#407 Christoph Lippuner from Semble: What does it Really Take to Build Healthcare Software That Works?

0:00James Somauroo:Welcome to the Health Tech Podcast. Here we talk about everything healthcare and technology and I'm your host James Somauroo. Hey everybody, this week I'm joined by Christoph who is one of the co-founders of Semble which is a practice management system and an EHR. So Christoph, welcome to the Health Tech Podcast. How are you doing sir? Doing great, great to be on. Thanks for having me. long-time listener first-time caller I believe which is very nice so thank you thank you for saying that um I'm not gonna I'm not gonna test you I'm not gonna tell yeah everyone says it Christophe everyone says it when they come on so I'm not gonna I'm not gonna test you but I do believe you um listen great to have you on um yeah did I remember jumping on a webinar with you guys actually and since then I've been following what you guys are up to and I think it's really it's really interesting being an EHR in the world of AI in a time where you're clearly faced with so much opportunity for what what the technology can do what everyone's expectations are there's a huge amount you can do for being a connector and a communicator dare I say the word interoperability and sitting in the center of lots of things so there's loads that we can talk about and there's loads that I'm looking forward to talking about with you but first of all it'd be great to learn a bit more about you because you don't actually have a healthcare background which is interesting and so I always like chatting to people without a healthcare background because it's fresh eyes and people tend to look at the space very differently and very uniquely and that often ends up being their advantage so with that in mind um it'd be great if you could tell us a bit about your story and do start from the beginning and give us more of the long version sure thanks james and as you said i uh we came in this very green my co-founder and i and um i barely knew my gp uh and here we are today uh with sample but um maybe a bit uh as you asked about my story um i don't think i was set out to be an entrepreneur, I was always driven by the creative act, by creating.

2:21And so I think essentially in entrepreneurship, I found a way to blend my passion for the creative act with the sense of purpose. And so that's probably what, in my view, got me there. So I grew up in Switzerland and Geneva, hence my accent. And it sounds a bit cliche, but when you grew up in Geneva and Switzerland, you either become a lawyer or a banker. I guess for me, it was the banker career. I went to business school in Switzerland, and then I joined an investment bank, an American investment bank, JP Morgan. And my dream, and I think that's probably where I also got my first lesson on my path to being an entrepreneur.

3:07My dream was always to be a banker in New York. I guess I just something that as a young boy, I wanted to achieve. And I moved from so when I moved from London to New York, I essentially realized that dream demystified it as well, realized that it wasn't something amazing. But I really learned that you can achieve your dreams and that whenever you set yourself to do something, you can actually achieve it. It's funny because there's an element of, I talk a lot about it also in the company, the power of visualization. And I do remember, it kind of maybe sounds a little bit cliche, but I would actually go to bed and visualize myself as a banker on Wall Street.

3:59and it's extremely powerful because uh you're actually there's a lot of studies have been made and we're not going to digress but uh your um uh neural pathways is essentially you actually feel the same as if it's happening and so it makes your ability to achieve those goals much higher

4:19James Somauroo:it's really interesting actually just on that sorry to interrupt you but just on that the that the neural pathways mimic actually doing the thing it's one of the reasons why people often love talking about the business that they're going to do one day but never actually do and they talk about it so much or they talk about the problem they want to solve or they talk about being the it's why people get stuck in that part because they get so much whether it's dopaminergic pathways or just whatever it is but pure joy from actually just talking about it rather than ever ending up doing the thing because that's where the pain starts coming in where it starts not actually working um it's just far easier to get stuck in the i'm just going to talk about it phase but it's the same it's the same thing actually that actually visualization is clearly or manifestation if uh if you want to go down that route but you know that's that's the way of actually getting inspired to do it I guess it's powerful and you know I often sit there I often get caught actually because sometimes with the goals that I have I I don't actually believe that I'm going to make it and I've even been guilty of apologizing for even where I am now you know even the act of you're not from medicine although you're from banking which I imagine is you know probably equally difficult to leave particularly well for very different reasons I imagine golden handcuffs and all the rest of it but I think it's it's so so difficult to leave medicine and I often attribute it to luck and I often attribute it to being in the right place at the right time or to just to various different things and I never like this I fall prey to never believing that I can actually do the thing and when I do the thing it's like I can I can explain it away for lots of other reasons I could definitely be better at this is what I'm saying I think I from what from from the stories you've just told it has inspired me to actually think about this a bit more seriously and go if I am planning to do xyz in my life or achieve these things or get the exit or you know get to three million revenue whatever it is like I could actually do a far better job of believing that it's possible, I think.

6:37James Somauroo:But what made you leave medicine? What made me leave medicine? Yeah. There's the party line and there's the truth, which I've probably left long enough now that I can explore what the truth actually was. But realistically, there were push factors and there were pull factors, which I think that right now there are a lot of push factors. there are a lot of people pushing being pushed out of medicine by the conditions and the state of things where they are pushing them out what I had though was slightly less of those than exist now but I had far more pull factors pulling me out as well so yeah I had the the conditions weren't great I had the fact that it wasn't quite right for me for various reasons and therefore I was rubbing people up the wrong way the way that I wanted to practice medicine was perhaps slightly different to what was expected of me it was big system thinking rather than you know more individuality in the art of medicine and all that sort of stuff there's a lot of reasoning there there was also some quite specific stuff around intensive care like I didn't like it for various reasons it was the only part of medicine i could end up being in anesthetics and itu because it was sort of the rock and roll end of medicine it was exciting it was very practical it was a complexity issue not a volume issue i liked it for all of those reasons um the problem though was that i think the way that that type of medicine is practiced just i didn't there's so much i didn't agree with and did and felt powerless to challenge it and so that created a load of frustration I started acting out I started like you know disagreeing with people quite publicly about the way people should be treated and it just I wasn't right for the system and I certainly wasn't right in everything that I was saying either it was just how I felt at the time but I've always been very very introverted but very expressive and I'm extremely expressive despite being an introvert when something matters to me and I feel either strong morally or particularly around areas of injustice so I often speak up incredibly loudly against things I don't believe in when they don't affect me and they affect someone else so when I see people being treated in intensive care in a way that I don't think is congruent with the morality of you know me or how I feel I'm disproportionately loud about it you can see how that just does not fit into a system of medicine that is just trying to get through the day when I'm trying to have very moral and philosophical conversations about are we even doing the right thing here and so I ended up being pushed out for that I guess one you know that being one of the main reasons but I love tech I loved solving problems I love solving problems in the system I was so big on quality improvement and so I ended up learning to write business cases learning finance learning all of those things and and the joy that I got from seeing a big thing unblocked in the system was far greater than the joy that I got from seeing a patient actually turn around and start getting better or be discharged or step down into better into different care in the hospital I worked like I got more joy from from like the one-to-many model of I've solved this thing which will now exist in perpetuity I got yeah disproportionate my joy from that so I was pulled into the world of writing business cases and learning finance and learning the technology and speaking to tech companies and helping those tech companies with their sales meetings and helping those tech companies with their pitch decks and their websites and the way that they were talking to people in medicine and so I ended up being like a comms consultant without really knowing it and that led to everything that I'm doing now.

10:30James Somauroo:So a very long version of what I should have done and much quicker for all the people I've bored listening that have heard that a thousand times. But that is the answer. Yeah, it's really interesting. And thanks for sharing. I think a lot of the stuff that you said resonates with me, including the introvert and loud part. Interesting. When you see things that aren't right. And I love the fact that you mentioned about this longstanding impact. And I think some of these elements are what drove me to start Sample. So yeah, I can completely relate to that. It must be hard leaving banking though. Like leaving banking where you're obviously, you know, unlike medicine, you're well paid.

11:16James Somauroo:You're probably quite, you're very comfortable financially. You're very comfortable in what you're doing. You've got status. You've got a lot of things there that you must have felt like to then like, you know, go and solve a problem in healthcare where you're starting a business from scratch and all these different things like that that's a that's a wildly so you must have felt like a fish out of water too right like there must have been things about that environment that were pushing you out as well as pulling you into you know solving problems yeah i think yeah 100 and a fish i'm a pisces so i'm a dreamer and um and so yes i think that for me once i as i said once i demystified the ultimate goal I wanted to achieve at that time, which was being a banker and doing big mergers and acquisitions on Wall Street.

12:03Once I reached that, I was like, okay, what's next? This doesn't really, it was a great journey, but it's not fulfilling anymore. And I really wanted to find something that kind of gets that fire back. You know, I think, why do I love the creative act? is that there's this fire burning inside you. And it's amazing. You go through sleepless nights because you're obsessing about what you're working on. And I'm a bit obsessional. But this is, and I was missing that. I went through this really interesting journey. I learned a lot. I think a lot of the stuff that I learned was really helpful as an entrepreneur.

12:47I think probably number one is that you learn the ability, you get the ability to look at complex situation and really extract the key elements out of it. And you kind of decompose complexity into clarity. And I think that this is probably beyond also the fact that it helped me understand much better how businesses work and the finance part of things. But I think that's probably what it taught me. And so I moved back from New York to London. And, well, I forgot to mention, New York was a blessing. I spent five amazing years. Also, it was fun to be in New York. But I met my co-founder, which was a really important event.

13:31He was a friend. So we got introduced through Common Friend, and we became friends. And so we've been friends before being co-founders, and we're still friends. And I think, to me, that is a huge success to be able to still call him my friend. And we just did a little trip two weeks ago. We went to San Francisco, just the two of us, to go to Sastr. And it was just so nice to spend that time with your co-founder. What's the key to keeping a friendship and a co-founder relationship both? I think I thought a lot about this. And I think it's segregating the different roles, right? Outside of work, we're friends and we try not to talk about business.

14:18and we kind of have the same circle of friends. And at work, it even gets more complicated because at work we're co-founders and we are CEO and CTO. So we have three relationships that we have to deal with. But I think what really got us to keep that relationship as co-founders and as friends is we're very... We're capable to see when we're wrong. Yes. And, you know, that self-awareness bit is really, really important in my view. And to admit when we're wrong and tend to move on. Yes. And I think that combined with the fact that we have, we disagree on many, many things. And we have our kind of, you know, arguments.

15:07But when it comes to long-term view, vision, values, we're just the same. and so I think that helps a lot.

15:16James Somauroo:I really like that because my co-founder is my wife which is thwart with some of those same complexities that I mean I think that the knowing when you're wrong and the ability to admit when you're wrong is so unbelievably important and kind of an extension of that is also just I think it actually helps us with the speed that we can go because we have this underlying incredibly consistent and unwavering empathy for each other and and and us and our situations because because we know each other and we love each other independent of the business we know each other so well that actually i know what jess is going to disagree with me on so i can already come at this in a very different way in an understanding way trying to explain my position more differently and and i think people often talk about oh you must you know you they sort of intimate oh you must argue all the time i don't know whether you get that as like oh we're friends i'm a co-founder it's like people always assume oh you must argue all the time must be horrendous you must have a terrible relationship etc but like really i think it just increases the speed i can imagine it's same if you're best if you're you know really close friends or best friends you know like it that the speed that you can go i think is much greater and i think the benefits way like far outweigh the the drawbacks if you are very close friends and the element of trust right i mean i think is is so fundamental um yeah it's trust it takes a long time to to trust someone and we go back here so i think that that was that was fundamental but yeah in that sense those five years in New York were instrumental in my building of entrepreneur career and when we so yeah so when we so when we moved back to London he actually moved back to London as well he couldn't live without me I guess can you blame him Christophe honestly no yeah of course but it was reciprocal so um in case he's listening to to the podcast but um uh the so came back to london still with jp morgan just didn't have the fire anymore and i knew when i met michael so that's my co-founder that i had found someone that is very complimentary to me and it started to it was almost like a seed that started to grow and I was like okay I always wanted to do something different and actually if I ever think about launching a business he would be a great a great co-founder and so fast forward we we started to we decided to to start a business I my wife-to-be was pregnant at the time which was amazing because that was the beginning of our first story so when we the first business we started wasn't in healthcare it was in food tech and we didn't know much about being entrepreneurs to be honest it was it was pretty it was pretty bad I mean we learned a lot I mean the outcome ended up being pretty good but we essentially it was a food takeaway app and it was basically pre-ordering food with quick service restaurant And there's relevance to the story here.

18:46And it was loyalty and payment. And I remember, because you talked about status of banking, I remember the first restaurant, quick service restaurant we launched with was a salad bar in Canary Wharf. And my former colleagues were working in Canary Wharf. And the first week when we launched, I was sitting on the floor in Canary Wharf. I went from a corner office in New York to sitting on the floor in Canary Wharf with my laptop. Michael next to me with his laptop. And actually we were because we hadn't developed yet the direct printing because what we needed to do is print the orders directly in the kitchen in a small kitchen printer.

19:27But we hadn't developed that technology yet. So we put like a big Samsung printer in their kitchen, in their small kitchen. and whenever an order would come in, I would copy paste it onto a page, onto a word and I would send it to get it to print. And that's, you... And you were happier, right? It makes you humble. Were you happier doing that than in your corner office? Oh yeah, we loved it. That's it though, isn't it? We had 20 orders and we thought we were the king and we went to have like drinks at a fancy hotel that cost us probably more than... Yeah, then you made that day. Yeah, absolutely.

20:04Exactly. And I still remember. And there's pictures. We have pictures of it. Oh, nice. It was amazing. And we spent a lot of time behind the kitchen as well. And so that taught me, look, if you really want to understand the complexity of businesses, because quick service restaurants are pretty complex organizations. They're essentially logistics business. They're not food business. It's all about logistics. And what we were doing is we were helping them to increase their output by putting a printer in the back and having more salad zone than just the counter facing. And so we realized that you have to really immerse yourself into a business to understand the business.

20:45And we took that away with us also when we started Sambl to spend time with clinicians, with healthcare professionals, understanding what they're going through because that's what we are. and then translating this into a product and into outcomes. So that was our first story. We ended up selling it to Just Eat. Amazing. Yeah, we were the first acquisition after their IPO. Wow. And I think that was probably another kind of aha moment on that journey. Interesting. So how do you go from that to healthcare? I guess there was an unfortunate event just when we were selling, at the end when we were selling Orogo, our food tech app, which was related to my mother.

21:33And I'll go through the story, but essentially Semble really kind of was born out of empathy for healthcare professionals. And you mentioned empathy before. Empathy is so important. and again spending time with the people you serve creates that empathy but my mother had cancer a few years back she's fine now but it was a pretty traumatizing journey and and it was obviously traumatizing for her the family and myself and I was thinking about what has gone wrong how come did it get to this could it have been avoided by the way my co-founder at that time had a very similar different condition but also similar situation with a family member and so we started to look into health care and felt like we wanted to get involved in health care because diving into into health care and understanding how health care professionals work we kind of saw a pattern first the immense pressure that healthcare professionals are under i mean it's we probably one of the the the learning points of this is i underappreciated the amount of pressure that doctors and their teams are under on the daily basis i mean there's an old saying that says if you can't be god be a doctor the level of expectations that come with They are huge.

23:09And the pattern that we saw is that on one hand, you have a huge amount of pressure and they're dealing with antiquated systems. And those antiquated systems are working against them and essentially are leading to situations that could have been avoided, like my mom's cancer. She should have been screened earlier and all that. But instead of blaming, we try to look at what can we do? How can we get involved to actually change the situation? and make a long-standing mark, as you said before, and actually trying to avoid as much as possible a situation like this. There's a crazy stat, which is pretty commonly known out there, but healthcare professionals spend up to half their time on their systems, and yet their systems are not fit for purpose.

24:03And so for seeing a patient for eight hours, you spend eight hours going through your system. There was an NHS study that was recently released where they mentioned that over 13 million hours are wasted on a yearly basis, just rebooting machine and waiting for pages to load. I mean, that's between 20 and 30 minutes a day per doctor.

24:24James Somauroo:As you say it, you know, I think back to being an F1, like a first year junior doctor. And, you know, you just mentioned something there, which sounds quite trivial, rebooting computers. The amount of times I had to reboot a computer every day because it was slow, it crashed. and by the way this thing took you know between four and seven minutes to reboot anyway and i need to get onto that because i need to write the discharge summary because i need to clear the discharge summaries because they're piling up in the doctor like all of this stuff is is it's it's so frequent and common that you mentioned empathy and understanding and this is where you know being from outside health care i think actually matters because something like saying oh we need to reboot the computer too often like you'd be a mixture of sort of like yeah that's obvious and sort of laugh that if you if you try to consider that as a serious problem or try to escalate that internally of like we're having to reboot the computer too often you're like you're joking you've got patients dying like they'll they'll they'll minimize it for various reasons or like it's interesting though that you know for an ex-banker that spends a lot of time on an incredibly fast computer you you can actually just identify that quite quickly like why having to reboot the computer so often that's ridiculous that's ludicrous why are you still running on windows 95 or 98 that's ludicrous a genuine fact that these things are still happening so like it's um it's it's amazing for for you know the way you've approached this conversation even of I feel like you're being quite empathic towards me in my previous situation I feel actually seen and heard and understood and I can only imagine that when you take that feeling that that empathy that you have and actually genuinely apply it to people that are going through this I imagine they're quite receptive to you and they actually end up sharing quite a lot with you about of things that could be solved yeah uh yeah and i think when i look back we we launched in in 2018 that was a time where healthcare professionals didn't get so much attention from the tech industry and so all of a sudden i don't know what they were thinking but they were opening the doors because all of a sudden there's two guys that have no idea about what healthcare is about but want to make a difference and want to understand what they're going through and what to understand.

27:03And all of a sudden, they felt very, on that part, very validated and heard. And I think that sense of empathy, we still today, we try to keep it very active. So now we have doctors on the team. But until very recently, we didn't actually have doctors on the team. And it's about constantly being out there with doctors, considering them as product co-founders, and knowing that they know, right? Our job is to understand their pain and then to translate it and basically translate it into features and outcomes that will deal with it. I think one thing on that journey in terms of empathy that probably not being a doctor was initially i mean there's probably many but one that i can identify which was probably initially a bit of an issue is that you tend to come into situations like these and say it's unacceptable and this is what we can do and this is the efficiency you can get absolutely and you know it's not about efficiency at some point right and when i think about the stories of users the ones that actually i'm more excited about that give me goosebumps aren't the ones where hey i increased on a number of patients, they're already drowning.

28:17What they want is just some more free time, right? It's stories like we had someone the other day who said, and probably the EHR is not the only issue, but she said, look, she works with a parent and their relationship had soured because they were drowned in paperwork and the level of stress that they had to go under actually has created this kind of break between the two. And since I've been using a system, and not plugging, but since they're using Samble, I guess I'm plugging, they managed to have time again and restore that relationship. And I think those testimonials are so powerful because, of course, it's about efficiency on the macro level, but ultimately it's about giving humans something and very important humans right the ones that look after your house giving them a tool that they actually gives them amplifies their impact gives them gives them leverage and somehow maybe is also enjoyable to interact with and so yeah so that's

29:27James Somauroo:that's what we try to do yeah i like that so solve the problem and then bring joy those are two different phases and and often people don't get to that second one i think people you're right are obsessed about solving the problem and actually to make something again we're getting into the more techie side now rather than the healthcare side but actually to make a product very sticky if you are able to bring joy i always come back to this example right like if i tick off what is it five or six tasks in asana it will just spray a unicorn across the screen with like a rainbow coming out of his backside.

30:01James Somauroo:I'm like, I remember the first time that happened, I was like, oh, that's cute. And then like, just dying to tick off tasks now, because like, I'm going to see a unicorn with a rainbow coming out of it. And it's like, these are these little things that like, when you're building a tech platform, it doesn't have to just look like a dull Excel spreadsheet. Like it can, it can do things that make things joyous. And that can have utility. It's, it's, it's, it's fine to come along and say, I'm actually just going to brighten doctor's day by like doing this thing that's completely unscalable and the cfo finds annoying because it just adds a few pennies on the pound but actually i know it brings a load of joy and actually do you know what we're going to get a lot more on the other end because of it or whatever but i think that's super interesting anyway before we go too too much further into this let's talk about symbol so explain what symbol is then now um or actually what was the idea initially and then what is it now and what's what are all the things you're helping with now and we can talk about some of that?

30:58Yes, so the idea and the vision has always been kind of the same of coming up with a solution that will allow healthcare professionals to spend more time with their patients, something that's very easy for them to use and that gives them the information that they need at the time of when seeing the patient. And so that's always kind of where we started. I think we started with the EHR bit and I'll talk a bit briefly about what Semble does, but we started it was the I guess we had a vision about structuring medical data and again we didn't come from a medical background but we thought okay you know if we if we find ways to structure medical data it's going to be super useful for doctors because it's going to make data more visible more informative and it's going to be also a way for healthcare professionals to uh to run a lot of analytics on it and very quickly we realized okay they're interested in the data but what they need is scheduling they need uh invoicing they need you pull that thread yeah and so exactly and so we ended up so sometimes i jokingly say we we got into this because we wanted to save uh the world healthcare world with medical data and we love doing a super uh fancy scheduling system but it's it's a it's a it's a broad solution and so kind of looping it back to the story our personal stories it was about really getting healthcare professionals to have access to that data but then also it's about creating the bridge between healthcare professionals and the patients and I think that's also a really important element in our journey is like how can we how can we involve patients more into the healthcare conversation and I think if all the way to preventative care looping and and giving empowering patients is super important but But what is Semble?

32:48So Semble, it's a healthcare platform that, as I said, automates workflows and connects healthcare professionals with their ecosystem. So it's about the efficiency bit and the enjoyment bit, also having a tool that really works and that takes away a lot of the pain. But it's also addressing a major issue, which you mentioned in your intro, which is the lack of interoperability. And in terms of just the what, and you did mention it as well, we are essentially a solution that covers everything that you need as a healthcare organization, from scheduling, documentation, billing, patient engagement, analytics.

33:29I think you said something before, which is really interesting about the tech and the behavior thing. I can't remember, I just had it in my head. But ultimately, what we realize is you come with a solution, there's a tech, and we can talk about AI, it's the same, but ultimately it's what's going to drive the adoption is the change in mindset, right? And so when we talk about the lack of interability, I think one thing that we've seen is that changing to a more connected healthcare world is also creating a culture of collaboration and trust. It is interesting because it's in some ways, and we also launched in France and we see it there as well.

34:17It's an industry with a siloed mentality when it comes to providers. And that's what we try to break down is your moat as a provider should not be holding your healthcare professional hostage to your closed systems. Ultimately, you're penalizing the patient. Your moat should be speed and adapting and staying relevant in the journey of improving healthcare. and so for us that element of being really collaborative and being an open system and essentially bringing interoperability into healthcare is a key key part of our of our

34:54James Somauroo:vision of how we can improve healthcare down the road okay so it's a system that as you say automates workflows it goes in and does scheduling billing documentation all of that stuff because as you say as soon as you start pulling the red thread on one of those things you realize that it's all interconnected with each other when you then say it's you know breaking down silos and all of this type of stuff just really practically then what where where is this sitting in an ecosystem of say say you've got a hospital group and that's connected to primary care because they refer in where is your system sat and what is it doing in that whole ecosystem it's really interesting the example that you take um we're versatile solutions so on the on the you can imagine on the gp side or even on the consultant side they will be using symbol right right everything and symbol connects to the hospital so that's for instance a case that we have or cases that we have where it connects symbol connects with the paths of the hospital right and so it makes for instance booking a room if you're a let's say you're a gastroenterologist and you need to do an endoscopy you need to send your patient into a hospital you're gonna you're gonna do an endoscopy on that patient you can book the room um you can uh out of symbol because it communicates with the hospital system if you do a biopsy the information is going to come back from the hospital system into Semble.

36:31And so basically you have a very, very comprehensive data set around the patient. So that's one use case. And other use cases that we see is we work with large cardiology clinics. They will use Semble to do everything and then they will build, they might build their own patient engagement solution because ours is not specific enough. And they use the API to basically connect their solution with Semble. And then what we're seeing, you talk about hospitals, it's interesting, what we're seeing more and more is on the outpatient side of things, hospitals are becoming a different type of organization.

37:15I mean, they become way more complex. It's not just that they're acquiring GP businesses, they're acquiring maybe physio businesses because they want to get closer to the source, to the patient. And all of a sudden you end up being this big organization that has multiple services and multiple systems. And so Semble, the way they think about Semble is to use Semble to connect, to do a lot of the stuff that they need on the outpatient side, but then also to connect the different systems and different parts of the hospitals that they want to keep. so for us it's not about it's not about it's not about us it's about how can we come in and bring agility and bring a tool that's adaptable to your own workflow as a healthcare organization

38:07James Somauroo:and that's ultimately what we're trying to do yeah because you're not imposing a product on them you're not imposing a way of working on them you're saying here's what you've got going on do you want to just connect it all and here's a single front end which makes a lot more sense now what's going to be going on in a lot of people's minds that are listening that know about this stuff is they're going to go okay that that might have a uk mindset anyway they'll go okay so that's this is clearly in the private sector right because there's there's absolutely no way that you're getting into any nhs systems and creating this anytime soon or at least overnight that's not going to happen although you know I've been led to believe for the last 20 years that's the direction of travel so I'm interested in in that bit I guess I think you're clearly global you're clearly doing this globally and it's thinking about a small scale private clinic single entity this seems relatively straightforward they'll go okay cool we've got these three systems it'd be great if they just had one front end you'll go in and do it and then as the private healthcare system it gets larger okay yeah we need to connect into these hospitals and they might have it and then the whole ecosystem they bought and all in the private sector whatever do you do any work in the public sector like how is it private versus public how do you think about it do you see this as how i often see the private sector is if we can prove it there if we can prove the model we can prove that something can then actually be used in the public sector it's been rigorously tested with people that can take the hit on margin so that we don't have to make our mistakes in the public sector is this something that you eventually see jumping over in that regard like how do you view that whole conversation yeah so we we obviously we'd love to get involved in the nhs and there's some ways that we already getting involved in the nhs you you've seen the announcement of of the nhs about decentralization of care community care and the nhs has is obviously dealing with supply demand issues and has been using also the private sector for some parts of of elective care and so we've been powering some of these some of these organizations on the private side that actually do work on behalf of of the NHS and we do work with community care and I think the the again the comment around interoperability and connected care becomes so relevant when we talk about community care right the decentralization of care promoting health equity and all these things but so when you uh thinking about the nhs um we're at the beginning of that journey so definitely for us at some point we'd love to get involved in the nhs we're seeing what the nhs is saying what the nhs is doing also see that the blurring of the line between the nhs and the private sector is increasing.

41:06Very much happening, yeah. Right. And so I think that the collaborative, and this goes back to culture of collaboration and kind of understanding that in an ecosystem you need different providers and you need a solution that's holistic.

41:24I think that at some point there is going to be an increased need for solutions that are connecting different parts of the healthcare system. And so we're staying on the line. But as you said, we've seen, look, we got into this with Michael. We didn't know healthcare, but we knew one thing is we saw health tech companies going into the NHS and struggling. And to exactly the point that you said, we said, okay, let's go into the private sector. Let's see whether we can make it. But let's keep in mind that ultimately, as also a mission-driven company, that the NHS is something that we want to go after at some point, 100%.

42:04James Somauroo:Completely. You've built a business, you've exited it, you understand the fundamental dynamics of how to run a business. If you go back to first principles, it would be ludicrous to build a health tech business and approach a potential customer that has no ability to adopt that tech. that makes absolutely no sense and so to then go and build the business and make your mistakes and you know refine everything in the private sector whilst it becomes ready it being nhs it has to become ready to accept this but there is still clear value being created from you understanding and knowing the private sector and how that works which can obviously be applied into the public sector when it becomes ready and i think that's the thing that you're right about the lines being blurred and you know there's there's interesting new layers of healthcare coming in now of like these kind of micro payments for certain things to skip the queue like 50 pound gp appointments in the private sector like but then you get referred into the public sector and there are interesting places where the prevention line is being blurred of like what what's expected morally and ethically with the other with the nhs budget on prevention where does that become like actually a social issue and you know education and housing and and food and all these things like all the it's so it's so blurred all these different things but ultimately you're right you need a mission you need a vision you need a purpose and an ability to communicate that an ability to execute it and you will go where healthcare is ready for you but there's no denying that value is being created with you helping those organizations because again there is no denying that whoever is doing this podcast or its equivalent in 200 years time there's no way they're going to be sitting here saying that healthcare is still so I wouldn't I'd hope not anyway but healthcare is still siloed things don't talk to each other like blah blah you'd expect the problem to be solved and it'll be solved by a company like yours once the NHS is ready I think that's the thing is that it's very easy to take a moral high ground of like oh well it's the private sector and you shouldn't do anything and you should all be focused on the NHS and blah blah blah like you're absolutely right when you looked at it the amount of people that I've seen in my very short health tech career I've been in health tech what 10-15 years like the amount of times that people have just banged up against the brick wall and then just fallen flat and gone out of business you know it it makes sense to have a diversified approach to how you're going to get revenue that is a first principle of how to do business that is not a moral position on what you think of the public versus the private sector and who deserves health care and who doesn't whether you believe people should skip the queue or not like it's not it's not it's not a commentary on that it's actually just building a business that stands to benefit a lot of people in future i mean that's that's my personal view anyway like i know i know that it's it's an emotive topic i think it's worth addressing one thing i wanted to ask about actually was that you mentioned the data set now the data set is super interesting because you're connected to so much like you're connected to so many different systems that clearly the data flowing through your system is of extreme value would be one way of putting it um how do you view that in terms of we live in a world of ai we live in a world where you know data is the new oil data is the new this etc etc i'm interested who owns that data actually as it flows through your systems and and whether you guys have license to use it or create anything on the back of it or and what you have planned in that regard because there's there's clearly a lot of opportunity you're well placed you're well positioned you see how different entities talk to each other both the organizations and the platforms themselves you must be very well positioned to have a real view on this sort of stuff and even just how do you see the future of this based on what you're what you're connected to but yeah data is the new oil question mark yeah yeah uh i guess so i mean i guess healthcare data has been uh there's been an accumulation of healthcare data over the years but yes indeed we kind of regroup a lot of that data so who owns that data it's the patient and and the healthcare professional the clinician the doctor so we we don't own that data right i mean And we store that data on behalf of our users.

46:58And so for us, it is about how can we safely, obviously, store that data? How can we structure that data, help them structure the data? And how can we make the data insightful for the doctors, but also down the road for the patients? And I think that's probably what we're really focusing on. We would consider that. But I think right now it's really about making sure that our customers, our users have access to their data, can do whatever analytics they want to do on the data, which, by the way, is really interesting. Since COVID, I'd say probably the level of interest that even smaller practices or individual doctors have on understanding their data, so not only the medical side of things, but the financial, the operational, is really interesting.

47:49The industry has really focused on the data, and I think it's a great thing. And so for us, it's to basically make sure that appetite for data, that they get fed the right data. And then it's obviously about data liquidity, which we use it with interoperability. But yeah, for us, again, this isn't about, it's never about, oh, data is the new oil, there's value to it, let's make money out of it. That's just not how we see business in healthcare and with Sample.

48:34James Somauroo:Where do things like the AI scribes and things fit in? Is that something that you would just help with an API for? Or is like, where would things like that fit into, or everything that's going on in AI at the minute? Like, where does all that fit into Semble? Yeah, so we see ourselves as a platform that integrates different solutions. And so we do integrate with an AI scribe solution. And again, it goes always back to what do our users want and what helps them. And so when we do this kind of integrations, we integrate them into the workflows and we try to make it in a way that it's very seamless.