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Healthcare Entrepreneurship-as-a-Service

Posted on May 7, 2014 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.

We are witnessing a dramatic unbundling of the services that power business. Almost every aspect of business can be unbundled into a monthly service.

My startup, Pristine, runs on a number of unbundled cloud services that until recently, would have traditionally been outsourced to HR firms or mega-IT companies. We run Pristine on ZenPayroll, RelateIQ, Google Apps, Expensify, Maxwell Health, Xero, Resumator, MediaTemple and more. Similarly, we’ve built our flagship service, EyeSight, on top of a broad array of development tools and services (check out the Pristine Engineering Blog to learn more about how the sausage is made). We’ve made it a priority to invent and do as little as possible by utilizing 3rd party stacks and services everywhere possible.

Healthcare is not immune to this trend. There are a number of companies that are unbundling health IT entrepreneurship:

This list should be 10x longer than it is. With all of the capital and startups entering the health IT space, companies providing the infrastructure to accelerate growth will thrive. As the old saying goes, “During a gold rush, sell pickaxes.” The companies listed above are selling pickaxes to proverbial gold miners.

I’ll conclude this post with some areas that can be commoditized as a service. Feel free to leave comments on other areas or companies that I missed.

  • Interoperability as a service (in lieu of HL7)
  • HIPAA compliant videostreaming as a service
  • HIPAA compliant image / video sending as a service
  • Analytics as a service

The Feds Are Supporting Telemedicine

Posted on May 5, 2014 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.

The Federation of State Medical Boards (FSMB) recently passed a model telehealth policy that promotes virtual visits for first-time encounter. This is notable for 2 reasons: first, many state medical boards liberally borrow from the federal boards, and second, this marks a shift from the old model in which patients were encouraged to see providers in person before engaging in telemedicine consults.

It’s encouraging to see the old, arbitrarily restrictive model fade, in favor of one where patients can begin building a relationship with their physician without travel. Indeed, people meet on the internet all the time; why can’t patients meet their care providers the same way?

The old model was arbitrarily limiting access to care, and thus driving up costs and driving down quality. Under the new model, patients should finally be able to login to a web service and be connected directly to a qualified physician that payers will cover. For telemedicine companies like American Well, Doctor on Demand, and others, this is a major coup.

This combination of technology and new guidelines will reduce ER visits, improve access, and ultimately reduce costs. Once it’s easy to get access to preventative medicine, patients will actually partake in preventative care. As a simple example to illustrate this, let’s examine my wellness check up habits.

I’m a healthy young male. I haven’t been to the doctor for a check up in close to a decade and have no intention of going. The process of booking an appointment, leaving my job that I love, and sitting in a waiting room are enough to deter me from ever going to the doctor. But if I could step into a private space and consult with a physician via a video consult for 15 minutes, I might actually get an annual check up. If the physician discovered something concerning and asked me to come, I would actually come in. But I would never come in for an in person visit without an explicit reason to. It’s not worth the pain and headache of going into the doctor’s office unless I have a reason to; the only way to achieve preventive medicine at scale is to make it easy for patients and providers alike.

Ambulances, ERs, and urgent care centers should expect a similar change in their operations. In these environments, specialists can now be reimbursed for first time consults with patients across a range of devices – iPhones, iPads, Androids, Macs, PCs, and even Google Glass. Neurologists can beam into ambulances for strokes, cardiologists for cardiac resuscitations, and trauma specialists for trauma cases. The opportunities are really endless, and my company, Pristine, is proud to lead the way in these new hyper-mobile telemedicine environments.

On the other hand, the new guidelines set forth by the FSMB aren’t all positive. Perhaps most perplexing, the FSMB did  not classify messaging and audio-only phone calls as telemedicine. They didn’t strictly forbid either activity, but they made it clear to payers and providers that live, synchronous video is necessary for reimbursement. In light of the shift to ACOs and value based models, this is perplexing. It’s been suggested that Kaiser Permanente and Group Health physicians reportedly spend up to 2 hours per day interacting with patients through asynchronous messaging.

Despite some setbacks in the new standards set forth by the FSMB, I’m incredibly excited about the future of telehealth across the continuum of care. The new model put forth by the FSMB is just the first of many steps toward a healthcare delivery system in which telemedicine powers the majority of care delivery across the country.