Episode 14: Starting in the health-tech world with no code

Jean and Jim and two amazing founders who have found product-market fit. How did they find it? By leveraging no code to build the first versions of their app, get it into users’ hands, and iterating fast and cheap. Don’t miss this great episode with some amazing insights be Jean Ross, co-founder of Primary Record

Jean Ross: And so I had this like aha moment of like, if families are willing to pay me $85 an hour, what could I do? What were the like wins from that business model to figure out what could I do with technology to make it more accessible to more families, so that they weren't getting into these problems or trouble areas, you know, they're more proactive and ready for these situations.

And that's when, I mean, just kind of when I think we first called ourselves ...care or something awful, um, but we ended up becoming Primary Record.

Jesus Vargas: Hey guys, it's Jesus from LowCode, and today we have Jean Ross with us here today. Uh, we have been working with Jean for quite a while and she's a nurse and we have been building this pretty cool and complex app for, for Jean and her partner. Um, so Jean, tell us a little bit more about yourself. 

Jean Ross: Yes, uh, thank you Jesus. I, um, I'm a nurse by training, uh, but weirdly before becoming a nurse, I studied the business side of healthcare. I got a master's in healthcare administration, which led me into the financial side of healthcare, which I absolutely deplored and hated. Um, and when I was about to have my first child I thought about becoming... what would I want to be? What do I wanna be? And I ended up going back to school to become a nurse. Um, I loved critical care and I spent about six years, uh, doing that, which is very prone to burnout just because of what you do for patients and for families. And part of that role is I got to jump around in my hospital to all kinds of units.

And when I started jumping around in healthcare, my eyes started opening up to how siloed each section of it was. And I started paying attention to why were some of my patients doing so well and some were not, and it always came down to these families, when they had a family support around them, that was educated or aware of what was happening, um, and due to some kind of family circumstances and just that burnout, I ended up leaving the hospital setting and decided to naively start my own business, where I would coordinate care for older adults in my community. I had, uh, luckily had a business degree, so I had some sense of how to run a business.

Um, but no concept of what it was like outside of the hospital.

Jesus Vargas: So was your idea to manage people that went to the homes of elderly and took care of them on a day-to-day basis. 

Jean Ross: No, so what, so what I would do is, what people often don't realize is there's this huge chunk of management and health care that falls on a patient, but when that patient is older or has dementia, or has some kind of issue where they can't take care of themselves or, or manage the healthcare system, it will fall on a family member.

Um, And when that family member becomes overwhelmed, they don't really know where to go. So my whole business model is that I called myself a care coordinator. And so a family would link up with me and say, here's my older parent, I'm so overwhelmed, I don't know what's happening, they're going from rehab to hospital or whatever the situation is.

 And I would just dive into this family story. And at first I didn't know what the hell I was doing, but slowly what I, what I soon realized as when I started, so that we came and got my own process, and all of that process revolved around "let's figure out the information and the team around your parent", cause we wanna understand how are we going to peace, who is on our team? Are they the best people? And what are they saying about your parent so that we can get a better picture, a bigger picture of what's happening. Um, cause often families didn't feel validated in what they were, you know, when, when they were talking to doctors, doctor seemed overwhelmed and dealing with their older parent, like it was just this total show, um, that just was kind of heartbreaking on some levels. And then here in the middle is this poor older adult. And so I would, um, interject myself into that relationship, and I probably attended between 400 and 500 hours of medical appointments with older adults. And what became very evident to me, um, in traveling with this older adult, from, from service to service hospital, to rehab, to whatever they had... 

Jesus Vargas: Was that just one client, one person, or multiple clients? 

Jean Ross: I found that my quota, cause this gets into the issue of scalability, right, I thought I could start this business and grow it here in central Indiana, and, um, and I realized I topped out about nine and then I became very, not effective for a family, because I was starting like into the world of Google drives and creating my own systems and like Google docs on how we're going to chart. Like, I was almost creating my own like EHR for like my patients and helping explain it to families. And we used a free, like a few free like caregiving type apps and they would do so good so much, but we spent... and when I started hiring nurses, It was very costly for them to spend their time to constantly updating these information systems that should be working for us easier.

Um, and so I lived, um, actually next to a gentleman that's been in the tech technology side of, um, SAS and products, um, for, you know, like eight years, and I've bugged him with all kinds of wild brain ideas that I had. And then finally, when I brought over this idea of, jim, like a family, It's, you know, everything, like the family is like the center, and they don't, you know, they don't have their own way to communicate, that usually falls on one person to like maintain the information and the process of everything.

And then it's, well, um, just overwhelm them and then it's just, that's usually when they would hire me. And so I had this like aha moment of like, if families are willing to pay me $85 an hour, what could I do? What were the like wins from that business model to figure out what could I do with technology to make it more accessible to more families so that they weren't getting into these problems or trouble areas, you know, they're more proactive and ready for these situations.

And, um, and that's when, I mean, it was kind of when, I think we first called ourselves ...care or something awful, um, but we ended up becoming primary record. 

Jesus Vargas: Do you think, so this idea came up when you have been dealing with elderly people, right? Or maybe people that came out of the hospital or are, or were sick, do you think, is that your client persona or do you want to start before that happens? 

Jean Ross: No, honestly, the older adults are usually pretty unaware of the failure of the information system around them. The, the user persona that I dealt with most on the phone was their, um, adult children, because it was falling on them to maintain. And what became apparent is not only are they trying to do their parents health, but they have their own family, their own health, they have, and then because usually a caregiver for one person in a family is a caregiver for many, um, you know, and then they've got aunt Sally, that's also just went in the nursing home, like, and so I just, it became this like female figure, honestly, because I think 70% of our family caregivers are female. Um, that is just what they call the sandwich generation.

Right, they're just caught right smack in the middle of aging parents and also, you know, kids and other family members. So that's kind of who I think of often, um, when, when we're kind of building our products. And when we started talking to these females, what we learned is that they're dealing often with aging parents or they're dealing with kids that have medical complex conditions that have multiple providers, so. 

Jesus Vargas: Why do you think that the healthcare industry has so many technology needs? We have worked with multiple clients in the healthcare industry, uh, and on top of that, something that, that I don't know, I think about it, is that there's so many regulations, like HIPAA, you have to be HIPAA compliant, and there's so many things around how you manage data, like, uh, healthcare data, right?

Uh, but even though with those requirements or that, that, those levels of complexity for small and medium businesses to handle data, there's still so many needs. Do you think like the, like the Silicon Valley, the technology industry hasn't looked into the healthcare industry or, because at the end, the healthcare industry, has a lot of money, right? There's a lot of money involved. So why are there so many technology needs in an industry that does have, and make a lot of money? 

Jean Ross: That's a good question, and I guess the view I have now in just trying to enter this space, I don't think there is the right policies and views of health information.

I think it was, I think HIPAA is wonderful. When you talk about protecting the patient business to business, I understand the needs there, um, but what has started to shift, I think at the federal level, especially with, um, there's this, uh, the recent, uh, cures act, is they're realizing when they're leaving it up to business to business the incentives are misaligned and the information is not getting where it needs to be to help the patient and family the most. And, because if you think about it, like I just changed my kids from our, our pediatric office to another primary care doctor. 

My pediatric office doesn't owe me anything in helping me get information to my primary care. Yeah, um, you know, I'm done with her. She's never going to get to bill me again. And, and, and she's a sweet woman, she doesn't think this way, but it's more work for her office to have to compile my records and mail them over or fax them, you know, that's time that they don't have, especially during this time.

And so I think with the shift of which I've always had this view is why isn't the data more attached to the people and the families that it matters the most, because honestly, you know, I'm the new, I know where I'm going to go get my flu shots with my kid, and I know what doctor I want to go see, and granted there's regulation around that with insurance and everything.

Um, and I think, with that shift, there's now even like more of a tightening on health information, because what I have seen has health information is very lucrative and that's kind of sad to think about. Um, and so it's been fascinating to watch how America is going to deal with this opening of a gate.

Um, and I see a lot of questioning, um, and it's also what we're going to see too. I feel is, you know, HIPAA is, I hold HIPAA in a very high esteem. I think it serves a purpose. I know there's a lot of Silicon valley that despises what it does, but I think it's a safeguard to ensure, you know, measures that are needed.

Um, but what I always tell folks, because you know, these consumer, this boom of consumer applications are not regulated by HIPAA. 

Jesus Vargas: Yeah, we are so used to share our information with anyone like any gap. And then, so yeah, that'll be a challenge, especially for the new generations that are used to share everything.

And then who are you going to share your medical records or your... 

Jean Ross: Right, and they don't know quite the negative effects of it. And there's a lot of like, you know, like scary stories here and there that you hear but we haven't really seen what that's going to be like. And that's what, cause when I started working with families on the outside, you know, I was trying to hold myself to like HIPAA standards and you know, all this.

And I remember one daughter being like, I don't care what I have to tell you, as long as my dad gets taken care of that's what matters. And it just shows you to like when you're in that crisis situation, you know, this, this willingness to share information, as long as it helps your loved one, you know, there there's some feelings around around that, but, but I think what we're going to see is w what hasn't caught up is the federal trade commission, which is where these consumer applications get regulated, I think needs to kind of beef up to make sure that all of these health consumer applications don't have too many bad actors, right? 

We're always going to have bad actors, just how the world works. But at the end of the day, I just hope for policies in our country that make sure that we have people with well intentions and good intentions, helping families get their information to the right spot.

Jesus Vargas: And do you think the FTC is doing or will do a good job regarding that? 

Jean Ross: I don't know. I have a few friends that are in DC and they, um, I think, I think our politicians don't always understand the situation. And so, I mean, I... 

Jesus Vargas: There are a lot of things that can go bad. Technology moves very fast... 

Jean Ross: very fast, and politics do not catch up. 

Jesus Vargas: And the regulators are like stuck between technology, that's going a hundred miles per hour and politicians that just don't move. So it's, it's kind of okay when we're talking just about technology, but we're, we're talking about your personal healthcare information, uh, that can be misused or used to do some bad things, then that, that that's worrisome, right?

It's not getting your facebook credentials. 

Jean Ross: Yeah, no. And I, and I think the public is, cause you also have public perception of all of that, right? So, um, cause I I'm in a lot of different advisory boards and committees and um, there was a, at a hospital I'm like on a patient and family advisory council and they were reviewing a consumer app.

And I absolutely love this gentleman was like 72 years old and he raised his hand and he asked the head product person, he goes, "so if I'm not paying for this, that means I'm not your customer, so who is your customer?" You know, cause there is, we need to educate people to, if you're not paying for something, you know, these companies aren't, they don't exist without money.

So you have to, before you go and think it's wonderful, you know that this is all free, you know? And I know I'm awful at reading those terms and conditions, you know, and you know, and I, you know, even in our own ideas, I'm like, how do we make sure people know, you know, like, you know, how do you educate someone really easily on their level?

Right, it's almost like they do that to bypass, I don't know this, so I'm kind of going on a tangent. 

Jesus Vargas: So coming back to the, to the app, um, so the Primary Record app, something that is usually very challenging and I think you're doing a great job in that app is providing a very good user experience, right?

Because usually when we're building an app or we're developing software, anything, we think based on our experience, right? So if I'm recording instructions on how to do something, I think in a certain way, because I've done that a million times. And then when someone is someone else sees that recording, they will probably won't understand because I am assuming a lot of things, right?

How do you make sure that there are no assumptions, because in an app like yours, that there are so many, I mean, the data is very important and especially when we bring to play these like elderly or children with, with medical conditions, or I don't know, family members with medical conditions, uh, the data is very important that it's well documented, that the data is right and updated and everything's in there, right? 

So how do you, how has that process been for you guys to think in terms of your user. Like, I have no idea, like if I'm a user of your app, I've no idea about anything, right, and we spoke about this a few months ago. I just had a baby, like, I don't know, I want to start documenting he's out of medical documents life right, somewhere. Uh, but I don't know how to do that. And that's something that you are doing in the app. How, how does that thought process has been in order to do that as well? And not only build the software and the app. 

Jean Ross: Yeah, I think, you know, this is where the, the Jim and Jean team I think is, is where we just really compliment each other.

But I think, and just in general, speak for anyone that's like, wow, this is really cool, low code, you know, how do I build a really good product? And, um, I, I mean, I'm just blessed to have a business partner that's done product development for like 20 plus years. And so the lessons that I have learned from him is, um, you, like when we very first started our ideas, all of our ideas came from my experience in those 400 hours of medical appointments.

Right, and all of the crying phone calls I've gotten, I was familiar with a problem of what families were experiencing. And when, when we went to try to figure out how we were going to solve that, we kind of just sketched up our ideas in like boards. And then we literally talked to a hundred other families.

To ask them how they thought about these ideas, right. It's just that you need feedback. And this is where I, I feel like nurses are incredible, um, and I tell them, and every like conference I'm at, because products that are focused on a problem at a consumer level, not the, you know, the admin people around a table trying to solve something, but the actual, like frontline person interacting with the customer, because you are hearing all the feedback instantly, you know how they feel about the system or, you know how they feel about that.

Um, and so that experience as a nurse and then Jim's product development just really helped us, um, like we even today is I think we had a conversation where we were disagreeing about something and we're like, all right, well, thank god this is low code, cause we'll just throw it in there and then we'll ask families what they think of it.

And so we have, so then what we did is we, people were fascinated in those interviews, uh, cause they all had their system of what they were doing to keep track of information and they were attracted to this kind of other way to do it, and maybe one that might help them more. And so we've just kind of kept a little list and we just interact with that.

We call it our little beta families, and that's, who's kind of in guiding us along the way. Um, and then our goal is, you know, you're not going to hit the ground and have thousands of users joining you, just, you just treat every customer and you get the feedback. Like even I was at my family dinner and I'm pulling out what's, where primary record is now. And when I like, see my family members struggling on an area, I ask them questions, "okay, well, what are you thinking right now?" or, "well, why would you pick that versus that?" And then you just learn and you just kind of keep reiterating. So that's what we've been doing for like a year now. 

Jesus Vargas: That's important, and that's why we tell people like, your app is a baby, you have to take care of it every single day, and you have to work on this every single day, because people like you assume things that your users orders won't understand, so that's something that's very, very usual. 

Jean Ross: Yeah. You have assumptions and where, you know, being belonging to a nursing community, I know that I don't, I have a really good sense of geriatrics, but when I have a pediatric question that I lean on my NICU nurses, like, okay, what a family say about this? Or, you know, so it's just using your resources to, um, but I think that's the hardest part is realizing you are making assumptions because when you're in the weeds, it's hard, so that's where, you know, sometimes just use your kid. Like I have a 13 year old, I'll hand them the app and ask him questions, you know, because you just can't see the problems, cause you've been looking at it for so long. 

Jesus Vargas: Yeah, yeah, that's true, that's true. If you were not doing these, what will you be doing like work, if you are not doing this, like the, the, the business that you have and the app, what would you do?

Um, the question is where do you see an opportunity for you to leave a mark probably in the healthcare industry or maybe some other industry that you like? 

Jean Ross: Oh, that's a really hard question. I can only picture this, um, I would, I do a lot of volunteer work. Um, but I think I am just, I'm so dying, I, because the healthcare system is so focused and patient centered and it's driving me crazy.

So if I could just change some of that language to make healthcare realize you see the patient once a year, who else is taking care of them the other 364? It's family, it's some support networks. So, so I think the biggest impact I would love to make on any of this is changing this view of when you have a patient, broadening that view to realize that patient belongs to a community, right. And family is very loosely defined. It could be the neighbor that helps out here and there, but how do we in healthcare, and to hit those really kind of eroded that you know, this idea of, we want to be private with just our patient.

Um, and so trying to figure out ways to safely broaden that scope would be, that'd be icing on the cake for me. Um, making sure that people get taken care of and, and it, cause the other hand is I'm married to a provider, right? So he is also stressed out by this entire system. So I think in my heart, I believe everybody is trying their best to help that patient in the bed, but everyone's kind of getting this us versus them mentality, and I guess I'm with my product of Primary Record or a Geminis product, just trying to level that playing field, because here you have this giant EHR you turn to with any question that sometimes doesn't have accurate information.

I just want the, I want the family to come to the table, armed with their own and empowered with their own information to help that interaction go quicker, um, and be more effective to make sure we arrive at, uh, a care plan, um, to really make sure everybody gets taken care of. 

Jesus Vargas: Yeah. That makes a lot of sense.

Now regarding Primary Record, what would you think? I mean, when we're speaking about launching your idea with an app or with software, uh, ideally we are thinking steps, right? So as soon as the app's finished, what would be your first goal for the app? 

Jean Ross: Uh, the first goal of the app is to put in the hands of our beta families that we've been promising a year for an app. Um, and to... 

Jesus Vargas: What is the end goal? Is the end goal funding and building a platform? 

Jean Ross: Yes, yes, so our end goal with, you know, using kind of this low code is, is that, is learning and learning enough to valuate that we figured out a way to solve a problem. And now we have seen many other ways that we could accelerate this application and make it even better, but that would all come with the need for funding.

So, yeah, so Jim and I are bootstrapping this idea trying to, and that's where low code becomes instrumental. And the things that we need to learn are amazing, with, you know, what you guys are building into our product so that we can quickly see all of, some of it, cause we still have tons of assumptions in that app that are gonna help get clarified along the way.

Um, but yeah, our, our end goal is, you know, if we can get a hundred people saying that this is helping them and, and, oh my gosh, it's saved, you know, this much time in a doctor's office or a doctor recommending it. Those to me are all wins, you know, that, um, that then we would just be pushing forward to get this. Out there into the world.

Jesus Vargas: Cool, that's great. Another question is, I mean, you have Jim who has a lot of experience, but if you were to do this all over again, what would be, what would you suggest a non-technical founder when they're evaluating, evaluating different options? Either no code low code or code, right.

Uh, what would be something that you would tell a founder that wants an app or an MVP like this is very important.

Jean Ross: I think the biggest piece for us, and I guess I learned it from Jim, is if you've got an idea, try to do it on your own, don't go right for venture capital, right? Cause then you kind of lose, you lose your traction of your idea because you probably had a really good idea and you were probably solving a problem.

But when you start involving other people, your ideas sometimes gets contorted and it doesn't go in the direction that you hoped. That's kind of like my first piece, but if I was a nurse on my own, I would hope that I would figure out that there was this thing called low, low code and that there was agencies like yours, right.

That I could just go to with ideas. I'm sure it would not go as well as it's going with Jim involved, but, um, but. I think it's, it's creating this space because nurses are not very technical and we're kind of intimidated by that. But when there's these stories of nurses building their own products from problems, trying to solve problems that they see everyday in their, their workflows.

And they're able to do that by just teaming up and paying this much, you know, fractions comparing to going to into development. Um, I think it's, um, it serves like a wonderful pathway, you know, for someone to just validate, cause there's always like when you're like an entrepreneur, like you're doing this, you're like sometimes you're working a job and then trying to see if you should let go of that to go. It just gives you that needed confidence to know, I do have a good idea and I got all of this data and now I'm ready for like the next thing. So you can unload that, that paying job and really take that leap because that's sometimes the scariest leap, I think for people.

Jesus Vargas: Yeah, yeah, yeah. So get beta users and validate. Yeah, that makes sense.

Jean Ross: Nope, exactly. I mean, and, and I did learn and, and it's hard because we fall in this trap too, as I've mentioned already, make sure their beta users that are not friends and family. 

Yeah. Honest, honest feedback. 

Yeah, yes. And sometimes you have to be like the weird person at like the grocery store, you know, like a costing people and public.

What do you think of this? Or what is that problem? Like would you use this?

Jesus Vargas: Good feedback. A lot of feedback, yeah. That, that defines the, the roadmap for the project on the longterm. Cool, where can people find, uh, uh, Primary Record app, or more about you or the business, your business Primary Record. 

Jean Ross: Yes, I, right now, I mean, we just, we have like our own little like front, you know, we threw up a website, but that's going to be further developed out as soon as we get this application up and running. So just that, you know, www.primaryrecord.com, um, is where they would find, um, information out about us and then, um, of where we're at in this journey, so. 

Jesus Vargas: Great, yeah. I'm really looking forward to get these apps out and in the hands of your beta testers... 

Jean Ross: I'm excited for you to be a beta tester, I picked up on that Jesus.

Jesus Vargas: It's really? Yeah, I think we are very proud of what we have done so far. Uh, you and Jim have a lot of experience and, and great feedback. Uh, so it's a very polished MVP. There's some apps, there's some MVPs that are just like out there... 

Jean Ross: And it wouldn't be to polished, like it's okay, that might be some feedback for us, but you know, you do you get into this paralysis of, you know, when did, I mean, we probably could have published something, you know, last year, but 

Jesus Vargas: Yeah, no, it it's, it's way more polished than most MVPs.

So that's, that's good. That's great. It's a very robust app. It's a large app. It does a lot of things and it does things very well. Um, because I think that was the goal, right? We have so many apps in our phone that you don't open them at all. So you have to have a good reason to open Primary Record rather than storing something in your notes app.

Jean Ross: Absolutely, yeah. No, exactly, or putting the doctor's phone in your contact list, like what's the, what's the benefit of putting it in your Primary Record? And so that's what we hope, we just hope from that moment someone does that, they see the value, so that's our goal. 

Jesus Vargas: Jean thank you for joining us today. 

Jean Ross: Oh, you did so wonderful.

This is fun, thank you for having me.

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