Assessment and Performance Metrics with Tiffany Shubert of Relias Healthcare

Chad talks to Tiffany Shubert, Senior Product Manager at Relias Healthcare. Relias is an online healthcare education company. They develop and create education and clinical content for anything from physicians to nurses, physical therapists, to in-home care aides in multiple healthcare settings. They span the entire range from acute care hospital settings to in-home care to hospice. Tiffany talks about how her clinical skills apply really well to product management, defining who you're solving the problem for, being all about your end-user, and making sure they have an amazing experience with your product. Relias Healthcare Follow Tiffany on LinkedIn. Follow Relias on Twitter or LinkedIn. Follow thoughtbot on Twitter, or LinkedIn. Become a Sponsor of Giant Robots! Transcript: CHAD: This is the Giant Robots Smashing Into Other Giant Robots Podcast, where we explore the design, development, and business of great products. I'm your host, Chad Pytel. And with me today is Tiffany Shubert, Senior Product Manager at Relias. Tiffany, thanks for joining me. TIFFANY: Hey. Thanks so much, Chad. I'm really excited to be here. CHAD: So, Tiffany, folks may not be familiar with what Relias is, although if you're in certain spaces, it's certainly a big name that you may have heard of. So why don't you start off by telling people a little bit about Relias? TIFFANY: Sure. So Relias is an online healthcare education company. Relias is in many, many different settings. But the majority of what we do is we develop and create education and clinical content for anything from physicians to nurses, physical therapists, to in-home care aides. And we are in multiple healthcare settings. So we span the entire range from acute care hospital settings to in-home care to hospice. CHAD: We do a lot of work with different clients in the healthcare space. And so many of them, without even me prompting, mention, "Oh, we use Relias." [chuckles] And it's remarkable to see. Is Relias the biggest provider of learning management software for the space? TIFFANY: So, we are the biggest provider of compliance training in the skilled nursing space. And we are a big provider in all of the other spaces. And really, where Relias started was in this notion of compliance training which, for those who are not familiar, really could benefit from a lot of design. That is the kind of training that every single healthcare provider has to take in order to see a patient. So that's where you take your patient privacy training, your bloodborne pathogen training, all of those types of trainings. And that's where Relias really started and has grown from there. CHAD: So, how long have you been at Relias? TIFFANY: So I started, interesting, in the end of March 2020. [chuckles] So yeah, it has been my pandemic experience, so almost two years now. CHAD: What brought you to Relias? TIFFANY: So I was at an interesting juncture in my career. I'm a physical therapist by training, and I was in clinical practice for about 15 years. And I transitioned over actually through a very interesting pathway but working for some different startups that were creating different technologies around healthcare. And one of the startups I had been with had run the course. And I was looking for something more around education, which is my original passion. And when Relias actually found me, I didn't realize it was actually in my backyard. CHAD: [laughs] TIFFANY: What drew me to it was this ability at this space where we could be looking at education, especially for clinicians, not as what I would call a penance which is how it's looked at. Like, ugh, I have to take my online education, or I have to take my training. But more of a hey, how can we make education interesting and dynamic? And how can we really apply many of the concepts we know about design and about really developing excellent products to clinical education? Which was incredibly exciting to me. CHAD: As you moved from someone practicing to product management in this space, did you do any formal learning or training in that, or did you just learn along the way? TIFFANY: A combination. Really my original experience in product was working for a startup company that was developing a really innovative concept around creating a soft, light exoskeleton, and they needed a clinician on staff to really understand how bodies move and what kind of problems could be solved. That position really evolved into being a director of user experience. And so that really entailed bringing our end users, who happened to be older adults, into the lab and having them really work side by side with the engineers who are creating the product. So I developed that whole program, validated it, expanded it. And from there, I really realized, oh, my clinical skills actually apply really well to product management. But now I do need to get some more formal training. So I went through some of the different...I actually went through the CSPO certification program, and then I have also just continued doing some more formal training at Relias. CHAD: I imagine that the industry itself experience being almost on the user side helps. But is it ever a hurdle that you need to overcome? TIFFANY: I think when clinicians first get into industry, they make a lot of mistakes because they want to solve every single problem. Or they want to give their users every single opportunity or every single feature. So, for example, if you sit down with a group of physical therapists, and if you say, "I'm going to build you an app for helping your patients with their home exercise program," every single physical therapist is going to give you a laundry list of 30 things that they want. And typically, where clinicians go in my role is they're like, "Okay, we're going to fix all 30 things." And really, it's that ability to narrow it down, narrow it down. And to be honest, if you're a good clinician, it's the same thing. Patients usually come with multiple complaints, and you've got to figure out what that number one complaint is and what you can do to address it. So that's where I think it becomes a barrier is wanting to fix every single problem as opposed to being able to really winnow it down. But when you can winnow it down, it's very powerful. CHAD: An extension of that that I've seen, which I think is one of the challenges in healthcare, is that there are a lot of edge cases. And in normal SaaS products like an e-commerce product or whatever, it's easier to say, "We're not going to solve that right now." But in healthcare, every edge case is an actual person that you could be helping. And so it's a little bit harder to really get in the mindset of not solving every problem. Because especially if the space of healthcare that you're in is literally life and death, it can be difficult from a product perspective to say, "We're not going to solve that case." TIFFANY: I completely agree. Those are just conversations that you have to have because you also have to look at if we spend all of this time solving all of these use cases or all of these edge cases, we're never going to have a product. So then you got to pull back, and you got to go, what is going to have the biggest impact? Or what are the components across every single patient that we can address? Because there's always going to be some commonalities, not necessarily disease space, but in how we actually address that patient and manage that disease or manage that impairment. It is a big trap that we fall into because you're right; healthcare provider training is you have to address everything. But the fact of the matter is that's not realistic. CHAD: What are some other challenges that you encounter while creating products in the healthcare space? TIFFANY: I think the biggest challenge is really defining who you're solving the problem for, and we run into this all the time. And this has become very clear to me lately that if you're working for a Facebook or a Google, you are all about your end-user. And it's all about making sure that that end-user has an amazing experience. But in healthcare, you've got patients, you've got clinicians, you've got hospitals, you've got healthcare systems. You've got private insurance payers, and you've got Medicare. And all of those groups may be interacting with your product. And all of those groups have totally different use cases and totally different problems to solve. So first of all, figuring out, like, who am I building this for? Who is going to pay for it? And where do those two things intersect? And that has been the biggest problem I have seen in innovation in this space over the last ten years has been, well, we're going to build this for the patient, and it's going to be amazing, and the insurance companies will just pay for it. That hasn't really panned out because nobody sat down and actually talked to the insurance companies and asked them what problems do they see happening that a product could solve? And then the flip has happened too where they've gone to the insurance companies, and insurance companies have said, "Well, here are the problems," but then they've never talked to the patients. So it's getting that multifaceted perspective and then boiling it down to what truly is the problem we're going to solve? CHAD: And the way I see it is that this problem is amped up in the healthcare space because there are so many stakeholders or people you're potentially building the product for. But it's a general problem too in enterprise software where basically the people making the buying decision are not the users necessarily or the people you're trying to help. And any time where that's the case, you also run the risk of very difficult to build a good product because the people making the buying decisions aren't actually the ones who are going to be using it or don't have the same needs as the people that you're trying to help with the software. TIFFANY: Exactly, exactly. So it takes a lot of time to sort all that out, and we rarely have that amount of time. I'd say one of the things that was so fascinating on the product that Relias and thoughtbot worked on was we had the time to go a little deeper and to really figure out...so the problem we were trying to solve is okay, we need a better tool. Physical therapists need a better tool to engage patients, specifically older adult patients. And again, so we had the conversation with the clinicians, and they're like, "Oh, well, we want all of these exercises." But then we paused, and we said, "But really, what is your biggest clinical challenge?" And they all said, "Time. We don't have enough time." So then we were able to pull back and not go, oh, this is not about making the best exercise program ever. This is about creating a product that actually solves the problem of time. If we can enhance efficiency, then clinicians will use it. They'll be happy with it, and we can take it from there. Solving the problem of time is a totally different problem than we have to create a product that offers you 30,000 different exercises. It was just a really important lesson because then once we said time, then all of a sudden, we had clinician buy-in. And then we also had an organization buy-in because the organization is going, "Absolutely. If you can save my clinicians 10 minutes, that's going to increase their productivity. That's going to give them more time with the patient. Or maybe we could even get so efficient that there are more opportunities to see more patients." So it's tricky to figure all that out. CHAD: So how did we figure that out? What tools did we use to have those conversations with people? TIFFANY: Yeah, there was a lot of really excellent discovery and meeting with a good variety of clinicians but all practicing in the same space. And that's one of the things I want to call out. When you look at healthcare, healthcare spans so many different settings. And there are not a lot of consistency or universal truths between settings. And what I mean is someone who is seeing a patient in a home health setting is going to have a very different skill set than someone who is working with a professional sports team, same training, same title, totally different set of problems. So we were really, really clear that we had to really refine this problem and get a very specific type of therapist. And we also wanted to get a specific...I'm going to just use home health just for an example. But okay, so let's make sure we get therapists who are working in rural settings, in-home health, and therapists who are working in urban settings in-home health because we wanted to make sure that we had a better understanding of the problems they were facing in these multiple settings. From there, from that discovery, got really, really, really very strict on what consistencies we were seeing around the problems that the therapists were running into. And from there, we just really focused on what was going to give us the most bang for our buck. And the problem of time was super consistent. The questions really were not like, well, would an app save you time? The questions were really what are your biggest challenges right now? CHAD: And did you do that in one on one interviews with them? TIFFANY: Yeah, those were one on one interviews. Yes. Yeah. CHAD: How do you, when you're doing it, collect the data from those interviews in a way that is conducive to analysis later on? TIFFANY: So I've used a whole variety of tools. And we were very analog in this particular one. We were interviewing one person, but there were about four of us on the call, and everyone was taking notes. And then everybody was highlighting common themes. And I've used focus group analysis software as well, which is always really, really helpful. But in this particular, we were really just going analog, and it worked pretty well. CHAD: And you were doing this without a prototype or anything like that yet, right? TIFFANY: Correct, for the initial without a prototype. Yep. CHAD: And so once you had that potential job to be done or value proposition, how did you go from that job to be done to a potential product? TIFFANY: So from there, we did go ahead, and we prototyped, and we prototyped a workflow that seemed to make sense given what we had heard from our users and then also just with my clinical background. And then that prototype really was the trick because a lot of times in healthcare, when you are working with clinicians, some are tech-savvy, but there's a significant amount (And this isn't age-dependent, but this is younger and older.) that are not. And so they really need a little bit of context to ground what their thoughts are and how they think you can solve them. So by getting that prototype in place and by letting the therapist really bounce around in there and see what was intuitive and what wasn't, that was the game-changer. And we could really see okay, here's our understanding of this. And whoops! Missed that one. [laughter] Oh, this all makes sense. But you could see as therapists went through what they appreciated was that the user interface was super simple, super clean. They could easily find things. And even those who didn't have a lot of self-efficacy around technology really felt at the end of a 20-minute session I know how to use this, and I could see how this will save me time. All of that data really helped us understand we were going down the right path. It was a little unsettling because when we looked at other products in the market, they would basically say, "We literally have 6,000 exercises that therapists can use." Well, we were really saying, "We're going to give you about 400. But the reason why is because it's a lot quicker to review 400 exercises and identify what you want as opposed to 6,000." And by and large, what we were hearing was that "Oh, well, when I use those apps that have 6,000 exercises, I just get overwhelmed, and it takes too long." CHAD: But that can be a little scary, too, because if you're in that situation where you know that the person making the buying decision is just going to look and say, "Oh, this one has more exercises." [laughs] TIFFANY: Yep, yep, yep. Yeah. CHAD: Actually, at this point, let's take a little bit of a tangent because you're doing this within an existing company, Relias. Relias isn't necessarily a small company. So what kind of reporting out or management of other stakeholders or the business did you need to do along the way? TIFFANY: That's a great question. And Relias is a big company, but also, this was a very new space for Relias. So they had never looked outward at a patient engagement tool. The focus had always been education for clinicians. So this was a very new space for them. And actually, the most important and early conversations really were with our legal team and our cybersecurity team. And that was because we were going to be creating a database for patients. Again, new space, and we really needed to de-risk as early as possible, make sure that we could actually build this thing, keep it safe, that the budget was going to align. Also, that information really restricted the kind of information that we can actually keep about patients. So having that on the front end saved us so much time later on. That was number one. And I would say anybody who's looking in the healthcare space absolutely has to start there because, again, the rules are changing constantly. And as clinicians, we are trained on how to take care of patients. We are trained to maintain patient privacy. We typically don't have a whole bunch of experience on cybersecurity and how you actually keep an online system secure. So you need to make sure you're talking to the right stakeholders to get the right information. So that was critical. CHAD: Some organizations have an executive sponsor on the team or embedded in the team so that there are direct status updates and awareness of new product development. Is that the track that Relias took, or was it something else? TIFFANY: That was absolutely the track that we took, so we did have an executive sponsor who we reported out to each week gave updates to. And he was able to communicate out to leadership as well. And we also had lots of opportunities internally to give updates and to do demos. So people could understand what we were doing; why we were making the decisions we were making to make sure everything aligned appropriately. CHAD: I'm a big believer in demos and that kind of thing to communicate. I think we all have been in situations where when you're working on a complex problem, even if you do all your research and answer every question in the most perfect way and all that stuff, if at the end of that process it’s the first time anyone's hearing about all the results of that, there's going to be so many questions about did you consider this? Did you consider that? And I think we all know that if instead we communicate things along the way and keep people up to speed, there's much more understanding but also trust in the process. TIFFANY: Yeah, absolutely. And I have also experienced what you're describing. And what I have found is it's really like the weekly demo can be really quick, super helpful, and then documentation, documentation, documentation. We've created FAQ pages because of exactly what you're saying. Because a lot of times, something isn't intuitive to a stakeholder, and maybe you've answered that question three or four times. So you've got to have it written down somewhere so that everybody's on the same page and understands. And even if they've missed seven meetings, if they come and have that question, hey, just so you know, we made that decision three weeks ago. This is why. This is the justification. This is why we're moving forward. CHAD: Yeah. Is there any other sort of techniques that you employ to try to keep people up to date or strike that balance there? TIFFANY: The main one, I think, is the weekly report out. And it is a challenge, and especially with things being virtual, of course, it's even more of a challenge because I think it's really easy to get insular but being consistent and being timely. So if everybody knows okay, I'm going to go to this meeting on Monday morning at 10:00 o'clock, it's going to be 15 minutes, and I'm going to know exactly what's happening, all of a sudden, that organization piece is so key. Keeping it short is really key, and then everybody's on the same page. And you don't end up with that; hey, wait a minute, I didn't hear about that. Or why is that happening? Because that takes so much time to manage. CHAD: We worked with one team several years ago, actually, but I realize that it might even be more relevant now. And I don't necessarily recommend this for every team. I think each team needs to find their own techniques that work well for their culture. But this team, rather than having meetings actually had...they had occasional meetings, but they actually had a team blog, internal, completely internal. And they essentially wrote a blog together that everyone who wanted to follow along was able to follow along with. TIFFANY: I think that's a great idea. I think in bigger companies, sometimes that gets lost. [laughs] CHAD: Yeah, it definitely worked for this organization's culture and who was following along, but it wouldn't work for everybody. TIFFANY: Absolutely. One other thing that I need to call out that I didn't was with some of the formative user interviews, we had to push on this, but we did try to get at least one member of engineering coming to some of those or at least getting some highlights. And this may seem like, of course, you would do that. But when you're working in a fairly large company that's entering into new space, there are new ways to be engaging your engineering team that are different and may not seem valuable at the time. So we rallied pretty hard to get some folks in there so that they could really understand the problem that they were going to be contributing to solving. And that was critical because the assumptions about if you're building an app for an older adult versus the realities are so radically different that you can only really understand it if you visually see it or hearing from your user. 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That's A-G-E-N-C-Y, the letter U. CHAD: Okay, so let's pop the stack now and go back to where we were before we took that tangent into that side of internal communication and management. So you had the prototype and were starting to show it to potential users and were getting positive feedback. What were the next steps after that? TIFFANY: So the next steps for us were running through...and to be clear, we actually were creating two apps, which I never actually said, one for the clinician, [laughter] which the problem was to solve time, and one was for the older adult. And I've had a ton of experience actually designing for older adults. So some people may think that that might have been the harder app. But there are some really straightforward design tenets that work when you're designing for somebody who's 60,70, 80, 90, 100-plus. So starting out on the clinician side, got our prototype, went through, validated it with about seven clinicians, identified some areas of confusion, identified some areas that we thought were totally intuitive and were completely not. So my favorite was we wanted a way for clinicians to identify the patients that they were going to see that day, and so we just thought that if they favorited the patients, if they just clicked a star, and they'll show up. And we had seven out of seven clinicians say, "Does that mean that they're actually my favorite patient? [laughter] Like, no. Okay, missed the boat on that one; regroup. We went through about three prototype revisions before we got to the point where we were really happy with the workflow and felt like it was intuitive. So that was the first thing. And then the second thing was on the patient-facing side. And for that one, it's a totally different workflow because it's just one human who's being given exercises. So it really was, okay, how do they access the exercises? How did they experience the exercises? And what makes sense? And so we had a lot of questions because we were trying to figure out, do we want written text? Do we want animations? Do we want animations with audio? So we had a really robust user group that we were able...we had about ten that we were able to actually demo, and they could give us direct feedback on. And then we had a user group of about 30 people that we actually just started sending prototypes and surveys to get some better feedback. And what we found is when we did more of the email, we would send them an audio clip of an animation. And we did some really lovely A/B testing that way. And we got much better results. Because generally speaking, when you interview an older adult about something you are creating for them, they're super positive, even about the stuff they don't like. So it was a lot easier to get more robust, more real feedback by removing the human element and saying, "Hey, tell us how you really feel." We got some amazing feedback that way. CHAD: That's interesting. And just in terms of timeline, was this happening pre-pandemic or post-pandemic? TIFFANY: This was post-pandemic. Well, we really started doing this design work in the summer of 2020, so right in the middle of the pandemic, yes. CHAD: Right. And so when you talk about these interviews and all that kind of stuff, everything was remote. TIFFANY: Yeah, everything was remote, worked fantastic. That has been one of the cool things about being in this space, especially in design space, technology design, and aging, is that the acceleration of the technology adoption that happened in 2020 was mind-blowing. I started working with design with older adults in 2014, building them different types of applications. And it just was incredible the level of comfort that I saw in 2020 amongst a much broader audience compared to 2014, 2015. CHAD: Yeah, we've definitely seen that as well across different products. And the underlying reason is bad, but it certainly makes what we're doing a lot easier to have more people comfortable, even with little things like being on a Zoom call and knowing how to share their screen. Little things like that would sometimes be a big hang-up for getting good interviews and good feedback with people. TIFFANY: Absolutely, absolutely, and doing some relatively complex things. Like, we were trying to validate doing a two-factor authentication, and we were able to do it virtually. So it's really giving us some really neat tools to reach a broad audience. CHAD: A little while ago, you called out that there are patterns for building applications for certain ages. Can you tell me more about that? TIFFANY: Sure. There's actually been a lot of research done in this area. I've contributed a little bit to it. [laughter] So what we really found especially early on...and I was involved with a project to take the connect technology and the Microsoft Connect technology and modify it to deliver a fall prevention program to older adults. So in my previous life as a physical therapist, I have a Ph.D. in human movement and did a lot of research in healthy aging and injury prevention. And older adult falls is a fairly significant public health issue. And there are a lot of cool things you can do to address it around exercise. But the problem is scale. So how do you actually bring some of these exercises to older adults at scale as opposed to one on one? So that's the context behind this. And so we started working with Microsoft SDK, building this out. And what we quickly realized is that the things that tend to make, let's say, a video game really cool and engaging are actually the worst things you can put into design if you're introducing an older adult or someone who's not comfortable with technology into a game. So you need a very simple interface, to begin with. And you need very straightforward commands. And so it's funny because, in 2013, 2014 the people that were in this space all came from the gaming world. So they'd make these really beautiful backgrounds and things jumping and popping out. And you would lose your user within two minutes because it was just so visually overwhelming. And one of the things that's interesting is as we get older, our brains are just not as flexible. They're super smart, but they get easily distracted. So what we learned is if you keep your user interface super simple, and then you make your early experiences very positive, so you keep the tasks very straightforward, you show success, what happens is your user gets a ton of self-efficacy. And they start to really realize that they know exactly what they're doing because they do. And then you can start doing some more interesting things. So what we found is with our technology, as we got our users, okay, they're using it three times, they're using it four times. They're being super consistent doing this exercise program. Let's make it more visually engaging then they could actually handle it because they weren't so worried about what do I do next to go forward in the exercise program? So yeah, so when you think about design, that was a really long-winded answer, sorry. CHAD: [laughs] It's okay. TIFFANY: But you want to keep things super simple and straightforward. You do need to infuse it with compassion and empathy, and if you can do small successes, really, really helpful. The other thing that is incredibly helpful, and this is going to sound a little hokey, is that any kind of avatar or chatbot who's super positive really, really can have a big impact. Because a lot of times, older adults are by themselves trying to navigate this thing, and they have no idea what's going on. And if a chatbot pops up and says, "Hey, you're at this stage, do you need any help?" Or "Hey, you pushed the red button, good job." There's this very interesting relationship that gets built with older adults and chatbots and avatars. They engage with them much more. And I think ultimately what I saw because we were using an avatar to lead through exercises is that self-efficacy increased because even though the avatar was leading them through the exercises, they ultimately knew it was them. Compared to if I was leading them through the exercises, there's always that yeah, I did it, but Tiffany taught me how. Whereas this is well, I did it, and the avatar taught me how, which really means that I actually did it. So I can actually do it. It's a really cool space. CHAD: In validating the exercise format through those surveys and that kind of thing, what did you learn in terms of the format? Was animated ones winning out? TIFFANY: Absolutely. What we learned was animation, hands down 100%. We also learned that animation plus narration really was the winning ticket. What we had tested we did some A/B testing where we did animation plus narration, and we had the exercise instructions written with the assumption that, well, some people are visual, and some people are auditory, and some people want to read the exercises. And we compared that to just animation plus narration and no written instructions. And the feedback we got was that it was too much. Like, you're reading the instructions, you're watching, and you're listening, and it just was confusing and overwhelming. And sometimes it wasn't an exact match because when you're narrating an exercise versus reading about it, the words aren't always exactly the same because sometimes it just doesn't make sense to make them the same. But when you just had the narration with the exercise, people were really happy. They could see it, they could hear it, they could replay it. And the other thing that was really nice about that particular format is it also gave a little bit of space. And this is on a mobile device, so when I say little space, I do mean little space where if the therapist had any specific cues, they could input it in there. So then now the patient's got...they can see the exercises, they can hear how to do it. "Oh yeah, and my therapist said, 'Make sure I put all my weight on my left leg.”’ So that just seemed to be the right package as opposed to dumping all of this information on the user. CHAD: One of the things, when I've worked with people or organizations before that can become a bit of a blocker, is identifying something like this. Oh, animations with narration that's what this should be and then needing to produce all of that in order to bring the product to market to create it all from scratch. Was this material that you already had at your disposal? Or was it going to need to be created? TIFFANY: It was going to need to be created. And the way we addressed that issue is we looked at, for lack of a better word, what are those key bread and butter exercises that just about every therapist prescribes to just about every person? I mean, it still was a sizable lift, but again, it wasn't an overwhelmingly huge production. So we went ahead and said, okay, table stakes. We've got to have these in because if you don't, then it's not really usable. And of all of these, which are the ones which are generic enough that if we built it once, a therapist could put in additional instructions to do any kind of modifications? So that was really how we addressed that. I would say if somebody is starting completely from scratch, pick a total of 10 exercises or a total of 10 things and just pilot that and just try to do low-fidelity prototypes and just validate it before going down the path. CHAD: So in the story here, we're moving towards actually building something. Was there a go/no go point in the product's life cycle where you needed to get sign-off on something in order to decide to actually bring this product to market? TIFFANY: Yes. And interestingly, we are in that point at this exact moment in time. [laughter] So we're at the point where it's released in alpha. We're getting some really great feedback. And on the clinician side, we're back to the original challenge around building something for patients. We are still actually putting finishing touches on making sure that we can really secure this database the way it needs to be secured in 2022 because things, again, are moving pretty rapidly. So we are waiting for our go decision as we speak. CHAD: But we did build something. TIFFANY: Yes. CHAD: So you didn't need to get full sign-off and go/no go before going from prototype to starting to build something. TIFFANY: Correct. Yes, yeah. Yes, sorry. CHAD: No, it's okay. TIFFANY: We had, like I said, we were really good communicating out. We had all the data to support the decisions that we made. We felt like we had a couple of very minor outstanding things that we knew that needed to still be addressed. But we also felt we were at that point where we could go ahead and build. And once we got in people's hands, we probably have much better data on how to address the outstanding items. CHAD: So given that you're at the point of you've gotten some things in people's hands, you're now making sure that this can be a product that you fully bring to market. What are some of the factors that are being looked at? And you mentioned security is one. What are some of the others? TIFFANY: Some of the others...I will say one of the things that is not a factor but was a factor early on is, hey, wait a minute, can older adults really use this? Are they really going to want to use this? That's a slam dunk. Yes, they can use it, and yes, they really want to use it. Plenty of data there. So one of the factors that's...believe it or not, the pandemic is actually throwing us a little bit of a curveball in the sense of there is so much transition happening in healthcare right now that we're having a couple of little challenges around...some of our clients are actually changing their settings. So our first target market is people who are in home health. Well, if all of a sudden you are going from skilled nursing and opening up home health, there are a lot of factors you've got to balance. So that's been a little bit of a curveball. And it's also been a curveball in finding our early adopters to really go ahead and test it out. And then the final thing that is a big challenge, and I think it's a challenge for everybody, is integration with pre-existing systems because there's so much variability and variety of EMR systems. I'll give you a great example. You could have a skilled nursing facility that has one EMR system, and that skilled nursing facility could contract with a rehab therapy company who uses a different system, but they're both seeing the same patient. We want to be super strategic about...because, again, that's a huge resource suck of looking at those API integrations. That's one of the things that we're really doing a deeper dive into now to really figure out where do we actually put these resources? What's going to give us the most bang for our buck? And knowing that the target is moving constantly. CHAD: What do you do while your...one of the challenges can be like, oh, we've got a team ready to build the product. Are you in a holding pattern now? Or what do you do? How do you manage that? TIFFANY: There are two ways to manage, and one is going back to your product right now and doing more testing, which is always a good thing because you're just refining, refining, refining. It’s tricky, though, because when you've got a lot of limits on resources, especially human resources, lots of projects going on, the tricky part is can I keep my team, or do they need to get repurposed? And I think it's all about having really honest conversations and if they are going to be pulled into another project, making sure everybody's on the same page about what that looks like so that if you are in a holding pattern, when you get off that holding pattern, that there's not a huge delay. Lots of conversations, lots of discussions, yeah CHAD: Well, I wish you the best in working through all of that and bringing this product to market. I know you've been a tremendous partner in working on this together. I know the team has enjoyed working with you. And we work with a lot of people at different companies, and your experience in navigating this has been notable. TIFFANY: Thank you. The team was amazing. I mean, it is a really great group of people, really open, at the same time, really able to crystallize some of the challenges in a way that was incredibly effective. So yeah, it was really a fantastic experience, and I'm very grateful for it. CHAD: So if folks want to follow along with you or get in touch with you, where are the best places for them to do that? TIFFANY: Either on LinkedIn. I, of course, have a space on LinkedIn but also at Relias. And my email is [email protected]. CHAD: Wonderful. You can subscribe to the show and find notes for this episode at giantrobots.fm. If you have questions or comments, email us at [email protected]. You can find me on Twitter @cpytel. This podcast is brought to you by thoughtbot and produced and edited by Mandy Moore. Thanks for listening and see you next time. Announcer: This podcast was brought to you by thoughtbot. thoughtbot is your expert design and development partner. Let's make your product and team a success.Special Guest: Tiffany Shubert.Sponsored By:AgencyU: AgencyU is a membership-based program where Chad Pytel works one on one with a small group of Agency founders and leaders toward their business goals. You'll do one-on-one coaching sessions and also monthly group meetings. You'll start with goal setting, advice, and problem solving based on Chad's experiences over the last 18 years of running thoughtbot. 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