Creating a Consumer Health Care Solution? First, Go Back to the Beginning.

Today, we’re approaching 14,000 health and fitness related apps in the Apple iOS App Store. While there is a great deal of talk about the “explosion in mHealth”, the reality is that we’ve seen an increase in ‘stuff’ and not an improvement in adoption.

I know I’m simplifying things, but let’s suppose the low adoption of these apps is due to one of two things. Either:

· People don’t want to be helped

· Most of the apps aren’t actually helpful. Or, at least not in the way the average person interacts with their health and healthcare.

The first statement is false. People do want help. They want to understand the system and how to navigate it better and our ability to provide improved outcomes requires that we get patients engaged. My critique is not novel.

So what will it take to move terms like “patient empowerment” and “engagement” from cliché buzzwords to the realized vision we all share? What will it take to stand out in a sea of solutions all claiming to lower costs and improve outcomes?

First, it will require founders, investors, and others looking to get involved in health care to recognize and embrace the systemic nature of our problems. More importantly, it requires those of us looking to innovate health care to take a hard look at our own experience within the system. The reality for most Americans is that our understanding of healthcare is coming solely from the perspective of a patient. While it helps us identify the real pain points for people receiving care, it makes it difficult to fully understand the origin of those pain points.

With few exceptions, the painful experiences we share as patients of a broken system (cold handoffs, lack of transparency, challenge to obtain our medical records, etc.) are the result of broken processes further up the chain. These are not problems related to poor IT design or bad UI. If you want to fix the problem you experience as a patient, you need to first figure out how to fix the upstream causes. Consumer solutions in health care need to introduce system-wide fixes.

An example. I recently spoke with a woman who spent most of her career designing system architecture in the early Internet era. She’s a computer scientist who had a profound experience 5 years ago, not unlike Dave Lulz’s, as expressed by Atul Gawande in his recent Cheesecake Factory article. She quit her job in telecom and spent the last few years working within the insurance industry to better understand their perspective. She’s now using the insight she gained from working within the insurance industry to create new ways to scale Patient Navigation concepts.

It may not be realistic for you to take a couple of years off to round out your knowledge base, but you should take some time to intrinsically understand the ecosystem that has created the problem you’re looking to fix.

There are a number of ways to go about this, here are a few that come to mind:

· Volunteer - For example:  in California, there is a centralized database where you can search for volunteer opportunities. This is a great way to witness the operational processes from the provider perspective.

· Sign up with a staffing agency to be go-live support for hospitals. It will expose you to the IT systems already in play and show you how clinical users interact with technology. It will also expose you to various clinics and hospital units in short order.

· Browse the job boards for major health systems. The best opportunity to get operational insight is to get a job outside of IT. Try to work within a department. Your focus should be to get in a position to observe patient care.

· Read HIStalk, which caters to industry IT folks. You may not read about who got funded, but you’ll find out what systems hospitals are buying today.

You should seek advice from clinicians and insurance providers, but until you have a near innate understanding of what’s driving them, it’s going to be difficult to devise a solution that fits into the existing ecosystem. While tempting, there are few pure consumer plays here – you’re going to need to work within the system.

Keep reading and listening, but most importantly, go experience health care from another vantage point. You don’t want to lose your outside perspective, but you need to grasp the constraints of trying to operate too far outside of the existing framework.

To fix the patient experience, you need to first fix the system that created the problem.

Dan Wilson is the cofounder of Moxe Health. He previously worked at Epic and is currently building products to help the underserved navigate our health system.