Can This Fix the Healthcare System?


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Referral communication within the healthcare setting is often one-way, damn near impossible to track, and sometimes does not include the required patient information. Don’t believe me? Check out these stats:

  • 25% of primary care providers (PCP’s) do not receive timely information from specialists after the patient referral is made.
  • 68% of specialists receive no information from PCP’s prior to patient referral visits.
  • The end result: 60% of referrals go unscheduled and 25% of scheduled referral appointments are missed.

So what can be done to fix this broken system?

Fix Broken Healthcare System

Enter Jonathan Govette, the founder of ReferralMD, a patient referral management application that is designed to become the replacement for the fax machine and allow millions of doctors the ability to track referrals without digging through file cabinets or using Microsoft Excel.

In this interview with Jonathan Govette, we learn why the healthcare system is broken and what can be done to fix it.

Here’s What You Will Learn

  • The personal story of why Jonathan built the ReferralMD platform.
  • What exactly is ReferralMD and why did the major EMR systems miss out on this important piece of the healthcare puzzle?
  • 3 reasons why the healthcare referral system is broken. Discussion points include: 1) Communication gap, 2) Paper vs. patient, and 3) HIPPA violations.
  • 4 simple and effective ways for medical practices to win more patients.
  • Why the analytics component of ReferralMD is so important.
  • Jonathan’s lasting advice for ambitious medtech doers: Update, update, update!
  • And much more!

This Is What You Can Do Next

1) You can listen to the interview with Jonathan Govette right now:

2) You can also download the mp3 file of the interview by clicking here.

3) Don’t forget – you can listen to this interview and all of the other Medsider interviews via iTunes.  And if you get a chance, leave us an honest rating and review on iTunes. It really helps out.

4) Read the following transcripts from my interview with Jonathan Govette.  Also, feel free to download the transcripts by clicking here.

Read the Interview with Jonathan Govette

Scott Nelson:       Hello, everyone.  Welcome to another episode of Medsider.  This is your host, Scott Nelson, and on today’s program we have Jonathan Govette, who is the founder of ReferralMD.  Welcome to the program, Jonathan.  Really appreciate you coming on.

Jonathan Govette:    You’re most welcome.  Thank you.

Scott Nelson:       Alright.  So, ReferralMD, let’s start out with the story of why you decided to go ahead and start this business.

Jonathan Govette:    Definitely.  Unfortunately, when I was very little, my mom was hit, right actually before I was born, and she had many injuries and throughout the years she’s been having to attend multiple physician meetings with different specialists on almost a weekly basis.  It’s gotten worse now [00:00:43] with her advent of having Parkinson’s over the last 10 years and with her health declining.  I’ve seen throughout my 30-plus years growing up many referral slips on the fridge, on the table, and I’ve always wondered, you know, why are we still using paper?

And unfortunately when the fax machine I think was invented around the ‘60s sometime, we’re still using that technology to communicate, and the last couple of years I finally had the aptitude to understand why is our healthcare system still using paper to relay critical [00:01:14] health to other specialists, and I’ve never really had a good answer why.  I’ve asked hundreds of different doctors why they still use it and their only answer really is because it’s the only thing there.

Luckily, the last couple of years I’ve done some research and found that there is a viable product there, a lot of people want to purchase it, so I decided, “You know what?  I’m going to form a team.”  I wanted to do something about it, number one, to help my mom, and also all the other patients I’ve talked to in the past that are in my life and affected myself personally, and I was fortunate enough to have the skill sets and also the team behind me now to actually design the application that’s going to change the world, how we communicate information.

Scott Nelson:       Okay, and before you give us that brief overview of this application, this platform that you’ve developed, let’s go back to your mom.  So you saw her take a primary care physician and he or she would refer to a specialist, and then you saw the lack of communication both to and from that referring specialist, then she would be referred on to another specialist, etc., etc., trying to deal with some of these chronic illnesses that she developed from that accident and then Parkinson’s.  So you saw that issue, and so what were some of the big things that you saw?  You mentioned the fact that just paper, was that what stood out the most is just why are we using paper in this day and age?

Jonathan Govette:    Exactly.  It was an amazing amount of paperwork that I’ve seen her having to actually courier.  She actually became a courier to that paperwork.  They’d actually hand her a slip, and unfortunately my mom, bless her heart, she forgets a lot, and she’ll end up leaving that referral slip somewhere and miss her appointment, and then unfortunately the other receiving party never received it because she was actually responsible for that.  And that prolonged her meetings, she wouldn’t have the appointment maybe for another three months, and unfortunately I’ve talked to many other patients like that.  They always seem to either lose it or, let’s say, were given an x-ray or MRI to courier, they lose that as well or they have to go back and pick it up.  And unfortunately, my mom, she’s an amazing woman but she is not the brightest of the bunch sometimes. [Laughs]

Scott Nelson:       Sure.

Jonathan Govette:    She forgets a lot, unfortunately, with Parkinson’s affecting her health that way as well.

Scott Nelson:       Right.

Jonathan Govette:    And she is unfortunately unable to maintain, and my dad, unfortunately, he’s a farmer, so he’s always on the farm pretty much from five in the morning till eight o’clock at night, and for him to have to remember all this as well, it makes it very hard.

Scott Nelson:       Sure.

Jonathan Govette:    And so seeing that process of her losing things all the time or just not really getting the best care, it just affected me to a point where I wanted to finally do something about it.  To give you a quick background on myself, I built software before, websites, for other companies, and I decided it’s finally time for me to do something not only for my mom but everybody else as well.

Scott Nelson:       Yeah.  Yeah, and to your mom’s point, and you’ve probably talked to a lot more patients than I have as you sort of built your system around this really big problem, but correct me if I’m wrong, your mom is probably not alone in the fact that a lot of these patients are either sick or it’s just they’ve got a lot going on emotionally and even to simply ask them to remember an appointment maybe complicated, with all the other things that’s affecting their life, you know, with a certain disease or a certain sickness.  So it’s a big problem that to your point seems like it’s been overlooked for a long time now.

And from a personal standpoint, even like a basic visit to like a dermatologist or something like that, I remember even taking my daughter to a dermatologist recently where the next appointment that we had scheduled for her, you know, you get the old card, the little card, and then you have to manually enter that information into your calendar and whatnot, and I’m thinking to myself, even before we met and talked, I’m thinking that’d be nice if they just sent you an email like with one click just sort of import that to my calendar without having to like remember to type it in.  And that’s so basic, you know…

Jonathan Govette:    Exactly.

Scott Nelson:       …and I’m not the one that’s dealing with the sickness or disease.  But good stuff.  So why don’t you give us a brief overview of ReferralMD, the system that you’ve built, and then we’ll jump into some of the other reasons why the healthcare referral system is broken and other ways to maybe, in your experience, the other ways that physicians can be better at marketing their practice and sort of enhancing the referral process.  So let’s start with a brief overview of ReferralMD.

Jonathan Govette:    Definitely.  The goal was—and anybody in the healthcare industry understands that most of the applications that are out on the market today are very complex.  If you work within the hospital system or even in practice management, you understand that companies like Cerner, Meditech, Epic, while the programs are great in a sense that they track information for you, they’re very complicated.  They usually take anywhere from hundreds of thousands of dollars to multimillion-dollar installations.  One of the partners, [00:06:08] Community Hospital, just spent 75 million dollars installing Epic and it does everything under the sun except for referrals.  It does not communicate ambulatory referrals to other practices, and neither does anything else on the market today with other third-party applications.

So we decided we want to make something that’s simple.  It does one thing very well.  It resembles emails, an email system you’re probably familiar with, maybe like a Gmail or Yahoo or AOL.  So you log in, you see an inbox and an outbox, and that’s pretty much it, along with some reporting that helps you determine who your best partners or colleagues are.  And that’s it.  We don’t want to have 10 or 20 features, and the reason why [00:06:48] is I always believed that as you add more features to your software, number one, your users don’t like it, number two, you actually dilute your market space for sales, because as you add more features less and less people want to buy it because they already have something that does something similar.

So when somebody first logs into our system, they’ll see a lot of white space, very easy to use, literally takes a few minutes to set up and you’re done.

Scott Nelson:       Mm-hmm.

Jonathan Govette:    No cost to set up versus the other systems on the market.  And obviously the goal is to get in the [00:07:17] system’s center for all of 30 seconds, receive on the other end, both parties, both you and your specialist can see instantly when the referral was read.  Any notes or annotations, any attachments such as x-rays, are all allowed to be seen instantly versus having to go back and forth to a file cabinet or pull it out of the EMR that you can’t find because you have to manually input it.

Scott Nelson:       Gotcha.

Jonathan Govette:    The current process, as you know and most people do know, it’s all fax-based or triplicate form, and obviously the time to maintain that system, I’ve done some surveys with a lot of different practitioners and they spend anywhere from 15 minutes per referral up to sometimes an hour or more per referral, maintaining it, filing it, faxing on the phone, hold time, etc.  If you equate all that time it takes to go through that entire process to actually get a patient through the system and actually have the appointment, it’s a very long time, and with our system you can reduce [00:08:15] down the total minutes.

Scott Nelson:       And did you say an hour per referral?

Jonathan Govette:    Exactly.

Scott Nelson:       Yeah.

Jonathan Govette:    Except for more complicated referrals, which have a lot of more fields.  You can consider the fact that they have to wait on hold for authorizations, for example, for insurance authorizations or for referrals, it takes a long time.  So in our system it not only does the referral but also does authorizations.

Scott Nelson:       Okay.

Jonathan Govette:    It’s one of the same things, pretty much.

Scott Nelson:       Okay.  And I want to circle back around to this later on in the interview…

Jonathan Govette:    Okay.

Scott Nelson:       …but you have a really cool little cost per referral calculator on your website that I would encourage everyone to go check out because it’s really interesting because it kind of shows you, if you’re losing out on X number of referrals per month, this is what that equates to financially in terms of dollars lost, but it’s really cool.  So, in essence, ReferralMD is a really simple exchange platform from the referring physician to the receiving physician to exchange information that’s HIPAA-compliant and all that stuff.  It’s basically a really simple way with some analytics built in where you can track how many patients are going back and forth over a certain period of time, etc.

Jonathan Govette:    Exactly.  One of the things that we were asked to build from a couple of our companies, and we actually integrated it, we’re actually building it out now, is a way to actually track the time, which this is completely new for anybody in the market, the time it takes to actually, when you receive the referral to when the appointment was made to when the actual appointment was held, you can actually track the actual down to the minute.  So if you have a partner that you’re working with that, let’s say, five cardiologists you send referrals to, and you want to know which one is going to be the most efficient with your patient.  You can actually know down to the minute which ones are actually receiving your referrals and actually handling that referral quickly, and that’s done on every single referral and also averages it as well.  So if you have a hospital you send referrals to, you can have an average time to completion for that hospital so you know whether or not that hospital is better or more efficient than the other hospital down the street, and that’s…

Scott Nelson:       So it’s almost a built-in accountability system then?

Jonathan Govette:    It really is.  Accountability.  That’s one metric that is missing from healthcare today, is accountability.  Now you can actually as a doctor know, number one, how accountable am I as a practice?  You can actually track your staff efficiency, but also your partners that you work with.

Scott Nelson:       Okay.  Okay.  Very Cool.  Real quick before we move on to some of these other issues regarding kind of the broken referral healthcare system, or the broken referral system within today’s healthcare environment, but you mentioned some other large EMR players like Epic, for example.  Was this just a big miss on their part or is their system built more for sort of the enterprise hospital-based environment where you’re basically tracking patient data versus kind of the referral side?  It just seems like a big miss to me, I guess, for lack of a better description.

Jonathan Govette:    How it all came about, obviously with the HITECH Act in 2009 and with Obama giving away X amount of dollars for Medicare reimbursement, etc., the meaningful use part I really didn’t include anything about referrals, so a massive 1400-plus EMRs popped out of nowhere, relatively speaking, and built platforms that emulated what reimbursements they could receive or their customers could receive.  So they missed that piece.  Number one, they built a system for just tracking only, meaning once we manually input information in the system and it holds it as archives.  That’s really all it was about.

They missed the point and everybody missed the point of communication because, number one, they weren’t getting paid for it by the way so they left it out, number two, it’s very hard to build as well.  Building a tool that is social in nature that actually is HIPAA-compliant and you could share information is a lot more complex than just a standard database because there are a lot more things you have to build into the system to make it work properly.  So those are two reasons why they left it out, and we decided that we wanted to build the first [00:12:26] that could do that, that actually can send information back and forth and actually track the metrics of efficiency and accountability.

And that’s really the difference between us and all the other EMRs on the market.  We’re not competing against them.  We’re actually a collaboration tool with them, so we complement what they already have in your system.  So if you’re using Epic or Cerner, you can still use our software because all we’re doing is replacing your fax machine or your triplicate forms.

Scott Nelson:       Right.  Yeah.

Jonathan Govette:    So that’s the benefit of us.  We can actually still sell or offer our services to everyone in the country and the world no matter what system you’re on.

Scott Nelson:       Gotcha.  Yeah, and even beyond replacing the fax machine, replacing email in some situations. I think one of your recent blog posts highlighted that where you had I think maybe a friend or something that one of the, whether it was an admin person or secretary within that primary physician’s office, asked him to email some very private information, which was interesting.  So I guess in some cases it’s replacing email as well. [Laughs]

Jonathan Govette:    Well, as everybody knows, yeah, email is actually not HIPAA-compliant.

Scott Nelson:       Yeah.

Jonathan Govette:    It’s actually against the law.  You can actually be fined relatively heavily for doing that.  And I’ve done a lot of surveys in the past and this one just shot up at us about a week and a half ago, two weeks ago.  One of our friends actually went to the doctor and wanted to get a stress test done.  The staff didn’t have their corporate email, which, number one, is still bad, but so she did give away her Gmail account.  And so our friend just wanted to get the appointment done.  He was already stressed out, hence the test.  He sent over the information.  He knew it was wrong but he just wanted to get the appointment really quickly.  So he actually sent his private information to her Gmail account, which will be there probably forever, even if she leaves or quits.  And it was shocking to me, but it happens all the time.  So we’re going to leave you with that for the users so they know that everything is going to be safe and HIPAA-secure.

Scott Nelson:       Gotcha.  Cool.  Cool.  So we’ll circle back around to maybe a little bit more about what you’re doing at ReferralMD, but let’s tackle some of these issues in regards to why the healthcare referral system is broken, and you mentioned some of them already and you’ve kind of discussed them a little bit, especially in regards to why you built out the ReferralMD platform, but the big communication gap is huge as we kind of briefly talked about.  But let me just read some stats.  I think I actually got these from your website, but 60% to 70% of referrals go unscheduled, 25% of scheduled appointments are missed, 25% of primary care physicians do not receive timely information from specialists post-referral, the average spent per referral is roughly 40 dollars.  I mean, these are shocking stats.  It represents a huge communication gap, and so that’s obviously one reason why the healthcare referral system is broken, right?

Jonathan Govette:    Exactly.  One of our blog posts mentioned about [00:15:24] different statistics that were relatively astonishing.  After doing some research over the last year, so I’ve talked to [00:15:32] Tejal Gandhi.  She works alongside of partners.org in Boston.  She also works alongside [00:15:39] Harvard Med and a few other large medical practices there.  She’s been doing research for over 10 years or referrals and how electronic referrals could help the industry.  Unfortunately, with the bandwidth problems of before 2000, we really didn’t have the infrastructure in place or even a cloud system built that could handle large files, etc.  And just until recently, within the last couple of years, we’ve been fortunate enough to have companies such as Comcast, AT&T build out their fiber throughout the country, so now people then have 25-meg-plus connections in their offices when five years ago we didn’t have that.  So that’s why I think it’s going to be a great time for healthcare to finally fix some of these problems that were plaguing us 10 years ago.

Scott Nelson:       Yeah.

Jonathan Govette:    Or actually for the last century, really.

Scott Nelson:       Yeah.  And when looking at some of these stats, it definitely affects all parties, the patient, the referring provider, and then also the specialist provider, I guess, in that sense.  It affects everyone.  But in your discussions with referring physicians, is that a big issue with referring physicians when they’re not receiving timely information back about their patients from specialists…?

Jonathan Govette:    It definitely is, not only just as a doctor you want to take care of your patient…

Scott Nelson:       Right.

Jonathan Govette:    I mean, really that’s their job.  If your patients aren’t being taken care of, number one, they’re probably not going to refer business back to you with their families, right?

Scott Nelson:       Mm-hmm.

Jonathan Govette:    So you lose revenue stream there.  But more so, that’s your liability risk.  If you don’t follow through and actually know that your specialists that you sent your patient to is doing the job, you can actually be held liable for that problem, and actually [00:17:23] with malpractice suits coming by every day growing and growing.

Scott Nelson:       Mm-hmm.

Jonathan Govette:    So those two issues obviously are very important to a practice, and they want to minimize those risks obviously.  So knowing that their patient is taken care of, they’re happy, it’s great, but you also want to save your wallet too. [Laughs]

Scott Nelson:       Yeah.  Yeah, no doubt.  And on the specialist’s side, the specialist that’s receiving the referral, they’re obviously concerned about, one, getting more referrals, but two, getting more referrals in an efficient way.  And I can speak from experience, a lot of specialist physicians struggle with that, like how do we effectively and efficiently manage incoming referrals?  It’s a big issue.

Jonathan Govette:    Exactly.  No, it’s massive.  We’re actually working with a physical therapy office here in California, they have 25 locations, and I’m working with one of their marketing reps that’s responsible for driving referrals to all those locations.  Right now there’s really no way for them to track his work.  So he’s out talking to 10, 20 people a day.  They have no clue where the referrals are coming from, if they’re from him or they’re from somewhere else.  So with our system, it’ll easily add him into the system that can manage that relationship between himself and all the other practices that bring business to them.

One thing we haven’t talked about though, we’re actually going to be building a platform with a social nature, or a social platform as well.  So if I’m a cardiologist in town and I’m looking for people to refer business to me, I can actually use our system to log in and see all the different types of general practitioners that are in my area and actually connect to them.

Scott Nelson:       Mm-hmm.

Jonathan Govette:    And then send a little welcome note, say, “Hey, I saw you’re using our system as well.  We’d like to build a relationship and let’s communicate,” and actually build a way for them to form relationships online.  Now, obviously, you still want to go out to lunch and meet them in person to make sure who they are, but our system actually can connect you to people that you might not know about.

Scott Nelson:       Sure.

Jonathan Govette:    And it’s all done within our system.  So you can actually build relationships, manage them and track them all within one portal.

Scott Nelson:       Okay.  Okay, cool.  So in that situation, that cardiologist in the example you just mentioned, so are you giving him, are you scraping data on the PCPs in a certain area and almost basically pulling up a list where he can automatically kind of see the PCPs in his area and say, “Oh, I know this group,” or “I know that group,” “I don’t know that group,” etc.?

Jonathan Govette:    It’s really based on a couple of different factors, what type of specialty they are, what gender, what insurance companies  they accept, and multiple other factors as well.  So the benefit is, for example, if I’m a primary care and I have a young lady and she needs some help managing a certain type of disease and she wants to be sent to a specialist that handles that disease plus is a woman and within let’s say 5 miles of her zip code…

Scott Nelson:       Oh, okay.

Jonathan Govette:    …we can actually pull up a strategic search and pinpoint exactly who that person is and send them there without having to randomly Google and hope they find something.

Scott Nelson:       Okay.

Jonathan Govette:    So our system actually dives a lot deeper than what a standard search can offer.

Scott Nelson:       Sure.  Okay.  It’s actually like an effective search with filters, or I should a search with effective filters.

Jonathan Govette:    Exactly.

Scott Nelson:       That’s cool.  That’s cool.  So communication gap is one big issue that your platform is helping to solve.  What about the hard paper versus the digital sort of point of this, the kind of the paper versus patient?  Again, we spoke about this in a little bit more detail, but can you sort of expand on that issue?

Jonathan Govette:    Definitely.  Most people know the EMRs are wonderful.  I mean, as we talked about before, they are fully digital except the one piece that matters to most people, especially the patient, is the referral process.  That is still left out.  That’s still being done with paper.  And there are some actually pretty astonishing stats that go along with it.  Now, these are all America or USA stats.

Scott Nelson:       Mm-hmm.

Jonathan Govette:    Right now there are 7000 people dying every year from just sloppy handwriting.  So this is both on prescriptions, referrals etc.  If you read your own referral note, they’re hard to read. [Laughs]

Scott Nelson:       Right. [Laughs]

Jonathan Govette:    I don’t understand most doctors’ handwriting and I really don’t understand my own either, so that’s why I make sure I type everything out.  Of course, with our system, we’ll fix that.  Even worse is, 3 out of 10 test results, so lab orders, etc. that are done with paper now, have to be reordered because they can’t find them afterwards.

Scott Nelson:       Wow.

Jonathan Govette:    So imagine if you’re a patient, you go in to a doctor and you have to reorder your tests that was maybe not comfortable or maybe a little private, you probably don’t want to have to go back and do it again but 3 out of 10 have to, and that’s terrible.

Scott Nelson:       Wow.  That’s a huge cost to the system too.  Especially in our day and age, when healthcare cost is probably the biggest issue on most people’s minds, that’s a big one, 3 out of every 10 tests are reordered because results can’t be found.

Jonathan Govette:    It’s shocking.  One-third of our cost in America could be reduced instantly if we actually transitioned to a fully digital system.

Scott Nelson:       Yeah.

Jonathan Govette:    And it’s pretty astounding.  Now, even worse, this is a pretty astonishing stat – almost 200,000 people die every year from preventable medical errors, and mostly, 86% of those, are administrative.  So we’re talking about referral slips and a lot of other issues, but mainly referrals. The referrals actually communicate most of the information today.

Scott Nelson:       Wow.

Jonathan Govette:    Very few patients call on their own to set appointments because they want to go through their primary care first to validate which doctor they should go to.  Most people don’t use software applications like, I mean I hate saying this, but ZocDoc and a few others that are out today, because those are all patient-centric, and as you know with Google Health and a few others that pulled out of the marketplace, patient-centric software unfortunately don’t work these days because most people either aren’t skilled enough to understand what their health requirements are or they trust their doctor enough they want to actually go to them first, which that’s what I do.  When I go to a doctor, I talk to my primary care and I say, “What do you recommend me doing with this?”

Scott Nelson:       Right.

Jonathan Govette:    I don’t Google and try to find out my answers myself.  I just don’t.

Scott Nelson:       Gotcha.

Jonathan Govette:    You know, I don’t trust myself enough.  I’m not a doctor and I don’t want to risk my life on Google.  I just can’t. [Laughs]

Scott Nelson:       Yeah.  Yeah.  No, that’s understandable.  And I think actually I recall reading a piece about one of the reasons why Google Health never really took off or they exited.  I can’t remember exactly the whole premise of the article, but one thing that stands out to me is they didn’t involve the physicians enough.

Jonathan Govette:    Mm-hmm.

Scott Nelson:       They made it too patient-centric, as you just mentioned.  So that’s interesting that you say that in regards to kind of this whole topic of paper versus patient in terms of one of the reasons why the healthcare referral system is broken.

Jonathan Govette:    Definitely.  It’s a huge problem, obviously, and that’s what we’re looking forward to fixing.

Scott Nelson:       Yeah.  Gotcha.  So let’s move on to the third point, HIPAA violations.  And again, another thing that we’ve lightly touched on before, but let’s discuss that in a little bit more detail, the idea of HIPAA violations.

Jonathan Govette:    Definitely.  There is actually a website and you can visit our website at getreferralmd.com, and you can go to our blog and you can find this information or you can just email me directly if you’d like to at jonathan@getreferralmd.com and I’ll provide you with the link.

Scott Nelson:       Mm-hmm.

Jonathan Govette:    Basically, the US government actually has a website that allows you to see all the different types of violations that are real time, meaning that happens in the market that any kind of breach or theft that affects more than 500 patients is posted on this link.  So it’s called the Wall of Shame.  We actually have a blog article that I’ve written actually just recently.  You can go to our most recent trending on ReferralMD blogs and it’s actually the fourth one down and it’s titled Wall of Shame.

Scott Nelson:       [Laughs]

Jonathan Govette:    Go ahead and read that, and it actually gives you a link directly to that article.  It’s pretty astounding.  I’m not going to mention any names but there are very large organizations that are on that list that you will know, and they affect millions of patients every year.  These people unfortunately think of the Oceanesque-type of hacking where somebody goes in through a pipe and steals the hard drives out of the server.  Well, that doesn’t happen.  It’s actually physical theft.  It’s actually one of the largest breaches available.

So, for example, physical theft of paper, files, physical theft of hard drives or actual laptops, are actually the top two of thefts.  So, for example, one of the recent thefts was a laptop was left in a van and the van was stolen, the laptop was stolen, and it had I think around one million people’s information on that hard drive.  Well, with a system like us, with ReferralMD, we don’t store your information on a hard drive.  So if you’re on your iPad or you’re on your computer, your safety is once you log out [00:26:19] be gone.  Nothing’s there.

Scott Nelson:       Yeah.

Jonathan Govette:    So you don’t have to worry about that.  Now, most EMRs are server-based and actually in-house.  There are some issues there.  Ours is cloud-based, which means we actually store information somewhere that’s completely secure, that’s armed guards 24 hours a day, and you don’t have to worry about that.

Scott Nelson:       Right.

Jonathan Govette:    So I always like to tell people, if you’re still imagining your paper systems or your [00:26:41] systems with files where you can actually back up on DVD and you’re trying to maintain that, please update to a modern system that allows you to back up automatically because you don’t want to lose your information.  I’ve talked to hundreds of doctors and a lot of them have been hacked.  And hack is a very general term, by the way.  They use that term and it still means theft.  So if somebody stole a paper file, it would still be called hacking.  So you want to be careful.  People always think, “Well, somebody’s going to steal my information online.”  They’re really not unless the systems that are in place are 10 years old, which unfortunately as you’ve probably heard the last couple of years, such as Sony and a few others, they built their databases very poorly.

Scott Nelson:       Mm-hmm.

Jonathan Govette:    We use all the modern encryptions.  We use military-grade 256-bit encryption methods.  Sony didn’t do that, and you consider they’re a billion-dollar company and should have, well now they are. [Laughs]

Scott Nelson:       Right.  Yeah, no kidding.

Jonathan Govette:    They’re changing that.

Scott Nelson:       Yeah.  Gotcha.

Jonathan Govette:    So that’s the biggest thing.  If you are going to talk to IP staff or you have a person down the street maintaining your security systems, you better ask them some important questions about that and read that article about security breaches.  And by all means, please update your browsers from IE6. [Laughs]

Scott Nelson:       [Laughs] Right.

Jonathan Govette:    It’s 11  years old.  Fire your IT staff if they’re still letting you use it. [Laughs]

Scott Nelson:       I would like to see stats on how many physician offices are still using IE6 because it’s probably, maybe not surprisingly, that those of us in healthcare, it’s probably pretty high. [Laughs]

Jonathan Govette:    One of the largest banks in the country, Citibank, is still on 5.5.

Scott Nelson:       Oh wow.

Jonathan Govette:    Which is over 12-1/2, 13 years old.

Scott Nelson:       That’s embarrassing.  Wow…

Jonathan Govette:    It’s scary, isn’t it?

Scott Nelson:       Oh yeah.

Jonathan Govette:    And they were hacked actually recently, too. [Laughs]

Scott Nelson:       Yeah.  Yeah, go figure.  Go figure.  But to draw this back to sort of that third point in HIPAA violations, I mean, I think as a society we’ve almost sort of gotten numb to the idea of HIPAA.  It seems like when you’re talking about any sort of technology within healthcare that’s almost always the first question that gets brought up, is it HIPAA-compliant?  Is it HIPAA-compliant?  I would venture to say 95% of people don’t even know what really HIPAA is.  It’s just sort of a buzz phrase.

Jonathan Govette:    Exactly.

Scott Nelson:       But even something as basic as the example you mentioned before, even with your mom, for example, taking triplicate forms, if those forms are left anywhere, if they’re accidentally dropped, etc., even if you relate it to your own self, if my name’s on a form to go see a urologist, for example, and someone captures that—well you can even draw an example as basic as that.  If someone were to steal that, if I left that behind, that’s sort of some revealing information.

Jonathan Govette:    Exactly.

Scott Nelson:       And maybe you don’t care, maybe you do, but why not just eliminate the paper altogether and send in the information through a secure platform?  It seems to make a ton of sense, and I’m sure you’ve realized this.  The more you’re entrenched in this space, it’s like, why are so many physician practices beyond the times and why aren’t patients calling for a more modern version of the transfer of this information?  No, that’s good stuff.  I know we’re kind of running short on time a little bit…

Jonathan Govette:    No problem.

Scott Nelson:       …but did you want to add anything else to that third point about HIPAA violations before we kind of move on to the next topic?

Jonathan Govette:    We’ve covered most of it, I think.  I mean, I just want to cover a couple of quick points.  The US Department of Health and Human Services, if you want to Google that and type in “breaches,” and you should be able to see all the information we’ve been talking about today.  It’s actually pretty astonishing.  If you’ve never been there, I’d recommend going in to look at it.  It actually outlines exactly what types of thefts happened to each type of organization.  So you can learn that everybody’s susceptible.  Everybody can be held at fault.  And we’re not just talking about simple [00:30:28] slaps on the wrists either.  Most practices, at least the small ones, could actually go out of business with some of these types of malpractice suits that go out [00:30:37], excuse me, of breaches.  You can lose everything, and you don’t want to, so protect yourself. [00:30:44] talk about [00:30:35] on that.  Second, don’t use email.  If you’re still using email to send information, please stop. [Laughs]

Scott Nelson:       [Laughs] Simple as that.

Jonathan Govette:    Help yourself out.  Upgrade to something that’s a little better, that’s actually less expensive, and you can help yourself and actually make your staff’s and your life a lot easier.

Scott Nelson:       Mm-hmm.  Cool.  Good stuff.  Let’s talk real briefly, I mean this could be a whole separate interview, but I wanted to touch on this briefly because you’re talking with physicians both on the referring side and the receiving side on a daily basis.

Jonathan Govette:    Mm-hmm.

Scott Nelson:       This is what you do, is you develop a platform to help that process.  So I want to get your take, and again, maybe condense this into maybe a couple of minutes, 4 or 5 minutes, something like that, but are there some things that stand out to you in regards to physician marketing? I mean, obviously, the referral component is a big part of that, but are there a couple of other tips that you can give to those folks that are listening in on this interview that really stand out, that you’ve seen to be really effective in regards to winning more patients, increasing referrals, etc.?

Jonathan Govette:    Definitely.  Let me give you a couple of quick tips, and they’re definitely available on our blog, so take a look at it.

Scott Nelson:       Mm-hmm.

Jonathan Govette:    I want to give you a couple of scenarios.  Now, everybody knows Google is the king of search engines.  When somebody is looking for a service of anything from a plumber or a doctor, dentist, you name it, they’re probably going to go Google it first and do a little research about you.  And if they can’t find you, then obviously there’s a problem there.  I’m going to give you a quick tip on actually how to generate some exposure online.  One is called Google Places.  If your practice is not on that, please go to Google and type in “Google Places” and create an account.  What that allows you to do is create a localized account where if you do a good job you should be able to see your information listed potentially on the 1through 5 pages.

Your goal though is to actually move up the rankings because most people don’t search past the first page.  So I’m going to give you the second tip, is to, number one, create a great website that’s simple, no wall of text [00:32:50].  You don’t want to have somebody scroll three pages down to find information.  You want to have everything [00:32:56] bolted, very simple, colorful, large buttons for them to do things.  They’re called actionable items, so you want them to either call you or email you.  Those are the only two things you really care about, because once you talk to them, obviously, you can sell them your services and what you offer.

And what you need to do in order to rank up on Google quickly enough, you need to write amazing content, which means in the form of a blog.  And what type of content you want to create is how-to guides, how to do something that your patients may not know.  And it could exercise, it could be how to eat healthy, but you want to write at least one to three articles a week, and you’re saying, “Oh my God, how do I that?”  Well, your staff actually has some good skills.  I recommend bringing them on board or you can a hire, a third-party firm, to help you write content as well.  What that allows you to do with Google is once they see that you have more valuable content than your competitors, they’ll slowly move you up the rank.

Now, this could take six months, it could take 12 months, [00:33:56] but it could be the difference between only seeing 20 patients a day to maybe seeing 50 or more.  So you actually double or triple your annual revenue by doing this simple tip, and for most practices that could be hundreds of thousands of dollars, if not millions.  So, I recommend that.  And there are some articles on our blog that actually teach you how to do that, and we’ll be happy to show you what those are if you call us or email us later.

Scott Nelson:       Gotcha.  Okay.  So there you have it, there really quick ways that you could probably implement right now.  And to your point about writing content, I mean there are a number of services that I’ve come across in the past probably six months that I wasn’t aware of that you can outsource…

Jonathan Govette:    Exactly.

Scott Nelson:       …that blog, sort of, that written content, at a relatively inexpensive cost, really, when you think about it.  And then maybe you can have someone from your staff go back and edit it or add some additional content to that existing piece.  So, good stuff.  Google Places.  Make sure your website is simple, with actionable items that are big and very clear.  The idea would be to get people to email or call you or get patients to email or call with questions.  And then make sure you have good content, so you can rank high on Google.  So three quick marketing ideas from Jonathan Govette with ReferralMD.

And speaking of that, you mentioned earlier, but getreferralmd.com is the website, and I don’t have a pull-up in front of me right now but you have a Blog tab I assume, and I would encourage everyone to go check that out if you’re interested in trying to win more patients and little tips like the three that Jonathan just mentioned.  There’s some really good content there.  You are heeding to your own advice, right? [Laughs]

Jonathan Govette:    I do it every day.

Scott Nelson:       Yeah.

Jonathan Govette:    I write content almost on a daily basis.  The real quick fourth tip, which I’d recommend to everybody watching, is how to use LinkedIn to market your practice.  There are some amazing tools on there.  I made a little video that you can watch on our blog.  What it allows you to do is broadcast your message out to millions of people instantly without paying a dime.

Scott Nelson:       Okay.

Jonathan Govette:    Just a little quick tip. [Laughs]

Scott Nelson:       Gotcha.  Okay.  There you go, LinkedIn.  And actually I remember that that’s one of the more popular posts on your blog.  Now that you mention that, I remember seeing it.  So, good stuff.  Let’s circle back around to ReferralMD.  The one thing that I’d like to ask you is the chicken and the egg syndrome that seems like a lot of startups, especially when it comes to technology, have experienced this sort of issue, but the chicken and the egg syndrome with you is that if your platform is for both the referring physician and the receiving physician.  Do you run into that a lot?  And how do you tackle that issue?

Jonathan Govette:    Actually, we don’t.  We’re very fortunate that both parties understand the problems with the current system.  They both spend almost the equal amount of time maintaining the referrals on both sides.

Scott Nelson:       Okay.

Jonathan Govette:    And unfortunately they’re one way only, so if one person updates one side of the referral, the other side is left out in the dark.  So we’ve actually had no problems.  In the last two months—we launched our website April 1st, around there, so about 10 weeks later we have already had 100-plus signups from major organizations.  I mean, I’ll name a few because they’re okay with it – [00:37:03] Harvard Med, MD Anderson Cancer Center, [00:37:07] Pittsburgh EDU, and numerous other large facilities, clinics, hospitals, imaging centers, laboratories, etc.  They all understand the value.

Scott Nelson:       Right.

Jonathan Govette:    So the benefit is, regardless of who signs up, our system will allow the sender, you can actually log in without having any contacts at all and still send a referral to somebody.

Scott Nelson:       Okay.

Jonathan Govette:    And then once they receive it they can log in, they can review it, actually work with you, and then once you reach a certain usage, then you actually start paying for it.  But you can use it for free forever up to 10 referrals a month.

Scott Nelson:       Okay.

Jonathan Govette:    And then once you start liking it and you start using it more, then you can upgrade to a subscription later.

Scott Nelson:       Gotcha.  And I have to think, as more hospitals begin to acquire physician practices, this would be a good tool just from an analytic standpoint in understanding this physician that we acquired a year ago, how many referrals are we losing outside of this group to a competing hospital or something like that versus the referrals that we’re keeping in-house.

Jonathan Govette:    That’s actually a really good point.  For example, Sloan-Kettering, their marketing director Joe, he’s working with us, his main goal is obviously, how do we track—they’re spending millions of dollars a year trying to acquire new patients.  They have no idea really in analytics to understand that yet, and with our system they could do that.

Scott Nelson:       Mm-hmm.

Jonathan Govette:    Another system, a real quick point, and this is for small practice.  If I’m a small practice and I’m sending a majority of my referrals out to, let’s say, a dermatologist, and I, let’s say, sent them over 500 last year, in my mind I know how much each of those referrals are worth to that person.  You know what?  With these analytics, maybe I should actually hire my own dermatologist for my own office so I can capture the revenue.

Scott Nelson:       Sure.  Yeah.

Jonathan Govette:    Most people don’t think about that.  Now, with our system, you can actually track and understand what types of referrals you’re sending and whether or not you want to monetize them or just continue sending them out to the people that you already work with.

Scott Nelson:       Yeah.  That analytics component, the more I think about it, the more I hear you describe it, that’s almost got to be one of the most beneficial aspects of this system.  And obviously there’s a lot of efficiency that you’re creating, not just efficiency but obviously the system becomes a lot more efficient, but the analytics component has got to be huge.  And so many times when I’m conversing with physicians, they don’t understand that component.  It’s like I’m confused a little bit because when you think about the patients they’re dealing with on a daily basis, they’re doing all kinds of diagnostic tests, and that in a sense is a little bit like analytics for that particular patient.  They’re seeing how that patient’s doing and how their disease is coming along and other symptoms better, etc.  I mean, in a sense it’s analytics, so why not apply the same sort of concept to your own practice?  I don’t know.  It seems like a lot of physicians miss out on that, but it’s got to be a huge component to your—a big aha! sort of thing once…

Jonathan Govette:    It really is.

Scott Nelson:       Yeah.  Once people get involved with it.

Jonathan Govette:    Well, it shocks me that, I mean, in most practices referrals could account for 40% to 70% of the revenue, yet that’s one area they don’t even track.

Scott Nelson:       Yeah.

Jonathan Govette:    And it could be so much more improved.  That’s why our reporting that we have is actually pretty extensive, and we have plans for a lot more in the future, too.  We’re actually getting a lot of results, or feedback, from the people we’re working with now.  They’re amazed.  They’re like, this is like money, which it is.  I mean, really, it boils down to understanding your practice, understanding which referral partners are beneficial to you, which ones aren’t, and how do you pivot anytime something goes wrong?

Scott Nelson:       Sure.

Jonathan Govette:    So if somebody’s not referring over time, well, A, you want to try to fix that, maybe take him out to lunch or call.

Scott Nelson:       Yeah.

Jonathan Govette:    If that doesn’t work, you switch over to another cardiologist, for example, that actually gives back or helps you back.

Scott Nelson:       Yeah.  Right.

Jonathan Govette:    And now you can actually track that relationship.

Scott Nelson:       Yeah, and you mentioned this earlier, I mean there’s a lot of marketing folks that work for specialists that will go out and, you know, and I know one guy in particular that I actually work with and he’s great, but the problem without some sort of system is that it’s really hard to major, you know?  It’s damn near impossible to major, really, unless you have a system like this that can track where these referrals are going to and coming from.  No, that’s cool stuff.  As we kind of conclude here, anything else that stands out in regards to your platform or the space that you’re operating in that we missed or didn’t get a chance to talk about that you’d like to at this point?

Jonathan Govette:    I think we did a really good job.  Good job. [Laughs]

Scott Nelson:       [Laughs] Pat ourselves on the back, right?  No, that’s good stuff.  I mean, I’ve got a whole list of stuff that we could’ve got into but for the sake of time, and I know the short attention span, I want to definitely try to keep it as brief as possible.  But definitely, I encourage everyone to go check out getreferralmd, G-E-T-R-E-F-E-R-R-AL-M-D, spell just as it sounds, getreferralmd.com.  Check out Jonathan’s platform, and really, check out that cost per referral tool that I think is under the Tour tab, if I remember correctly.  It’s really a cool tool to get an idea of how much referrals are costing in terms of time, etc., that kind of thing.  So, definitely, definitely, check that out.  And also check out Jonathan’s blog.  There’s some great content there as well.

So, Jonathan, as a last sort of question for you, any, you know, one or two pieces of advice that you’d give to the folks listening?  Obviously, they’ve listened to this interview, so they’re fairly ambitious.  They want to make a difference in whatever capacity they’re in right now.  So what one or two things would you leave for them?

Jonathan Govette:    Update your website weekly.  If you really are serious about getting more patients or helping the patients that you currently have, update your website daily with great information and keep them coming back because, number one, that means they’ll refer more business to you, and number two, Google will love you and rank you accordingly, and you’ll make more money that way as well.  So those two things, do that almost weekly and you’re going to do wonderful.

Scott Nelson:       Gotcha.  So be persistent.

Jonathan Govette:    Exactly.

Scott Nelson:       And I think you’d agree that it does take some persistence for sure to keep that bad boy updated, but it’s well worth it in the end.

Jonathan Govette:    Oh, it does.  It’s a workflow you have to maintain and put on your calendar if you’re not good at scheduling, and make sure you have a [00:43:31] log-out time every week, or every day if you can.  And then lastly, go ahead and sign up, we’re actually entering beta relatively soon.  We’re actually hand-selecting people that we’re working with to go into beta, so go ahead and click on “sign up” on the top right-hand corner of the website and enter your information, and we’ll contact you personally with a phone call.  And if you missed anything about this interview, feel free to ask me in person, I’ll be the one calling, and you can ask me any questions you want and I’m glad to help you out.

Scott Nelson:       Gotcha.  Cool.  There you have it folks.  You can call the founder, Jonathan Govette, personally if you have questions.  There you go.  And call him quickly before this blows up too fast, right?  [Laughs]

Jonathan Govette:    Once we get to about a million users, it’s going to be a little hard to return too many phone calls, but I’ll try.

Scott Nelson:       That’s right.  That cell phone that’s in your email signature will disappear. [Laughs]

Jonathan Govette:    I’ll try it to keep it on there as long as I can.

Scott Nelson:       That’s right.  Well, good stuff.  Thanks again, Jonathan.  I’ll have you hold on the call here for a second as we conclude, but thanks again for jumping on.  I really appreciate it.

Jonathan Govette:    Perfect.  Thank you.

Scott Nelson:       Alright.  There you have it, Jonathan Govette with ReferralMD.  Make sure to check it out.  And thanks everyone for listening.  Really, really appreciate your attention.  And again, I always want to mention this at the end of the interviews, if you’re looking for  a really easy way to consume the content from these interviews, go to iTunes, do a Medsider search, M-E-D-S-I-D-E-R, on iTunes, subscribe to the podcast for free, that way all the new interviews will be downloaded to your iTunes account for free.  So if you’re on a drive, if you’ve got some time on a subway or train or wherever you’re at, if you’ve got some extra time, you can catch up on some of these interviews.  So there you have it.  Thanks again, Jonathan, for coming on, and until the next episode of Medsider everyone, take care.

[End of Recording]


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