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Exclusive Interview with Adeel Sarwar, CTO at CareCloud
Carecloud serves more than 40k healthcare providers across the globe with its comprehensive suite of proprietary, cloud-based solutions. CareCloud, Inc. is a leading healthcare technology company with a comprehensive suite of proprietary, cloud-based solutions for growing healthcare organizations. With the mission to deliver the most comprehensive technology-enabled solutions to healthcare organizations of all sizes, spanning a wide range of specialties, thousands of providers across the globe are growing their practice with Clarecloud. In this interview with the CTO of CareCloud Adeel Sarwar, Medigy grabbed some great insights on the innovation lifecycle from the perspective of a CTO, their journey, and a couple of tips for budding innovators to overcome challenges to meet the expectations of their buyers. Our vision is to enable providers to focus on delivering quality care to patients by providing them with a comprehensive suite of integrated healthcare solutions. For many medical practices, regardless of their size, there are multiple administrative, regulatory, and technical burdens, including staffing, selecting, deploying, and maintaining software. CareCloud solutions are designed to address most of these challenges, which include electronic health record systems (EHR), practice management (PM), patient engagement (PXM), revenue cycle management (RCM), robotic process automation, chronic care management (CCM), and remote patient monitoring (RPM). As CTO, I am fully engaged with our healthcare providers, understanding the changing demands in the modern workflows, utilizing new technology stack and cloud-based infrastructure for our suite of integrated healthcare solutions, to ultimately improve their daily workflows. At CareCloud, our key focus is on bringing new technology-enabled solutions constantly and upgrading the existing software with better tools. As CTO I need to make sure that we are at the forefront of innovation and product development. I work with my team to create product and technology vision for the company to be on the cutting edge to develop and implement technology, digital health roadmap with short-term and long-term goals, and bringing new technology solutions that ease up the tasks of healthcare facilities. We remain in constant contact with our customers to better understand their requirements and decide OKRs. Our OKRs are always very clear, specific, measurable, and well-documented. This helps us to align clients and our teams to achieve a unified objective. Every objective is assigned to a team and an owner so that everyone is well-aware of their responsibilities and takes ownership of the project they’re assigned to. Each object is assigned a timeline, where larger objectives may have a timeline spanning over quarters, and shorter objectives have their timelines in weeks. The larger goals are further broken down into mini-goals with results. We set check-in sessions with our teams and customers to monitor and share the progress. The process has really worked well for us in meeting the OKRs and keeping the customers happy. Yes. I truly believe in the innovation management process. A lot of people think that to be innovative, you just need to brainstorm and generate a lot of ideas. Yes, to be innovative, you need ideas but that just takes you half the way. It’s the execution process that actually matters to transform an idea into an actual innovation. There are many innovation management processes available. At CareCloud we use a customized innovation management process, and that has proven to be very helpful for us. First, I believe, there isn’t anything called ‘common sense.’ When I am talking to my team about vision, ideas, products, and strategies, I don’t skip the minor details considering that it’s basic knowledge and I don’t need to touch that. I always explain the details and we ensure to document all of the minor and major details before proceeding with a project. There is always someone in the room who needs those details. Secondly, the broader vision. Unless the team knows about the whys, they can answer the hows. So, I always start with why; why we are going to work on some requirement, why it’s worth spending our time and energy there, who would benefit from that, and how would they benefit from that. Once we know the whys, then we move to the hows. And there are always more smart people in the room, who then know the answers to all of the hows. Not documenting the requirements in full detail: Tackled through a change in the model for requirements gathering and documentation Prioritization with decision-makers I believe every project depends solely on the way it’s documented, then drafted, and then executed. If the first step isn’t taken right, the overall project will definitely fail. In order to build a stronger foundation, we have to focus on the first step: Documentation. For a brief period of time, we’ve been through phases when our documentation wasn’t thorough and struggled in finding the right steps to figure out where we have been going wrong. It was like finding the missing piece of a puzzle, once we had that, there was no going back. Since then, we’ve been very much focused on the initial step of the documentation to ensure every minor to major detail is well-documented to go back to in any step of the development of a product. Moreover, prioritizing the decision-makers is of utmost importance. Finalizing the decision-makers of a project who make the last call on how the project has been executed so far is the key to the success of any project. It’s very well said that innovation isn’t creativity, it’s a discipline you manage. I strongly believe in it and we follow it at CareCloud through a customized innovation management model. Like quality, we believe that innovation is everyone’s responsibility, and people should have confidence that if they have an idea, then they will be listened to and encouraged. Based on ideas, we have specialized innovation teams for different areas like Patient Engagement Innovations, Clinical Workflow Innovations, Claim Scrubbing, EDI Innovations, Internet of Medical Things Innovations, etc. These teams have highly skilled team members and experienced leaders who work on the selected ideas. These teams use innovation management processes and tools to better convert ideas into actual innovations. This customized innovation management model has proved to be very helpful and successful for us. We are going through a time of great resignation. It’s not just healthcare and IT, but the rest of the industries are equally impacted. At CareCloud, we try to minimize the impact. We have defined multiple processes to manage turnover and succession. First, we provide an environment where our teams may continuously learn, feel challenged, get exposure, deliver, and feel accomplished. So providing them with a rich learning environment where they may perform and grow, keeps our turnover rate under control. We have multiple team members with us who have been with the organization for fifteen-plus years now. Secondly, we have good knowledge management processes. Processes, products, stories, architectures, and feedback are properly documented and archived in the knowledge management platform. Further, every team has multiple members who know the industry, processes, and deliverables. We also give our leaders the space to work with different teams after a certain time period. This makes sure that multiple members of the organization have knowledge of multiple areas. All of these efforts have helped us during our success and growth. My advice is don’t fall into the trap that innovation just means developing new products and tools for the clients. Innovation is much more than that. It’s all about managing your present, improving your past, and creating your future products and services. As a creative team, you have to come up with innovative ways to improve the existing products and services that clients are using. At the time when those products were developed, the requirements of clients, your understanding of the space, tools, and technologies, everything was different. And a lot has changed since then. It’s imperative to improve existing products through continuous and rigorous innovation. And then as an innovation team, you have to come up with new products and tools that don’t exist yet. You have to create the future. Overall, it’s your responsibility to find novel ways to optimize clients’ processes, decrease their costs and increase their revenue. We have a good innovative culture and receive a lot of ideas across the company from our colleagues. To prioritize the ideas and tasks, first, we see how well they are aligned with our business strategy. For example, in the last few quarters, our strategy was to disrupt the healthcare industry through next-generation care delivery models that include Telehealth, Chronic Care Management (CCM), Remote Patient Monitoring, IoMT, Web 3.0 Healthcare tools, and better-integrated products. So, all the innovation tasks prioritized were around the same business strategy. Secondly, among the finalized task, we further go for the 80/20 rule and prioritize those tasks that will provide the biggest impact and value, with low effort. Once prioritized, we attack those tasks and knock them out in a timely fashion. Working in the Healthcare Industry for more than two decades now, and being an innovative Healthcare IT company, we have a good understanding of the industry, requirements of different specialties, requirements of different groups, and different care delivery models that we need to support. So, we align our business strategy in a way that we understand the industry segment that we are serving, and have ready-to-use, highly customizable solutions for them. Even then, we come across clients where either change is required in the product workflows and services, or altogether new development is required. To understand and evaluate that, we first try to understand their workflows, and why they are doing things a certain way. The key here is to listen, really listen, and listen to understand. And then ask the questions to understand the details. Once we understand the details, then we go back to the whiteboard, try to find out what we believe would actually work for the client, and then bring those ideas to the client proposing how and what changes in our products and services would serve them better. 100 out of 100 times, clients welcome and appreciate those discussions and ideas as they start feeling that we know the business, we know their workflows and know their requirements. As we do such detailed evaluation and validation processes, our pilots and the feedback go really well. We keep all sources of learning open that may help us in our decision-making. We check the valuable insights shared by reputable organizations about the Healthcare industry, its challenges, changing requirements, and provider and patient expectations, and try to see how to re-align our strategy and vision. You definitely need innovative hiring strategies to hire innovative members. And start with the very first step – job posting. Most organizations absolutely ignore this part. You must be innovative in your job postings and Ads. Just mentioning in your job postings and Ads that you are looking for innovative people, is not enough. We have to be specific by giving examples, like mentioning the organization’s innovative culture so that readers know what they should expect. The second important step that we really think about is job posting platforms. We don’t rely on any single platform. Based on the required skill set and the position, we decide which platforms fit the specific requirements of the vacancies CareCloud has. We also go to our team members asking them what platforms they use, and what events they attend and ask them for recommendations on the platforms, so that we may target the right audience. And then we focus on the screening and enable processes to ensure we don’t lose the candidates who have the skill set and mindset to think out of the progress in the process of hiring. Creative and innovative candidates have a tendency of using non-conventional cv formats and share different levels of detail in their resumes. So, we make sure that we don’t lose them in the screening process. Overall, we’ve had an exceptional HR team, and there is close collaboration between HR and IT on the recruitment process. And we just don’t stick with one strategy, we review our strategy time-to-time making sure that we are constantly improving. The most important factor for us is Trust. When we are going to partner with someone, we need to make sure that our goals are aligned, we can mutually benefit from each other, and we can trust each other. During the partnership, our teams would be working together, and we would have access to each other’s financial and creative resources. So, trust is an important factor there. Our product design approach is always usability and product adoption centric. And this is what we focus on during our pilot stage, to verify that products have great user experience and can be adopted easily. Before we start working with our testing groups, we define very clear objectives and matrices. And this approach has always helped us. We get a clear understanding of what is working well and what needs to be changed or improved. Giving an example of our recent Remote Patient Monitoring (RPM) solution, we developed our solution where patients were required to use blood pressure monitors from home and their data would be shared in real-time with EHRs. So we designed a simple process, where patients would download a simple app on their phones, connect their blood pressure machine with the app through blood tooth and that’s all. But during the pilot, we found that patients were finding it difficult to pair the devices with apps through Bluetooth. We got a clear understanding that our solution has usability issues and would have adoption challenges. So, we immediately went back and changed the design from Bluetooth to 4G/LTE-powered devices. Now patients don’t need to download any app. Just unbox the device and start using it. The size of the pilot depends on the size and scope of the product. We form big enough pilot testing groups to get sufficient feedback and small enough groups that it’s not overwhelming to set them up. For smaller projects, it could be 3-4 members with a 2-4 weeks timeframe. For medium-sized projects, it could be 10-15 people with an 8-10 weeks timeframe. We schedule regular checkpoints to review the feedback being received, to see what we are learning, what our hypothesis was, and what’s the actual hearing from the pilot group. We understand it’s hard for clients to share all requirements, but not sharing major requirements is a problem. For instance, not giving proper time to demos, not asking questions early in the stage, and not including staff in the decision-making process who would actually use the system are the most common mistakes we have noticed our competitors make. But at CareCloud, we bring along everyone from the initial stages to the execution stage and are transparent about everything we do so our client has a clear idea of what to expect. We understand that innovation is an iterative process, and failure is part of that. We give everyone the space to practice, experiment, and learn from their mistakes. Like every rise has a fall, we strongly believe every fall has a rise with perfect motivation and support from the leaders. We don’t let failure turn into disappointment, grief, and embarrassment for staff members. We support our team members equally during the bad phases of their lives, talk to them, support them and find the best strategies that could come in handy to bring them back into the game. We make failure a learning experience for them, help them adjust their strategy, and support them to try again and come back even stronger. Learning from failure. We have observed that there are two main reasons why innovations fail. The first is the inability to develop the product that we wanted to develop. In this case, we try to learn what went wrong in our innovation processes. Why we could not develop what we wanted to develop, what were the challenges, and how to overcome those challenges, and then try it again with a different approach? The second reason for the failure is the inability to get customer traction. We try to learn here and seek if we are trying to solve the right problem. Are we looking at the problem from the right angle or should we change the lens through which we are looking at the problem? Failure is a very part of the innovation process. Almost all companies fail at some point during their innovation journey. Even the most successful and innovative companies like Microsoft, Google, and Apple failed in their journeys. Microsoft Zune, Google Glass, and Apple Newton; name it. But the most important thing is, they learned from their failures. It’s all about learning. The first step for us is to very clearly define the objective of the innovative work. We very clearly define the problem statement, how we are going to solve the problem through our innovative work, and who would benefit from the innovative work. Once this first step is done, then we define the innovation matrices by using which we measure the innovation. The matrices include all the right KPIs that help us monitor our progress and how aligned we are with our strategic goal to solve the problem. Our focus groups are part of our innovation management framework, and we keep them engaged while measuring the KPIs. This helps us a lot to be on track making sure we don’t deviate from our goal. There are multiple measures that we take to achieve this. Having an innovative culture is very important. When employees work as part of an innovative culture, that becomes part of their daily life. We are very open and transparent about our challenges and the problems that we want to solve in the healthcare industry and share these with our staff. We encourage them to look at these opportunities and come up with innovative ideas and solutions to solve these. We totally understand that innovation is an iterative process and the solutions that team members would suggest won’t be perfect. So, we tell them that it’s a judgment-free environment, and encourage them to take initiative and bring ideas and they won’t be judged on that. Rather they would get the required help in the iterative process to refine that. We provide incentives for staff to be innovative. This includes both monetary and non-monetary incentives. In monetary incentives, we have bonuses, RSUs, and spot awards. In non-monetary incentives, we have awards and recognitions, career development and mentoring, and the choice of working on the desired project. Some of the top qualities that I have noticed are: Curiosity: Always wondering and questioning, trying to understand the current processes and problems, desiring to know more, and then generating new perspectives. Out of box thinking: Not afraid to break the norms, challenging the conventional wisdom, and thinking out of the box Industry Awareness: Understanding the industry, customers, opportunities, and risks Open-Minded: Understanding that innovation is an iterative process, accepting failures, willingness to change if new information is present The job shouldn’t be 9-5, some days are productive, and some aren’t. What should keep us going is the eagerness to learn, innovate and grow. If in my team I find someone who is working excellent but merely finishing their 9-5 duties and not taking up ownership of a project, lacks innovation and seems out of its place, we try to find out the reasons for that since not every day can be the best day of their lives. I personally make sure to provide an open ear to the person to talk to, and to find out the reason why are they not motivated for innovation; Are they hesitant to share ideas and be innovative? Are they afraid of the rejection of ideas? Do they think they don’t have the required support? Do they lack the resources that they need for innovation: time, money, staff, and support? We try to address the underlying problem and once we have found the root cause, we try to resolve it as a priority. As stated earlier, our prime focus while hiring is to find people who are creative, innovative, and think out of the box so any resource who is performing below the threshold of innovation is highlighted and cared for in a way to bring the best out of them. It’s imperative to understand the changing requirements of the business, understand clients’ needs, and be aware of the business competitors to always stay one step ahead of everyone. Learning should never stop in life and I believe constant eagerness to improve skills and learn new things helps a person think out of the box and bring new ideas that would eventually help the organization and the person in their career as well. It’s important to have clear communication within the whole team and as a leader, to understand your team, the leader should ensure an open-door policy where their team can bring new ideas without any hesitation. There are two steps I take to oversee all of the ongoing projects: Everyone needs guidance, it’s the responsibility of the management to navigate their team in the right direction. Auditing my own governance model helps me challenge myself to do better for my team and for my company while thinking out of the box with active brain-storming sessions with the team always bringing new ideas to the table. Yes, we do, but we would like to keep this information secure. You know there’s no ideal customer but an ideal relationship. It all comes down to how we build our relationship with the client, how open we are to their suggestions, and what leadership qualities we possess to seize their ideas into actionable items as well as convince them of the changing needs. So yes, the ideal relationship is what we are focused on. Interoperability has been a challenge because There are a lot of diverse data sets in healthcare systems that need to be integrated and the patient data is delicate and sensitive to be dealt with. a lack of standardization in the healthcare industry and we were able to overdeliver by understanding the pain points of our clients and resolving those issues with technology-enabled solutions that fit organization of all sorts through extensive customization to fit into their existing workflow. Some early models were available in the form of HL7 but they were not sufficient to handle the diversity of data. Yes, it took time for FHIR to mature but ONC has taken steps for interoperability efforts. How is CareCloud’s technological infrastructure contributing towards erasing some misconceptions on this subject and helping its customers? We take integration very seriously. We understand that large healthcare organizations use diverse healthcare systems for different functions, so interoperability is of utmost importance. They have sensitive data that needs protection and a seamless workflow that helps the healthcare organization ease up the additional administrative burden. Therefore, over the last 20 years, we have been developing integrations with different healthcare systems in the industry and have developed our integral integrations engine “CareCloud Connector” that encapsulates all of these integrations. All of our clients majorly benefit from all of these integrations for better interoperability and a smooth workflow that allows them to focus on providing the best care for their patients. Additionally, we have opened “CareCloud Connector” for the rest of the industry as well and everyone in the healthcare industry can leverage that to automate all of their tasks without worrying about errors and mishandling. In fact, Medigy’s community of practice (CoPs) also focuses on these major sectors. So, our question to you, how is CareCloud leveraging its technological infrastructure to help providers achieve their goals on care delivery and patients enhance their care experience? I am glad to hear that Medigy’s CoPs understand the importance of home healthcare, chronic care management, and remote patient monitoring. For us at CareCloud, it’s all about connecting the dots. We already have a robust EHR, a Practice Management System, and an integrated telehealth system that is being widely used by thousands of caregivers across the country. Our technology is not decades-old technology. We are using cutting-edge frameworks with enterprise-grade scalable cloud-based infrastructure. These cutting-edge tools help us bring all the innovations much faster to caregivers and consumers as compared to our competitors. That’s why we were very early in this space to offer home healthcare solutions including chronic care management, remote patient monitoring, and telehealth. The key here is that these solutions integrate seamlessly with our electronic health records (EHR) software and practice management solutions giving users a great experience. When I joined CareCloud, I was impressed to learn about their vision, and how they wanted to disrupt and digitize the HealthCare industry. And that was one of the main reasons for me to join CareCloud. I joined CareCloud in 2004 and was the 8th software engineer to join the Engineering team. At that time, CareCloud was in the early stages of software development. The business model at that time was around revenue cycle management (RCM) and transcription. The first version of the proprietary revenue cycle management (RCM) software was developed and rolled out, and internal teams started using that. A web-based scheduler and transcription system were there. Visual Basic 6.0 and ASP were being used. But they had a bigger vision. The major challenge at that time was to speed up the development, do major enhancements in the RCM system, build the EDI system, and start the development of the first-generation EHR. And now when we see back, we are proud of our teams who have accomplished these and other goals. I was promoted to CTO in 2017. But I have been serving CareCloud since 2004 and in my previous roles as well, I was able to recommend and implement the changes. I always listened and I got the required support. And in my CTO role, I was given the confidence to take even the toughest decisions. As CTO and working with CareCloud, I knew the challenges, strengths, people, culture, and how to navigate. And that helped me in my role. It all starts with the basics. If you have the basics right, then you can improve the processes. Most organizations believe that they have done the basics right. But if you take a break, zoom out and then analyze, you immediately start realizing what’s going wrong. I was able to bring major changes to how our Product Managers and Business Analysts used to work. Even the way we changed our requirement gathering documents and adopted the new ways for wireframing made a major difference and our Engineering team was able to perform better. On the technology side, we always believe in the cutting edge, and we keep improving our tech stack. Our initial applications were developed by using Visual Basic 6.0 and ASP Classic. We never got stagnant in technology and kept improving it. With our fourth-generation EHR being used now, we are using .NET Core, the Latest Angular framework, and cutting-edge databases. We believe in transformation, and we showed that we can deliver that. We are very good at new technology adoption. With the iOS and Android apps boom in late 2000, we were among the initial healthcare IT solution providers to provide our apps and even got listed among the top 5 healthcare apps on App Store. One of the important goals of a CTO is to align IT with business goals. It’s our responsibility to support the business and help bring in more revenue. If CTOs are siloed and are not aligned with the business strategy, then that’s a recipe for failure. Among other factors for failed and delayed projects in the past were this non-alignment between the IT leadership and business leadership. Modern CTOs understand this and are well-aligned with the business. And it brings its own challenges, where the business has a lot of expectations and there is pressure all the time to deliver. I believe in the saying: “The best way to predict the future is to create it.” At CareCloud, we are creating the future of healthcare. We want to see the healthcare industry adopting technology like other industries, like the financial industry, airline industry, and tourism industry. These industries have adopted technology so well. The healthcare industry needs to perform better and provide solutions where the consumers and caregivers need it the most. We truly believe that care delivery models need to change. We have already proved that through the great adoption of integrated telehealth care tools. We have already introduced Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) solutions. Everything works in a seamlessly integrated fashion with our products providing usability and adaptability. This is what makes us different than our competitors. Though it’s been a decade since healthcare providers have adopted EHRs but there has not been much innovation there. The industry is not looking at the true needs of caregivers. Our next-generation electronic health records (EHR) software would fill that gap too, and we are very excited about that. Here is my advice for the young CTOs: Technology is just a tool – Know your industry, understand the problem that you are going to solve, and use technology as a tool to help you solve the problem Think – Don’t drown yourself in emails and firefighting. Leave some free time for you to think, build a vision and roadmap Invest in your people – Look for talent in your team, mentor them, help them polish their skillset, and grow them as your leaders, and then delegate Book – Modern CTO by Joel Beasley 3. How would you describe yourself? A CTO that drives innovation, transforms business models, manages IT operations, or a CTO that optimizes business operations? I would describe myself as a CTO that drives digital innovation. There isn’t any single factor that influences a CTO’s role. It depends on the size of the organization, along with the richness of the offering/product suite. —————————————————————————— Edited by CareCloud Interview questions by the Medigy teamSection I: CareCloud at its best in innovation
Section II: All About CareCloud
Section III: Rapid Fire Round
Adeel Sarwar
CHIEF TECHNOLOGY OFFICER - CareCloud Adeel Sarwar, Chief Technology Officer, joined CareCloud (formerly MTBC) in 2004. As CareCloud’s Chief Technology Officer, Mr. Sarwar is responsible for overseeing the development and dissemination of technology for external and internal customers, clients, and vendors to improve and increase business outcomes. Mr. Sarwar has extensive experience in designing and developing healthcare products and has the unique ability to align revenue growth, strategy, and innovation with IT business goals. Mr. Sarwar has served in a variety of impressive leadership positions within CareCloud including Lead Software Engineer and Technical Manager.
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