Lonnie Rae Kurlander took a leave of absence from the Boston University School of Medicine with only eight months left in her program. Today, she is the CEO and co-founder of the exciting healthcare startup Medal. I recently had the honor of interviewing Lonnie and learning more about her experience transitioning from medical school student to San Francisco entrepreneur. Enjoy!
George: A lot of kids dream about becoming a doctor, but only a select few make it into medical school. What lead you to pursue a career in medicine?
Lonnie: I think I’ve always been a bit of a bleeding heart, so when I was younger, anything I thought of or spent my time on was something that I thought was for the good of others. When I was in middle school, I thought I wanted to be a clinical researcher, but then as I got a little older, I found that I really wanted to be involved directly with individuals. It was their story, their humanity, that compelled me. That is when I realized that I wanted to be a physician.
George: How did you get started?
Lonnie: I went to undergrad at Vanderbilt and was in the pre-med track. After undergrad, I went and spent some time in Ghana (via Projects Abroad) to better understand what healthcare was like in developing nations. I wanted to see how they were getting the very fundamentals of their health systems in order.
It wasn’t what I thought. There was a shortage of very basic things. In many cases, the hospital didn’t even have heart monitors. I think the thing that struck me most was that the hospital where I worked didn’t have walls or a ceiling in their surgical arena.
George: Wow. What an experience. What did you do after returning from abroad?
Lonnie: After I returned from Ghana, I went to Boston University School of Medicine. Part of why I liked Boston University was because their center for healthcare for the homeless. A lot of what I’ve worked on and a lot of what I’ve looked at has been focused around populations that are most in need. I’m always looking to make the biggest impact and the center was a great opportunity to do that. At BU, it’s part of every rotation, and a large portion of the patients that come through were directly because of the center.
George: How did your association with the healthcare for the homeless program impact how you look at medicine?
Lonnie: You realize that a lot of health limitations are social in nature; you realize that a lot of the things that affect people are the fact that they had to take three buses to get to you; you realize sometimes patients don’t take their medication because they’re in a homeless shelter and have nowhere to hide their insulin needles. At the end of the day, you’re treating human beings, and what it really taught you was to ask questions and to try and learn about what was occurring around the patient. I think sometimes that can be overlooked. It’s one thing with acute or trauma care—you have someone in front of you who is dying and you’re saving them and your impact is very black and white. But when you have people with chronic illness, I think so much of that is actually social at it’s core. The maintenance of that, the ability to sustain that maintenance and to have the support structures and the systems for actually dealing with it, and to deal with it well. I think those broader impacts on health can be overlooked.
George: Is it accurate that you left medical school with 8 months left in the program?
Lonnie: Yes, I had 8 months left. I originally intended for it to be a leave of absence. I wanted time to pursue this entrepreneurial venture. I was planning to come back but over time I realized that I had the opportunity of a lifetime to potentially affect many, many more people this way. I still believe in coming back, I still want to finish my medical degree, but I will do that once the infrastructure is in place to provide the type of care patients deserve. And that’s not a shortcoming of a single location, as you know at Redox, this is a national problem, and it is, therefore, our responsibility to put it in place.
George: Did BU have a specific entrepreneurship program for medical students?
Lonnie: No, there was no program. There was (is) an MD/MBA program, but there wasn’t a program in place for students to take time off to do entrepreneurial activities. I was the first there. From what I understand, there has been additional work done in that space now and there are many more medical students now pursuing these kinds of opportunities. There’s a program teaching data science, there’s a few other programs that students have started that didn’t exist when I was there.
George: I’m fascinated by this conflict between providing direct patient care in a clinical setting and the attraction of positively impacting a larger number of lives, albeit physically removed, by creating healthcare-facing technology. Is that something you think is going to be a growing dilemma that medical students face?
Lonnie: I think every generation sees the environment that they’re brought into and all of the things that are wonderful about it and all of the wisdom of the ages. I think they also have a freshness to them that lets them imagine how things could be even better. I think if you look back over the years, you see in every industry, in every group, the people who come in and bring fresh new perspectives. They accept the wisdom of the ages and of everything we know, which is remarkable—being able to save the life of someone who would formerly not have any shot… things like heart attack or sepsis, people who would have died and we’re able to save them. That’s a miracle! Now, we look at that with fresh eyes and say, “well, actually, there’s these other things that our generation is so used to in other quadrants of our lives and we want to see it here because we believe we can do more good.” Even more good. I think you see that everywhere, if you’re looking for it.
George: Can you tell me a little bit about the about the early days of Medal? One of the things I find most impressive is the team you’ve assembled. Can you touch on how you started getting people on your side to collaborate with you and pursue your vision?
Lonnie: I think one of two things happen—either you track them down or they track you down. And then there’s always serendipity, but I think it’s more about recognizing something amazing when it walks through your front door. A lot of this has been about being unafraid to completely track people down. I think you have to not be afraid of someone saying “no”. One of my mentors, one of the people who I really wanted to talk to early on, is an example of this.
I had heard about the way that the credit card industry started—specifically Visa. In the early days of Visa, there were all these small, fragmented credit card agencies. Each bank had its own kind of card, and if you tried to take a card from one place to another, it didn’t work. It wasn’t actually the cards; it was the payment systems. Each payment system was separate. It’s a great analogy for the way the United States healthcare system is today. I read a book by the man who founded Visa named Dee Hock. He’s been living on his own very privately for the last 30 years. He’s 87. I sent probably a hundred emails and phone calls before I finally got him on the phone. He didn’t want to see me so I asked him if I could get on a plane, drive to his house, get out, shake his hand, and leave. He said, “Well, if you’re going to come all of the way here, you might as well stay.”
George: How did you finally get him on the phone?
Lonnie: I talked to two people who knew him and they asked him if he would be willing to talk. Turned out, he was. I think that story is probably not so dissimilar from the way I’ve tracked people down or the way they’ve tracked me down. When you get someone in a room who has something very different to say and they believe it very strongly and they’re capable, you stand to learn a lot. The other side is to treat people fairly and with a great deal of respect and honor, because when you’re able to do that, amazing things can happen. Dee actually said something wonderful to me: “when someone says ‘no’, they just haven’t said ‘yes’, yet”. I don’t think that’s always true, but a lot of the time it really is.
George: Do you have a relationship with him today as a mentor or a board of directors or anything like that? Did it lead to connections that you’re currently working with or just great insight?
Lonnie: A little bit of all of them. We’ve been out there a few times with our team and investors and various people and he’s given us a wealth of information and advice. I tend to send him emails pretty regularly—he’s a very wise man.
George: How did you find your co-founder?
Lonnie: My co-founder is Andy McMurry. He tracked me down. When I started Medal it was a personal health record service called Caribou Health. At that time, Andy contacted me wanting to advise. We met, talked about what we were doing and how we were doing it and Andy joined and became my co-founder!
George: Did you play hard to get?
Lonnie: Not at all, actually. He was the most knowledgeable person I had ever spoken to on the subject of technology in the medical space. It was immediately obvious that he was incredibly talented, incredibly knowledgeable, and that working with him would be a joy and an honor. We decided to work together the day we met.
George: That’s incredible. Were you in Boston at the time or were you in San Francisco by then?
Lonnie: We were in San Francisco at the time. He had previously been responsible for architecting a system called SHRINE (Shared Health Research Information Network). It started out by linking all the Harvard Hospitals together and then ended up expanding to over 60 academic institutions throughout the United States for querying across those systems and it encompassed millions of patient records. It was cited by the FDA for drug surveillance and he also advised the CDC. It was very clear (very fast) that Andy knew what he was talking about in a very deep way.
George: Could you speak a little bit on why you moved from Boston to San Francisco?
Lonnie: When I took my leave of absence, I came out to San Francisco, the reason being that was that it was (is) the center of technology innovation. When I was in medical school, I rotated through a lot of the hospitals in the Boston area, world-class institutions, and still those systems weren’t what I was expecting or hoping for. There were a lot of great things about them. Wonderful things about them! Except they didn’t work like I expected them to, so I moved to San Francisco to find out what Silicon Valley knew that we didn’t. It was that simple: I wanted to understand technology. I wanted to understand the development of technology, and I wanted to understand the ecosystem where that technology was being developed. The best way to do that is to go first-hand and find out.
George: Now that you’ve been there, do you think it’s clear that Silicon Valley knows a lot of things that medicine needs to catch up with? Or do you think that there’s some truth to the fact that medicine and healthcare are just very different beasts and that some things that apply in Silicon Valley and in traditional tech environments don’t work as well in healthcare for a variety of reasons?
Lonnie: Yes. *laughs*
George: I think it’s incredibly important to have more people like you who have that understanding of the traditional healthcare environment and are also strong on the tech side. We hear a lot from different industries who look at healthcare and say, “why are you guys so stupid? why is this not better?” But then people who work in the setting on a daily basis understand the very real limitations that exist.
Lonnie: I think that you have to have, as you said, people who understand both the current workflow, the current challenges. It’s like when someone comes in and they say, “Well, why don’t you do it this way? I’m going to give you this huge shiny thing with all these analytics and it’s going to work all the time!” And then the people on the other end get it and they’re like, “I can’t use this. I can’t use it because I don’t understand why it told me what it did and I don’t have a logical answer other than ‘the machine told me’.” Or, “I can’t use this because it doesn’t understand the regulations.” Or, “I can’t use that because it doesn’t work with my existing system.”
It’s always these other things! It’s not that they’re not important—they are, but you have to have people who can understand and navigate, people who can also understand what technology can do. It’s almost like being out-of-the-box within-the-box, because for better or for worse, the system is a certain way and it’s one of the largest industries in our nation. You can’t just up and turn it on its head. You can change it, improve it, revolutionize it, but you can’t rip it out and replace it overnight.
George: Do you have any thoughts on if there is going to be a very dramatic change in the way we receive care or from the types of organizations that deliver it? Does healthcare need to be redesigned from the ground up or you think it will continue to be established institutions that lead the charge?
Lonnie: I hate to speculate. I think it will be a bit of both because if you look back at those institutions, they’ve done so much. They have the knowledge of the ages, they have a lot of wisdom, many of them being revolutionary themselves. If you look at Johns Hopkins University, they’ve come out and said, “Hey, look, we have a healthcare crisis today.” They’re the ones that publish research on the rate of medical errors in the United States. That is a core institution. On the other side of that, you have groups that came in only somewhat recently and became medical institutions like Epic. Then you have the next-wave. It’s like any other industry you look at—you’re going to have organizations that are great and have been great for a long time. You’ll have new organizations that come in and work within that ecosystem or bring something new to it. That’s how it is in any industry.
We’ll have new technology, new innovations, new ways of doing things. I do think that healthcare in so many ways is opening up, but I think that it’s going to be profound partnerships between some of the absolute leaders and thought leaders and academic leaders and new and innovative technology companies that are going to drive forward the next wave of change.
George: Some people say sharing medical records is not a technical problem—it doesn’t happen because of authorization, security concerns, or partnerships for example. Some people argue that there is a technical issue. A big part of what you’re solving is any medical record available anywhere. What sticks out to you as the biggest barriers to healthcare interoperability?
Lonnie: I think there are 3 core reasons that we don’t have the type of interoperability that we want yet.
- Data transport from a technical perspective is not always simple. Even in a perfect world, APIs for the exchange of information are a technical challenge and moving HIPAA data is even more of a challenge. I think that FHIR will help enable a profound shift in the way that information is transferred in healthcare and will improve that dramatically.
- Security is a prime concern and the way that data has been stored in the past needs to be upgraded in healthcare. Many of the breaches that occurred have occurred on local servers. I also think that what is important is true innovation in security and in the way we store and think about that data. That’s one thing we’re working on very deeply.
- The value that is driven and the ability to do more with that data is limited by the availability of that data and the incentive structures around sharing it.
All three of these things are core issues that must be and are being addressed today.
George: Lonnie, this has been fantastic. Do you have anything else you’d like to share?
Lonnie: I think that currently, electronic medical records are incomplete and inaccessible. There are wonderful systems that enable us to work with the existing frameworks, but the current systems for sharing medical records are less efficient and less compatible than they could be. What we at Medal and our collaborators do is to make that easier to use to help deliver higher quality care and to make the sharing of medical data more secure. This is a problem that will be solved, but it will take a lot of people who care very deeply about seeing it through.
Keep an eye on Lonnie and Medal everyone!
Medal is a medical data platform dedicated to reducing the cost and time required to get clinical information to individuals and their care teams. Medal offers an electronic medical record application that can be installed on any electronic medical records system in minutes and provides structured data output with medical coding concepts. Founded in 2015, the company is headquartered in San Francisco. For more information, please visit www.medal.com.