The Pursuit of Something Really Worth Doing

Simon Woodside and Balaji Gopalan, founders of MedStack

MedStack is a developer platform for fully-integrated and secure healthcare apps, enabling an ecosystem of digital experiences that enable better, more informed care. In the following article, MedStack co-founder Balaji Gopalan discusses why he took the leap to work on such a bold venture.

When I explain to people that MedStack is my first startup, I’m occasionally greeted by expressions of surprise that it took me so long to getting around to it. I’ve been openly enthusiastic about technology and entrepreneurship for a number of years, but always as employee in someone else’s company, or as an advisor or educator.

The answer to what to the question of what took me so long stems from the sense of healthy skepticism I’ve developed over the years. Let me be clear: I carry a positive outlook in most things. But I’ve come to realize that important initiatives must be pursued with an even mix of elbow grease / hard work and regular, diligent questioning of whether one is on the right path and on the right end of the Pareto Principle. It’s not easy to start a company, so I wanted to ensure, before I gave up all the things one gives up to run a startup (especially in one’s early 40s), that I was onto something I could really feel good about sinking my teeth into.

MEDSTACK’S ORIGINS

MedStack wasn’t my idea. In fact, I’m not entirely sure I could have come up with this kind of idea on my own. I’ve always thought of myself as less of an ideas man and more of the enthusiastic, operational critic, a “yellow Pen person” in the vernacular of the excellent book Back of the Napkin. This approach would serve me well, when my brilliant and adventurous co-founder Simon Woodside, who had been building healthcare apps for a number of years, called me up and asked me to explore with him the theory that a platform to make healthcare integration easier for apps would lead to a transformative new ecosystem.

Turns out, his hypothesis had merit.

PLATFORM THINKING

I’ve been working with platforms for more than a few years. I’m fascinated by them, which is somewhat unexpected given that I can’t really call myself a software developer in any sense of the word. But the business dynamics involved in one company opening up its technology assets to another, democratizing its business position to others so that truly revolutionary products, solutions, experiences and workflows may be created that neither could or would create on their own, really inspires me.

I’ve been fortunate to have had the opportunity to work on many platform projects over the past two decades, from:

• the first cross-company aircraft program at Bombardier Aerospace;
• to opening up of BlackBerry’s proprietary push infrastructure to developers
• to helping to bring mobile to the world’s biggest Internet companies,
• to launching an app showcase at D2L,
• to introducing Nymi’s wearable security Developer program,
• to helping EventMobi with their events platform strategy.

I’ve been witness to numerous examples of sums being greater than their parts. When I was presented with the idea behind MedStack, I was intrigued by the opportunity to apply the same postulate to something as big and important as healthcare.

THE HEALTHCARE APP OPPORTUNITY

What follows is an outline of my analysis of the MedStack opportunity and how I turned healthy skepticism into tremendous optimism for what we’re doing:

I have numerous friends and relatives in healthcare professions, and I also have aging parents who are heavily reliant on healthcare services. My wife is a physician and one of the hardest-working people I know, consistently motivated to provide better care and experiences for her patients. In conversation with them, however, I’ve come to learn first-hand how healthcare data is collected, analyzed, shared and communicated in typical systems. I was shocked by the stark contrast to other verticals, in which continuum of technologies that blur the line between consumer and enterprise paradigms have become critical components in delivering value. Meanwhile, in healthcare, we have:

• a population makeup that continues to skew more elderly;
• chronic disease more prevalent than ever before;
• hospitals overrun while wait times continue to be too long

but the industry still largely runs on paper charts and documents, and memory-delivered histories via in-person interviews.

Unlike most other verticals, healthcare is still reliant upon paper and interviews

Both Simon and I have come into the healthcare industry through similar inspirations, asking: why is software eating (nearly) everything, while this, arguably the world’s biggest problem, seems largely unaffected?

It isn’t, entirely. Health and Fitness apps are the fastest-growing category in the mobile app stores in terms of usage by a factor of 2. They’re estimated to be worth $6.5B now, and will be worth over $27B in just two years. The opportunity is recognized, and it’s BIG. But it needs something else to stick, to go beyond downloads to something that truly changes us and the way we live.

BUILDING APPS IS EASIER THAN EVER BEFORE … RIGHT?

In my work to build and deliver a unique, wide Product Management education curriculum at BrainStation, and in consulting on product strategy with various startups in our community over the past couple years, I’ve come to develop an updated and renewed appreciation for the powerful set of tools available to innovators to build digital applications of many shapes and sizes. It’s now easier than ever before to spin up a company and a product at very little cost.

Software innovators and visionaries are the new heroes of the business world, and:

• digital design tools,
• online research,
• testing, feedback and support tools,
• platform services,
• cloud infrastructure,
• mobile integration frameworks,
• real-time analytics,
• app stores,
• social media,

coupled with:

• accelerators,
• enthusiastic mentors
• and an increasingly adventurous capital market (with still a ways to go, mind you)

means we can all walk through that door.

But when it comes to healthcare, the game is just different.

WHY HEALTH APP INNOVATORS FACE UNIQUE CHALLENGES

With the emergent digital health data privacy regulations in the US and Canada and elsewhere, such as HIPAA and PHIPA, one can’t simply send patient data through run-of-the-mill cloud services, nor consumer messaging platforms. And as the news demonstrates, there is a crackdown of increasing frequency on violations of these new and very complex regulations. The rules aren’t written by technology startup people and our experience tells us that it can run between $30,000 to $1M and a few months to a year or more delay for compliance-readiness to be built by startups, in architecting all the physical, logical and procedural security protection measures which are outside their scope of interest or expertise.

Innovators looking to transform the way healthcare professionals deliver care through digital tools typically respond to this through one of three approaches:

1. They try to figure it out themselves, to the tune of delays and expense as per above.
2. They hire consultants to handle compliance for them, which works, but is also very expensive and is only a temporary fix, as the regulations evolve.
3. They decide not to bother, in hopes that they can get away with it, or more likely, that they won’t be sharing patient data at all and leave it as a pure consumer play … one more fitness tracker in the App Store.

The generally-accepted rule of software is: if you have to build something that isn’t your interest or expertise, leverage a third-party or open-source platform, as described above. None of these approaches take advantage of that well-proven adage, and that is the opportunity presented by MedStack.

WHAT IS MEDSTACK?

MedStack’s first reveal in April 2015

MedStack is many things, but in aggregate, it’s a system that powers the creation of applications that collect and share patient data, and the integration of those applications into a holistic ecosystem that connects Developers, Patients, Providers, Payers and Institutions:

• We have a fully built-for-compliance cloud infrastructure, supporting both Canadian and US regulations independently.
• We take care of the monitoring, logging, restricted access, physical and logical security for our customers so they don’t have to and we do it to the letter of patient data privacy law, based on Simon’s years of experience in healthcare apps.
• We offer app workflow building blocks similar to those found in consumer platform services such as Salesforce’s Heroku, and Google’s App Engine, but purpose-built for healthcare: secure, compliant identity management, health data form entry, health wearable and sensor monitoring, a health data object store, secure, compliant messaging, and de-identification and data aggregation support for big data analytics.
• We standardize data model definitions for everything from blood pressure to wait times to insurance codes across all apps on Medstack, cloud-enabling industry-supported standards like Apple HealthKit, ResearchKit and CareKit, and HL7 FHIR, uniquely enabling Provider and Payer systems to support at scale multiple applications all through a single integration point and interface, and greatly reducing the complexity and cost in Electronic Medical Record data interoperability. This is the key to opening the healthcare opportunity to a wider ecosystem of Developers.
• And we’ve structured our business to easily partner with application design and development service studios so that we can help healthcare workers with innovative ideas to improve the care they deliver to patients via apps implement their visions without the burden of complex and heavy IT resource analyses.

SO WHAT DOES ALL THAT MEAN?

As we bring the secure software platform approach to healthcare, particularly the currently-barren space between consumer health, fitness, nutrition and sleep tracking and hospital IT, where everyday technologies can cloud-deliver machine / IoT / wearable / app-sourced data to healthcare workers so that they can provide better, smarter and faster care to the patient, magical use cases emerge. Our vision is that clinic visits become re-characterized from “Tell me what happened” to “I know what happened. Let’s talk and do something about it.” An extensive marketplace of applications, integrated with healthcare institution data systems and with insurance Payer triggers, will be available to providers to choose from and recommend to patients, just as they do medication, therapy and medical devices.

And this is why I’ve taken the leap. I wanted to ensure my startup adventure would be in building something really worthwhile. MedStack seeks to solve a difficult problem that has the potential to change the world at a fundamental level, and I believe I’m uniquely equipped to tackle the problem because it requires and will only be possible via a platform strategy, something I know a little about.

We are absolutely thrilled and honoured to be a member of the world-class technology startup communities in Waterloo, Hamilton and Toronto, Canada, Philadelphia (see below), as well as their parallel health innovation ecosystems in the local community and in academic hospital networks. We’re hoping and expecting that our platform can bridge these two worlds, accelerated by the tremendous talent around us. We know we’re only getting started, and we will most certainly be challenged and face additional big mountains to climb.

Powered by our vision in 2016.

But nothing really worth doing was ever easy.

UPDATE: MEDSTACK IN 2016

I have received overwhelmingly positive feedback on this article and support from friends, colleagues, mentors and others in the entrepreneurial world, and felt an update was warranted for those curious how our mission is progressing in the time since.

The idea behind MedStack is bold, but for those building healthcare apps, or those in the healthcare system driven to provide better care, the gaps that we seek to address are important and obvious. We now have 6 customers committed and fully engaged with MedStack, from startups to institutions, with a large pipeline in play. Applications being built and offered include those that manage scheduling and wait times, systems for therapy adherence and condition detection and reporting.

But our big adventure is still ahead. In the Spring of 2016 we were chosen to join the latest cohort of Dreamit Health, a US-based Venture Accelerator focused on healthcare technologies and innovation. We join 15 other companies from around the world, carefully chosen from a pool of several hundred, and are now exploring the opportunities MedStack can bring with tier 1 healthcare institutions such as Penn Medicine, Independence Blue Cross and Johns Hopkins University. App-powered care feels closer than ever.