Customer (and Patient) Control – An Interview with Dr. Mohammad Al-Ubaydli

Dr. Mohammad Al-Ubaydli is founder and CEO of Patients Know Best, a personal health record system designed to put the patient first. By giving patients control of their own health records, the system allows more efficient and effective relationships between doctors and patients, as well as between doctors and specialists comprising teams of care providers. Patients Know Best is based in Cambridge, UK.

1)   Before Patients Know Best, had you ever thought of doing something entrepreneurial, or did the drive really start with the problem and solution you discovered?

I started with something entrepreneurial in a sense because I knew I was going to start my own company. I was setting myself my own syllabus, so I went through medical school having learned how to program; I was just teaching myself how to write medical software and the intention was that I’d basically solve problems for physicians. And that’s what I did during medical school. I also grew up in Cambridge, and in Cambridge… I was told in school that when you’re in Cambridge, you start your own company, so I believed them. I knew I would do that one day. The final piece for me was learning business, so I worked for a management consultancy in the States, in Washington D.C. While there, I saw the problem that I thought, “OK, this is really important I could commit to, I can see myself dedicating the rest of my life to solving this because it’s really important.”

Beyond that, there’s also a business model behind solving this problem, and I guess I just wanted to solve this for myself. I was facing the problem as a patient, trying to organise my care, trying to manage my health. I spent a year sulking that no one was doing it, and 2008 came along and I said, “You know what, I’ve literally written the book, so I have to do it. Let’s just go and do it.”

2)   How much has the service evolved since you started as a result of patient and physician input? What developments do you foresee with regard to the service in the near future?

We started with an embarrassingly minimum viable product. We took all the classic startup advice, start with the minimum market product: we launched with only one feature. I came back to the UK and I began asking for interviews from my friends who were doctors and then asked them to recommend other doctors to speak to. They weren’t saying, “My problem is I don’t have a PHR.” They said, “My clinics are overrun with patients and I’m always late in helping my patients. There are budget cuts, I can’t get enough staff…” All these very clinical, very operational problems. So I just began building up clinical problems, and I thought, if you use the patient as an asset rather than a liability, we can help. What’s the minimum feature they would need, that they would pay tomorrow, to use? And the one thing they said was, “We want to send messages to patients across institutional lines, if the hospital wants to send a message to the patient and cc the GP, or GP send a message and cc the social worker, for example.” And that was the only thing we launched with.

To give you some contrast, the UK government spent tens of millions on Healthspace, which is their sort of attempt at a patient portal. And only after they went through that sort of tens of millions did they get the feedback of, “I don’t really need any of these features, but I really need to send messages.” So then they began trying to do messages, but by then they’d spent so much money, no one was going to give more money to develop the software any more. So, we started from that feature and every single other thing you see in the software is because a doctor, a nurse, a patient sat down and said, I need this, or I’m stuck on this.

The whole thing top to bottom has been built by the user saying what they need; we respond every two weeks by putting out new features. From our perspective, it’s great because we’re only building stuff that people care about, but also our users are huge evangelists. Every commissioning customer who uses us can point at a part of the screen and say, “That was mine.” And then they go and tell all their friends, “Go and use this software because that was mine. And also, whatever you tell these guys, they’ll do it in two weeks. They really respond really quickly and I’ve never had a software company do that with me.”

3)   In one of your customer videos, Gary Hotine describes looking for something that would be like “Facebook for Patients.” I’m curious to know how apt a description you feel that is for Patients Know Best.

A lot of our users describe us as the Facebook of healthcare. When we trained patients in the beginning, the docs were kind of worried that the patients wouldn’t understand how to use the software. When we sat down with them, most of the trepidation was that they did not believe the docs had actually handed over the records and given them control. But as soon as they get there, they’re like, “Oh, I see, that’s like Facebook. I’m good.”

From that point onwards they just go ahead and use it. It’s like Facebook in the sense that it’s a very easy method of communication, pulling data from everywhere and it can send lots of places. It’s not like Facebook in the sense that we’re not selling your data and we change the terms of use every week: we are not confusing our financial benefit with your privacy desires.

4)   When you started, I’m guessing it was pretty much just you. How did you then go and assemble a team? What qualities did you look for?

It started with just me having the idea and doing some of the research in the States and then deciding I needed to go back to the UK to start it. Cambridge was the place to do so, both as my home and because I’d heard that Cambridge receives 7% of all VC funding in all of Europe. It’s just a crazy number. So I came back to Cambridge and just did a bunch of things to start building the team. I emailed the CEO of Cambridge Network and said, “I’m coming back to the UK, I’ve trained as a programmer and I’m starting this company; I have no team, no product, and no customers. Who do you think I should talk to?” “Let’s have coffee.”

I think he took pity on me, but he said, “You know you should talk to Ian, he’s a CFO of VC backed companies and I think he’ll talk to you.” It turned out we shared the same pub, and we kind of just spent 2 hours the first time talking about the company and he thought it was really interesting. Over the next four months, the poor guy, Ian, taught me accounting. And then eventually he became a member of our board of directors and CFO of our company. So he was the first really heavyweight executive to commit his time to the company.

Then from the development side, I started by just getting some contract developers to build the proto-type and then some other ones to build the final software. We now have developers from the UK (obviously), but also the States, from France, from India, just a real international team. And they tended to have some experience with healthcare in the past that meant that they were as frustrated with healthcare as I was. And so they’re quite evangelical.

In parallel with that, I got a meeting with Dr. Richard Smith, who was the former editor of the British Medical Journal. It took me six months to get a meeting with him—because everyone’s trying to get a meeting with him—but I knew when I was reading his editorials as a medical student, he was always on the patient’s side, often to the anger of his colleagues and medical professionals. But he’d always be on the patient’s side. I knew that if I could just get a meeting, he’d get it. And sure enough, he got it and he agreed to new meetings. And then one day, he agreed to be chairman of our board of directors.

As you build that core team of world class people, it’s just easy to get people. Everyone then wants to join up.