Reflections & analysis about innovation, technology, startups, investing, healthcare, and more .... with a focus on Minnesota, Land of 10,000 Lakes. Blogging continuously since 2005.

Category: Innovation (Page 1 of 78)

The Unconventional Path That Took a Small Midwest Startup to a Multi-Billion-Dollar Fintech Success

Its founders met at MBA school, faced some scary challenges over the years, but kept their eye on the consumer. Now valued at $3.5B+ on the Nasdaq, Sezzle isn’t done yet embedding value into its app and platform.

(Note: This post first appeared on the blog of Great North Ventures.)

image of the two Sezzle cofounders

Paul Paradis (left) and Charlie Youakim, Sezzle cofounders.

I first met cofounders Charlie Youakim and Paul Paradis in 2016, just months after they had launched Sezzle. They were part of a pitch session I’d organized at a conference held at the University of Minnesota Carlson School of Management, the very place where they’d earned their MBA degrees six years earlier. Of the six early-stage Minnesota startups pitching that day, three went on to significant success, as I wrote recently. But none quite like Sezzle. The name, by the way, is a combination of “sell” and “sizzle” – and indeed they have.

This is a story about their journey over the ten years since, as related to me by Paul Paradis, Sezzle cofounder and president, with whom I had the pleasure of reconnecting at a founders dinner sponsored by Great North Ventures. Soon after, I arranged a sit-down with him to hear about many of the fascinating moments from the eventful journey of this super-successful startup.

“Sezzle in many ways is putting Minnesota’s fintech scene on the map,” said Rob Weber, managing partner of Great North Ventures. “And there are several more emerging embedded fintech startups focusing on a variety of markets that certainly can be inspired by their story.”

The Sezzle story begins with how Paul met and bonded with his cofounder, Charlie Youakim, the company’s CEO.

The Ping-Pong Partnership
Long before Sezzle became one of Minnesota’s most successful technology companies – and eventually a publicly traded Nasdaq fintech valued in the billions – its two cofounders were simply graduate students at Carlson trying to navigate one of the most chaotic economic periods in modern history.

Paradis and Youakim met at Carlson between 2008 and 2010, right in the middle of the financial crisis. Paradis recalls professors abandoning their planned curriculum to discuss the real-world collapse unfolding in front of them.

“All of our finance classes, the teacher would say, ‘Put your books away. We’re just going to talk about what’s going on right now,’” Paradis said. They had an education in finance they weren’t expecting when they signed up.

The two became close while working together in Carlson’s Consulting Enterprise program on a project for the Itasca Project, studying employment growth in the Twin Cities region. But it wasn’t just classroom collaboration that bonded them. “We became really good friends and ended up just becoming ping-pong obsessed,” Paradis said. “We would just play ping pong all the time together.”

Those early years also shaped their entrepreneurial instincts. Jobs were scarce. Internships had dried up. Traditional career paths suddenly looked fragile.

“I had the pleasure of working with and supporting Charlie and Paul as students. Both were highly engaged and did outstanding work,” said Phil Miller, now Assistant Dean at the Carlson School. “Their class really struggled with the depths of the financial crisis, but I suspect that helped them both in the long term. Paul was a motivated student, and we were able to connect him to a business development role post-graduation. Charlie was a driven founder from the beginning, passing up a traditional internship to work on the code base and business model for what became his first startup. Both of those journeys seem to have given them valuable experience on how they wanted their partnership in Sezzle to go. It’s been a joy to see them struggle through early challenges to the success they’re currently seeing.”

Youakim, a University of Minnesota engineering graduate and former software engineer, moved to Charlotte, North Carolina after business school and cofounded a parking technology startup called Passport. The company raised serious venture capital and grew quickly, but eventually Youakim and his cousin – his cofounder – had a falling out. He returned to Minnesota at the end of 2015 looking for a fresh start.

“He had a big chip on his shoulder,” Paradis said. “He wanted to show that he had something more in him.” Paradis, meanwhile, was growing restless in the consulting world. When Youakim called with the idea of building something new together, the timing was perfect.

The First Idea Failed Fast
The original version of Sezzle looked nothing like the company consumers know today. The founders initially believed they could reinvent ACH bank payments by authenticating bank accounts instantly, allowing merchants to avoid expensive credit card fees while still offering consumers cash-back rewards.

The concept attracted investors quickly. Thanks largely to Youakim’s reputation from Passport, Sezzle raised roughly $1.8 million in seed funding before launching its product – an unusually large pre-launch round for a Minnesota startup at the time. Investors included local angels, former Passport backers, a Belgian VC firm, and even a Chinese seed-stage investor.

But once the product launched in early 2017, the founders quickly realized they had a problem. “The small merchants didn’t care about saving 150 basis points on processing,” Paradis said. “They cared about growing their business. That’s number one, two, three, four, five.”

Consumer adoption was even worse. Even offering unsustainable cash-back incentives of 5% or 10% barely moved usage rates. After only two months in market, Youakim concluded the model was not working.

“He’s very good at that,” Paradis said of his cofounder’s willingness to take quick, decisive action. “In this case, it was a pivot, but more broadly, Charlie diagnoses a problem and immediately sets out to fix it. The rest of us were saying, ‘We raised all this money on this idea. It’s only been two months.’”

At the same time, Sezzle was pursuing a spot in the Techstars Target accelerator program in Minneapolis. The company reached the final interview stage – right as the team was internally debating whether to abandon its original business model. “We were literally debating whether to pitch the old idea or the new idea,” Paradis said.

They did not get selected. In hindsight, it may have been one of the best things that ever happened to the company.

Discovering Buy Now, Pay Later
As Sezzle searched for a new direction, Youakim noticed something interesting happening overseas. A fast-growing Australian startup called Afterpay was exploding in popularity with younger consumers. At the time, the “buy now, pay later” (BNPL) category barely existed in the United States. Another company, Affirm, focused only on large purchases like furniture and fitness equipment. But Afterpay had found something different: smaller installment payments that appealed to younger consumers wary of traditional credit cards.

Paradis and Youakim realized the U.S. market shared many of the same demographic trends as Australia, especially after the CARD Act of 2009 made it harder for young adults to get credit cards.

“We saw a bunch of Australian merchants promoting the hell out of Afterpay,” Paradis recalled. “And Charlie said Australia has always been a great test market for new tech because consumers behave very similarly to the U.S.”

The founders also discovered something critically important from regulators: if they structured the product as four payments or fewer, they could avoid many traditional lending regulations. “That’s when we said, okay,” Paradis said.

Their first sales strategy was surprisingly simple. “We started contacting all of Afterpay’s merchant customers that also sold in the U.S.,” Paradis said. “We basically pitched ourselves as ‘the Afterpay for the U.S.’”

It worked almost immediately. Merchant signups surged. And then Afterpay itself came calling.

“You Can Join Us or Compete Against Us”
Afterpay invited the Sezzle founders to San Francisco with a blunt proposition. “You can either join us or compete against us,” Paradis recalled. The Australian company offered what Paradis described as a lowball acquisition offer. Sezzle declined.

Within months, Afterpay officially entered the U.S. market with major retailers including Urban Outfitters and Revolve. Suddenly, Sezzle found itself in a brutal competitive battle against much larger, better-funded rivals.

The timing could hardly have been worse. Sezzle’s Series A financing nearly collapsed when a Chicago VC pulled its term sheet after Afterpay announced its U.S. expansion.

“That was a big blow,” Paradis said. The company needed a Plan B. Youakim provided it personally. He still owned a significant stake in Passport, his previous startup. When Passport investors offered to buy his shares during a new financing round, he sold all of his ownership and poured most of the proceeds into Sezzle. “He led the Series A himself,” Paradis said.

That decision would later become enormously important. Today, Youakim still owns a substantial portion of Sezzle, thanks partly to that personal investment during the company’s most vulnerable period.

Why Stay in Minnesota?
As Sezzle gained traction, the founders encountered another challenge familiar to many Midwest startups: coastal investors questioning why the company was based in Minneapolis.

“We’d go out to New York or San Francisco, and they’d all ask, ‘Why are you in Minneapolis?’” Paradis said. Some investors openly encouraged the company to relocate. Fundraising, especially for a fintech lender, proved much harder from Minnesota than it would have been in Silicon Valley or New York.

But Paradis says staying in Minnesota ultimately became one of Sezzle’s defining characteristics. “We were one of the only hot tech startups in town,” he said. “So if you wanted to work for a company like that, we had the buzz.”

The company recruited heavily from the University of Minnesota and Macalester College. Paradis also credits Youakim personally for choosing not to relocate the company.

“I have to give a lot of love to Charlie for that,” Paradis said. “I think he would have moved us, and he didn’t, primarily because of me. My family was here. Of course, his family was here, too, but he didn’t have kids yet. My second daughter was born the week I joined Sezzle full-time, and my wife worked for 3M. So I was much more tied down here than he was.”

The Australia Gamble
Despite improving traction, Sezzle still struggled to raise a strong Series B round in the U.S. Then an unexpected opportunity appeared. An Australian equity analyst visiting Minneapolis asked a simple question: Why not go public in Australia instead? That was a way to raise significant funds.

Australian investors already understood buy now, pay later because of Afterpay’s success. Better yet, Australia’s venture capital ecosystem was far less developed, making public listings more common for emerging tech companies. It was clearly an intriguing idea.

Youakim flew to Australia for a non-deal roadshow arranged by investment bank Ord Minnett. “He called me and said, ‘Paul, we’re doing it,’” Paradis recalled. “We were going to be able to raise a lot more money and at a much better valuation.”

The IPO process became a whirlwind. Paradis joined Youakim and Sezzle’s CFO for investor meetings across Sydney, Melbourne, and Hong Kong. At one point, after flying overnight to Hong Kong, the team showered in the airport before heading directly into all-day investor meetings in 100-degree heat and humidity. “It was incredible,” Paradis said. “We were actually planning to take a helicopter to Macau that night to celebrate, but Charlie fell asleep at the dinner table after we ate Peking Duck at the Mandarin Oriental. Still, it was a great ending to a great day.”

The company successfully listed on the Australian Securities Exchange (ASX) in July 2019.

The Crash
For a time, everything seemed to be working. Sezzle raised additional capital. The buy now, pay later market exploded globally. Affirm went public in the U.S., and markets soared during the pandemic-era fintech boom.

Then the cycle reversed – violently. Afterpay sold to Block for $39 billion in 2021, briefly fueling optimism that Sezzle might also achieve a major acquisition or Nasdaq listing. But by late 2021, fintech markets were collapsing.

Sezzle pursued both an IPO and acquisition discussions simultaneously. Nearly every potential acquirer backed away as markets cratered. Except one: Zip, a BNPL company based in Sydney.

The two companies publicly announced a merger. At the same time, Sezzle itself was under severe pressure. The company cut international expansion plans, terminated merchant partnerships, and laid off roughly a quarter of its staff. Its market capitalization collapsed from roughly $1.5 billion to just $40 million.

Nonetheless, Sezzle chose not to close the Zip deal. However, it produced a crucial lifeline: an $8 million breakup fee. Sezzle used that money to stabilize operations and race toward profitability instead of raising additional capital in a terrible market.

“We just slowly started digging ourselves out of the hole,” Paradis said.

Reinventing the Company Again
Sezzle’s eventual recovery required another strategic pivot. The merchant business had become hypercompetitive. Instead of relying solely on merchant integrations, the company shifted toward direct consumer relationships. Sezzle decided to focus on the subprime segment of the consumer market.

It launched subscription offerings, expanded its mobile app, and introduced products like Sezzle Anywhere and On Demand. The company also rebuilt carefully and efficiently.

Today, Sezzle employs roughly 500 people globally, including about 100 in the Twin Cities and approximately 250 in South America, particularly Bogotá, Colombia.

“We’ve found incredible talent there,” Paradis said. “Same time zone, highly educated, strong English skills – and much more efficient from a cost standpoint.”

Sezzle remains headquartered in downtown Minneapolis in the historic Dayton’s building, though like many tech companies it now operates largely remotely.

And despite Youakim now spending much of his time in Puerto Rico, a strategic location between Minneapolis and Bogotá, Paradis says Minnesota still matters deeply to the company’s identity. “He’s here every other week,” Paradis said. “His family’s here. Our roots are here.”

The company listed on the Nasdaq (Symbol: SEZL) in August 2023. It voluntarily delisted from the ASX, and its final day of trading on the Australian exchange was January 12, 2024.

Today, with Sezzle once again thriving, the company stands as one of the most remarkable startup success stories ever produced by Minnesota’s technology ecosystem – a decade-long journey shaped by pivots, near-collapse moments, international gambles, and an unusually stubborn commitment to building a major fintech company far from Silicon Valley.

A Strategy Well Executed
“Charlie and Paul’s ability to execute was very clear from the first time we met with them in January 2018,” said Rob Weber of Great North Ventures. “What was unclear in our initial meetings was how they were going to be able to compete against larger, more well-funded rivals Affirm, Afterpay, and Klarna. But their ability to adapt their strategy over time has been super impressive to watch.” He noted that it was Sezzle’s proprietary business intelligence system that enabled them to accomplish “far more with far less” than their rivals. “We benefited from that approach with our own startup, NativeX, before we became VCs. So we know what a difference it can make.”

Buy now, pay later (BNPL) in its earliest forms took roots through embedded partnerships across a wide range of merchant checkout processes. “It started off as a niche play, but is now emerging as core financial infrastructure,” said Weber, which he wrote about recently.

Recent Stellar Results
Sezzle reported a very strong Q1 2026 with 29.2% revenue growth, gross margins of 74%, net income of $51.3M, and adjusted EBITDA of $71.1M. Management raised full-year guidance, with revenue growth now expected to be 30%–35%, adjusted net income to $180M, and adjusted EPS to $5.10. Key drivers included improving credit performance, higher consumer engagement, and subscriber growth up 44k to 714k.

The company said product expansion is underway, including Pay-in-5, a virtual card in Canada, enhanced long-term lending, Sezzle Mobile on AT&T, and roadmap items such as deposit accounts and checking, positioning Sezzle to become an all-in-one services platform for value-focused consumers.

The company is embedding AI across support, product, and operations to increase efficiency and scale. And it is pursuing a bank charter, with an application targeted for this year, to improve regulatory defensibility and long-term economics.

“It’s going to be an exciting year for Sezzle,” said CEO Charlie Youakim on the earnings call. “2025 was about enhancing our current consumer ecosystem. We improved the app experience, expanded engagement features, leaned back into higher-value consumers, and continue to give our users more reasons to come back to Sezzle. But in 2026, we’re pushing that strategy further. We’re moving beyond being a product consumers think about only at checkout.”

He sums it up this way: “We’re building an all-in-one services platform for the value-focused consumer. The strategic goal is to make Sezzle more useful in more moments. The more value we provide, the more reasons consumers have to come back… We should see consumers using Sezzle more often across more merchants and across more use cases. That’s exactly what we saw in the first quarter.”

As the month of May 2026 came to an end, investment site Seeking Alpha named Sezzle the best performing financial stock of the month based on one month price performance percentage. In addition, that same week, another site published this article: Sezzle Tops the List of Best All-in-One Fintech Apps of 2026.

Learn more about this amazing fintech success story at Sezzle.com.

 

The Coming $1-Trillion Space Economy, and How Minnesota Plays Into It

Our state may not launch rockets, but it quietly builds the technologies that make the growing space economy possible.

Minnesota actually has a surprisingly deep set of companies connected to the space industry. Many state firms provide materials, electronics, engineering services, sensors, and manufacturing that go into spacecraft, satellites, and launch systems used by organizations such as NASA, SpaceX, Boeing, and Lockheed Martin.

Several notable Minnesota companies are directly or indirectly participating in the space economy. Here are just some of the state’s companies with space industry connections

1. ION Corporation (Eden Prairie) – Aerospace engineering and testing company doing direct NASA mission work.
2. Stratasys (Eden Prairie – Nasdaq: SSYS) – 3D printing is increasingly used for rocket engines, brackets, and satellite components.
3. QuesTek Innovations (has a facility in Waconia) – Advanced alloys and materials for rocket engines and extreme thermal environments.
4. Collins Aerospace (Burnsville) – Part of Raytheon Technologies. Collins systems are used in satellites, spacecraft navigation, and communications payloads.
5. Northrop Grumman (facility in Plymouth) – Global aerospace contractor. Minnesota operations contribute to electronics, engineering, and mission systems.
6. BAE Systems (Minneapolis) – Builds radiation-hardened electronics, sensors, and spacecraft avionics used in many satellite systems.
7. Chandler Industries (Minneapolis) – Supplies high-precision components used in spacecraft assemblies and aerospace hardware.
8. EarthDaily Analytics (U.S. operations in Maple Grove) – Uses satellite data and space-based imaging analytics for agriculture and climate intelligence, an important part of the satellite data economy.
9. Timmaron Group (Minneapolis and Silicon Valley) – Was a solution architect in the development of Starlink’s satellite system.

An Emerging Space Infrastructure Project

The Minnesota Aerospace Complex in Rosemount is a planned $1+ billion hypersonic testing and aerospace facility. Potential uses will be testing hypersonic vehicles, spacecraft reentry materials, and advanced propulsion systems. If completed, it could become one of the largest aerospace testing facilities in the U.S. (More here.)

Three Main Sectors

These Minnesota sectors feed the space industry:
• Advanced manufacturing: Minnesota has strong precision machining and electronics supply chains used by aerospace primes.
• Robotics & autonomy: Companies building robotics and AI systems for inspection, drones, and autonomous vehicles may transition to space applications.
• Satellite analytics & AI: Minnesota’s agtech and geospatial analytics firms increasingly rely on satellite data.

Little-Known Companies, But Some Big Ones, Too

Minnesota doesn’t yet have a large cluster of rocket startups, but it does have a quiet ecosystem of organizations connected to the space economy — often through satellites, materials science, robotics, geospatial data, and advanced manufacturing. Think the supply chain of space.

In geospatial and satellite data, consider Descartes Labs. It was founded in New Mexico but maintains a significant Minneapolis engineering presence. (Note: In 2024, Descartes Labs was acquired by EarthDaily Analytics, which has operations in Maple Grove.) It uses satellite imagery and AI to analyze agriculture, climate, and geopolitics. Its customers include U.S. government agencies and global enterprises. It works with data from NASA, ESA, and commercial satellite constellations. Satellite data analytics is one of the fastest-growing segments of the space economy.

In the category of robotics, sensors, and autonomy, don’t forget about a major tech firm like Seagate Technology (Nasdaq: STX) with its work in advanced data storage R&D. Storage systems are used in satellite ground systems and data infrastructure. Its technology supports satellite data processing pipelines.

Another publicly traded firm is SkyWater Technology (Nasdaq: SKYT), a Bloomington-based semiconductor foundry. It produces radiation-tolerant chips and advanced microelectronics. Radiation-tolerant semiconductors are essential for satellites and deep-space missions.

Why Minnesota Could Become a Space Supply-Chain Hub

Thus, Minnesota has many ingredients needed for space-industry infrastructure. Again, these are our main strengths: 1) advanced manufacturing – including precision machining and aerospace components, 2) materials science – extreme-environment materials and additive manufacturing, 3) semiconductors – specifically radiation-hardened electronics, and 4) AI and geospatial analytics – which is turning satellite data into usable insights.

A Trillion-Dollar Industry On the Verge of Breaking Out

For a further perspective in the space industry, and how 2026 could be the year things really take off (pun intended). see this recent blog post from my client Timmaron Group. (SpaceX IPO, anyone?)

And this recent WSJ article will provide some further perspective: The Space Economy Is Mission-Critical. Here’s What Leaders Need to Know.

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Postscript: The list of Minnesota companies above is not intended to be all-inclusive. Know of another company doing space-related work here in our state? If so, tell me in the comments.

 

Eight Up-and-Coming Healthcare & Medtech Startups I Hosted Recently

Among many other things I do, I serve on the Board of a wonderful organization called MinneAnalytics, a community of some 20,000 data and business professionals. The seventh edition of our Healthcare Data Science Conference took place Friday, April 19, 2024 at the Best Buy headquarters campus in suburban Minneapolis. More than 1000 attended.

In my role as Startup Showcase Organizer, I hosted yet another session of startup pitches at this conference. It was the 15th such session we’ve had over the past decade. (We do them at all our major conferences, not just the events we do focused in healthcare.) Not counting this session, we’ve now featured a total of 114 startups, which collectively have raised hundreds of millions in capital and created thousands of jobs. About 10% of them have had successful exits via acquisition so far.

Big Crowd

The startup session at the recent conference had what I think was the largest attendance of any we’ve ever done. It was standing room only throughout the two and half hours. I attribute that both to the quality of the startups, and to the amazing medtech ecosystem we have here in Minnesota.

The startup presenters and their companies were as follows. I encourage you to visit their websites to learn more the amazing work each is doing!

• Mark Summers, Dosentrx

Dosentrx web page image

 

• Tony Hyk, TheraTec

TheraTec web page image

 

• Jeremiah Scholl, AESOP Technology

AESOP web page image


• Keith Kallmes, Nested Knowledge

Nested Knowledge web page image

• Lia Butler, NeoPrediX

NeoPrediX web page image

• Laura Stoltenberg, Cryosa

Cryosa web page image


• Ping Yeh, Vocxi Health

Vocxi web page image

 

• Chris Darland, Peerbridge Health

Peerbridge web page image

 

A VC Panel Discusses Funding Issues

A panel I organized took place after the startup pitches. It packed the room even further — very little standing room was left! The topic was, “The Current Funding Environment for Healthcare and Medtech Startups.”

Panorama of the audience during the panel

I asked each panelist, What was the single best insight or comment you would cite from the discussion?

Frank Jaskulke, Medical Alley Association: “Having heard Stephanie Rich share that they may see 2500 companies in a year to invest in 3 or 4 — that really highlights the competition startups face. But it also speaks to the importance of engaging the right investors, not just any investors. A startup can waste a lot of time chasing the wrong targets.”

Stephanie Rich, Bread & Butter Ventures: “The biggest thing I was struck by was the interest in venture and healthcare by our ecosystem and attendees! The attendance and questions were amazing.” [Stephanie sat in for her colleague Mary Grove, who called in at the last minute with a cold.]

Dave Dalvey, Brightstone Venture Capital: “The tracking and market implications of ‘overhang’ or ‘dry powder’ as it’s called in the venture capital industry are important to understand. Too much or too little un-invested capital held by active venture managers, at a time when a new company is in the market for funding, has a significant impact on the pricing, terms, and general receptiveness of a fund manager to a new opportunity.”

Greg Banker, Vensana Capital: “I liked Dave’s comment about making sure to research VCs before you go out to fundraise, to ensure you’re a match for their criteria — or that you’re similar to other investments they’ve made in the past. For example, if you’re raising a seed investment and the fund you’re trying to talk with has never done anything but Series B and beyond — well, not likely a fit.”

We had some great questions after each pitch, and after the panel. Thanks again to all who participated and attended!

The next Startup Showcase will be held at the largest annual MinneAnalytics event of them all: Data Tech, to be held on June 7, 2024 at the same venue. It will draw 1200+ registrants and feature 40+ speakers, in addition to the startup pitch session.

Data Tech conference logo

If you’re able to attend, look me up!

Partying at SXSW for Your Health

(NOTE: This post first appeared at GritDaily, a brand-new media site I just learned about prior to SXSW, where I am now – magically – a contributor. Shout-out to my buddy Will.)

street scene at SXSW at night

Did someone say they party at SXSW? ©NomadSound

People go to South By Southwest for all kinds of reasons.

Nonstop parties would be one. Call me crazy, but I went for the conference sessions in the healthcare track. (Okay, a few parties, too.) I wanted to learn about disruptions and innovations in the biggest monster market of ‘em all – at $8 trillion and counting. Knowing there was so much startup action in the healthcare and medtech sectors, I was anxious to learn more about the trends and issues driving all the excitement and change — really gnarly, difficult change — in this space.

One panel I landed in over the weekend taught me about something being touted as a “real sea change” in consumer healthcare.

Turns Out Your Doc Has Been Talking Behind Your Back

But I guess we knew that from watching this Seinfeld episode.

Seriously, physicians have to continuously write notes into your medical record as part of your normal healthcare. They have to fully document your symptoms, diagnoses, treatments, drugs prescribed, etc, etc, in great detail. They don’t just do it for your benefit – it’s a legal requirement. It’s all entered digitally now into your Electronic Health Record (EHR). But did you know that, until recently, patients didn’t get to see those notes? That was the basis for a panel at SXSW called “Transparency in Healthcare” — which was all about a movement that’s blowing up that old notion of, well, it’s-none-of-your-business.

It’s called Open Notes, and what it’s doing (quite successfully, I learned) is getting institutions. to allow you, the patient, to see those doctor notes whenever you want. That may not sound radical to you — maybe just common sense? But change tends to come s-l-o-w-l-y in the healthcare industry.

Why would this matter to you if you’re a healthy person — just, say, getting an occasional physical, or going in for a sore throat? Not much maybe. But if you have a chronic health condition, requiring you to see a physician – or physicians – frequently, it matters a lot. And one of the panelists, a former punk rock drummer, had that kind of story to tell as a malignant brain tumor survivor.

Consumer In Charge

“Healthcare has been physician-oriented for too long,” said Trevor Price, a VC on a panel I caught the previous day. “It lacks consumer focus, which is crazy,” said Lynne Chou O’Keefe of Kleiner Perkins, another on that same panel. So, I was ready now to hear what these Open Notes folks had to say about how “transparency” in healthcare is playing into that trend.

On this panel were Cait DesRoches, executive director of OpenNotes (she’s also an associate professor at Harvard Medical School), and Liz Salmi, a strategist with Open Notes and a former cancer patient. (The punk rocker referred to above, who actually once performed at SXSW when she was 19.) They were joined by Rasu Shrestha, a radiologist and big supporter of this new movement, who’s also chief strategy officer of Atrium Health. The excellent moderator was Bryan Vartabedian, a physician at Texas Medical Center, and also a writer and podcaster.

“It’s not software, we’re not a vendor — rather an international movement, funded by philanthropy,” said DesRoches of OpenNotes. “That way, we’re free from conflict of interest.”

Just how consumer focused is healthcare becoming? “We go see ‘Dr. Google’ first, before we see our own doc,” said Shrestha. Up to 7% of all Google searches are healthcare related, according to panelist Liz Salmi – more than 70,000 per minute.

“I’ve never seen anything like this (the reaction to Open Notes),” she said. “People want this!” Some 200 organizations in 20 states have already signed on to the Open Notes program.

But Are the Docs Buying In?

Okay — but how have doctors reacted? “When I first heard about this, I was freaked out,” said the moderator (a physician). “It’s a real culture change,” said radiologist Shrestha. “Initially, the thought was, we’re all gonna get sued more!” He also heard doctors saying, “We don’t have time for this.” Which caused him to think to himself, “What, you don’t have time for your patients?” But he’s since seen the “embrace from the physician community going way up” in his work at Atrium Health in North Carolina.

“Patients do now have a legal right to their records in the U.S.,” said Open Notes’ DesRoches. Still, most healthcare organizations “don’t make it easy.” With increasing adoption of Open Notes, it is getting easier, she said. “But culture change has to come with it.” Training of clinicians and nurses must play a big role.

Has there been a change in doctor behavior because of Open Notes, where it’s been adopted?

At first, DesRoches said, they tend to think they’ll get buried in calls and emails after patients are able to read their notes. “But for every one that does call, we find two that didn’t because they now better understand their instructions.”

Do doctors have to change the language they use in notes, because they know patients are now reading them? “We think of this as a backdoor to empathy that can only lead to better healthcare,” said DesRoches.

“We now have an opportunity to turn the EHR into a living, breathing, realtime document,” said panelist Shrestha. At Beth Israel Deaconess Medical Center, Open Notes’ DesRoches said they’re even starting to have patients write a short note about what’s happened since their last visit, and actually make that a part of their own medical record.

Shrestha, the radiologist and strategy officer at Atrium Health, said it’s now possible to leverage voice and AI technology “to have conversations with our patients that can go into the legal document – a co-created record.”

Then he stood up, tore open his blazer, and revealed a “Fight Burnout” t-shirt. “Doctor burnout is a huge problem today – read the studies,” he said. Because of the increased time physicians have to spend at the keyboard, entering so much data into the EHR, “docs now have their backs to the patient 44% of the time. That’s not why I went to med school!”

The clear message? If Open Notes can help alleviate that pressure, via the promise of that “co-created record,” it can only help lessen the burnout problem. Do you want a doctor who’s so stressed out, he or she can’t focus on you?

Of Open Notes, Shrestha said, “We’re seeing transformation before our eyes. We’ve cracked open (the EHR) to let the sunlight in.” Open Notes exec director DesRoches added, “Change is here – we’re not going backward.”

Yep, that’s an advancement in healthcare worth partying about.

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Update 3/18/19:

You can’t read this post and not read this (just published):
Death by a Thousand Clicks: Where Electronic Health Records Went Wrong | Fortune
Some serious investigative journalism here. Long read, but definitely worth it.

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