seems to be right in front of you and those are the people with the checkbooks. But it's also the people with all the white coats and the stethoscopes as well. So that’s good stuff. Let me pivot a little bit to how we met. And so you and I had met through social media. And I told you when I started speaking with you that you're a guru on social media, on LinkedIn and other sites. And I'm wondering how you got, you know, how do you decide to post things and how do you write things so that they're eye catching and not superficial? Because I'm in awe of your ability to do so. So give me the secret sauce Maybe not all of it, but some of it.

Dr. Josh Liu: Well, thank you, that's honestly very kind of you to say. I really appreciate it. I think there's a few things that that I've learned, actually, it came from, I think just reading about other people about what actually gets folks excited and engaged. So, here's how it works for me. So one is I don't know who came up with this, but the idea was that really good content does one of three things. It either educates, inspires or entertains. And so I try to live by getting into one of those three buckets, if I can. I think the second thing for me is that it's really important that it's authentic to me that I enjoy writing about. It's a topic that I find exciting and I care about. Actually, when I started doing this, some folks actually asked me like, Hey Josh, are you actually writing this stuff? Or like, did you hire a ghostwriter, etc.? And I was like, I write it all myself and like, I would never like, hire ghostwriter because then it just won't be authentic and it wouldn't be me. I think you got to do it yourself. I think the other thing that's worked for me is when I started writing more seriously, I actually wrote down a list of about ten points of views that I had, like high level points of views that I have, some of which are controversial or at least very, very narrow in thinking. And some people would disagree with them, which is great. And then that way I always had some points of view that I could always go back to and write about that are authentic to me. So, for example, one of my points of view, which might be a bit controversial, is I think in digital health, pilots are a waste of time and you need to design implementations from the perspective of scale. From day one, you may end up discontinuing the solution. But if you design as purely a pilot with no plan for what happens afterwards, I think it's set up for failure. So I hate the word pilot for many reasons. A lot of folks think pilots are okay, they're good, it's a great word. And so may disagree with folks, But I think having a point of view, I think is a very powerful thing. The last thing I'll just say is that I've learned is the hook or the first line of the piece is the most important. People have a very, very low attention spans. If you can't capture attention in the first sentence, you lose the person completely. They're going to scroll onto the next thing in their feed. And so I'm very thoughtful about ok, like, what is something about this piece that could have in The very first line that's going to make Craig stop and go oh, I need to take a closer look at this for at least ten more seconds.

Dr. Craig Joseph: That is a lot of secrets that are kind of obvious after you say them, but not obvious beforehand. So, thank you for sharing that. That's great. I too write all of my own stuff. I will admit that ethically I lapse once or twice and a blog post I had someone said, I can let me help you write that. And then they wrote it and I was like, yeah, it's pretty good. And put it out there. And I just kind of got a tsunami of criticism from people, right? No, it wasn't you. It wasn't you. It was it was a long time ago. But like, they were like, why didn't you talk about this and why did you say that? And this sounds kind of vanilla. I violated just a bunch of the rules that you just enumerated for us. Not on purpose, but yeah, they could. What they the message that they weren't giving to me was but indirectly I got was this is not you. We know it's not you because you did a bunch of things here that we wouldn't we don't expect. And so yeah, I think that's a that's a big difference right there. So awesome. Well Josh, we are near the end. And as you may know, at the end of this podcast, we always like to ask our interviewees, that's my term for you right now. What are some of the things in life that are so well-designed? Maybe one or two. I don't need a long list, so well-designed that they bring you joy and happiness. First. The answer Always people give is this podcast. So let's just let's go past this podcast and go on to other things that maybe are not so obvious. Are there one or two things that are so well designed?

Dr. Josh Liu: I was going to say your podcast, Craig, but I'll go to option two just because you said so.

Dr. Craig Joseph: Thank you. I appreciate it. I'm trying to be more reserved.

Dr. Josh Liu: You’re just so humble.

Dr. Craig Joseph: A lot of people say that.

Dr. Josh Liu: I bet. So I have a really nerdy answer, but it's authentic to me. So I'll share this with you. Many years ago, there was a calendar app for your phone. It was called Sunrise. I loved this app. It was the best calendar app I'd ever used. Then one day Microsoft acquires it and eventually they kill it. They sunset it, it's funny, they sunset the Sunrise app. That's actually kind of funny.

Dr. Craig Joseph: That is ironic right there.

Dr. Josh Liu: There you go. And then they basically folded it into the Outlook app. And at first, so basically, I'm sure everyone here has probably used Outlook where if you open up the Outlook app, you have your inbox for your mail and there's a tab for your calendar. And when that first happened, I was so upset, I was like, I lost my favorite calendar app.

Dr. Josh Liu: And like, why are they putting the calendar in the mail app? I mean, there's a reason why there's two different apps for mail and for the calendar, and I'm so confused as to why they did this. And eventually I got it because I started doing more work on outlook and I had to go back and forth between my calendar and my inbox to schedule meetings, and it was now just one tab away instead of flipping through two different apps. I was like, oh my gosh, like my life is so much better through how they designed this now and integrate the two. And I just learned that, you know what, a lot of times great product designers uncover things that even as a consumer I'd never even think about, I never even thought like, they should be in the same app. My life would be so much better until I experienced it. And so that's my nerdy story of how I found Outlook to somehow be one of my favorite apps.

Dr. Craig Joseph: This is a first. This is a first.

Dr. Josh Liu: I figured it would be.

Dr. Craig Joseph: No, that point is very well taken and I think most of us are you know we don't like change because we're humans and change scares us. And so when anything changes, unless it's clearly, clearly solving a huge problem for us, we don't like it. And I think that's part of the designer's purpose in life is to look beyond what we say we want and give us what we need. And that's not always easily done. In fact, that's rarely, easily done. You as a designer, whether you want to call yourself a designer or not, you lead a software company you're doing design. It's the same thing. Like you've got to really not ask folks, what kind of apps should we design? You have to find out what their problems are and then to design the app to solve those problems in an efficient way. And it may be a way that they've never contemplated before and might be a way that they really dislike when they first start using it. And so you to your point, like what I think one of the great questions that you asked some of the patients that you're working with, what would you, what do you wish you would have known at the onset? And as you were talking about that, I was thinking, you know, a lot of people, even if you tell them what even if someone says, this is what I wish I would have known, and then you tell that to someone who's about to have that procedure or that experience, sometimes they're just not ready to hear it and there's just nothing you can do except give that information and kind of and hope for the best. But that's a designer's dilemma there. Well, this was great and if Microsoft wants to support this podcast, we are always open to that. And we'll use you on the TV commercials, probably too late for this year's big event, like a Super Bowl or some other championship. But we can try again for next year. Doctor Josh Liu it was great having you. Thank you so much for explaining how your company works, what cool things you're doing and how we can all be better at communicating not just on social media, but almost anywhere. Thank you so much.

Dr. Josh Liu: Thanks, Craig. It was great to be here.

Topics: featured, Healthcare, Patient-Centered Care

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