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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