The Paubox Encrypted Interview Series allows us to chat with leaders in healthcare IT, compliance and cybersecurity to pick their brains on trends and best practices. In this Encrypted Interview, we chat with Beth Jago and Aarti Khullar, co-founders of The Shrink Space a female-founded, HIPAA and VPAT-compliant software platform that streamlines the off-campus mental health referral process for university counseling centers (UCCs) and improves access to care for students nationwide.
Early career and professional growth
Rick Kuwahara: Before you founded The Shrink Space, you both were practicing psychologists, so what drove you to start a digital health startup?
Aarti Khullar: Yeah, it's a great question. It was personal, first-hand experience where we really saw the difficulties in finding a therapist ourselves as graduate students, but then also in making effective referrals as psychologists that really motivated us to develop The Shrink Space.
We started as grad students, both Beth and I, trying to find therapists which at that time over a decade ago was frankly complicated.
It was a daunting pen and paper process, it was filled with ghost directories on our insurance plans and now over a decade later, it remains largely the same, if not worse. And frankly, a little bit more challenging for the Gen Z students because they're now more accustomed to scheduling everything on their phone and their computer.
The following graduate school when we both worked as college counseling staff, we really started to experience the dramatic increase in student demand for clinical services.
So we were faced with the increased administrative challenges to maintain accurate, and up-to-date referral lists but with limited resources, we all didn’t really really have the time and bandwidth to do so.
And then Beth and I each transitioned into private practice where we were in our individual practices as psychologists and we face the challenges of not really having a seamless way to communicate our ever constant practice changes to these referring counseling centers and to our student patients.
It's with this understanding and these perspectives as each of our users that Beth and I decided to build a solution that would use technology to streamline, but also alleviate the unique referral pressures for student, counseling center staff member and community provider. With our ultimate goal in building The Shrink Space has really been to improve access to quality mental health care.
Challenges of growing a digital health startupRick: So from an operations perspective, as far as you started The Shrink Space now, what's been the biggest challenge or mission you have in growing it?
Aarti: As I mentioned, our mission is to improve access to quality mental healthcare. And we've seen students very excited to have more control and more transparency over accessing and the decision making regarding their mental healthcare.
But I think one of the biggest hurdles that we've seen has been in affecting systemic change.
We all know that healthcare, but particularly mental healthcare, has lagged behind in terms of innovation. While this is for a number of reasons, some include resistance to change, and the need to ensure student and patient data is being protected properly.
Ultimately, it is patients' lives that we're talking about here. And so, we’ve found that providers and universities are at times cautious, particularly around integrating the tech solutions.
So we’ve tried to work with each university and provider to show them how our technology supports them to reduce their administrative load thereby freeing up more time for them to do the clinical work, which is what ultimately they are most interested and excited about doing.
Rick: Great. And since you've gotten into the digital health space, how have things been in comparison to your expectations?
Beth Jago: I would say things have certainly been a lot harder than we ever expected going into building out this site, and planning for that years ago.
Just to sort of piggyback off of some of what Aarti mentioned in terms of our challenges, I would say that the varying abilities of each university and each of our mental health providers, regarding technology, is pretty wide.
So our customer service team regularly responds to our users, both providers and folks at universities about their questions, concerns, issues, that arise and as they're completing profiles or signing up.
And it's just not one size fits all, each person comes with their own set of capabilities and experience with technology and so it's trying to understand, okay, where is this person having difficulties or struggling? How can we best support them?
And knowing that it's always on a case-by-case basis, I think that's probably been a challenging thing that we didn't necessarily foresee at the beginning of all of this.
Technology and mental health
Rick: So one thing Aarti mentioned earlier was how students are excited about The Shrink Space and being able to have access this way versus the old processes. But fortunately, there still does seem to be a lot of stigma around mental health, especially for youth. How do you both see digital health being able to help with that?
Beth: It's a great question and I think this is one that we've talked a lot about.
We've put a lot of thought into the stigma around mental health, as we've been designing and building out our platform and here I think one of the most important things is that we really understand the technological expectations of both students and young adults today.
And in many ways I think our mental health field really needs to modernize, to meet students and youth where they're at, which is often on their phones.
Just as young adults expect to be able to make dinner reservations online, or they expect to be able to book their next vacation online, I think they also expect to be able to connect and book a therapy session online.
And the fact that this capability is just not ubiquitous, I think contributes to some of that stigma and the mystery surrounding mental health treatment.
So on our site, what we've done is really designed it intentionally to be intuitive and accessible and to provide more transparency for students about the mental health search process. You'll notice that much of our interface resembles what you might see on an OpenTable or an Airbnb.
And we've done this so that students feel a sense of familiarity, feel a sense of comfort and trust as they're navigating through our site, because we think that when an online experience feels familiar and expected to students that this will help to contribute to a reduction in stigma.
So there's that piece. And then I think we have also gone the extra mile to have a social media presence and a blog for our students to just sort of further normalize mental healthcare and the process of accessing treatment.
Keeping patient trust with data security
Rick: So one of the biggest challenges with any healthcare, piece of healthcare technology, is being able to keep the data private and secure. So when you envisioned The Shrink Space, how early did you take into consideration securing all the PHI you'd be handling?
Aarti: Yes, this is a very important question. Beth and I went into this assuming that this would be the industry standard. As psychologists we understand the high priority, for good reason, our field places on HIPAA and so our expectation was that our technology would be no different.
The thought was that any time student PHI or Protected Health Information was being handled particularly on behalf of the university, we would need to keep it secure.
And so this has always been one of our goals. We think about it in the same way as when a student goes to therapy they expect confidentiality, and they should expect the same trust and privacy in The Shrink Space technology.
All that being said, we also understand and appreciate what you're saying, which is keeping patient data private and secure can pose challenges and difficulties. It means features are more costly and timely to build, and it can also be difficult at times to manage and balance the needs of a university counseling center that wants to know where their student is at in connecting to an off-campus provider. So we strive to find a way to provide counseling centers with that data, while simultaneously protecting our student privacy.
Beth and I decided early on that privacy was of paramount importance and so we've prioritized it and for many reasons.
And, we're very glad that we did because it's allowed us to create a secure backend infrastructure from the start. And it now gives us a framework that allows us to add more complicated features, such as gaining student consent before we share any referral disposition to their university counseling centers.
And in regards to future features, our secure backend infrastructure will allow us to facilitate the flow of information and communication between each of our users. And ultimately that is the goal of HIPAA, to help with care coordination and help with information flow.
And so while it has been timely and costly to implement a HIPAA compliant infrastructure to make sure that all PHI was being handled securely, we're very glad that we did this because it builds customer trust and allows for our future growth.
Rick: That's a good point what you said about HIPAA. A lot of people feel HIPAA actually can sometimes hurt information flow with this regulation. So that's a big challenge you guys are taking on working with those universities.
Aarti: Yes, and I think HIPAA regulations were created in a box to some degree. And it can be complicated to know how does it work in the real world.
I think the goal of HIPAA to protect patient privacy and to improve care coordination, while difficult to follow, has served us well because it allows us to instill that trust with our students and universities.
Rick: And it's great that you are taking security into consideration as you're designing a platform. That must have been a great help when you were actually going out to universities. I'm sure they had some worries about the security of everything.
Aarti: I think it has certainly alleviated concerns. I think we've seen some schools more concerned about it than others.
I think it's complicated to know how much does HIPAA apply in these third-party vendor situations?
Schools have felt a lot of relief knowing that we're compliant because it allows them to say ‘we may not know what the rules are here but we want to make sure that if we're handing off the care coordination to The Shrink Space, they're continuing to handle PHI in the way that we would be expected to.”
And so I think that that's been a real advantage in us choosing to be compliant.
Looking to the futureRick: So, what's your vision going forward in the next 10 years?
Beth: I think our vision, just as Aarti is mentioning, is really to continue to improve the mental healthcare coordination process through our platform for all three of our users.
So for university counseling centers, we plan to continue to grow and improve so that our service is more seamlessly integrated with other third party services that universities might already use.
So something, for example, like EMR systems to make sure that we're integrating with them, with the overall goal of really saving them more administrative time.
And for students, young adults on our platform, it's really to help them efficiently connect with mental health providers so that they can spend more time in therapy actually working through the things that they need to, rather than spending time trying to find a therapist or even feeling demoralized when the referrals given to them are just not a good fit for a number of reasons.
And then lastly, I think for our mental healthcare providers, we want to continue to improve their practice management by automating parts of the referral process that are easily automated, so that then therapists can spend more time doing the part of the work that they love doing - the very human component of therapy that we believe no technology can ever replace.
And beyond that, I think we hope to one day become the one stop shop for mental healthcare providers, as a space they can come to find renters for their private practice offices, to join consultation groups about client issues, to look for supervisors etc. So that's sort of a longer term goal.
Rick: How do you keep up with industry trends? Any good podcasts, blogs, influencers or newsletters that we should be following?
Aarti: Well, we're of course really excited about HIPAA Critical. As I had mentioned, HIPAA's complicated and it's confusing, and a lot of the things that we read, the lawyers we speak with, the security auditors that we hire, they have a binary/black and white script they follow and so it can be, at times, hard to know how does this apply in the real world?
The four episodes that you've put out so far have been really helpful in understanding its real world application. So we really love what you're doing here, and I think that you're filling a much needed gap in the healthtech podcast world.
Other podcasts that I really love are Recode/Decode by Kara Swisher. I also really like the Digital Health Today podcast by Dan Kendall, which helps me stay on top of what's going on in the digital health world.
Some newsletters I really enjoy are Daily Carnage. It's a daily marketing newsletter out of Pittsburgh. And then The Information has a great weekly newsletter on the tech industry and they also have a good daily roundup of tech news.
And then for higher education, we follow The Chronicle of Higher Ed, which gives us the latest about what's going on in the university/college world.Beth: Yeah, and I would add to that in terms of other podcasts, I would say a16z is a technology podcast that's been really helpful for us in the past, particularly around data with healthcare that certainly informs some of our knowledge around HIPAA. And then regarding other just mental health-related podcasts that are not sort of technology-specific, I think there's one that's really relatable and interesting called Lenny Says, which is just about a variety of different topics, relationships, healing women's issues, etc.
Rick: What do you do to de-stress and relax?
Beth: [chuckle] I don't honestly know what it's like to relax. I have no conception of that, honestly, since we started this project years ago, that's been a very elusive thing. I mean, I can tell you the things that I used to do to relax and that would probably entail something like exercising couple of times a week, taking even three minutes in the morning to just meditate. Unfortunately, I can't say I do those things with regularity now, because I just don't have the time, so I think it comes down to one thing for me these days that actually helps me feel like I'm getting some separation from work, which is really being with my daughter. I have a little toddler, and she... Kids are just very much in the present moment and so when I am with her, I have no choice but to be present with her and engaged. So the certain times during my day when I'm with her, forces me to not be thinking or managing 20 different things at once but just to be present.
Rick: That’s great.
Aarti: I love that Beth. I don't have a child so I guess that's both good and bad [laughter]. I've picked up running and yoga more than ever. I've managed to miss Mad Men when it first came out, so I'm catching up on it now, so no spoilers, please. It's an incredible show from both a psychological perspective and gender perspective. So I’ve had a lot of fun being engrossed in that. Cooking, honestly, cutting vegetables has never been more cathartic, and reading for pleasure are some other ways I’ve been finding to relax.