Kyna Fong, Elation Health — Founder Q&A

We weren’t setting out to be entrepreneurs from the get-go. We didn’t have some time horizon in which we needed to make X number of dollars. We just really believed in solving this problem.

Kyna Fong sometimes describes herself as an “accidental entrepreneur.” And taking a glance at her resume, you’d have to agree.

Graduating at 19 years old from Harvard with a bachelor’s degree in applied math and a master’s in computer science — in the same year, mind you — and then on to Stanford where she earned her PhD in economics focused on healthcare, Kyna seemed earmarked for a stellar career in academia. She would go on to spend four years as a tenure-track professor in Stanford’s economics department while also being selected for a Robert Wood Johnson Foundation health policy research fellowship at UC Berkeley.

But her career plans took a sharp detour when she and her brother, Conan, a health IT strategist, decided to pair up and work on finding a better way to improve how healthcare gets delivered.

The idea didn’t come out of the blue. The siblings had grown up inside their physician father’s primary care practice, with Kyna doing everything from answering patient phone calls to negotiating with insurance companies as the office manager. Kyna and Conan knew just how much commitment and time physicians put into keeping their patients healthy. When practices began shifting from paper records to electronic systems, the duo was shocked at how poorly these technologies were designed and how much they hindered the doctor-patient relationship.

Indeed, technology was the last thing doctors like their dad wanted to interact with since systems at the time detracted from their main goal: top-quality patient care. The situation wasn’t any better years later and that’s when the siblings started Elation Health to build intuitive technology that would smooth the work of managing a medical office’s processes, support compassionate patient care, and make life easier for practices like their father’s.

Elation Health offers solutions that automate and streamline the amount of manual intervention required in a doctor’s daily tasks — everything from appointment scheduling to patient charting to integrating with hospitals and labs.

At last count, Elation Health has more than 15,000 clinical users caring for 7 million patients. Kyna herself is surprised by how quickly Elation’s technology, with its “clinical-first” focus, has spread among independent primary care practices. We spoke with Kyna and found out more about the back story that led to this moment.

Q: Your dad was a doctor in Edmonton, Alberta, but when you were in your teens, he took your family to the US. What triggered the move?

He’s very passionate about medicine and patient care and became frustrated with the Canadian healthcare system. He felt that it didn’t allow him to truly care for his patients and support the personalized relationships that he wanted to develop.

Q: How old were you?

I was almost 12 at the time. All of our extended family was back in Edmonton — my grandparents, uncles, aunts, and cousins. And then one day it was like, ‘OK, we’re moving to the US.’

Q: That’s a big change, especially when you’re 12. How did you feel about the move?

I was pretty unhappy about it overall and took it the hardest of the four kids in our family. The younger two were pretty young at the time so they were less affected.

Q: You ultimately ended up in Walnut Creek, California. How did that wind up being your new home?

We made the decision as a family. We laid out the entire map of the US and picked places where we might want to wind up. And then we visited each of those places in order to decide where we wanted to live.

Q: Once you settled in, you began to help out your father and eventually became the office manager when you were still a teenager. What did that entail?

Since he likes to focus on the practice and caring for his patients, my job was to take care of all the other things, like getting paid by insurance companies and hiring and training the staff.

Q: Do you think that experience played any part in leading you to one day operating your own company?

Certainly, I still apply a lot of the lessons I learned in those early days of working on the frontlines of healthcare to what we do with Elation now. It’s interesting because I’ve never been a big career planner. I’ve always been pretty open-minded, wanting to do things that have an impact and that I enjoy doing.

Q: For example?

Well, most people decide whether to do their PhD quite some time before they step foot into the program. For me right up until the spring term of my senior year, I still wasn’t sure. And if you had asked me a year earlier, I probably would have said, “No, why would I do a PhD?”

I am OK seeing where things may take me. I never specifically planned to start a company. In fact, sometimes I describe myself as an accidental entrepreneur — I really wanted to solve a problem, and it turns out I needed to start a company.

Q: That’s a lot different from what you usually hear about the people who start companies in Silicon Valley.

Right. Entrepreneurs who wind up starting companies usually decide earlier in their career that’s what they want to do. There’s a lot to be said for that approach and many people have obviously been successful taking that path. I was the total opposite. With my brother, we were hung up on fixing a problem that we saw and just started working on it in our spare time. Eventually, we looked at each other and it was like, “Oh, I guess we should be quitting our jobs and do this instead.”

Q: Let me turn back the clock. You studied applied math at Harvard and then did a PhD in economics at Stanford. What attracted you to academia?

People often describe academia and entrepreneurship as polar opposites. The two realms obviously work at very different speeds. But I think the thing that attracted me to academia is similar to what I also enjoy about entrepreneurship — which is being on the edges of the known and trying to create new things. The thing that gets me excited is trying to create, discover, and solve problems that haven’t been solved before. I think that’s really fun. And in a startup, what’s extra fun is that you get to do it with a team that’s excited about the same mission and together you’re helping to make it a reality.

Q: Is the biggest difference between being a CEO of a startup and being a professor at Stanford the ability to generate results on a clearer timetable?

That’s definitely a big difference. When we started Elation, for example, I was on the engineering side and we would build something one day and the next day we’d have people using it. We’d know right away whether it was good or not. So, the feedback loops are so much faster and that makes you actually feel the progress.

Q: It’s fairly unusual for your co-founder to be a relative, let alone your brother. You once said it can make some easy things hard, but it makes the hardest things easy. Can you elaborate on that?

What I meant is the ultimate trust in knowing what my co-founder’s intentions are and knowing that I can trust him. He might have a different view. Or maybe we’re working off of different information or even see things a different way. But at the end of the day, I know that he’s coming from the right place. That’s one of the hardest things to develop in a relationship between co-founders, especially when things get hard.

Q: That’s a good segue to talk about the business. Can you think back a few years and talk about the disconnect that you saw developing between the promises that were being made about how tech was supposed to change healthcare and the reality that you were seeing on the front lines?

When I studied at Stanford, a lot of the professors there had served in various administrative and government roles, and I was very fortunate to have a few of them as advisors and mentors. One of them helped me get involved with a health plan in Southern California and see ahead to how healthcare was going to get transformed by technology. I shadowed their chief medical officer for several months and did multiple projects for him.

The hope was that we’d be able to gather all this data and gain new insights to help transform the way that we delivered healthcare and make decisions so much better. But then I thought about my dad’s practice and his colleagues and technology was not helping them. Actually, technology was the last thing they wanted to deal with. They actually saw it as detracting from patient care and making it more difficult for them to do their jobs, so technology was not being used at the point of care by the people delivering care.

Q: Because the systems in place were getting in the way of the relationship between doctors and their patients?

Yes. The systems were kludgy and had been built several decades earlier — definitely not the most beautiful form of technology that we’ve seen. But it wasn’t just a product and a technology issue. The companies that were building clinical software for doctors were incentivized to actually build for and focus on the billing because the billing is what generated their revenue. And so, the clinical became subservient to the administrative; the result was that much of healthcare or patient care was compromised because of the financial incentives and because of the way the dollars flow in the system.

Q: When you came up with the idea for Elation Health, did people whose opinion you value try to wave you off from going further because of the challenge involved in trying to reform healthcare?

Absolutely. But even though I could see it would be super hard and take a long time, it was also something that Conan and I saw was needed and totally critical. And there was a huge opportunity here. Again, we weren’t setting out to be entrepreneurs from the get-go. We didn’t have some time horizon in which we needed to make X number of dollars. We just really believed in solving this problem.

Q: By nature, are you stubborn about sticking to your guns when you believe you’ve got the right answer?

Yeah, I’m not one to be easily discouraged. I definitely have a lot of grit. I don’t think I’m irrational though and if something just made no sense or wasn’t succeeding, I would internalize that.

Q: You studied game theory in college. Does that discipline impact any of the work that you’re doing in healthcare?

Not in a direct way, but yes. Game theory to me is really a way of thinking and analyzing and strategizing. I think of it more as a discipline in how to think and analyze problems. It allows me — and I think it actually equips me well — to work in healthcare because the field is just so complicated and there are all these problems. Microeconomics, in general, really trains you to have a structured way of thinking and reasoning about complex problems. I would say that’s probably the skill that I carry most with me.

Q: So, what does an overachieving professor-turned-tech entrepreneur do in her spare time to keep sane, assuming that you do have spare time?

Besides the company, I have my hands full with my two kids — a five-year-old and a one-and-a-half-year-old. Growing up, I loved to be active and play sports, and really any games that need hand-eye coordination. I keep balance by relaxing with friends and family and just enjoying the people that I’m around. Maybe that’s me getting old or something, but I try to enjoy the simple things.

Q: Final question: When it comes to influences or role models who loomed large in your life, is there anyone who stands out?

The most influential person in my career has to be my dad, if you think about my personal story and how I ended up in the places that I did. Of course, I also had the good fortune of having amazing teachers and mentors over time who nurtured my growth and encouraged me to do, really, anything. And I grew up that way, not really seeing boundaries or barriers. That’s helped me a lot in life.