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What Data Do You Need in Order to Guide Behavioral Change?

Posted on June 2, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

This is an exciting time for the health care field, as its aspirations toward value-based payments and behavioral responses to chronic conditions converge on a more and more precise solution. Dr. Joseph Kvedar has called this comprehensive approach connected health and has formed both a conference and a book around it. BaseHealth, a predictive analytics company in healthcare, has teamed up with TriVita to offer a consumer-based service around this approach, which combines access to peer-reviewed research with fine-tuned guidance that taps into personal health and behavioral data and leverages the individual interests of each participant.

I have previously written about BaseHealth’s assessment engine, which asks individuals for information about their activities, family history, and health conditions in order to evaluate their health profile and risk for common diseases. TriVita is a health coaching service with a wide-ranging assessment tool and a number of products, including cutely named supplements such as Joint Complex and Daily Cleanse. TriVita’s nutritionists, exercise coaches, and other staff are overseen by physicians, but their service is not medical: it does not enter the heavily regulated areas where clinicians practice.

I recently talked with BaseHealth’s CEO, Prakash Menon, and Dan Hoemke, its Vice President of Business Development. They describe BaseHealth’s predictive analytics as input that informs TriVita’s coaching service. What I found interesting is the sets of data that seem most useful for coaching and behavioral interventions.

In my earlier article, I wrote, “BaseHealth has trouble integrating EHR data.” Menon tells me that getting this data has become much easier over the past several months, because several companies have entered the market to gather and combine the data from different vendors. Still, BaseHealth focuses on a few sources of medical data, such as lab and biometric data. Overall, they focus on gathering data required to identify disease risk and guide behavior change, which in turn improves preventable conditions such as heart disease and diabetes.

Part of their choice springs from the philosophy driving BaseHealth’s model. Menon says, “BaseHealth wants to work with you before you have a chronic condition.” For instance, the American Diabetes Association estimated in 2012 that 86 million Americans over the age of 20 had prediabetes. Intervening before these people have developed the full condition is when behavioral change is easiest and most effective.

Certainly, BaseHealth wants to know your existing medical conditions. So they ask you about them when you sign up. Other vital signs, such as cholesterol, are also vital to BaseHealth’s analytics. Through a partnership with LabCo, a large diagnostics company in Europe, they are able to tap into lab systems to get these vital signs automatically. But users in the United States can enter them manually with little effort.

BaseHealth is not immune to the industry’s love affair with genetics and personalization, either. They take about 1500 genetic factors into account, helping them to quantify your risk of getting certain chronic conditions. But as a behavioral health service, Menon points out, BaseHealth is not designed to do much with genetic traits signifying a high chance of getting a disease. They deal with problems that you can do something about–preventable conditions. Menon cites a Health 2.0 presentation (see Figure 1) saying that our health can, on average, be attributed 60 percent to lifestyle, 30 percent to genetics, and 10 percent to clinical interventions. But genetics help to show what is achievable. Hoemke says BaseHealth likes to compare each person against the best she can be, whereas many sites just compare a user against the average population with similar health conditions.

Relative importance of health factors

Figure 1. Relative importance of health factors

BaseHealth gets most of its data from conditions known to you, your environment, family history, and more than 75 behavioral factors: your activity, food, over-the-counter meds, sleep activity, alcohol use, smoking, several measures of stress, etc. BaseHealth assessment recommendations and other insights are based on peer-reviewed research. BaseHealth will even point the individual to particular studies to provide the “why” for its recommendations.

So where does TriVita fit in? Hoemke says that BaseHealth has always stressed the importance of human intervention, refusing to fall into the fallacy that health can be achieved just through new technology. He also said that TriVita fits into the current trend of shifting accountability for health to the patient; he calls it a “health empowerment ecosystem.” As an example of the combined power of BaseHealth and TriVita, a patient can send his weight regularly to a coach, and both can view the implications of the changes in weight–such as changes in risk factors for various diseases–on charts. Some users make heavy use of the coaches, whereas others take the information and recommendations and feel they can follow their plan on their own.

As more and more companies enter connected health, we’ll get more data about what works. And even though BaseHealth and TriVita are confident they can achieve meaningful results with mostly patient-generated data, I believe that clinicians will use similar techniques to treat sicker people as well.

Check Out the New Healthcare Entrepreneurs Chat

Posted on March 29, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As most of you have probably seen, I’ve been spending a lot of time interviewing healthcare IT professionals and posting those interviews to the Healthcare Scene YouTube channel. Often I think that there’s no better way to tell a story than to hear it from the people behind the story. Plus, I love trying to suck pieces of insight and wisdom out of someone who knows a lot more about a subject than me.

While my Healthcare Scene videos have focused on various health IT topics, I’m excited to also be doing a number of video interviews in a new series we’re calling Healthcare Entrepreneurs. I’m lucky to have Melissa McCool co-hosting the Healthcare Entrepreneurs chat with me and we’ve already been lucky enough to have a group of amazing entrepreneurs share insights and perspectives on entrepreneurship and healthcare.

A great example of this was our interview with Carissa Reiniger on The Challenge of “Focus” for Healthcare Entrepreneurs. Turns out that these lessons applied well to entrepreneurs from every industry and even apply well to those working for a corporation. It seems that Focus is a universal challenge. Carissa offered some great insights into how to work on this challenge.

2016 March - Telemedicine and Healthcare Entrepreneurship-blog

If you want to watch our next episode of Healthcare Entrepreneurs, you can join us live on Wednesday, March 30, 2016 at 7 PM ET (4 PM PT). We’ll be talking with Jamey Edwards, CEO of CloudBreak Health, about Telemedicine and Healthcare entrepreneurship.

We know that entrepreneurship in general is hard and entrepreneurship in healthcare has added idiosyncrasies that can make it even more of a challenge. Hopefully Healthcare Entrepreneurs can shed some light on these challenges, talk about things that can help healthcare entrepreneurs, and create a community of healthcare entrepreneurs who can help each other.

Are We In a Digital Health Bubble?

Posted on January 7, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As I walked through the exhibit hall at CES, I must admit that I was extremely overwhelmed by the number of digital health options that were on display. Certainly the size and grandeur of the booths was off the charts. Take a quick look at part of the iFit booth:
Digital Health at CES
Yes, that is 4 girls walking on treadmills on a vaulted stage. Of course, this was maybe 1/3 of their booth. Behind me they had a massive closed room and another girl walking on a different treadmill. Plus, upon closer inspection you might also notice that they have a bed on the vaulted stage and cloth coming down from the ceiling. I think they officially call that cloth “silks.” While I didn’t see it, you can tell that they’re going to have a Cirque du Soleil performer working the silks to attract attention to their booth. For those keeping track at home, there is a great sleep sensor from EarlySense on the bed.

While many might consider much of this absurd. The show and staging doesn’t really bother me too much. Since I organize the Healthcare IT Marketing and PR Conference, I understand how hard it is to stand out at a conference. No doubt this booth left an impression. iFit even got exposure in this blog post because of it. We could argue if it was a good investment or not, but that’s a different story.

All I could think about as I walked through the incredible number of digital health solutions at CES was “Not all of these can survive.

Of course, many in the startup world would say that 90% of startups fail and so it shouldn’t be a surprise that so many of the companies exhibiting at CES will disappear. That’s true, but I never felt like this in past years. In past years at CES it felt like a number of players with some overlap and some competitive pressures, but that there was plenty of pie for everyone. This year has me wondering if that’s still the case.

As I mentioned, I’m hoping to publish a list of all the various health tracking devices. I realized that this going to take a lot of work. I’m still planning to work on it, but it’s going to take some time to do it right. One person I talked to said that there are about 700 health tracking devices out there. Of course, the real challenge is that 500 of them still don’t actually deliver (ie. they haven’t gone to market with a product or they can’t deliver the results they say they can deliver). Even 200 legitimate companies makes for a really competitive environment where people still talk about Fitbit and the Apple Watch and don’t know many of the others.

Let me be clear though. I think there’s a ton of tremendous innovation happening in the digital health space. From a consumer perspective all of this competition (bubble if you will) is great! Competition will push vendors to take what they’re doing to a new level. We’ll have a ton of amazing discoveries that will ripple through all of these companies. This is all great and will work out well for consumers and healthcare.

Plus, on the fringes you find some people doing unique things. The problem is that many of those companies have a hard time being heard with all of the other companies making so much noise. Sometimes I’m talking literal noise. I think it was the Under Armour booth that felt like they were a Las Vegas night club. It made it a lot of fun to visit and certainly attracted attention. I just wouldn’t want to be exhibiting at the booth next to them.

Figure 1 – The Quiet Medical Education and Collaboration Platform

Posted on December 22, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As a healthcare IT blogger, I try to keep up to date with the latest happenings in healthcare IT. Of course, it’s impossible to keep up with everything, but I’ve generally heard of tech companies that are getting traction in healthcare. Either someone tells me about it, I see it on social media, or the company reaches out to me directly to have me write about them. However, sometimes companies quietly do their work and don’t ever hit my radar while they’re gaining significant traction. That was the case with Figure 1 who I first saw on a venture capital blog I read regularly.

The venture capitalist described Figure 1 as instagram for doctors. I’d describe it as a medical education and collaboration platform. Both are pretty accurate depending on your goals. The former is better for raising money and the later is better for understanding what Figure 1 actually does.

No doubt what Figure 1 has built is impressive. They have over half a million healthcare professionals (I think they’re close to a million, but they seemed to be waiting to announce when they actually hit that amazing milestone) on their platform that are viewing images on their platform. Maybe more impressive is that over 50,000 healthcare professionals use Figure 1 on a daily basis and Figure 1’s “medical cases” have been viewed over 1 billion times. They have a very international audience with healthcare professionals from over 100 countries (They verify professionals in over 75 countries). That’s a really significant international medical community.

This is no surprise to me. The first EMR forum I was part of 10 years ago when I started this blog created a section of the forum where doctors posted various medical images. It was a really popular part of the site and doctors seemed to love it. So, it made total sense to me that a mobile optimized version of what was happening on that forum would be even more popular.

Just to put what Figure 1 is doing in perspective, here are some user stories that Figure 1 shared with me:

“I saw a patient who was immunocompromised and had ecthyma gangrenosum on Figure 1 recently, and then later I saw it in person on a child. I’ve never seen that kind of rash before in person, and I knew exactly what it was because I’d
seen it on Figure 1. I treated the patient for exactly what it was instead of something else.”

And now for an international take on what Figure 1 is doing:

Dr. Hugo Zuniga is a family physician working in the Peruvian rainforest in a rural farming community of about 2000 people. As the only physician in the area, Dr. Ziniga is forced to treat many injuries, illnesses, and infectious diseases. Specialists are only available to the community via larger hospitals outside the rainforest. These hospitals are far and require a planned ride to reach them. The cost of visiting these hospitals is typically more than members of the community can afford, so Dr. Ziniga often lends money to his patients for treatment.

Dr. Ziniga says that Figure 1 helps him treat his patients. As an example, he speaks of one particular case where he was able to aid a five-year-old patient with a recurring infection. The patient was sent to a large hospital outside the rainforest for surgery, but the doctors there sent him back untreated, saying he didn’t need surgery.

When the patient returned to the community, Dr. Ziniga felt the other doctors had made the wrong decision. Suspecting that the patient’s adenoids were causing the recurring infection, he posted a photo to Figure 1 asking others if they agreed. After receiving support from the international Figure 1 community, Dr. Ziniga sent the patient back to the hospital, where he was given the surgery he needed.

Dr. Ziniga has no ambulance and few medical supplies. But now, with Figure 1, he says he doesn’t feel as isolated anymore.

I’m really impressed by Figure 1’s approach. It’s largely being done outside of the medical establishment, but it’s generally complimentary to the medical establishment. It’s not easy getting 100 doctors on any platform. Half a million healthcare professionals is really impressive. I’d love to know what you think of what Figure 1 is doing.

The Benefits of Real-Time Locating Systems in Healthcare

Posted on November 16, 2015 I Written By

The following is a guest blog post by Stephanie Andersen, Managing Partner at ZulaFly.
Stephanie Andersen
“It is frustrating to not be able to find things you need when you need them.”

This is a recurring theme from professionals I interact with across the entire healthcare spectrum.

The healthcare industry is a setting where assets are seemingly in constant motion. With this movement comes increased possibility for assets to be misplaced or leave the building, creating unnecessary replacement expense that can negatively affect your organization’s bottom line.

Real-Time Locating System, or RTLS, has been on the scene as a dependable solution to tag and locate important, valuable assets that easily go missing and has increasingly become more important to a hospital’s bottom line.

Stop Replacing, Start Locating

Where are assets and how are they being utilized? RTLS answers this question in ways no other technology has been able to before.

In my conversations with healthcare leaders, many express concern over how often valuable assets walk out the door. RTLS possesses the strength to know if assets are moving at hours or in areas they should not be, as well as when assets reach the door.

In the healthcare industry, assets such as PSA and infusion pumps, beds, wound vacs, ventilators, Doppler systems, and workstations on wheels are just a few items staff members are tagging and keeping closer tabs on thanks to RTLS.

Staff can also use RTLS to evaluate whether an asset should be moved from one area to the next to increase utilization, compared to simply buying another one.

As a whole, replacement costs are reduced and the amount of dollars sunk into unused or forgotten rental equipment becomes remedied thanks to RTLS.

At ZulaFly, I am often asked if there is a way for hospitals to track ambulances and other care transport vehicles so that hospitals can have a 360 degree view of what is happening inside and outside of the facility. We have developed a GPS offering that combines with RTLS to create this comprehensive view.

Increased Staff and Patient Safety

A quality RTLS system gives staff members a device that allows them to easily call for help in real-time.

Additionally, RTLS affords patients a button-press solution in case of an emergency. Because the RTLS tag allows staff to quickly locate where the issue is occurring, the situation can be quickly attended to and remedied.

Industry leaders are seeing the value of RTLS within their healthcare facilities, quickly realizing how reduced replacement cost and time saved searching for assets create considerable return on investment.

About Stephanie Andersen
Stephanie Andersen is a 17+ year professional within the software industry, spending over ten of those years working at Microsoft. Through various roles and responsibilities that range from technical support, to project management, to driving sales, to business operations and even product development, Stephanie has become focused on sales, marketing, and business development. This strong skillset and unparalleled experience has been key in developing the go-to market strategy that has brought ZulaFly from concept to completion, and most recently to market.

John Doerr’s Excitement for Digital Health

Posted on September 24, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

John Doerr, a venture capitalist in many of the most famous tech companies, was onstage at the TechCrunch Disrupt conference where he was asked which of his latest investments he was most excited in. He replied that his most exciting investment was still in stealth mode, but that it was a healthcare startup and that “They aim to do for healthcare what Google did for health.”

Here’s the video of John Doerr talking about this investment and investing in healthcare:

I always love when billionaires like John Doerr are spending some of their time focused on healthcare. Certainly many of them have underestimated the complexity of healthcare and the entrenched system. Certainly many of them have made some bad investments. However, I think the more entrepreneurs and investors that focus on improving healthcare the better. So, I’m pleased he’s spending some time and energy with healthcare.

As for this company in stealth mode, I’m pretty sure Wolters Kluwer might argue that they’ve been doing that with health information for a long time. It will be interesting to see what a new startup tries to offer when it comes to making the world’s health knowledge available in a consumable format.

ePrescribing of Controlled Substance (EPCS) Now Allowed Nationwide

Posted on September 1, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This is really exciting news. Especially for me since the only post I’ve ever taken down after it was published was a post I did about an FDA pilot of controlled substances on September 13, 2009. It turns out the press release I got was premature and so I took down the post since it wasn’t accurate information. About 6 years later (technically the DEA first proposed the rule in 2008), we finally have ePrescribing of controlled substance available in all 50 states.

Surescripts put together this great animated gif to celebrate the occasion.

We still have some work to do to get every doctor on board with ePrescribing, let alone ePrescribing controlled substances, but we’re getting there. In fact, I suggested today at me EHR workshop in Dubai that ePrescribing has been one of the most successful standards in healthcare. Can you think of any other healthcare standard that’s been more successful? HL7 lab data comes close, but I still take ePrescribing.

How long until we have near 100% adoption of ePrescibing? Any predictions?

Dropout Docs – The Answer for #HealthIT Startups?

Posted on July 23, 2015 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin is a true believer in #HealthIT, social media and empowered patients. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He currently leads the marketing efforts for @PatientPrompt, a Stericycle product. Colin’s Twitter handle is: @Colin_Hung

We’d like to welcome a new guest blogger to our ranks. If you’re on social media, you probably know Colin Hung (@Colin_Hung), Co-Host of #hcldr. Colin is also head of Marketing for @PatientPrompt, a product offered by Stericycle Communication Solutions. We look forward to many posts from Colin in the future.

Recently both Nick van Terheyden (@drnic1) and Mandi Bishop (@MandiBPro) shared a link to an interesting article via Facebook. “Dropout Docs: Bay Area Doctors Quit Medicine to Work for Digital Health Startups”.
Dropout Doctors - Bay Area Doctors Leave Medicine for Healthcare Startups
The article highlights a new phenomenon happening In the Bay area – would-be doctors are dropping out of prestigious medical schools to pursue careers in digital health. Even those that complete their schooling are opting to join digital health start-ups/incubators (like Rock Health located in San Francisco, very close to USCF Medical Center) rather than apply for residency.

Being a doctor or a surgeon was once the pinnacle of achievement in American society, but with changes to reimbursements and general healthcare frustration, many are not seeing the practice of medicine as the rosy utopia it used to be (or was it ever?). Now even physicians are succumbing to the siren call of #HealthIT where there is a chance to “do good” and make a difference on a large scale.

I believe this trend could be a good thing for #HealthIT. Having more peers who are enthusiastic and passionate about improving healthcare can lead to more positive innovations. Consider the following quote from a doctor who joined a health care company instead of practicing medicine (from the KQED article):

“I realized that the system isn’t designed for doctors to make the real change you would like to for the patient.”

Having more people who want to put the patient at the center of healthcare makes my #HealthIT heart race. You can’t teach people to have this inner fire. It is something that is intrinsic to the individual…and we need more peers in #HealthIT with this flame.

There is just one line from the article that don’t agree with:

“…dropout doctors are well-positioned for a career in digital health as they have an insider’s view of the industry – and ideas about how to fix it.”

I think it is a bit of a stretch to say that people who went through med-school have a true “insider’s view”. Having not worked in a practice or in a healthcare setting, they would not be familiar with the political, financial or workflow aspects of care on the front lines. I hope these doc-dropouts are humble enough to remain open-minded as they listen to real-life customers provide feedback on the technologies and solutions they are involved with. In fact, dropout docs would be well served by remembering one particular part of their medical training – truly listening to the patient – which in this case may be the entirety of healthcare.

Telemedicine Startup Offers Providers A Shot At Equity

Posted on April 22, 2015 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Over the last couple of years, the number of telemedicine vendors out there fighting for business has exploded.  These include DoctoronDemand, GoTelecare, HealthTap, MDLIVE, American Well and many, many more.

Health plans are jumping on the bandwagon too. For example, United Healthcare  has been running a popular national television campaign advertising its “virtual clinic” services. UHC is my plan, so I can attest that this service — shown as embedded in its member site — hasn’t been rolled out yet, but that only makes its desire to get out in front of the trend more noteworthy.

Telemedicine models in play include companies that recruit providers and sell them to consumers, vendors who enable telemedicine via proprietary platforms and firms that lead with community building. At present the direct-to-consumer players seem to be somewhat ahead, simply because they’ve already begun developing a national brand, but the story doesn’t end there.

Though consumer-facing telemedicine companies probably have a viable business model, they’ll have to build a memorable consumer brand to make it, something that takes a great deal of  time and money.  On the other hand, vendors that offer white-label telemedicine technology to hospitals and health plans have at least as much to gain, without having to win the loyalty of fickle consumers.

One telemedicine player doing just that is Nashville-based PointNurse, which has developed a distributed collaboration and communications platform providers can use to deliver telemedicine services. I just spoke to CEO Cyrus Maaghul, who gave me a company overview, and was interested to hear that his venture is taking things in some new directions.

PointNurse is different than most companies in the telemedicine space for a few reasons.

For one thing, the platform includes block chain capabilities, which allow providers to accumulate credits for both community participation and actual care delivery. (In case you aren’t familiar with block chain technology, which powers crypto currency Bitcoin, you may want to click here.)

These credits aren’t just for fun. Eventually, when providers accumulate enough credits, they get a pro-rata share of a dedicated pool of equity.

Consumers, for their part, are given a multi-signature wallet which stores both their personal and clinical information, resulting more or less in a PHR with added capabilities. PointNurse hasn’t yet devised a way to share the data with provider EMRs, but that’s a short-term goal.

A wide range of providers can participate in PointNurse, including not only MDs but also nurse practitioners, pharmacists, RNs, LPNs and elder advocates.

A sister venture, HealthCombix, will license the technology underlying PointNurse to hospitals and payers. HealthCombix will provide APIs and tools to build their own distributed applications.

As Maaghul sees it, it’s critical for providers to realize more than a short-term benefit from participating in telemedicine. “I wanted to make providers feel highly motivated — that they can gain from this [arrangement],” Maaghul said. “This creates value for the patient.”

Of course, there’s no proof yet that this or any particular telemedicine business model is going to capture its market niche.  In fact, it’s not even clear what niches will emerge in this space; after all, though it’s moving fast it’s far from mature.

That being said, this approach has some intriguing aspects. I’ll be interested to see whether its business model and and unusual underlying technology work out.

The Fundamental Challenge of Building a Healthcare-Provider Focused Startup

Posted on March 6, 2015 I Written By

Kyle is CoFounder and CEO of Pristine, a VC backed company based in Austin, TX that builds software for Google Glass for healthcare, life sciences, and industrial environments. Pristine has over 30 healthcare customers. Kyle blogs regularly about business, entrepreneurship, technology, and healthcare at kylesamani.com.

Over the past few years, the government imposed copious regulations on healthcare providers, most of which are supposed to reduce costs, improve access to care, and consumerize the patient experience. Prior to 2009, the federal government was far less involved in driving the national healthcare agenda, and thus provider IT budgets, innovation, and research and development agendas among healthcare IT vendors.

This is, in theory (and according to the government), a good idea. Prior to the introduction of the HITECH act in 2009, IT adoption in healthcare was abysmal. The government has most certainly succeeded in driving IT adoption in the name of the triple aim. But this has two key side effects that directly impact the rate at which innovation can be introduced into the healthcare provider community.

The first side effect of government-driven innovation is that all of the vendors are building the exact same features and functions to adhere to the government requirements. This is the exact antithesis of capitalism, which is designed to allow companies to innovate on their own terms; right now, every healthcare IT vendor is innovating on the government’s terms. This is massively inefficient at a macroeconomic level, and stifles experimentation and innovation, which is ultimately bad for providers and patients.

But the second side effect is actually much more nuanced and profound. Because the federal government is driving an aggressive health IT adoption schedule, healthcare providers aren’t experimenting as much as they otherwise would. Today, the greatest bottleneck to providers embarking on a new project is not money, brain power, or infrastructure. Rather, providers are limited in their ability to adopt new technologies by their bandwidth to absorb change. It is simply not possible to undertake more than a handful of initiatives at one time; management can’t coordinate the projects, IT can’t prepare the infrastructure, and the staff can’t adjust workflows or attend training rapidly enough while caring for patients.

As the government drives change, they are literally eating up providers’ ability to innovate on any terms other than the government’s. Prominent CIOs like John Halamka from BIDMC have articulated the challenge of keeping up with government mandates, and the need to actually set aside resources to innovate outside of government mandates.

Thus is the problem with health IT entrepreneurship today. Solving painful economic or patient-safety problems is simply not top of mind for CIOs, even if these initiatives broadly align with accountable care models. They are focused on what the government has told them to focus on, and not much else. Obviously, existing healthcare IT vendors are tackling the government mandates; it’s unlikely an under-capitalized startup without brand recognition can beat the legacy vendors when the basis of competition is so clear: do what the government tells you. Startups thrive when they can asymmetrically compete with legacy incumbents.

Google beat Microsoft by recognizing search was more important than the operating system; Apple beat Microsoft by recognizing mobile was more important than the desktop; SalesForce beat Oracle and SAP because they recognized the benefits of the cloud over on-premise deployments; Voalte is challenging Vocera because they recognized the power of the smartphone long before Vocera did. There are countless examples in and out of healthcare. Startups win when they compete on new, asymmetric terms. Startups never win by going head to head with the incumbent.

We are in an era of change in healthcare. It’s obvious that risk based models will become the dominant care delivery model, and this is creating enormous opportunity for startups to enter the space. Unfortunately, the government is largely dictating the scope and themes of risk-based care delivery, which is many ways actually stifling innovation.

Thus is the problem for health IT entrepreneurship today. Despite all of the ongoing change in healthcare, it’s actually harder than ever before to change healthcare delivery things as a startup. There is simply not enough attention of bandwidth to go around. When CIOs have strict project schedules that stretch out 18 months, how can startups break in? Startups can’t survive 18 month cycles.

Thus the is paradox of innovation: the more of it you’re told to innovate, the less you can actually innovate.