I’ve had the luck to attend medical school in the city of San Francisco during what will be looked back on as the start of transformational change in our health care system. My growing interest in technology and new business models as the disruptive forces behind this change, as well as marriage to a technology entrepreneur, has me frequently rubbing elbows with movers and shakers in the digital health space. One question I constantly receive (other than how I feel about being replaced by a computer) is how to get ideas and products in front of practicing physicians for product feedback or to test the market. Even more commonly, I’m asked why we are so resistant to technology and change in the way we practice. My reply usually takes some form of the following.
1. Show us the data.
The robust system medicine has developed for testing innovations in clinical care, disseminating these ideas, and transforming practice standards is being entirely overlooked (or alternatively scoffed at for being too cautious and slow) by most entrepreneurs. We insist on data to show that the newest pharmaceutical drug, procedure, or implantable device is safe and at least as efficacious as placebo, (and due to comparative effectiveness, this may soon become as compared to the standard of care). It should not be any different for an EKG iPhone app I use to rule out a myocardial infarction in your mother, or a motivational weight loss app the patient invests days of their time into with no results. These are not restaurant recommendations where a failure means bad sushi. These are people’s lives and well being, and we feel it’s unethical to start recommending unproven products.
2. You are at the wrong conferences.
You must attend more than the flashy mobile and digital health conferences. These are fantastic settings in which to meet other entrepreneurs, investors, and a tiny subset of MDs, but are devoid of significant numbers of practicing physicians. Consider showcasing your wares at the medical society conference most relevant to your product. Most of us are not paying several thousand dollars (remember we don’t have expense accounts) to watch five minute demos on Beta version products, with panel commentary by investors and consultants rather than people who actually practice medicine. For example, if you have a product for chronic disease management or care coordination, consider the next American Academy of Family Physicians conference. Or attend the local medical society meeting and connect with the medical thought leaders in your community. This message is also important for the individuals in government and major private payers trying to stimulate innovation and physician uptake in this industry. They must appear at our medical society conferences and grand rounds at leading institutions with assurances that the major regulators and payers for health care are going to put their money where their mouth is. The Office of the National Coordinator has done an impressive job of this with electronic medical records and e-prescribing.
3. You are being written about in the wrong places.
Even doctors know that many product descriptions on TechCrunch are essentially spell-checked versions of the Founder’s press release. You may be hot at the next tech meet up, but we couldn’t care less, and even fewer of us are consistently reading that website. Figure out where we get our information and focus your efforts there- its the health section of major newspapers, sites like iMedicalApps.com, KevinMD.com, here at The Health Care Blog, or more commonly high quality academic journals where your claims and data have been analyzed by someone other than an unpaid intern.
4. You don’t understand the health care payment and regulatory system, and why I can’t buy what you’re selling.
Most physicians have no room to be innovative or take chances in their clinics due to the highly regulated environment we work in, and we dismiss you if you call us afraid of change. I realize entrepreneurs and regulations are like oil and water. But ignoring them or expecting us to find the loopholes for you leads to naive business plans. Be our partner in proving these products work so payers and the hospitals systems most of us now work for will get on board. Alternatively, seek out those systems that have some form of capitation for payment, or the increasing numbers of membership-based primary care clinics. These business models have more leeway in what technologies they use to provide care, and an obvious incentive to invest in lower cost quality alternatives.
5. You come off like a used car salesman.
Remember that the pharmaceutical industry got to us first, and we are on high alert for smoke and mirrors. Have you ever considered the ratio of adjectives to nouns and verbs in your pitch? We are increasingly skeptical of terms like “crowd sourcing”, “social”, “big data”, or “mobile” as cover for a product that has only a website placeholder and a hypomanic Founder. A mature dialogue means admitting that fixing health care isn’t easy, and that the current system while broken is not made up of fools who despise novelty.
6. You misuse the expertise of physicians and other health care providers in your company.
Our value is not in confirming that your Congestive Heart Failure protocol is accurate; our real worth is in the business model and product design, especially if its a product you want integrated into our work flow. Sure the guy in practice for forty years who hates computers isn’t a great partner. But you put yourself at a competitive disadvantage when you don’t have a sharp business partner who also understands the immense complexities of medicine, the health care system, and how a physician, payer, or hospital administrator actually thinks. The smorgasbord of mobile health applications developed in the last few years, with few finding any real traction, suggests to me that its not the technology that is the hard part. Consider how long email has been around, and how few people can use this medium to communicate with their doctor. I certainly don’t think you need to drink the health care industry Kool-Aid for ten years to solve serious problems. But I do believe you need to at least know what’s inside the box to think outside it.
I’ve love to hear from other physicians; what else could digital health entrepreneurs do to get their products in front of and used by clinicians?
Rebecca Coelius is a future family doctor studying at the University of California-San Francisco. She’s interested in new models of primary care provisions and payment systems and disruptive tech innovations in health care. Coelius is the founder of SpanAfrica, which helps African grassroots organizations access global expertise, resources and volunteers.
Spot on awesome article. As a physician AND a technology entrepreneur (EndoGoddess App for diabetes), I agree about the disconnect between the two worlds. I’ve taken the approach of first focusing on the patient and their user experience with an evidence-based app design. Then, I’ve been raising awareness at tech conferences in order to generate funding. Once there is enough funding, I am then going to do a clinical trial which I will then use to discuss with physicians and insurance companies. Staying active in understanding the new developing payment models with healthcare reform is also an important part of my process. Hope to see more physicians like you in this space!!
Thanks for the kind words Jennifer. I have been following your work and wish you continued success!
Dr. Coelius, I’d like your take on the Weeds’ “Medicine in Denial.” I’ll send you a copy (pdf) if you’d like.
Sure, please send. RLMitchell1 at gmail
No its actually Rebecca Coelius, my maiden name is Mitchell. You are welcome to contact me through LinkedIn as well if that makes you more comfortable, my # and email is public on the site, which is why I didn’t mind sharing it here.
I am linkable. You screen name was/is not. This was a red flag, when I see an unlinked name, particularly ostensibly by the very author of the post. Don’t take offense.
The Weeds’ graciously gave me a full copy of their very important book. They cite a creative commons utilization permission, but it is not blanket. See my blog.
Also, as to the technology itself, especially health IT:
A site of “worst practices to avoid” (as opposed to the typical “best practices to emulate”):
Also see the somewhat related article “Domain expertise just as critical as technology in healthcare” by Sculley at http://mobihealthnews.com/16016/sculley-domain-expertise-just-as-critical-as-technology-in-healthcare/
“You never compromise on the user experience,” he said.
Excellent article! HITs the nail on the head. I am so tired of seeing doctors blamed for the HIT companies failure to make the technology relevant to me and my practice and my patients.
There is no way I am going to drag more than one, maybe two, electronic devices into the exam room with me, and no way I will drag around a device I only use on every 10th patient encounter. Also see the article on this blog about KEAS/Mint.com for insight into how programers and hardware engineers miss the big picture of where their fancy apps and features fit into real life.
You don’t see the tire salesman out on the sidewalk with a sign that says, “you need my tires, stupid.” If he isn’t selling enough tires he takes a hard look at what HE is doing wrong without wasting time trying to convince his potential customers that they don’t know how to make a proper purchase.