A guide for entrepreneurs to get a doctor’s attention

I’ve had the luck to attend medical school in the city of San Francisco during what will be looked back on as the start of transformational change in our health care system. My growing interest in technology and new business models as the disruptive forces behind this change, as well as marriage to a technology entrepreneur, has me frequently rubbing elbows with movers and shakers in the digital health space. One question I constantly receive (other than how I feel about being replaced by a computer) is how to get ideas and products in front of practicing physicians. Even more commonly, I’m asked why we are so resistant to technology and change in the way we practice. My reply usually takes some form of the following.

1. Show us the data. The robust system medicine has developed for testing innovations in clinical care, disseminating these ideas, and transforming practice standards is being entirely overlooked (or alternatively scoffed at for being too cautious and slow) by most entrepreneurs. We insist on data to show that the newest pharmaceutical drug, procedure, or implantable device is safe and at least as efficacious as placebo, (and due to comparative effectiveness, this may soon become as compared to the standard of care). It should not be any different for an EKG iPhone app I use to rule out a myocardial infarction in your mother, or a motivational weight loss app the patient invests days of their time into with no results. These are not restaurant recommendations where a failure means bad sushi. These are people’s lives and well being, and we feel it’s unethical to start recommending unproven products.

2. You are at the wrong conferences. Instead of attending only flashy mobile and health 2.0 conferences, consider showcasing your wares at the medical society conference most relevant to your product. Most of us are not paying several thousand dollars (remember we don’t have expense accounts) to watch five minute demos on Beta version products, with panel commentary by investors and consultants rather than people who actually practice medicine.  For example, if you have a product for chronic disease management or care coordination, consider the next American Academy of Family Physicians conference. Or attend the local medical society meeting and connect with the medical thought leaders in your community. This message is also important for the individuals in government and major private payers trying to stimulate innovation and physician uptake in this industry.  They must appear at our medical society conferences and grand rounds at leading institutions with assurances that the major regulators and payers for health care are going to put their money where their mouth is. The Office of the National Coordinator has done an impressive job of this with electronic medical records and e-prescribing.

3. You are being written about in the wrong places. Even doctors know that product descriptions on TechCrunch are often essentially spell-checked versions of the founder’s press release. You may be hot at the next tech meet up, but we couldn’t care less, and even fewer of us are consistently reading that website. Figure out where we get our information and focus your efforts there — it’s the health section of major newspapers, sites like iMedicalApps.com and here at KevinMD.com, or more commonly high quality academic journals where your claims and data have been analyzed by someone other than an unpaid intern.

4. You don’t understand the health care payment and regulatory system, and why I can’t buy what you’re selling. Most physicians have no room to be innovative or take chances in their clinics due to the highly regulated environment we work in, and we dismiss you if you call us afraid of change. I realize entrepreneurs and regulations are like oil and water. But ignoring them or expecting us to find the loopholes for you leads to naive business plans. Be our partner in proving these products work so payers and the hospitals systems most of us now work for will get on board. Alternatively, seek out those systems that have some form of capitation for payment, or the increasing numbers of membership-based primary care clinics. These business models have more leeway in what technologies they use to provide care, and an obvious incentive to invest in lower cost quality alternatives.

5. You come off like a used car salesman. Remember that the pharmaceutical industry got to us first, and we are on high alert for smoke and mirrors. Have you ever considered the ratio of adjectives to nouns and verbs in your pitch? We are increasingly skeptical of terms like “crowd sourcing”, “social”, “big data”, or “mobile” as cover for a product that has only a website placeholder and a hypomanic founder.  A mature dialogue means admitting that fixing health care isn’t easy, and that the current system while broken is not made up of fools who despise novelty.

6. You misuse the expertise of physicians and other health care providers in your company. Our value is not in confirming that your congestive heart failure protocol is accurate; our real worth is in the business model and product design, especially if its a product you want integrated into our work flow. Sure the guy in practice for forty years who hates computers isn’t a great partner. But you put yourself at a competitive disadvantage when you don’t have a sharp business partner who also understands the immense complexities of medicine, the health care system, and how a physician, payer, or hospital administrator actually thinks. The smorgasbord of mobile health applications developed in the last few years, with few finding any real traction, suggests to me that its not the technology that is the hard part. Consider how long email has been around, and how few people can use this medium to communicate with their doctor. I certainly don’t think you need to drink the health care industry Kool-Aid for ten years to solve serious problems. But I do believe you need to at least know what’s inside the box to think outside it.

I’ve love to hear from other physicians. What else could digital health entrepreneurs do to get their products in front of and used by clinicians?

Rebecca Coelius is a medical student and founder of SpanAfrica.

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  • http://www.consentcare.net/ Martin Young

    My conundrum is that I am a doctor with a good idea battling to find an entrepreneur to develop it. Works both ways!

    • http://www.facebook.com/RebeccaCoelius Rebecca Coelius

      Absolutely! I’d suggest going to a few of the digital health incubator meet ups, lots of young programmers and other tech savvy folks there who will dive right in if your elevator speech moves them. I’m not sure where you are located, but you could try Blueprint Health, StartUp Health, Rockhealth. Some academic institutions have departments that try to make these linkages, for example at UCSF we have a new Center for Telehealth. The West Wireless Institute in San Diego widely advertises being interested in collaborations too. Even better would be a programmer or other entrepreneur writing a rebuttal to my post. =) 

      • Anonymous

        Rebecca,

        Great post!  I’m a physical therapist and I also embrace your idea of the transformation of the health care system.  In fact I believe we are on the brink of a revolution greatly led by technological innovation.  I’m presently conceiving and incubating an idea for my profession that can only work if embraced hand in hand with the physicians we rely upon for a steady flow of patients.  I’m lucky because I’m working with a group I’m certain can produce the technology that in no way I could ever do as a PT (similar to your fortune of being married to a tech professional) .  We are presently in the market analysis phase of the process and where we’ve had great success probing and surveying rehab professionals, we’ve had difficulty breaking through to have MDs hear us out in the same way.  As I said, we are in the “idea” phase of things without a product.  Any suggestions as to how to best get the opinion of MDs where at present it appears they have little interest dealing with a little old PT?

        I’m on the East Coast and wondering what exactly Blueprint Health, Startup Health, and Rockhealth are and if they are something open to a wider range of health care professionals.

        Thanks a bunch!

        • http://www.facebook.com/RebeccaCoelius Rebecca Coelius

          Hi Jeff,

          Sorry you aren’t getting much traction with your referring MDs. Its hard to answer your question without a sense of the product, but I’d think that neuro, any of the outpatient adult specialities like Fam Med or Internal Medicine, and PMNR would be a good start. I’ve had great luck just in cold calling or emailing if its presented as an idea to collaborate on rather than a product to be purchased. I know PTs are often folded into orthopedic practices out here, perhaps that could also be a way of making some direction connections to MDs through a PT colleague? I know its hard if you aren’t affiliated with an academic center or the system you work in doesn’t have you rubbing shoulders often. You could also consider posting your idea and a request for feedback on one of the LinkedIn groups. The AAFP and ACP has one, and Health 2.0 is a great discussion group. 

          The organizations listed are digital health incubators, people chosen receive a small amount of start up money and lots of mentoring and support from world class people in tech, investing, medicine, and payer sides of the industry. They all also hold frequent meet ups that range from bar schmoozing to more formal conferences open to all. Definitely great places to start (Blueprint and StartUp are in the NE, RockHealth is out in SF). I also found PlanCast and MeetUp really helpful when I was living in NYC for identifying digital health events. 

          Good luck! 

        • http://www.facebook.com/timrichpt Charles Timothy Richardson

          Hi Jeff,

          I’m also a physical therapist developing a PT clinical app. I’ve applied to Rock Health at http://rockhealth.com/ as well as Health 2.0 Developer Challenge http://www.health2challenge.org/. 

          New physical therapy apps seem to be on a (small) hot streak now, especially with Kinect technology.

          I agree with Rebecca – you need a trusted developer on your team. 

          I developed an app last year with a developer I found on GURU.com – he pulled a “Mark Zuckerberg” on me, stole the app and now we’re in court.

          Note that Health 2.0 Rock Health REQUIRES at least one member be a developer.

          You’re on the right track integrating your practice with HIT. 

          I would point out to Rebecca that many of the vendors at last year’s HiMSS conference in Orlando were physicians – perhaps its just their salesforce that come across as used car salesmen :)

          I’d love to chat – I’m at TimRichPT@PhysicalTherapyDiagnosis:disqus 
          .com if you’d like to discuss HIT generalities.

          Good luck!

          Tim
          http://www.PhysicalTherapyDiagnosis.com

  • Anonymous

    Touché. These all represent barriers to digital health technologies. I loved this!

  • DraconPern

    A success project requires doctor(idea), developer(implementation), and investor(money).

    I have got a few developers interested in medical software development and I am a developer myself.  Right now I do IT at a cancer / diagnostic clinic. 

    The developers in our group have a range of skills: development from scratch and health system data integration.

    I have started a google docs here asking for ideas. https://docs.google.com/document/d/1vaYMnqgGGV3PcSYtwDkeMctR2v4zoWbN1ymKjrAsqpE/edit?hl=en_US#

  • http://www.orthoonc.com Felasfa Wodajo

    great article and really well written

    I also get frustrated by the implication that the constraints of physician payment = resistant to change

    also appreciate the shout out to iMedicalApps – thanks !

  • Anonymous

    Rebecca,

    Thanks for your common sense assessment!  I also think that physicians have to understand the complexity of the technology and need to give more than a few minutes to think about how this might work in the current environment and the environment of the future.  You are right that there is a great deal of over-promising and under-delivering, as is the case in most sectors.  My question is:  do most physicians really think they can provide the service patients need in their 15 minutes visits?  If not, how can patients receive the care they need from their physicians and other providers?  When that’s figured out, determine what technology is needed to facilitate that care.  Until then, forget the one-off apps that don’t contribute much to the overall care most patients receive.

    • http://www.facebook.com/RebeccaCoelius Rebecca Coelius

      Sandra I absolutely agree. In any new industry there is the tendency to look at the product as it is today in all its roughness, and make a snap judgement that it will never work rather than seeing the future potential. Iteration is not well understood. While policy and payment limitations are very real today and should be taken seriously when an MD cites them as a barrier, they are evolving in an unprecedented way and a terrible reason to not believe in digital health’s potential. 
      In answer to your question, most physicians absolutely DO NOT believe they can provide quality care in 15 minutes. We hate it as much as patients do, especially in primary care.  Thomas Bodenheimer at UCSF has written a ton about this and is a national leader in advocating team based care, highly recommended reading! Most also don’t believe that limiting interactions to face-to-face encounters makes any sense, so would eagerly use digital health products if they were proven and funded.

      Most of the capitated systems I’ve encountered are also more realistic about the time needed for face to face encounters because they can allocate money in rational ways. This can mean allocating different amounts of time depending on the complexity of patient. Or in team based care they might use their allied health professionals for most of the more heuristic or algorithmic based encounters and repetitive procedures, and then reserve much longer periods of time for MDs to deal with medically and socially complex patients.  

  • http://www.consentcare.net/ Martin Young

    Exactly right! If you had millions of dollars of VC available and an MBA I’d definitely give you a call!:)

    • Anonymous

      I think the reality right now is that no VC will touch medical with a ten foot pole especially not after Google and Microsoft both pulled out of health. There are almost no medical related start ups from places like y combinator for 2011 if that tells you anything. Basically, entrepreneurs aren’t looking to do health start ups at the moment, there are other much lower hanging fruits. 

      • Judah McAuley

        You are quite incorrect about the lack of funding for healthcare IT start ups. In the last couple months, in Portland alone, there was a 50 million dollar VC fund established for healthcare IT, the Software Association of Oregon is starting a Healthcare + IT Innovations series to bring medical and technology innovators together and at least a couple of healthcare IT companies in town have received multimillion dollar investments. And that is just in Portland.

        • DraconPern

          Right.. there are VC funds (e.g. they are raising money) being established. But VC’s (people with the money) are sitting on the sidelines.   http://techcrunch.com/2011/12/19/are-health-startups-the-next-big-opportunity-tctv/ They are looking to avoid what happend back in the 2000′s when they invested in health related startups.

        • http://www.consentcare.net/ Martin Young

          So how do I find the young entrepreneur looking for a good head start to tap
          into this potential?

  • http://twitter.com/healthbyconnect healthbyconnect

    Rebecca this is a well written article that we as a new company will take to
    heart.  We created HealthByConnect as a
    free TeleHealth service to health providers to help patients with follow up
    visits via video conference that is easier than skype. We are patients who went to
    doctors for their expertise in developing the product. Even with laws in place
    supporting TeleHealth, Payers supporting TeleHealth and the service being free,
    study’s supporting TeleHealth and patients wanting to use the service we are still
    finding Doctors resistant. We are open to any advice you can provide.

    • http://www.facebook.com/RebeccaCoelius Rebecca Coelius

      Thanks for the nice comment, I am a huge advocate for telehealth, both from a systems and personal perspective as I would love to have this as a future provider. 

      My understanding is that the payer side of telehealth is more complex than what you’ve shared, but I’d be very interested in hearing your experience as someone immersed in the space. For example, in this year’s telehealth policy CMS will only pay for telehealth if it is used in extremely rural or underserved areas that don’t otherwise have regional access to that specific type of physician. They also have strict definitions of what type of device or SaaS are required  to provide telehealth. I’ve heard private insurance companies are very interested in telehealth like services, but more from a RN triage or overnight hours perspective that they provide on a macro company level, than actually reimbursing at the individual provider level. I’d love to hear if there is a private payer doing the latter. The integrated systems like GroupHealth, Kaiser, or the Cambridge Health Alliance can be great places to show proof of concept as they already operate like ACOs or are capitated. The direct primary care movement (Qliance, MedLion) is also very interested in this. 

      If you happen to be located on the West Coast, UCSF has a Center for Telehealth that wants to test products like yours, I’m sure Stanford has hordes of people, and West Wireless has a place on their website where you can make requests for collaboration (though they do not offer grants to do so). Generally all academic health centers now all have Health Informatics Deps, and this is such a hot topic its hard to imagine somebody not biting. 

    • http://www.facebook.com/RebeccaCoelius Rebecca Coelius

      Thanks for the nice comment, I am a huge advocate for telehealth, both from a systems level and personal perspective, as I would love to have this as a future provider. 

      My understanding is that the payer side of telehealth is more complex than what you’ve shared, but I’d be very interested in hearing your experience as someone immersed in the space. For example, in this year’s telehealth policy CMS will only pay for telehealth if it is used in extremely rural or underserved areas that don’t otherwise have regional access to that specific type of physician. They also have strict definitions of what type of device or SaaS are required  to provide telehealth. I’ve heard private insurance companies are very interested in telehealth like services, but more from a RN triage or overnight hours perspective that they provide on a macro company level, than actually reimbursing at the individual provider level. I’d love to hear if there is a private payer doing the latter. The integrated systems like GroupHealth, Kaiser, or the Cambridge Health Alliance can be great places to show proof of concept as they already operate like ACOs or are capitated. The direct primary care movement (Qliance, MedLion) is also very interested in this. 

      If you happen to be located on the West Coast, UCSF has a Center for Telehealth that wants to test products like yours, I’m sure Stanford has hordes of people, and West Wireless has a place on their website where you can make requests for collaboration (though they do not offer grants to do so). Generally all academic health centers now all have Health Informatics Deps, and this is such a hot topic its hard to imagine somebody not biting. 

      There is also quite a bit of literature on telehealth (and a long history of usage) from within the Indian Health Services and in global health. 

    • http://www.facebook.com/RebeccaCoelius Rebecca Coelius

      Thanks for the nice comment, I am a huge advocate for telehealth, both from a systems level and personal perspective, as I would love to have this as a future provider. 

      My understanding is that the payer side of telehealth is more complex than what you’ve shared, but I’d be very interested in hearing your experience as someone immersed in the space. For example, in this year’s telehealth policy CMS will only pay for telehealth if it is used in extremely rural areas that don’t otherwise have regional access to that specific type of physician. They also have strict definitions of what type of device or SaaS are required  to provide telehealth. I’ve seen private insurance companies very interested in telehealth like services, but more from a RN triage or overnight hours perspective that they provide on a macro company level, rather than actually reimbursing at the individual provider level. I’d love to hear if there is a private payer doing the latter. The integrated systems like GroupHealth, Kaiser, or the Cambridge Health Alliance can be great places to show proof of concept as they already operate like ACOs or are capitated. The direct primary care movement (Qliance, MedLion, the Ballard Clinic in the Swedish Health System) is also very interested in this. 

      If you happen to be located on the West Coast, UCSF has a Center for Telehealth that wants to test products like yours, I’m sure Stanford has hordes of people, and West Wireless has a place on their website where you can make requests for collaboration (though they do not offer grants to do so). Generally all academic health centers now all have Health Informatics Deps, and this is such a hot topic its hard to imagine somebody not biting. 

      There is also quite a bit of literature on telehealth (and a long history of usage) from within the Indian Health Services and in global health. 

  • Anonymous

    Rebecca this is such s spot on article. Many vendors to the industry tend to not understand the challenges health care executives and doctors live with just to get through a typical day. They constantly blame them for being slow to react or adapt, call them poor business people and have no empathy for the challenge of finding time to do research on new technology whether it be care related or business related.

    This industry is fraught with vendors who claim to have all the answers and yet have no clue of the operations, challenges, culture, regulations and restrictions to the change they are proposing.

    All providers want to be more efficient, want to provide the best quality of care, want patient loyalty and want to get paid for the services they provide with the least cost and inconvenience to make that happen.

    Thank you for sharing this article, I preach much of this to my group on a daily basis.

    Best regards

    Anthony Wunsh

  • http://www.facebook.com/people/Annette-Mednvpolitics-Mohs/100000303940188 Annette Mednvpolitics Mohs

    Great article. Right on task.

  • http://twitter.com/SkinClick SkinClick

    @DraconPern, I’m an entrepreneur based out of Chicago IL, and I’m working with a team to build a patient portal that allows for diagnostic support in certain types of health cases. We’re looking for developers, and if your team can help that would be amazing.

    Look for our startup on twitter @SkinClick.

  • http://twitter.com/Lasse_Koivisto Lasse Koivisto

    Hi Rebecca,

    Great article. I would like to hear some more thoughts about what you think about health startups. I’m partner at an EMR Startup in Brazil and I would like to share with you our approach and receive some feedback. 

    How can I contact you?

    Cheers!

    • http://www.facebook.com/RebeccaCoelius Rebecca Coelius

      Hi Lasse,

      We are connected now on LinkedIn, feel free to send me a message and I’d be happy to talk about your EMR startup. I’ve worked quite a bit in the space from the evaluation of product and the medical practice regulation/attestation requirements end. 

      • http://twitter.com/Lasse_Koivisto Lasse Koivisto

        Hi Rebecca,

        Great. I’ve sent you an email. It seems I can’t send you a message in Linkedin. Strange.

        Anyway. I’ve got your email from your Linkedin account. 

        Cheers!

  • http://euonymous.wordpress.com euonymous

    Great article. Although the article’s intent and the responses are mostly from software oriented IT folks, what you say is true for the medical device field as well.  Input from the surgeons we speak with are critical to how we engineer instrumentation.  I’m working with a startup surgical instrumentation company and we’re very encouraged at the reception the products have received and the surgeons lined up to work with us.  Looking to the future when we’ll broadly market the products, what you say is excellent advice. Thanks.

  • http://www.facebook.com/profile.php?id=507201326 Ifedolapo Sulyman Olanrewaju

    Outstanding piece…!!!
    As a west African-trained IMG with keen interests in health informatics, I am fascinated by your thought process and the exciting discussion that your article has generated.

    I hope to read more from you and many of the excellent discussants on your blog as I develop a closer understanding of the workings of health informatics especially as it applies to resource poor developing countries in sub-saharan Africa

  • Anonymous

    Hello Rebecca,

    Great article and right on point. I think that it would be ridiculous to expect a busy Doctor to be trolling site like TechCrunch looking for the next big thing. Our clients have a hard enough time staying up to date on the research that directly benefits their patients, running their practices, and actually having a life! 

    There just isn’t enough time to really focus on patient care and run down a lot of the obscure loopholes in the system. The cost isn’t worth the benefit…

    As a founder of a medical billing company I’d love to hear your thoughts on some of the fears and complaints you have heard in the medical field in regards to adopting EHR and transitioning to a web-based practice management system.

    Thanks

    -Patrick