When the EHR goes down, care doesn't stop, but the chart, the meds, and the allergies do. Chao Cheng Shorland explains why EHR downtime is a patient safety problem, not just an IT one, and how her team is working to end pen-and-paper charting during outages.
In this conversation:
Chao Cheng-Shorland, CEO and Co-Founder, ShelterZoom
Megan Antonelli, Chief Executive Officer, HealthIMPACT Live
00:00:00 Intro: Welcome to Digital Health talks. Each week we meet with healthcare leaders making an immeasurable difference in equity, access and quality. Hear about what tech is worth investing in and what isn't as we focus on the innovations that deliver. Join Megan Antonelli, Jenny Sharp and Shahid Shah for a weekly no BS deep dive on what's really making an impact in healthcare.
00:00:30 Megan Antonelli: When the air goes down, the clock does not stop for patients. Clinicians lose the chart, the meds, the allergies, and they keep delivering care anyway. In the dark. Most health systems still file that under it. My guest argues it belongs under patient safety. This is Megan Antonelli, CEO of Health Impact Live, and this is our female founder series on digital health talks. Chao Cheng Shoreland is the co founder and CEO of Shelter Zoom. She came up as an enterprise architect before deciding. The hardest problems are the ones nobody plans for. Let's get into it. Hi, Chao. How are you today?
00:01:05 Chao Cheng Shorland: I'm good. Yeah. Very good. Thank you so much for inviting me onto your show.
00:01:12 Megan Antonelli: Absolutely. Well, I'm so excited to talk to you. Reading about your background. Um, you know, really intrigued me in terms of how you got to, got to healthcare. So tell us a little bit about, you know, your story and what you did before shelters in.
00:01:25 Chao Cheng Shorland: Yeah. So before I moved to the States and started the shelter, I lived in Australia and worked for a lot of large organizations as a chief architect and enterprise architect. So what happened was from the financial services to the manufacturing, you know, supply chain and to oil, gas. And, um, every time you kind of work on these major programs, you always feel, wow, there's just so much you can do with the content, with the data, with documents. So, um, I remember back in In ten. I took on a very major program as a chief architect to design and deliver a end to end solution for forty billion dollars program, which is a joint venture between ConocoPhillips and Origin Energy. And because they just got their license through the coal seam gas, liquefied gas, you know, and export to Asian markets and the international market. And when I went on to program, wow, this is like a massive amount of data and the documents and the supply chain moving across all the materials. So I saw just a lot of downsides of the existing technology. And I was thinking one day I should really contribute my ideas and making the world a better place. So then the opportunity came twenty seventeen, when I met with my co-founder, who's New York based. And, and then we actually had a very similar vision. And I thought, wow, I've done so much in the corporate world, I don't really want to become a CIO or the further anymore. I just want to kind of do my own startup. So that's how I started the shelter.
00:03:05 Megan Antonelli: Oh that's amazing. And so shelter Zoom started outside of healthcare in kind of the, in the oil and the finance side. And then you saw, you know, a need within healthcare. And I imagine, I mean, we talk a lot about, you know, or for years we talked about how much healthcare was sort of behind finance, behind, you know, industries that had so much money. I mean, frankly, that's in some ways the difference, right, is that they've had a lot of money to be able to invest in a lot of reason to do that. And there isn't quite, you know, maybe the complexity, I suppose, you know, those sitting on a oil field might argue with me, but tell us a little bit about, you know, what convinced you and what you saw in healthcare that you could bring that bring this to?
00:03:47 Chao Cheng Shorland: Yeah. So when we first started, it was a content management, security and data ownership company. So twenty eighteen, we invented the world's very first document token. And we immediately thought about healthcare. Um, the applicability right. You can actually tokenize medical records. So once you tokenize now patients or the owning hospitals can own those documents, really control the share control, um, the digital rights. And it's really a great use case. So we were so excited to bring that to the hospital. Um, when we developed the document GPS platform and then hospitals will look at this, gee, this is really innovative, but that's not our top priority. And so what's your top priority? He said our top priority is pen and paper. Um, during downtime how can we get rid of that? So I first time I heard, I was thinking, wow, is that the healthcare big challenge? They said, this is the biggest challenge ever since we, we had a EHR because now the students from the universities, they don't even learn paper anymore. They just assumed everything is electronic. So now, during downtime, not many doctors even know or nurses even know how to do the paper charting. It's becoming really bad. And for, uh, especially for patient safety. So I then went to many hospitals to validate and making sure I was not kind of like, uh, hearing just one side of the story after probably, I would say a dozen major hospital systems and everyone, uh, told me the same story. I concluded, wow, this is a major problem. And now I'm aware of this. I really should actually help fix. So, you know, out of all this a little bit naivety didn't know how challenging this is. And I took on this, um, really the challenge and the three and a half years later, I'm just so grateful for all these hospitals told me this problem and we are really on the way to eliminate pen and paper during that time.
00:05:55 Megan Antonelli: Yeah. That's amazing. Well, I, I know, I think I, you know, I heard it recently and I've heard it a number of times, but another female founder, um, you know, Judy Faulkner has said, you know, that the, the medical EHR is record is as complicated as, you know, rocket science. And I think, you know, um, the taking it into, you know, sort of the simplification and the work that you're doing with it is no, no easy feat. Um, and you know, it always, everything looks a little bit simpler, uh, at the beginning. And then the complexity is, is there for sure. Um, you know, and I think, you know, you're describing a problem. We talk a lot about the pit, the show, the pit on, on.
00:06:34 Chao Cheng Shorland: That's right. Yeah.
00:06:35 Megan Antonelli: And they literally, you know, had this, um, happen where we saw, you know, them rolling in fax machines and, uh, calling people who, you know, no longer worked in the ER to help them, uh, during that downtime. So I think, you know, both, uh, the CEOs of the hospitals and as well as lay people kind of are now understanding that this problem. But, you know, and, and talking about it really not just in the frame of, you know, what gets missed and what doesn't, but it really is a patient safety problem. So tell us a little bit about, you know, how you've approached it from at shelters, um, and what that looks like.
00:07:13 Chao Cheng Shorland: So from day one and what I saw is a problem directly in impact on patient care and that right at the beginning. So if you look at the traditional, um, kind of approach, right, it's about disaster recovery, but disaster recovery is after failure. You have to wait for it to restore to be able to get a back up going or whatever the method. So you are really missing that whole period. You know, you're not able to properly take care of your patients. And our design principle is it. And it just cannot impact on frontline workers, so the care delivery cannot stop. So health care shouldn't stop. So that's really the design principle and the invention of our method. And then we actually received the USPTO granted patent as the very first system didn't impact on front line workers. So the whole concept can, you know, extend from physicians, support workers, but obviously airline and all others. But our focus is really the EHR downtime, the healthcare side. So that's, um, um, really the major difference between spare time and the disaster recovery. So we really focus on continuity during failure, not disaster recovery after failure.
00:08:33 Megan Antonelli: Got it. And for our audience, tell us the spare tire is the name of the product, right?
00:08:39 Chao Cheng Shorland: That's right. So we just thought it's so appropriate because we're not trying to build a spare car or a, a massive kind of something because we understand it's a lot of clinical clinical workflow, but we build a very lightweight and a large data high performance. Even under very limited network connectivity, you can function. So just like the spare tire in your car, you always want to carry a spare tire in case something happens because anything can happen. And you immediately put a spare tire, get you to the next the safety spot. Then you can replace by the mentor again. But what's interesting is spare tire. Anything you captured during downtime inside your spare time will be automatically sync back into your primary system. So in that way, you do not have to spend four times, seven times longer to double do the double manual data entry.
00:09:33 Megan Antonelli: Right? I love that, I don't know, I speak another analogy or image that I remember seeing very early as we were, you know, kind of doing, you know, content and events and interviewing folks about healthcare. It was the CIO's changing the tires while the car is moving. Right? So as we were taught when we were talking about EHR implementation, that was, you know, and I, I love an analogy. Um, and sometimes I beat them to death and I, you know, certainly use that one over and over again. But it is, it's, it's a great one. And certainly coming up with that, I think must speak really to those, you know, leaders who have been, you know, really, you know, sort of driving that car and changing the tires for years. Um, you know, so that's, I love it. Um, now I think that the piece around what you said, which is recovery is where we tend to focus, right? And not thinking as much about what happens to the care in those hours. And so, you know, tell me a little bit about, you know, how people have sort of gotten that wrong in the past and what spare tire does to, to change that.
00:10:40 Chao Cheng Shorland: So at the moment, um, if you don't have spare time, everything's Downtime procedures, pen and paper. And recently I spoke with a CIO at one of the top AMCs. And he said to me, when my team come to say, doctor, I'd like to show you the hour downtime procedure. He said, oh, you're talking about pen and paper, right? You don't need to use the term downtime procedure. Sounds very fancy, but really you're just talking about paper charting. How can I do the paper charting? So he had a bit of a laugh. And but it's actually the reality, which is very, very sad. So hospitals all have the manual downtime procedure. And then some actually do have a read only access to certain type of solutions, but they can't really do any more. Um, you know, like a workflow or do the notes, do the orders, do the medication. They just completely stop at that point. Then after that's all pen paper. So this actually, uh, cause such a problem, especially in the acute care when you actually need to all the medication, lab or radiology you use paperless in the hospital during downtime, you will see tens or hundreds of paper runners running across building from building floor to floor because they have to deliver in the in the paper. Right. And the paper format. So, um, the problem is after twenty four hours, literally even paper collapsed because the paper piles up the bill like the whole floor and just paper, you can't move anymore. And the people cannot move fast enough and they don't have a proper fax because a lot of times communication got cut off as well. You can't really send the urgent, um, the order like a medication order to the pharmacy to get the, um, the medication back. So this really impact on patient safety and everything gets delayed and a lot of um procedures get cancelled. So at the end of the day, truly patient safety is the biggest concern. And then the mortality rate and some from some recent research during downtime is actually increased by twenty percent, sometimes even fifty percent. So now with the ransom attack happening and the downtime on average twenty four days, now it's not two hours, you know, twenty four days on average. So you really have so much paper to move and it's completely not manageable.
00:13:12 Megan Antonelli: Yeah. I mean, you know, I think the threats we, I mean, we hear about them so often and so frequently within the, um, you know, within the hospitals and then where, you know, where they get hit and how they respond in terms of, you know, providing this to, to health systems. And you talk about this a bit in terms of like the reactive recovery versus proactive resilience. And so when you're talking to your, your customers right now, you know, how are you explaining what that shift looks like in terms of, you know, kind of planned planning around restoring the systems and, and what, what that sort of mindset looks like.
00:13:48 Chao Cheng Shorland: I actually think the hospital system themselves, the awareness has really increased so much because I remember two years ago when I was actually explaining to people about spare time, everyone could see it's so important, but some hospitals will say, oh, you know, we can get by, by this, by that because they don't really understand. This is not just a backup system. It's really just in time. Immediately get going. So, um, now because of the cyber attacks, AI driven kind of, um, you know, cyber attacks and then plus ransom, I think the hospital, the awareness is really like overnight. It's just everyone realize, wow defends itself no longer enough. You have to have resiliency. Resiliency is the really the game. So that's really increased the, the, um, kind of the, uh, the desire to adopt this type of, um, you know, solutions. So I think, yeah, it's just the maturity level, um, has really increased a lot. And then also a lot of decision makers now really thinking about, hey, if my hospital goes down, that is a huge amount of liability. So they just couldn't afford and needing a solution like this.
00:15:02 Megan Antonelli: Yeah, yeah. No, I think the mindset has changed and the nature of the threats have changed as well. I mean, in terms of, you know, kind of AI and not that it hasn't been there before, but it's moving fast, adoption is moving fast. And the, the threats from that are coming into play. What are you seeing and how are you kind of reacting to how, you know, leaders should kind of balance on, you know, the AI coming and, and, um, you know, kind of keeping that, protecting the patient data, keeping the trust intact. And as you said, kind of that focus on patient safety.
00:15:38 Break: You're listening to digital health talks. When we return, we'll continue our discussion on how technology is revolutionizing healthcare delivery. Stay with us to hear more insights on creating sustainable, patient centered digital health solutions.
00:15:56 Chao Cheng Shorland: AI really arrived so fast. It's super fast. And then, um, but the trust really hasn't. So every hospital is trying to figure out how they actually really implement, um, the proper enterprise like AI. And, um, we have actually engaged with a lot of hospitals and they are at the beginning of their journey rather than they all already figured out how to do that. So they're building a lot of foundations. So one of the pieces really missing is the trust, the governance that AI actually in my mind should be self-governed. You can't you can't govern AI. There's just millions, you know, AI can create within a day. How can you govern them? So AI needs to really have the inbuilt governance um vehicle, right. Governance themselves. So interestingly, you actually say that because um we are about to launch a new platform called AI. It's actually blockchain based, um, the cryptographic based end to insert into LLM or other kind of the content management and ensuring every decision is a source, this trusted source. And you can actually audit a few months later, hey, where's my decision come from? Where did the data go? Who has viewed who has actually done something to it? So you have a total data lineage across your whole AI workflow. So we are also very excited to add that into the spare time, you know, into the, uh, the whole, um, you know, the hospital and the life science kind of ecosystem.
00:17:28 Megan Antonelli: Oh, amazing. Now explain to me a little bit. Let's go back to spare tire. I mean, what does it look like if it's not pen and paper? What is it? What? What? You know, what are the health systems sort of implementing when they're implementing it?
00:17:40 Chao Cheng Shorland: So, um, the data really comes with, uh, two modules. So the first module is the end user, right? Physician, um, or the user experience. So when they come in, it literally just caters for all your essential workflow from the paper chart, sorry, not paper chart from the and the chart. And you know, your chart overview to taking clinical notes, do the vital sign reading, do your, um, the diagnosis and then um, also the orders, medication order, lab radiology, you know, mar and then results. So all the, um, the essential workflows are there. So it really can't replace one hundred percent paper, but it's really a large percentage of paper. We also have the best data management. So you can actually really check what where are the empty beds, you can quickly move the patients in so all the. Obviously the ADT part, the admission and discharge and transfers all covered as well. Then we are actually releasing a Ed tracking board. So like you said, the pit show, hey, when the Ed tracking ball goes down, you don't know what's happening. Your emergency department, that's actually very dangerous. So we actually releasing that as a just a board. You can actually keep running and even your primary board goes down. You still have a backup spare tire board, you know, to, to really triage a patient and do other things. So on the other side of the fence is administration board. So that's really where you can actually set up your hospital facilities. You know, you can import your facilities from your primary system into here and then all your provider details. Then you can actually manage your HR seven integration. So it's integration is very simple because it's all templated. It's everything's configurable. So you just need to say, hey, I need this workflow. And then all the default and also the role based access, everything coming in the package. So the most amazing thing about spare time, we designed it in a way. It's so simple. There's no user training required. So literally, we actually had a lot of doctors and nurses kind of use the system. They actually found out there's no training required. They all figured out so fast and it's just so easy to use. The reason we did that is actually really intentional because it's not a system you use all the time. It's not like your regular EHR or your normal corporate system, right? This is your downtime. It's only when you need your downtime. You activate that. Now you can use it. You don't expect anyone will learn have even the time to learn. So the system has to be so intuitive. And I'm just really glad that we actually achieved that.
00:20:31 Megan Antonelli: That's amazing. So does it sort of live within your system during normal times and then get activated when a threat comes in and you have to go to downtime? How does that like, how does the shift, what does the shift look like? And forgive me if I'm coming at this from a layperson's perspective, but I am.
00:20:51 Chao Cheng Shorland: Oh no problem. So spare time is always in the passive mode when your primary system is running. So it's read only. You cannot actually write anything because we want to make sure primary EHR is your master system. So it does get a subset of data, get synced in real time through HL7. Then as soon as your, um, the primary system goes down, you can immediately activate spare time. Now all the doctors nurses, they can now divert into spare time. They will have an icon on their device or you know, anywhere they actually need that access. So they can just click on the icon, go into the spare time. And then now at that point of time, they can actually start doing all the normal workflow charting, you know, vital signs, you know, everything. Yeah. They can make a medication order. So, so then after the downtime, after downtime is over and it will actually turn back into the passive mode at that point of time. And they will be prompted by the signs that, hey, do you want to sync the data now? So then they can actually confirm and sync all the data. So they will produce the reconciliation report and then making sure all the data come back to the primary system safely.
00:22:08 Megan Antonelli: Amazing. So and one more technical question. And then then we'll move on.
00:22:12 Chao Cheng Shorland No problem.
00:22:14 Megan Antonelli: My brain starts to hurt now, but the in terms of, uh, EHR agnostic, what does it work with? Epic Oracle everything.
00:22:24 Chao Cheng Shorland: That's right. And as long as you have HL7, literally all EHR systems now do. And you can actually use, um, spare time. So we have the bidirectional HR seven engine is a proprietary. We built ourselves because to overcome the volume and the speed problem of the standard, um, you know, engine. So it's very high speed and now you can connect with um, doesn't matter. It's Oracle epic Meditech Athena or any system is yeah, can use spare time. And just like the car, you really should have a spare car as a spare tire for your car. Doesn't matter. It's your Toyota or Mercedes Benz, right. You should all have one.
00:23:07 Megan Antonelli: Yeah, absolutely. That's great. Amazing. Well, I'm excited to hear about, you know, kind of the implementations. I know you're on pilots with a number of different hospitals and being implemented. So excited to hear how it develops. And I think, um, as we, you know, this, the female founders series. So to talk a little bit about, you know, I mean, you worked in oil and energy. I did events and many years ago in that space, I think I was always the only woman in the room. I'm sure it's changed now, but back then, um, and then of course finance and now, um, I mean, healthcare is probably a little bit of a refreshing, you know, uh, compared to those two industries in terms of diversity, but kind of leading a company in this space. Um, tell us, you know, what you would share with other female entrepreneurs and leaders. Um, you know, about that experience.
00:23:54 Chao Cheng Shorland: I actually found it. It's extremely rewarding. So, uh, when I first went into healthcare, um, I understood the scope. It's just so big, right? And there's just a lot of, um, kind of paths to navigate. And, um, the systems are very different from other, um, industries. Um, it's just very, um, kind of, um, um, how, how I describe really very concentrated and then, um, you know, everyone has their playbook and what's really interesting is once actually, you know, a group of people and you find actually healthcare very small in terms of stakeholders. It's just it's a community so tight and like everyone knows each other. You go to him, you go to, you know, other conferences, hey, it's just like, I feel like it's a reunion. And that part I actually didn't find in other industries, I found actually health care is almost like a very family orientated large industry, but yet actually it's just so personal. So, um, I actually really enjoy actually last three and a half years, just so dedicating health care and we do a bit of life sciences as well. And I was always very fascinated by healthcare and life sciences and just had a lot of curiosity. And I actually thought, um, you know, at the beginning of twenty twenty three, when I became aware of this problem, I was thinking, gee, this is really amazing opportunity for me to get so involved in healthcare, right? And because the interoperability Problem. A lot of other things that can really help resolve along the way as well. So yeah, I think, um, really grateful for the healthcare, especially in the US. You know, for me, it's coming from Australia, it's a very different culture, but I'm able to really navigate and now having a very, uh, I think a very strong and a market fit, um, product, you know, offering to the healthcare, really helping them to be resilient.
00:25:50 Megan Antonelli: Yeah, I love that. I mean, I, I felt that as well. And that's, you know, sort of, I mean, I was always a healthcare person, but when I would do, you know, the occasional finance or energy event, it was always like, I want to go back to my people. And it was especially in convening and bringing people together that, you know, I think healthcare has such a collaborative, uh, take and perspective that they want to work together, but they also have sort of, you know, this academic problem solving, learning, uh, that kind of helps with that, you know, as you said, sort of family community environment that that people, you know, are all coming together to tackle these problems. And you've been working on, you know, a problem that that is a real challenge for people. And when you do have that solution, uh, you know, you're easily, you'll easily find your home and, and be embraced.
00:26:39 Chao Cheng Shorland: And, and the people do embrace. They actually, so many people said to me, child, you don't need to sell your solution. Your solution sells itself because everyone understands the problem. And it's just so, um, you know, encouraging to hear things like that. You know, I don't find that in other industries, to be honest. I feel like you always have to kind of like think about, um, how do I position myself, you know, what's my GTM and then this one and it, to be honest, I kind of never actually revealed any of the shows. And we literally just had three, um, three people selling, uh, spare time, not even selling. It's more like a consulting, um, help people understand, you know, the solution. And, uh, yeah, we covered, you know, double digit percentage of acute care market within ten months. It's like a really, like extraordinary.
00:27:33 Megan Antonelli: Yeah. No. Amazing. Well, to speak of another founder and another company that we all know very well, they, you know, they didn't spend a lot on marketing or sales in the beginning and it sold itself. And here it is, you know, epic being one of, you know, certainly the one of the leaders and a big leader in the EHR market. So, um, when you have something that people need and that works, um, you know, it does sell itself. But that being said, tell our audience where to find you. If, um, you know, they want to learn more about this amazing product.
00:28:03 Chao Cheng Shorland: So this has its own dedicated, um, website called spare tire dot io. So it's just like the car spare time American spelling. So then you also can go to our parent company called shelters. Um, so the shelter like a Zoom zoom, g c o m and zoom dot com, and you can find the product and spare time as well.
00:28:26 Megan Antonelli: Awesome. Um, and we always close with, you know, we have a segment called five good things. We close with, uh, one question in terms of what, you know, what you think is going very well, you know, and what's genuinely good in digital health right now and what you, you know, kind of are most excited about in terms of where healthcare is heading.
00:28:44 Chao Cheng Shorland: Um, yeah, I actually, uh, one thing obviously excited by AI, but at the end of the day, this is how I feel cyber security, cyber resilience is must have AI. Not saying it's, uh, not must have, but comparing to your survival, right? Cyber security and resilience is really your survival. AI is just make things much more efficient, much more, um, you know, the cost effective. So I feel, um, you know, really focusing on your, um, security posture, your resiliency kind of readiness. It's really a very it will really bet on the the right path. So to me, I think it's a lot of amazing innovation coming through in healthcare and a lot of very dedicated companies producing high quality products. I think it's a really a great time to look at your strategy, how you actually balance, you know, between AI and other type of must have technology.
00:29:44 Megan Antonelli: Yeah, I think that's a really great point. And I think it's true. I think, you know, for so many years, cybersecurity has sort of been that, you know, yes, we have to do it. Yes, we have to do it. And I think, as you said, it's now it's a must do. And, you know, beyond that, it's become, you know, it's become interesting and it's become this sort of, you know, move and push towards patient safety, the relevancy of it around resilience and what matters. It's, it's not any, you know, it's not something of, you know, well, we'll let them deal with it. It's just a risk issue. But it really is a patient care issue. And I think you stated that really well. So. Really a pleasure talking to you and getting to know you and the product. Um, you know, spare tire and shelter zoom. And I hope our audience, uh, you know, finds it and gets it, gets it running to, to, you know, prepare their health systems as well.
00:30:35 Chao Cheng Shorland: Thank you so much, Megan. It's such an honor talking to you. And I really enjoyed the conversation.
00:30:41 Megan Antonelli: Absolutely. I look forward to seeing you in the future at a Hims or health impact soon. And to our audience, if this conversation got you thinking, that's the whole point. That is why we're here. Share it with someone who needs to hear it. Subscribe to Digital Health Talks and follow us on YouTube. This is Megan Antonelli, CEO of Health Impact, and this is Digital Health Talks. Let's keep fixing health care one conversation at a time.
00:31:06 Outro: Thank you for joining us on Digital Health Talks, where we explore the intersection of health care and technology with leaders who are transforming patient care. This episode was brought to you by our valued program partners. Heidi, the eye care partner built for every moment of the clinical day. Natera. Advancing. Contactless. Vital signs. Monitoring. Sailpoint. Securing healthcare identity management and access. Governance. Your engagement helps drive the future of healthcare innovation. Subscribe to digital health talks on your preferred podcast platform. Share these insights with your network and follow us on LinkedIn for exclusive content and updates. Ready to connect with healthcare technology leaders in person? Join us at the next Health Impact event. Visit healthimpactnews dot com for dates and registration. Until next time. This is digital health talks where change makers come together to fix health care.