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How Carego International extends the reach of mobile medical care

Jon Reed Profile picture for user jreed July 16, 2014
CEO Steve Landman isn't your garden-variety Silicon Valley entrepreneur. Here's how he resolved his love/hate with technology to bring medical care to remote areas of the world.

Carego Internetional CEO Steve Landman isn't your garden-variety Silicon Valley entrepreneur. You see, he keeps trying to avoid tech obsessions in favor of field work in countries where educational and medical needs are glaring. But the tech keeps calling him back.

Like in 1998, when an old friend summoned him to Madagascar to develop a mobile application to collect data on bird flu and control outbreaks. Or in 2001, when Landman journeyed to the Amazon river in Ecuador to launch the first incarnation of Carego International, in the form of floating medical clinics. Today, two of Carego's portable clinics still float up and down the Amazon, serving 25 patients a day in remote villages. The portable clinics are now deployed in 11 other countries, and Carego's services have expanded as well.

Landman's career progression has its unexpected roots as an early Oracle employee, back when Oracle was a startup and he could call Marc Benioff a co-worker. From there, it was the life of a serial startup guy, starting companies, selling some of them (one to HP). After launching a company called Mobile Airwaves in the late 1990s, it was time to re-invent again.

The inspiration for Carego International dates back to a classic entrepreneurial 'what if' session - in this case, 'What if abandoned cargo containers across the world could be repurposed into something useful?' But I'll let Landman pick up that part of the story. Spoiler alert: Landman didn't end up escaping technology with Carego - he doubled down on cloud instead. Here's why.

Jon Reed: You've struggled to find fulfillment in tech pursuits, but surely in Madagascar you were impacted by how mobile technology could extend the reach of health care?

Steve Landman: I’ve been in other Third World countries, but for some reason, that trip to Madagascar just touched me - it made me think, 'I’m getting so greedy, what am I doing to help humanity'? Because I'm not helping by building technology and selling it for profit.

Reed: And your time in Madagascar sparked the birth of Carego as well.

Landman: Yeah. In Madagascar, I looked around and thought, 'Wow, all these people are dying - and they’re dying out in the open because there’s no place to treat anyone. There’s no facilities, there’s no place to keep drugs from expiring or going bad; there was nothing clean. How can we do something differently?'

From portable clinics to a viable business model

Reed: But how did this lead you to repurposing shipping containers?

carego containers1
Landman: There’s a huge surplus of shipping containers all around the world, except for China. They're just sitting around, decaying and rotting. I had a friend who built green rooms for the movie industry. I said to him, 'Hey. I want to build a shipping container clinic.' So we went down to LA and started designing the shipping container clinic. We can literally drop them anywhere – and in different sizes as needed, including operating rooms. You can do just about anything with a shipping container. We actually are in the process of bidding for a hospital made out of about 10 shipping containers for the Vietnam military.

Reed: Did you have any funding to get started, or did you finance it yourself?

Landman:  I self-funded in the beginning, and then I got a bunch of angel investors and did a Series A round. I haven’t had to raise money since. We officially incorporated as Carego International in 2005; today, between tech staff, clinical staff and contractors, we have about 450 folks worldwide.

Reed: So you've figured out that this is not only a difference-maker, but a viable business model.

Landman: Right. Keep in mind, our patients are low income earners,  but you can really make an affordable model where you’re not using doctors and expensive staff - you’re using clinical officers and nurses to treat people and make if affordable. Basically, it’s $3 to $4 for a consultation, a lab test, a drug, and a follow up consultation. I have another non-profit that raises money so we don't have to turn anyone away, but we really try to encourage people to encourage people to pay for their healthcare, because then they take a vested interest in it.

Reed: And about that went halfway across the world, but you couldn't really get away.

Landman: (laughs). Well, as we soon figured out, we need technology to run the clinic.

'In the countries we're serving, there is no other way but cloud'

Reed: Cloud seems to have played a big part from the beginning.

Landman: I live in Silicon Valley. Having worked with Benioff, I followed his vision of cloud and CRM from the beginning. In the countries we're serving, there really is no other way but cloud - installing local software was not an option. Most of these places wouldn't have a server on premise. To maintain and support servers locally would be virtually impossible.

Reed: And how did Progress Software's Rollbase solution come to play such a key role?

Landman: I had been working with the Rollbase founders for a few years, because they’re based here in Silicon Valley too. When Rollbase was acquired by Progress, they adopted me.

Reed: For those who are skeptical about cloud platforms, what has the value been to Carego?

Landman:  Well, we were originally on the platform from Salesforce. We developed our first EMR on, but it was pretty limited; it was not flexible and the reporting wasn't good. There were a couple of things that drew us to Rollbase, which is now part of Progress' Pacific PaaS. One is the hybrid model. The hybrid model is awesome for us, because we can have a public cloud and a private cloud.  When you’re talking about, for example, a large hospital that actually has budget and IT stuff, we can actually put in a private cloud in their location.

On the other hand, for onesie, twosie clinics around the world, a public cloud works perfectly. Given that we're essentially a philanthropic, social focus company, cost is a huge issue for us and the doctors we work with. From a pricing perspective, it was really the right solution.

Why cloud platforms made a difference

Reed: So you essentially built an EMR app on the Progress platform?

Landman: Yes - we built an EMR app, an HIS app, and a practice management app as well. We call that Carego Complete. It's an integrated, cloud-based EMR and practice management app. Basically, it automates both clinical and business processes for small to mid-sized clinics. Another key Rollbase feature was the online/offline capabilities. Connectivity and power is spotty at best in most areas we serve.

Reed: PaaS advocates claim that it's easier to build apps on a platform that has rapid application development tools built-in, and point-and-click type interfaces. Did you find that to be the case?

Landman: Absolutely - the tools allowed for quick development. It’s really just like drag-and-drop and name your fields; it's not hard to develop an application. I've even done some development on it - and I'm not a programmer at all (laughs).

Reed: For your customers, it's as easy as going online to use the applications, or downloading them onto mobile?

Landman:  It is that simple actually. In the mobile case, they actually download an app, then it synchronizes with the database and the accounts are all set up and provisioned. End users are always impressed by how easy it is to usem and the functionality we can deliver. When you can give people immediate access to health records, without needing to mess around with paper filings - suddenly you can extend the reach of these systems into very remote areas.

Reed: Indeed - so you don't use at all anymore?

Landman: No - we actually built our own CRM on progress and our own project management and customer support center on Rollbase also.

Reed: Can you boil down the benefits of cloud platforms into some numbers?

Landman: Yes - we go to market 50 percent faster now. I'd say 80 percent of a typical development project can be handled with point-and-click, which definitely reduces development costs. We maintain the apps via over-the-air provisioning once we've built them, so maintenance is not hard.  We also built a knowledge base where our providers can log some of the cases that they’re seeing - outbreaks of Cholera or Dengue Fever or whatever - and we can actually push those out to clinicians. Also, with this setup, we are able to offer on-demand, pay-as-you-go pricing to our customers.

Reed: I'm betting your biggest obstacle isn't technical, but resistance from institutions in the countries you move into.

Landman: Absolutely - a lot of times, a government doesn’t think we belong there. That's the case in Vietnam - they make it really difficult for us to get anything done. We find ministries of health say all the right things about wanting us there to help, but when you really try to get work done, they really are the biggest impediment.

Next up: Vietnam - and calling a truce with technology

Reed: So what's next - Vietnam I take it?

Landman: Yes, I'm relocating to Vietnam temporarily. We actually got a 12 year contract for the whole country, to put 40 million students on one platform - a student information system. Eventually, that will be on Rollbase as well. That revenue allows us to do so much good for countries like Vietnam and other countries like Kenya, Uganda, Congo.

Reed: Sounds like you are finally resolving your technology push/pull dilemma.

Landman: Perhaps (laughs). I'm starting to see technology as a means for us to generate great revenue that allows us to do the social mission work. Now I see technology as an enabler to do social good.

Reed: And your momentum seems to be building.

Landman:  A few months ago, we dropped a container in the Congo, and that was pretty amazing. There's just no infrastructure there. I've seen a lot of places, but nothing's ever touched me with sadness like the Congo, and just how bad it is there. But that makes us determined to get in there and do something. Anywhere we work, you see the smiles on people's faces when they see that someone has come to provide them with care.  It’s special to be a part of.

Image credits: All images provided by Carego International or re-used from the Carego International web site with express permission.

Disclosure: Progress Software PR helped to arrange this interview. Progress Software does not have a financial relationship with diginomica, nor does Carego International. Due to my interest in cloud platforms, I reached out to them to pursue a customer story.


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