How long does it take to diagnose guttate psoriasis versus pityriasis rosea? Swimmers ear versus a ruptured eardrum? A kidney stone? A urinary tract infection? An ankle sprain?
So why is the typical “cycle time”, the time it takes for a patient to get through a clinic such as mine for these kinds of problems, close to an hour?
Answer: Mandated screening activities that could actually be done in different ways and not even necessarily in person or in real time!
Guess how many emergency room or urgent care center visits could be avoided and handled in the primary care office if we were able to provide only the services patients thought they needed? Well over 50% and probably more like 75%.
Primary Care clinics like mine are penalized if a patient with an ankle sprain comes in late in the year and has a high blood pressure because they are in pain and that becomes the final blood pressure recording for the year. (One more uncontrolled hypertensive patient.)
Today the notion that health is a preferred state of being, rather than a set of disconnected functions or services, is increasingly being embraced. A recent JAMA article promoted a health measurement system called the “flourishing index” focused on 6 key domains: happiness and life satisfaction, physical and mental health, meaning and purpose, character and virtue, close social relationships, and financial and material security.
Gro Brundtland, former director-general of the World Health Organization, wrote
in the World Health Report 2000 that
“The objective of good health is twofold – goodness and fairness;
goodness being the best attainable average level; and fairness, the smallest
feasible differences among individuals and groups.”
the age of Trump, with forced separation of immigrant mothers and children,
criminalization of abortion, and purposeful obstruction of enhanced access to
health care for vulnerable populations, it becomes impossible to ignore a
significant modern-day truism. Health is profoundly political.
Health is a collection of resources unequally distributed in society. Health’s “social determinants” such as housing, income, and employment, are critical to the accomplishment of individual, family, and community well being and are themselves politically determined.
In this two-part series, we examine several common misconceptions
made by health tech start-up companies in working with Health Systems and
offers advice on how to recognize and address each. From approaching systems
with a solution-first mentality to not understanding the context in which
health systems work, we look to provide constructive criticisms meant to
support more effective partnerships between health systems and digital tech
and Reactions from the Industry
Understand the Current System Environment We Are Working In: In some cases,
technology solutions are barricading healthcare systems inside. In other
cases, they are allowing us to seamlessly interact with other systems. Typically, large healthcare systems have a
combination of both. For outside solutions to be effective,
start-ups need to be intimately familiar with the existing (and on-the-horizon)
systems that healthcare organizations are using or contemplating. Rarely
will a solution not have to interact with existing software solutions – and
this goes well beyond just the EMR.
Have an Integration Plan: A
stand-alone solution, which doesn’t tie to one or more of the healthcare
institutions key systems of record (SoR) or systems of engagement (SoE) is a
useless solution. Your solution should be able to stand alone in the first few
weeks, as users begin to use it and get familiar with its capabilities.
However, as soon as value is realized
(not necessarily achieved), it’s crucial that your solution support either SMART on FHIR, FHIR,
HL7v2.x, or all of the above. If you don’t have a believable integration story
fully worked out, you’re not ready to launch into the health system market. Go
back and do your homework.
Having a Clinician Is Nice, But Not Enough: The physician, nurse, or other clinician on your team helps credibility but we also understand the incentives associated with selling solutions, and this takes away from the altruism you think we will blindly swallow. And they are rarely businessmen or women who understand both the complexities of solving a problem that isn’t theirs and starting, let alone, running a company. Pair an MD with an MBA? Now we’re talking.
Start-ups are an increasingly important “node” within the
healthcare ecosystem. They are challenging status quo concepts that have
long been ingrained in the healthcare system, like questioning the value of
traditional EMR systems, or shifting the power of information to patients, or
breaking down cost and quality transparency barriers. They may be the future of
the industry, but startups have a long way to go to truly transform the
system. The reasons are many, from an incredibly convoluted and bureaucratic
review process and rigid risk-controlling regulations and policies, to the
large-scale organizational inertia most of our healthcare systems have.
And while all of these hurdles can and will be overcome if we work
together, there are still several lessons each “node” in the ecosystem can learn to more effectively work with each other.
This article is directed at the emerging digital solutions trying
resiliently to help transform this stubborn industry. It provides some critical
lessons in dealing with healthcare systems and is accompanied by reactions from
a digital solutions expert with serial digital health entrepreneurship
experience. We hope to provide perspective from two people living and
breathing, and surviving, from both sides of the
equation every day.
and Reactions from the Industry
Healthcare Startups Must Understand how Provider
Systems Operate: Most
health systems are increasingly becoming rightfully skeptical about new
solutions because they feel the solutions don’t understand the environment of
their system. To help overcome the challenges of introducing your innovation into a complex business and
clinical environment, startups must understand how health systems operate to
include how they make decisions, contract and evaluate solutions.
Recognize that Decisions are Consensus-driven and Permissions-based: Unlike
other industries, where “shadow IT” is rampant and there can be one or two “key
decision makers,” in health systems you’re not likely to get very far without
figuring out how to build consensus among an array of influencers and then
figuring out how to get permissions from a group of key decision makers. You
should seek a “Sherpa” that understands enough about your solution to champion
the idea of change – which is really what you’re seeking when you’re
selling a new solution (the solution is just the means to accomplish the change,
it’s the change that’s hard). The first thing to focus on is to identify the
group of decision makers and how you convince them that the status quo should
be abandoned in favor of any change –
then, once you know how to convince them of some
change you’ll work with the group to get the right permissions to work on the
change management process – which will then influence a purchase of your
Today on Health in 2 Point 00, we have another takeover! Dr. Jennifer Schneider, president of Livongo, is here to give us her take on health tech news. On Episode 81, Jess asks Jenny about Daye, a startup developing cramp-fighting CBD tampons, which just raised $5.5 million, and LetsGetChecked, which raised $30 million for at-home health testing. Jess also asks about Jenny’s new book, Decoding Health Signals, which offers a blueprint for building a consumer-focused healthcare company.
Innovation, in collaboration with Springboard Enterprises, is hosting an
exciting new 10-week Scale Up Accelerator program for women-founded health tech
companies (or those with at least one female key
executive) located in the Southeastern US (FL, GA,
AL, MS, LA, NC, SC, KY, TN). Because both women-led startups and the
South East are lagging in access and closure of venture capital, this unique
cohort is dedicated to accelerating the growth and financing of companies
within these demographics.
The program will run from Jun 26th – Aug 30th and
includes a kickoff boot camp (June 26th – 28th) at the
GuideWell Innovation Center in Orlando, FL. Most of the program will be conducted virtually other than the 3-day kickoff boot
camp and a innovator/investor matchmaking showcase at the end of August. During
weeks 2-9, the cohort companies will be matched with various advisors and are
expected to connect with advisors every week. In addition, each week will
incorporate a virtual 2-hour workshop/collaboration session led by subject
matter experts on key challenge topics faced by most early-stage health tech
criteria for the cohort:
Company must be a health, wellness
or medical device technology company that addresses critical gaps in providing
affordable, accessible health care or holistic health/wellness solutions for
diverse populations and communities in the United States
Life sciences companies are NOT
eligible for this cohort
Women founders or key executives
must own a minimum of 25% of the company’s equity
The company must be headquartered
and have a minimum of 50% of its staff located in the Southeastern US (FL, GA,
AL, MS, LA, NC, SC, TN, KY)
Can show proof of “Scale Up”
traction through revenues, capital raised, customer acquisition, and product
development (see below)
Addressing a huge market
opportunity in the U.S. healthcare, holistic health or wellness industry
Today, THCB is spotlighting Lygeia Ricciardi. As the former Director of Consumer e-Health at the ONC, Lygeia tells us about patient access to health data and the ONC and CMS’s new rules on interoperability. But now, she’s the CTO of Carium Health, going from a “consumer activist consultant-type” to actually working with a startup. Carium provides a platform for consumer empowerment and engagement, helping to guide individuals through their health care and wellness journeys.
Burnout is one of the biggest problems physicians face today. We believe that addressing it early — in medical school — through coaching gives physicians the tools they need to maintain balance and meaning in their personal and professional lives.
We say that after reading comments from participants in our coaching program, “A Whole New Doctor,” developed at Georgetown University School of Medicine. This program, born almost by chance, provides executive coaching and leadership training to medical students, who are exactly the right audience for it.
Medical students tend to begin their education as optimistic 20-somethings, eager to learn and eager to see patients. After spending one or two years on the academic study of medicine, they move to the wards where they observe the hidden curriculum — a set of norms, values, and behaviors conveyed in implicit and explicit ways in the clinical learning environment.
In the hospital, convenience and expediency, deference to specialists, and factual knowledge tend to replace the holistic and patient-centered care that is lauded during the preclinical years. This new culture nudges some students to the brink of burnout and depression. Some consider suicide.
A lot of Americans think they should be able to make an appointment with a specialist on their own, and view the referral from a primary care provider as an unnecessary roadblock.
This “system” often doesn’t work, because of the way medical specialties are divided up.
If belly pain is due to gallbladder problems you need a general surgeon. If it’s due to pancreas cancer, you need an oncologic surgeon. If the cause is Crohn’s disease, any gastroenterologist will do, but with Sphincter of Oddi problems, you’ll need a gastroenterologist who does ERCPs, and not all of them do. Now, of course, if you’re a woman, that abdominal pain may actually be referred pain from an ovarian cancer, best treated by a GYN-oncology surgeon, which anywhere in Maine means a drive down to Portland.
The other day I saw an older man for a second opinion. He had been through one hand surgery for a small tumor many years ago in Boston, and another unrelated operation for a fracture in Bangor a few years ago. Then, after a non surgical injury, he developed stabbing pains in the same hand. Someone referred him to a neurologist for EMG testing, which was normal, and the man told me that was all the neurologist did, not a full consultation.
Today on Health in 2 Point 00, where am I?! In Episode 80, Bayer’s Eugene Borukhovich is here to answer Jess’s questions—but don’t worry, he’s channeling his inner “Matthew”. Get Eugene’s take on Jawbone’s $65 million raise after its relaunch and find out if he disagrees with me about Noom’s recent $60 million raise. Jess also picks Eugene’s brain about what G4A is looking for in their challenge applications, so don’t miss out — Matthew Holt