Fixing Healthcare Data: AI, Interoperability & Business Strategy with Dominique Gross of HART

In this episode of Curve Ahead, host Brian Wiles interviews Dominique Gross, CEO of HART, about healthcare data management, AI in health IT, and scaling a tech company. Dominique shares how she transitioned from mechanical engineering to leading a fast-growing health IT firm, how AI is shaping data interoperability, and why saying no is sometimes the best business decision.

Key Takeaways:

• The challenges of healthcare interoperability and standardization
• How AI enhances but doesn’t replace human oversight in health IT
• The role of product management in identifying business focus areas
• The importance of knowing when to pivot, restructure, and scale

Tune in now for expert insights into AI, healthcare innovation, and leadership in tech.

Transcript

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Welcome back to Curve Ahead. On today's episode, I am joined by Dominique Gross, CEO of Heart, an IT firm transforming how healthcare organizations manage their data. In this episode, Dominique shares her story from mechanical engineering to leading tech driven healthcare company and how her background in product management has shaped Heart's strategic growth. Some of the key themes that we will explore today are the challenges of healthcare data and interoperability and why standardization is still a long way off. How AI is already playing a role in healthcare it, but why human oversight is still crucial. By the end of this episode, you'll learn why focusing on core competencies is key for scaling and how saying no can sometimes be the best business decision. Dominique, welcome to the podcast. Do you mind introducing yourself? Sure. Great to meet you, Brian. My name is Dominique Gross. I'm the CEO of hart, a Kansas City based health IT firm. Can you tell me a little bit more about your background and how that landed you as the CEO of hart? Absolutely. I actually started in mechanical engineering that I get an interesting degree that's really focused on problem solving in a variety of ways. I started out actually at a H VAC company focused in healthcare facilities. I was working at the Fred Hutch Cancer Research center for quite a while and I just found a love for healthcare and ended up joining a company called Philips based out of the Seattle area. Came into the defibrillator business there. Philips was a company made up of a lot of acquisitions and so I got a great experience because coming into a really small company that had been acquired by Philips and spent a few years there just falling in love with product and working with clients and the marketing team as an engineer. And I thought gosh, I really love this so much, I should go into marketing. And so I got an MBA and really got deep into the business aspects of how to work with clients in a more productive product management focus or business orientation. Learned kind of the other half of the brain in running a business and was lucky enough to get a role in product management and spent the next really six years doing different kinds of product management. Everything from designing and developing new products to how do you invest across portfolio products, how do you then take that to market. That was a really interesting experience to really just see the kind of broad production of everything from ideation to 10 taking things to clients. And then I was lucky enough to get a leadership role kind of managing the federal segment at Philips for all 17 businesses. It was a pretty unique time at that point. It's pretty competitive and so part of how were looking to expand that business was we ended up launching all of their health IT products to the federal space. They had never done that before. And so it was a great opportunity to dive in and launch a whole new business to such a large client. The federal space here in the US across VA DoD, NIH is the largest client for Philips. So it's a really robust business. And so it was a unique experience across those three years, really managing everything tip to tail in terms of commercialization, working really deeply with the sales team. And after that experience thought, you know, let's try something different. And so I ended up working at IT Intuitive Surgical, which could not be more interesting. In a sense the most well funded startup it feels like on the planet some days, but totally different culture and experience. And I spent three years helping them launch their robotic bronchoscopy system. It's a really unique time because also sort of a startup within a really large company these days. And so it's just been a path of finding these kind of really interesting, unique niches of small spaces in really big companies. Kind of really focused in commercialization and kind of building up these businesses over time. And it led me to Heart actually, which was a pretty unique opportunity there. But that's just been the last couple years. So let's get into Heart. Tell, tell me a little bit more about what heart does and then how you ended up there. Yeah, so Heart is a health IT company really focused on interoperability. What we help clients do in all segments of healthcare is move data from A to B. We store data, we transform data, we just make things work. So much of the industry right now is very manual and what the team has been able to do over the last decade is really build up kind of modular data models to make it much faster and technology focused, which is super unique in the market. They've been doing that over the last 12 years now and we're really kind of just hitting the stride in our growth phase. You wanted to know how I got here? Well, that's actually kind of a funny thing. You know, you fall into some of these places. I had some friends actually from Phillips who were part of an MBA program I used to help lead. And a few years ago they called me and said, hey, can you come help evaluate this business from the technology and the healthcare side? They had been doing more of like the code review and the tech side and said, but we don't really know much on the healthcare side, so can you just come in and kind of help? And so I Did. I was lucky enough to join the board and start working with the leadership at the time and called up a number of friends from my health at days at Philips and said, hey, if you had a solution like this, do you think it would still be valuable in the market or do you think these problems have been solved? And every single one of them said, oh my gosh, please come help us because this is still such an issue. And it is, you know, it's a really unique business and that's kind of where we came to was, gosh, there's a ton of opportunity. It's not solved yet. So who better than this company to come out and really just land grab with that? That's awesome. So you had mentioned that Heart kind of specializes in data, especially around healthcare. I mean, I think that's, correct me if I'm wrong, a very highly regulated space. So, you know, can you tell me about some of those challenges there? Since it is such a highly regulated piece of information, you know, how do you guys handle that? Yeah, health, it is kind of funny. EHR space I would say is more regulated in a sense because it's obviously dealing with clinical data. Right. So there's a lot more rules around that. What we do specifically from interoperability is regulated in some ways and in other ways is totally not. Which is confusing relative to healthcare markets. You're like, hey, this seems odd. So really what that boils down to is there's a lot of standards, but there's not like one standard, one regulation. And so it's really more kind of trying to find the ways to navigate, you know, 15 different things, normalize that. And I think that's where technology and HART has been really lucky to come in and say, okay, you know, over the years there's been some many different kinds of standards out there for data communication like HL7 and FHIR and now you've got new things like TEF and honestly it's just still very messy. And so we're lucky, I guess in that sense that it's not kind of standardized like the financial industry or airline industries or anything useful at this point. There's still so many different methods that there's still a ton of opportunity to help. Is that a risk that there that the industry does go to a single standard, mostly probably implemented through legislation? Gosh, I'd actually be pretty pumped for that. You know, it's still going to be hard and I think the healthcare market is, it's unique because it is hard and there's so many different people and it's so resource constrained. You know, the average health system or hospital in the US has a margin of like 2%. You know, that's they're lucky if they're making money. Money. And so even if there is some standardization, the fact of the matter is most of our clients are just super resource constrained. They don't have the expertise to do this kind of work. So if anything, one single language or standardization would make our life so much faster and easier. So I'd be pumped for that. But I still think that's just so far away. You know, this is the holy grail of life, is having, you know, your medical records be wherever you go. We've been working on this for 20 years already. More than that probably, but we still have a ton of time before that's really a reality. Well, I'm glad to hear that. It's not a like immediate risk. How, how do you and Heart kind of embrace new technologies? I know that AI is a huge trend recently. How and can you at heart embrace technologies like that? Yeah, you know, AI is an interesting thing in some ways we kind of already use it, right? We use data models, we use large language models just after years of experience. So in some ways it's really prevalent in just the day to day work we do anyhow. But as things evolve like ChatGPT and these things, I look at them and I think the team looks at them as tools to use when and how they're appropriate. I think at this point AI is only as good as the prompt you put in. So you still need so much experience and knowledge behind it and thankfully we've got that. And I think that's what makes a really unique team. And these things are phenomenal tools. They make work so much faster. Right. Our marketing team uses them, our engineering team uses them, and I think they have to be treated just as they are, which is a supplement to what you're already doing. We have been exploring it for new uses for our clients and I think the question always comes down to like, what's the value? Our clients need things faster, easier, simpler. And so if that can be accomplished with some of these tools, then that's definitely where we are. I was having a conversation, I think it was last week with regards to AI and I don't think it really matters what space you're in, is that AI is kind of in a human sandwich. Right. You need a person to create the prompt and input it into the model and then you need a human to analyze the output. So. So like we're not to a point where we're getting rid of people quite yet because we still need to do at least those two steps. Leveraging those large language models is super beneficial, especially when it comes to data analysis or development. I know that there's been quite a few new tools on the market over the last year or so that specialize in just that. Yeah, absolutely. And I think in our space, a lot of what we do is recognizable in a sense of like, you could totally use AI to help, you know, automatically understand what's the incoming data. Where do I put it? Right. What makes healthcare fun though, is people don't do things the same way every time. Right. Somebody used a great example for me the other day where there's two neighboring hospitals that are literally across the street from each other. One's a children's hospital, one's a regular kind of normal hospital. And they use completely different nomenclature for how they identify their patients. Same patient, totally different, like IDs. So matching a patient like that in our new world only gets you so far with AI until you have to find all of the uniqueness. And I think that's exactly right, what you said about, you know, like a human sandwich in some ways. Right. You, you need that sort of like AI or tool or whatever you're going to use. In our case, it's historical data models to get you to that 70% or 80% of work in faster, more efficient ways. And then you need that interpretation to say, okay, well, here's what the rest of it looks like. Here's the decision making points. I don't see that changing in healthcare anytime soon. Not to mention people are just not comfortable with it. We have a lot of conversations with clients and physicians on the know. We do data cleansing and part of that is removing duplications or patient matching between two data sets or two hospitals. And every single time they'll say, well, don't match a patient. If it's not 100%, I want you to flag it for me so I can confirm because there's so much just like concern of the uncertainty to like the risk. And I appreciate that. Right. I think it's a big part of our decision making too, to say, okay, what's the threshold? If it's 99%, is that enough? Like, where do you find the comfort to say, okay, if 99% of these fields match, we think it's pretty much the same patient should we approve it and I think that's where AI is going to continue to be kind of like the risk factor, I guess, where, at what point do you insert those decisions for folks to confirm or move on? And I don't think that problem's unique to health care at all. I think any sort of data when like even in marketing. Right. I've worked with large Fortune 500 companies and when we do a data scrub of their customers and it's very clear, a duplicate, they want to make sure that we aren't getting rid of people that they can continue to market to. And we have to prove without, with like a typically thing, it's like a 98% certainty that is a duplicate customer and then we can delete it. So like it doesn't matter where you are in the world or what it is that you're doing. I think that companies realize how valuable their data is and it's going to take small miracles to get rid of it. Yeah, absolutely. I think you're right. We don't do so much of that, let's say on our marketing side, I would say, you know, we obviously have a lot of active components on that from brand awareness and the marketing campaigns. I guess I'm less worried. The risk, the risk goes down significantly for us as we start to kind of move away from Phi and I think once you have that comparison, everything seems less exciting. So let's change topics a little bit. You had mentioned that you are kind of quote unquote the founder 2.0 of heart. Can you kind of explain that to me a little bit more or. Yeah. Well, what's your thinking behind that? Well, I have to give our founders credit where credit's due. Hart was actually founded in 2012 by Craig Jennings and Mo El Katie. And you know, the vision was an incredible perspective at that point in time. They wanted to create kind of a healthcare platform that others could develop on supervisionary. At the time I think they had a lot of interesting comparables at the point where they were looking at finance, they were looking at airlines, they were looking at all these kind of different platforms for connectivity and thought why didn't we solve this in healthcare? The nuance of that of course is it requires some pretty capable people on the other side from a healthcare standpoint. And while there are some amazing facilities and IT teams out there, it's not the norm. We talked about them being pretty resource constraint. So. So for about really the first kind of 7ish years, they were focused in kind of different areas. Heart originally was founded in Costa Mesa, got their start with St. Joseph's Health System there in Irvine and helped really build out the platform with them. And along the way they kind of kept getting distracted is maybe the best way to say it. I think this happens a lot with early stage companies where they're trying to find their product market fit. And at the time Hart built the platform, which is phenomenal, and then started doing remote patient monitoring for St. Joe's because they asked them, Right. And had a staff at one point of over 60 registered nurses to do remote patient monitoring. Which couldn't be further from building a tech platform for interoperability later down the road, you know, they ended up building out a platform or basically expanded, expanding their current platform to help do billing and coding and predictive billing and coding based on diagnosis. Right. And along the way they just kind of kept getting into these scenarios where they were just distracted. There's a massive market in the underlying unsexy stuff. That's the core business of just interoperability. But there's shiny things along the way. Right. And that happens. I feel like that's not really unique actually for a lot of entrepreneurs is they're just trying to make money and they're trying to find their fit. So when I came on to Heart, it's been now almost two years really what I was looking at was what's the core product market fit? Right. What, what do we really sell at the core? Who's been our longest clients? What do we do for them? And in that journey, that was really educational for me because half our clients didn't even know what we did for them. And the remarkable thing is we're moving millions of records every year from one client to another, or one facility to another, or whatever it might be, but they have no idea really like what we do for them. So that was really eye opening, I think, at that point to see kind of the history of 10 years prior of providing amazing value to the point where they've had some really long standing clients, you know, six, seven, eight year clients, but just seeing kind of the level of distraction that can happen in your strategy over time and how the business can kind of just stagnate in some ways because of it. Right. So when I came on to Heart, a lot of what my journey was taking the great technology and the base and the unsexy stuff that was actually super valuable and saying, how do we package that so people understand the value, People want to buy it, they understand why we're special and unique and that's been a whole journey. So for the last, really two years, we took what was a business of 20 plus engineers who were kind of focused on shiny things and have really evolved that to somebody like a business that's well rounded, that's balanced in all functions. We have the first sales team ever, which is hard to believe, but, you know, things like that make a massive difference. I think a big part of why I came in, why I'd consider myself founder 2.0, is the business had never really grown, truly. I mean, it kind of stagnated at that 5ish million for years, like plus or minus in any given year, and had not really reached the potential of what the market is. So when I started in a lot of that was just defining the space. What do we do? Where do we play? Who are competitors? What is the opportunity? And then building a balanced business to support and execute in a way that was really meaningful. So Instead of having 20 engineers, we now have five important things that needed to change to say no. We're actually really focused on commercialization and growth. And in a lot of ways that's been, you know, a rebirth of the business in some ways. And I expect we're going to change again in a sense of like, you know, that phase from 3 to 5 to 7 million to 10, you do a lot of growing and evolving, and at some point we're going to be a 3.0, right? And eventually we'll be a 4.0. And I love that. But in some ways you are kind of like a new founder when you have to start from the ground up like that. But I was really lucky to come into what was really already a product market fit, even if they didn't realize it. So how did your background in product management kind of help identify, hey, here's our core competencies and this is really how we need to kind of pivot to best suit our customers and then see growth further down the road. Yeah, gosh, that was probably the product management side of really just deeply understanding client needs, the unmet need that they have that we're serving the value. You know, what is the value story? How do we save them time, do something unique and special for them. All of that was really kind of my first several months just talking with clients and asking, you know, what do we do for you? What do you value about it? How, how do we work for you? You know, all of those kinds of things in a educated way, but in a way that really we could get it kind of the crux of what's our durable differentiator. How do they want to buy from us? We changed several contracts in that process to say, okay, you know, here's what we're actually giving you. Right. I remember my very first week were responding to an RFP and it was just the funniest experience ever because the client didn't know what we did for them. So they put an RFP into the world for competitors to reply to. And they got what they got back because they didn't understand what we did. And so for the next several weeks and months, we spent a lot of time together, retained that client, thank goodness. But it was a journey of discovery, really, of just spending a lot of time with clients, a lot of time with the team. And product management at its foundation is exactly that. It's market research, it's understanding client needs, it's understanding how do you match that to value From a commercialization standpoint, I truly couldn't have done what we've done without it in any way, shape or form. You know, actually think about that a lot. CEOs tend to come in with different experiences, right. I have a colleague who is also a first time CEO for a different company and we talk a lot about kind of how our skills differ. He was more product engineering, I was more kind of a mix of marketing and product management and commercialization. And our journeys have been very different. And without sort of my base experience, I don't think we could have made that shift to say, okay, here's what our proper pricing and packaging and offering should be. Because this is how our clients want it. You know, this is what makes us valuable. Like our clients want nothing more than to have problem solvers, you know, people who will come in and just ask questions and solve those problems. And how special in a market to be able to do that and not be commoditized, right? So I think that, you know, just my general background and experience really made all that possible. I've spent a lot of time with the team, kind of just coming up with what we actually sell as a product, how we're going to offer that, how can we make it easy for clients, right? We always ask ourselves, like, are we giving them too many choices? Is this difficult to understand? You know, we spend more time with that because it is really unique in the market. People don't want complexity, they don't want to have to deal with all of these ins and outs. Particularly in an item world where that's all you get. So it's been really, I think, super valuable to have that history. I mean, even so far as how do we invest in an R and D portfolio. One of the first things I did when I came to Hart was assess what all of our R and D projects were, what the revenue opportunity was, how much it was costing us, and we killed half our products at that moment in time. Said, this is not going to move forward because it was either not going to net us enough revenue to cover the cost, or it was too small of a market to continue to invest in. And those are tough decisions. But without that kind of baseline knowledge of how do you invest for a return and how do you understand where you're going to be really unique in the market, it's hard to make those decisions. You had mentioned something, and I think it kind of goes back to what you were talking about when you said you were considering yourself the Founder 2.0. Right. You were having the conversations with your clients and they were looking for problem solvers. And I think that is kind of where a lot of founders kind of fall into extending themselves into additional areas in their portfolio that they may not normally because they have clients who are willing to pay the bills and willing to say, hey, can you solve this thing too? And this thing too, and this thing too. So you see scope creep in the actual organization and then it kind of gets muddy as to what it is that they do at the core of the business. But you're doing exactly that, right? You're problem for your clients because that's what they're hoping that you'll do for them. So I totally understand both sides of that, needing teams to help support you and solve problems, but also being a founder and getting so tied up with shiny things or requests from clients that like, it muddies what your core competencies are as an organization. And because of that, it can definitely stagnate your growth. Yeah, I think that's a big part of just having a leadership team. We do a lot of time together to say, you know, what is our vision, what is our mission? But more importantly, what are we going to say no to and where do we bring in a partner and what kind of partner? And, you know, that's been almost as important as everything else that we do to say, like, okay, where is our boundary? Right, we're going to do this, but not this. We're not going to be subject matter experts in any of this stuff. We're going to find partners to help do those things. And that's helped a lot because it does keep the focus. Because you can't invest in everything, right? Everything is a trade off. Everything is a choice. We talk about that a lot to really kind of keep us focused because that's exactly where were. We were in shiny thing land. I used to call it candy land, which is super rude, but it really kind of felt like that because it was so exploratory. It was not a free for all, but just exactly that. Right. They're opportunities and they're trying to fulfill those opportunities in whatever way they come. But it comes at a cost. And sometimes it's a pretty high cost, whether it's for your focus or otherwise. So we've been super intentional about where we want to play in the market, how we want to play, what makes us unique and how do we reinforce that, how do we go deeper in that, either from a tech or competency standpoint, Maybe it's a simple as an offering. One of the things that I think Heart's done a phenomenal job and the team has done is taking what's a great product and finding the 15,000 ways to sell that thing. But it's still the same thing. But believe it or not, you can problem solve in that way. Right. You don't always have to create something net new from an actual product standpoint. It could just be in how you deliver it or part of the process. Right. And I think people forget that sometimes that, you know, you can have different combinations of things and that becomes a net new solution. Right. And so we've been more focused in that space to say, how can we continue to provide great service, great products, great tools, but not cross the line of things that we don't want to build an expertise in? And that's been hard to stay focused, but it is super important because you can't do everything. I used to have a professor at my MBA who always said, you know, nobody walks into a restaurant and orders lukewarm tea. They order hot tea or they order iced tea. Nobody ever orders lukewarm. So figure out what you are. You can't be everything to everybody. You got to pick something. So we do a lot of that of just figuring out what is the need we're going to solve and just. Really hyper focus on that kind of love that analogy. You can't be, I mean, being the T, you can't be everything to everybody. It's so true. Because there's always a trade off. And I think I keep kind of thinking back to your product manager experience when you're Thinking about how there are these trade offs, especially when you're considering return on investment when seeking new work, or how you're solving problems for clients. Because like you had mentioned, you ended up killing off a bunch of products because you, there just wasn't a future there. It was costing you time and resources and money that just didn't have enough ROI to continue. Yeah, just that process there. ROI comes in so many ways. I think people also forget that too. Right. Some of it is, you know, based on your strategy. Are you trying to get as many clients as possible? Are you trying to get as much margin as possible? So for us we've constantly kind of thought about that as well in terms of how do we align our roi. You know, in some cases it's a competitive play even. Right. But I will say one of the things that's interesting about our market is while it took some time to really kind of define our market for interoperability solutions in, you know, healthcare, I think about 80% of it is white space, which is strange. You know, it's alternatives. Either people are doing it themselves, sort of with people, or there's some competitors in the space. But nobody's really gone gangbusters in our space. Most people have been there for 10 plus years, you know, maybe a little bit less. And nobody's hit these like magical numbers. Like the largest competitor we have has 500 employees. That seems weird. So for us we're thinking, man, considering there's like a $12 billion a year EHR market, it makes no sense that the transformation, the migration and you know, storage and all of those things, that market is still so tiny. It's just because nobody's found the right product market fit for the solutions to really build that market in a big way. I think we have, which is pretty unique. But defining that space, targeting it and then figuring out just that, like what do I say no to? How do I define roi? Is, is it competitive things? Is it not competitive things? And there's, there is always a trade off, right. To say are we going to give on price so that we can get volume? Are we going to give on maybe the contract structure so that it's more favorable for both of us to try and drive a particular outcome. There's lots of different pieces that we think about when it comes to ROI in those decision makings. And then you've got R and D which is on a totally different zone. Right. R and D is so interesting because in a lot of ways it's kind of a sunk cost to the future. Right. In some ways, you're doing exploratory stuff. You know, in an ideal world, everything you're doing will get to some revenue at some point, but sometimes you have to kind of go on a journey to get there. So it's R and D is a little trickier with the roi, but in some ways it's pretty fast. If it's obvious, you know, were running this one project when I first started that used aws, which is now what we fully migrated to. But at the time, were doing a dual on PREM and AWS strategy, and the AWS piece of it that were running was like X what our on PREM was. And at the time, it was revenue. It was not revenue generating at all, was never going to make money. It was just a support service, basically. So we killed that immediately because. Because why? Why fund this thing that's costing us extraordinary amounts of money that has absolutely no revenue in its future? It was neat and it was certainly exploratory. But that's where like the Candyland piece comes in. Sometimes you're like, wait a minute. We have to have more diligence around the kinds of things we invest in. Even if we know sometimes it's going to be exploratory, it may not happen immediately. It's been a pleasure. I really appreciate your time today.