Baby Steps

I received a worried phone call from a physician friend of mine in Michigan. After a grueling shift, he had to spend another few hours writing notes documenting his patient encounters. Just when he was about to submit them, on the verge of exhausted delirium, the electronic medical record crashed, and he lost his work. He sent an angry email to his hospital’s health IT department but lost restraint in his diction, coloring his inquiry with language none of his colleagues have ever heard him use.

Among other healthcare professionals, this story has mostly fallen upon sympathetic ears. We suffer the agony of having to use dysfunctional software in hospitals on a daily basis, software that has changed little since the advent of Microsoft Windows, software inconsiderate of user interface and design, software solely preoccupied with the desire to satisfy the Center for Medicare and Medicaid Services’ security checklist without attempting to make its users lives easier.

I’ve recently had the pleasure of reviewing abstracts for this year’s Medicine X conference at Stanford, one of the largest health tech conferences in the world. Some of the applications were along the lines of established trends in health tech: wearable technology, personalized genomics, health information analytics. A few abstracts touched upon terra nova as “Meaningful Use” continues to unfold. After reviewing a batch of abstracts, I called up an old friend I had met back in NYC. We had actually met during my weekend on the MIT campus, when we won the 2014 Hacking Medicine hackathon with our Google Glass app. Our call inspired me to ring up fellow founders, many of whom I had met in NYC, others back here in San Francisco. Incubators function like venture capital firms. For every batch they incubate, a few land most of the investment funds by demo day, the rest are left hungry.

So what is the secret to cracking healthcare? A good starting point is the reminder, especially to techies, that healthcare does not want to be disrupted. The name of the game is baby steps. Find a point of friction in the healthcare workflow (you won’t have to look hard), understand the current solution, and offer an incrementally better solution. The barrier to entry must be minimal or you can guarantee that no hospital bureaucrat or private practice doctor will bother to even view a demo.

Individuals and organizations in the healthcare industry are constantly in defense mode. Our line of work is loaded with risk, and healthcare professionals tend to be risk-averse. Compounding this is are the Department of Health and Human Service’s threats of draconic punishment which lead to the adoption of outdated software written in Visual Basic by industry monopolies. HIPAA and Meaningful Use are prime examples of laws written by healthcare monopolies who want to ensure that smaller, more agile players run out of funds before they finish jumping through bureaucratic hoops.

Our tech-enabled home healthcare startup found enthusiasm among tech-minded clients in the Bay Area and southern California, but wearable technology is too expensive and immature in its current form to appeal to most patients and physicians as a practical tool. While our team was writing code to integrate with activity trackers, the director of a large NYC-based home health agency told us to ditch the tech toys and build a call center. At the time, we scoffed at the idea, a former Google employee and a physician-coder yearning to bring fire to man. In retrospect, he was right. The barrier to entry to this approach is far lower than trying to make wearables work. I can say the same thing about Google Glass startups. I can imagine a day when healthcare professionals might actually use a Glass-like wearable device in their practice, but that day is not today.

Omar Metwally, MD