Innovation in Healthcare Technology

A few comments from an outside observer

I woke up this beautiful (read: misty and cold) San Francisco morning and decided to do a bit of reading. I came across an article which I disagreed with, which led to an impromptu rant on the state of technology in healthcare. Instead of slapping it on the article’s comments, I am posting it here.

I want to present my opinions with the caveat that I’m not in healthcare. I’m a software guy, and I would *love* to talk about this with folks more knowledgeable.

The original article is over at VentureBeat, go read it now. I’ll wait.

My rambling response, which should read as a warning to any entrepreneur who’d think of jumping head-first into this “multi billion dollar opportunity”, is below:

I read the article with hope but doesn’t seem like there’s much new or even specific highlighted by the author. These promises have been made for some time, but as always in entrepreneurship, the idea means nothing. The challenge is execution: developing market-ready versions of these promises and financing their adoption in a staid marketplace filled with traditional risk-averse buyers while having the faintest hope of making a profit in a reasonable time-frame is actually *very difficult*. This post ignores the skeletons of dozens of startups who’ve seen the same opportunities and flung themselves at them with all the apps they could build.

In my opinion, writing an article purely about trends that have been ongoing for years (decades?) without discussing the abysmal success rates for the startups “riding” them is only presenting one side of the coin. not including specific examples of products that could be built to address those trends makes it worse. Here’s my brain dump:

IMHO, health-tech innovation is lagging far behind the internet. HealthTap itself is a glorified forum, not that there’s anything wrong with that. Most of what’s written in this article is trivial to build from a technological perspective; it’s Yelp / OpenTable / Palantir applied to healthcare, these aren’t new ideas and they have been attempted. The hard part is getting adoption in a market of bumbling physicians and the clueless risk-averse bureaucrats managing them, all but the most enlightened too wrapped up in the demise of their profession to learn how to use apps on their iPhone. [wait: are we talking about healthcare or venture capital? /jk!]

Actually, the problem is deeper than that. In my experience the hard part is that “talent to build” and “ability to sell” seem to be confined to totally distinct subsets of companies especially when it comes to health-tech. For example, the dashboards the article above describes are trivial to design and build for a good product + engineering team (cf. @axiomzenteam) BUT to sell them into the healthcare system requires a slog of unfathomable proportions. Conversely, the folks that have the healthcare connections and would be able to get a hospital to trust and buy their system will know next to nothing about user experience and product design. Or perhaps they will not care, because they know their product will be bought on the basis of golf games not screen shots. They will hire an ex-MSFT dev lead and a team of offshore programmers and build something so ugly and difficult to use it will give the hospital in question technology indigestion for a decade.

Take electronic medical records, the simplest and most blindingly obvious use of digitization to improve patient care. In the days of paper records, doctors took a half hour at the end of their day and scribbled up patient notes. Now, doctors are forced to wrestle with terribly-designed software, going through a half-dozen clicks between accomplishing simple tasks not only burning time but generating frustration and mental waste. Patient records now take *longer* to maintain, which makes doctors dislike the software, which makes the entire healthcare system reluctant to try new technology.

I would have loved to see some discussion of how to elevate urgency with doctors and hospitals. I would have loved to see what *they* consider important and what *their* priorities are for the coming few years. If it’s the predictions in this article, great; no technological innovation needs to happen. All we need to do is find out who Sean is talking to and build some apps for them.

I also think (hope?) that real “innovation” in healthcare can go way beyond medical records and finding good doctors or visualizing outbreaks on a map. It can be about using big data to find cures or treatments for rare diseases. It can be about making clinical studies crowdsourced and more efficient. It can be about personalized medicine, genomics, and the possibilities offered by technology to entirely disintermediate the hospital or doctor’s office. It can be about long-distance consults and surgeries, or about empowering nurses into providing more holistic care. Perhaps most cool, it can be about sensors - tiny ones that go inside your body or more powerful ones that see in from the outside - and the software required to crunch the massive amounts of data into usable, actionable insights.

It can even be about providing doctors the information they need to branch out from the current mindless specialization and narrowmindedness, and look at medicine from a broader perspective, taking in multiple inputs and seeing a patient’s pains in context of his/her whole life, diet decisions, medical history, financial realities, even quantified self metrics (data that should definitely be protected from snooping by the healthcare system). Unfortunately, to physicians today, the pain they see depends on what they’ve been trained to see: if i’m holding a hammer, all I see are nails. This perspective belies much of the waste in America’s healthcare system. I don’t think that software, no matter how brilliant, is enough to enact change by itself.

I don’t mean to sound defeatist: on the contrary, I would relish the opportunity to work with smart, passionate, and realistic folks from the healthcare industry to reify the promises of technology in making our lives better. It just seems to me that the challenges are *not* technological, as implied by most commentators; they are human.