Digital Health Startups

5 lessons learned while assisting Healthcare #startups by Shailesh Gogate @sgogate


18 months ago Faichi Solutions, http://www.faichi.com/ an offshore product engineering partner, decided to focus on two verticals: Healthcare and Media/ Publishing.

To scale a company, one should pick one or two verticals to focus on (especially when you have limited budget 🙂 ). These two verticals were identified based on the number of clients we had in those 2 verticals and customer references :).


In the first 4 years of operations, we had worked with a Population health product which was pivoted from a Wellness product, a Patient Management product, and a Health Management platform. In the last 18 months, we have worked/ working on two TeleHealth products, another Population health, a Behavioral Health, and two Health Management products.

While assisting different Healthcare ISVs (product companies a.k.a Independent Software Vendors), Faichi Solutions was initially a product engineering partner. Having that said, we learned a lot (and continue to learn) of business and operational issues (and are now an integral part of the development and release lifecycle). Listing 5 learnings (amongst many) below:

1. Add a product owner even if the Client has one: Core members of a startup end up wearing different hats. It’s hard to manage/ explain (and document – the biggest challenge) user stories, workflows, questions of the developers/ testers (should be accessible). Solution: Have another product owner who mimics client’s product owner. It removes a lot of roadblocks. This is very helpful to finish the number of user stories planned during a sprint.

2. Be ready to educate your Client and be educated: When your key point of contact is a domain expert and not a tech expert (although she thinks she understands technology), you end up educating the Client on technology and its processes. One has to communicate in a way which is politically correct (without hurting the ego of the entrepreneur, requires a different kind of skill). In the same breath, would like to point out, engineering partner needs to understand the nuances of client’s business. Sometimes a simple step in a use-case could be nerve-wracking, keep an open mind to learn.

3. Incorporate business dependencies while estimating a task: While estimating development effort for a user story, e.g. integration with EHR, one may estimate 4 to 5 weeks. However, there are a lot of business dependencies which have to be considered. For e.g. To get a buy-in from the CIO of a hospital / large clinic (particularly if it’s an on-premise EHR) to integrate with a product can take up to six months or more (or none). There are tons of such examples.

4. Have a domain expert on the project: Even if you are engaging with client’s VP/ Dir of Engineering, there are a lot of user stories which need clarification before and during the designing or coding process. For e.g. while moving from ICD 9 to ICD 10 codes, there is an architecture and UI change. The domain expert should point this out early in the process. There are changes being incorporated in US Healthcare, which is going to affect the revenue of a product. One should be able to filter out key implementations from the list of buzz words floating around (e.g. MACRA).

5. Build accelerators to reduce time to market: Anticipate what features are likely to be added to multiple products. For e.g. for telehealth clients, “Patient Intake forms” will be needed in a few months time. For a different set of clients and prospects, Chronic care management workflow will be required. In the initial years, we could not anticipate these needs. However, in the last 18 months, we added a few accelerators which add significant value for our clients. Not only these accelerators are helpful in reducing time to market of our clients, they were also helping in reducing clients’ cost.

There are a lot of best practices which have to be followed while working with offshore teams e.g. Good / Open communication, Tools and Processes, Daily standups, SCRUM masters on both sides, and much more. All of these are implemented and optimized as the relationship with Clients mature. However, the ones which come to mind at the top the head for Healthcare startups are listed above. Am sure engineering/ operation managers will have a lot to share. Feel free to add your learnings in the comments section below. 

Author
Shailesh Gogate

Shailesh Gogate is an entrepreneurial business development leader with deep expertise across Product Engineering services. Shailesh holds more than 20 years of IT industry experience working with companies across the world. He has a strong interest in product management and adds value to healthcare product companies to make them successful.

Strategies to Foray into Digital Health by @JPpattanaik

Author: JP Pattanaik, Sr. Business Analyst & Akanksha Rajeev, Business Consultant

in this article, provide an insight to various strategic options for Indian IT product-centered organisations to consider foraying into healthcare industry

The article was first published in Express Healthcare, Feb 2016 Edition. The article is republished here with the authors’ permission
24 Mar 2016, India



Abstract 

The lucrativeness offered by the healthcare IT industry has brought significant attention worldwide. Healthcare industry is considered ever green and healthcare IT has attracted the attention of global players for investments. There are a section of players who are pioneers in the industry and have recorded significant growth. At the same time there are laggards who want to build such capabilities and tap the untapped market following the recent industry trends and success stories. Healthcare IT organisations have to cope with transforming business model while adhering to strict regulatory demands of the industry. They need to carefully adopt strategies based on the organisational maturity, capital and the time they have for go-to-market. In pursuit of quick success, often organisations commit mistakes choosing the right approach while building potential health IT product capabilities. This article highlights different strategic options for Indian IT product-centered organisations thinking of foraying into the healthcare industry
Global Healthcare and Healthcare IT spending trends

According to industry estimates, the global healthcare spending is expected to grow at an average of 5.2 per cent year on year during 2014 – 2018 to a total of $9.3 trillion. In spite of its vastness, both developed and emerging nations are dealing with issues like ageing population, rising incidences of chronic diseases, rapidly increasing cost of healthcare, disparity in quality of care, infrastructural challenges, workforce shortage, non-uniform distribution of healthcare facilities across the community locations etc. The burden faced globally today has never been so challenging than ever it was.

An estimate by the Economist Intelligence Unit (EIU) the regional healthcare spending during the year 2015 is expected to be as given in the table.
Globally, most nations have been challenged to improve quality of care while reducing the cost of healthcare by means of inventing cost effective methods for an optimal outcome. The challenges described above have led to adoption of healthcare IT solutions such as Electronic Medical Records (EMR)/ Electronic Health Records (EHR) for safe storage of healthcare information and to make more informed decision.
According to an estimate by MarketsandMarkets, a leading research organisation, the global healthcare IT market is estimated to reach $56.7 billion by 2017 — up from $40.4 billion in 2012 — due to the demand for clinical information technology, administrative solutions and services. Among the various healthcare IT solutions offered, EMR/ EHR segment dominates the sector.
Gartner estimates healthcare providers in India are likely to spend $1.2 billion on healthcare IT products and services in 2015, a seven per cent growth over 2014. Software spending is likely to grow 6.2 per cent to reach $103 million in 2015, up from $97 million in 2014, led by growth in vertical specific software. An estimate by Frost & Sullivan, healthcare information technology market in India is expected to reach $1.45 billion in 2018 mainly due to fast adoption of technology by stake-holders. India being a developing nation, the health IT spending is still much less than that of the developed nations. The rest of the paper discusses various drivers for healthcare IT initiatives, its attractiveness and approaches for Indian health IT organisations for an effective go-to-market strategy.
Drivers of Healthcare IT in India 

Some of the major factors contributing to the growth of healthcare IT globally are listed below:

  • The continuously growing pressure to cut healthcare costs
  • Need for care coordination and management demanding integrated healthcare systems
  • High rate of return on investment in healthcare systems
  • Financial support and incentives from the government
  • Growth of medical tourism
  • Government initiatives, conducive policies for the sector
  • The rise in the ageing population
  • Growing demand of health IT products to reduce medication errors
  • Rise in incidences of chronic and lifestyle disorders
  • More informed and engaged patients.

Why do more and more Indian IT organisations want to venture into Healthcare Industry?  
Healthcare has a huge addressable market. India as a country has witnessed a rather steep growth trajectory only in the last decade with the advent of the private sector. The influence of technology has been an important growth driver, with healthcare models based on IT intervention now becoming a reality. The accessibility of healthcare today is more than it ever was, consequently increasing the opportunity for new players. Emergence of new delivery models which are scalable, less capital intensive and yet promise better earnings is one of the major reasons the healthcare sector has lured the investors. Diagnostic chains, single speciality clinics, wellness centres, primary care set-ups etc. are all emerging models of healthcare and it is still evolving. In a nutshell, healthcare industry provides array of opportunities for new experiments at a promising return on investments. The penetration of healthcare IT is still in its infancy providing ample opportunities to all competent healthcare IT solution providers. With increased importance to healthcare needs, the adoption of modern healthcare IT systems is bound to grow.


Approaches for Go-to-Market  

In order to tap the business opportunity presented by the IT enablement of healthcare institutions, the IT organisation should evaluate options and consider one that suits the best. A single approach may not fit all. In pursuit of quick success, often IT organisations opt for suboptimal options, which may not meet their long term objectives. Following are the three strategic options to realise the business opportunity presented by healthcare IT market:
  • Approach 1: MODIFY Enhancing an open source software
  • Approach 2: CREATE Building a greenfield system
  • Approach 3: ACQUIRE Acquiring a licensed product

The table below provides the advantages and disadvantages associated with each of the approaches.
An organisation should evaluate the functional, technical and business capabilities while prioritising a strategic approach. Each of the approaches can be evaluated based on the following parameters:

Cost and effort
Total cost of ownership (TCO): Total cost of ownership refers to the cost to the organisation for sustaining a product line. This includes the license fee for the product and cost of the application maintenance and support.
Effort: This is the effort that needs to be put in by the organisation to meet the desired product criteria driven by Customer/ Market needs.
Potential Revenue: This refers to the revenue that would be generated by the organisation on entering the market with the stated product.

Market factors
Time to market: This is the time taken to launch the product in the market for customers.
Market acceptability risk: The risk that the product launched into the market is not accepted by the clients. This is particularly high for a new product launch.

System related factors
Customisability: The capability of a system to be easily customised for desired features. Creation of a greenfield system offers the highest amount of flexibility as it can be designed keeping product expansion in mind.
Scalability: The capability of a system to be easily scalable for larger implementations. While a greenfield system can be designed to be scalable an open source or acquired product may have limitations.
Skilled resource availability: The major constraint of a system is the technology stack that it is built on. Having technically sound resources trained exclusively on the same platform is one of the major factors for system selection.
Legal/ IP Risk: Enhancing and commercialising existing open source systems would give rise to potential legal risks. Some systems are covered under various public licenses which prohibit the commercial use for profit.
Security risk: With the ever growing population that is being catered through the IT enabled system, security of the healthcare data plays a vital role in the evaluation of a system. Many laws of the land mandate patient privacy and prohibit the transfer or usage of the healthcare data and thus require utmost authorisation and protection for the same. Any shortcomings in the system that compromises patient data security would pose a security risk.
The evaluation of each of the approaches based on the above mentioned parameters are summarised in Figure 2.

Key Considerations  

A greenfield system though requires investments, is a safer approach as it minimises some the risks demonstrated in other two approaches. However, all organisations may not be in a position to have proprietary systems to exploit the immediate market opportunities presented. The pioneers always have the advantage to exploit the market opportunities with less competition. New players should carefully choose the market segment they want to make an entry. When an organisation lacks significant market presence and experience, it may be recommended that the organisation should take baby steps and stay profitable yet. A big bang approach may not support the ultimate objectives of the organisation. In this context it may be recommended to health IT vendors that the
Approach –‘MODIFY’ can be considered as a short term strategy with an objective of learnings, small scale implementations and R&D.
Approaches – ‘CREATE’ and ‘ACQUIRE’ can be considered as long term strategies with an objective of achieving the vision of the organisation.
Approach – CREATE demands investment in terms of time and ensuring the product exceeds expectations than a competing product while 
Approach – ACQUIRE enables the organisation a quicker go-to-market for realising the opportunities. However, the risks associated with the approach must be given due consideration.

Conclusions  

The lucrativeness of the healthcare IT market has received significant attention. It is an obvious choice to exploit the opportunities presented. The pioneers and the laggards are equally keen to make the best of the opportunities. An approach that works best for a pioneer may not be of same value to a beginner. In pursuit of quick success, organisations should not commit the mistakes of engaging in a wrong approach to make a foray in hurry. It has been rightly said, “There is no shortcut to success.” Organisations need to carry out a risk and return tradeoff before formulating and executing any strategies for the best possible outcome.

References  

i. 2015 Global Healthcare Outlook. Common Goals and Competing Priorities By Deloitte, Whitepaper, 2015.
(http://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/gx-lshc-2015-health-care-outlook-global.pdf)
ii. Global healthcare IT market estimated to reach $56.7B by 2017 By Ashley Gold, News Article, FierceHealth IT, May 10, 2013.
(http://www.fiercehealthit.com/story/global-healthcare-it-market-estimated-reach-567b-2017/2013-05-10)
iii. 2014 Global health care outlook: Shared challenges, shared opportunities By Deloitte, Whitepaper, 2014.
(http://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/dttl-lshc-2014-global-health-care-sector-report.pdf)
iv. Overview of International EMR/EHR Markets: Results from a Survey of Leading Health Care Companies By Accenture, Whitepaper, August 2010.
(http://www.accenture.com/SiteCollectionDocuments/PDF/Accenture_EMR_Markets_Whitepaper_vfinal.pdf)
v. Healthcare IT market in India may touch $1,454 million: Study
(http://timesofindia.indiatimes.com/tech/tech-news/Healthcare-IT-market-in-India-may-touch-1454-million-Study/articleshow/24142487.cms)
vi. IT spending by Indian healthcare providers may rise 7 per cent in 2015, Gartner says
(http://timesofindia.indiatimes.com/business/india-business/IT-spending-by-Indian-healthcare-providers-may-rise-7-in-2015-Gartner-says/articleshow/47295710.cms)

Disclaimer: The ideas and opinions shared in this article are personal views of the authors and have no bearing or impact on the official policy or position of United Health Group or its entities

Authors

JP Pattanaik

Healthcare Management and IT Consulting
Akanksha Rajeev

Healthcare Management and IT Consulting

The Formula of Driver and Demand- Indian Startups story via @drruchibhatt

Author: Dr. Ruchi Dass

Health Innovator (HIT, BigData, IoT, Analytics and Cloud) | TED Speaker | Investor and Mentor
15.Feb.2016, India

The healthcare industry is currently experiencing change at an unprecedented rate. Change is not only occurring in the technology used in diagnostics and care delivery, but this change is so fundamental that it could, and likely will, fundamentally alter the business model of the industry.
Today we have fitness bands, healthcare apps, appointment schedulers, health chats and several such means to access healthcare but one thing that all of this does not necessarily correlate with high quality of care or better outcomes.
We need to understand that “Not even a Ferrari will get us to our destination without a driver.”
Formula of Driver:
Driver = (Need + Incentive) where;
Incentive = (Value + Reward)
Need = (Gap + Demand)
To define the best drivers, we need to first address the need. Need might not make economic or business sense but it is the best opportunity to leave an impact. No one remembers how much business a “Mughal-e-Azam” or “Usual suspects” did but everyone remembers that these were great movies with splendid performances.
In India, we have several such needs today. A survey conducted by HCG on several pressing issues in the field of health and safety highlighted the following:
  1. Women safety
  2. Elderly concierge services
  3. Child safety
  4. Personalized nutrition
  5. Health Insurance for OPD services
  6. Cancer support/ early detection
  7. Infertility
  8. Fitness (scientifically monitored) and performance 
This list is not exhaustive. I don’t need to look at statistics to confront the horrid truth. News stories of women from all over India being raped, beaten, killed are flashed across us day after day – and we all are aware of it. The fatal Nirbhaya gang-rape saw an outpouring on the streets of Delhi – protests decrying the fragile status of women in India. Candle light marches, editorials examining the patriarchal and sexist traditions of our country, an awakening on social media – even conversations on streets revolve around the night they cannot forget: the night that took Nirbhaya. We need to do something about women safety. Devices, trackers, processes, helplines- whatever little or more we can do. 
 If you are an innovator in this area, please get in touch with me.
For elderly even small accidents can be deadly. While simple falls, such as slipping while walking off a curb, may seem relatively harmless, they can actually lead to severe injury and death in elderly individuals, according to a new study published in The Journal of Trauma: Injury, Infection, and Critical Care. As the population continues to age, it is important for physicians and caregivers to be aware of and prepared to deal with this issue, which could significantly impact the overall health and wellbeing of older adults. 
In addition to it, low blood pressure, low blood sugar, heart attack and other things can be very worrisome and need constant monitoring. Innovators call to action here is to come out create and raise awareness about such bracelets, devices and jewelry that can be adorned for a purpose.
Without calorie count possible, limited heart rate tracking and availability of other vitals; performance management and fitness efforts are less effective. Measuring your heart rate using a heart rate monitor is a good way to gauge the effectiveness of your workout because as you strengthen your body through exercise, you also strengthen your heart.
Measuring the rate of your heart during exercise can help you determine when you’re pushing your body too hard or need to push it harder to achieve the level of fitness you are seeking. I love the work Hexoskin and Kenzen are doing. I am looking for something more affordable and focused for Indian market.
Health tech is blazing hot right now and there’s no shortage of companies working on innovative products designed to change the face of healthcare as we know it. That’s a good thing, considering Indians are as unfit as ever and bureaucracy continues to muck things up for physicians and patients alike. As technology evolves, it could upend some of these problems. One thing that’s certain: Consumer-driven healthcare is coming. And these companies are helping make it happen.

All the best !

Author

Article By: Dr. Ruchi Dass

Digital Health Influencer & Health Innovator (HIT, Big Data, IoT, Analytics and Cloud)| TED speaker | Investor and Mentor
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