Cliniko founder Joel Friedlaender on bringing digital transformation to healthcare

Joel Friedlaender is the founder of Cliniko, a practice management software for clinics and allied health practitioners to manage their scheduling and booking, patient records, invoicing, and more. When he started the company with his partner about 10 years ago, the healthcare industry felt like it was still stuck in the past, technologically speaking. Clinics were still using various systems with unintelligible interfaces and hosting their software on on-site servers, making it impossible to access information from anywhere else. Joel and his partner saw that there was an opportunity, and they quickly jumped on it.

Cliniko has been helping thousands of healthcare professionals to accelerate digital transformation in their businesses ever since. But the most challenging moment came last year, with the onset of the COVID-19 pandemic. As face-to-face consultations were no longer an option for many healthcare providers, Joel and his team dropped everything and asked themselves: what could they build to help their customers (and their customers’ patients) adapt to the new normal?

It’s not easy to adopt new technologies at such a high-stress time, especially when you’re also intent on keeping a high standard of care, providing a personalized patient experience, and making sure everyone’s data is secure. (We’ve recently completed a HIPAA attestation examination, so we can appreciate just how sensitive healthcare data is.) But if Joel has taught us anything, it’s that tech can actually help you to take better care of your patients.

We recently spoke with Joel to learn more about Cliniko’s approach, organizing work in a remote-first setting, and what the future holds for the healthcare industry.

If you’re short on time, here are a few quick takeaways:

• Although Cliniko stumbled into a remote-first work approach by accident, it ended up working wonders for them. Why limit yourself to candidates in your area when you can just focus on finding the best candidate for the job?
• As boundaries between workspace and home intertwine, our partners and families are getting more involved in our work than ever. And so, Cliniko decided to embrace it – partners aren’t just invited for work events and meet-ups, they’re also a part of the company’s social Slack channel.
• This past year has accelerated digital transformation in many businesses, and the health industry is no exception. Joel believes tech like telehealth and virtual check-ups aren’t just a band-aid for COVID-19 times – even in the most physical healthcare therapies, they’re here to stay.
• One would think globalization would make it easier for countries to harmonize data compliance practices, but Joel has had quite the opposite experience. In the past few years, countries have figured out different ways to legislate how personal data is handled and protected, and as a result, companies who serve worldwide audiences have a lot more requirements to meet.

If you enjoy our discussion, check out more episodes of our podcast. You can subscribe on iTunes, on Spotify, or grab the RSS feed in your player of choice. What follows is a lightly edited transcript of the episode.

A much-needed update to the health industry

Dee Reddy: Joel, we are so delighted to welcome you to the show today. To kick things off, would you like to share a little bit about yourself and how you ended up as founder at Cliniko, the practice management software used by more than 30,000 people in over 70 countries?

Joel Friedlaender: Sure. My background is as a software developer, and I’ve been doing that for just over 20 years. About 10 years ago, I started the journey with Cliniko. At the time, I was working as a software development manager in a small company, and my partner, who’s an osteopath, had been asking me for quite a while to make some software for the allied health industry, as she saw a need for it and there wasn’t much modern software around at the time.

“We took out a loan against our house to do a renovation but used it to build a company instead”

In the end, I quit my job, and we took out a loan against our house to do a renovation but used it to build a company instead. We started building out what is now Cliniko. It took about seven months from the time I started working on it till we sort of launched publicly, and it’s just gone better than we expected.

Dee: Yeah. I mean, that must’ve been quite a nerve-wracking time in that you were really putting all your eggs in one basket.

Joel: It sounds like it would be more than it was. I wasn’t so happy in the job that I was doing and the potential upside to be able to work for myself and start a business was big. It was exciting, and the worst-case scenario wasn’t so bad. So we were just both super keen to give it a good go.

Dee: And, I suppose, between the two of you, you’ve got sort of that intersection of technology and healthcare that’s reflected in the products you built together.

Joel: Absolutely. It was a huge bonus to have with me, side-by-side, a user of the potential system who knew what it needed to do and how it needed to work. It was essential.

Dee: As you say, you started it just over a decade ago with what was quite a straightforward idea from your partner, who wanted this booking system. In your opinion, how has the health tech landscape changed in that period? Because presumably it’s been a time of quite dramatic change.

Joel: I think that the most significant change from back then is that a large number of systems now are web-based, which they weren’t at that time. At the time when we launched Cliniko, being web-based was quite a point of difference. The software industry was already there – there were a lot of applications already moving web-based. But in the allied health space, specifically, it was a little bit behind.

“We were using modern software practices and what was successful elsewhere and bringing it to an industry that didn’t have them”

I don’t think we were doing anything revolutionary. We were using modern software practices and what was successful elsewhere and bringing it to an industry that didn’t have them. A lot of people back then were still hosting their software on servers in their clinics, they were using Windows-installed software, they couldn’t use Mac or something if they wanted to. I think that’s the most significant change – now, Cliniko and others are web-based and give practitioners a lot less tech to worry about in having to manage their network and service and also the ability to access their information outside of the clinic. In the last 10 years, that’s probably been the most significant shift.

Dee: And do you think with the apps that people use in their day-to-day life that the patients overall are more open to using a tech-based health product?

Joel: Absolutely. I think they’re more comfortable with their information being stored in it, and particularly around the booking side, which is probably where the patients interact the most with a system like ours. They almost expect to be able to book in from their phone or online in some capacity, whereas it wasn’t the case even just a few years ago.

Dee: Yeah. When you have users who are used to being able to order food and watch and track the delivery from the restaurant to their door, I guess it makes sense that you would be able to do similar functions when it comes to monitoring your health.

Joel: Absolutely. I think there are two parts. One is the convenience of it and the ability to book in at a time when the clinic might not be open and taking your call, and the other, specific to the healthcare sector, is you might be booking in for an appointment that might be a little bit sensitive or private and not having to announce on the phone what you’re booking in if you’re at work during the day or something like that. Being able to do it discreetly via an online booking can be beneficial in this context.

Accidentally remote

Dee: I know from reading about Cliniko that you’ve always operated as a remote-first company. Can you tell me why you felt this decision was right for you and your team when you started off?

Joel: Sure. Our first hire to the company was a developer in Poland, and we’re based in Melbourne, Australia. That was back in 2012, but it wasn’t intentional at the time. I would like to say that I had this big vision that we were going to be a remote company, but really, I put up a job ad that said, “Looking to hire a developer in Melbourne.” I thought I wanted someone to sit and work side by side with, but it just so happened that this person didn’t care much for the requirements of being in Melbourne and applied anyway. When we went through all the applications, they were the standout one. And we were open to it. We’re not so set in stone that, “Here’s what we thought we wanted. We got to stick to it.” We were open to that, and it ended up working out brilliantly for us.

Dee: That’s amazing. I love that they just ignored the requirement to be in Melbourne. Fair play to them.

Joel: Absolutely.

Dee: Was that quite unusual though, 10 or even five years ago, to be building up a team where everyone’s in different places and different countries?

“This was just hiring the best person we could find, and it turned out they weren’t in Australia”

Joel: I think so. People did hire developers overseas, but not in the same way. I think people might have outsourced at the time – they would go to a company in a typically cheaper demographic area. And that was the key reason to be doing it as well, to save on price if local developers were expensive. But this was quite different. This was just hiring the best person we could find, and it turned out they weren’t in Australia. And in bringing that person on, we obviously started to set up systems and processes that worked with a remote team because we needed to, and then, as that had worked so well for us, the next time we were looking to hire, we just felt, “Why are we going to be restricted to someone within certain kilometers from where we’re working as opposed to looking anywhere in the world to find the best person?”

And I think it was unusual. When I had chats with my family, they wouldn’t understand how that could work. They’d be asking me questions like, “Well, how do you know they’re doing any work?” Or things like that. So it was definitely much more unusual at the time in 2012 than it is now. But still, even now, there’s a long way to go before remote work is done by a lot of companies and done properly.

Dee: I think you’re right there. Surely it’s been quite advantageous for you in the past year to have that remote working culture already built up?

“COVID and lockdowns still had an effect on our team and our company, but we didn’t have to change our work situation, we were well set up for that”

Joel: For sure. I think it’s been advantageous for us since day one. I’m a big advocate for it. Part of the reason for the success of our company has been the way we’re working like that. And definitely, COVID and lockdowns still had an effect on everyone, it had an effect on our team and our company, but we didn’t have to change our work situation, we were well set up for that. That was a big help.

Dee: How big is the team now, Joel, and where are people-based and with what functions?

Joel: We’re about 45 people now. We have people in Australia, the US, Canada, Brazil, Portugal, UK, Ireland, Scotland, soon to be, France, Malaysia. I’ll probably forget some, but really I have people all over the place. There’s someone in the Philippines as well. So, just like I said, when we’re hiring, we’re just looking for where we can find the best person. The location doesn’t matter. The only exception to that would be when we’re hiring for support and we need to cover a particular time zone. But then, we’re hiring for that time zone, we’re not hiring for a location.

Dee: I was going to ask about that. It presumably means you can have that sort of 24-hour service, which being in healthcare, it’s probably quite important to be able to offer.

Joel: Absolutely. And that came about sort of naturally. We weren’t aiming for 24-hour coverage, but as we started to hire more people, our support team actually got together and just said, “You know what? We’re already covering most of the times, what if we schedule a bit better and we do make sure we’ve got 24-hour coverage?” And they just did that amongst themselves. So, we do have that 24-hour coverage, at least during the week, but it almost happened by accident just by having these people in different regions when we needed them.

Dee: Well, it’s organic. I suppose it’s a sign of a good support team that they realized that there was something that they could offer.

Joel: Absolutely. And it has been really good for our customers to know there’s always someone about.

Getting the partners involved

Dee: Brilliant. Going back to the COVID side of things, it has been over a year since companies across the world have been forced to adopt that practice. In some places, like Ireland, for example, we don’t know when we’ll be back in the office just yet. So rather than ask for your tips on remote work team building, because I think that’s a fairly well-covered ground at the moment, I’d love to know what your advice for creating a sustainable team culture is. How do you mark achievements or life events? How do you manage when you have to have in-person meetings with someone that might actually be local?

Joel: My number one tip for culture in a remote company is the least helpful during COVID, which is we have yearly team meet-ups, or every second year, we have team meet-ups. And I think that has been really good for us as a team over time. Even though our team is remote, it doesn’t feel like a bunch of contractors. People really have close friendships with people all over the place. I think our meet-ups had a big impact on that – it helped a lot that we would get together for some smaller meet-ups, and every two years or so, we would gather the whole team somewhere in the world. But that’s obviously not possible at the moment.

So I think that one thing we do is use a team chat tool. We use Slack for our team chat, and I think having plenty of space for non-work discussion is a big help. We have a lot of channels that aren’t about work. We have a DIY channel, we have a channel about books, a channel about food, a channel about beverages, which is mostly about coffee, we have a whole bunch of different channels to try and encourage chat on different topics.

“We kind of had a realization that people’s partners are a part of their work, whether they’re actively included or not”

And we have one just called social, where anything not work-related can sort of fall into that one. We also invite team members’ partners into that channel. We find that people will sit with Slack on their phone, and they’ll get messages from people in the team, funny jokes, whatever, and it’s a bit isolating for their family, so we make sure to invite everyone’s partners into that channel so they can join in and be a part of things. That’s also the place where we’ll celebrate birthdays, work anniversaries, things like that.

Dee: Now that is something I’ve never heard before. That is really, really interesting. Where did the idea for that come about? Do you think it was in any way inspired by the fact that you and your partner had started the company together?

Joel: I don’t know if it was from that or not, but we kind of had a realization that people’s partners are a part of their work, whether they’re actively included or not. At the end of their day, people are going to go back to their partners, they’re going to talk about the people at work and their partners are going to be involved. They’re going to know what they’re up to, they’re going to know who they work with. But it’s all from the outside, and it’s a little bit odd. That partner knows all the people at the company, but none of the people at the company know the partner.

I think we just have this disconnect that doesn’t need to be there. So we have this social channel to try and encourage them to come and be involved and be themselves in their business. And then, when we have meet-ups, partners are always invited. Even when we do our full team meet-up, every couple of years, we invite and pay for partners and kids to come along to those, because we think, as I said, the family’s already a part of it, but maybe the business is excluding them, and we want to not do that and just involve them where we can.

Dee: Gosh, that’s really, really unique. I can see how that would work especially well at the moment.

Joel: Absolutely. Especially with people working from home, I think their partners are more involved in their work than ever. So it would be a boost now.

Dee: Yeah. Because your partner kind of becomes your only workmate, I guess.

Joel: Absolutely.

The shift to telehealth adoption

Dee: To kind of broaden things a little bit, how do you feel the health tech industry overall has been affected by COVID? Obviously, it’s a pandemic, but do you feel that there’s been an acceleration of trends that maybe you’ve been observing before?

Joel: Yeah, I think it has brought a few things forward that were always in the works and starting to come about but now hit the forefront. The most obvious and biggest one is telehealth. A lot of clinics went through a lockdown, they weren’t able to operate person to person, and they either wanted to find ways to help people that still needed their services that couldn’t go face to face, or they just wanted to have a way to still bring in some extra revenue to their business and keep themselves relevant and in touch with their patients for when they get to reopen again. I think that largely telehealth has been the answer to both for many clinics.

And it’s not that telehealth wasn’t around already, but we’ve brought it forward. The advancement of telehealth has come forward many, many years in the space of the last 12 months. Many clinics have adopted it, tried it out, and I hear from so many that they plan to incorporate it into what they do moving forward. There’s a lot of benefits for telehealth other than the COVID side and the ability to keep operating. There are some places like regional areas that don’t have access to healthcare that could get it via telehealth, and that’s a real enabler for them. There could be people with disabilities or elderly people that aren’t able to leave their homes to go and receive the healthcare they need that could get it via telehealth. There’s a whole range of people that I think it makes healthcare available to.

“Last year, we pretty much put a hold on all the development work and just took a step back and said, ‘What’s going to help our customers over the next six months?'”

Dee: I was going to ask, have there been areas of your business that you’ve had to prioritize differently from what you’d maybe anticipated in your roadmap?

Joel: Yeah. Last year, around March, we pretty much put a hold on all the development work we were doing and just took a step back and said, “What’s going to help our customers over the next six months, assuming COVID and lockdowns ramp up like they did?” And telehealth was the obvious front-runner, so that was the first thing we did. We incorporated sort of an in-built telehealth solution into Cliniko. And we got that done into beta within about seven days. And then there were other things like allowing patients to fill in forms online and signatures on forms and things like this that we did throughout the time. It was really just prioritizing whatever people needed as it went along. Mostly, I think being adaptable was important because no one knew what was going to happen next and we just had to be ready to change if we needed to.

Dee: And I suppose being able to offer people that extra avenue to access healthcare in the middle of everything that’s going on is probably a huge boost to people.

Joel: I think so. People definitely wanted some help to be able to still operate, and maybe even some inspiration. We tried to help by providing some educational material on different ways they could operate their business during lockdown that perhaps they hadn’t thought of and we got some experts in to help us provide some information to try to inspire them a little bit for stuff they could do in the meantime.

Dee: And tell me, do you feel that a lot more clinics, companies, and patients have come online in that period than you would have anticipated otherwise?

Joel: For sure. As a business, we saw growth over last year, and we, like many companies, we’re buckling up for a downturn. We knew that our customers were going to get hit by lockdown, and we assumed that we would see a decent number of customers need to drop out at least for a while. But we saw growth during that period. And I think that’s because a lot of clinics that weren’t already online moved online. All of a sudden, they couldn’t go into their clinic and that meant they couldn’t access their records because they were sitting on a server in there. A big drive for the growth we saw was people going online and switching to telehealth as well.

“People have realized they can add value in other ways – maybe by using telehealth as a follow-up session to make sure someone’s doing their exercises”

Dee: Looking beyond COVID, what do you think the future holds for the sector? Will there be more people like you mentioned that have adopted things like telehealth during this period that will actually make it a part of their business? Where do you see everything going?

Joel: I think it was an eye-opener for a lot of people. There are many therapies, especially physical therapies, like physiotherapy, osteopathy, podiatry, chiropractic, whose staple is going to be hands-on treatments. But even those learned that they can do a lot of value add via telehealth. There have been interesting studies coming out for physiotherapy showing that it’s as effective or better via telehealth than hands-on. And that’s a directly physical, manual manipulation-type healthcare service. I think people have realized they can add value in other ways – maybe by using telehealth as a follow-up session to make sure someone’s doing their exercises. That can be done via telehealth, and maybe every second session, you have them come in or something like that. I think a lot of businesses are considering how to incorporate it into their workflow. And then, there are other modalities like psychology that could move a lot more towards telehealth.

Dee: Yeah. I suppose, for certain types of therapy, it would be quite beneficial to the patient to be in the security of their own home.

Joel: Absolutely. We’ve heard that a number of them are having more success via telehealth, at least with some of their clients. So that lends itself to a bit of a mixed offering where it can be telehealth for those that it’s better for, and others can still come in if they need to.

Dee: I love that. I mean, it’d be so interesting to have that as a blended type of therapy in the future.

Joel: Yeah. I found it fascinating because it’s such a hands-on thing. What I loved about it was one of the key hypotheses, which is that people don’t do their exercises when they come in to see their physiotherapist. They come in, the physiotherapist does its work, and they go away and think they’re fixed. But when they have a session via telehealth, if they don’t do their exercises, nothing’s going to happen. So there’s more compliance and a better result long-term.

Dee: I have been guilty of doing that exact thing that you’ve described. So I could see that I would be a very good candidate for that sort of treatment myself.

Joel: I’m exactly the same.

The importance of being data compliant

Dee: One thing you mentioned, Joel, was around the medical health records clinics might’ve had but not had access to at the time. I think that kind of points to a broader issue within health tech. I mean, you must manage the data of millions of patients across the globe at this stage. I assume that with what you do, you need to have really robust data practices. It must be of utmost importance to the companies that you’re working with.

Joel: That’s right. I think the biggest risk to any health tech company would be data loss or a data breach, or something like that. So it’s a lot of our time and effort that goes into it. I remember somewhat begrudgingly starting it on Cliniko because it’s a lot of overhead and a lot of work, and you don’t feel like you’re doing the business value-add stuff that you want to do – you’re not adding new features that customers are excited for, you’re doing things behind the scenes that no one ever knows or cares about. But it’s essential. As a business, it becomes somewhat of a competitive advantage later on because anyone else in the space will need to do the same.

“We’ve got the Australian Privacy Principles, we’ve got GDPR in Europe, we’ve got HIPAA in the United States, and we need to meet all of the requirements”

But we also have a lot of legislation to deal with because we have customers in more than 70 countries. In Australia, where I am, we’ve got the Australian Privacy Principles, we’ve got GDPR in Europe and possibly the UK with how it’s panning out, we’ve got HIPAA in the United States, and that’s different for Canada, and we need to meet all of the requirements, we can’t just pick one. It is onerous, but it also gives some comfort in how secure our system becomes.

Dee: Yeah, some colleagues of mine can very much appreciate the challenges that you go through on that. We’ve recently offered clients the ability to store and process healthcare data in a HIPAA compliant manner on Intercom. But I was going to ask you: how do you go about adapting your product to the different data privacy practices in different regions?

Joel: Thankfully, so far, we haven’t had clashes where, to be HIPAA compliant, you can’t be GDPR compliant, or something like that. So we are able to aggregate the requirements and build it all into the same product. But one thing I’ll say, with HIPAA specifically, is that it has some requirements that can be onerous and restrictive to the person using the system. So with those, we put them in as options within the software. If you want HIPPA compliance, you can turn that on and that’s going to take away some functionality. As an example, you can’t email anything that could have personal information in it. So we remove that option if you turn on the HIPAA compliance. But we don’t do that to everyone because for some people it’s okay to do it and it’s a useful feature. It’s a little bit of opt-in for people using to meet their requirements.

Dee: So it’s all down to the settings that you as a clinic would set up at the start of using it, and then Cliniko essentially saves you from yourself and saves you from creating a breach?

Joel: Exactly. It’s not on us to enforce these things upon people, we just want to make it as easy as possible to meet the rules. Because ultimately, the rules are binding them more than us, so we need to do our bit to support them.

“For a while, with globalization, I was thinking these things had to start to merge, but if anything, we see them going in a different direction in every country”

Dee: Obviously, that’s a huge challenge for you in building out all these different supports for people. Do you think, in the future, we will see more or less consistency in these types of compliance across regions?

Joel: For a while, with globalization, I was thinking these things had to start to merge, but if anything, we see them going in a different direction in every country. If you look at Canada, different provinces are coming up with their own rules or legislations. So, even though I would like to see a global consensus on it, the trend is that it’s getting more granular and that everywhere is doing their own. And also, there are a lot more requirements to store information only within that area as well. So I think the trend shows us no, that it is getting harder.

Dee: That’s interesting to see. It kind of feels like moving backward to a certain extent. Before we finish up, Joel, one question that we love to ask people on the podcast is whether there’s someone in their discipline that they aspire to or are inspired by.

Joel: So, I can’t think of any offhand. I’m terrible at reading books, and I don’t really follow along with what other companies are doing. One of the core philosophies we’ve kind of had is that every business is different, and we really just want to operate our company as it makes sense for us. An obvious example would be that we’re a software company, but we shouldn’t copy what Google does because what Google does is very different from what we should do for success. For the most part, I would say, I keep my head down, focus on our company, and just look at what solutions we need. So I don’t have a particular person that I would say I’m inspired by or trying to aspire to.

Dee: Well, that’s fair. Hearing your story and hearing the story of Cliniko, it sounds like you’ve done that from the start and that’s been working pretty well for you. So we’ll allow that as an answer. Lastly, then, where can our listeners go to keep up with you and your work?

Joel: We’re doing some video content for Cliniko that they can find on YouTube, and for myself, I’m @jfriedlaender on Twitter, they could follow me there. But I can’t say I’m super active.

Dee: Fantastic. It’s been an absolute pleasure chatting with you today. Thank you so much for joining us on the show.

Joel: Thank you very much for having me on. I appreciate it.