Startup Physicians

From Tragedy to Traction: How Clinical Rigor Built a National Pediatric Innovation Movement with Dr. Dave McSwain

• Alison Curfman, M.D. • Season 1 • Episode 21

Share episode

When a devastating clinical moment sparks a career in innovation, what happens next? In this powerful episode, Dr. Alison Curfman is joined by her longtime collaborator and friend, Dr. Dave McSwain — CMIO at UNC Health and co-founder of the national pediatric telehealth research network, Sprout. Together, they reflect on how a single missed opportunity to intervene became the catalyst for designing systems that now save lives.

Dr. McSwain shares the story of how telehealth helped save a child’s life, and how strategic research and collaboration transformed a fledgling idea into a national framework. They unpack the power of evidence in healthcare innovation, the difference between casual metrics and rigorous evaluation, and why startup founders must learn to speak both clinical and financial languages.

Whether you're a physician-turned-founder or a clinician curious about what’s possible, this episode is a masterclass in taking meaningful experiences and turning them into scalable, fundable, system-level change.

Episode Highlights

[00:00] - Introduction to Innovation in Pediatric Telehealth
[03:03] - The Evolution of Telehealth: A Decade of Change
[05:59] - Personal Stories: The Impact of Telehealth on Patient Outcomes
[08:54] - Building a Research Network: Overcoming Barriers in Telehealth
[11:54] - The Importance of Evidence in Healthcare Innovation
[15:09] - Navigating Financial Challenges in Healthcare Programs
[18:06] - The Role of Data in Evaluating Healthcare Technologies
[20:57] - Leveraging Academic Skills in the Startup World
[23:45] - Collaboration: Finding Your People in Healthcare Innovation

Dave McSwain:

So you get used to this idea that, well, everybody knows this stuff, right? And then you get into a different world where suddenly you're in a space where you've got cybersecurity experts and you've got digital infrastructure experts and data and analytics and all of that, and it's foreign. And so you've you feel like, well, I have no business in this space. And still, to that day, as the Chief Medical Informatics Officer for a large health system, I get that feeling sometimes in a conversation and you have to reground yourself on why you're there and why your your expertise and your your perspective matters.

Alison Curfman:

Welcome to Startup physicians. Please like and follow our show to join our community of physicians who are reimagining healthcare delivery. Hi everyone. Welcome back to startup physicians. I'm your host. Dr, Alison Curfman, and I'm excited to be joined today by my colleague and friend, Dr. Dave McSwain. I think you're now like the fourth or fifth Dave that I've had on this show. So got a pattern going on there.

Dave McSwain:

We are common. We are many, yes, but I'm

Alison Curfman:

really excited to introduce you guys to to this part of my journey, because Dave was part of my he helped shape the earliest chapter of my innovation journey. He is currently the CMIO of UNC Health, and he was my co founder in launching my first organization, which was called Sprout. It's still called Sprout. It's the national pediatric telehealth research network. So together, we really learned what it takes to bring clinical rigor into the innovation area, using using research and how to build something useful and measurable. And so whether you're an academic clinician or a startup founder or someone who's trying to bridge both worlds, this conversation is really about how research and metrics and smart partnerships can really unlock real value. So thank you so much, Dave for joining me.

Dave McSwain:

Thanks, Allison. I'm really excited to be here. It's It's hard to believe it's almost exactly 10 years ago to the day that you and I really started to collaborate together on the pediatric telehealth Research Network. And years, I can't

Alison Curfman:

believe it's been 10 years. Well, yeah, so we can talk a little bit about your background and our journey, but for those of you doing the math, I think it was, you know, 2014 early 2015 that Dave and I started collaborating on how we could build out better solutions for pediatric telehealth that was pre pandemic. So quite frankly, there were not a lot of people interested or doing telehealth at that point. So it's just funny how much things change, and especially with the acceleration of the pandemic, of the acceleration of adoption. But it's funny how you know it's it's now such a ingrained fabric of what we do in healthcare. That doesn't sound very innovative anymore, but back then, it was,

Dave McSwain:

well, yeah, that's the we had. We had focused on some of the core problems, and that positioned us really well when the pandemic did strike, to be a huge resource, not just for pediatric telehealth services, but for services that were being rapidly stood up across the country, and I think we even had some international calls during that period. But yeah, I'm a I'm a pediatric intensivist, and so I like to dive into complex problems all the time, and I don't just limit those to the clinical world. And we were able to take a really innovative approach to addressing this new technology in a way that's really paid a lot of dividends down the road.

Alison Curfman:

Yeah, so I think, I guess we could just rewind and start back to where you and I first crossed paths, and we could talk about kind of what we learned together along the journey. I very distinctly remember meeting you at a session on telehealth at the American Academy of Pediatrics meeting. I think I talked to you afterwards, and I think a couple other people were there. I very distinctly remember like sitting on the floor in the hallway of a convention center talking about all the problems in pediatrics that could be solved with virtual care.

Dave McSwain:

Yeah, and it was, it was amazing, because one of the things that I've carried with me through my career is that you find your people and you work with them no matter where they are. They don't have to be in your institution. If they are aligned and they're trying to do the right things for the right reasons, then you figure out a way to work with them and that day was a day where I gave a talk at the AAP, and a few people came up afterwards, and we were clearly aligned on what some of the challenges were. And we developed that, that collaboration and that partnership, and it has lived on till today. Yeah,

Alison Curfman:

yeah. And another thing that. I think is really meaningful about our kind of shared pathway. I know I've shared this story before, multiple times, that one of the things that got me even interested in finding new solutions, using technology for for healthcare, for kids, was really just a really devastating case when I was a fellow where a kid with a unrecognized head injury, I got a call from a rural hospital, and they didn't know what was going on, and they put the kid on the helicopter, and the kid didn't make it. And I, to this day, like still feel a lot of emotions about that. And I think that what stood out to me was that if I had been able to see that child, then he may have had a different outcome. And even just a couple years after you and I started working together, I I know that you had a case that turned out very differently.

Dave McSwain:

Yeah, and you know, it's the in terms of my origin story with telehealth, it was very similar in that as a pediatric intensivist, I had had a few phone calls. I remember one in particular where the outcome was just was not good, and I knew that if I had been able to see that patient, it would have been a different outcome. And then, yeah, my favorite story from my pediatric critical care telemedicine program. She was a little four year old girl, perfectly healthy, playing in her garage, slipped on a wet spot, hit her head, seemed fine, but then became unconscious about an hour later, and went to her local emergency department with a massive epidural hematoma, and we were able to call into that emergency department, connect via telehealth, provide real time support through a high definition connection. I had my nurses and the residents there with me. They were giving dosing guidance from mannitol. We were giving instructions or guidance on the intubation and everything that needed to be done. And then we actually arranged the transport so that that she could be transported straight from the door of the hospital into the operating room. And the neurosurgeons were waiting there for her to evacuate the hematoma, and they did that within eight minutes of when she at the door, and now she's, I'm going to tear up if I'm not careful. You know now, she's a young lady that is, is fully recovered. She does dance, she does art, she's she's amazing. And I've talked to her family before, and I've asked them each time if I can share her story. And they're very open to that. And in fact, because of this, that experience, they set up a charitable foundation of their own. It's called the Andy medaney Foundation. And they raise money for traumatic brain injury, and they do it in her honor, and not her memory, which is just Yeah, hard to say without tearing up, but I think that's the kind of thing where you you focus on the problems that you need to solve, and it's not about it's not about using technology for technology's sake. It's about using technology to solve big problems and developing collaborations to solve big problems, because we can't do any of this by ourselves. It's

Alison Curfman:

true. It's true. Yeah, you're gonna make me cry too, because I I carry a lot of these stories with me, and I know that, you know, it just it stood out to me so much when, when this case happened for you, and it was several years after my case it happened, and it was so parallel, but it had such a different outcome, and it had such a different process, that all the information flowed through, and The amount of support that was available, and the amount of process that had been developed and tools that were being used to change the outcome, and the fact that she's doing so well today is just really inspiring. And so I think you and I have always been people who want to try new things, test new things, come up with new ideas. Start with a whiteboard, like, what else could we do? What could we do different we each take an experience that you know is really devastating and try and redesign what a different solution could be. But along the way, I think one of the we hit some barriers early on that you can't just like, redesign a solution within traditional healthcare, because there's a lot of barriers. And I think that one of the things that made our approach so successful was really taking a very MVP sort of approach, like, what's the, what's the first and next best step that we need to take to make big impact. And so I'd love to have you share your perspective of, kind of how, how our research network started, and what sort of approach we took, and how that unfolded.

Dave McSwain:

Yeah, you know, so in the presentation that we'd referenced, I'd talked about how, how important it would be to have research to to provide the data necessary to. Gain adoption from not only providers, but also hospital administrators, folks they were going to no one was doing right. Nobody was doing it at the time. And you know, and and healthcare, healthcare providers, physicians are raised in an environment of evidence based practice, and so to not have the evidence for this new way of communicating with your patients or communicating with other teams, it doesn't matter how amazing it sounds, or even if you've got some really cool demos, if there's no evidence behind it, then you're not going to really get traction on a big scale and be able to scale it out and get the kind of financial support you need. So I talked about that, and I talked about how in pediatrics, collaboration was crucial because we're talking about relatively small problems, or not big problems in small populations, and that having consistency across programs was a big challenge. And so we came up in the conversation afterwards, and we were talking about, okay, how would we do a multi center study? And it became obvious very quickly that we couldn't do a multi center study on a on a given program, because, you know, nobody really understood what everybody was doing across the country. And then we kind of had the aha moment of like, okay, so if our study is let's figure out what everybody is doing across the country, and we just do a survey and make that a national survey of pediatric telehealth and gather the right kinds of data. Then we can recruit folks into our collaborative through the survey, we can identify what people are doing around the country, so we can make connections with people and support those collaborative research projects, and we understand better what the barriers of doing those projects would be, who to connect with whom, and you've got a network of like minded collaborators kind of built in. And that's where all of this started. We ended up getting NIH funding for it, and it's been going since then.

Alison Curfman:

Yeah, and I think that sometimes we would find things like, okay, there's no evidence, nobody's nobody's doing telehealth. Why? Why is no one doing it? Well, they're not getting paid for it. There's no payment or policy. There's no payment for it. And why is there no payment? Because there's no policy. So policy. There's no policy around like, this is how you do it, and this is what you bill for, and all of that. And there was no policy because there wasn't an evidence base, because no one had really measured it, because it was new, and there was no evidence base because nobody was doing it, or the people that were doing it were doing it in like, little, tiny pockets. And so this network effect of bringing all of these early adopters together to share their best practices and really create kind of a rigorous sense of best practices, and how to advocate for payment for these sorts of things, how to actually create policy around it. That was a lot of our initial work,

Dave McSwain:

yeah, and I you know, the program that you had developed was, I mean, first, it was an amazing program, the pediatric wraparound services for medically complex kids on Medicaid. I mean, that's just an amazing program, and it was so remarkably successful, but you can only communicate that so much through word of mouth. And fortunately, we developed, you know, financial evaluation frameworks for how to evaluate these programs in a way that mattered to the people who are going to be responsible for sustaining the program, you know, in a way that mattered to the payers, in a way that mattered to the patients, identifying those metrics, and we were able to conduct a study on your program and just demonstrate remarkable results, which we knew already that it was a remarkable program, but Then having those demonstrable metrics of that really profound impact that the payers could see, I think, played a huge part in in having those payer stakeholders be very supportive of continuing that program.

Alison Curfman:

Yeah, so, and what Dave's referring to is when I worked at a nonprofit healthcare system and built this complex care program with my team, and we had massive reductions in inpatient stays and in ER visits and an unnecessary utilization, and saved millions of dollars for Medicaid on a on a relatively small population of kids by keeping them out of the hospital. Is super meaningful program, but there was no way to bill for that. So our goal was to prove the pilot that create the model, do a pilot, show that it worked, and then beyond that, to figure out how to work with payers to actually get them to pay for the program. And so sprout and Dave were both very important. You. Contributors to the research project that we did to really determine, like, how do we actually do an economic evaluation of this program? Because it's not something that's been really measured before. So we designed that, we published that, and unfortunately, the program did not make it. Didn't continue in that setting, but it also probably wasn't the right setting for it to actually achieve scale. So we were a small, you know, piece of a puzzle at a large hospital system that, you know there, there wasn't a lot of experience with negotiating value based contracts with Medicaid or for pediatrics and and so I think that creating that initial foundational data of of something I was already doing in an academic a more academic setting or more traditional setting, was so important because it became the foundation for the company that I initially built or that I eventually built. And I think that when it came time for, first off, the firm that found me and recruited me found me because of this paper, and Second off, when we were pitching, imagine pediatrics to plans, we had foundational data about the model that we were describing. And I think that that's really important. And I think Dave, you have this dual lens as both a researcher and a chief medical information officer who does a ton of vendor analysis for a large healthcare system of the different types of data, like different flavors of different levels of rigor of data, and how that affects you as someone who you know chooses whether or not to invest in a product? Yeah,

Dave McSwain:

I think no one is surprised for me to say that healthcare systems are facing some significant challenges these days and a lot of financial pressures, and also there's a ton of technological solutions that are coming out every day it feels like, especially with the emergence of artificial intelligence and generative AI, natural language processing, all these new models, where not only are there new companies coming forth every day, but companies you've previously, previously been working with, or they buy their product from, are coming to you and saying, Oh, we have this new agentic AI model that we're incorporating or that we're developing, and it's, you know, it's an overwhelming, overwhelming number of options, and one of the ways that we really vet through those options is to Look for data. I think in previous years, there was a little bit more flexibility, where, if a healthcare system got excited by a new technology, you could you could get it through governance, you could get it through to a pilot stage at least, and then you could collect the data on it yourself and and move that forward successfully. I think now we're having to be much, much more selective, and we have to have pretty strong assurances that that return on investment is there. And the only way to do that is to be able to evaluate good data from the company. And of course, that that puts companies in a bit of a catch 22 because if you can't get it implemented somewhere, then how are you going to get the data that it's going to be able to convince other healthcare systems that they need to implement? And I think that when you when we start talking about, with the previous discussion around sprout, what are some of the key challenges or the key problems that we need to address. I think it's there. I think it is the how do you adapt our research approaches to be able to function in a rapid cycle and adaptable way that will synergize with technology development and provide provide meaningful data, not only for the companies developing the products and how to direct the development, but also for the healthcare systems or practices that are looking to implement that product. And how do you partner? How do you develop those collaborations towards doing that? I think there are approaches that can occur, but the culture is not really aligned towards that. Historically, there's been a sense that research is too slow, and it and traditional research is pretty slow, but so is the governance process of getting a new technology implemented through a large healthcare system across numerous sites, and we're working on optimizing that too. You know, it can take years from the time that a vendor reaches out to someone at a healthcare system until that technology is actually implemented, and that process would be greatly expedited if you had the data necessary. Necessary to drive decision making around it, and you knew what you were targeting, and you knew how it could be impactful in your populations, and you were confident that the vendor, the the the company that you were working with, understood those challenges and how to work with them. And

Alison Curfman:

so when you talk about this, first off, I see this all the time, and I totally agree that like startups like may be more focused on operational or marketing data and not so much around like, how do I actually get rigorous data that proves that this works, or proves that this is done in a valid way? And I do get the sense that it's like, oh my gosh, if you had to design like a randomized trial for every single MVP, that would never work at a startup. But right? I see an opportunity here, and it's I actually frame some of my services this way with companies that I work with. I have a very robust academic research background. So for people out there who are like, Oh, I'm, I'm, I'm in academics, yes, of course I know, like, all the things about, like, how you would measure something, or bias, or all the, you know, sensitivity, specificity, all things that we, you know, all have to learn in medical school. And you kind of take it for granted that you have this deep understanding of how to measure things in a valid way. And, you know, who doesn't actually have like, a deep academic research background is like investment bankers, you know, and, yeah, and people who are, you know, focused on marketing campaigns or product development and, and it is a piece that I think, if you can figure out a way to do it in an agile, flexible, fast way, like some amount of valid, valid research, validity in a flexible way, in a fast way, it can be so valuable for startups, because I know the difference for imagine. First off again, I was recruited to go be a founder of imagine, because of this paper that I put out, and then it was the foundation of our pitching when we were working with early clients. And it was part of the reason we were able to close a deal so quick, is we had pilot data that was peer reviewed of the program we were proposing. And so it wasn't like a hypothesis of like, well, maybe we could do this. It was like, No, we've done this before, and we've measured it, and these are the outcomes. This is the foundations of our business model. It came from this data. And so what would be your thoughts or recommendations from someone who is of more of an academic research background, but has never even considered that that sort of background could actually be valuable to startups. I

Dave McSwain:

would just say your skills are incredibly valuable in this space. And I think that's where sometimes physicians fail to recognize what their value is. I think in the health IT space in particular, there's an incredible tendency towards imposter syndrome for physicians, and I think it's because we were raised in an environment where everybody around us for a decade or more was kind of learning the same stuff and focused on the same stuff. And so you get used to this idea that, well, everybody knows this stuff right. And then you get into a different world where suddenly you're in a space where you've got cybersecurity experts, and you've got digital infrastructure experts and data and analytics and all of that, and it's foreign. And so you've you feel like, well, I have no business in this space, and still, to that day, as the Chief Medical Informatics Officer for a large health system, I get that feeling sometimes in a conversation, and you have to reground yourself on why you're there and why your your expertise and your your perspective matters. And I think in this situation, you know, physicians have an immense opportunity to inform what it's like to live in that space that this technology is looking to address, you know, to inform what metrics matter and to whom you know. There may be some metrics that matter to the physicians on the front line and others that matter to the hospital administrator and others that matter to the ED you know, departmental medical director, and others that matter to the patient and the families or the communities or the employers or the school system, and having lived in that space for however long gives you an incredible understanding of that interplay, and when you can really understand How different metrics would intersect across those different stakeholder groups, you know, so that it doesn't just matter to the frontline physicians, but it also matters to the payer. And this is why, then, that's where you can bring so much value and understanding of not just what to measure, but how to measure it. And if you can bring. Some research expertise to the table, then you can adapt the approaches. You know, we've all read our evidence based medicine articles and done the critical reviews, and we know how to spot biases and poor design, and we know how to mitigate some of those. And I think that sort of expertise could be incredibly valuable in the startup world,

Alison Curfman:

for sure. And I think one of the things that we did, both at sprout and early on in my startup experience, and that I've brought to other companies that I work with, is the idea of a metric and evaluation framework. So I know one of the things that we found early on at sprout, especially as we're trying to get a baseline of like, who's doing what? What are they working on, who's doing similar things that could collaborate. And how can this all affect policy to actually get payment for this sort of service so that other people will start doing it too. And we developed metrics frameworks to get people on the same page that we we all knew what we were measuring, and if somebody's doing it at like 10 different institutions, at least, if they're using the same framework, that's the opportunity to pull data or to pool insights, and just even providing that guidance of like this is how to even think of the different type of metrics based on who the stakeholder is, or based on What stage of the, you know, project you're on. I did that. We did the same thing in our early design process when we were building our clinical model at my first company, which was, you know, creating a framework of metrics of like, not only like, who cares about this variable, but also like, where does it come from? How long will it take us to get it? Because there's some data that is a lot faster to get, like, a survey, and then there's a lot of data that takes a lot longer to get. Like, gosh, if we're talking about claims data, we're talking like, oh, the claim has to be processed, and then it has to be, you know, it's going to be like, Yes, three, six months before you actually get that first big lag, and then how long does it take you to get a critical mass of that data to so we could actually put it on a projection of like, this is going to be the more powerful data, and it's going to come and it's going to affect these stakeholders, but you're not going to get it until the end of the first year, but this is the early data that we could use. And when you're thinking about things that way, and you're trying to build a case for a concept, and you're realizing that as a startup, you're constantly pitching, you're constantly trying to grow what you're doing, and you you need to be iterating on, you know, the data that you're able to share, having a framework for it is is incredibly valuable, and it's something that I have actually found that other other startups that I work with now really value as well. So I think that, you know, we've talked a lot about data, we've talked a lot about research, we've talked about kind of your dual hats as being a researcher and someone who evaluates a lot of vendors. Do you have any kind of last thoughts for physicians that are listening, that are interested in using their research or more academic skills in a new way?

Dave McSwain:

Yeah, I think the key thing is just to collaborate, to find your people, find your peers, and I know you're working in that area, to set something like that up. I think that's incredibly useful. I think being in that space where you've got like minded individuals that you can bounce ideas off of, that have had, the experiences that that you need to have, and can advise you developing mentor mentee relationships. That's That's incredibly valuable because, you know, I said this before, but you know, you can't solve a huge problem by yourself. It's just impossible. Anybody that tells you that they can solve a really big problem in healthcare by their by themselves either doesn't understand the problem or doesn't understand their own limitations. You have teammates. You have to find them, and, you know, find the people with a different expertise than you, because you do bring expertise to the table, and you can solve these big problems if you find the right people to tackle it with. Yes,

Alison Curfman:

absolutely. Well, I have really enjoyed this conversation and reconnecting with you and talking a little bit about our journey together and what we've learned. I really appreciate you coming on. If people want to find Dave or connect with him. He is on LinkedIn. We will put his bio in the show notes. And I really appreciate you all tuning in, and I'll talk to you next time. Thank you for listening to startup positions. Don't forget to like, follow and share you.