Waiting for the Wrong Bed (ft. Alan Portela)

There's always a bottleneck at almost every hospital. What was the problem that you all have solved?

If I had to define everything in one sentence, we do personalized, clinically guided, AI-driven patient traffic flow optimization. This is like a traffic jam when you're driving on a freeway. You know that you're stuck in traffic. You know there must be an accident, something down the road that is creating this gridlock, this bottleneck.

And what I like to do is find, transform Welcome to Digital Voices, where healthcare and life science leaders explore the real work behind transformation. This podcast is about people, leadership, and the conversations that move healthcare forward. Now your host, Ed Marx.

Alan, welcome to Digital Voices.

Thank you. Thank you, Ed. And it's a pleasure being on this forum.

Someday we're going to dive into just your personal story to the extent you could tell us all about it, growing up in Argentina and some of the crazy things that you've been involved with before healthcare found you. So we'll leave that as a, like a teaser. Alan, give us, give us something about yourself as a person. Before we jump into some of the newer things that you are into, and then what preceded that to get you into—

Well, as a person, I think that I always had this incredible desire to identify and tackle the hardest challenges we all face in our lives. And I do that professionally, But also in my personal life. And what I like to do is find transformative ways to fix them. Of course, on the business side, I find them. In the personal side, they find me.

I can relate to that. And we've known each other, man, like 20, 25 years. You know, I get a lot of credit and it really is my team where We were sort of leading mobile health back in the day, and one of the main applications that we were using and saving lives came from a company that you were all about. Tell us a little bit about that company, and then we'll jump into current day. But I always like to, I think it's a good reminder, like how far we've come.

Yes, yes. And you're right. It was, I tell you exactly when it was. It was 2000, 2011, 2012 when we met. And that was the time that this venture group, Sequoia Capital, made an investment in Airstrip and they brought me in as their chief operating off— I mean, chief executive officer. And I was there for 12 years in that capacity. It was very interesting because Airstrip at the time was considered the pioneer in medical-grade mobile surveillance. And it was very hard to, when you're creating a new category, to talk to people about it. But you were the first one that not only we could talk about it, you gave us great ideas, but also you deployed it at Texas Health Resources. At the time. So, so yes, it was a long time ago.

Yeah, no, it was great. And, you know, the iPhones were just coming into vogue and talking about mobility and things like that. So you're like a pioneer. And so, and I appreciate it because we literally were saving lives and you've continued to evolve with time and technology. And so now you're leading Depth Health, but something happened as a catalyst into Depth Health. So, why don't you share? You know, I know it's a personal side of your life, but share a little bit because I think it'll give people a greater understanding, like why you're so passionate about what you're doing today with Depth Health.

Yes. Yes. Well, thank you for asking that. I will start with that personal story because there is also the pandemic that made a significant impact Yeah. In our lives. But I will start with that personal story. It was about 2 years ago that I decided to, with my good partner, Jean-François Lancelot, my CTO, co-founder, we have been working together for 34 years and he never likes to admit, But we started the company because we knew that we had to transform patient throughput, patient access, and we needed to leverage our personal and professional experience and knowledge on the clinical medical-grade surveillance because we needed a more personalized view to patient throughput or patient flow optimization. It was in July of 2024 that— it was actually the 1st of July we started the company. But ironically, at the same time, literally the same week, I, after having a radical prostatectomy to get rid of prostate cancer, And unfortunately, at the time, few months before, I was told that I have biochemical recurrence. The cancer came back or never left. And now it was time to start a lot of conventional treatments that are not ideal for patients. And as you recall, I said that I like to find challenges and find transformative ways to To fix those challenges. So it was in July that I started that first— that same week, an immunotherapy. I was actually N1 volunteer as the first prostate cancer patient to try an immunotherapy that boosts your immune system and combined with radiation. It really tackles Cancer. But, it was proven for bladder cancer. This is a company, ImmunityBio. As you know, a very good friend of mine, former investor, large investor at Arescript, Dr. Patrick Soon-Shiong. It was him that when I knew that I had to do hormone therapy and other things I didn't want to do on a Sunday morning, I texted him and I said, Patrick, do you have anything for me? And, he said, well, I do. And you will be the first one for prostate, but it works already for bladder cancer. Would you like to be the number one? So he actually started the, what is called the single investigation on new drug FDA process. I was approved as N1. And I started that same week that I started the company. About 8 shots of immunotherapy over a period of a year and a half, but the results showed within 4 weeks. But also, it was at the same time, that week that I started 33 sessions of radiation. And as a man of faith, I knew that the number 33 had a very important significance.

Yeah.

without talking about that. But, at least, I can tell you that it was a reminder that from the most difficult journeys, the most incredible things sometimes begin. And, that was my journey. So, it started exactly that week. And, here I am. Yeah.

No, it's great. Thank God that we have incredible scientists and Physicians and clinicians and researchers doing all those. And, and yeah, you're— it's a, it's an amazing story. And, and we'll put some links into the show notes that people could find out more. But yeah, it's amazing. And then you birthed the N1.

Since you are, since you are a very good writer, I can tell you that I hear that there is going to be a book and I will be a chapter of that book on my incredible success story that hopefully is going to impact millions of patients that have prostate cancer.

Totally. It'll scale up to that. And you and I have been talking for years since the time, I guess, 2010, 2011, about, you know, what would be sort of the ultimate sort of patient experience and throughput. And now, thanks to the advancements in technology and you and your co-founder, We're there. So for our audience, tell us a little bit about Depth Health and give us an example of what you're doing. And again, we'll put show notes, we'll put links to all this information for everyone to follow. But, you know, sort of at a high level, Alain, what was the problem that you all have solved? Yeah.

So when I was at Airstrip, Airstrip became mission critical during the pandemic, helping with patient surveillance in the ICUs, emergency departments, cardiac telemetry units. And as the pandemic started going away, I decided to immediately tour hospitals to understand what are the big challenges that they face now. Many of those challenges they had before, but they became worse.

Yeah.

For example, when you have higher patient volumes, higher patient acuity because of COVID and now you have post-traumatic stress disorder from clinicians that now are retiring at an early age, new clinicians, less experienced coming in, nurses at the bedside. I knew that the patient experience and the provider experience was going to suffer significantly. So I started touring many of the hospitals that were our clients. We had 750 hospitals deployed in the US. So we had places like HCA, Ohio State University, NYU Langone, And others. And the first thing that I saw is something that we saw before, the waiting areas in the emergency department. But I was very fortunate. The same way I met Dr. Patrick Soon-Shiong, and he saved my life curing cancer with a miracle, I met a physician, Dr. Neil Patel at Vanderbilt University. When I was touring hospitals, as I was looking at the waiting area, he said, Alan, let me tell— let me bring you to where the bottleneck really is. And he showed me the hallways in the emergency department. And I could just see that— That is called the boarding area. These are patients that are admitted and they're waiting for an acute care bed. Bed in the hospital. So as he's educating me on this challenge, I immediately started thinking that this is like a traffic jam when you're driving on a freeway. You know that you're stuck in traffic. You know there must be an accident, something down the road, up the road that is creating this gridlock, this bottleneck. So I remember asking Dr. Patel, where is the accident? What's going on somewhere that is creating this? And he said, when patients come in, we triage them. Everybody does. And everybody in triage, the nurses will assign an emergency severity index score. Of course, you have high volumes. Immediately you say ESI 1 is very acute, Emergency Severity Index 2 and 3 is intermediate, and 4 and 5, things that maybe are not acute but need immediate attention. A lot of patients that are going to be treated and released, but also a lot of issues with behavioral health that need a lot of attention. So immediately when I was looking at that, I started saying, okay, and the accident is where? It's the Emergency Severity Index 2 and 3. These are patients that are waiting for intermediate care or cardiac telemetry. So when you look at a boarding area and you see 100 patients, and you see that 60 to 65% of those patients are in that category of what is called ESI 2 and 3, but 60% ESI 3, and they're all waiting for the first bed. There is a bed that is available, that is clean, and there is a resource that is taking care of that bed, and then that patient will move. So immediately at the time, I started thinking, and I asked Dr. Patel, are all these patients really that acute? And he said, probably half of them Are more stable. But with these volumes, it is the safest thing to put them in those units because there is going to be a better ratio between nurses and patients. There's better equipment to monitor them. So that was the beginning in my mind of what needed to be done. And then if you look at traffic, there is an accident, there is a bottleneck, and you go into Google Maps and it tells you, What is the alternative route?

Right. All right.

Well, that whole thing is what started our company. And if you want, I tell you now, what do we do to deal with that traffic?

Yeah, no, it's fascinating. That's a common problem. We all know that. And I get into a lot of hospitals as well. There's always a bottleneck at almost every hospital. Yeah. So give us an example of how, you know, what you're doing at Depth Health solves that. And then we'll move on to to leadership because you have got so much experience in solving problems. I know everyone wants to hear some of your leadership philosophy. So yeah, tell us how you solve this particular challenge.

I'm going to mention 3 things or 4 that have been a challenge up to this point. One is pilots. Pilots don't work. 2, Key performance indicators/ROI that could be attributable to a vendor. 3, which I think is the one everybody talks about, AI. And AI, I heard it from one of your guests the other day, Dr. Bard from UPMC. And he said, AI, these are tools. but they are not the solutions. And many vendors came up with AI tools and they thought that was the solution, but they didn't succeed. And we see them coming and going. And it's not because the tools are not good. It's because the vendors are claiming ROI that cannot be attributable to them.

Yeah.

So if you think about it, if you are going to do a pilot, you have to take a different approach. And the approach that we took at DEF, I told my partner, he's the most brilliant architect you can meet. And I said, hospitals don't have resources to analyze, to help us to analyze retrospective data. So we have to find a way to ingest 12 months of, let's call it, Epic EHR data at 1, 3, 5, 10 hospitals. We have to be able to ingest all that data and look at every data that the patient journey had. And once we do that, I said to him, we need to figure out what AI tools Can we apply retrospectively to start figuring out which patients at the time they came to the hospital and they were admitted with an ESI-3 score, which patients were potentially over-trialed? They waited 10 hours in the boarding area for the wrong bed.

Hmm.

How can we find out a way to de-escalate Retrospectively, those patients, can we also look at those beds that they could have gone at the time and create a whole digital twin simulation of a hospital or 5 hospitals to figure out where is the problem, what is that we can do that is attributable to us, and actually what is the cost for each of those challenges that they're facing? For example, boarding time, 120 minutes of extra boarding time from 4 hours, which is what the Joint Commission recommends. It's about $1.43 per minute per patient. So if you have about 5,000 patients that are over-trialed waiting for the wrong bed, those extra 2 hours could be $1 million. Then patients are transferred between facilities because of capacity, not because of medical necessity. We were able to quantify exactly what patients were transferred unnecessarily when they could have gone inside the hospital into lower acuity environments. So once we built the platform to analyze data retrospectively, and we did that by applying 3 layers of AI. First layer, actually not AI, but mathematical scores like the National Early Warning Score, qSOFA for sepsis, modified shock index. That's how we initially figure out which are the retrospective patients that were stable. Then we use EPIC deterioration index, EPIC sepsis, and then we bring third-party tools from very prestigious universities like Virginia, Michigan, that are in the category of xAI. Why do I say xAI? Explainable AI. We don't want just insights. We want them, the AI, to tell us an explanation why they give us that insight. So we created this engine of the That gives us the ability to look at multiple AI tools and figure out for each part of your journey which AI tool provides the best insights and explanations for you so we can move you faster through the system and improve your patient experience, but of course, your care. On the ROI, what we do is we specifically tackle KPIs, and we developed that with our first client partner, St. Luke's University Health Network, we developed the KPIs for about a year because we only wanted to choose something that we could show that we are making an impact. So number one, we don't do a pilot, we do retrospective analysis. 2, we spent a year talking about what could be the right KPI that is achievable to us. For example, left without treatment, Reduction of boarding times, reduction of overtriaging, reduction of cardiac telemetry overutilization, but also unnecessary transfers between hospitals. I love the dog there. Yeah.

This is Isla. I think this is the first time she's on a Digital Voices podcast. She's made a cameo before on our YouTube channel, Ed Talks, but if she sees the door open, she just jumps on my lap now. So yeah. I know.

It's a bigger audience I have now.

So. She found it so interesting when you started talking about AI, you know, she's like, I want to get in on this conversation. So.

Yes. So basically what we do, once we bring the right tools, is to— we use a tool that we call Real-Time Advisor for Clinical Expert Routing. We see that in the emergency department boarding area, there are about 100 patients admitted, about 60 are Emergency Severity Index 3, immediately we run the tools and we can de-escalate, escalate after risk assessing those patients, which ones should be rerouted. Of course, that recommendation goes to a command center, and it is the nurses and the bed coordinators at the access or transfer center that then, if they agree with our recommendations, they reroute. those patients. So if I have to define everything in one sentence, we do personalized, clinically guided, AI-driven patient traffic flow optimization.

Yeah.

Patient experience is better because I am making a recommendation on Ed's condition on where you need to go. So you don't wait 8 hours or 10 hours. Yeah.

It's huge. And the impact on the family, Impact on quality, saving lives, financial impact. You're kind of hitting the quadruple aim sort of things with this all-in solution as opposed to point solutions. You're covering that whole continuum, and that's what's pretty exciting. So it's great to see this come to fruition now that the technology has sort of caught up to where we've always needed to go. Alan, let me end with this. So you've been a serial entrepreneur, a leader, CEO of these amazing companies doing really good for people in all the quadruple aim type of things that we talked about. What's one recommendation you might have for our listeners who are all leaders in their own right, but maybe they're thinking about, one day I'd like to be CEO of a company like Depth Health. What would you say to them? What's one thing?

First of all, you always have to Disrupt yourself. And that also is not about the technology, it's about the approach to the business. When I was at Airstrip and I, it was in 2011 and we raised all this funding from Sequoia and HCA CommonSpirit at the time, Dignity Health. You, at the time, that was the model. You raised a lot of money, And you hired big teams, subject matter experts, and the model is different now. And what happens when you raise a lot of money is that you better have a very clear line of sight on when you're going to bring results, because if you don't, in 2 quarters, the venture capital team is going to tell you, you have to pivot, do something else. So first, Make sure that you raise initial funding, seed funding, from people that believe in your vision. If you can put some of your investment like I did, you do. But, you know, I remember the movie It's a Wonderful Life. I remember when I was finishing my last session of radiation, And I was putting a lot of my own money with my wife in the business. And I remember how difficult times were and how I was feeling at the time. And when I started telling the story, not my personal story, but what I was about to do, money started coming in like that Christmas story where a global company said, we would like to make an investment. Are you taking any investments? Yeah. Then the chairman of neurosurgery at a very prestigious medical center said, can I make an investment? I would love to partner with you. And I started receiving without asking a lot of things because I had the passion, I had the experience. So, if you don't have the experience, bring somebody that has the experience, that has the reputation in the market. But also start with less funding and only go to the investors, the big investors, when you have, when you are post-revenues, when you are able to prove the ROI, an ROI that is attributable to you so they can call the client and they can basically validate that the ROI is attributable to you. Because today, without ROI, the customers don't buy. Without ROI, the investors will not invest. Start small, build the business, prove it, bring the value, raise the money.

Love it. Yeah, Alan, you gave us like 4 or 5 things there. And I think the main one, the first one is all about disrupting yourself. Thanks so much for being my guest on Digital Voices. Always great to catch up with you. And so fascinating to hear about all the great things that you're doing and glad that That you've been healed and, and setting the pace for the rest of us.

Thank you for listening to Digital Voices. We hope today's conversation sparked ideas, reflection, and connection. Subscribe on YouTube, Apple, and Spotify Podcasts so you don't miss an episode.