From Emergency Medicine to Disrupting EHR Technology with Dr. Brian Fengler, Co-founder of EvidenceCare

Dr. Brian Fengler joins us on the show to talk about the latest in healthtech and innovating EHR technology to save lives in fewer clicks.

Brian is the Co-Founder and Chief Medical Officer of EvidenceCare (recently named as an Inc. 5000 Fastest-Growing Company), a company that provides a clinical decision support system (CDSS) that’s uniquely integrated with the Electronic Health Record (EHR) to optimize clinician workflows.

Dr. Fengler authored a treatment protocol for Pulmonary Embolisms when he was a resident at The University of Virginia. Despite being an expert in the field, he encountered a challenge while treating a 36-week pregnant patient suffering from a massive pulmonary embolism. Like 80% of healthcare decisions, he had to make a snap decision based on a quick internet search. Even though he was able to save both the mother and the unborn baby, he realized there was a gap in evidence-based information available to providers when they need it the most.

Looking to fill the gap in 2014, Brian founded EvidenceCare with Co-Founder, Jim Jamieson, to create software that would help physicians make better decisions for their patients and hospital. Before EvidenceCare, he was an Assistant Professor of Emergency Medicine at St Thomas Midtown and Rutherford Hospitals, one of the Founding Physicians and Managing Partners of Physicians Urgent Care, and a partner-owner of the Middle Tennessee Emergency Partners physician group. Dr. Fengler is now revolutionizing decision support at the bedside by providing what clinicians need to give better, evidence-based care.

Today, Brian shares more about his journey starting a healthcare tech company, EHR innovation, optimizing clinical workflows, and how the healthcare system can and should be improved.

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Transcript

Kelly Stanton: 0:17

Hey there everyone. Thanks for listening to From Lab to Launch by Qualio. I'm Kelly, your host, and excited for today's guest. We've done over 60 of these interviews now and we're in the top 10 of podcasts for life sciences, which we think is pretty cool. We love help getting the word out on the life changing products and the innovators behind launching them so please rate the show and share it with your friends who are science nerds just like us. We know you have some. Lastly, check out the show notes if you have a story or a product you want to, uh, to bring on the show. Today we're talking with Dr. Brian Fengler, the co-founder and chief Medical Officer of Evidence Care. They provide a clinical decision support system that integrates with a patient's electronic health record to optimize clinician workflows and decision making. They've had great traction. And recently our named one of, Inc's 5,000 fastest growing companies. It's no wonder why their software helps physicians make smarter decisions and fewer clicks. This may be surprising to you, but many healthcare snap decisions are made after a quick internet search. Evidence care is embedding industry leading content right into an EHS for better and faster decision making, which saves lives. Let's bring him in. Thank you, Dr. Fengler for joining us.

Dr. Brian Fengler: 1:30

Absolutely Kelly, uh, happy to be here.

Kelly Stanton: 1:33

So we love talking with doctors who jump into entrepreneurship. Tell us a little bit about your background for those who don't know you.

Dr. Brian Fengler: 1:39

I grew up in, uh, upstate New York. My mother was actually a nurse, uh, on labor delivery floor. So I spent a lot of time as a child, uh, in the hospital hanging out being around, you know, the hospital and medical care and the nurses. And so when I went off to college, you know, I just sort of always had that expectation that I would go into the medical field. And so, You know, as I got into medical school and started looking at different specialties, was immediately drawn to emergency medicine. loved uh, the energy, loved the fact that you could work hard and take care of people, you know, at their most vulnerable when they needed you the most and, and actually make an impact and, and be there, uh, you know, for those scary moments. the level voice in the room that could think objectively and, uh, and help solve problems in stressful situations. Through my experience in emergency medicine is where I sort of, uh, you know, identified the gap, uh, that clinicians feel, uh, very, uh, you know, on a daily basis, uh, around how it's so hard to apply the right care to every patient just because. Is evolving so quickly, it changes, uh, you know, every year. Uh, and every patient has their own sort of unique factors that need to go into making you know, what decision is best for them. And so that really kind of became my passion, uh, and, and why I ended up co-founding evidence scare was, was really wanted to help. Bring information into the physicians and nurses workflow to help them make better decisions and you know, help them take better care of their patients.

Grant: 3:17

That's a,

Kelly Stanton: 3:18

that's a really fascinating story. That's awesome. I love, I love how excited you are to bring your knowledge into, improve the process too. That's, that's, that's great. Walk us through the current state of things around electronic health records and some care variations that we see there

Grant: 3:33

today.

Dr. Brian Fengler: 3:35

Yeah, I think, uh, the EHRs are getting better. I think there was, uh, a lot of frustration when the mandates first came down. I think there has been a very focused effort over the last few years to help make the clinicians' workflow easier, more efficient, reduce clicks, all those things. And I think those are making folks happier and happier with the EHRs. I mean, there's definitely a huge opportunity there. I. Just 10 years ago, we were using paper and, and now we have everything digitized. You can only imagine how much more information there's now becoming available, uh, analytics, insights, machine learning, all those things. Unfortunately, you know, that hasn't all been, you know, that benefit hasn't all been realized yet. There still is a lot of care variation. You know, depending on what studies we look at. You know, anywhere from 25 to 40% of the care that's delivered to a patient is, is not only unnecessary or unwarranted, but. Uh, could potentially be harmful to the patient. If you're exposing them to medications or, or radiation from imaging tests, that's not necessary. And I think that's sort of really the next frontier of medicine is, uh, is how do we optimize the care. That's most appropriate for each particular patient, uh, so that we can not only get them better, but reduce complications, uh, and of course reduce costs. You know, we don't have, uh, infinite resources as we know in healthcare, and so we need to do, uh, you know, a better job of delivering the right care to each patient.

Grant: 5:08

You've

Kelly Stanton: 5:08

experienced the gap in evidence based information firsthand. Tell us about that story and how it motivated you.

Dr. Brian Fengler: 5:16

Yeah, so sort of the, the genesis story behind evidence care. And I'll, I'll try to be as brief as possible, but, uh, sort of a two part story. When, when I was completing my, my medical training in emergency medicine a, a patient presented to the hospital where I did my residency at, and, uh, the patient had a, a massive blood clot in his lungs. It's called the pulmonary embolism. And at this time, uh, you know, 15 years ago, there was some debate in the literature as to, you know, what's the best care for those patients and. After ion, we felt that this patient warranted receiving clot busting medicines to try to break up that clot. We were just about to administer. That medicine, uh, when a whole team of, uh, you know, white coats came down to the er and, uh, it was the ICU team. And we got in a conversation over the indications for these clot busting medicines. And, uh, that, uh, conversation became an argument and the argument ended with the ICU team going into the patient's room in the emergency room. Disconnecting him from the oxygen and the wall monitor and physically pushing his stretcher out of the emergency room and saying, well, he's our patient now. So we'll make that decision. So they load the patient up in the elevator, they take him upstairs. And unfortunately, this, this gentleman died five hours later. Having never received the clot busting medicines that, you know, we, we were gonna give him in the emergency room. Uh, and so this became a big case at the hospital. Because of that case, I ended up doing a year of research and I ended up publishing a protocol in the American Journal of Emergency Medicine for how. Emergency physicians should be assessing patients with, uh, blood clots in their lungs. And, you know, based on that individual patient's, uh, indications determining what the, the optimal therapy is for that patient. And so I, I finished my residency and I moved, uh, here to Nashville. And, uh, second part of the story now you know, about 10 years ago I was working, uh, one night at the hospital here in Nashville. And, uh, a young woman presented to the ER with, uh, extreme shortness of breath. And, and I walked in the room and I had one of those moments as a physician where it's just, it, it hit me, you know, just, wow, I need to do something fast. Cuz, cuz this, this woman is very, very sick. And the problem is she had a huge clot sitting between her heart and her lungs. And that was bad enough, but as it is, she was also 36 weeks pregnant. Oh. And so here I am and I'm, air quotes here, the expert on pulmonary embolism, you know, published, uh, the protocol. And, and I'm still at a loss for, uh, if, if what I do for her, how it's gonna impact her unborn. And so I did what actually 86% of doctors do when they have a clinical question which is I asked the nurse to go, uh, prepare that medicine, uh, while I ran and found a computer and got on Google and started searching for what happens when you give a pregnant woman these clot busting medicines. And, and many of doctors and nurses have been there where you can't find the information you need fast enough. The nurse yelled a few minutes to me from the patient's room. You know, I need you in here right now. I, they're running back into the room and, and the woman is about to go into cardiac arrest. Uh, and so I went up to her and I, I said, ma'am, you're very sick. You have a large clot sitting between your heart and your lungs. I'm worried your heart could stop at any moment. I'm gonna give you this medicine, which is a clot buster to try to break up that clot and, and save your life. Uh, and she looked up at me and she says, well, what's the risk to my baby? And I said, I don't know, but if I don't save your life, then you know, your baby's gonna die also. And, and so that moment was the genesis of evidence scare and it hit me like a truck, uh, because I was. Immediately struck with the fact that, you know, physicians and nurses are making these critical decisions, uh, every day multiple times per day with a complete lack of information at the bedside to help them make the best decisions for their patients. And that's, You know, that's been my passion, you know, and, and my mission in creating Evidence Care was to be a tool that helps bring, that information into the physicians and nurses workflow so that we can help them make the right decision for each patient.

Kelly Stanton: 9:49

How did it turn out for the woman

Dr. Brian Fengler: 9:52

Uh, she did, she did very well. So, yet we administered the medicine. You know, she did very well. Uh, the clot actually dissolved. They watched her for a week in the intensive care unit, and then they, uh, you know, induced labor and, uh, she has a healthy baby boy. I get pictures on my phone every, uh, every year or so from her. And, uh, Everything went very well.

Kelly Stanton: 10:16

Good. Good. Yeah. What a, what an amazing story. And, and certainly can see, that sort of outcome, you know, feeding your passion here for sure. So, out of that, you've managed to build one of the fastest growing healthcare tech companies in the US despite the state of our economy. Uh, how do you go about hiring talent and building a quality culture in that setting?

Dr. Brian Fengler: 10:38

Yeah, I think you know, we like any company, you know, had, had you know, our concerns at the beginning of Covid and worried whether we were gonna make it through, uh, as many companies worried. We were very fortunate, uh, to make it through. You know, the first phases of c you know, one of the things we've really focused on over the last few years is, is company culture. We had a new, uh, CEO come in you know, Bo Baril, who's, who's just amazing person, amazing leader and, and really leaned in, uh, e even more than almost felt comfortable from the perspective of building culture, highlighting values you know, and, and that has just. You know, played itself out over the last two years to, you know, while many companies have, lost, key, employees you know, can't find good employees, you know, to bring onto the team for the skill sets that they need. You know, we've kept our whole team intact. We've been, go out, been able to go out and hire and bring on, you know, new, fresh talent. All because we've built a company culture that you know, people wanna work for. People are excited. And, uh, you know, to sort of start, it sounds so basic and easy and simple, but not enough companies are, are taking the time to slow down and, and prioritize those things. And I really believe that that has contributed to our success over the last few years.

Kelly Stanton: 11:58

Sounds like it. So how do you see this technology evolving in the next few years?

Dr. Brian Fengler: 12:03

Yeah, we're, we're very excited. You know, we're, we're, we're just now, after three to four years of working on it, you know, getting the depth of EHR integrations that are needed to, to really, uh, Be integrated into the physicians and nurses workflow in a way that when they're using our applications, they don't even know that they're using a third party application. They just think they're using their ehr. And, and really helping to make their workflow more efficient. You know, which is, What, what they wanna do. They, uh, they're frustrated with how many clicks they need to make per day. Uh, they're fr they feel like the, you know, the electronic health records are sort of holding them back and, keeping them from their patients. And so, first and foremost, we wanna. Improve their efficiency, make their job easier. And then at the same time, if we can help deliver to them, you know, the care that is most appropriate for that patient, well then we're helping them take better care of their patient. And, uh, you know, just sort of, completes the circle there in terms of where we see the product evolving, you know, We're, we're doing all the, you know, machine learning and AI with our applications, pulling in patient data, delivering clinical insights, you know, even go beyond, the speed of, of the published evidence, being able to keep up. And so we're, we're very excited about all of that. And it, and it all starts at the physician and nurses level of, of making their, efficiency, better, making their job easier while helping them deliver better patient.

Grant: 13:34

And the thing

Kelly Stanton: 13:34

that's sort of trotting around in my brain at the moment too is, is from the company perspective, the pharmaceutical, the medical device companies. Yeah. What an amazing, you know, cuz one of the things, of course we have to do an industry around post-market surveillance and all that kind of activity, but Also kind of keeping an eye out on whether it's expanded indications or, you know, patient outcome data. We don't always mm-hmm. we don't always have great feedback loops for that kind of information. So it sure. Seems like you guys are uniquely positioned, you know, to, to provide some important insights back to the manufacturers of the blood clot dissolver. Yep. For example, right. And, and that sort of thing. So is there. Sort of plans for the future around that? Cause I know we can also sort of start to tread a little into like, is this clinical study activity or not? Yep. What, what does that boundary look like for you guys, and how about the future of that sort of partnership to make that information

Grant: 14:32

more

Dr. Brian Fengler: 14:32

available? Yeah. Yeah. We think there's a huge opportunity and you know, again, depending on what studies you look at The studies show that it takes some say seven to 10 years, some say up to 17 years for knowledge to get translated into the physician's, you know, mindset and, and applied to their patients. You know, it used to be that pharmaceutical companies could, sponsor conferences and it, it, you know, uh, take the physicians out to dinner. But now that a lot of those activities are being limited and so we really do see that, you know, embedded applications are gonna be the way. That we can deliver evidence based guidelines to the providers. And it just so happens that sometimes those guidelines include, you know, these newer therapeutics, uh, devices and, and, and pharmaceuticals that have been proven to have better patient outcomes, lower costs. But the physicians are still practicing what they learn 10 to 20 years ago. Yeah, exactly. So they're still putting patients on Coumadin, you know, and they're not, they're not using the new. Oral anticoagulants and, and things like that. And so, there, there is so much opportunity for industry to partner with, you know, the medical societies and also vendors to help get this clinical evidence into the physician's workflow, into the nurse's workflow. And, and not through the perspective of, bias and more expensive things, but, evidence supported medical society, uh, you know, vetted. You know, proper treatment of your patients based on the latest evidence.

Kelly Stanton: 16:08

Definitely. Yeah. I just, man, I just see this huge potential for that. Mm-hmm. Uh, alright. Well to kind of switch, switch gears a little bit here. If you could go back to the start of your career, what would you tell yourself based on what you know now?

Dr. Brian Fengler: 16:23

It's gonna take you 10 times longer and you're gonna need 10 times more capital than you, than you expect.

Kelly Stanton: 16:31

that's, uh, yeah, it's always more time and money, isn't it?

Dr. Brian Fengler: 16:35

Yes. I I mean, as a, as a physician, entrepreneur, and, you know, for all the entrepreneurs out there, you know, when you're raising, you know, your first seed round and, and you just say, you know, if, if I just, if I had a million dollars, like I could, I could create this whole thing. It's gonna be, you know, change the whole universe. It's, you know, and then you, you go through your first million, like, like that. And, and then next thing you know, it's 10 20 and, and it's. Geez, I, I wish upfront we knew how much it was going to cost and how much time it would take because we would've had a different plan and approach for, first three to four years of the company. I mean, I felt like I was raising money, you know, 80, 90% of what I was doing was raising money, and that was taking away from our speed to market, our product development, our, Strategic alliances and, and, and client, you know, results. And if I went back and, and I am counseling, you know, entrepreneurs now in the Nashville market and, you know, I, I look at their one or two year projections and I'm like, Nope, it's gonna cost It's gonna cost way more than that. You know, if you're gonna do it, do it, do it right, you know, so that you, you're not looking over your shoulder, every, every month, worried about, you know, Hey, we gotta go raise more capital.

Kelly Stanton: 17:53

Definitely, yeah. I spent a good bit of time doing quality systems in the startup space, and I've seen that so many times. It, it is, it will always be, uh, more expensive and a lot longer than you think. Yeah. So a fun question. We had another guest on our show and I just love this question. So now, We're asking it all the time. Uh, if, if I walked into a Barnes and Noble bookstore, where would I find you in that store?

Dr. Brian Fengler: 18:18

So you would find me in the coffee shop my wife, you know, used to joke with me at she'd. before I had evidence care and I was, uh, just a physician you know, if I had a day off, I would say, I'm going to the office. And she knew that meant I was going to Barnes and Noble And I would go pull the, you know, the Kiplingers and the uh, the Fortune magazine. And I, I'd pull all the business magazines, money Magazine, and, you know, I'd sit there for a couple hours and, uh, read all the finance magazines and, and have a cup of.

Kelly Stanton: 18:47

Nice. Nice. So where can folks go to connect with you and follow along with Evidence Care's Progress?

Dr. Brian Fengler: 18:54

So, uh, myself and, and my team were very active on LinkedIn. You know, could also go to our website. Uh, I think, uh, evidence.care/info, uh, is, is the right place to start on our website to, to learn more about what we do. So yeah. Thank you. I really appreciate the opportunity.

Kelly Stanton: 19:11

Thank you for your time. It's been, uh, it's been fascinating learning about what you guys are doing. Look forward to seeing more. Awesome. Thank you.