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.

  • Jay Mason

    Thanks Dan. Very healthy advise for any company hoping to have a lasting impact on the health of engaged or isolated consumers.

  • Brian Mckenzie

    That hones it in nicely without the rhetoric- thanks for the post

    • Dan

      Thanks Brian, it was my pleasure. I’m excited to see the surge of technologists/developers making their way into HIT - there are so many processes that will benefit from the increased attention.

  • frankille

    Interesting article and I don’t disagree with your points but there are a couple of other things that I think are relevant to this discussion. I will try and make this short as I could spend the rest of the day writing on this topic

    First statement from your article.

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

    This is a very complicated matter much of which technologists can not fix.
    Until physicians are reimbursed for their time interacting with consumer/patient solutions this Health 2.0 movement will continue to progress very slowly.

    Second statement from article
    “People do want help”

    People may claim they want help but my six years of experience in HIT and patient engagement has proven otherwise. People claim they want help but no matter how sick they are people want to be rewarded in some way for their efforts. Sadly improved outcomes is not enough. We are a culture whose motivations and responses are stimulated by rewards such as money or other tangible objects. Solutions like Virgin Health Miles is a good start but will need much wider deployment and adoption to make a significant difference.

    14,000 iOS health apps do not have much value as the data never leaves the phone and therefore not actionable by caregivers. Companies like Runkeeper and HealthSaaS have developed platforms to connect mobile apps and make data available but integration with back-end EHR systems is an additional challenge that we can discuss some other time.

    Regardless of your motives I would encourage everyone to volunteer as many groups such as the VA could really use your help.

    • Edbury Enegren

      Until physicians are reimbursed for their time interacting with consumer/patient solutions this Health 2.0 movement will continue to progress very slowly.

      1. Plenty of physicians in this space consider themselves as being reimbursed already - they’re salaried practitioners and consider the adoption of new solutions part of their job, not peripheral to it.

      2. Physicians tend not to be the locus of the largest bottlenecks when considering changing the systemic problems in healthcare.

      • Dan

        While your point about salaried practitioners adopting “non reimbursable” services is somewhat valid, my experience is that a majority of this adoption is driven by organizational decisions. For example, Kaiser and Geisinger both employ their own docs and are arguable at the front of operational and technology innovation. Their physicians are using new tools daily. This is not the norm.

        Under the current fee-for-service system, the majority of practitioners do not have the luxury of performing non-reimbursable services. They certainly don’t operate under the impression that “it’s part of my job”. When physicians take the time and energy to do things they aren’t paid for, they are going above and beyond. No one expects to work for free.

        There is widespread recognition of this problem, thus the willingness at all levels to play with alternative methods of reimbursement and the gradual consolidation of systems into larger IDNs. As more and more providers become employed, the opportunity for adopting new, non reimbursable services increases - so long as you can sell the enterprise.

        No disagreement here that physicians aren’t the largest bottleneck.

    • Dan

      Thanks for opening up some great points for further conversation.

      Your comment about the limitations technologists face in fixing the problem is a great one, and I couldn’t agree with you more than you agree with yourself. Given that the problems in health care aren’t tech related (unless we created them), I’d like to turn this into a challenge to anyone looking to bring new innovation to health care. We need to be prepared to help organizations implement new operational practices, supported by whatever technology we’re introducing - this is the reality of working within an enterprise space.

      Coincidentally, I wrote a reaction to the most recent National Governors Association meeting that touched on this topic in a bit more detail.

      I disagree with you a bit on the notion that people don’t want help. We want help, but only when we want it. Bear with my circular logic for a minute - though this probably deserves it’s own post.

      Unlike entertainment, the desire for preventative care isn’t a facet of our basic instincts. Where you may not need to incentivize users to download spotify, if you want people to make use of your health care tool when they aren’t in pain, you’re expecting an unnatural type of interaction. Medicine men weren’t exactly lauded for their primary care abilities. I agree it’s unfortunate that modifying behavior requires tangible incentives, but I suspect it’s going to be our reality for quite some time. The challenge then is how best to deliver the right incentive at the right moment - definitely not easy, but where would the fun be if it was?

      Could not agree with you more about the need to get data into the hands of the care teams…this is so critical. Opening up a portal to the data is a non solution, it must flow into the EHR and be imbedded in a contextual way if it is to play any part in influencing care delivery. I’m incredibly interested in this area and seeing how things develop.