Every day it seems that we read about the launch of a new startup or technology application claiming to disrupt and reinvent the health care system. This flood of activity comes at a time when the health care industry is in dire need of entrepreneurial spirit, fresh perspectives and new skills. But to create products and services that have the potential to make a large impact, entrepreneurs and health care professionals need to work together.
For new products to impact health and health care outcomes, we must find a way for them to be adopted by physicians, patients, health care institutions, third-party payers, and regulatory agencies. This will require entrepreneurs and institutions to work together.
The majority of health startups today appear to be disconnected from the health care systems they are trying to change. In most cases, this seems to be by design. Entrepreneurs pride themselves on innovative thinking that is outside the established norms and models. To quote Einstein, “We can’t solve problems by using the same kind of thinking we used when we created them.”
While entrepreneurial thinking leads to exciting new ideas, it often sidesteps two key constraints of health care design: integration into established health care systems, and adoption by both patients and providers based on the product’s effectiveness in achieving desired outcomes. In a collaborative environment, research can inform development of ideas from the beginning of the product cycle. For example, mobile app startups focusing on fitness and nutrition could benefit from learning about the National Heart, Lung and Blood Institute’s POWER trial, which demonstrated the effectiveness of remote behavioral intervention in achieving sustained weight loss for two years.
At Mayo Clinic, we work on inter-disciplinary product teams that include designers, strategists, health care professionals, technology partners, and most importantly patients. Yet even with designers embedded inside Mayo Clinic, we routinely encounter wicked problems (problems that are impossible to solve because of unclear or changing requirements) when it comes to implementing solutions into clinical operation. Driving product development towards better health care outcomes requires the coordination of many aspects of the health-delivery system.
We recognize that the health care institution is only one of the many stakeholders required to successfully bring new solutions to market. For example, Mayo Clinic’s Healthy Aging and Independent Living (HAIL) lab is a participatory prototyping environment within a retirement community in Rochester, Minnesota, that specifically involves external partners--i.e. retirement community residents, physicians, administrators, insurers, and retail distributors--in the product research and design process. The HAIL Lab will be a place for designing, prototyping, and piloting new services and technologies to promote "aging in place," helping seniors stay home.
Today’s established health care institutions, rife with legacy systems and bureaucratic processes, have to learn from fast-moving entrepreneurial startups. We believe that a successful transformation of the health care system will come from a collaboration between the two, leveraging their unique strengths, expertise, and knowledge. One of the challenges will be bridging these two very different cultures and value systems to achieve health care innovation that creates value for patients as well as for established health care organizations.
The entrepreneurial spirit is driven by a passion for bold change and fueled by rapid advancements in technology. Entrepreneurial efforts to “change the world” are frequently met with resistance. Naysayers question product feasibility and stakeholders apply pressure to maintain the status quo. Competition is intense and constrained time lines and budgets drive strategies and decisions based on short-term thinking. Success in this environment requires top talent, a high level of autonomy, tolerance for ambiguity, and a fast-cycle iterative design and development process. Problem solving is based on “in-market development” and rapid learning from failure.
There is a critical gap between the way many entrepreneurs think about the problems in health care and the way medicine is actually practiced by the physician and experienced by the patient. In many cases entrepreneurs frequently lack the health care expertise required to identify critical issues related to patient and physician needs, health care outcomes and costs, and barriers to adoption.
So does a bigger company stand a better chance? Google Health was built around the assumption that people wanted to actively collect and store their health data, and it ultimately failed to gain widespread adoption. Still, Google was unable to build a service that could be integrated within the existing health care ecosystem. As ex-Apple CEO John Sculley notes,"the thing that is missing [in health care] is getting the people with the domain expertise aligned with the people with technological know-how to turn ideas into branded services." Mayo Clinic has partnered with many large technology enterprises and still finds the critical issue of adoption and implementation to be a continuous challenge.
Entrepreneurs recognize the importance of technological innovation in just about every area of human endeavor, including health care. But at the same time, they can be techno-centric and disconnected from the specific problems facing health care today. The risk is that one ends up with an innovative technology in search of a health care problem to solve or a need to retrofit a solution into a system for which it was not designed. In some cases, the solution simply does not address an unmet medical need. In other cases, a new technology cannot be integrated into current practice and workflows. While the latest popular technology may initially attract many users, in health care, success is not measured by the number of users in the short term, but by impact on health care outcomes.
Progress in medicine is driven by science and technology, but the practice of medicine is also an art. It involves judgment based on experience, a high degree of integrity, communication and trust in the physician-patient relationship, and compassion. Physicians and health care professionals are trained in the complexities of disease mechanisms, treatment and prevention, and navigating the health care infrastructure. While diagnostic and therapeutic decision making can be enhanced by computer-based algorithms, disease management also requires an understanding of the patient experience combined with a high dose of compassion and empathy. That can’t be substituted with technology.
There seems to be a disconnect between the practice of medicine and the way in which many health care startups view innovation and technology. There is also a gap between the pace of innovation and the capacity for established health care institutions to rapidly design and adopt new technological advances. This can be partly attributed to the differences between the culture, values, and goals of established health care organizations and those of entrepreneurial startups. Health care institutions are frequently organized into departmental silos and employ traditional management models and bureaucratic systems. Such infrastructure does not easily lend itself to the fast-paced, iterative, consumer-based design process employed by startups, and it makes it difficult for startups to integrate their solutions into the health care system. Many health care startups are attempting to apply their technologies to complex medical conditions without having involved physicians or patients during the design process. Even in areas such as fitness and nutrition, the likelihood of success would probably be increased by involving the right people from in the medical community.
While we recognize that health and health care apps are still in their infancy, many end up being deleted within the first week of being downloaded. That said, the health care apps that have shown promise are those that have targeted chronic diseases, and have been designed in collaboration with the medical community and then piloted with patients to evaluate its efficacy. Imagine the possible impact these solutions might have on health and health care outcomes if they were designed in such a way that a physician or nurse could prescribe them to their patients.
Given the complexity of medicine--prevention, detection, diagnosis, treatment, management, and palliative care--how can a startup develop a solution that will have a positive impact on a health care system in transition? The solution is an interdisciplinary team that cuts across different technologies, biomedical disciplines, and organizational cultures.
This team needs to involve patients, physicians, entrepreneurs, and health care executives. It needs to develop products that will improve health care outcomes and that can be easily adopted by key stakeholders. To get started, entrepreneurs need to consult with patients, empathize like doctors, talk to hospital administrators, and communicate with health care organizations during the design process. Health care organizations will also need to get serious about collaborating with entrepreneurs earlier rather than later. Addressing the challenges within health care will not be easy, but it doesn’t have to be so complicated--you just need a small interdisciplinary team that can design like an entrepreneur, empathize like a doctor, understand the patient, and effectively navigate the health care system.