Manny Nijjar: Lessons Learned From the NHS Staff Passport

Today’s guest is Manny Nijjar, co-founder and CEO of Truu, which is a healthcare-focused IDtech product that’s been involved in one of the most impressive production verifiable credentials rollouts to date. Their platform, alongside a handful of other vendors, helped the largest health system in the world respond to the COVID-19 pandemic—all while Manny was also serving on the front lines as an infectious disease doctor, leading his hospital’s COVID-19 response.
The main takeaway from this episode is that involving end-users in your product development is key. You’ll hear how the biggest barriers for the NHS staff passport were not technology problems but user experience and adoption problems. And as an end-user of his own product, nobody can speak better about these points than Manny. He then breaks down those learnings and how he’s applied them to adjust both the product and go-to-market approaches he’s taking at Truu.
This is an amazing opportunity for IDtech builders to shortcut the trial-and-error process of launching a product, by hearing what worked, what didn’t, and what Truu is doing about it next.
To learn more about Truu or to contact Manny, email manreet@truu.id. Visit Truu’s website at https://www.truu.id/.
Reach out to Riley (@rileyphughes) and Trinsic (@trinsic_id) on Twitter. We’d love to hear from you.

Full Transcript

Transcript lightly edited for clarity.

Riley Hughes: Welcome to the Future of Identity podcast, where we talk to the people building the ID tech products of tomorrow. I’m Riley Hughes, co-founder and CEO of Trinsic, and we build infrastructure for launching awesome identity products. Today’s guest is Manny Nijjar, co-founder and CEO of Truu, which is a healthcare-focused ID tech product that was involved in one of the most impressive production verifiable credentials rollouts to date. Their platform, alongside a handful of other vendors, helped the largest health system in the world respond to the COVID-19 pandemic, all while Manny was also serving on the front lines as an infectious diseases doctor, leading his hospital’s COVID-19 response. My main takeaway from this episode is that involving end users in your product development is key. You’ll hear how the biggest barriers for the NHS staff passport were not actually technology problems, but were user experience and adoption problems. And as an end user of his own product, nobody can speak better about these points than Manny.

Riley Hughes: He then breaks down those learnings and how he’s applied them to adjust both the product and go-to-market approaches that he’s taking at Truu. This is an amazing opportunity for ID tech builders to shortcut the trial and error process of launching a product by hearing what worked and what didn’t, and what Truu is doing about it next. I loved this episode with Manny, and I hope you do too. And now, on to the episode. Manny, welcome.

Manny Nijjar: Hi, Riley. Thanks for having me.

Riley Hughes: I guess I just want to start out by asking, how are you? Are you okay? Are you resting now? How are things?

Manny Nijjar: It really has been a crazy seven years since I started this journey in the identity space. But yeah, the last three years have been— Life-changing, both personally and professionally, going through what we went through, and you learn a lot about yourself and you learn a lot about humans. You see the good and the bad and everything in between. I think the biggest take for me is just the confidence of knowing I can execute something very complex, and I had to do it under pressure when your back’s to the wall.

Riley Hughes: Could you give us a glimpse into your experience in the early days of the pandemic as an infectious disease doctor on the front lines, keeping in mind the software product that you were in the midst of developing, and maybe how that experience changed the way you looked at the product that was needed to solve the problem at hand?

Manny Nijjar: Basically, ideation started in 2015, my own problem as a doctor facing issues with identity, credentialing, checking a doctor is good enough to look after a patient. Then beginning of 2018, the NHS were looking actually at blockchain-based solutions. I think there was two use cases, and one of them happened to be the same use case as me. How do we move staff quickly so they can go and see patients quickly and validate them? We’d done a discovery project with Big Four companies, so it was Oracle, Accenture, IBM, and Microsoft. We’d just done a proof of concept, so we’d shown a license being issued as a credential and a doctor sharing it with a hospital. That was October, November 2019. So in August, obviously things were starting in China, but very kept quiet. I remember going to a wedding, and they were all asking me, How is it? And this was the beginning of February, and I was like, I think if you’re vulnerable and you’re elderly, I think it’s going to be bad. And then within two weeks, I saw everything that was happening in Italy, and I became really scared.

Manny Nijjar: From mid-February, mid to end of February, that was it. I… Basically had to lead the response in our hospital. From the end of February, and basically for the next two and a half months, it was getting at 5:30, 6 in the morning, go home at 11, 12, have five hours sleep, come back in, get called in overnight because people didn’t know what to do. Everyone was terrified. Staff were terrified, couldn’t get hold of any PPE. We ran out of oxygen. We had to divert patients. We were telling people this like two weeks before it was happening and no one listened until the day. And then at the same time, the benefit for the product was the NHS centrally was winding down technology projects because they had to focus on the COVID response. But they did ask, Do you think your product at NHS level can help? And that was the first time they said, Well, actually, we want to do this digital staff passport. And I was like, Look, the technology is nice, but we can get something out there and it’ll be good, and we can develop it over the next few months because there’ll be more waves, right?

Manny Nijjar: And the woman who was a consultant, and I don’t know what consultancy she worked for, she turned around and went to me, I don’t think you realise the urgency of what frontline staff need at the moment. And she didn’t realise who I was and what I did, right? It’s just so systemic of what is wrong. There’s such a big disconnect from the level from there to what actually is going on.

Riley Hughes: You mentioned you, as a doctor, having a pain point that you wanted to solve. Can you illuminate for us what was that original pain point and the original vision for Truu? And was that the same thing that was applied during the pandemic for the staff passport, or did it evolve?

Manny Nijjar: So we go through repeated identity checks, right? And that’s very time consuming. That can be three months lead-in time. We know there’s a shortage of workers. There’s big waiting lists. So that’s a lot of time spent. And some of the calculations is about 800,000 to a million clinical encounters are wasted just on doing identity checks for doctors. So that’s big, right? And then all the health economics, the delay in that, and it’s a big administration burden on us. We’re already burnt out. We can’t keep doing more and more paperwork on top of what we have to do, right? So that was the, how do you know that that person is that person can do what they want, right? So patient safety, time efficiency, so we can go and look after patients and allowing the movement because there is a shortage of workforce. And then it just becomes every benefit after that: cost efficiency to hospitals. auditability to hospitals. There was also issues about fake doctors at the same time. So there was a psychiatrist who’d been practicing for 23 years who wasn’t a doctor.

Manny Nijjar: There was a doctor in the public health system, which the NHS is, who’d got struck off but had continuously practiced in the private. There was a disconnect; no one was able to check. There’s a big misconception about the NHS. It’s not this one big organisation. It’s this one big umbrella organisation, but there’s 200-plus hospitals, but they’re all run as separate companies. So they all have their own separate liabilities, so they all need to check, right? So how do you move one to another? And so the urgency and movement of doctors was needed, and so they wanted to do what we did, but actually in a more compact way. It was like a minimal viable product, but a really good proof of concept of there is a need. Everyone knows there’s a need. We can demonstrate it. And there was a lot of lessons learned there.

Riley Hughes: Okay. Yeah, it feels like you are the person that the universe raised up for this moment in time, right? Both with your background in the medical space as well as the identity space, the problem that you were working on, it just all really converged on this moment. And as you applied decentralized identity products to this problem that you’ve described, in concert with a handful of other partners working to solve this problem with the NHS during the pandemic, did the clinical hours wasted on paperwork go down?

Manny Nijjar: Yes. So by the time we’d built something that was workable, it was June, and the first wave was done, right? And ultimately it did get used, and it was looking for other use cases it could be used for, and it was how could you prove you can vaccinate people and you can send it and prove it? So I think it got into about 100 hospitals, but the issue they had, I think, was the number of end users, so the number of…

Riley Hughes: You know, the hospitals procured this solution. Did they recommend that the clinicians use the product, and the clinicians didn’t have the uptake?

Manny Nijjar: So interestingly, this was all pushed centrally because it was normally that’s not how procurement happens, right? It all happens as individuals, but this was centrally pushed because of COVID. And so it was pushed and said, okay, we will do this. And that was very much our partners who integrated it, because we gave it—we were very small, right? We understand our limitations. We know where our expertise is. We’re really service and user design based, enabling the technology, really trying to do the application level, but we understand all the technology. The problem that they had was number of users, I think it was only 400. We’ve almost got a million workers. I think it’s just the unintended consequences of people thinking they know better. And I was really busy with COVID as well, right? So I tried to engage, but I was like, look, we were small, we learnt our lessons. They’ve taken it to another level. We’re continuously involved, but it was that user experience. It’s doctors trust doctors, nurses trust nurses. We know what we want to do.

Manny Nijjar: That product has to really help you, and people have really emotionally connected with you. They know what they’re doing, not some sterile, hey, you need to do this because we say we’re going to do this and this is the policy.

Riley Hughes: For the record, I think 400 clinicians is a great achievement. That is a big deal, and I’m sure that you got a lot of learnings from that. So what was that first product that the end users were given to adopt, and what was the initial reaction to it? What learnings or feedback did you get from them in that initial rollout?

Manny Nijjar: So people were issuing and connecting and then issuing credentials, so that was fine. I think from the hospital end, it was okay. It was going through an integrating partner, so they collected all the feedback. But what I heard from the sessions was they were really struggling to get people on board because when you’re in the space, and that’s like me being like a technologist, you really need to explain things to people. Where our product is like, hello, welcome to Truu Digital Health Staff Passport, and it says, What are you? A doctor, nurse? Okay, we are now going to do your pre-employment checks for you. How do you want to do this? Do you want to go in person or do you want to do something remote? They didn’t have that. They don’t know. They’re like, Oh, you’re giving me this, and I don’t—what can I do with this? Right.

Riley Hughes: If I could distill maybe what I’m hearing, the generic general-purpose wallet approach required a lot of education that people didn’t have time to go through, and also is sort of an additional administrative hurdle to jump through on the front lines, as opposed to a wallet approach that’s more tailored and specific to a persona that can take a user through a journey that does the educating for them in the specific context that they are, you know, interested in, and that that approach is at least working much better for this use case. Is that a good summary?

Manny Nijjar: Yeah. It’s like anything you open. It’s like the first time you go through an application or something, it takes you through the clicks, right? But it’s orchestrating it, and then you go, Well, now you can use this for this if you want to, right? And once we have this, it can solve so many problems in our space and bring so much efficiency and trust and bring back time to us so we can look after ourselves, then we can be the best that we can be for our patients, right? Because there is a lot of burnout, and it’s a balance, right? But it’s an ecosystem, and everyone has to be involved. But I think the influence of the end users was really, really diluted. I wouldn’t say we were pushed aside. We were very busy, but I think people realized the potential centrally. And they wanted to put their name to it, you know, and people saw it as a pure business. But for us, business is part of solving the problem. It has to make business sense because we really want to solve the problem, right?

Riley Hughes: You are in a position where you are both the application builder, you’re building software, building a product to solve a problem. You’re also the end user. There are many industries, many products that are being developed in all kinds of industries. by technologists, by business people who maybe haven’t lived those lives before. And they’re going in and they see a problem, they hear of problems, and they really have a desire to help and apply ID tech solutions to these hard problems. But maybe if they don’t have that personal lived experience themselves, how would you suggest that they go about getting that insight and understanding from those end users?

Manny Nijjar: I think it needs to be a lot more open, because it’s a complex problem. It’s not just going to be solved by one company. We gave a lot of our stuff away because we genuinely believe the users are going to want to come back and use your product because it’s the best thing to use, right? I’ve been to conferences where someone is telling my problem to me, and they see I’m there, and you can see the embarrassment on their face because they want to take credit for something, and people are looking around and going, Well, we know that. This pie is big enough for everyone. Try and grow the pie together. Your identity is so complex. I call it what we’re doing functional identity, right? I have a medical… I’m eligible to get a medical license. I have a medical license. I’m eligible to apply for a job at a hospital. And then I’m eligible to do X, Y, and Z in a hospital, right? Very functional. But there’s so many other nuances and aspects around that, and I know that journey very well because I’ve done that so many times, and I know what the pitfalls are.

Manny Nijjar: The other thing I’d say is don’t be too fixed on your ideas. Because I remember, look, I was evangelist of SSI at the beginning. I was like, ultimately, pragmatism in the real world to make a couple of steps forward in the space, you’re going to have to compromise on some stuff. But you can own it, you identify it, you show it, and you go, we know this isn’t perfect, but this is better than what’s happening. We can’t get there without going through this bit.

Riley Hughes: How has that looked in practice, Manny? If you look at kind of where you started with the pure SSI vision, and maybe a lot of people listening are there right now, they have this vision of where they want to be. What are some of those things that happened to your product or to your approach that are maybe different than what that initial vision would have been that could help some of these other people get to that pragmatic approach faster?

Manny Nijjar: We’ve got a very defined ecosystem already, right? For us, it was like, oh yeah, we can get every single one of them on board, and that has been difficult, but we have then targeted the most trusted, and they’re on board. And so now we’re like, well, actually, every one of these organizations is at a different stage in their digital maturity and digital transformation. Some are really advanced, some are really early, some are very manual. So we didn’t want to initially hold any data or issue any credentials, as Truu. But ultimately, I think we’re moving to a position where we’re like, actually, we will have data providers or people who run it who don’t have the ability to issue verifiable credentials and don’t currently want to have a technology to directly issue it. We can run a check and we can issue it, and that can just be a very easy journey for doctors to collect everything. That’s the issuer side, because it’s always been the incentivization of the issuer, right?

Manny Nijjar: We can do that by paying for their API on a subscription, whatever, and then you’ve loaded a doctor’s passport, right? Now they have something they can use. And for the verifiers, the verifier has never been an issue. They’re like, yes, this brings efficiency. For us, it was very much, we are going to get every single issuer individually to go and do it, right? And then we’re like, oh no, but we can get other people to check because we don’t want to hold any data. But then we’re like, well, actually there is ways we can work with it. We can call it and we can run the checks and hold it. And then once you get the verifiers on board, then you start doing business models where you’re like, okay, every time the verifier checks, potentially we get paid as Truu because we issued it. But then we go to the issuers that we’ve been calling, them checking stuff that you issue, and that I think will be eventually the model. That is where we’ve come to. I think there will have to be temporary third parties, even though that goes against everything in our whole SSI model.

Riley Hughes: You could build the most amazing, elegant, perfect SSI utopian solution that your heart can imagine, but if it’s not taken up by end users and actually used in the real world to improve people’s lives, then what’s the point, right? And the first step is getting something issued to them that they can use to get value. And I think this is a really interesting thing to unpack just a little bit more because on the one hand, what I’m hearing you say is that that’s a challenging step, and that by calling some APIs or by bootstrapping this ecosystem somehow by being a proxy issuer for whatever the ultimate data is that you want to get into that wallet, you can get these doctors and other clinicians on board faster and sort of streamline that process. At the same time, you’ve also done work with some of the biggest, largest, most trusted issuers out there, and you have had traction there. You know, I think sometimes the best issuers of data are like the slowest-moving institutions out there.

Riley Hughes: How should people balance this, like going after the big whales like the NHS, which, to your credit, has moved in this direction and has offered tenders and the staff passport program, at the same time in balancing that pragmatism of getting a solution up and running now faster for people to get onboarded?

Manny Nijjar: I think a lot of our early work was really heavy on policy, so it was really top-down saying, hey, tender policy, this is the technology. Even if we abstract it, individuals should have their data format so they can share, so it solves this problem of moving around, instead of it being in a physical into digital format. And so that was written in policy, so we’ve got digital staff passport. So that’s something you can call to, right? Now you can call to it, but you need to also go from the bottom up. And why we’ve been able to do that is we had this vision really early on. We worked at the General Medical Council, and we started in 2015, 16 with nothing, just drawings, and this guy was like, I don’t know what you’re saying. I can’t conceptualize it. You come back a year later, you come back a year later, then the year later you’re showing something. That’s sometimes just how you have to develop with organizations. I would really just say focus on the end user, have them part of your team. You will find people who want to do it, who will add so much value to it.

Manny Nijjar: And I think you should really open with your partners and don’t sell, don’t try and sell. I know some businesses you need to sell and you’ll have a sales team, but if you’re really going to work with these big organizations, they should have visibility of this problem. And that’s what it’s been like for us. It’s like they know there’s a problem. It hasn’t been hard to sell it. It’s just people have been trying to solve it for years and never been able to do it.

Riley Hughes: Feels like there are important technology developments that have happened that have enabled a new age of ID tech products to come out to address some of these challenges. At the same time, most of our conversation is centered around the business, policy, and user experience challenges of getting a solution to work in market. I feel like I, in this identity space, go to conferences, listen to podcasts, and otherwise speak to people who seem to come up with new variants of verifiable credentials and different kinds of identifiers and new blockchains and new technology solutions that they hope will address some of these problems. As a builder who’s spent so much time boots on the ground, both as an end user and as a product developer, how much of this problem do you think can be solved with new and better cryptography or other technology solutions versus simply better product and user experience and business model innovations?

Manny Nijjar: It was really valuable to go to those conferences, which I have not been to for a while, because the conversations are, as you say, this technology or this protocol works or this implementation of this works, and it’s our way is going to work and we’re going— no. They are important conversations. I’m not saying they don’t need to happen. They need to happen. But you need people to say, We want this. And I think that’s what’s happened with our product development, is very much like we’ve really abstracted and become very agnostic, and it’s like we just want what the user sees on the app to be the same. We could have four or five different identity tech stacks because ultimately it’s the capabilities that they provide for that experience to solve that business problem. Some of the early technology was very rigid and it didn’t let you do stuff, but it was really good because it helped you demonstrate stuff. You want to be able to replace that engine under the hood of the car with something that’s faster if it needs to be faster.

Manny Nijjar: I think now the next step is people are trying to drive it through governments, which is important, right? To get it into the hands of users, and then make sure it’s trusted. We’re becoming more and more important in our knowledge that we gained really early on when we were really focused on technology and we really moved, and what we kind of learned without realising.

Riley Hughes: Well, I’m hearing the theme of this episode, I think, is just about end users, getting them involved and getting their feedback and learning from them and building what it takes to solve their problem. I want to ask you, Manny, what does the future of identity look like to you, and why does that matter for the world or your world of healthcare workers?

Manny Nijjar: The future of identity is really important just because currently it’s control, right? It’s how we’re controlled and how we’re influenced. If it’s not done the right way, it’s going to cause huge inequalities, what people are going to be able to do and not do. In the physical world, we have trust because I’m in a hospital. I have a badge. I have nurses who can account for me when I come and see you. In a hospital, I’ll get challenged: am I even allowed into this ward? And it’s trust relationships. And that’s one thing I have as a core. I’ve always built trusted relationships physically with patients because I need them to trust me so I can share information. They can make a decision, and I can help make them a decision to make them better. That’s a basic pillar of medical ethics, confidentiality, right? So with EPR systems, I go see anyone’s record. You look at it during COVID. I’ve never had so much misinformation about something I’m an expert in. How do you weigh that? What is the weightedness of that information, right? Let’s start really simple.

Manny Nijjar: Can I do what I do with my physical papers in a digital format without having to go through a third party? For me, that would be the future of identity. I have my passport, I have my medical degrees. Now how can I have them somewhere where it’s safe and only I have access to it and I share it when I want to share it?

Riley Hughes: This has been an amazing conversation. I’ve really, really enjoyed it. Manny, if people want to follow up with you or talk more with you, where should they find you?

Manny Nijjar: Yeah, just, you can email me at manri@truu.id. Anyone who wants to connect, work with us, just let me know and just drop me a line and I will get back to you.

Riley Hughes: Yeah, well, thanks a lot for coming and thanks for listening. You can find us on YouTube, Apple, Spotify, and wherever else you listen to podcasts. Feel free to reach out to Trinsic at trinsic underscore id and me at Riley P Hughes on Twitter. And visit Trinsic if you’re interested in building the ID tech products of the future. Subscribe to get new episodes as they drop, and thanks again for listening.