A Kiwi Original - Michael Greenstein | Florence Digital 014

Florence Health is a much overdue health solution for patients in doctors waiting rooms and New Zealand hospitals. The solution is already delivering lower wait times at the doctors, social distancing compliant waiting rooms and enhanced clinical experiences because patients are more empowered through the choices available to them.

Listen to Michael Greenstein share the opportunity for better health outcomes in New Zealand and the tech export opportunity that could contribute significantly to New Zealand's future.

TIMESTAMPS

2 mins 43 seconds How Florence Health solves increased demand on healthcare.

4 mins 37 seconds Helping DHB’s doing more with less.

7 mins 50 seconds The benefits for clinicians in bettering the patient journey.

10 mins 49 seconds The waiting room experience, perceived and real stress.

14 mins 55 seconds Exporting Florence Health integrated solutions to overseas countries. 

16 mins 22 seconds Running a health business from Hawke’s Bay.  

20 mins 11 seconds Complexities unique to healthcare like data protection and privacy.  

22 mins 32 seconds Covid-19, telemedicine and the changes coming up for patients and doctors.

24 mins 28 seconds Why governments should back kiosks at the reception of all New Zealand doctors.

27 mins 22 seconds The origin story of Florence Health as a spinoff from Luke Irving’s tech business Fingermark Global. 

LINKS MENTIONED: 

Florence Digital https://www.florence.digital

Transcript

A Kiwi Original Ep. 14 - Florence Health

[00:00:01] A lot of time was wasted because of the way they processed patients in a linear way. We created, you can say the Air New Zealand check in experience for the DHB, so by the time they are checked in, all that paperwork is already done.

[00:00:18] Welcome back to another episode of A Kiwi Original, this is episode 14, and today on the show, I have Michael Greenstein from Florence Health, a company that is what you would call in New Zealand, a tech company.

[00:00:32] But it's more than that, it's a company that is revolutionizing the clinical experience, so patients have a better time and doctors can do business in a different way to help people in a more effective manner. So, first of all, thank you very much for coming on the show Michael. 

[00:00:49] Thank you for the invitation.

[00:00:51] Tell me a little bit about what Florence Health does. What's the, what's the problem that your software or your technology sets out to solve?

[00:01:04] Good question. Just to put it simply, over the next years, the demand for resources on the health care system are growing. You have the age waves and we have a lot of people in older years and they're gonna need health care. But the resources available are going to remain somewhat absent. So as things, as more patients need more services, we're not going to see that many more hospitals, we're not going to see that many more clinics.

[00:01:35] We won't see bigger waiting rooms. So DHB's right now have to figure out how to do more with what they have. And in the process of handling patients, there's a lot of inefficiencies. And what Florence tries to solve is figure out ways of lessening these inefficiencies and making things work better, smoother, faster, quicker. For the benefit of the clinicians, but also the patients.

[00:02:03] So decreased waiting times for clinic services and increased capabilities in the clinic rooms themselves, because there's a lot of waste in the back room, a lot of time was wasted because of the way they processed patients in a linear way. And Florence comes in and makes this a little bit smoother and gives back people their time.

[00:02:26] So this is a solution for district health boards or places where there is that patient to doctor relationship, and probably something that businesses have been through for many years, if not always, is how can we do more with less and how can we be more productive. What's different in terms of, in this particular cycle if you like, of what Florence health is delivering, like how are you able to do or help these DHB's do more with less that has never been done before?

[00:03:02] Well, we started off with a project with the Auckland District Health Board and they were interested in creating a self check in for a particular clinic in, the clinic at Greenlane. So we were commissioned to develop this product, this procedure. And through that is what was the birth of Florence per se. And so we created, you can say the Air New Zealand Check in experience for the DHB's.

[00:03:35] So you know how comfortable it is now, you used to go to the check in counter and deal with the person there and get your tickets and your baggage. But now you don't have to think about doing that, unless you have to. You go over to the kiosk and you know, you could do it on your phone or, you know, then you're checked in. And so that same kind of situation we can use for patients in hospitals. So the first step of the way is we've got a self check-in kiosk.

[00:04:03] And the patient walks up to one of these units, and if they have their NHI number or if they have their letter that has their NHI number on it, in some cases, the letters that you get sent for your appointments have a barcode on them. So you walk up to the kiosk and you either scan your letter or type your NHI number, it knows it's Ryan. And then it will ask you some questions and then it checks you in to your appointment. And it tells you what lobby area to go wait in while waiting. So that's the first part of the function.

[00:04:33] Now, that's not there to replace the receptionist. It's there to take care of some pretty routine things that a receptionist needs to do that can be handled through automation easier, which leaves more time for the receptionist to actually interface with the patient. And so when you check in, they have to ask questions, they have to make sure your demographics are up to date, and your phone numbers right, and your address is right, and your next of kin is right, they have to ask you if you want to stop smoking.

[00:05:03] So there's all this interaction that goes on and takes time to check in. Meanwhile, you have 10 people who are also wanting to check in to their appointments so all this has to be done for each patient. So the kiosk relieves the receptionist of that and so we can ask about the smoking sensation. We can have demographic updates on the kiosks themselves. So by the time they are checked in, all that paperwork is already done.

[00:05:27] That makes sense now because, I, you know just the way you've made that metaphor, or that contrast with the airline industry. Certainly the difference in those airlines that have rolled out technology means that the people that are working for the airlines, like Air New Zealand, can focus on the customer service and actually making you feel welcome and comfortable rather than the actual technical checking in procedures.

[00:05:55] Is that the same approach here that you let the, does the technology then almost call forward to the hospital to say you can expect this patient that they've checked in on their app? Like how, what are the benefits for the hospital or for the clinician?

[00:06:13] Ok. You're actually getting ahead now, but that's exactly where we're going with this. This is the first step in bettering this patient journey. And so now we have a self check in. But like you say, what about how long is my wait going to be? I just checked in for my 9:30 appointment. But really, you're not going to be seen till 10:30.

[00:06:35] They know that because you're the backlog of people. So our next project that we're currently engaged in and we do have a pilot running in a facility in Auckland DHB, is what we call, we have a patient tracking system. And this system actually acquires a timestamp of a patient's journey, so we're able to produce data that gives that time stamped information back to the patients and to the clinicians.

[00:07:07] A typical patient activity for an appointment might be, in some cases they're very simple, you go into a room, you talk to your doctor and you leave. But a lot of the time, you've got to get a shot, you've got to get a picture taken of your eye, or you've go to go to radiology, you've got to do other things, and each one of those takes up time.

[00:07:26] And so what we're doing is calculating what are the times of each of those activities, and then using that data and we're able to feed it back to the patients in forms of an LED LCD display, where we'll have it in the lobby or in the cafeteria so people can see how long they are in the queue.

[00:07:47] We're going to use mobile devices where they can be cued on their mobile device and they could be summoned to their appointment at that point, so they won't have to sit in a lobby area, they can sit in the coffee shop and be called to their appointment. And so we are now in the process of developing this product. And fortunately, we've got some nice partners with us, too. We're working with some groups of people to make this all happen, and it's very exciting because this particular piece is, this is the equation that makes a huge difference.

[00:08:20] It does, because, I mean, I know from personal experience it's the, it's not necessarily the waiting that's the problem, it's the unknown time. Like if you know that it's only two minutes to wait, you're going to stick in that lobby and you're not going to move. But if you knew it was going to be an hour and a half, maybe you'd sit outside in the sun, or maybe you would go and read a book.

[00:08:40] You would be able to use that time, or at least, for some people, it's more around psychologically being prepared for something that maybe they don't want to even do. They don't want to be there. So I think being able to use that data in a way which is providing it back to the patient makes it actually a better experience.

[00:09:00] And I wonder what that would then do for the clinician engagement when you've got someone that's maybe at a lower stress level going into the appointment.

[00:09:11] Yeah, that's huge that you even know about that because that whole waiting, that's its own discipline. And you're exactly right. Your perceived wait time versus your real wait time can be totally two different things if you, and the stress comes when there's a difference between those two.

[00:09:27] So if you were told you have a 10:30 appointment and the appointment is 11:00 and you were told that, then that half hour goes pretty easy. But if you're there at 10:30 and no one is seeing you or anything and it's 11:00, you're going what's going on here, I have a 10:30 appointment.

[00:09:43] So just, you know, being able to mitigate that does lessen that stress, even to the point where somebody has a 10:30 appointment and they're in the parking lot trying to get a parking space, which as we all know, most hospitals have some pretty rough parking. And so here you are, you know you're going to be late.

[00:10:01] You're just stressing, trying to get to your appointment on time, because you know if you're 15 minutes late, you know, there's a good chance they can't see you anymore. And so wouldn't it be great to have some way to communicate, to let that clinic know that you're here, you're just trying to get there, you're in the parking lot. So these are the small nuances that we'll be able to do to lessen that stress on that patient.

[00:10:26] What do you need from the DHB? So if someone from a District Health Board is listening to this, what's the, what's the engagement process like with Florence Health to go through the steps from, you know, doing the feasibility or scoping through to like a full rollout? What's that whole process like?

[00:10:46] That is what we do, is we start off with an engagement where we do scope out and find out where the problems are. Because we do have these products separated, so we have the self check in as a standalone product to that next part where we find out the times, you know, where we're getting that data, that's our patient tracking system.

[00:11:07] So they're two different animals that work together. So we do do the scoping, one of the key things is our ability to interact with the patient administration, the patient information system for that hospital.

[00:11:21] So there's 20 DHB's, and there's four or five different one of these PAS systems throughout New Zealand. So the South Island's got one, we've got several, they've got two or three  in the South Island, and then even the same application of a PAS, different DHB's have  tweaked it so they're still a little different. So our first goal is to be able to talk to that PAS. Because we have to be able to check that patient in and know what their demographics are.

[00:11:52] So we're not moving around any medical information, it's just that demographic information and we have to know their appointment schedule. And so that's key. And so we're now working with manufacturers of these PAS'. And so we have integrated to three of them right now. And so that's the first key, because that's a fairly extensive operation to get that whole thing going.

[00:12:16] And so once we have that down, then it's a matter of engaging with the DHB's and finding out where their problems are. Usually the busier clinics are the ones that need our services off the bat. So the ones that are serving 300 patients or more a day are usually the ones that are best served with this kind of automation. But really, when you get down to it will work down, once you have the system, then it'll work down to a smaller clinic also.

[00:12:44] Sorry to interrupt, this won't take long. Subscribe to the show and you'll never miss another one of these amazing episodes. Right back to the show.

[00:12:56] So that seems like a lot of upfront work in terms of coding and software development into the, what were they called the PAS, p a s? Is that right? Yes, patient administration system. Patient administration system.

[00:13:09] So there's obviously a lot of investment that's gone in upfront with the expectation that DHB's in New Zealand will take this on as a way of becoming more efficient and offering a better patient service, is there, looking forward for Florence Health, is there an export opportunity? Are there other health markets that this could potentially solve the same foundation problems just with different software integrations?

[00:13:37] Absolutely. So yes, all these PAS' that are here in New Zealand also are distributed globally. So, yes. So once we're integrated with them here, and like many tech companies, you know, New Zealand is where things get developed and tested and marketed.

[00:13:57] And once things are sweet here, then it's smart to go ahead and take that abroad. And with our system, we have to be, we have to have total remote control over this thing, so if it's sitting in Thailand, we've got to make sure that we can fully take care of it remotely. So, you know, these are kind of the growing things that you have to get into. Yeah. But the big focus here is definitely on the global market, once we get this all sorted here in New Zealand.

[00:14:28] Super exciting. Now, Michael, we know each other from previous lives working together, when I did some time in Hawke's Bay. What's it like for those who are listening, running a software organisation from Hawke's Bay versus where, you know, Kiwis are more, probably more aware of something being run out of Wellington or Auckland.

[00:14:52] What's the differences that you find with you and your team working from Hawkes Bay? More airplane rides, because really, you know, it's, you know, having lived in Auckland for a while then moved around the country there and being here, you have that extra hop you've got to make to Auckland quite a bit.

[00:15:13] You know, now, with the situation we're doing, home isolation, we're doing a lot of the, you know, the conference calling and video. So I used to use that a lot anyway. I do physically need to go to hospital and it's good to be in front of people, but I think this is the new normal. We're gonna see a lot more of the video conferencing as possible. So now being in the provinces, you know, it's the same as being anywhere else.

[00:15:43] But prior to this, yes, I did have to travel a little bit more by making it to Auckland often, but you still can get anywhere, and living in the provinces, I can't say enough good things about it. Auckland's an hour away in case I need to be there, Wellington's an hour away.

[00:16:00] Excellent. And, when you go and visit your customers in the medical profession, what type of insight does that give you in terms of being able to then develop the product further?

[00:16:15] That's so key, Ryan, it's like everything we do is driven by the needs of the clinicians and the patients. So, you know, we have to find their problems. Fortunately, I've got people involved in Florence that have medical experience so they know the insides of how things work in the healthcare industry and that has helped out quite a bit. Like each product, we actually develop it with a partner, a health care partner. And that way, you know, we are learning organically what the problems are and organically how to solve them.

[00:16:56] Case in point, this patient tracking system that we have on a pilot in Green Lane for ophthalmology, there's a situation there with the system works really well, but the clinicians aren't doing what they need to do to make the system work right. Because there's no value to the clinicians for hitting a button.

[00:17:19] It doesn't do anything to them. It doesn't speed up their process, it doesn't, it's just one more thing in a very busy schedule that they have to deal with. So, you know, so when we develop this, we realise off the bat that that was going to be kind of a situation. Even though they love it now, and they use it and they know what it does.

[00:17:36] You know, we had to create ways that the system would work without them having to interface with it as much. So we took the onus off the clinician and and now allow the system to do what it needs to do using bar codes and other new technologies that we're bringing in to to make the process transparent to the users, which is really nice. So they end up with depth.

[00:18:00] It's really, it's good to hear that you're approaching it from that perspective because technology doesn't solve the business process, it just optimizes it or allows it to do things in a different way. So if, for Florence Health if you've got those people with experience from the clinician industry, from the health industry, then it gives you kind of a unique advantage in a way.

[00:18:26] Maybe if you were to maybe cover some of the things that are unique within health, that maybe other industries and business don't have to be, they're less stringent. For example, with data protection or privacy and regulations, what are some of the additional things that you've got to be aware of within health that don't affect other industries as much?

[00:18:50] The privacy thing is huge, and since we don't really move around any health care data, we're able to, you know, work around that.

[00:19:02] And, you know, being able to, our system lives in the cloud. And that's a precarious place in the health care market right now. They're finally starting to use the cloud and not have to have internal servers anymore. So we're getting there, but that's, you know, that's something that other businesses have adopted cloud computing much quicker than the health care industry.

[00:19:28] You're right. It's something, I remember when I was in telecommunications that the the industries that had the longest gestation was health, government, council and defense. And they were highly lucrative, but you needed to have patience, not patience, as in the hospital patients, but you just needed to be able to hold your breath for a long, long time.

[00:19:54] So, you know, well done for being in this arena, because hospitals were one of the first things that were established in, you know, in society, they're a pillar along with education and government, they're foundational industries. And they work in a standardized way because that's the way they've always worked. Even though, you know, cloud technology's been around almost 20 years now. So are you finding that, or has the penny dropped and now there's a awareness that we're not gonna do it with more buildings or more humans?

[00:20:31] Yeah, I believe especially with the Covid 19 issues, things, this is a whole new game, a whole new playing field. You know, this whole, the whole thing with the telemedicine, you know, the telemedicine, being able to consult with a patient, has been around for years. I've got some doctors next door, they never used it.

[00:20:51] Now it's all they can use and they love it. I think it's a lot of adoption, the patients like it too. And, you know, they can do a lot more patients, you know, now than they could before because they're adopting some of these things that they were, you know, an arm's length away before, too.

[00:21:04]  So, yeah, I think we're gonna see a change. But to answer a part of your other question, what's different with working in this protocol? You know, in New Zealand, we have 20 DHB's, and they all operate independently.

[00:21:18] And so, you know, I've got to deal with each one individually. And I also, you know, really can't share knowledge between each one. So that's an earful on how, you know, you go about doing this. So that's been, you know, one of the interesting parts of working, especially here in New Zealand. You know, you have basically 20 different customers that all have the same need, you know.

[00:21:42] And I actually wish it would be at a more unified system, because I think it would be less expensive for healthcare in New Zealand. So the Ministry of Health, if they could, if they could do this on more of a global scale rather than, you know, for each DHB, we have a lot of different costs involved. If it could be done over a wider area it would be more beneficial to the health care system.

[00:22:11] So the follow up question there, Michael, is, you're a software company, but you can't necessarily influence what, how government's going to structure their health departments.

[00:22:25] Given Covid 19 and given that everyone's working to a whole new set of rules or maybe no rules at all, what would be, you know, your ask of government at this time or to consider once we're through this phase, what are some of the things that you're seeing from the ground level and knowing what you know around how technology can solve some of these problems, what would be your request, in to government?

[00:22:56] Well, I think it's pretty obvious that, you know, this separation thing, you know, we've got it now, it might come up again. Having a kiosk at reception really does a number to separate that first line of communication.

[00:23:14] And so, you know, if we had these systems in place now, you know, throughout the country, it would be a different situation being able to go up to your clinic and actually have that sort of interaction.

[00:23:27] Right. So you can actually, the problem with the current doctor's rooms is you've got to go in to reception and you're already within your two metre bubble of everyone who's waiting. So would this, would your kiosk then separate that to a two meter area that is defined around where this physical kiosk is rather than where the physical reception is?

[00:23:50] Absolutely, we can do that. Exactly. And we can ask those important questions before they go any further. You know, that if they, you know, have they been anywhere out of the country, you know, or whatever, we actually, before the office, before the clinics got closed down for the lockdown, we had that question on the kiosks. We actually had that Covid question before they even started.

[00:24:13] And the kiosk can be cleaned, you know, so that all can be taken care of. And we actually have another solution now where you can walk up to the kiosk and use your phone to operate the kiosk so you don't even have to touch the kiosk anymore. So there's, you know, different ways you can interact with a piece of equipment.

[00:24:33] And that's super smart, too, because like going back to that airline analogy, I'm really comfortable with the Air New Zealand app and how to order coffee or check in.

[00:24:43] And I know my 71 year old mum is really confident using her own phone to navigate her life. If there was an app on there to check in the kiosk, she'd find it just as easy because it's her own phone.

[00:24:58] This is a kiosk of its own form. Exactly. And because everything we do is web based, you know, which device is irrelevant. It doesn't matter what device. So kiosk, laptop, iPad, phone, any of that will work our system.

[00:25:19] What was the, where did this technology all come from? Who created it, why was it created? What was the origin story of this because this is a fascinating Kiwi story that I don't think a lot of people know about.

[00:25:32] You mean in particular for the whole Florence and how this whole thing came about? Yeah.

[00:25:37] It was an engagement, you know, Luke Fingermarks were involved in digital signage and kiosks. And the ADHB was interested in coming up with a self check-in solution. And this was back four years ago, I think, five years ago, maybe longer.

[00:25:56] And so that's when this whole thing started gestating. Now, here's an interesting thing. So that was being worked on by Florence, years have gone by, we've had a couple of people taking the helm of this and moved it forward a little bit, kicked the ball down the road. And now we're you know, we're ramping up and doing really well.

[00:26:14] And it turns out that the original guy who wrote the software for that kiosk is now back with it working on this. And the original person from ADHB who was the business analysist, who was responsible for that project, she now works for Florence. So we've got some people who have been in this game, this particular game for, you know, since day one, who are still at it because they enjoy doing it, and they see the benefits.

[00:26:46] And how will you know, Michael, when you've left your mark, like, what does success look like when you've done your job at Florence? 

[00:26:53] When I see these kiosks, we're in four different DHB's now. And I'd like to see them in all 20 and I will stay at this until I see them in all 20.

[00:27:06] Well, that's a wonderful goal, and I have no doubt you will achieve it. I know that you're very forward in terms of business development, and your listening skills of what a client wants is probably something that is unique because there are a lot of salespeople that just talk about features and benefits, and I think through our relationship over the years, it's been your listening skills and being able to get to the root of the problem before proposing any solutions.

[00:27:31] So I wish you all success with Florence Health. And, you know, I look forward to seeing what you're doing in terms of New Zealand Made technology. We need more of it. It is a great export for this country. And, you know, if this company rolled out to other countries, it certainly will bring back some export receipts to New Zealand for us.

[00:27:52] Absolutely. Absolutely. I'm looking forward to talking to you again, maybe in a year.

[00:27:56] Sounds good to me, Michael. Appreciate your time particularly in this busy period we're going through, so thanks very much for being on the show.

[00:28:03] This has been A Kiwi Original brought to you by the New Zealand Made team, thanks for watching. The New Zealand Made trademark is used by over 1200 businesses in New Zealand.

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