Sean Doolan

For years, tech behemoths and digital health innovators have attempted to “reinvent” health care, but they’ve ignored the institutional infrastructure issues that plague the people who deliver care — doctors, nurses, physician assistants, and others — or tried to replace their function altogether. The results have been only small gains and larger scepticism.
Health care innovators and disruptors have missed the sweet spot for change by taking aim at the wrong components of the industry: its practitioners.

Striving to disrupt health care by replacing practitioners has been one of the great missteps of digital health innovation, modelled on Silicon Valley’s displacements in other industries. Platforms like Shopify and Etsy upended e-commerce by empowering artisans and small businesses to directly reach consumers, while Airbnb and VRBO transformed the vacation rental market by eliminating the transactional friction between homeowners and renters. Unlike big-box stores and rental agencies, though, health care practitioners are not middlemen who can simply be disrupted away.

Quality care
Nor can health care be productively disrupted by disregarding how health care providers prefer to work. Technology should enable clinicians to do their best work and take joy in it — not undermine the methods they’ve developed to deliver quality care. Investors and innovators should instead aim to disrupt health care’s legacy IT companies, which move slowly and keep providers operating in IT antiquity.

These companies generally offer one of two technologies: electronic health records for patient information that are really designed to help providers’ employers get paid; and picture archiving and communication systems which are, at their core, large databases for medical images.

Neither of these was designed to make health care practitioners’ jobs easier. Yet they’ve become core to the practice of medicine, despite often working against providers by distracting them from being able to focus fully on patients. It hasn’t inspired them to believe in the potential of technological innovation.

For too long, oligarchic IT companies have profited from building and protecting monolithic silos that create barriers to better care and prevent health care practitioners from embracing new technologies — technologies that would allow them to make better clinical decisions for their patients.

Disrupting the stranglehold these companies have on health care calls for a back-to-basics approach to innovation, one that centres on clinicians and builds technology to augment their skills and abilities. Rather than forcing health care providers to wrestle with, adapt to, and settle for clumsy technology, digital health companies should instead build tools and technologies that automate practitioners’ most mundane procedural tasks and support their ability to work as fast as they can think. With tools that improve workflows and allow for higher throughput, health care providers will have more time to evaluate information, more time to communicate with their patients, and more time to use their knowledge and experience in the service of care.

Two decades ago, for example, medication management relied heavily on paper and fax machines. Electronic prescribing created lasting, transformative change because the technology was built to streamline medical workflow issues like routing, medication history, and prior authorisation while automating mundane processes like renewals. Health care craves more provider-focused innovation like this, and there are plenty of pockets in specialty care filled with opportunities.

Radiology, a health care specialty uniquely reliant on software, is ripe for this kind of disruption. Radiologists are hobbled by poorly conceived and siloed technologies like picture archiving and communication systems that require them to devise time-consuming workarounds, like having to lug around multiple computers to log into separate systems.

AI solutions
The initial mindset for introducing innovation to radiology focused on replacing radiologists’ imaging and diagnosis expertise with artificial intelligence, a concept driven by futurists. Yet despite the hundreds of AI algorithms approved by the Food and Drug Administration, few are actually in use. That’s because they do not integrate across radiology’s legacy IT systems, and end up disrupting the wrong components of the field — the components that are core to why individuals become radiologists. Radiologists don’t want AI solutions that replace the essential functions of radiology. They want AI solutions that fit into their daily workflows and make it easier for them to do their jobs.

I believe that the strongest health care companies over the next decade, and especially the next three to five years, will be the ones that embrace a provider-focused approach to disruption. It will require a new generation of digital health founders and technologists who understand that health care can only be as dynamic and outcomes-focused as its practitioners are equipped to be.

(Doolan is the founder and managing partner at Virtue, a pre-seed/seed stage venture firm exclusively backing health care founders).
-- statnews.com