Episode 15: Asking for What You Want – How Dot Health is Changing the Way we Look at Health Data

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For Huda Idrees, Founder and CEO of Dot Health, leveraging innovative health tech solutions means creating a better patient experience

In a special live studio recording, staff at HIROC had the opportunity to hear from Huda Idrees, founder and CEO of Dot Health.

With host Philip De Souza, Huda talks about how the burgeoning startup is leveraging partnerships in tech, healthcare and government to change the way we view patient data.

Huda offers advice for healthcare leaders on improving the sustainability and efficiency of healthcare organizations.

Transcript

Imagine you could step inside the minds of Canada's healthcare leaders, glimpse their greatest fears, strongest drivers, and what makes them tick. Welcome to Healthcare Change Makers. A podcast where we talk to those leaders about the joys and challenges of driving change in our complex and demanding healthcare organizations.

Philip De Souza: Hi, I'm Philip De Souza, Director of Communications and Marketing at HIROC. Today we have the fortune of hosting a special recording of Healthcare Change Makers. Today's interview is being held in a live studio with staff from HIROC. As part of HIROC's continuous pursuit of learning, we make it a point to expose our staff to unique conversations revolving around healthcare. Whether it's what's trending in insurance, risk or patient safety, or getting some one-on-one time with healthcare change makers. And today we're sitting down with Huda Idrees, founder and CEO of Dot Health.

Huda has been making waves in the healthcare sector lately. Her career spans working at companies like Wattpad, Wave, and Wealthsimple. Let's get right to it.

For those of you who may not know Dot Health, can you tell us a bit about the company, Huda?

Huda Idrees: Sure. Dot Health is Canadian based and we build a real time health data platform. We help all Canadians get access to their own health information. This could be everything from doctor's notes, to lab results, to medical imaging.

Philip De Souza: And where did the idea come for Dot Health?

Huda Idrees: I mean, if you think about the core concept of it, it should have existed like 30 years ago. It's not a new concept, but it's definitely a new take on an old concept. And it came about just like all good problems or companies start, came about because we were trying to solve it for one person. And this one patient was going through an unfortunate oncology diagnosis, and was having a really difficult time just managing their own care. And honestly it shouldn't be that hard for anybody to take care of themselves. And yeah, Dot Health was born that way.

Philip De Souza:  Wow. Amazing. What is the biggest challenge for healthcare organizations when it comes to empowering patients and driving innovative change in your opinion?

Huda Idrees: It really depends on the industry or the geography that you're trying to make change in. When it comes to Canada, government involvement or heavy government involvement is both a blessing and a curse. Of course it's a blessing in terms of, we do have a publicly funded healthcare system for the most part. But it also means that a lot of change is really slow because government is involved. And so it depends on who the biggest stakeholders are. In the U.S. for example, which is a very different healthcare system than ours in Canada, there are very different problems. You have to deal with the HMOs and the different sort of monopolies in different states over there. We have to deal with governments shifting or not shifting on their own pace.

Philip De Souza: And do you and your team at Dot Health work at all with government?

Huda Idrees: Yeah, we do actually. And that's good question because when we started, we didn't think it was possible. But Dot is just over two years old now. We turned two in March this year, and we've spent time now advising both provincial and federal levels of government. We've had massive influence actually for a very small and kind of young company. We've had quite an influence on policies. There's some policies that are upcoming in the province, that we've had a large part in that shaping, which we're really proud of and really excited about.

And on the federal level, even though Canadian federal government doesn't actually have as much of an impact as I wished it would on healthcare, we've still had... We spent about the last two years really, so the entire time we've been around, advising the federal government on how they should look at both health policy with the provinces, but also areas that they should fund or not fund.

And that's been really interesting, at times infuriating, but really, really exciting that we're able to have a seat at the table, given where a young organization.

Philip De Souza: Yeah. It's very difficult to have a seat at the table. What can you attribute to that? How did you get a seat?

Huda Idrees: We're kind of like the squeaky wheel. We talk and insert ourselves in a lot of conversations. The press is really kind to us. As an organization, as a tech company, we actually spend very little money on things like marketing today. And most of our clients and most of our end users actually come from press or referrals. That's where I think press has been really, really, really great for us. And the Globe had the exclusive on us when we announced, and we've had a ton of coverage sort of across the country.

We've done very concentrated launches in specific communities that are really close-knit compared to Toronto. One of our first areas of rollout was London, Ontario. And it's just been really helpful from there, building lots of relationships with people on the ground, and that eventually sort of bubbles up to having seats at tables because people recognize your importance in the community.

Philip De Souza: And so true actually in healthcare, I think that regional component is so, so critical. Why London? How come you started up in London, Ontario?

Huda Idrees: A lot of you probably already know this, I mean, London has been kind of the hot test bed for lots of companies. Because it's a really... It's about 500,000 people. It's very neatly split between the different demographics. And if you can roll something out successfully in London, chances are you can do it in the rest of Canada. It's a very representative group.

Companies like IKEA or Tim Horton's will actually do a lot of their launches in London, Ontario first and then take it elsewhere. We took a little bit of guidance from them and rolled our service out there. It was late last year, when we did a very concentrated launch. And we're now available across Canada. Quebec is coming up next year, which will be exciting. But yeah, we're available across Canada.

Philip De Souza: Wow, that's amazing. Some folks believe data collection of any kind is risky, while others believe data can help identify solutions to everyday problems. What's your view? I guess I kind of know, but let's hear your view.

Huda Idrees: What gave it away? There's different ways, again, good and evil ways of using the same type of technology. And I think it depends on what you use it for. When it comes to data collection and a big stance that Dot Health takes is putting the patient in control. We're not trying to siphon information off and keep it away from the patient who eventually owns it. We actually can't do anything. The way we're set up architecturally, we can't actually do anything with the information without the patient permission.

Philip De Souza: Okay.

Huda Idrees: Our entire business model operates on an explicit patient consent model. We don't do anything with the data unless the patient authorizes us to collect it, share it, do whatever with. And I think that's important. It's important for our end users and our clients and our partners to understand how we're using this information. And it's important for the community to keep us honest and hold us accountable.

Philip De Souza: Yeah. No, that's a good point. And I guess speaking of that accountability and honesty, the people who come to you, do they have different expectations on how you secure their data?

Huda Idrees: We have the luxury of being a newer organization, so we've managed to set up a lot of our databases in a way that's microservices based rather than monolithic databases that contain everything, that are more susceptible to viruses, like WannaCry, or to hackers, et cetera. So we do have that luxury, and what we try to do is make it as easy as possible for people to understand how we're keeping their information secure. We haven't really come across anyone who says either the safeguards that we have in place are not enough, or that we should be doing more. Because we'll follow best practices as much as possible. We have third party auditing and penetration testing that makes sure that we're keeping up to the standards out there, all of the servicing, all of the services providers that we use are SOC compliant, etc.

We do try to do as much as possible, and so far so good. When new things do become available that we should be adopting, we'll try and make sure that we're keeping everybody, including our partners and end users abreast of what's happening. And almost like whittle it down to basic terms. Often in the world of technology, everyone will try to use jargon to like confuse the user. I mean there's no need to do that. I mean we're pretty straight up about how we operate and how our organization works, how we make money. We're pretty straightforward about it, so this is just another one of those things, and it's an important one.

Philip De Souza: No, and it's very... That transparency I think is what's catapulted your organization because there's that trust I feel. Who do you look to, people, organizations, who are innovating to promote safer care and enhance the patient experience? Could be here in Canada. It could be around the world, anywhere.

Huda Idrees: I think globally, lots of Scandinavian countries have really pioneered a lot of health tech infrastructure. We had a visit from Toomas Ilves, who used to be the president of Estonia, which is a nation of just 1.3 million people. But he came and chatted with the team, and I thought it was incredible how just a small organization that is basically like smaller than Toronto. And when you think about it, they actually started with whatever they had, and created something called X-Road, which is a way to exchange information between the government arms in Estonia, to deliver a purely digital experience, in that country for its citizens. And if we can do that, that's incredible. People like Toomas, I really look up to because he pioneered that country in a way that would seem really daunting for me, and it's incredible how far they've come.

There's of course lots of incredible local advocates, who have been making real change. There's lots of companies. Companies like Reacts app, that allows people to have digital consultations with their doctors. Lots of companies like that actually. Dialogue, Maple are part of it. There are other health tech organizations like Verto, who allow people, caregivers to coordinate their care. There's people like Julie Drury, who's a big patient advocate, and has been making a lot of change within the Ontario government, to then be looked at in other provinces as well.

There's people that are perhaps less known, a doctor named Cathy Faulds, also out of London, is a huge change maker and an a big thought leader in how primary care can be really helpful for people in healthcare overall, and how primary care can be used more effectively. There's of course people like Anna Foat, who's a dear friend of mine, but currently works at Sun Life actually of all places. But has a really incredible way of bringing together communities to discuss important issues. Is leading one of the Ontario health teams out of London as well.

Huda Idrees: There's lots of people making really important change and having really important conversations, and they're all an inspiration. Because it's hard and sometimes kind of a thankless job to constantly tell your story, or constantly talk about the same thing over and over again and not get anywhere. Yeah, I look up to them in a big way and when I'm frustrated sometimes, those are the Twitter feeds I'm looking at it.

Philip De Souza: And do you often hit that wall and feel that kind of frustration? Whether it's with policy or with people, or just people opening to new ideas and new ways of thinking. Do you get that a lot?

Huda Idrees: Yeah, like all the time. I am probably the most impatient person in the whole world. For me to be in healthcare is a little bit ironic because healthcare is like a hurry up and wait kind of a game. And it is, it's super frustrating. And there are days when I'll wake up and I'll say, "What am I doing? Or will we even get through a lot of what we're trying for?"

And to me, two years seems like such a long time, and to other people it's like nothing. And one of my advisors says this to me all the time because I struggle with it, and I'll call him every now and then. And one thing that he says that I think I'm just going to like tattoo on my forehead. He says, "Your ambition is supposed to outstrip your progress." I think that's kind of cool.

Philip De Souza: I like that. I like that. No, very cool. What's your background? Right.

Huda Idrees: Right, right. Yeah, I went to engineering school, so that's how I actually came to Toronto. I'm not from here. I moved to Toronto to go to U of T Engineering, which is... It was like my best time I think in Toronto. It's an incredible school and I'm like an obsessive fan girl. They're probably very tired of me now. But I had a great time there.

And I think engineering as an education is interesting because a lot of what it is, and I think they should promote that more, is they teach you how to think, which is you can't really put a price on that. It teaches you how to think about all these different sorts of problems. And it's all very methodical. It feels very like linear problem-solving. You come to something, you sort of whittle down all the problems to a basic equation, I want to say. And then you go about solving it and finding all the people that you need that have complimentary skill sets.

I come from an engineering background. I kind of fell into the startup world. I wanted to work in the automotive industry. Of all the things, I wanted to work in the automotive industry, when I was in school. But I luckily got a job at Wattpad, so I almost went to Google, and then switched gears to go to Wattpad. And my mom was like, "Oh my god, I can't even pronounce that. Like what are you doing? I could at least tell people she works at Google. People know what that is."

Wattpad at the time was not far from here actually, their offices. But it was just seven people. They now have like 80 million unique monthly users.

Philip De Souza: Wow.

Huda Idrees: It's a massive global community.

Philip De Souza: It's Canadian?

Huda Idrees: It is Canadian.

Philip De Souza: That's right.

Huda Idrees: It's actually founded by U of T Engineering grads.

Philip De Souza: That's right.

Huda Idrees: Yeah. So that's cool. And then I kind of kept going. Once you start working at a startup, it's a little bit like a disease, you can't get rid of it. You keep working at other startups or keep looking for that type of work environment, which is super fast-paced. People often throw you into the deep end and expect you to to swim, which is just the way I learn. Lots of other people don't learn that way and that's cool. But it's really good. It's like optimal condition for me.

Then I worked at a company called Wave, which recently sold to H&R Block, and then of course at Wealthsimple, which we sold to PowerCore in 2016, and then that's when I started Dot. It's been a series of very different technology startups, but I've been doing pretty much the same thing at it, which is creating product experiences for end users.

Philip De Souza: That's amazing.

Huda Idrees: It's been fun.

Philip De Souza: And you've done so much.

Huda Idrees: It's been a lot of fun. I'm super lucky.

Philip De Souza: Yeah, you are. No, but you're talented in what you do, so that's why. What's next for Dot Health? I know you-

Huda Idrees: Like world domination?

Philip De Souza: Yeah. You mentioned the international side. That conference. You talked about UK, some work there.

Huda Idrees: Yes.

Philip De Souza: Is there anything big on the horizon that you can share or that you're excited about?

Huda Idrees: Yeah, I mean we're a Canadian company and very proud to be, but we do think that this is a global problem. Dot Health, members of the team have presented kind of all over the world. We haven't done so much Asia, but we've done Australia and New Zealand. We've done the UK, the U.S., parts of Europe. And everywhere we go, the problems are the exact same problem. Everyone is looking for a way to more easily and cheaply be able to move health data around to improve patient outcomes.

Everyone's looking for the exact same thing and we think we are an important piece of a much bigger puzzle. And you see health innovation happening in all these different communities in a different way. The way we see Dot growing is really becoming that transaction layer for people moving forward. Even though we're... The most visible part of our company right now is the user facing front end. Almost 100% percent of our users actually use us on mobile apps, but that's not actually most of our work. Most of our work actually happens in the background, when we're building these partnerships with these large organizations, and helping move large sets of data around for patients. We want to be able to do that globally.

And I often give the example of Visa. When you go and you tap your Visa card at a point of sale, what's happening in a fraction of a second is basically magic. There's a bunch of transactions that are happening in a fraction of a second. It's telling the merchant that you have enough credit to be able to purchase something. That your creditor is telling the... Visa basically that you have the ability to purchase this $5 latte, or whatever it is. And it's bizarre to me that, that can't happen in healthcare, and like why not?

Philip De Souza: Yeah.

Huda Idrees: Why shouldn't we be able to move around the world, get healthcare when and as we need it, whether it's prescriptions, whether it's lab tests, whatever it is. It's an artificial thing to put a geographical boundary on it. And the way we see it is it's a global platform and a global problem, not really a Canadian one.

Philip De Souza: Yeah. Has anyone ever compared it to Blockchain at all?

Huda Idrees: Yes. Blockchain is a way to share information, yes. And it's a way to secure it, and it's a way to keep this information accountable and maintain the integrity of it, cool. But the problem in healthcare is that we don't even have an aggregate amount of data. What are you going to apply blockchain technology to? Like a single lab result? It doesn't make any sense. Plus it's very unsustainable actually to mine any type of data on the Blockchain, just because you're using a lot of energy to actually do anything with a small piece of information.

From my perspective, we need to first solve the problem of having all this health information come together, before you're going to try and apply something as complex as blockchain technology to it. But we do get that question a lot. That and all the other buzzwords, like are you in AI and ML company? And I'm like, "Just throw more acronyms at us."

Philip De Souza: Too funny. By day, you're a passionate founder and CEO of Dot Health, what else are you passionate about?

Huda Idrees: By night, I am also a passionate founder and CEO of Dot Health. It is not a 9:00 to 5:00 kind of thing. The one thing that's always been in the background and it's not a secret. I do think we need to build more equitable workspaces for people. I often find, and I've written about this at length and talk about it a lot. A lot of workspaces are not accessible to most people. And often, especially in the world of tech, there's a very specific kind of demographic that is promoted and accepted in tech, and everybody else is sort of almost pushed out. And a big part of building Dot Health was trying to build a company that I would want to work at.

I want to create more spaces like that. And I want other companies to, I mean, I don't want to say follow Dot Health's lead, but also do some of this. Also create spaces where people can feel comfortable and supported in doing their best work. That's something that I'll spend a lot of time both talking about.

And then also when it comes to accessibility, Dot Health is built on a lot of an accessible kind of platform. We want to make it easier for anyone, whether you're someone who has connections into a hospital, or you don't, or you're a newcomer, to have easy and simple access to your own information. And the same happens with workspaces and with technology as a sector. I want to see in my lifetime, tech be more equitable.

Philip De Souza: Yeah, yeah. That's very good. You said one of the best pieces of advice you've received was to learn to ask for what you want. So what do you want?

Huda Idrees: I want healthcare to be accessible and sustainable for everyone globally. And that seems like kind of like, "Oh, let's end hunger," kind of a thing to say. But I actually think this is super doable. And we need to convince the right people in the right places to do it. But at the end of it, nobody can really argue with the outcome. You can't really argue that making healthcare more sustainable is a bad thing. And that's what I want. And I think technology can leverage that. You can use sort of leverage technology in a big way to get to that outcome. And that's what I want.

It was a very tiny first step, which was me really going and asking people for exactly what I wanted, which was to create an organization that can actually make change in this space.

Philip De Souza: And when you did that, did you get like blank stares, or like you want to do this? Did you feel that at all?

Huda Idrees: Initially there was some... There was sort of, like with everybody I guess. But I'm not from healthcare, right? I'm not a doctor, I didn't spend time in healthcare before. A lot of the criticism I got was, "Oh, well you don't know. You don't know what problems are like in healthcare. Or you need to have a medical degree in order to attack this problem, et cetera."

But from the venture side, so Dot Health is venture backed. From the venture side, we had a a much easier time. Both because I'd worked in technology companies before, so investors had kind of an idea of how we were approaching it. But also from just looking at the problem and seeing how much room there was for improvement, that was kind of an easier journey than I would have expected.

Philip De Souza: Yeah. No, that's very good. If anything, what keeps you up at night?

Huda Idrees: Yeah, I really can't sleep. I don't know that it's anything in particular. I mean obviously running a business or running a company is stressful for lots of different reasons.

Philip De Souza: And how big is your team?ki;

Huda Idrees:  We're 20 people full-time.

Philip De Souza: Wow.

Huda Idrees: I know that seems bigger... Every time I say it, kind of it's okay that you asked, but sometimes when you ask me, there's a part of me that like, "Ooh." Because it's tough. It's almost like being responsible for these people's lives.

Philip De Souza: Yes. And how many did you start off with when you started?

Huda Idrees: Like two.

Philip De Souza: Wow. Okay.

Huda Idrees: Yeah, so it's been interesting.

Philip De Souza: Two to twenty in two years, that's amazing.

Huda Idrees: Yeah, it's interesting. And that definitely... Just the regular day-to-day stuff definitely keeps me up at night.

The other thing that I often think about is how... Especially because it's an election year, how people are going to vote in governments, who do or do not care about healthcare sustainability and how they view it. If they're going to view it from an institution focused lens, I think we're going to be exactly where we are right now, which is an unsustainable, constantly inflating, a dollar amount, to deliver poorer healthcare and get less value. And that's something that really bothers me. It's really terrifying to see how much people have to wait to get basic access to things like medical imaging, or to basic diagnostics in the city or even in this country.

We have clients on Dot Health who are from Nunavut, who have to travel and drive like five hours for a single doctor's appointment. And sometimes that appointment is, "Yes, you're okay, or no, you're not okay. This is what you have to do next." And that's just heartbreaking to say someone has to disrupt their entire life, just to be able to get a small piece of information. Why can't we make that more accessible? Or why can't we make that digital in some way? And we hear these stories, I mean every day. It's heartbreaking.

Philip De Souza: Yeah. No. And I guess so because you have so much passion, what advice would you give them?

Huda Idrees: I think today, in today's climate in healthcare, hospitals have a ton of power. If you are someone who's either a hospital administrator, or leaders, or someone like that, I think a lot of what you need to do is pay attention to what the patient experience looks like. I know that's not a key area of motivation given the way our funding is set up in the province. But it's something that you can actually pay attention to and drastically improve your own institution's sustainability and efficiency.

I think from a non sort of currently involved in healthcare type of person, I would say, I mean lots of people come up with different health tech companies, and they're like, "Well what about this and what about that?" And I'm like, "We need like 20,000 of those companies to actually create some kind of real change." And it's happening, and it's a little bit slow, but it is happening. And I want like 20,000 other companies just like Dot to be created because until and unless that happens, we're not actually going to move anything anyway. There's a lot of pressure the private sector can put on the public sector to make them better and more efficient. And if we keep doing that in different areas of healthcare, imagine where we could be, and how much we could pioneer the world of health tech globally.

And I sincerely believe that Canada, both our talent and our healthcare system are an important ingredient in global pioneering of healthcare.

Philip De Souza: You are absolutely right. Because I'm seeing it now and I'm exposing myself to more. That's how I met you. And at our conference this year, we had someone from WinterLight Labs, and whole bunch of other startups from JLABS come to our conference as visitors and as speakers. And just hearing the innovation that they're implementing, and how they're partnering with many of our subscribers actually already, right now, and they're implementing this in their organizations is just amazing to see.

And you're right, I think it's pushing boundaries, but it's also getting people to think differently, which is why we invited you.

Huda Idrees: No, it's important I hear you.

Philip De Souza: It's very important. Yeah, that's very cool. What's on your nightstand? What are you reading nowadays?

Huda Idrees: I read a lot of books at the same time. There's a couple, and I'll mention a couple that I'm reading. One of them... I actually recently got my Canadian citizenship.

Philip De Souza: Oh, congratulations.

Huda Idrees: Thank you. Thank you. I'm reading Building the Canadian Nation, which lots of you have probably already read, because I know it's a textbook they use in schools, by George Brown. And I'm reading that and kind of paying a lot of attention to how a lot of very important areas of our society came to be in the first place.

And then the Rise of the Chaordic Organization, which is by Dee Hock, who was one of the founders at Visa. And I almost use that like a guidebook. Dee is an incredible leader and set up that company in a way that ensured that sustainability. And a lot of what I think about is how to keep Dot Health, its structure, honest, accountable, and transparent, and sustainable in the future. It's a heavy book, but it's a good one.

Philip De Souza: Are there any questions from the audience today? Yes, Lori.

Lori Borovoy: You said that you hear patients' stories every day, how have those patients' stories influenced you, and what have been some of your biggest learnings or changes you've made because of some of the patients' stories?

Huda Idrees: Yeah, that's a great question. Specifically to people giving us feedback. I would say Dot Health really is what it is because of the feedback that we've gotten from patients or users who either tried to use our system or currently use our system.

I remember, I think this woman was like the, I don't know, the 300th user or something on the platform. And I'm a... I started out as a web programmer. The first version of Dot Health was built on the web alone, so you didn't really have mobile accessibility. And I remember she called me because I would include my phone number in all the welcome emails. And she called and she was like, "You know what I don't do when I walk into a doctor's office?" And I was like, "What?" She's like, "I don't carry my laptop with me." I was like, "That's a really good point." And three months later we launched our native apps on both our mobile platforms. And those have been a massive inflection point for the business. We've grown in a very different way being on mobile.

Same thing with the types of data that we collect. Because we started with oncology patients, we started in the acute care sector. We were really focused on building partnerships with hospitals. And something that we learned very early on through user feedback was that most of their data actually lived in the community, which is when we started really paying close attention and building partnerships with primary care providers, with pharmacies, with diagnostic companies, with medical imaging providers, et cetera. I would say really all of Dot Health has been shaped by a lot of feedback and listening to how people use it.

Where this is not been rolled out yet, but another area that we're currently focusing on is fertility. Typically when women are going through infertility treatments, they need access to information really quickly because they need to make decisions based on that information. And right now they're sort of Frankensteining some kind of a solution where Dot Health is a part of it. But we'd like to be a bigger help. And we're really getting to that point by interviewing them, getting to know how they're using our system and what we can do to make it better.

Kopiha Nathan: I'm a privacy officer here at HIROC. One of the things that we often run into is related to health information and jurisdiction, and where it can move and so on. I think a lot of healthcare organizations are struggling to move ahead with innovation, just because also privacy roles and that information security, they don't have money to spend on security related investments and so on. How would you handle that? How do you handle privacy and yeah, movement of data from one jurisdiction to the other? How did you solve that problem?

Huda Idrees: That's an important question because the aspect of security and privacy comes up all the time for us. But we actually spent the first eight months of our existence just working on privacy and security, which is a point of improvement. It shouldn't be this hard for anyone to get started in healthcare. And what we had to do was basically look at all the provincial and federal legislation around the protection of data, access to data and maintaining integrity of personal health information. All the provincial legislations are like sort of similar, but have like weird nuances, so you have to accommodate for all of those. Plus we're not built on a certification model. There is no certification that you can get that says you are now okay to share information. It's very much like guidelines based. So you have to be as cautious as possible, and you have to make sure that you're taking on liability or not taking it on as needed.

For us, we were really careful to make sure both we were complying with all the pieces of legislation, but also making it so that it wasn't so difficult for the user to access it. And again I'll say we have the luxury of being a newer organization, so the way we set up all our database infrastructure was very different than how a hospital would've set it up decades ago. I think that gave us a little bit of a leg up, which was really good.

I think for current organizations, where they can start is with smaller areas. Whether it's a certain department, we often will go and advise our partners in a similar fashion. If you have a certain department that maybe has a newer EMR setup than another department, start there. Start by providing information just for this specific department, whether it's maternity, whether it's fertility, whatever it is. And take it from there because you have to start with baby steps.

But yeah, we had to spend a lot of time doing all that. And we still do quarterly, we have third party penetration testing to ensure that all of the code that we're pushing out doesn't have vulnerabilities. They do come back with different, high, medium, low levels of vulnerability. And then we have to react to them, and basically write a report back saying what we patched in, and what happened.

Christina Salomone: How did you get the first partners or users of Dot? How did you get them to jump on board when you were just a startup? How did you convince them?

Huda Idrees: Yeah, so our first user, as I was mentioning earlier... I didn't actually think this was a real business initially. The very first user on our system was someone going through an oncology diagnosis. They had actually late-stage liver cancer, so it was... I was just doing anything that I could to help them. And it kind of started from there.

He was going through chemo. And what happens with chemo is it's kind of a social thing because you're sitting there and you're getting chemo with a bunch of other people who are going through a similar situation. And without knowing it and a bit of an accident really, he started telling all the other people around him what access he had to his information. So then... And at the time, this is just a one-off thing. I'm just sort of making it on the side just to help him. And it was like a Heroku instant, which is like a very quick and easy way. Kind of an expensive platform, but a quick and easy way to set up a web application. So that's what I'd done. And then he started referring us to other people, and what am I going to say no to someone go through like cancer treatments? I was like, "Obviously I will help you."

Just started creating... I literally just created separate apps for everybody. And at one point I had 200 of them running separately, where I just gave like admin access to individual apps because there was only one user per app. And there were 200 of them, and I was like, "Okay, there's a problem here." Clearly this needs to be a different platform. I need to be able to manage differently. I can't go to 200 code bases and make the same change over and over again. And so that's when there was a big sort of change in my mind around, "Okay, maybe this is a real business." And then when it came to trying to access information from healthcare providers, and because we started with hospitals, we actually had all these people who again were referring each other to the system.

We had these people making requests of hospitals, and we would have hundreds of requests come from Dot Health to a hospital, and they would often, it was kind of like a brute force tactic. They would call us and be like, "Who are you and how do we stop this?" And we were like, "Well we... " We kind of created the problem and then we also created the solution because we were like, "Yeah, we can come in and we can help you try and move this information easily, and we can show you and prove that this is how we identify who the user is, this is who they are. We'll give you all of the information that they've passed along to us in a way that will make you confident that you can move this information.

Philip De Souza: You went into the actual hospital then? You and your team?

Huda Idrees: Like physically?

Philip De Souza: Yeah.

Huda Idrees: Physically, yeah. Early days, yeah, we did.

Philip De Souza: Oh, okay.

Huda Idrees: Some of them are on similar EMRs, so that's become a little bit easier for us now. But yeah, we've had to go in institution by institution.

Ellen Gardner: Yeah, that was a great answer about, yes, getting your first client. And I wondered who are your clients now? Are they individuals or is it large healthcare organizations? Or does it cover the landscape? Who are your main clients?

Huda Idrees: Yeah, we have sort of two types of clients. We either have individual users, who are using Dot Health to access their own information, or we've built these partnerships with large organizations like hospitals, or long-term care facilities, or retail pharmacies for example, that we work with and our team make this information more accessible to end users. We sort of sit in the middle of two parties, one that collects healthcare information and one party that needs access to the health information.

And from the patient perspective, the types of users that we actually have are not specific to a chronic or acute condition really. They're almost like evenly spread out across, people who are managing some kind of an active condition, or people who are actually completely healthy, have no specific health concerns, but are just trying to make sure that they know the most they can about their own health data. And I think that is the kind of user that will really propel Dot Health into the mainstream. Because being knowledgeable about your own health is not a... It shouldn't happen just because you've come up against an issue. It should just happen sort of throughout.

And when it comes to our partner network is what we call it. When it comes to them, we're really... Because we're a small team, we'll start by focusing on certain verticals. We started with acute, moved into primary and pharmacy. We're starting to do a lot more work in fertility and longterm care. But for example, we don't really have a huge footprint when it comes to allied health or mental health.

Philip De Souza: Yeah. I guess my last question would be if... You're a woman in tech of color, any misconceptions people have of you or Dot Health?

Huda Idrees: The biggest area where it's come up is definitely in venture. This is a very known problem. But often in the world of venture, especially if someone is like me, where you come from a very like specific group to people's eyes and you don't look like the typical person who raises venture money, a lot of the comments I'll get are very gendered. And because we're tackling the problem of healthcare, which impacts really everybody, I get very like gendered criticism, which is like, "Oh cool."

If I was raising money for a company that dealt in women's health, I would have an easier time, 100%, than I do because we're sort of looking at healthcare as a global spectrum. Because it feels like, at least popular culture, because it seems like there's a specific demographic that is allowed to make changes for broad strokes people. And everybody else should just like stick to their own.

Yeah, I have stories for days.

Philip De Souza: You do, definitely. Well, I do want to thank you again for taking time to chat with us today. It was an amazing conversation. Thank you so much.

Huda Idrees: Thank you for having me.

Philip De Souza: For coming to chat with you and see what you do in the future.