Next Unicorns: Building the future of healthcare communication with Abridge CEO Shiv Rao | E1784

Why did they go from not moving fast to moving fast? Is it just because it's so broken and they're so exhausted and they're finally ready to capitulate and use the technology?

Today, another amazing episode of our The Next Unicorn series. If you want to see all the startups we've featured in this over the years, thisweekinstartups.com/nextunicorns. What is the idea behind the show? We find promising companies that we think could change the world. And just last week I interviewed Andy Beck. He's building Path AI. If you remember that, it helps make pathologists superhuman. They get a 3D model, they look through the microscope, and it makes it easier to diagnose things like cancer, maybe more accurately, will drive treatment, and hopefully extend people's lives and suffer less suffering. Great mission. Today, another AI founder in the healthcare space. Dr. Shiv Rao is a cardiologist, teacher, former corporate VC, and he converts them into what the industry calls, I believe, SOAP notes. SOAP notes stand for Subjective, Objective, Assessment, and Plan. Basically, the concept is to save doctors and healthcare professionals a ton of time, maybe reduce the errors, and again, we're just suffering increased lifespan so that the human species can enjoy more of the limited precious time we all have on the planet. Welcome to the show.

How has the last five years been with the ascension of the show Succession and everybody telling you, Shiv, like, on the show, I love that character, that must be...

Yeah, I mean, it's so good. I mean, it's The Sopranos and Succession, and then I gotta fight for my number three spot.

So how long have you been working on the company?

It is interesting how something can just break the dam and then everybody goes from being like, 'I would never even ride in an electric car,' and then they're like, 'When can I get one? And what's the wait time? And how many can I buy?' We just, these revolutions are like slow, slow, slow, and then boom, they just arrived. So one of the things I remember about having me install this stuff with headphones and training for two or three hours to get it to work, and it would have them say these words over and over again. And now, you know, I start looking at the Zoom transcript and you can watch the Zoom transcript in real time during a call. I didn't know you could do that. And I was interviewing Dharmesh, the CEO and co-founder and CTO of HubSpot, and I was watching our discussion in a live transcript, and I was like, it's completely accurate now. Explain to the audience how it went from being you got to train this thing for three hours to be a disaster, or less of a disaster. Siri can't call your spouse or get the... you know.

Yeah, absolutely. We'll do it right now.

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Breaths, and I was fine, but then when I woke up in the morning, I kind of tripped a little bit because I was so short of breath, and the dizziness came back.

Yeah, it's definitely when I'm going up the stairs it's much worse than going down the stairs or walking on a flat surface.

No chest pain, but I did feel a little tingling in my shoulder on the side of my heart. That's why I called.

Yeah, I did. When I woke up in the morning and then when I got to the top of the stairs, those are the two instances of feeling lightheaded in the last two days.

Those weren't all for me, but yes, I did eat too. I have been overeating. I'm 40 pounds overweight and the diabetes isn't good. I gotta cut back.

Okay, great. Are they covered or do I have to come out of pocket for those?

The Ozempic or Wegovy, I keep hearing about those.

All right, okay. Stop taking my metoprolol.

Sharing them. So where are you at now?

Okay, all right. It's a range, you know, it depends.

All right. Well, you tried doing six podcasts a week and that's how stressed out you are. I get it. I get it.

Okay, okay. Atorvastatin? Yes, I got you. Don't worry.

Okay, we'll talk about it.

Exactly. Awesome, man.

Yeah, no problem.

I just gotta go through that whole four minute conversation and then summarize all the facts that were in the whole dialogue.

Exactly. And that's documented correctly.

Doctors have been using this in the field. Where are you at?

And how many? For the person who's the tip of the spear, the doctor who's got the most, not you, how many have they done and what's their reaction been over the last six months?

What was the most positive feedback and what was the most negative or scared, cautious feedback?

Yeah, absolutely.

Yeah, so that's like this industry nomenclature around a type of code that you can bill for. Those are the billing codes. We hear about that all the time.

10 hour shift, except a 12-hour shift. I mean, we're talking about a 25% lift.

It's so interesting. When I had Aaron from Box, Reid Hoffman on, and founder of Airbnb, Brian Chesky, I asked them what percentage of time they were saving. I asked Dharmesh the same thing. They all said like 20, 30, 40% depending on the role. It feels like we're all, this current wave of AI innovation out of the gate seems 30% of people's time. That's kind of mind-blowing if you think about on an entire economy. Now we're seeing it not just an artist making wedding invitations or you know... valuable. And then you mentioned earlier there's a shortage. You get all your doctors to use this and use it well, in year one you get a free doctor for every four. Every three doctors, you get the fourth free. Just think about what this could save in healthcare. And then less mistakes, and the mistakes are costly. So that's like, and obviously there's cost and money, but this also costs in death or missing a diagnosis and suffering, which are really hard to even quantify, although I guess people do quantify them.

Yeah, exactly.

Fantastic. Exactly. So I get that note, I make my quick edits. On average it takes about 20 seconds if that for people to quickly make it... the part about the NFL kids or whatever.

Can I play them or are they just transcript like this? So do I get the entire conversation or just...?

So I guess that's probably on the roadmap.

We try to make it as simple as possible. Per doctor per year or per clinician per year. And we go deep on the other side of this note. We integrate it all into the right places in the medical record because there's discrete fields. Part of this is not just the generative piece, it's all the copy and pasting you might have to do if we weren't integrating. We're going to make sure we already do with these large health system customers, but across all the EMRs, we'll make sure to get all the data in the right places. When you're on the team, of course it's 2023, but there's always somebody where the buck stops, and that buck stops on their desk and doesn't get into your bank account. These high-level folks are hard to find. They're hard to target on social media platforms, but LinkedIn is the social network for business, and they have 930 million members ready to do business with you. And that includes the 180 million senior level decision makers. Plus, don't tell anybody, there's also 10 million C-level executives there. That's a ton of purchasing power. LinkedIn ads is built specifically for B2B market workers. No other platform in the world can offer these eyeballs, and you can target them obviously by their location, the size of their organization, their vertical, and their title. When you think about business, I want you to just think about LinkedIn. LinkedIn equals business. Business equals LinkedIn. It's that simple. Start your first campaign by going to linkedin.com/nextunicorn to claim your credit. That's linkedin.com/nextunicorn. Terms and conditions apply because LinkedIn is so generous to this week in startups audience.

Yep.

Exactly.

Totally. So that must happen already. The idea of even taking your temperature at home or your blood pressure at home, or even knowing how many hours you slept last night, that's something that didn't exist... detecting atrial fibrillation. So there are patients who've been diagnosed with AFib because of the Apple Watch, and then we kind of really pull them through.

Well, the 12-lead, the chest-based, is going to give you a lot more detail on what's going on, but the Apple Watch is validated to do a good job on detecting that diagnosis, that issue. So I wonder if they're going to get that glucose monitor working. There's that rumor that you can have a watch that will be able to tell your glucose level.

Well, congratulations. You started on this years ago and we're all caught up, and now everybody's probably want to throw money at you after four years of you begging them to support your vision and them saying it's too early. And now they're too late, and all these investors are going to have to play catch up now, pay a little bit of a higher price for not having the vision to back you earlier. Congratulations. Are you hiring right now?

I do.

Clinicians and patients and administrators across some of the biggest health systems in the world. And in your training a model and you ship it in a matter of minutes, and you get that feedback. That's the kind of culture we have. We're building responsibly, but we're building incredibly quickly, and we're getting feedback loops that are just instant. You gotta check these things. You got people, you gotta check them, but we have the instrumentation in place where we can benchmark very quickly quantitatively and decide to ship. So I think one of the best compliments we got from an early customer was, 'Abridge on Monday was amazing, and it was better on Tuesday, and even better on Wednesday, Thursday, Friday.' And that's the speed that we're going at right now, which in healthcare is a totally new thing. It's all happening and... using it every day and see if they can get 20, 30% faster at their jobs and make your company more profitable or get to profitability. This is an incredible revolution. It is not undersold. It is not oversold. It is undersold. You and I who are in the trenches with this, you can just see how this is going to compound. They just had Tim Urban on. I don't know if you've ever seen Tim Urban's favorite famous chart. It's like progress and then... and I'm making a line that is just a very slow gradual growth line. Hopefully producer Brian has it handy on the show, and it's like puts a little stick figure on the line, and then the line goes hockey stick straight up, more than a hockey stick, like a skyscraper. And... yeah, I mean, doctors are going to be learning stuff they just... the idea that you're a doctor and you have to do trial and error and triangulate around what's going on. Like you said, you're starting to get Apple Watch data now. Imagine you've got a thousand patients in your network as some insurer, and it starts sending messages to your clinicians like, 'This person's heart rate is this,' and you both get an alert. You're both dumped into a chat room, and it's like, and the ambulance driver is on the way to their location. That's the world we're going to live in. All of a sudden you're going to get a phone call from your doctor. It's like, 'Hey, Dr. Shiv,' and it's like, 'Yeah, the ambulance is on the way.' And you're like, 'Why?' And it's like, 'Well, we saw you're having this happen with your heart. We just want to be safe.' And... coming to. I mean, it's going to be a crazy world. The fact is, people have gone flying off their mountain bikes alone, and if you have the latest iPhone and it has the crash detection, and somebody got knocked out unconscious, and somebody came and saved their life because of their Apple Watch or phone. I mean, this is going to be... I was an EMT for a little bit, and just what's going to happen in emergency medicine combined with this. I used to have to sit there, I did dispatch too for an ambulance, and they would be wailing down the BQE in Brooklyn yelling at me the vitals. I'm writing the vitals down. I'm on the phone with Victory Memorial Hospital or Maimonides, and I'm reading the patient's blood pressure to the nurse at the emergency room while... blowing my mind more than anything else in 2023 is that healthcare is moving at the pace that it is with this technology. Is it really moving faster finally? It is moving so fast. Why did they go from not moving fast to moving fast? Is it just because it's so broken and they're so exhausted and they're finally ready to capitulate and use the technology?

Yes, of the audience, humanity. I, as the host of This Week in Startups, thank you.

Thank you so much. I'm in Pittsburgh.