Alexis Smirnov, Co-Founder and CTO at Dialogue, discusses healthcare evolution at one of the world’s largest virtual care providers.

Avenue Code: Tell us about your personal career path. How did you get to where you are today?

Alexis Smirnov: Throughout my career, I have had several opportunities to build the first iterations of transformative technologies. Creating something out of nothing has shaped my perspective on what’s possible. 

I started coding at the age of 14, and, while still a teenager, I had the opportunity to help write software for the Sojourner, one of the first Mars rovers. After moving from Moscow to Montreal to continue my studies, I joined Softimage, which was later acquired by Microsoft. Here I helped pioneer software for 3D graphics. After gaining internet software experience at Zero-Knowledge Systems, an internet privacy company, I then co-founded Pi Corporation. The term “cloud” didn’t exist yet, nor did the idea of storing personal information there; we created the cloud computing technology we currently use in the form of Dropbox and iCloud.

I subsequently became interested in machine learning and artificial intelligence related to natural language processing, and I helped to build and run an incubator at Radialpoint. Even at already stable businesses, there are always opportunities for innovation. 

When I met Cherif Habib and Anna Chif, we started asking what it would take to solve access to great healthcare for Canadians. The result is Dialogue, one of the leading telehealth companies and Canada’s biggest and fastest-growing provider.

AC: You describe yourself as a technologist, a designer, and an entrepreneur. How do these unique areas of expertise inform and enhance one another?

AS: I'm a technologist at heart, and when you’re building highly complex software, design becomes increasingly vital. By design, I mean more than user experience - I mean how things work. I’m a strong believer in using design thinking to create systems that solve user problems. Entrepreneurship was born out of this ability to create innovative solutions. Incidentally, I’ve also come to appreciate design as a hobby in diverse areas like furniture and lighting. 

AC: You co-founded Dialogue telehealth services in 2016, but I’m sure the advent of COVID-19 introduced several new growth opportunities. Can you tell us about how Dialogue has adapted during this time? Did you experience any challenges in scaling up services? 

AS: Scaling 10x anything is hard, and scaling 10x during the pandemic is harder. We’ve been thrust into the frontline of creating a solution for a vastly increasing number of people, and when you’re faced with a calling like that, doubts fade away; you simply step up as a team to provide care. 

From a business perspective, when you’re providing virtual care services and your market segment suddenly goes from niche to mainstream to a preferred option within weeks, opportunities abound. For example, we started Dialogue to provide virtual care services as a corporate benefit for businesses. During COVID-19, we formed partnerships with Canada’s two largest insurance carriers to provide group insurance plans to employees with Dialogue embedded as part of their product. 

When you become an essential service to so many people and the quality of your work results in kudos on a daily basis, you earn the right to offer more services. We recently announced that we’re expanding Dialogue services to include an Employee Assistance Program that includes mental health, legal, and financial services.

AC: Have these opportunities for new services changed or expanded your mission?

AS: Yes. Originally, we were laser-focused on providing primary care, but healthcare and wellness is much broader than what is treated in a walk-in clinic. We expanded our strategy from providing a single service to becoming a platform for multiple programs that drive health and wellness outcomes. It’s a major transition, but it was the right thing for us to do because now we can improve humanity’s wellbeing by using technology to deliver excellent care. Both technology and care are integral to our mission.

AC: How are you integrating technology and human healthcare services for your customers? 

AS: It’s easy to create and sell an app that provides some form of health service automatically without human expertise; it’s hard to provide empathetic, expert service at scale. We’ve merged technology with human-powered service, putting humanity at the forefront of our work. While we have a strong tech stack and ML capabilities to optimize the workflow and remove bias, our app fundamentally supports a conversation between two people. 

AC: What trends do you see in telehealth as a whole? 

AS: We’re at the very beginning of a global transition from physical-first healthcare to digital-first healthcare. This is a transition that other industries have seen, but healthcare has been slower to go digital because there is a vast variety of health conditions and care plans. Because it’s a multidimensional space, we’ve seen a shift to more and more specialties within healthcare. Technology is being developed to support this care, and as more consumers go digital, we have more proof that it is a safe and effective form of care. So the biggest trend is the expansion of use cases and opportunities for virtual care. 

AC: In what ways is healthcare digitization unique from other industries?

AS: Healthcare is highly regulated, which means that data interchange scenarios are difficult. While there’s a good reason for this regulation, it does hinder the realization of some use cases and therefore the creation of some AI models. Most digital services are global by default - if they are successful, they are scaled up. But with virtual care, you have to be mindful of how you expand internationally.

Adoption is another challenge. Healthcare is innately so personal and physical in nature that many people don’t initially relate to a virtual modality. Once they experience it, however, they are converts.

AC: What is the key to successful strategic partnerships?

AS: Alignment of vision and values is fundamental. No matter how commercially attractive a partnership is, if there’s value misalignment, it will impact the result of the partnership at the end of the day. Beyond this, I look for complementary strengths. For example, we partner with an AI research center founded by Yoshua Bengio since it has the capacity to conduct deep learning research and we have the capacity to apply it in the healthcare domain.

AC: What are you personally most passionate about in your career?

AS: I get excited about opportunities that make an impact at scale. I’m drawn to deep problems experienced by many people, and I’m wired to think about technology as part of the solution.

AC: What are some of your biggest takeaways and learning experiences throughout your career as a technologist and entrepreneur?

AS: A lot of people who are goal-oriented celebrate only when they complete their goals successfully. I’ve learned to draw motivation and excitement from the journey as opposed to the achievement of a goal. The secret is to become inspired by the process as well as the accomplishment. This way, I get to raise a glass of wine more often than once a quarter!

AC: Cheers to that, Alexis! Thank you for your time today. We look forward to watching where your journey takes you next!


Holly Camponez

Holly Camponez is the Director of Design & Creative Services at Avenue Code. She is passionate about the potential of design thinking to create a positive impact both socially and economically. Holly lives in Northern California with her husband, son, and three cats.

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