Picture of video screen with Dr Jonathan Baktari and Reuben Hall during the recording of Moving Digital Health podcast

Our guest this episode was Dr. Jonathan Baktari, the CEO of eNational Testing, E7 Health, and US Drug Test Centers. He brings over 20 years of clinical, administrative, and entrepreneurial experience. He’s been a triple board certified physician, specializing in internal medicine, pulmonary, and critical care medicine.

Dr Baktari joined Reuben Hall to discuss the successes, leadership, and technical challenges of creating e7 Health, eNational Testing, and the US Drug Centers.

“One of the things we did was that we actually had our staff be heavily involved in guiding the development team. In other words, we looked at the friction in the system that the staff was feeling, whether it was on their side or on the customer or client or patient side. In other words, they identified barriers and obstacles that the clients had to go through by living and breathing it every day.” Dr. Jonathan Baktari

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Read Transcript:

Reuben (00:04.834)
Welcome to the MindSea podcast series, Moving Digital Health. Our guest today is Dr. Jonathan Baktari. Dr. Baktari is the CEO of eNational Testing, E7 Health, and US Drug Test Centers. He brings over 20 years of clinical, administrative, and entrepreneurial experience. He’s been a triple board certified physician, specializing in internal medicine, pulmonary, and critical care medicine.

Dr. Baktari, thank you for joining us.

Jonathan Baktari MD (00:37.108)
Thanks so much for having me. Big honor.

Reuben (00:41.034)
Well, maybe we could start off, you can tell us a little bit about your background.

Jonathan Baktari MD (00:46.531)
Perfect, yeah. As you alluded to, I went through the traditional medical route and went to medical school, residency, fellowship, and practiced medicine. And slowly after a while, sort of worked my way into administrative medicine, worked for insurance company, health insurance companies and hospitals. And then eventually, you know, we started our own sort of technology healthcare companies and that’s sort of evolved in the last 10-15 years. But that’s been sort of the quick summary.

Reuben (01:24.318)
Okay, and E7 Health is described as a preventative health and wellness company. Maybe you can give us an overview about that.

Jonathan Baktari MD (01:35.455)
Yeah, we started that back in 2009. We really wanted to focus on a part of preventive health and wellness that revolved around adult vaccinations. You can imagine this is pre-COVID, so the idea of adult vaccinations wasn’t on everyone’s forefront. But it was very important, and it was a thing that didn’t get a lot of attention.

Per the CDC, there’s about 50,000 vaccine preventable deaths in the United States annually. And so we thought, you know, we would try to create a vision of a company that would focus on anything to do with adult vaccinations and all the services around that at the exclusion of doing primary care, urgent care, or occupational medicine. And we basically focused on sort of the books of business that adult vaccinations were involved, which is things like employee health, student health, travel medicine and a whole source of adult physicals that need adult vaccinations and also general health vaccines like your pneumonia shot, flu shot, tetanus shot, your zoster shots. So a lot of shots that were difficult to get and a lot of primary care doctors that stopped carrying them.

Reuben (03:00.592)
So let’s go back to the beginning for the entrepreneurs and the audience. How did you get E7 Health off the ground?

Jonathan Baktari MD (03:11.475)
Well, I’d love to say that, you know, it was just perfect execution and we did everything great. But I would be lying. I think a lot of it had a learning curve. Initially, I think some of my administrative skills, you know, working for hospitals and insurance companies and being, you know, I taught in three medical schools over my career as an assistant clinical professor of medicine. So you draw on some of those skills that but it definitely was a learning curve. You know, on my own podcast, I talk about this a lot, which is being a leader is not a soft skill. It’s a skill you need to acquire. And how you acquire it is really that, you know, interesting thing. You either acquire it by making a lot of mistakes.

Or you acquire it by finding a mentor, seeking out people’s advice and guidance, but it’s not a soft skill, as I’ve said many times, just because you’re well-liked and people like you or people respect you, that doesn’t make, that doesn’t give you the skill sets you need to navigate in running an organization.

Reuben (04:35.33)
And tell us about how you’ve been able to incorporate digital health technologies into E7.

Jonathan Baktari MD (04:44.739)
Yeah, I think it was kind of fortuitous because when we started E7 Health, we thought, well, you know, we’ll just buy some off the rack electronic health records and different third party technologies. But what prompted us to start writing our own software is we realized because we were creating our own space, there was nobody out there doing adult vaccinations as the core of their business.

Jonathan Baktari MD (05:14.423)
So there was so we couldn’t find anything off the rack. You know, you couldn’t just go to Macy’s and get a perfect fitting suit. So became clear, you know, we’re going to have to tailor our own suit. Because nothing anticipated the kind of work we wanted to do. So it was mainly out of necessity. And of course, we started really small. I can let you know, let’s just use technology to address this minor thing. And as soon as we did that, that changed our lives. We said, oh, well, let’s do more of that. So even the digital health thing was, one, an evolution, and two, it was a necessity because we couldn’t use anything off the rack. Nothing. Nothing made sense off the rack. So we were forced to becoming a software development company and a technology company.

Reuben (06:14.003)
And what was the first problem you solved with technology that helped, you know, improved your operations?

Jonathan Baktari MD (06:24.755)
I think that was very rudimentary. I think it was just, for example, we were spending three, four, five hours a day scanning paper forms. I mean, there was a whole scanning department and I recall staff, you know, staying until eight, nine, ten o’clock at night because we had a backlog of scanning and that just seemed insane.

Jonathan Baktari MD (06:54.387)
So we said, okay, well, why don’t we just digitize some of these forms? So, you know, we brought some developers on board to just, just to digitize our forms and we thought, oh, once we digitize, we’ll be done. Like, there’ll be nothing left to do because everything would be digitized. But of course, to digitize it, you need to have a platform to digitize it into.

And then you need to search for it and find it. And you need to attach it to a patient. And then what else do you want to do once you have a file on that patient? And what about how they book appointments and what? So you can imagine how that evolved that once you want to digitize things, well, then, okay, but you need a platform to put them into. Okay. Now you’ve got the platform. So we really bootstrap that we basically took a lot of our, you wanna call it profit or whatever, and so in many years just reinvesting it.

Reuben (08:00.014)
And how did you build the team? Did you initially hire people full-time to start building the software or work with contractors or other vendors?

Jonathan Baktari MD (08:15.007)
I think you, yeah, we started working, uh, with some different groups. And of course we, you know, just like anything else, we made some changes and, and moved to different groups. And basically we got to the point where. You know, I want to say it’s an outside group, but they’re basically only working on our stuff. So as best as become basically in house, because they’re only.

Jonathan Baktari MD (08:43.247)
They’re only working on our stuff because it’s just endless now. Now that we launched the national testing and us drag test centers, it’s, it’s basically, um, by now you can almost call them an in-house development team.

Reuben (09:01.114)
Yes, it’s great when you’re able to get to that level of partnership on the technology side. So, you know, you know, mindset development builds a lot of those, you know, type of internal systems as well with our with our partners. And, you know, over the years, it really does become that kind of, you know, one team, one goal mentality.

So it’s pretty important to the success of what you’re building to be able to find that partner that’s just as invested as you are and can help push that forward.

Jonathan Baktari MD (09:42.307)
Yeah, I agree with you. I mean, that can certainly make or break you, right? Because let’s say you want to develop technology and somehow you pick the wrong group. That could potentially be determined whether your company succeeds or not.

Reuben (10:02.098)
Yes, we’ve certainly heard a lot of horror stories from clients that come to work with us. They have an existing software, but it’s a bit of a mess under the hood, and it’s full of bugs and other issues. And we end up in the role of the fixer-upper sometimes of an existing codebase.

Jonathan Baktari MD (10:29.835)
Yeah, it’s quite challenging. So I think on that sense, we’ve been pretty fortunate.

One of the things we did was that we actually had our staff be heavily involved in guiding the development team. In other words, we looked at the friction in the system that the staff was feeling, whether it was on their side or on the customer or client or patient side. In other words, they identified barriers and obstacles that the clients had to go through by living and breathing it every day. So most of the suggestions were compiled and eventually communicated to the development team by the staff. And I don’t want to even just say the leadership. Sometimes it was simply the receptionist would say, hey, have we ever thought of having this disinformation into over here so we don’t have to double input it or the person can’t make a mistake or, you know, or if they lose their password or log in, have we thought about blah, or, you know, what happens if a mom comes in with a kid that they have to fill out two forms or one form, how do we link it? These are all things that I don’t think developers selling, sitting in a silo somewhere would know is a necessity or convenience. Unless the people on the ground. So we joke that our staff really were almost lead development because, and anyone in our staff could put into the electronic suggestion box ideas. And so we had like a jot form where people were like literally put in ideas of how to either improve quality, reduce friction.

Jonathan Baktari MD (13:51.531)
improve accessibility, reduce the amount of work our staff has to do. I think one of the things people forget when they write technology for their own company is how important it is to get rid of work for your own staff. I think a lot of people think, well, my staff is getting paid hourly, so, you know, whatever. I mean, but we literally try to figure out any and everything we could remove from them. Because the less time they’re facing a computer and punching things in a computer, the more time they can be spending with the client, the patient, or working on other things that will improve the experience, the quality, and what have you. So it’s not a win when someone’s at a computer screen punching in a bunch of stuff. That we don’t view that as a win. We view that as a loss.

There’s an article, I think I did a podcast on this last year. The study came out that said like in the medical world, you know, 75% of the time a doctor is seeing a patient, they’re staring at a computer. I mean, that’s so you, if we can say, oh, if we can get that 75 down to 25%, well, that means that 50% they’re going to actually be.

eyeball to eyeball interacting with another human being. So the goal of this technology is to get your eyes off the screen and get your eyes and actually helping people. Because I think there is no upside to you spending a lot of your time punching stuff into a keyboard.

Reuben (15:44.99)
Yeah, I think there’s a lot of great points there. The biggest argument for digital health solutions and the biggest benefit is to just get physicians more time with patients, get them off the computer so that they can spend their time in higher value, more important situations. And…

You’ve obviously proven that’s the case at E7 Health as well. And going back to what you said about everyone being involved in the development process, I think that’s so important as well, because there’s so many different users of a piece of software. Sure, there’s the patient that might be filling out the form, but as you said, there’s complex scenarios with different family members. There’s the admin who might be reviewing helping those forms get filled. There’s the physician who’s digesting the information. There’s often multiple roles in the stakeholders and the importance of seeing a software product from all those different angles to provide something that works for everyone really.

Jonathan Baktari MD (17:03.835)
Well, yeah, one interesting tidbit that I think I found pretty fascinating is because we are a lean and mean organization, one of the things I notice is when someone makes a suggestion and literally a week later that suggestion is live, I think it really emboldens people.

I doubt if you’re at a hospital and you have a suggestion for Epic for some change they can make. I don’t think you’re writing an email to Epic. You’ll be retired by the time that gets implemented. So people just give up. And they’re not writing emails to Epic and saying, please, have you thought about auto-populating this so I don’t have to put it in five times.

Jonathan Baktari MD (18:03.263)
So I think there’s this learn thing that there’s no point to making suggestions for software improvements because the version 3.12 is coming out another year and a half. It’s not going to matter. So with us, we’re so fortunate because we literally get a new version every week. And I think that that’s the value of people seeing

Jonathan Baktari MD (18:32.927)
I mean, we don’t take everyone’s suggestion every time. But when someone makes a great point, especially when it comes to patient quality or patient safety, we literally have it online the next week. If an error is made, even if it’s caught, or even if we come up with a potential error that could have been made, we don’t waste any time. We literally have to go into production and then we push it live. So I think… people are more likely to be engaged in improvement of software if they actually believe, one, someone’s gonna listen to them, and two, even if they listen to them, it’ll come online in their lifetime.

Reuben (19:21.142)
Yes, and that’s why the early adopters, the first users of the software are so important because they’re often the highly engaged people that really need this to solve their day-to-day problems. I’m curious if you’ve built software to solve your own business problems, and clearly that’s working for you. Have you gone the next step to then commercialize any of that for other vaccine clinics across the world.

Jonathan Baktari MD (19:58.411)
We actually did that. We’re in the process of doing that for US drug test centers. So US drug test centers as a sister company of E7 Health. E7 Health does drug testing to support student health vaccinations and other employee health that need vaccinations, but they also need a drug test. So we develop a drug testing division inside E7 and then we spun that off to a national drug testing company. And we realized the platform US drug test centers was on was not ideal. It was a third party platform. It wasn’t ideal for managing a nationwide drug testing companies, which are referred to as TPAs in the industry, third party administrators. So third party administrators involved in drug testing really we felt had no platform. So first we created the platform so we could sit on it, meaning get off of other third party platforms. And so we’ve been sitting on that platform ourselves and that platform is called USTPA Gateway. So if you wanna see us ustpagateway.com. So we created that platform and now we’re about six to 12 months away from basically offering that as a SaaS to our competitors.

Jonathan Baktari MD (21:25.343)
other TPAs that want to hop on board. And so we’re just getting the SOC 2 certification and other things that we’re going to need to have other companies be on it. So that’s our current project to take our own technology and offer it to the industry or to the public, I suppose, if you want to call it like that.

Reuben (21:52.294)
Yeah, I think that’s a great example of a path to commercialization is building that custom product to solve your own needs, really honing in on the features and refining the functionality in-house till it’s ready to be provided in other contexts.

Jonathan Baktari MD (22:24.311)
Yeah, it’s been a fun project because it’s when someone develops a software like that, it helps for them to actually be a client on it because who should know better what features are important than the people who are literally trying to run a TPA and then offer it to other TPAs.

Reuben (22:52.466)
You do see some startup founders that don’t have that background in healthcare and they’re trying to solve a problem. They may have identified a legitimate problem. They’re trying to solve it from the outside in, I think, which is very difficult. Often it’s much more effective to solve that problem from the inside and then grow out of that.

Jonathan Baktari MD (23:20.427)
Right. And I think the other cool feature about that for people who can pull that off is it actually builds a barrier to entry for other competitors to come into that. Because they may like see that, you know, that your software exists. But the barrier entry is to know all the pain points and all the issues you need to address. And sometimes the only way you know that is to be like, to be a client on that software. So I think the cool thing for people who are able to pull that off, it sort of builds a moat around their business potentially.

Reuben (24:01.686)
Certainly that’s the competitive advantage. You mentioned the SOC 2 compliance. So obviously it’s highly regulated and security and privacy is paramount. Maybe you could talk a little bit about that aspect and how you’ve had to deal with your software.

Jonathan Baktari MD (24:24.983)
Yeah, I mean, full disclosure, we’re just going, starting to go down that road and identifying vendors who are going to walk us through it. But it is pretty complicated. You have to hire a whole another team of developers and what have you. And we’ve had some preliminary meetings on it. And it’s going to be a long six to 12-month process. I wish I could give you more details. But one, I’m not the best IT guy to talk about it. But I have said on the first few meetings, and it’s not for the faint of heart, it looks like a lot of work, but we’re gonna have to do it.

Reuben (25:06.17)
Certainly, it’s a lot of work, but it’s work that needs to be done. And in this industry, there’s nothing more important than protecting that patient data, for sure. We’ve actually been going down our own road of SOC 2 readiness, I would call it, because we’re not there for an audit quite yet.
It’s a tough process, but I think it forces you to ask a lot of tough questions and make changes that are for the better in the long run.

Jonathan Baktari MD (25:45.507)
Yeah, I mean, the one downside about it is it does slow down development. Because right now, we can make any change we want, push it live, ta-da. So I know once we move down that road, and that’s probably why we pushed it off a little bit, because we really wanted to have some unencumbered software development. But once you go down that road, then the changes are much slower. And

So we wanted to really get the bulk of the development prior to that and then kind of have that be the icing on the cake.

Reuben (26:25.19)
Yes, there’s certainly a trade-off there. You’re right that you’re no longer going to be the lean machine that you were before. But sometimes there’s a way to separate that, to still have the beta version that you can still iterate on quickly that’s with a smaller user group. And then once changes have been proven at that level, then you can promote them essentially to the… the full product and still keep quicker durations and learning in a real agile fashion that way.

Jonathan Baktari MD (27:02.999)
Oh, that’s a great idea. You’re saying like, keep a beta version with a smaller group, keep pumping away at that. And then when you’re really happy with it, then kind of upload it all up to the final version.

Reuben (27:17.214)
Yes, exactly. Keep that small, lean, agile team going with a smaller user group. And then have it controlled in terms of who can access it. So it’s not part of your SOC process because it’s happening separately. And then once changes have been tested and proven, then you can push them up to the public product. That there’s obviously more change control and compliance issues to go through there.

Jonathan Baktari MD (27:56.943)
That’s a great, honestly, that’s, I’m learning. So that’s not, we hadn’t thought about that, that I’m gonna actually take that and I’m gonna ask my staff to respond to that. That’s a great idea. Good idea, I’m learning.

Reuben (28:09.722)
Oh, excellent. Good. This is a great conversation. I’m really interested to see how you progress through that journey of moving into a SAS model.

Jonathan Baktari MD (28:27.631)
Yeah, it’s gonna be fun. We’re excited.

Reuben (28:31.894)
So what are some of the big challenges you’ve run across? Obviously, if multiple businesses, multiple technology solutions here, I’m sure there’s been a lot of bumps in the road.

Jonathan Baktari MD (28:45.623)
I mean, I think the bumps in the road are like twofold. I mean, there’s the bump in the road that we’re talking about, which are just developing an organization, developing culture, hiring, firing, promoting. So those are organizational challenges. And then from the technology challenges, I mean, I think it really is trying to develop technology in a sequence that makes sense as opposed to just randomly developing features and you know what’s more important what’s less important what needs more attention what needs less and then trying to you know bootstrap it all because if you have an unlimited budget obviously things are a lot easier and so understanding without with a limited budget you know where do you where are you gonna get the most bang for your buck and you know, trying to navigate that. So these are all things that we think about every week, every month, like what is the best use of our finances, our attention, our focus, and our limited bandwidth.

Reuben (29:57.938)
I think having to make those prioritization decisions is so critical though to, you know, to having a focused and effective product. I think, like you said, giving unlimited budget, a lot of times things get thrown in that are just like, you know, kitchen sink ideas like, well, what about this? What about this? All like, let’s just, let’s just put it in there. Whereas if you have to be more considered about where you’re spending your time, you’re probably only developing the really important priority features that are clearly required.

Jonathan Baktari MD (30:38.507)
I think we struggle with that. But yeah, those are right on.

Reuben (30:45.838)
So I’m curious, what do you see coming down the pipeline? What gets you excited about the future of either digital health in general or the opportunities for your different organizations?

Jonathan Baktari MD (31:02.679)
Well, I think two projects that we’ve worked on, one US direct test centers and USTPA Gateway, which we’re going to launch soon, are very exciting opportunities. And then eNational testing, another sister company that we launched to provide clinical laboratory testing for anyone across the country. We have thousands of laboratory locations that we’ve contracted with. So our goal was that to make that very Amazon-esque, where you just go in a few clicks, you can get your cholesterol tested, half a mile away from your house and make it very simple for you to take more control of your healthcare. We’re really proud of that. That’s something that’s live and growing and we’re very, very proud of that.

Reuben (31:54.19)
And do you see a lot of new types of tests coming onto the market now, or it’s aside from, you know, just kind of what we’re all familiar with in terms of like the drug testing everything. But it seems like there’s a lot more things that you can get tested.

Jonathan Baktari MD (32:15.211)
Especially on eNational testing. We have a men’s health package, a woman’s health package. We have food allergy testing and all sorts of testing that you now have access to, literally like, you know how like on Amazon, three clicks and you can order a widget. I mean, that’s really the way we’ve set it up, three clicks and you can have, you know, your testing done and results sent to your, you know, portal or email to you in a few days. So we’ve done that. I mean, I think we have hundreds and hundreds of tests that are available at any nationaltesting.com for almost any major or small, medium to small city in the country. We probably have a laboratory location very close by where you just literally order it on our website. You take your donor pass, walk in and get your test done. So it’s really been made super simple.

Reuben (33:12.65)
Excellent. Well, I know you have your own podcast, so you’re pretty much a veteran at this. Is there anything else you’d like to add, some of the wisdom you’ve gained over the years?

Jonathan Baktari MD (33:27.735)
Well, on the technology side or on the organizational side or…

Reuben (33:30.902)
Well, let’s talk about the technology side.

Jonathan Baktari MD (33:34.527)
Yeah, I think technology side, I mean, I wish, obviously, I wish I knew before what I know now. So and actually, that’s one of the goal of my podcast, you know, what I try to do is I try to pass on, you know, every mistake I made, or I came close to making, and to pass it on and say, you don’t have to make these mistakes. And there’s so much so much you learn through the school of hard knocks and you end up paying tuition one way or another. So I tell people, find a mentor just because it was your idea doesn’t mean you’re going to be the good CEO. Or just because you’re the main guy who invested the money doesn’t make you the most qualified person to run the company.

Doesn’t mean you can’t run the company, but go and seek out help, mentorship, learn. Uh, being in charge is not a soft skill. And just cause people like you, you know, it doesn’t make you naturally a great leader, uh, to, or, or the best person to navigate an organization. You know, I’ve said this a thousand times, just because you’re likable and people like you is not going to make you land a 747. Right. You’re just not. You could now you could land the 747, but you’re going to need to acquire some skills.

Reuben (35:13.975)
And a team to help you out as well.

Jonathan Baktari MD (35:17.267)
How do you put that team together? well it won’t be because you’re just likeable. Right? I mean, you have to acquire some skill. How do you interview? How do you hire? How do you fire? How do you motivate? How do you pick the right person? How do you promote? How do you demote? How do you? Just because you’re a nice guy doesn’t mean you have those skill sets yet.

Reuben (35:42.81)
I’m curious, have you had the benefit of some great mentors over the years, or do you feel most of your learning has been the hard knocks variety?

Jonathan Baktari MD (35:53.611)
Yeah, I’m really lucky. I’m really lucky. I found some really great mentors, really amazing. And I know this is hard for doctors to do, but you know, when I find someone like that, you know, my goal is really shut up and listen really. That’s a hard one. Just, you know, just shut up. I mean, once you identify that, you know, you really think they’re the Michael Jordan of whatever it is you’re looking for. If Michael Jordan is about to teach you how to shoot a basketball. Do you have any cut? Do you do you have any comebacks to him? I mean, is there anything you say like, well, that sounds good, Michael, but I’m not sure like, do you have a comeback to Michael Jordan? I mean, if he tells you this, how you shoot it, huh? So I think that’s hard for people, especially people who are already in charge to just once they identify someone, who they believe is like the authority on the subject matter, then just, I mean, yeah, you can ask questions, I suppose, around the edges, but I wouldn’t challenge that person.

Reuben (36:25.526)
Yeah. You shouldn’t. Yeah, take the mentorship where you can get it for sure.

Jonathan Baktari MD (37:11.683)
I think the key is though identifying the right person. Obviously you can be mentored by the wrong person. So I mean, I think then you need to seek. We used to go to a lot of conferences and really vet out people that we thought were really one ethical, honest and true leaders and were subject matter experts.

Jonathan Baktari MD (37:41.301)
So that’s a lot, there’s a lot less tuition than the school of hard knocks.

Reuben (38:19.522)
Well, thank you very much for joining me on the podcast, Dr. Baktari, and thanks for everyone who’s listening to the Moving Digital Health podcast. If you enjoyed this conversation, please go to movingdigitalhealth.com to subscribe to the MindSea Newsletter and be notified about future episodes.

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