What was your first job? My first job ever was as a newspaper delivery boy at the age of 12 in northern New York state. My first job after I finished my undergraduate education was as an engineer at GE's Research and Development Center in Schenectady, New York.
Did you always want to work in IT? Every job I have had in my professional career has involved information technology. When I was a university student, I became interested in programming computers to model physical products and systems. Now, I have spent more than 35 years using these incredible machines to first design other machines and then to model the human "machine".
What was your education? Do you hold any certifications? What are they? Growing up I had a fascination with how things worked, so when I left school I headed off to university to study engineering. I was also quite capable in mathematics so during my undergraduate education I focused on developing mathematical models of physical systems implemented on computers. I received a Bachelor of Science and a Master of Science degrees in Mechanical Engineering and a Master of Science degree in Mathematics from Rensselaer Polytechnic Institute in New York. I then completed my doctorate in Mechanical Engineering at Stanford University for my research in computer simulation of blood flow.
Explain your career path. Did you take any detours? If so, discuss. Starting HeartFlow was actually the result of a chance encounter 26 years ago. In late 1993, while I was a PhD student at Stanford, I went to a talk led by the university's new chief of vascular surgery, Christopher Zarins, M.D., who gave a talk entitled "Blood Flow and Your Health" in the engineering school. Chris would later co-found HeartFlow with me. Listening to Chris speak about blood flow and cardiovascular health, I realised that the computer modelling techniques I had been studying for the last several years could be used to quantify blood flow in patients' arteries. I completed my doctoral research at Stanford with Chris and Thomas Hughes, PhD, a very famous professor of mechanical engineering at Stanford at the time and a leading expert in computational fluid dynamics, on the topic of computer modelling of blood flow in arteries and did the first simulation of blood flow in arteries from medical imaging data. In 1997 I became a professor in the school of medicine at Stanford and focused on developing computer simulation technology. Ultimately, I became a professor in the Mechanical Engineering, Bioengineering, Radiology and Pediatrics departments for another 10 years before starting HeartFlow in 2007.
A digital healthcare start-up born out of Stanford University, HeartFlow has grown into a global company deploying technology in hospitals from the US and the UK to Europe and Japan. Within the UK, it is estimated by The National Institute for Health and Care Excellence (NICE) that HeartFlow could save the NHS £9.1 million a year.
What type of CTO are you? First and foremost, I'm the type of CTO that values interdisciplinary collaboration. For me, the success of HeartFlow rests in our ability to draw on the expertise and experiences of people from a variety of specialties - whether they be cardiologists, computer scientists, data analysts, engineers, mathematicians or hospital administrators. Second, I focus my efforts on hiring exceptional people and leading and managing them, but not micromanaging.
I travel frequently, meeting doctors and patients from across the world which gives me a comprehensive understanding of how our technology is actually being used, as well as any challenges or issues people may experience with it. This knowledge helps me to continuously learn about how we can improve our product to meet the needs of healthcare practitioners.
Which emerging technology are you most excited about the prospect of? AI has been ‘emerging' for a while now but I'd argue it's just as, if not more, exciting today than it was when technology enthusiasts began talking about it decades ago.
Today, AI is giving physicians an unprecedented understanding of how they can treat their patients. Tomorrow, it'll have the ability to predict patient outcomes from different surgical decisions, give doctors insight into their patients' long-term health and allow them to understand just how aggressively to treat a problem. That, for me, is very exciting as it opens the door to truly personalised and precise technology-led healthcare.
For cardiology in particular, I believe AI's capabilities will help physicians collate data, as more of it is gathered and analysed with deep learning technology. AI has the potential to become a powerful partner for physicians, and go beyond simply aiding in the accuracy of diagnoses but helping them achieve a deeper understanding of the severity of a condition and better explain to patients their symptoms and provide them with personalised treatment plans. At HeartFlow, we are also using AI to learn which factors are most predictive of plaque rupture and heart attacks. This research is really exciting and could one day remove heart-attack from its position as the #1 killer of men and women.
Are there any technologies which you think are overhyped? Why? While AI is extremely exciting, some aspects of its use in healthcare are indeed becoming overhyped, for example the notion that AI will obviate the need for radiographers to read medical image data. My own view is not that AI will replace Radiographers, but that Radiographers that use AI tools will replace those that don't.
What is one unique initiative that you've employed over the last 12 months that you're really proud of? From a business perspective, in the last year, I have become a big fan of "organizational health" after reading the book The Advantage by Pat Lencioni. This is something we practice at HeartFlow which has led to significant improvements in how we function as a team. From an engineering perspective, we have focused great efforts in improving the efficiency of our software development processes to enable us to release every two weeks, which is quite challenging for a regulated software company.
Are you leading a digital transformation? If so, does it emphasise customer experience and revenue growth or operational efficiency? If both, how do you balance the two? HeartFlow is a leader in the digital transformation of healthcare. We are aiming to address the challenges of tight budgets and growing burdens on physicians by changing the way they diagnose and form treatment plans for coronary heart disease. For this reason, it is a good example of how the customer experience and operational efficiency are carefully balanced with innovation.
Healthcare can be a financial drain for both patients and hospitals, but with HeartFlow, physicians can be confident they are selecting the most efficient and cost effective care pathway for their patients. For example, the HeartFlow Analysis has been shown to reduce the number of unnecessary tests and procedures as well as reduce the overall cost of care by more than $4,000 USD per patient after one year. To date, over 30,000 patients worldwide have received the HeartFlow Analysis.
In addition, HeartFlow is also working within a physician's existing workflow and giving them a tool that becomes integral to their practice. In the last year, we released a mobile app that helps doctors easily access their patients' HeartFlow Analysis with one tap. The app provides an interactive and accessible way for physicians to interrogate (e.g., zoom in and rotate) the 3D anatomical model of the patient's coronary arteries, and identify the patient's FFRct values which helps physicians assess the impact of a blockage on blood flow. This information is not only valuable for the physician, but also helps them visually explain their diagnosis to patients. The app provides the HeartFlow Analysis and additional information that helps doctors determine the best course of treatment on the go.
What is the biggest issue that you're helping customers with at the moment? Coronary heart disease. It's the UK's biggest killer and our technology is helping doctors to better diagnose and form treatment plans for patients suffering with the condition. The HeartFlow Analysis has been evaluated in five large, prospective clinical trials that included more than 1,300 patients and were conducted at major medical centres worldwide. One study (PLATFORM) found that the use of a HeartFlow-guided strategy resulted in the cancelation of a planned invasive coronary angiography in 61 percent of patients. After one year, none of the patients who had this procedure cancelled had suffered any adverse clinical events and the use of HeartFlow created substantial financial savings when invasive diagnostics were unnecessary. The study also revealed that a HeartFlow-guided patient evaluation strategy showed greater improvement in quality of life at a 90-day follow-up as compared to standard non-invasive testing.
How do you align your technology use to meet business goals? The purpose of HeartFlow as an organisation is to help clinicians diagnose and treat coronary artery disease for each patient while reducing the need for unnecessary procedures. The roll out and use of our technology is closely aligned to our core reason for existing as a company.
Do you have any trouble matching product/service strategy with tech strategy? Not really. Our product/service strategy is closely aligned with our tech strategy. We are developing many exciting technologies, but these are highly focused on improving or extending our core product and service. We have somewhat of an embarrassment of riches in that we are the first company in this tech space, namely an AI/Cloud/SaaS company in healthcare, and have no shortage of adjacent and transformational products for the future.
What makes an effective tech strategy? A disciplined approach to determine what is most critical to meet the needs of the business combined with a deep understanding of your customers. We develop and wield tech at the leading edge of healthcare, but we are single-mindedly focused on aiding physicians in improving the care of patients.
What predictions do you have for the role of the CTO in the future? In the future, our role will have a greater emphasis on the management of AI and machine learning. For me, it's important that these technologies are applied to advance medicine and inform physicians to achieve better patient care. It's absolutely not our focus to create machines capable of doing all of the clinical work for physicians. I am a big believer in augmented intelligence to combine the best of machine and human intelligence.
Secondly, we will have a bigger role in ensuring the safe use of customer, patient, and employee data. To run a successful business, CTOs will have to demonstrate how user data is protected or risk trust and larger reputational issues that could be damaging.
Finally, CTOs really need to balance activities related to core, adjacent, and transformational products. Finding this balance is critical for an early stage as well as more mature business.
What has been your greatest career achievement? Growing HeartFlow and seeing it help doctors in their diagnosis of thousands of patients around the world. We have ambitious growth plans and I'm excited to see where we will be in five years. It is both rewarding and humbling to have the privilege of helping physicians care for their patients.
Looking back with 20:20 hindsight, what would you have done differently? As a start-up, it is very difficult to time technology investments that must precede, but are necessary, to achieve growth. In some cases, I would have waited a little longer to make some tech investments until we had seen more market data to predict business growth.
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What are you reading now? Two books, Sapiens by Yuval Harari and Essentialism: The Disciplined Pursuit of Less by Greg McKeown. Most people don't know that I… Have been downhill skiing since I was 5 years old and am quite insane on the slopes. I started doing ballet/trick skiing when I was 10 years old and, even at 55, can ski just about anything in front of me, forwards or backwards. I am a different person when I am at the top of the mountain with a pair of skis on me. In my spare time, I like to…Spend time with my family and be involved with my kids' activities. I also like to exercise, and to deepen my understanding of mathematics and science. Ask me to do anything but… Go shopping. I don't have the patience, interest or aptitude for it. |