Life of a Startup CTO

In this episode, we talk to John Orosco, cofounder and CTO for Sansoro Health, who draws on a wealth of experience in software development and integration to share insights on the current and future state of data exchange in healthcare. John was an early pioneer in the use of application programming interfaces (APIs) in healthcare and he makes a compelling case that this approach is now poised to transform the health IT ecosystem. He is also an entrepreneur who has launched several successful companies with a deep commitment to solving real world problems. John is known for being candid with his opinions and he comes through when we turn to one of his pet-peeves. We round out the discussion with some sage advice John learned from his father.

Dr. Dave Levin: Welcome to 4 x 4 Health, sponsored by Sansoro Health. Sansoro Health, integration at the speed of innovation. Check them out at www.sansorohealth.com. I’m your host Dr. Dave Levin. Today I am talking with John Orosco, Co-founder and Chief Technology Officer for Sansoro Health. John has decades of experience establishing and growing healthcare organizations with a focus on software development and clinical integration initiatives. Probably cofounding Sansoro, John was at Cerner Corporation for over nine years in a variety of roles. He subsequently co-founded Jase Health, a firm that provides custom development and professional services for health systems that utilize Cerner Millennium. In my experience, John has an unique ability to understand both complex technical issues and visionary strategy and remarkably to explain them in terms we mere mortals can understand. I can also personally attest that he’s a fun guy to hang out with. Welcome to 4 x 4 Health John. I’m gonna ask you a series of four questions and you have up to about four minutes to answer each one. Let’s get started! Tell us about yourself and your organization, John.

John Orosco: Well, first of all thanks for having me. Yeah, a little bit about myself, so as you mentioned I’m currently the Chief Technology Officer at Sansoro Health. Sansoro Health which is a Health IT software company that’s focused on solving a lot of the challenges that we know about in and around integration and interoperability. Our flagship product which is called Emissary which is a middleware software that effectively allows for real-time reading and writing against electronic medical record databases for the purposes of allowing third parties that have unique and niche departmental solutions or need access to patient records that would be in the EHR, giving them the ability to have that access and so that’s what we’ve developed. We started the company in 2014, we are currently at just North of 40 to 43-ish employees, we’ve taken two rounds of funding or Series A, Series B, we actually took a part which would be the seed round. So, we are in a good spot. We’ve developed Emissary to effectively connect to five of the major EHRs that folks know about. Cerner, Epic, Meditech, Allscripts, TouchWorks and Athenahealth and really the vision moving forward is that Sansoro want, we wanna be a leader in integrating health data information. So, as we do EHR integration today, that doesn’t mean that we’re only gonna do EHR data that could be other data sources in and around healthcare. So, that’s what we do, what’s what I, my role is and in my role as a CTO, really oversight for you know, the technical architecture, how we build in what it means to construct, true rest services and what that means related to a healthcare environment. Me personally, I’m, I live in Iowa and was born and raised in Iowa, lived here as you said I worked at Cerner Corporation. So, I lived in Kansas City for seven years, moved back to the Motherland once we started having a family and I reside here, our company’s base in Minneapolis and I frequent Minneapolis on a regular basis and spend most of my time either here Minneapolis or going to wherever our next business venture takes us.

Dave: That’s great John, my guess is you’re gonna tell us more about some of the technology but I have to admit I’m curious. This is at least the second startup that you’ve been a part of. Why startups John?

John: Well, for me personally, when I had left Cerner, this would have been in 2007, I think it’s just me seeing a need that I felt confident and comfortable with that I knew could be fulfilled and so, the first venture Jase Health was really just this notion that I knew what the market was looking for in terms of needing a better way to integrate third parties in that case, specifically with Cerner environments because that’s what I knew and third parties wanted it, health systems wanted it and there really wasn’t a good mechanism to at least in the market in Cerner you know, it wasn’t set up to really facilitate that sort of integration in a way that was going to be effective and productive for everybody that wanted it. So, you know, not knowing whether or not this was gonna be successful, I think that’s a big part of being an entrepreneur is just you really don’t know, you sort of have the sense, you take a risk and you go out and venture on your own. So, when I did that, it was pretty clear fairly quickly that even with the projects I was working on one at a time, the fact that  you could see the looks on people’s faces when you actually solved problems that they’ve been struggling with for years and tried numerous different things and all of a sudden they engage with you and you work with them in a collaborative way and you actually make it work and it wasn’t that painful and to know that they just have a deep appreciation of just getting the work done. So, for me it’s always been about being frustrated with what I see going on around me and in healthcare there’s probably countless things that frustrate different people and me having a background in a skillset where I feel like well, it doesn’t have to be this way. If we can, literally can make stuff work, that’s what I think drives me having this ability to and a desire to want to do startups and so that same appreciation blended itself to win we co-founded Sansoro. So, it was very much a similar thing, it just was sort of taken to a different level which is, I knew Cerner, I knew it was possible there and started to see and understand better what was possible in these other systems while they’re all written in different technology stacks, it really doesn’t matter at the end of the day. They all support the same workflows, they are all doing the same stuff. There’s mechanisms to build a platform that can allow for this kind of integration.

Dave: That’s terrific. I suspect you’d agree with me. It’s kind of an addiction too. Once you start to work this way, it’s pretty hard to go back to the old way. Let’s pivot to our next question, what’s the most important or interesting thing that you’re working on right now John?

John: Well, probably a few things. The most important things that we’re working on right now is just in and above, you know, outside of just expanding our footprint in terms of the kind of datasets that we can expose to the rest platform that we have. Doing things like, taking more advantage of a cloud infrastructure, right. So, it’s interesting in healthcare today that you’ve got all other digital economics that have really pretty quickly embraced and taking advantage of pure cloud hosting and a lot of efficiencies gained in overhead in just physical servers and network and management and building infrastructure that healthcare is one that’s slower to adopt but even in healthcare what we’re seeing in the last few years even is there’s a lot of health systems and third parties and the industries as a whole is starting to embrace could even more. You’ve got health systems that we talked to that quite frankly some of their strategy roadmap topics are how can we do a better job of moving what we’ve traditionally had to administer and manage internally out to the cloud, right and you’ve got Amazon Web Services, you’ve got Microsoft, you’ve got Google, you’ve got platforms that now have embraced this notion that they can be HIPAA compliant and our signing BAAs and all those good things and you’ve even got other companies that sort of build themselves in and around that more fundamental service offering to offer even a more stringent HIPAA complaint, security compliant, infrastructure that makes it far easier for folks to do development for one, deploy solutions and make those available to customers and so at Sansoro, one of the things that I am excited about and I know the rest of the company is excited about is embracing that further, it’s going to help not only us operationally , that’s benefit in and of itself but even for our customers and our customer’s customers which is make it more efficient for them, make the support easier, just have a more cohesive infrastructure that we can build all of our solutions around, that’s one thing that’s very exciting. As we look to expand on that, even the cloud sort of sets up a lot of other things that we have on the roadmap, you know, I alluded to a little bit earlier, we expose data real time right now for five EHRs in particular. As we look to build an infrastructure and a framework that will allow for development to other data sources. So, it’s health data isn’t just in the EHR but there’s a good majority of it, that’s why we’ve been focused there but there’s other data sources and so to set up a framework that would allow really a community of developers. So, it doesn’t have to be Sansoro badged developers only. We’re the ones that do it today but there’s a model that works where we can take the infrastructure that we built and allow these subject matter experts that know these data models and different data sources in and out a way to expose that and turn what traditionally has been closed proprietary systems into open platforms and so that’s also exciting. The cloud sort of is the foundation for that. So, this framework that’s gonna open it up to other data sources the fact that we can work and partner with other third parties that offer very unique data services. For an example, we’re working with a group that as an additional benefit for us, not only being able to do real-time data integration for the data that’s in the EHR but offering a bolt-on service that would allow for semantic interoperability or semantic normalization. So, how do you actually interpret this raw data that can be stored in different varying formats, summarize that with some metadata layer that semantically normalizes that and that, those kinds of things that we can build on will make it a lot easier for people to do integration. Right now, people are just trying to solve a problem of getting access to data that they otherwise couldn’t and we’re solving that problem but then what’s the next evolution of that. So, those are some of the things that we are working on and some of the things that works at about.

Dave: Well, obviously I’m biased because I’m involved in some of this too but I like the way you’ve summarized it which is you know, initially making the access problem go away and then in a series of steps adding more and more value to that data as it flows and that’s very cool. I want to pivot to our next question so, and I want to remind you John, this is a family show. So, no swearing but tell us what’s your pet peeve or favorite rant these days?

John: My biggest pet peeve a rant, it continues to be, it’s the reason why, even back in 2007 I got into the business that I did which is this notion that integration and interoperability in healthcare is too hard, it’s just, it’s too hard to figure out, it’s too complex to make work. I’ll give folks it’s hard, it’s complex but it’s not, it’s not that hard and it’s not that complicated. The stuff that we’re doing today at Sansoro, could have been done 15 years ago, could have been done 20 years ago, should have been done. I actually worked at a company where I saw it done. So, this notion that you can turn a close proprietary system like these EHRs into open platforms, that’s been in existence for a long time. There’s no good technical reason why that isn’t already rampant throughout this industry. It has everything to do with non-technical things, we call them political things. So, I think that’s the biggest pet peeve that I have in a gig and why I got into the business I did with the Jason and Sansoro is stop listening to all the reasons why we can’t do anything and literally just go do it and stop waiting for other people to do it for you. So, I think that’s probably my biggest pet peeve and I think we spend a lot of time you know, not only providing a technical solution that actually solves problems but really sitting and having conversations and explaining to folks why this is possible now, how it could just come out of nowhere and it’s like, it’s always been there. It’s just as a collective group, I’m part of it, you’re part of it, we’re all in this healthcare, healthcare IT consortium. We’ve all just been staring at each other, looking at each other, talking about it and nobody really been doing anything about it and so that’s why we’re excited about doing what we’re doing. So, that’s still really my pet peeve but I think I feel better about it because now we’re actually proving it. It’s no longer this theory, it’s no longer, I would be really cool if we’re doing it and now, now we are really trying to figure it out and get more people to understand that this can happen today. It doesn’t have to wait two years from now or fives years it’s gonna be better, ten years it’s gonna be better. It literally could be better today. So, that’s what drives me nuts but I feel better about where we’re at and I think the markets getting more educated in and around that topic.

Dave: Boy I’m revved up just listening to you talk, I’m ready to follow you up the hill and boy, you should also just like a classic entrepreneur, innovator, saw the problem, frustrated by the bureaucracy, jumped in and started making stuff happen. So, good for you. Let’s wrap with the final question today which is what’s your most sage advice for us John?

John: My most sage advice, that’s a really good question. Here’s my most sage advice and this actually is advice that was given to me by my father which started when I was really young and it wasn’t really directed by it. So, it was sort of indirect and I’ll explain what that means. So, from the time I was very small, my dad used to tell me when I would respond to things and I would say something like, I can’t do that or I can’t do this or I can’t be there. My dad would always respond with, can’t means you won’t and I didn’t know what that meant. So, think about being seven-eight-nine, you know, I just thought well, my dad’s just trying to make me mad and he would consistently tell me that when I’d say things. Especially if I said I can’t do something, he would say, can’t mans you won’t, and as I got older you know, I really wanted to understand what that meant because I was, I didn’t understand it when I was younger and as I’ve gotten older, I understand what that means and I think I’m guilty of it, I think a lot of people are guilty of it and what that really means is if somebody, if you say that, you really have to think about, really are you able to not do that or are you really trying to say what’s more accurate is you won’t do it because there’s a huge difference. There’s probably very few things that you literally can’t do. So, I can’t jump a hundred feet straight up in the air. So, that’s probably accurate, I can’t do that but if I say, well, I can’t get involved in this or I can’t go solve this problem, more accurately probably should be stated that you won’t do it and I think that’s been a large part of me growing as I’ve grown up and become a professional and even as I, I think about things that are challenges in front of me today before I say, I can’t do something or even if it comes out of my mouth, it’s the first thing I think about which is, am I literally saying I can’t do it because there is barriers that are outside of my control that prevent me from doing something or am I, what I’m really trying to say is I don’t have the desire to do it. So, what I should say is I won’t do it and I think it’s hard for folks to respond to some requests until people I won’t do it but a lot of times that’s more accurate and it should be more open and honest about it. If you won’t do something just say that but if you’re gonna do something, do it. So, it’s sort of indirect advice that was given to me. I’d, you know, I sort of try to live by that and I think that would probably be the most sage advice that I’ve gotten that I like to share with others.

Dave: Wow, that’s really terrific and like you, some of the most sage advice I’ve gotten was from my dad as well. We’re fortunate to have had fathers like that. John, times up today. I wanna really thank you for taking time to chat with us and perhaps we will have you back again sometime.

John: Yeah, absolutely.

Dave: You’ve been listening to 4 x 4 Health, sponsored by Sansoro Health. Sansoro Health, integration at the speed of innovation. Check them out at www.sansorohealth.com. I hope you’ll join us next time for another 4 x 4 discussion with healthcare innovators. Until then, I’m your host Dr. Dave Levin, thanks for listening.