Giving Smart People Powerful Tools to do Impossible Things.

May 2025
Today is a pretty great day. My birthday is next week. And I finally get to tell you that I’ve joined this fascinating company called Evidently.

My background is in marketing complex, technical products, and — very much by accident — telecom. All of that experience left me with a much higher awareness of two things.

First, that I have gathered the world’s largest collection of special-interest knowledge about the history of telecom. I will, at no cost to you, attend and ruin your garden party or wedding function with long, drawn out explanations of railroad companies becoming telephone companies. How problematic actual sharks were to early intercontinental trunking. And how early telephones were marketed with rubber mats to put under them because an old telephone receiver design used a water and acid mixture that dripped and burned holes in your carpet.

‍But, the experience also left me with this sharp awareness of what happens when you put powerful tools in the hands of smart people trying to do impossible things. We saw it over, and over, and over over the years at Twilio.

And to date it's been one of the best parts about my career. Always look for the helpers.

‍People & tools.
‍After we wrapped up Objective at the end of last year, I took the holiday off, and then jumped into helping friends and friends of friends with marketing projects. I was really looking forward to settling into it for a few years. Gods laugh when you make plans.

Evidently is a healthcare company. Evidently makes AI tools for doctors, nurses, surgeons, pharmacists, and everyone else involved with providing you care when you need it. You’d probably be surprised to discover how many people are actually involved in making your boring six-month well check go well, and making sure the hospital you went to is paid accurately for keeping you well.

I started helping the Evidently crew with some projects. And it started becoming very obvious very fast that this group of people was absolutely lunging. You see a lot of performative urgency in tech. Especially enterprise tech. Always Be Closing. Always be Prepping a QBR Deck. Always Be Panicking. These folks, though, were running a rock scramble and didn’t seem concerned about who was or wasn't watching. It’s something I loved about building Objective with that team, and it’s something I loved about my 15 years helping to build Twilio.

But more importantly, these folks were intuitively doing that thing. That thing we hung our hats on at Twilio. Building powerful tools for smart people who, in this case, have this impossible responsibility of providing thoughtful, intentional patient care in an environment that is burning out doctors and whole healthcare organizations out at an astounding rate.

Here are some facts about your healthcare.

‍Your patient record is most likely over a thousand pages long. The average American patient record is. So is the entire Lord of the Rings trilogy. The Shire, Khazad-dûm, the Mad King, and all the side-quests they cut from the movies. All of it.

Your patient record has notes from doctors your doctor has never met, lab results from tests you probably don’t remember, scanned documents, and actual honest to god images of faxes. Occasionally, some or all of a patient record will also be accidentally duplicated back into itself. Software is hard. Old software is very hard.

‍Your doctor has an average of seven minutes to get familiar with all of this before they see you. Where they’ll have an average of 15 minutes to try to make the best decisions they can about your wellbeing — understand issues, find diagnoses, and prescribe medication you’ll put in your body.

During an average 12 hour work day, your doctor spends 6-7 hours in software, trying to find insight in all of this data. Every day.

On average that also includes the 1-2 hours they spend after their shift has ended.

This same overwhelming wave of data and complexity is also happening at hospital-scale. Being able to accurately document and classify your care is directly linked to a hospital’s ability to collect revenue from insurance payers. At the time of writing this in May 2025, 16 US hospitals have closed. 37% of US health care organizations are operating at a financial loss while still trying to recover from the pandemic. And that was before federal funding cuts started this year.

I met a kidney doctor a few weeks ago. I asked if it _felt like_ the overwhelming wave it _looked like_ from the outside.
‍“No. I gave a talk just last week where I described it more like a tsunami.”

‍Making the Hard Things Less Impossible.
Content warning: the rest of this involves a description of losing a family member to brain cancer. If you aren’t comfortable reading the rest - all my love to you.
‍Part of what makes this company, and this team fascinating to me is how technology and AI can help healthcare organizations adapt & thrive. But there’s also a less-tangible aspect of it that I only encountered in a meaningful way as an adult. Making hard things a little bit less impossible for the healthcare workers getting up every day to deliver care at a level of excellence they're proud of.

My mother died just before my 36th birthday of a glioblastoma, the most aggressive kind of brain tumor in adults. All cancer is haunting. This cancer, like a lot of them, was also just savage.

She was diagnosed on a Tuesday, and died seven days later. Due to its progression at diagnosis, she had already lost big parts of her short & long-term memory. She recognized my brother and I for most of the week. But the rest of her reality, and all of the people she loved in it, delaminated over the course of just a few days.

We loved each other a lot, but we never really figured out how to be a mother and a son together as adults. Having parents is hard sometimes. I imagine that having kids is hard most of the time. The tangible impact of all of this was that the last 5-10 years of her medical history were a black box. By the time she was admitted, she wasn’t able to help inform it or advocate for herself. And that intervening week before she passed generated a whole new lifetime’s worth of doctors notes, radiology & surgical reports, and lab results.

The doctors, nurses, and surgeons involved in her care were, for the most part, really thoughtful and caring people. But they were also - absolutely all of them - scrambling, exhausted, and emotionally drained people trying to do their best in an impossible situation.

Technology wouldn’t have changed how her life ended, for her. But I do think powerful tools can make such a hard thing less impossible for all of the doctors, and nurses, and surgeons, and case workers who get up every day to do this work.

I’m really looking forward to building this thing with these people. And I’m looking forward to the opportunity to try and make the work all of these health care workers do a little bit less impossible.