The Holy Grail of Healthcare and How To Find It

Since Imhotep and Hippocrates pioneered the concepts of examination, diagnosis, treatment and prognosis, we have made significant advances in how we treat patients. And yet, if we close our eyes and imagine in ancient times for a minute watching the agony that a patient felt over a grim prognosis, or the pain of a physician realizing there was nothing more that could be done, we may realize that many things have not changed. The heart of healthcare is still that delicate interaction between a patient and a physician. In those intimate moments where the patient hangs on the physician’s every word, there is nothing else beyond human connection and empathy.

The difficult truth is that a lack of technology in healthcare is not the problem- the presence of disjointed technology that does little to foster the relationship between doctor and patient is. It has become difficult to prioritize the doctor-patient relationship, when most technology serves either the doctor, or the patient, but not both in earnest.

Both doctors and patients are experiencing flooded streams of information but a drought in answers. Patients want to know more about their conditions and treatments, and doctors want to know more about their patients. Yet the promises of more online communication, Dr. Google, and physicians with different opinions waiting at the touch of a button do very little to bridge the chasm between doctor and patient. We are left with more communication, but less meaningful conversations. Without a renewed focus and appreciation for the patient physician interaction, we risk losing the central fundamental truths of medicine in a whirlwind of digital interventions and data mining.

To be sure, much of this technology is well intended. Telemedicine can augment care in regions where providers are in short supply, EHRs were meant to improve physician efficiency, and online communication have the power to empower more longitudinal care. However, we see telemedicine startups targeting already doctor dense regions, EHRs have proven to be the target of frequent doctor derision, and online communications have not improved longitudinal care. These sleek shiny technology solutions have found their way deep into the tangled traditional threads of the healthcare world with little clinical impact.

The great challenge awaiting digital healthcare is to create connective technology that binds products together in a clinically relevant way that serves both patient and physician.

Where are these connections needed?

1. Pre-appointment, patients are eager to share symptoms, family history and more with their physicians. Patients are accessing second opinion physicians, crowdsourcing medication information, and researching possible treatments long before they walk into a physician’s office. There is a great need for a platform that aggregates this information and synthesizes it for the physician before the patient and physician meet.
2. Post-appointment, patients need to feel the reassuring presence of their physician long after they leave the office. There is a need for platforms and systems to track, monitor and guide patients along the path to recovery. While many small pieces of this puzzle exist, there is nothing truly comprehensive and ubiquitous yet.

Where are the doctors in digital health?

Rock Health reports a strikingly low number of MD founders in digital health. Out of 233 venture deals conducted in 2016, only 21 deals included deals with physician founders. It is possible that by increasing the percentage of MD founders, as well as the inclusion of MDs early and often in the startup process, we would be able to better see the holistic picture of medicine. As it stands, there are still critical gaps that need to be filled beyond the connective technology.

Where are the gaps?

1. One of these areas is in the management of payment processing- an area surrounded by regulation and behemoth companies. The issues within this arena are too complex to distill here, and perhaps is a leading reason why payments have yet to see meaningful innovation. Payment processing is a massive tangle of inefficiency on four sides: physician, patient, hospital, and payer. Each of these sides needs payment innovation that fits into the unique workflow and needs of the different user groups.
2. A troubling issue is the lack of solutions that are affordable and effective for low-income groups; many of the digital health solutions are currently at a high price point. Furthermore, high-end therapeutics are slowly beginning to enter the market at extremely high price points. The inherent paradox in healthcare as a business is that healthcare is about serving universal need, regardless of ability to pay, and a business must have payment in order to subsist. This is particularly poignant in healthcare, where there is a moral obligation to provide the best care possible for any patient, regardless of ability to pay. Entrepreneurial insights around how to engineer solutions that are within the grasp of the ordinary citizen are necessary.
3. There is also a gap around how technology is validated, whether that technology is a medical device or pharmaceutical drug. Clinical trial applications have been built, but distribution is still a challenge for many companies in the space. These companies need to reach out directly to patients in order to provide value to their pharmaceutical or device company partners, but by doing so face high customer acquisition costs and barriers to entry.

As a patient, we all want the simple solutions when we walk into a doctor’s office. Take these pills, and you’ll be all better. One shot, and you’re protected. We want the magic healing of a scraped knee for the rest of our lives. Yet in digital health over the past five years, we have seen that healthcare is anything besides simple and magical. It is complex and cluttered and noisy- the strongest hope one can have for the digital health ecosystem is that our solutions take away clutter, and simplify more than they complicate. It is often those on the frontline of medicine who have relevant ideas for this- physicians are perhaps the most cognizant of the drawbacks of technology entering into the sacred space of communication between a patient and physician. In the next five years, the winners within the space may very well be the companies that take us back to a place where healthcare is just the simple combination of a patient, a physician, and the very best science can offer. The winners will ensure that while Dr. Google can be the first source of information, it will not be the only.