The history and challenges of CAREFUL: the tech business podcast with Paul Essery

Paul Essery from The Tech Business Podcast interviews CAREFUL CEO Dr DJ Hamblin-Brown, about the product and its history and the challenges of developing and selling digital health solutions and being a clinical entrepreneur.

With thanks to Paul Essery of The Tech Business Podcast


Paul Esserry: Hey folks, Paul Essery here, and I’m delighted this afternoon to be with Dr DJ Hamblin-Brown from CAREFUL. DJ, thanks for taking time out of your schedule to chat with us. What you’re doing is really interesting, and I think people will be fascinated to hear about it. For our listeners, tell us a bit about yourself and the business, and then we’ll talk about the technology.

Dr. DJ Hamblin-Brown: Thank you very much indeed for inviting me and for your listeners for listening in. As you said, my name’s Dr DJ Hamblin-Brown. I’m the CEO of CAREFUL.

CAREFUL is a clinical coordination app, a platform that allows clinicians and managers to provide better, safer, faster clinical care.

I’m primarily an A&E clinician or emergency doctor. I’ve not always been a doctor; I’ve had a couple of stints outside of medicine. The first one as a computer scientist, that was my first degree, and also doing some operations consulting in other sectors, including oil and gas and manufacturing.

I’ve actually done some medical management as well. I was the group medical director of an independent group here in the UK. My last job before the pandemic was as the medical director of a 5,000 employee medical group in Asia.

For the last few years since the pandemic, I’ve been working with CAREFUL and my co-founder Roohi, who lives in Dubai, on this product, the CAREFUL platform.

To give you a brief idea of why we developed this platform: when I was a junior doctor, I quit medicine to become a management consultant for a while. Being a junior doctor was truly, truly awful. I have a lot of sympathy for the junior doctors who are complaining at the moment about their conditions of work because there’s an enormous amount of inefficiency and waste in hospital medicine, but also throughout healthcare, as people faff around trying to coordinate care, do jobs, understand what’s happening with patients and so on.

I found it really depressing to have spent so long learning medicine and then find myself being basically a clerk, without much chance of being successful because I was always behind on whatever I was doing on the ward.

In 2009, the other energising fact for me was that my mother was very nearly killed by a hospital because somebody forgot to do something. They forgot to prescribe something important to her care. She ended up spending three weeks in hospital and several months recovering as a result of iatrogenic heart failure.

I made the connection between my experience as a junior doctor and the outcome for my mother, which was so awful. It was just through a sheer lack of ability of the hospital and the teams to keep track of all the things that needed to be done. It was just forgetting to do something that caused such a bad outcome. And she’s one of millions of people who have poor outcomes in healthcare because of that sort of thing.

In summary, CAREFUL is about trying to solve that problem. It’s primarily about saving time and helping clinicians and managers to organize things better, and hopefully at the same time saving lives.

Paul: Brilliant proposition. I mean, who would be against saving lives and reducing medical errors? It seems to be a fantastic proposition and a great problem if you can make a dent on that. Tell us more about the tech. What does it enable people to do? How does it stop errors happening? What are the outcomes? How does it improve the lives of doctors and patients?

DJ: I’ll do my best. The thing to say is that the people who use our product really love it. In fact, there was a doctor who told me just yesterday that he hadn’t been able to log into CAREFUL for a few hours, and at that point felt completely naked. He said, “I was completely unsighted, I couldn’t do my job.”

They love it because it gives them real visibility about what is happening to their patients. It’s really weird; people outside medicine and healthcare don’t necessarily realize this, but managers and clinicians, people who work in healthcare, are often completely blinded to what is actually happening with the patients in their care.

If you ask somebody on a hospital ward to point to a random patient and say, “What’s happening to this patient right now? What is happening next? Who’s responsible for whatever is happening next?” Often people will not be able to answer that. They can’t answer it because the systems we use to manage healthcare, particularly in secondary care in hospitals, are really not fit for that purpose. They’re fit for the purpose for which they were built, which is largely around order management, billing, and recording stuff that happened in the past.

What people really need is something that sits above that EMR that allows them to manage tasks, to manage conversations. So CAREFUL really replaces WhatsApp, spreadsheets, phone calls, bleeps, emails, all that stuff that goes around getting people to work together.

Let me give you a couple of examples. We’re working in a hospital in Wales where they’re using it for unscheduled care. Their medical team are using it as a management tool to ensure that they know where their patients are at any one time. They don’t have an EMR to speak of, and they’re saving at least 30 minutes of every single doctor’s time, every shift because they’re not faffing around making phone calls, trying to communicate with each other, writing stuff down in books or whatever it might be.

More importantly, from the patient’s point of view, they’ve reduced by half the amount of time it takes to make a medical decision in the emergency department. If you’re waiting six hours and now you’re only waiting three hours, well that may sound awful, but it’s a hell of a lot better and it’s also much safer.

Paul: It strikes me also that it reduces the levels of stress for both the patient and the doctor because it makes life easier and they know better what’s happening. Stress is all about not being in control, not knowing what’s happening, isn’t it?

DJ: Exactly. Now, I wouldn’t necessarily say that our product has yet reached the stage where the patients are able to see this information because we haven’t got that, but that is part of our plan, of course. It would be great if you were a patient and could say, “Oh, I’m due to have an ultrasound today. I wonder when that’s happening.” And then to see, “Oh look, it’s happening soon.” But that level of patient awareness of what’s happening to them in the process is also missing for sure. And it’s very stressful for patients. You sit in a waiting room for three or six hours, it’s horrid. It’s like being delayed for a plane or a train, nobody tells you anything. It’s very frustrating. And that’s bad for you clinically.

I’ll give you a second example if I may. Coordinating care between elderly care homes, GP practices, and pharmacies is difficult anywhere. We are working with a group of people in Australia, and the GP has been the driving force behind this. He’s able to manage a hundred patients in an elderly care home, about 20 patients who are in a chronic mental health support facility, and to use CAREFUL to manage the people who are involved in that care. This includes pharmacists, nurse practitioners that he employs, plus the nurses on the wards in the care home, plus the people who occasionally visit the mental health facility to make assessments and stuff.

All of those people are on CAREFUL and they’re able to see what each other are doing. In one particular case, it saved a massive error in prescription, which we know that we caught. But it saves time again, it saves time and it saves all sorts of hassle.

In a big UK trust, we are in ICU to site handover between consultants, junior doctors, they can all see what’s happening to the sickest patients in the hospital, even on mobile. So when they’re traveling between sites and all sorts of stuff, it’s really fantastic for them.

We’re also working with a large hospital in the south of England on a regional referral system so that patients that are coming in from other parts of the region can be managed as they flow in and out of their critical care facility. That’s coming soon, we hope.

In summary, we are replacing not the systems that run big hospitals, but the systems that are the patchwork of emails and phone calls and referral letters and hand faxes. We still use faxes.

Paul: That process of trying to coordinate those things horizontally has always been difficult in big organisations. Wherever you make a dent on that, that’ll help everyone, won’t it?

DJ: We are making a dent on it, albeit in a small way. I mean, I wouldn’t like to say that we’re a particularly huge organisation, but we have significant ambitions. One of the ambitions, which I didn’t mention, was that it’s going to be really easy for us to add AI into this layer of collaboration and coordination that sits across multiple systems. We are essentially using data which doesn’t require – we can integrate with all of the systems we’re using. But then adding a layer of AI around task management and answering the question, “What should happen to this patient?” is going to be quite interesting.

Paul: Fabulous. I think it’s a great proposition. I know a number of people that have experienced some problems with hospital care.

DJ: I just have to tell you, we demonstrate this product and we talk to people about this, and there is not one person that we have spoken to that didn’t say to us, “Oh, you know what, that happened to me. That happened to my wife. That happened to my daughter. She was moved between hospitals. They lost their notes. Or the GP didn’t ring me back. I was prescribed the wrong things.” All of this level of barriers that exist, the information flow between organizations in a complex patient pathway, it’s really, really tough. And we can basically sort that out of the box because of the design of the system.

Paul: Brilliant. When you look back over the last few years, tell us about some of the challenges. I suspect there’s quite a list of them. Tell us about some of the challenges that you’ve been dealing with and how you’ve overcome them, perhaps.

DJ: I laugh because as with all things in life, you always can say quite legitimately, “If I’d known then what I know now, I wouldn’t have taken that decision.” But then if you hadn’t taken that decision, you would never have learned what you’ve learned.

That said, I’d say there were three things that really stand out for me that I didn’t realize when I started working in healthcare. I’ll be as quick as I can because I don’t want to take up too much time.

The first is that healthcare has extraordinary inertia in a bad way. That inertia is caused by risk aversion, which in itself is a good thing. You don’t want people just experimenting on patients, but it does give you a real difficulty in getting people to adopt new technology. There’s a lot of people who are willing to try new technology, but actually adopting it is a different matter. There’s a point at which they go, “Oh, that looks interesting. Yeah, we’d quite like to do that.” And then they say, “Oh yeah, would you actually have to buy it? Oh, well, in that case we need to go through these hoops, this enormous bureaucratic sort of group of tasks which together will basically slow you down.”

I also say that bureaucracies, which many healthcare organizations are, prefer to buy from bureaucracies. So if you’re not big, it can be tricky. Getting into the NHS, for instance, is, you know, you often have to get confronted with, “Well, if you’re not in the NHS, you can’t be in the NHS.” So these are hurdles.

The second is the NHS in particular, but healthcare in general is very fragmented. So selling to one hospital, great, you’d think that you’d have passed enough hurdles to then sell to another one, but no, you have to go through the same thing. So you are selling to a market which is highly, highly fragmented, just vertically and horizontally.

And I think thirdly, what we’ve realised is that the people who we are satisfying with our product are often really not the purchasers. And the purchasers often don’t see the problems that the users have. So the users are clinicians and managers who are struggling every day to make things stick together. And the purchasers are people with budgets and the conception of what the problems really are, and for which they think they’ve bought expensive systems already. So they’ve spent 40 million pounds on a system that does X. Why doesn’t it do Y? Well, because it doesn’t, and so trying to persuade all of the people in layers from the purchasers all the way through to the users to buy something is a much more challenging enterprise sale than I ever would have realized.

But I don’t know if that’s for any budding healthcare or health tech CEOs out there. That last point about making sure you know who your purchasers are versus who your users are, you need to persuade all of them.

Paul: Of course, you know, the bigger the organization, the harder they are to sell into, you know, because they’re more complicated and more risk-averse and all the rest of it. And the NHS, of course, is one of the biggest in the world, isn’t it?

DJ: It’s not exactly… Then my point about fragmentation is it’s not one organization, it’s literally thousands. Certainly, there’s 400 acute trusts, sorry, 400 trusts, mental health, community, whatever, all with different needs, all with IT departments, all with people who are…

Paul: What I meant is that the public perceives the NHS as being one.

DJ: They do. They do. And then of course, I thought in some ways, and naively a few years ago, I would’ve thought the same thing. But of course now it’s…

Paul: Obviously, an interesting journey that you’ve been on that you’re still on, but a great proposition. I absolutely get the proposition. Tell us about your thoughts about the direction of travel. What sort of impact do you want to have? What are your ambitions for the business? Where are you going?

DJ: Well, I’ll tell you what, I think the need for the product that we have is so huge. What I’d really like to do is just to sell more of it. But that’s really because I think that the need is there because we need to improve the functionality and the usability of information technology systems in healthcare by a factor of not 10, but a hundred or a thousand to make it 10 times or a thousand times easier to use stuff to get stuff done.

And I think that what that requires is actually nothing technical. It requires trust. And I think what’s really important about healthcare systems is that people trust them. And there is a frightening statistic that somewhere between 85 and potentially a hundred percent of doctors use WhatsApp in order to coordinate patient care, not just in the UK but globally. And they use WhatsApp because WhatsApp is trusted, rightly or wrongly. We trust WhatsApp not just to store our data, but to do so reliably to be there every time we touch the internet on WhatsApp is available.

And so people say to each other, “I’ll send you that on WhatsApp.” And I guess if I had an ambition, it would be to solve this problem by creating an organisation where it became common to say, “I’ll send you that on CAREFUL.”

Paul: Yeah. I mean, if you do that, if you can do that, I mean, you’ll be doing pretty well. So, I mean, and I like to see a bit of ambition and I think, you know, if you can, that it’ll have a big impact. So good luck.

DJ: Thank you.

Paul: So anyway, thanks for taking the time out. Thanks for telling us that story and, fantastic. Like I said, I mean, I love to see a bit of ambition, so good luck going forward and you know, maybe come back in a year or two and let’s know how you got on.

DJ: Paul, thanks so much. It’s nice to speak to you.

Paul: Likewise. Cheers. Bye-bye.