Episode #5 - Brendan Keeler, Head of Product at Flexpa and Health API Guy

Written By Omar Mousa

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Description

Concept to Care speaks to Brendan Keeler. He is the Head of Product at Flexpa. Flexpa is a developer friendly infrastructure that connects applications to identified claims data. Flexpa enables effortless sharing of claims data with your application in seconds. They’ve created the fastest, simplest, HIPAA compliant method for accessing identified claims data from anyone.

You’re going to hear about Brendan’s experience at Epic and the role it played in laying the foundation for his healthcare career. Brendan will give us all a master class in interoperability, the types of problems and an in-depth view on the solutions in the market today. He will walk through his EMR selection playbook and share an intimate love letter to a particular EMR vendor. We will dissect Brendan’s brain for how he thinks about tech start up culture and how that manifests within Flexpa. Lastly, we understand the origin story of the Health API Guy and share lots of laughs throughout the episode.

In our conversation, we discuss:

  • Brendan's odyssey through the realm of healthcare, and how he culminated his mastery of healthcare interoperability

  • Explaining the interoperability challenge, navigating the technical solutions available, and strategies for evaluating vendors in this landscape

  • Epic v Particle, an overview of what happened along with a perspective on potential paths forward

  • To EHR or not to EHR, how should think about build vs. buy, the len’s of your tech enabled organization, and a love letter to a headless EMR partner

  • Mastering your career journey: Cultivating your personal product “skill tree”, navigating expectations with finesse, and infusing humor into organizational culture.

  • Deep dive into who is the Health API guy and what’s next for him?

www.concepttocare.com

Show Notes

Where to find Brendan Keeler:

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Where to find Angela and Omar:

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Referenced:

Check out our website: https://www.concepttocare.com

Subscribe to our newsletter: https://concepttocare.substack.com/p/episode-5-brendan-keeler

Transcript

[00:00:00] Brendan Keeler: It's become an overloaded term. Interoperability is anytime someone's like, Ooh, I'm connecting two softwares. They're saying, Oh, interoperability. That's wrong. I think that's wrong in my book. At least it's, it makes it too big, too muddy to have any real meaning or value. I personally separate it out into sort of like two main types of things.

[00:00:19] Brendan Keeler: There's interoperability, which is connecting between different enterprises. And then there's integration or intra operability. So within an enterprise, how do I connect my systems? 

[00:00:31] Angela Suthrave: Welcome to Concept2Care, where we hear candid stories of success and failure, discuss strategy, and dive into the details that offer advice on what to do and what not to do in healthcare.

[00:00:43] Omar Mousa: Whether you're a seasoned pro growing your career, or just starting out our aim for this podcast is to be relevant, real world and tactical. We're dedicated to not only entertaining you all, but also empowering you with actionable insights that can be applied beyond the podcast. One concept at a time.

[00:00:58] Angela Suthrave: This is Angela 

[00:00:59] Omar Mousa: and this is Omar. 

[00:01:00] Angela Suthrave: Welcome to concept to care. 

[00:01:03] Omar Mousa: In today's episode, we're talking to Brendan Keeler. He's the head of product at Flexpa. Flexpa is a developer friendly infrastructure that connects applications to identify claims data. Flexpa enables effortless sharing of claims data with your application in seconds.

[00:01:16] Omar Mousa: They've created the fastest, simplest HIPAA compliant method for accessing identified claims data for anyone. In this episode, you're going to hear about Brendan's experience at Epic and the role it played in laying the foundation for his healthcare career. Brendan will give us a masterclass in interoperability, the types of problems, and an in depth view of the solutions in the market today.

[00:01:35] Omar Mousa: He will walk through his EMR selection playbook. And share an intimate love letter to a particular MR vendor. We will dissect Brendan's brain for how he thinks about tech startup culture and how that manifests within Flexbox. Lastly, we understand the origin story of the health API guy and share lots of laughs throughout the episode.

[00:01:52] Omar Mousa: Enjoy the conversation. We sure did.

[00:01:59] Omar Mousa: Brendan Keeler, the health API guy. Welcome to concept to care. So glad to be here. So glad to be here. We were really excited. Angela and I have been raving about this upcoming recording, so we're really excited to get into a lot of the interoperability topics and some of the other things you've been talking about lately.

[00:02:18] Omar Mousa: Before we get into all of that, can you just tell us a little bit about yourself? Yeah, 

[00:02:21] Brendan Keeler: sure. Man in many homes. So, Jersey, Philly. Went to Indiana for college, went to Notre Dame, jumped up to, well, there you go. Jumped up to Wisconsin, worked while working at Epic and then the Netherlands for a couple of years, San Francisco, and now Portland.

[00:02:39] Brendan Keeler: So been all over. I have a twin brother, so I technically have the transitive property and can claim even more homes because you may see me in Chicago or Denver. And yeah, I've been in healthcare interoperability. Via Epic, via Redux, via Zeus, and now Flexpa, my whole career. 

[00:02:56] Angela Suthrave: You said that you started your journey and, you know, you've been at Epic.

[00:03:00] Angela Suthrave: Can you tell us a little bit about what that was like? 

[00:03:03] Brendan Keeler: You ever seen like Star Wars? Like the Death Star? It's like being inside of that. No, I'm just kidding. It's like a great place to learn healthcare. You're in a dominant EHR. You're surrounded by young people. They hire out of college. So you're, you have all these fun, young, talented people.

[00:03:19] Brendan Keeler: You know, it's not like all fun. You can't drink with customers. There's all these like. Unique cultural elements to epic and it wasn't it was a very intense workplace. It was like 90, 100 hour weeks. You'd be really grinding, but to go from just like, oh, I have a comp sci degree to, oh, I have a. On the job masters in health care epic was really good for that.

[00:03:42] Angela Suthrave: And when we were talking with you earlier, you had said that, you know, you have some. Fun stories that you might be able to share with us about your time there. 

[00:03:51] Brendan Keeler: Sure. Yeah. I mean, let's see, which one do you want to hear? Do you want to hear about the time the guy got in front of the 13, 000 people and talked about his dog pooping?

[00:03:58] Brendan Keeler: Like that was really fun. I think like, it's just like an interesting, it breaks all the molds of like, what successful companies look like. Right. It's entirely private. It's never going to be acquired. And it will never acquire companies. Everything's built by Epic. So like there's no Salesforce, it's this own CRM.

[00:04:17] Brendan Keeler: That's like the chassis of it is the same thing as the EHR. It's there's no Zen desk. Like there's this SLG, you know, support log thing. Sorry, acronym, but it's Epic specific. No one would know what it means. These support logs are also built in the same chassis. So like everything outside of like core Microsoft word and that sort of thing.

[00:04:39] Brendan Keeler: Is built internally, and so that's like a, it's not how you're taught outside of, uh, that company, like what a company trajectory look like looks like, you know, you're not taught that you don't need to take venture capital money. You don't need to look to be acquired that you don't need to go public. And so.

[00:05:01] Brendan Keeler: I don't know if those things are right or wrong, but it's hard to argue that Epic's been really successful and yeah, it was really good. They offered things like a sabbatical. So I got to go on my wife's sabbatical. She was an Epic employee as well at five years. And then I got to go on my sabbatical. And I got back and I handed my laptop in and said, I'm done and move back to the States.

[00:05:21] Omar Mousa: That sounds incredible. Brendan, your career has been primarily in healthcare, or for the most part, all of healthcare. And then in interoperability, you've become sort of a subject matter expert in interoperability for our audience. Can you just define? In your own words, what interoperability is and what is the distinction between interoperating and then integration itself?

[00:05:43] Brendan Keeler: Yeah, sure. I mean, it's become an overloaded term, right? Interoperability is anytime someone's like, Oh, I'm connecting to softwares. They're saying, Oh, interoperability, that's wrong. I think that's wrong in my book. At least it makes it too big, too muddy to have any real meaning or value. I personally separate it out into sort of like two main types of things.

[00:06:04] Brendan Keeler: There's interoperability, which is connecting between different enterprises. And then there's integration or intra operability. So within an enterprise, how do I connect my systems? And so integration, that intra operability, it's really old, right? Like, as soon as, like, UCSF or whoever the 1st hospital was that started doing software, like, proto.

[00:06:28] Brendan Keeler: They started to be like, oh, like, how do I connect that to my lab system? I registration system. And so all that integration, it has cruft. It has this buildup of technologies to connect since the 1970s, the 1980s. And you get all these weird acronyms. And I'm going to say a bunch of them. We're not going to explain them, but they're, they're common in healthcare.

[00:06:49] Brendan Keeler: There's HL seven, there's X swell, there's fire, there's CSVs, there's proprietary APIs, and all that buildup is meant to accomplish the same goal, which is how am I getting, how am I integrating these ancillary applications with my core EHR? And so that integration problem, that's one problem separate from that is interoperability.

[00:07:12] Brendan Keeler: It's how does ventricle health talk to accolade? How does accolade talk to an employer or a payer? You know, like, it's how to do all the players that exist. These disparate organizations interact. And so that's providers to payers, that's providers to pharmacies, that's providers to other providers. And so much more, it's not just simple, like, Oh, let me pass back clinical data back and forth over HIEs, you know, the ZEUSs and the particles and the healthcare laws.

[00:07:40] Brendan Keeler: It's really also pretty old, as old as the claims clearinghouse. So, like, all that interoperability, that problem space is just about how do we make an ecosystem where there's digital transactions between the players and healthcare, these different enterprises. 

[00:07:56] Omar Mousa: If you're submitting claims to the clearinghouse, are you interoperating?

[00:08:00] Brendan Keeler: Yeah, 100 percent right. You're sending to a payer. They're never another covered entity. And thinking about it in that way, you can start to say, okay, well, interoperability is a number of sub problems, which one am I tackling? And what are the right tools to solve that problem? 

[00:08:14] Omar Mousa: I always thought that was like, step 1, but interoperability felt like this other harder problem.

[00:08:18] Omar Mousa: So it's interesting that like organizations. Have been interoperating. 

[00:08:23] Brendan Keeler: It's a great point. Like, some of these are very solved problems claims, except when change health care is down is a solved problem. Like, but if you keep going down up the maturity curve as a virtual clinic, as a, you know, a digital health provider organization, a tech enabled, uh, provider organization, you're going to start to hit ones that are kind of solved, right?

[00:08:44] Brendan Keeler: Like the. Yeah. You're going to start pulling data like this isn't all the data. This is 70 percent of data. You keep going. You're like, let me do referrals or let me do prioritization. Let me do scheduling. Can't do it. Doesn't it's not solved yet. So there's interoperability problems that are completely unsolved all the way to completely solve.

[00:09:03] Brendan Keeler: And like, yeah, like, I think as a PM in healthcare, Yeah. You, you venture in and you start to be like, Ooh, is this one of the solved ones or one of the semi solved ones or not solved at all? 

[00:09:12] Angela Suthrave: That is very interesting. So we think about interoperability as the Holy grail. And I'm hearing you say, listen, interoperability has been around for a long time.

[00:09:23] Angela Suthrave: There are certain areas that have been solved. Maybe you could tell us where, what areas you feel like have been solved very well versus what areas. We have a long way to go. And for those, why is it so hard? Why haven't we figured it out yet? 

[00:09:39] Brendan Keeler: Yeah, totally. I mean, it's, it's exactly that interoperability.

[00:09:42] Brendan Keeler: You crack it open. It's not a single problem to be solved. These component parts, some are simple because we've had to do them from day 1 or like billing needs to occur. And so the claims data networks eligibility, those are some of the first things that a provider organization Needs to tackle generally, right?

[00:10:02] Brendan Keeler: Like there's different go to markets, but generally that's like 1 of the 1st ones you go and you figure out which clearinghouse you're going to use or which. API vendor to overlay clearinghouse and you move on to the next thing. That's probably E prescribing because. Sending meds is pretty important.

[00:10:19] Brendan Keeler: That's all right. Sure. Scripts exists. There's on ramps to share scripts. Checkmark on to the next 1 lab integration. Okay. Checkmark clinical data exchange. And so you start to see you move down that progression. And so you skip some if your business doesn't like, if you're go to market or different business needs don't align with it.

[00:10:38] Brendan Keeler: But you see that common pattern of. Moving through this maturity curve and solving different interoperability problems, and then eventually being like, okay, this 1 for scheduling. That's a phone call. The way we're going to interoperate is via fax or phone call because that's the fallback for all this is analog workflows.

[00:10:56] Omar Mousa: So, how have these problems manifested? Angela talks about the alphabet soup that we have today. So. For example, like, what are the data standards and what are the solutions that have made it possible for these organizations to communicate with one another? 

[00:11:12] Brendan Keeler: So, like, alphabet soup is common in tech. It's not just health care, but it's like, in tech, you.

[00:11:17] Brendan Keeler: Accumulate craft based on when tech is adopted. And so if you look at, like, programming languages, we change programming languages every 2, 3 years in terms of what's dominant, like, what's the cool stuff to use behind the scenes. And you sort of have that with healthcare standards. And so you had HL7B2 and that's in the 1980s, 1990s.

[00:11:40] Brendan Keeler: You have HL7B3 and the continuity of care document, CD, CDA, that's in the two thousands and 2010s. You have FHIR, which is the popular hot standard now. And these are all like trendy and Vogue. They, they might solve different problems. There's other ancillary standards like X12 and NCPDP. So if you sort of like look at which standards are used to solve different problems, you're almost like a geologist dating something via the lithosphere.

[00:12:11] Brendan Keeler: When our biologist looking at tree rings, you're, we build up these layers of standards and if you say, okay, claims is via X 12, X 12 was really popular early on. So this was a, a problem that was solved in the nineties. And you say, oh, this one was solved via N-C-P-D-P or CDA. It's like, oh, that was in two thousands or 2010s.

[00:12:33] Brendan Keeler: So yeah, you can do this sort of archeology on it all and see that we built up this history and this complexity over time. And so since not everyone is the metaphoric, our biologists, archeologists, or whatever, they don't have the time or cognitive. Capacity to think about that and also solve the problem they want to solve.

[00:12:52] Brendan Keeler: You have all these API companies that exist to insulate to keep you not having to deal with old standards and old technologies. And so there's a huge growth in those in health care in the past 5 years. 

[00:13:04] Angela Suthrave: What are the different types of organizations that are looking to interoperate better and what workflows are they trying to support?

[00:13:14] Angela Suthrave: What do you see the most often? 

[00:13:16] Brendan Keeler: Yeah, sure. I mean, think of everyone that's involved in healthcare. I'm going to be, I'm going to go categorically through it and try and list the major organizational types, but there's probably more. You got traditional hospitals and clinics. You have virtual care clinics.

[00:13:30] Brendan Keeler: You have tech enabled, you know, startups, you have labs, pharmacies, payers. So you have those covered entities. Those all do different things and they all have relationships between them. And then you have business associates. You have applications that sell to providers that sell to payers. You have health navigators and Medicare brokers.

[00:13:50] Brendan Keeler: You have non covered entities. You have patients themselves who want healthcare data. You have public health, you have clinical trials, pharmacy, or pharma, pharma, Life insurance lawyers, and so, like, whatever, 14, 15 different organizational types. There each has different needs. Each has different workflows.

[00:14:09] Brendan Keeler: And so, if you just do the simple math of just assuming 1 time, like, 1 is 1 unique workflow between each type. It's like 200 combinations and some of those problems are solved and some are completely analog and it ranges from prior authorization clinical data exchange record retrieval for life insurance record retrieval for providers.

[00:14:32] Brendan Keeler: And it's not just, oh, let me toss some clinical data over the wall and that solves interoperability. It's actually like, what does each of those workflows look like in a digital era? And do we have the infrastructure there for it yet? The answer is resoundingly no on the whole, but for specific problems, it's yes.

[00:14:52] Omar Mousa: It feels like one of those, it depends answers for sure. Let's pick them the most common organization type that we probably see in health tech today. The tech enable, you mentioned tech enabled services, they have a lot of reasons to want to tap into some of these solutions. If I, or if you were an IC PM today, listening to this podcast.

[00:15:12] Omar Mousa: And you are, you've never solved an interoperability problem before, where should you go to learn how to solve for, you know, your use cases. 

[00:15:23] Brendan Keeler: Well, you got to go ask health API guy, GBT, you know, like the AI version of me, which does not exist, but nah, I'm just kidding. I think you're working on this. No, everyone, everyone is right.

[00:15:35] Brendan Keeler: Like you're not, you're, you're behind, but, but no, I think like, I think health tech nerds and digital communities that popped up in like, The COVID era, everyone's like, can't go outside. Might as well join the Slack community. That's actually well worth the price of admission. Just because any question like this, you're like, what should I use for forums, like, or what should I use for this interoperability problem?

[00:15:58] Brendan Keeler: Somebody's thought about it. Someone's going to answer it. And so that crowdsourcing that's really, really powerful. But there's many reasons to join health tech nerds or other similar communities. But I think that 1 alone is worth what it costs. I think also, there's a ton of increasingly a ton of free impartial content.

[00:16:15] Brendan Keeler: So, like, I think of the errors of content on the Internet for health tech and 1st, it's just like. You're reading it, but, you know, it's bullshit. Sorry, earmuffs for kids, you know, it's both this bullshit because they're just trying to sell you something with it as a vehicle. And then you have sort of the growth of the sub stacks and things like that that have slightly slightly less bent in that way.

[00:16:40] Brendan Keeler: And now you have sites like that are like, their whole business is to try and be impartial. I think that's like, in my career, just watching that grow. It's become something you can actually learn from versus like. Just trying to peek through the curtain and figure out what's bullshit and what's real, which is still the case.

[00:16:56] Brendan Keeler: If you read, go to the marketing website for many products. 

[00:16:58] Omar Mousa: You and your content, you talk a little bit about the different types of. Solutions out there, like, for example, like a headless business, or some of the fire APIs, which are considered on ramps, or even like flexible, who's open aggregator. And then there are closed aggregators.

[00:17:16] Omar Mousa: Can you talk a little bit about each and each, each and every, every 1 of those? 

[00:17:20] Brendan Keeler: Yeah, you're talking about the API Bible article I wrote. Yeah. And so if you're looking at API companies, every API company is going to go, we're striped for this. We're plaid for that. And it just doesn't mean anything at that point because they're wrong.

[00:17:36] Brendan Keeler: They're actually lying to you. And that, that was the impetus for that article. And if you're looking at them and they have an API, they're one of four things. One is they're, they're making software. They're making sass. And they're just offering API. They're saying, oh, you kind of want control via programmatic control and not just via, you know, the, the interface we give you.

[00:17:58] Brendan Keeler: Okay, that's great. Like, headless, headless business, especially like an headless HR can be very powerful. If you're a builder, you're really like a tech. In the spectrum of tech enabled, you're really tech enabled, but it's not really an API company in the sense of like a stripe or a plaid. Those are all networks.

[00:18:16] Brendan Keeler: And so if you think about networks, either you're an on ramp, you're providing access to a preexisting network or you're building a network, you're an aggregator. And so companies like Flex, but we aggregate open content, these, these mandated APIs and make it available so that you don't have to go do that work yourself.

[00:18:35] Brendan Keeler: There are closed aggregators that build business relationships. They're unique to them, like a redox or something to build a network. And so those are some of like the tactical ways to like segregate and think about API companies. I think more tech, like better for like the random IC thinking about vendors is thinking about like, okay, what these axes, you can start to divide them on what problem are they solving?

[00:19:00] Brendan Keeler: So what data is being made available or what workflow are they accomplishing? Is it claims data? Is it clinical data? Is it wearables? Is it provider directory data? Is it cross cost transparency data? Those are all different problems, like different data sets that help you solve different problems. What's the method of access?

[00:19:20] Brendan Keeler: Is it an HIE? Is it patient or consumer authentication? Is it a different method mechanism? And then what's the modality? Is it an API? Is it a user interface? Is it a flat file? And so like segmenting in that way, you can start to pick apart these vendors and say, do they have the right modality for me?

[00:19:40] Brendan Keeler: Health Gorilla has a user interface. Particle only has an API. Zeus has a plugin to my EHR. So modality matters. Content, so like the actual data types matter. And cost matters, right? Like going and getting price shopping for different things for different companies and vendors that offer the same thing.

[00:20:00] Brendan Keeler: Obviously important. 

[00:20:01] Angela Suthrave: I really like the way that you simplify that. To think about it, because I think sometimes when you don't. Aren't as familiar, it is very overwhelming to try to figure out. What are the different axes in which you can evaluate these vendors? So I think. You said modality, the content and the cost would probably be the 3.

[00:20:19] Angela Suthrave: To sort of parse out these vendors. To them, figure out which 1 is the best for your specific use case 

[00:20:27] Brendan Keeler: totally. And like, how you figure that out, we can ask them and be very blunt and they should be honest. But like, it's sales. You never know if you're gonna get a shark or the honest type of salesperson.

[00:20:38] Brendan Keeler: I tend to go and look at their website and say, look at. Who do they serve specifically where their customers are? Those customers like me. That's one two is what is their product list that can help distill things. But like, actually, more importantly, the developer documentation, you can usually, there's other tools like built with you can use to find if it's not visible or public, but APIs are honest where marketing websites aren't.

[00:21:05] Brendan Keeler: And so, like, going, look at the API, you can say, okay, how would this work? Gets you a little closer. And then press releases, like, obviously kind of BS, but they're trying to tell you something. They're trying to project something in the world. And that can be really good. So like, that's what I do. Anytime I'm looking at a random industry, I'm like, let me go look at ed tech APIs because it's a Saturday.

[00:21:25] Brendan Keeler: I'm a board. 

[00:21:28] Angela Suthrave: I think that all the time on Saturdays, 

[00:21:32] Brendan Keeler: I had a long paternity leave. So I had to do something with my daughter. 

[00:21:35] Angela Suthrave: That's really smart. The way that you think about that to get to the truth versus what they're trying to project. And when you think about this area, how do you, can you describe the regulatory challenges That are common with interoperability.

[00:21:51] Angela Suthrave: Sure. 

[00:21:52] Brendan Keeler: Let me ask the question. Are either of you guys either now or back in the day, a gamer? I did dabble if I do say so myself. Okay. Well, imagine product management as like an RPG, like a role playing game. And I think of product management as different trees, skill trees you might take. I think regulatory comprehension is a PM superpower.

[00:22:14] Brendan Keeler: It's taking. The subject matter expert PM skill tree all the way to level 100. And if you're doing that, you deeply understand the space. And that's something that's when you're applying for a job or when people are looking for something special about you, very easy to point that and be like, okay, I can do this.

[00:22:33] Brendan Keeler: I can go read a 200 page document. Can everyone do that? Not really. And so I think that's a superpower. It's not one that everyone has to have, but it's definitely something as a PM. If you are able to think, yeah, it's kind of interesting. I kind of, let me go see what the CMS is doing. There's a severe advantage to that.

[00:22:53] Brendan Keeler: Largely speaking, you guys know this healthcare is regulated. Every piece of it's regulated. It's bipartisan, both Democrats and Republicans are going to keep throwing regulation at us and neither is going to have a really severe deregulatory effect and especially for interoperability. They keep pushing things forward.

[00:23:13] Brendan Keeler: There's going to be new national infrastructure, new capabilities, new requirements. So, for, you know, digital health practices for tech enabled service providers, you're going to be affected by this in certain ways, because it's going to go and say, hey, you actually have to go and do Tefco or do prior authorization and you can view that as compliance.

[00:23:33] Brendan Keeler: Your vendor certainly will, but you can also view it as. What operational efficiencies can I gain by doing this? And so I think there's this false narrative. That's really popular, especially like Silicon Valley, like, be a Bill Gurley and that type of thing. That's like regulation stops innovation and, you know.

[00:23:55] Brendan Keeler: Makes the incumbents like entrenches the incumbents. Sure. Like there's a few cases that that happens, but it's actually bullshit. The opposite is it's provably false where companies said, Oh shit, there's this regulation coming. Let me take advantage of it and disrupted or became dominant. And so I think if you stay on top of regulation, if you're that superpower, the PM with that superpower, and you hope your company stay on top of it, it's an extreme tailwind.

[00:24:22] Brendan Keeler: There are companies existing today that 5 years ago had a million ARR and now have 100 million ARR only because of regulation. And so it's laughable and it's sort of saying, oh, I have to go buck regulation and and try and fight against it. Or, you know, I'm a prior auth, as a prior auth startup or something.

[00:24:45] Brendan Keeler: Maybe you pay attention to the prior auth rule and take advantage of it. So, yeah, I think that PM should sign up for the ONC's newsletter. They should get into the regular regulatory channel and health tech nerds. It's not just interoperability, telehealth, e prescribing, CMS reimbursement. There's so many like sub niches that people can take advantage of.

[00:25:06] Brendan Keeler: And become experts in, in a way that's differentiating. Sounds like 

[00:25:11] Omar Mousa: somebody played Diablo two, maybe back in the day. That's right. 

[00:25:14] Brendan Keeler: You got me level nine, level 99 barbarian. You got me. 

[00:25:19] Omar Mousa: I love it. So you talk about like, we just recently talked to drew vicious thun. He talked about the native digital health tech product manager.

[00:25:26] Omar Mousa: You mentioned a lot of those. I feel like it's, it's an addition add to what he had said, but it definitely jives. I think it's not enough to know, you know, just even the technology or you got to understand the buyers, you got to understand all the, the, the nooks and crannies of healthcare. And you know, you're, you hit that on the nail, I think right there, let's, let's talk about something a little bit recent, right?

[00:25:50] Omar Mousa: And when this podcast comes out, hopefully it's, it's still relevant, but over the weekend, uh, April 20th or April 6th. Epic, I guess, denied or kind of closed off access to care quality for particle health. Can you talk a little bit about what happened? 

[00:26:09] Brendan Keeler: Sure. Yeah. I mean, it's a lot of rumor right now, like particles put out a press release today, but largely speaking, Particle, Epic, Health Gorilla, Zeus, all the on ramps and all the EHRs that participate in this health information network, the trust framework that is care quality.

[00:26:26] Brendan Keeler: Have 2 rules 1 rule 1, you have to be providing treatment. So you have to be a provider giving some sort of treatment to the patient and rule 2 is sort of a quid pro quo. You have to give back data. There has to be reciprocity and so underpinning FX decision. Which is to not respond to the queries of certain particle health customers, not all, but some was the belief or proof that fraud or abuses happened and like, I don't want to cast judgment there.

[00:26:59] Brendan Keeler: I think they'll figure it out. Someone else can cast judgment, but it is irrefutable. That this is happening on the network today that there are lawyers on the network that there's farmer on the network. There's clinical trials on the network, but there's payers on the network. And all of those parties deserve to have access in some way, right?

[00:27:19] Brendan Keeler: They have some good business reason to have access. But not as treatment, and so figuring that out is the biggest problem and that is the care quality has to figure out that we. As in the health care community, you have to figure out because. Otherwise, we just are saying HIPAA doesn't matter. Data privacy doesn't matter.

[00:27:40] Brendan Keeler: Patient privacy doesn't matter. And in these particular times. With different threats to women's health with different increasing privacy regulation at the state level, all these different reasons now, more of a need to care about privacy than ever ever. The sort of blankets that anyone can access, you know, health data for anyone they care, you know, it's a real slippery slope.

[00:28:03] Brendan Keeler: And so, yeah, it's a good wake up call for us all to to work on this to say, give more scrutiny to something where it's been. Awesome and to see. You know, venture coal and accolade and all these companies. Start to have access to prior medical records, giving access for treatment. Awesome, but as we start to expand other use cases, unintentionally.

[00:28:29] Brendan Keeler: Without the thought of how it should work, we're going to risk a lot of a lot of bad outcomes period full stop 

[00:28:37] Omar Mousa: and with the change health care. Crisis a lot of folks are moving off of change health care, right? And they're looking for expertise and help on how to do that. Do you think folks are going to be moving off of particle?

[00:28:51] Omar Mousa: And if so, what advice do you have for them to do that in a cost effective way, efficient way, and one for the providers, that's not disruptive to care. 

[00:29:01] Brendan Keeler: I think it's sort of apples and oranges in the sense that particles competent and particle wants to do well by their customers. Like, and I don't, not to say change doesn't, but change has not been able to deliver on that promise for 40.

[00:29:16] Brendan Keeler: Five days for however long it has. So like switching off of change. Is existential for providers, right? It's you need to go at certain points, start billing those claims. I expect the particle. Team and epic team who are both very competent and both ultimately trying to help. Their patients help providers to figure this out and do for the network to be better for it.

[00:29:41] Brendan Keeler: That's my guess, but, yeah, I think there's going to be alternatives. Zeus off gorilla, Metroport, all these groups that are on ramps. They do exist, and if some customers feel lack of trust as a result, we'll see some switching. I just don't expect it to be as drastic as change where. It's just like, it's too long.

[00:30:00] Brendan Keeler: It's just too long as a business to not be able to do this core function. 

[00:30:04] Angela Suthrave: I think we, you know, earlier when we were talking about what makes this so the interoperability of the problem so hard to solve, I think we just hit it, right? Which is people have very good reasons to be accessing this data and we want to provide longitudinal care.

[00:30:22] Angela Suthrave: At the same time, you want to make sure that this data doesn't get abused or used in a way that it's not intended for. 

[00:30:30] Brendan Keeler: Yeah, 100%. Like, and the best way to accomplish that is to not give people this art. This right now, it's a huge arbitrage, right? Like, either I follow the rules and I have 0 access to data or I do some mental gymnastics and I break the rules and I have access to data.

[00:30:47] Brendan Keeler: And to accomplish these really good business, the really good business goals, oftentimes helping the patient, right? Like helping the patient get life insurance, helping the patients participate in a clinical trial. None of these are bad in a vacuum, but breaking HIPAA, utilizing the pathway that is like, just like not allowed.

[00:31:08] Brendan Keeler: Isn't the right path. It's actually to build the paved paths that are necessary to support them and support them in the right way. Okay. Because what's right for a provider to access from another provider in terms of, like, how it is, is the reimbursement, like, all the mechanisms might be different than what a payer accessing from a provider or pharma accessing from a provider.

[00:31:28] Brendan Keeler: So, if you have different paved paths and different infrastructure. You can actually tailor it to the use case much better. Like that's, that's ultimately where I would like to get to is just like, let's build what's right for this, these two partners to exchange at scale. 

[00:31:42] Omar Mousa: If you were to wave a magic wand, you know, given all of this, and I mean, it's pretty negative experience for some folks.

[00:31:51] Omar Mousa: Like what would you change about, I guess, the networks or yeah. I 

[00:31:58] Brendan Keeler: have a path for payers to participate. I'd have a path for patients to access their data with. With identity proofing, right? Because the big problem, no one says patients shouldn't be able to access their data views via these networks. But if I say to you, Hey, I'm, if I don't identity proof you, I can sign up as little Wayne and pull little Wayne's information.

[00:32:19] Brendan Keeler: You're like, ah, that's not good. And that's what like DTC, you know, direct patient access looks like without strong identity proofing. And so that needs to be deployed and put out into the wild use cases for pharma for clinical trials for public health public health Can't really use these channels and pathways.

[00:32:37] Brendan Keeler: And so Yeah, just like getting that defined so that people can use it and so that any abuse that does happen There's no there's no argument because you can say you should have gone this way on the thing that we made for you versus You know, you had no other option, but that's the desperation angle. I think it makes people go.

[00:32:58] Brendan Keeler: Oh, well, they had no, no other options. Like, okay, that should be motivation for us to figure it out. Not for us to, you know, facilitate data privacy violations. And I'm not saying particle did that. I'm just saying as a whole, the network incentivizes it right now. 

[00:33:16] Angela Suthrave: We want to pick your brain a little bit more about electronic medical records.

[00:33:21] Angela Suthrave: If your organization told you tomorrow, hey, we want you to go source an EMR, what would you tell them? 

[00:33:28] Brendan Keeler: I'd say, Andrew. I'm really surprised that flexible is pivoting to providing care. But, uh, no, I'd say I can totally do that. I can get the job done, but I need to know a ton more for this decision because this is a build by HR is a build by and there's no 1 right answer for a provider organization, or even if you subset to tech enabled care, virtual care.

[00:33:53] Brendan Keeler: Because within just digital health provider organizations, you have such a drastic variety you have. What is the care delivery modality? Is it virtual? Is it hybrid? Is it in person? What's the geography? Is it 1 state? Is it many? What's the go to market motion? Is it direct to consumer? Is it in network? Is it payer sales?

[00:34:14] Brendan Keeler: Employer sales? Is it a value based care contract? What's the patient population, the pediatric is a medic medicare Medicaid specialty and most importantly, technical talent. So, tech enabled companies, tech enabled digital health companies. Are not a monolithic, uh, cohort, they are a sliding scale. 'cause I, I advise some of 'em and some of them are like, we're building everything.

[00:34:41] Brendan Keeler: We might as well be Facebook like we're, you know, full tech, team tech, tech tech. And some are like, we got the IT guy in the back and like we got, we just raised $50 million. 'cause our care model's really cool. Cool. It's like, holy shit. How, how is this the same cohort? It's not. And so if you think about that spectrum, it's impossible to say like, oh yeah, one EHR.

[00:35:03] Brendan Keeler: Is the answer, it's certainly not some care orgs are just like notes E prescribing and DTC billing. Not going to name names, but like, you know, like they exist. They're like, well, ends in Rome and stuff like that. Some are brick and mortar value based care. And so there's plenty that I like, right? Like, if I'm thinking, let me buy something.

[00:35:27] Brendan Keeler: I want to be able to build on top of it. Healthy canvas elation, even Athena health. Those all can be great, or they can be absolute disasters, depending on your unique needs, telehealth or in person. The same goes for fully headless EHRs. So you have like MedPlum. MedPlum, you're not getting a ton of UI out of the box, but you can build it.

[00:35:51] Brendan Keeler: Whatever you want better than, you know, if you're a true builder, that one's a great chassis to build on. And so if you're copy pasting your EHR decision from another care organization, you are essentially admitting that your company is copy pasted from another care organization. Do you want to admit that?

[00:36:08] Brendan Keeler: I don't think you want to admit that. So that's how I think about it. So I would go back to leadership and I'd say, here's what I know about our requirements, who we are. Tell me if I'm missing something. 

[00:36:21] Omar Mousa: Uh, that's the second quote, earlier quote, you said, APIs don't lie. And I, that's just, I I'm going to put that on my tombstone.

[00:36:31] Omar Mousa: All right, Brendan. So how do you think about systems of record versus systems of use? I actually, I hear this all the time and I don't, I don't really know a good answer, right? Like when it comes to building on top of an API enabled EMR, like who's running, who's running the show here? 

[00:36:47] Brendan Keeler: Yeah. I mean, like, okay, old school before the growth of tech enabled digital health providers, you just had your EHR.

[00:36:55] Brendan Keeler: It was the system of record and the system abuse. Bye. The pressures of, you know, being a tech enabled venture backed company mean that you're like, that patient experience is not good enough. That provider experience is not good enough, but we still want the aspects of compliance. We want all the functionalities and maybe we do want some of the user interfaces.

[00:37:18] Brendan Keeler: So having that system of records still be that EHR, it just decoupled, right? Just having the APIs to build. The really cool patient app that plugs right into it, or perhaps even your own provider screens or care management screens. You know, you have companies like oak street, they still have their system of record their core, but then they've basically rebuilt everything to be much better for their physicians and their care management team separate.

[00:37:48] Brendan Keeler: Just referencing it. And so. Again, nothing is right. I hate to not have the silver bullet for people listening to this, but certainly identifying. I am a virtual care company, or I am a tech enabled provider company. What is my differentiator? Is it that patient app? Is it a certain improvement for the provider workflow?

[00:38:11] Brendan Keeler: And then. Making sure you have the right level of API enabled EHR, a decoupled EHR, or a headless EHR, a MedPlum, like that comes down to just like, how much do you want to have the systems of use not be the defaults from some EHR and be something that you think you can do better. Some people view that as redundant, undifferentiated work.

[00:38:34] Brendan Keeler: And some people say, look how shit everything is today. We can do better. 

[00:38:39] Omar Mousa: You say that's like a non answer, but I think it's a great answer. I think you're basically saying if it's core to your business, it's core to your model. Yeah. It makes sense to, to build something to be systems of use and then have the EHR being system record.

[00:38:53] Omar Mousa: The canopy Greenway example, I think is a. Is a good 1. So, no, that's a great answer. Thanks. 

[00:39:00] Angela Suthrave: And we know that, um, flex by uses med plum that headless, um, HR that you were talking about. And so, given that flex is an open aggregator. Can you explain that strategy? 

[00:39:13] Brendan Keeler: Yeah. Yeah. I'll go on a, a brief interlude here because I just want to say it like really loudly for everyone to hear.

[00:39:20] Brendan Keeler: I love Medblum. I love it so much. Like imagine you're on that first date or you're hanging with a new friend and like everything is clicking. There's that like je feeling you just get along like that's Flexpa and Medblum. They're open source. So it's like, if I want to go fix something, the team wants to go fix something.

[00:39:38] Brendan Keeler: You just have agency. You can just go do it. They think about the same problems in the same way we do. And they have a similar tech stack. So we can go and contribute. We understand it. They ship fast. Like I'm like, oh, we're going to go here, report this issue. And then we'll have to go fix it. And then they go and they put it out the next week.

[00:39:55] Brendan Keeler: So they're awesome. And the other thing about MedBlum is it's not just an EHR it's under the hood is like a fire server. And so we don't use any of the EHR capabilities. We just use the fire server. Cause it's, I think best in class for that. And so. Anyway, love letter. It's a med plum. I don't know if you knew you were getting that, but it's like one of those technologies that once you use certain tools, you're like, shit, I gotta go hype that.

[00:40:21] Brendan Keeler: And then, yeah, they're awesome. 

[00:40:23] Angela Suthrave: I love the love fest. I don't know that I've ever had a partnership or a vendor. Uh, relationship where I can shout it from the rooftops the way that, uh, you just did that for MedPlum. So that's incredible for you too. One day, 

[00:40:38] Brendan Keeler: Angela, you'll find that vendor. I 

[00:40:41] Angela Suthrave: will. I will continue to go on my blind 

[00:40:44] Omar Mousa: We'll be, we'll be sure to link out the MedPlum and, and shout them out in the comments or in the, in the show notes. That's incredible. Let's, let's shift gears to your experience because I think your, your work history is actually quite interesting. I don't know how intentional it was, but it seems from the outside in, it seems very intentional.

[00:41:08] Omar Mousa: And what I mean by that is. When you look at the order of operation over, like, the job sequencing, it was Epic to Redox to Zeus Health and now Flexpa. So you've kind of gone from electronic health record to two on ramp companies and then on to this open aggregator, but, like, all touching various different problems, but still, you know, Very core technology stuff.

[00:41:32] Omar Mousa: I mean, Brennan, like, tell us, like, was that you just mastermind genius behind that? Like how intentional was that? Was this part of your plan on becoming an authority in interoperability and how do you follow your footsteps? 

[00:41:45] Brendan Keeler: Oh, yeah, you know, I got out of college. I was like interoperability and healthcare.

[00:41:48] Brendan Keeler: Let me go find all the company. Now I was, it's completely unintentional. And like, that's been most of my career. I was on the track to be in the Air Force. I did ROTC didn't work out. That's a conversation for in person, maybe some beers or something. And then I desperately needed a job. I did not want to go home to parents basement.

[00:42:09] Brendan Keeler: So I was about to go to Accenture. I don't know what Accenture Brendan would have been like, and instead of friend was like, Hey, why don't you come up to Madison and work at Epic? And so complete happenstance transformative for my life, my career. I'm married to someone I met at Epic. Like there's all these things that you can derive from it.

[00:42:28] Brendan Keeler: And similarly coming back from Epic and the Netherlands, I moved to San Francisco. I'm like. I need to get a job. I need to get outside the epic bubble. I want to be in person cause I'm in the SF. Like, and then I had applied to all these different startups and it was either a clinical trial startup called go Balto, which was in person.

[00:42:47] Brendan Keeler: It was an SF or Redux, which was remote, but it was, you know, some ex epic people still healthcare. And I was kind of leaning go Balto and they just completely ghosted me and I needed to respond to Redux. And so I said, yeah, let's try this remote thing, which now feels prescient or at least feels like I was out of the curve.

[00:43:05] Brendan Keeler: And then I'm super psyched. I did. Redux was awesome. Go Balto was acquired by Oracle like a week after I started. So I would have been working at Oracle, which is not, I don't know about you guys, like not my dream job and all this to say like complete unintentional route. How do you become. An expert in interoperability, I think was another question you asked, but I think that, yeah, like these, these companies I've worked with, like Epic, they get, they get a lot of hate this week, especially, but they do put the most data onto nationwide networks.

[00:43:42] Brendan Keeler: They have the most FHIR APIs, they have the most inputs and outputs and interfaces of anyone. So while working there. Seeing the litany of, you know, the full spectrum of integration and interoperability sub problems in about as semi solved form as possible gave me like a picture of what's the ceiling?

[00:44:03] Brendan Keeler: What's possible today? If it's being if it's possible or semi possible, some aspect that customers probably looking at or trying to do it. And so that was good. Like, broad. And then Redux, Zeus, and Flexpa were like, dive into sub problems, dive into app integration at Redux, so how does an app connect to a health system, dive into health information networks at Zeus, dive into patient authorized access for Flexpa.

[00:44:28] Brendan Keeler: And so, got deeper, but it's just because it's less like, oh, I was tactically like, I need to work there. It's just, it fit the phase of life. I was. I went to Flexbus, so I could be more remote, so I could, you know, be with my, my kid more and things like that. And so, yeah, I think, like, there's tons of other interoperability domains that I sort of, like, know cursorily that I just know from curiosity, right?

[00:44:53] Brendan Keeler: Like, do you identify data, like the data vans and health areas of the world or prior authorization? I think like the only way to find out, out about those things is curiosity. And curiosity is the main driver for expertise. You know, you can lock into what company you work at or what product you build, but curiosity is something you control.

[00:45:13] Brendan Keeler: And so that to me is how you build expertise in any domain, is just wanting to know an ending, wanting to know more about it. 

[00:45:23] Angela Suthrave: And I think having that growth mindset where you're open to the idea that there are a lot of things that you still need to learn. 

[00:45:33] Brendan Keeler: Totally. I think being curious, being open to opportunities.

[00:45:36] Brendan Keeler: Defaulting to saying, yes, like all these mantras, like, I'm strongly for it because you will never know everything about a subject. And so I start, like, conversation, like, this is what I think, how you'd solve this integration problem or interoperability problem, but I actually don't know. Maybe maybe the price changed.

[00:45:56] Brendan Keeler: Maybe there's a new capability. And so. The curiosity, even for things, you know, like, the back of your hand. He still needs to be there. And so I think I recommend to, like, young PMs, the young people, like, who are trying to get into the thing. I'm like, just be curious and then write it down. If you write it down, it's the best way to solidify the curiosity you've had to distill it down from.

[00:46:20] Brendan Keeler: Like, the jumble of thoughts into a reality, and I think that forcing function creates the hard learnings that stick around. I think people get scared that people are easily curious, but. When I say get, do the writing piece to like, oh shit, like. I make a judge, there's activation energy, there's perceived opportunity costs.

[00:46:41] Brendan Keeler: And like, most importantly, there's failure and like, you guys are doing a form of not writing, but like, content creation that shows that you get it, like, creating, thinking about it, trying to distill it into something is a product. And I think if you're a product manager. You got to be willing to to write or create because that's how you show you can learn everything to absorb it.

[00:47:03] Brendan Keeler: If you can't communicate communicated back into the world, then you're not actually showing that you're an expert or really. Maybe aren't an expert. 

[00:47:13] Angela Suthrave: Yeah, I definitely think that there's a big part of embracing that discomfort. And putting yourself out there and being open to failure or being exposed to people's judgment when you are, you know, creating content or, you know, writing.

[00:47:31] Angela Suthrave: So I think that is a big part of growth is that where you're uncomfortable and you have to stretch yourself. 

[00:47:39] Brendan Keeler: There's no failure, right? Like, it's like, it's like if you just are creating something and you've done it for yourself and you've like distilled the thoughts down. You're better off, right? And so the effort of doing, I think is, is in and of itself, the action alone is worth it.

[00:47:57] Brendan Keeler: And you only get better by doing it. Like my, the 1st articles I ever wrote were just absolute dog shit. And like, if I go back and read them, I'm embarrassed, but that's okay. Like I got better and I developed. My thoughts, my way of constructing interoperability in this segmentation of things, just by trying to put it down, pen to paper.

[00:48:15] Angela Suthrave: And I remember when we were talking and we'll, we'll get into more of the health API guy here in a second. You were saying a lot of this, you were doing and gathering knowledge internally. And then when you write. Then you're sort of putting out into the universe externally. And I really liked how you frame that.

[00:48:35] Brendan Keeler: Yeah. I mean, there's a confident as you first write for yourself and write for your team and that you're going to have to do that to be a PM, right? Like you're going to have to write things down, might be in Europe, but like eventually then you're doing PRDs, but then write, write everything, write longer documents, write longer form and write for the company and then write for the world.

[00:48:54] Brendan Keeler: Like you can build up that confidence. And like, that's actually. Exactly how I did it. That's exactly how I was writing for redox internally. And I was like, oh, let me go right for the marketing website. Let me go right on this this thing. I own, so I can be a little more on caged. And so, like, I don't know, like, get the uncaged level of writing.

[00:49:13] Brendan Keeler: And then if you're if you're on hinge. Uh, maybe tone it down, but on cage, that's good. 

[00:49:18] Angela Suthrave: I like that distinction. That's good. We also talked about you having a contrarian view of your career path. And so can you tell us about that view? 

[00:49:29] Brendan Keeler: Yeah. I mean, I don't know how much of a hot take it is, but I think like, Rigid career planning and goals can work, but it's fundamentally anti fragile and you actually leave a lot of meat on the bone.

[00:49:41] Brendan Keeler: And so like, people be like, Oh no, exactly. Go ahead at what you want and like plan it out. And I think, I don't know. It just feels like if things don't go your way, you, you, you feel like a failure. If you, if you, if life presents something that's off that track, you'll say no. And so like, I actually advocate for build awesome things.

[00:50:02] Brendan Keeler: Develop expertise and surround yourself with people, both internal and external who know you build awesome things and have that expertise. And so, like, if you do that opportunities present themselves exactly when you need or hope. And you get to have this awesome career. You get to redo like a puppy in the dog park, you know, running around after the cool thing.

[00:50:26] Brendan Keeler: And I don't know, like, I think that you should know what you want, right? Like you should know. I want, I want, if I want something to be able to prioritize that, at least in the short to medium term, but the really structured, like this is where I'm going and how I get to be CTO or something, there's just an antifragility to it that can lead to misses.

[00:50:47] Omar Mousa: Speaking of getting that awesome career, let's talk about, like, interviewing for your product job, right? Or not for your specifically, but just in general, like, what tips would you have for someone who's interviewing today for product? Could you share your approach for confirming that? Your vision for the product management role aligns with the expectations of the hiring company.

[00:51:11] Brendan Keeler: Yeah, yeah, I mean, I think that what's really important and it's really, really hard, especially if you're a junior or you're really in love with the company is to be brutally honest with yourself and the perspective employer. About the things you want, and it gets back to, like, just a 2nd ago, it's like, I don't think the multistage plan over 10 years necessarily, but you definitely need to know the things that you want out of a new role.

[00:51:36] Brendan Keeler: And so you should not assume that a different role materialize where the benefits will change or that you'll figure out something that that doesn't seem like there's alignment on. There's lack of clarity on. Like, my experience is it's a coin flip. Sometimes you get it. Sometimes you don't. And until you do, you're less effective.

[00:51:53] Brendan Keeler: You're less happy. You can even get resentful of your job. So, I think by being super crisp and saying, these are things are important to me. 1, you're expressing this confidence. That's really refreshing to a hiring manager. It's really refreshing to somebody. When they say, oh, you know, like, I think it's really important that what's your paternity leave?

[00:52:15] Brendan Keeler: And they say, okay, we don't really have good paternity leave. Well, there's not gonna be, there's not be as much conflict or problems there. There's a variety of things. It's not just benefits. It could be just about the role, right? You're like, oh, I think I'll get into product management after a bit in this role.

[00:52:31] Brendan Keeler: You probably want an explicit promise or you want something to say, yeah, this is going to really happen. And so, yeah, I think when people come to me and I'm hiring and they show that confidence to say what they want and it maps to what we have or what we could offer, I'm like, okay, cool. Like, that's really awesome that this person is willing to say that rather than just make up what's going to make them happy or make up what's going to make them successful here.

[00:52:57] Brendan Keeler: I can do that. I can do that for them if they come on. And so that's my, that's my main advice to people is just think a little bit about that. Be don't be afraid to say it because it's better to say it and just not have the role that you thought was awesome because the company is awesome. You know, if that works out, then you'll, and you're unhappy.

[00:53:18] Brendan Keeler: Who cares? You've deceived yourself and you've deceived the employer. 

[00:53:22] Omar Mousa: Is there a crispy thing you've told a previous employer before taking the job? 

[00:53:28] Brendan Keeler: So like, I mean, I was very upfront about paternity with flexpa and that was great. And that, that led to alignment and success. I was not so clear about time zones and like working across time zones and expectations there, how remote something was, I think that's something that's very fuzzy these days.

[00:53:48] Brendan Keeler: In terms of, is it really remote? Is everyone remote? Do they schedule meetings that are remote? Do they bias towards async? Do they communicate well async? Like, that's something that now, as I, if I ever think about roles again, or if I'm communicating Flexpa to somebody, I make sure we're aligned there.

[00:54:06] Brendan Keeler: Because, There's a remote where it's like, you're in an office or 50 percent is in the office. And then you're the one guy on the, you know, the, the speaker phone and then you can't hear anything. You're up at 6am. You certainly want to assess that sort of thing out. And so, yeah, that's been me before, but luckily I was young and didn't have a kid.

[00:54:27] Angela Suthrave: And you sort of talk about these different product management archetypes, right? Do you have to be the politician, the sales engineer, the Jira jockey? I really liked how you talked about that. Could you. Can you explain that to us? 

[00:54:41] Brendan Keeler: Yeah. So back to the RPG. Okay. So you have these different shapes. Yeah. You have these different PM shapes and like, there's no one ideal PM.

[00:54:54] Brendan Keeler: Instead you have different, you know, different backgrounds and skill sets. So I came from sales and customer facing roles. Cool. Like I know how to talk to customers. That's a, that's a skill tree. That's a, that's a differentiator. And you can take that for a long way. You have deep user empathy. Technical roles can understand data and product deeply.

[00:55:16] Brendan Keeler: Strategic minds can, you know, the MBAs can understand like the market conditions, the competitions to make really good bets. And so I think that as like, those are the three legs of the PM stool and those are the skill trees general, and there's like subsets. And if you're able to, you know, match your skillset, those skill sets with the needs of the PM role that you're applying to or you're at, you're gonna be happy.

[00:55:45] Brendan Keeler: But if you're hired, and you're thinking, I'm this MBA, I'm a strategic mind, and sort of like a jeer jockey type of role, an unempowered PM, who is just given something to go and, you know, translate to the, to the engineering team. Oh, boy, like that's not going to be fun. And so a real important part of getting hot, like when hiring is understanding, what are they looking for?

[00:56:10] Brendan Keeler: Is it the right fit? And so I think a good question to ask is just who are you, who might be working with most closely? Did they mention engineers? Is it other PMs? Is it customers? Is it strategy? Is it executives? And if they say, oh yes, like everyone, you work with everyone. Sure. That's true. But like push harder because there's, it's not satisfactory or honest.

[00:56:31] Brendan Keeler: There's somebody. There's someone you can tease out. Do they view you as a jiro jockey? Are you going to be working exclusively with the engineers? Do they say, oh, yeah, customers and sales. Okay, sweet. Like, you're forward facing. You're, you're. Getting the tighter iteration loop. And so for me personally, I don't think I would take a product job if they don't mention customer and sales interaction.

[00:56:54] Brendan Keeler: Like I thrive on that. Like that's really important to me. It's really, really important to me that the products that I'm involved with, that I understand those needs and have customer empathy. But, like, many backgrounds, many skill sets, many also desires. And so there's different ways to use that question of, like, who you'd work with to figure out, you know, is the role aligned?

[00:57:16] Brendan Keeler: Is it the politician role? Is it the basically a support role? 

[00:57:20] Angela Suthrave: And Brendan, do you feel like you can push harder during the interview process later in your career where you really know what you want? Or do you find that Anyone can do it. Even someone who's more entry level or an independent contributor can, can do that.

[00:57:39] Angela Suthrave: Or do you feel like earlier in your career you should make concessions so that you can really learn from a certain environment? You know, such as an epic and understand what's good and and then move to more of an ideal type of fit. 

[00:57:55] Brendan Keeler: You certainly can. Right? Like, if you don't, you have no idea what you want, then you don't, then you, you can just go for it.

[00:58:01] Brendan Keeler: Like, the only thing you want is a role. Great. But like, there's a lot of people that if you tease it apart, they actually do have things they want out of the product world. They have things they want out of this junior role. And so that's why, like, it has to be looking hard at thyself and and coming to grips with this because it's not even if you're junior, you probably want something.

[00:58:23] Brendan Keeler: And maybe it is just maybe it is just a role. But actually, like, like, I mentioned the last question, if someone just wants a role, okay, well, do they really want, like, they really want flexible. They really want the role we have, or are we just a job? 

[00:58:37] Omar Mousa: So like, 

[00:58:38] Brendan Keeler: it's actually the more opinionated you are, the more it's like, okay, you actually match what we found really good match.

[00:58:46] Brendan Keeler: And it's really, it's like, hiring is like dating, right? Like you're in it, you're, you're putting a ring on, you're getting married when, as soon as you would get that contract. And so, Not that there's a contract when you're married. That's weird. But like, you know what I mean? Like, it's, it's, there's a semi permanence to it.

[00:59:00] Brendan Keeler: It's really, it's really, you're spending a lot of time onboarding to, to let someone go is really hard. So finding right fit, finding alignment by not just matching on, Oh yeah, like I need a position. But being like, oh yeah, this company is exactly what I want. This role is exactly like what I want, uh, is differentiating.

[00:59:19] Brendan Keeler: And so for flexible, when we've hired some people really, really want to work at Flexbo and really, really want to work at a role, you know, as the most recently we hired for an engineer. Well, that engineer is customer pricing and engineers is on sales calls. That engineer understands HubSpot. And like, okay, like that, the person we hired Kyle highly aligned with that once that has sought that out before.

[00:59:43] Brendan Keeler: Sweet. Like that. I feel strong confidence in that higher in a way that I wouldn't if just someone wanted to roll. 

[00:59:48] Omar Mousa: You incorporate a ton of fun, I'd say into or a sense of humor into the seemingly dry topic at times. Right? Like, Interoperability or like, yeah, I think I've seen more than 1 game of thrones meme or reference in your content and it also seems like flex is very supportive of your writing endeavors.

[01:00:12] Omar Mousa: And I'm wondering, like, how you've brought that kind of sense of humor or that. I don't know what to call it. I guess that passion for cultivating fun into or a positive work culture into your, into your organization has, how has that worked for your, your, the, the product organization or even the tech tech organization?

[01:00:32] Brendan Keeler: Yeah, I mean, communication is hard. People do not listen. People do not read. And say this again for people that weren't listening or reading, but like, people don't listen. Communication is hard. And so humor is a hook. Humor is a hook to have people stay engaged. Humor is a hook for people to read through the whole article.

[01:00:57] Brendan Keeler: Humor is just something to bind people to whatever you're trying to convey. And it's hard because you want to be when you're doing something that's educational, you're doing something that's technical humor can be distracting. And so like, there's that balance, but ultimately it's the trade offs are worth it because adding humor, adding clear language makes you simplify it makes you try and make it a little less dense.

[01:01:23] Brendan Keeler: And so my experience has been articles that are funny. People listen to or at least pretend to articles that are not people don't read and at least the numbers on like, subset show that. And so humor also is something that chat include Claude. I don't know. They don't do well yet. So it's like a good mode against our overlords.

[01:01:46] Brendan Keeler: So if you're ever, if you're like, okay, I don't want my job to be taken. Oh, you were 

[01:01:53] Omar Mousa: to go get a degree in comedy and then come to health care. 

[01:01:59] Brendan Keeler: I'm actually not that funny. Memes are pretty easy. You just got to keep working on them. 

[01:02:03] Angela Suthrave: Omar, you and I are going to do improv next.

[01:02:08] Omar Mousa: I don't know. Maybe 

[01:02:12] Angela Suthrave: I will be embarrassed to admit this, but I have Googled many, many times. How to be funny. So I'm, I'm just going to admit that. 

[01:02:20] Brendan Keeler: Are you, are you an AI Omar? Are we sure that Angela isn't an AI? 

[01:02:26] Omar Mousa: I've seen her in person, but, but sometimes I'm always questioning. It's hyper 

[01:02:31] Angela Suthrave: realistic. All right.

[01:02:32] Angela Suthrave: We've talked a lot about writing. And so you are the health API guy. It's incredible. Can you tell us about why you started that? How you started that in that journey? 

[01:02:43] Brendan Keeler: Sure. Yeah. I mean, it's the journey I sort of like briefly went through earlier. Like it's I know some things I worked at Epic, so I knew a lot and I went to Redux and I said, shit, I want Redux to know these things.

[01:02:55] Brendan Keeler: So I started to write things on the internal blog and the marketing team came to me and said, Hey, this one was really good. Can we reformat it and send it externally? They're like, it could be a good content piece. I'm like, sure. I've never done that before, but let's do it. And so we did that. It got some nice, you know, some nice views.

[01:03:15] Brendan Keeler: I've got some nice feedback from people in the HL7 community and customers. I was like, ah, that's cool. Like, let me do more of it. And so I started to do that a little bit faster and the internal review process is marketing has a lot of things they needed to do. And so it was backed up and I went to the CEO and I said, Hey, can I go write this on this new thing, sub stack?

[01:03:37] Brendan Keeler: And I'll just point to Redux because it's kind of, kind of nice and impartial. It's like, Oh, here's somebody right about it. And like when, rather than be like hype, hype, hype, my company, it's point to it when it makes sense. So yeah, that's like that led to it. And then. Continue to do it continue to write things that I was saying repeatedly.

[01:03:56] Brendan Keeler: Like, ultimately, I don't write all that often. I'm not committed to a particular cadence. I'm not like doing a weekly newsletter biweekly. I write the things that people ask me about a lot. And so I have notes about them. I have tweets about them. A lot of content. I built elsewhere and sort of package it up and I put up as an article at some funny memes or at least memes that tend to be funny and I ship it, you know, like a PM ships based on customer and I'm shipping based on what people are asking about.

[01:04:25] Brendan Keeler: And so I find that it unlocks better conversations. If I can say, hey, like, in advance of this, go read about integration or go read about. You know, interoperability suddenly, we can just go directly into, like, okay, you're a DME orders startup medical device startup. Sorry acronym. And, like, we can just talk about, like, solving for that versus how does integration work?

[01:04:49] Brendan Keeler: Or what are the technologies or. Whatever. And so laziness, laziness is a key thing to think about when you're writing. 

[01:04:59] Omar Mousa: What you mentioned, you write about the things that people tend to ask you a lot. What are the top three things that people ask you? 

[01:05:08] Brendan Keeler: The HR selection. So like where healthy guy guy went from like, Oh, like a few people reading it to like 15, 000 people read it overnight or whatever is B to B E H to BHR or not to BHR.

[01:05:21] Brendan Keeler: Like Shakespearean. EHR selection. It's older, but it still has the most views by a long shot. It's still, we talked about it earlier, still relevant. There's been other good resources like Elion that have added on to it. Canvas has a good post about it. And it's sort of like put the headless EHR concept that probably someone else had said something like that before, but I get a lot of references as like having come up with that.

[01:05:46] Brendan Keeler: How to win friends and integrate systems. Because. It's like the core thing of, like, I need to integrate to an HR. How do I think about that? Super common problem. So that people reference that, or I send it to people in advance of a conversation quite a bit. And then API Bible, so frustration with Stripe for X, Plaid for Y, hated the metaphor, want to prove them wrong, but actually, like, I think it's the one I'm most proud of.

[01:06:13] Brendan Keeler: I got to look at all these parallel industries, like what's going on in FinTech, what's going on in marketing tech, what's going on in EdTech, and that, you know, like that, that side quest or whatever, you open up a lot of like, What could be done in healthcare when you do that sort of thing? 

[01:06:32] Omar Mousa: I think it's also when you read the API Bible and, you know, I hear that expression a lot, right?

[01:06:38] Omar Mousa: The, the plaid of of X or the stripe of Y. those are 2 very impressive companies. And you make those comparisons and even put flex button show that. You know, flex is doing similar similar things there and I, and. I think it's a very good plug for Flexpa and also just indicative of how great Flexpa is.

[01:07:00] Brendan Keeler: Well, I mean, like there's like the, how the API functions is distinct from like quality of company. Flexpa is great. Are we stripe level yet? I don't know that, but like, I think from an execution standpoint, we're really slim and we put out a lot of products and I think that's really cool. That's distinct from just like, If somebody says like, I'm Stripe for X and they're not really an API or whatever, it's just hype to get VCs interested.

[01:07:30] Brendan Keeler: And like, I just hate that. I don't know. Everyone should hate like fake hype based on just like cargo culting off of another company. 

[01:07:39] Omar Mousa: Like a vertical platform with an API, basically. Yeah, totally. Okay. Yeah. I get you. 

[01:07:44] Angela Suthrave: You are a, you know, this prominent writer. You have a lot of people that read your writing and you are an advisor to a lot of companies, including startups.

[01:07:55] Angela Suthrave: Do you think that those 2 things are related? And you know, what advice would you give to product folks who are looking to be advisors or startups? 

[01:08:04] Brendan Keeler: Yeah. I think the challenge here is that like advising mostly comes by virtue of not thinking about it or pursuing it too much. You know, like you're like not thinking about it.

[01:08:13] Brendan Keeler: And then all of a sudden it's like, Oh, someone's like, Hey, what if you like advising? I'm like, is that consulting? What is it? What is the advising? And so, yeah, it came from writing. Somebody was like, I like what you wrote doing the advisor. Here's some equity. Can we meet every so often. And then since then, I've seen I took I took on a lot earlier in my.

[01:08:32] Brendan Keeler: Career, because I, again, had no child, I now have a one year old, which is its own sort of advising time sink, but constant advice, she doesn't listen. I don't get it, but you know, like, and I just found that there's actually a wide spectrum of advising and some are like, every so often they ask a question or an intro, some you're like pounding the pavement, helping them fundraise, some you're doing their product management until they can hire a PM.

[01:08:58] Brendan Keeler: And so. It's not really all that fun all the time. It's not all that glorious all the time. It's not certainly like, not a money making endeavor, unless equity pays out, or you somehow get a good compensation structure. But if you're interested in it, I think it's a great mechanism to have that curiosity, have that learning and sate it.

[01:09:20] Brendan Keeler: You get to see different organizational structures. You get to see different kind of team compositions, different tools, and like certainly different problems. And so I've never worked at a virtual care company, but I advise one Rivero and I get to see the full, like how the bed is, the bread is baked.

[01:09:36] Brendan Keeler: That's really cool. And so I think that's the biggest reason to go after and do advising. And I think the way that you tracked it, you can be really targeted. You can go and say like, Hey, I'm an expert in this. Do you need an advisor? You're gonna have a lot of misses before you get a hit, but I have friends who have done that path.

[01:09:55] Brendan Keeler: I think more, it's just like what we talked about earlier. It's like project out into the world through writing, through content, through the things you've done, your expertise and startups or other companies are going to identify and say, Oh shit, that person has something that helped me solve problems that I couldn't otherwise.

[01:10:14] Brendan Keeler: And if you have specialized experience, it certainly helps, right? Like if you're just a product manager, there's a lot of product management managers out there. If you're interoperability or EHR selection or digital health market or you know, have grown a team to be a huge team, like there's tons of ways to specialize and then to say to the world, like, here's an article on growing a huge product team and managing huge product team.

[01:10:38] Brendan Keeler: Or you're whatever problems that these companies are trying to solve. And once they find them, they'll come to you and say, you're an expert in this. Help us. Help us be successful. And so, yeah, for me, that's interoperability that's EHR selection, product management, you know, more generally is something I've definitely helped with and just like digital health marketplace awareness, but the specialty can be anything.

[01:11:04] Brendan Keeler: It's just making sure people know. Then you actually know that because if you've always focused internally and then no one will know except for your colleagues. 

[01:11:13] Omar Mousa: Brendan, you've done so much already, but what's next for the healthcare API guy? 

[01:11:17] Brendan Keeler: I got to get some of the work in progress, like out the door. I like.

[01:11:22] Brendan Keeler: So many articles, I have an article on change, I have an article on like, what it really is a certified EHR, on HIEs, on Epic, and some other ones that are like, more nascent. And so, focus, I need to focus in and get them out. I think it's tough because 1, I write really long articles, my editors keep saying like, 10, 000, no one reads all that just chopping it in half.

[01:11:46] Brendan Keeler: And I refuse to do it. I like the whole piece, right? Like that's my, it's my, my monument. And I might be wrong, but it's just my health die on. And also just like insights and inspiration. You can manufacture them, but they're better if they are built when they come to you. And so, yeah, I like to put the articles out when they're ready, but that's, what's next is just to keep putting out the things that People are interested in and I know about

[01:12:17] Angela Suthrave: all right. We have arrived at our very exciting concept. Closing call. And so Brendan would love to ask you, are there any frameworks or methods or processes that you found to be especially helpful that you would like to share with us? 

[01:12:33] Brendan Keeler: Yeah. I mean, I'm, I'm generally a less is more for frameworks and methods.

[01:12:36] Brendan Keeler: I use getting things done for like my own tactical organization. Like that's a ubiquitous book at this point. I just modify it for myself, Kano model and like for product prioritization, I'm sort of a basic bitch when it comes to, you know, product like methodologies and things like that. You guys have actually recommended things that I'm like, Oh yeah, I need to, I need to maybe do a little bit more listening to, you know, the, the Lenny's of the world and things like that.

[01:13:05] Omar Mousa: What is a tool that is highly valuable to you that you think others may not be using? 

[01:13:11] Brendan Keeler: Well, I already did my, my love letter to MedPlum. So I'm going to give some other tools. Let me just call them out. I'm calling out strongly. I think Datadog is awesome for observability. I think people don't realize it's, it replaces like, Mixpanel, Amplitude, all these other things.

[01:13:28] Brendan Keeler: And yeah, it's expensive, but like, it's cause it's awesome. And they continually make it more awesome. I think WorkOS. It's also awesome. It's a replacement for Auth0 and Okta. I don't think you should use Okta or Auth0 for logins anymore. WorkOS is fractionally cheaper and way easier. So like, I'm sorry, Okta, if you ever listened to this, but like, WorkOS is distinctly better.

[01:13:52] Brendan Keeler: Yeah, those are two like, like hype tools, like, that you should consider, save yourself some money and some headaches. 

[01:13:59] Angela Suthrave: What are some concepts in healthcare that excite you at the moment? I 

[01:14:05] Brendan Keeler: think we talked about infrastructure networks, just like all those nascent and analog networks that people are building into digital, into digital things.

[01:14:16] Brendan Keeler: I think network effects is the only real moat in technology. Everything else is fleeting is temporary, like, all the strategy minds are like, oh, we're building them. Oh, it's like, it's not network effects. It's not permanent and even network effects can go away as people flee a platform. But it's it's 1 that you like, look at Twitter.

[01:14:35] Brendan Keeler: Like, Twitter has done everything to kill themselves. And network effects have kept it alive, and so I'm obsessed with networks and network products. And I think referrals, image exchange, study, study, subject, subject, identification, open scheduling, prescription transfer. Like, there's so many networks to be built in healthcare that are really freaking hard to build.

[01:14:56] Brendan Keeler: But do you want a non disruptible permanent legacy, build a network product. 

[01:15:03] Omar Mousa: Do you think product management is science or an art? 

[01:15:06] Brendan Keeler: Art. It's definitely art. Each company is like a different canvas. Like there's different, some are gonna be sculpting, some are gonna be graffiti, some are NFT pixel art or something.

[01:15:18] Brendan Keeler: And like each product role, like we talked about, has totally different demands of the PM. So it could be that GR jockey, it could be the master politician, it could be the voice of the customer, it could be a pseudo account executive, an implementer, subject matter expert, developer, even. And so are you going to be Picasso and, like, just do the 1 art form?

[01:15:40] Brendan Keeler: You're probably staying at 1 company and really developing that skill set or you're building the ability to do a bunch of different tools. You're changing your chisel out for a mallet or a paintbrush. And so I think PMs as an artist have to be. Willing to, there's no science to it. It's not this methodical, here's the equation.

[01:16:01] Brendan Keeler: It's building competency with the right tools to build something beautiful. 

[01:16:07] Angela Suthrave: And lastly, where can people get in touch with you if they want to reach out and do you have any other shameless plugs? 

[01:16:16] Brendan Keeler: Done some pretty shameless plugs and like, and, and love letters, but, but flexa.com, flexa.substack.com. Please sign up there 'cause I sometimes publish over there.

[01:16:26] Brendan Keeler: My colleagues publish over there. And it's also good content health. API guy substack.com for aforementioned content you can come to Twitter for. Unrepentant, slightly more unhinged, maybe not uncaged. And you can go to LinkedIn for more like uncaged content. And so you call me, beat me if you want to reach me, Kim possible.

[01:16:50] Brendan Keeler: That's right. 

[01:16:53] Omar Mousa: I've I've been loving these references, Brendan, that wraps up basically all that we've, we've wanted to chat. This has been a blast of a conversation, Angela. I greatly enjoyed it. Thank you for coming on to the show. Yeah. Thanks for having me. This was fun.

[01:17:12] Omar Mousa: Hey, thanks so much for listening to the show. If you liked this episode, don't forget to leave us a rating and a review on your podcast app of choice, and make sure to click the follow button. So you never miss a new episode. This episode was produced and edited by Marvin Yue with research help from Aditi Atreya or Angela and Omar, and you've been listening to concept to care.

 

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