How should a health system choose its 1st departments for a new Digital Health innovation?

Imagine you are a hospital or health system looking to implement a new Digital Health solution.

Maybe you’re looking at Digital Care Journeys to engage and remotely monitor patients pre and post-surgery, thereby reducing staff burden for patient education, phone calls and early discharge. Or perhaps you’re excited about Ambient Voice Technology to automate clinical documentation and reduce pajama time for frontline staff.

Even though you have an enterprise-wide rollout in mind long-term, you have to start somewhere and demonstrate success. You want strong internal references for all the change management you’re planning to embark on. Everyone will watch whether those initial champion departments were successful or not.

So what departments do you start with: Women’s Health? Orthopedics? Cardiovascular? Oncology?Primary care?

Make your decision thoughtfully. Because no matter the situation, WHO champions your innovation first has a huge impact on the long-term success of this initiative.

I’ve seen health system innovations tank simply because they chose the wrong place to start.

How do you choose the right leader for your initial Digital Health implementation?

So how do you decide where to start?

I advise health system leaders to choose champion departments based on 2 key factors:

1. Impact and ROI: Who has the biggest need?

Not all departments or units will get the same benefit from a new innovation.

However, to demonstrate the potential upside as quickly as possible, you should strategically identify departments that have:

  • (a) the biggest pain points that matter today
  • (b) the highest volume of activity

For example, at SeamlessMD, Orthopedics is often the best department to first use our digital care journey platform because:

  • Total joint replacement is among the highest volume procedures
  • There are various burning platforms, such as drivers to increase surgical throughput by safely shifting to more same-day surgeries, value-based care incentives (e.g. bundled payments), etc.

In contrast, the wrong first use cases for us may be:

  • A rare pediatric condition because it’s usually much lower volume, and therefore would take a lot longer time to collect data and show benefit
  • Gallbladder surgery because there are minimal pain points you could make a dent on – e.g. LOS, readmissions, ED visits etc. are relatively low

2. Champion availability: Who are your self-motivated, early adopters?

Technology is not a magic pill – it’s simply a tool that has potential for impact when used effectively.

Even the best Digital Health interventions need strong people support to navigate change management and motivate the team to adopt the technology while data is being collected to prove the ROI.

Reflect on your organization’s history and ask:

  • Who has a track record of being believers and evangelists of new innovations?
  • Who has successfully led initiatives to improve quality, patient experience or operations in the past?

We all know those clinical or operational leaders who are not only dissatisfied with the status quo, but are also change makers with a track record of putting in the work to improve how things are done. Bring your innovation to them and see if they (and their department) will get on board.

For example, at SeamlessMD, this might be:

  • The Orthopedic surgeon who leads the same-day surgery initiative
  • The provider who started Enhanced Recovery After Surgery (ERAS)
  • The Quality or Patient Experience leader for a department

Should you only start with 1 department?

I’ve worked with health systems who are fully committed to the vision and have rolled our platform out to 10+ departments in 12-18 months.

But what if that’s not you? What if you want to dip your toes first?

In those cases, I still generally advise health systems to go a bit bigger. Start with at least 2 or 3 departments simultaneously at the beginning.

Why?

There are too many unknowns with just one department:

  • If it goes well: did you just luck out with the perfect clinical/operational teams involved?
  • If it goes poorly: is it because the vendor and platform are not the right fit? Or were there unique challenges in that department that would not be an issue with other departments?

With only one department in play, you won’t ever truly know. So the best way to fully answer those questions is to have multiple data points available from Day 1.

What do you think? What’s worked for you when bringing a new healthcare innovation into your organization?

Why do we underestimate patients?

When we started SeamlessMD 10 years ago we faced lots of skeptics:

“My patients don’t like technology”

“My patients won’t know how to use an App”

“My patients are too old”

“My patients won’t be motivated to care for themselves”

“It’s great that this works for X’s patients, but my patients are different”

One of the biggest lessons I’ve learned is that empowered patients can do more than we expect. 

To this day I remain in awe when I read patient feedback about how they are using SeamlessMD to track their symptoms, take incision photos, gain motivation to get up and mobilize, adhere to their infection prevention instructions – all because a piece of software, combined with the right clinical content/algorithms, gives them automated prompting, guidance and re-assurance.

And these are not young, healthy patients. Our biggest demographic are patients in their 60s-80s, often frail, with multiple comorbidities!

The downstream effects on quality, safety and cost for health systems has been incredible:

  • ↓ $1,000-$8,000+ costs per patient
  • ↓ 1-2 days length of stay
  • ↓ 45-72% readmissions
  • ↓ 43%-72% ED visit reduction
  • ↓ phone calls by 50-65%

BUT patient empowerment requires provider engagement.

I’ve met providers who just look at a patient and assume they can’t be empowered with technology. So they don’t even offer it!

Yet we’ve seen the biggest successes and the best results when providers are fully bought-in:

  • Framing the app to all patients as standard of care: it’s opt-out, not opt-in. No assumptions about who is able to use it!
  • Promoting use across the patient journey, not just the beginning: in clinic, in hospital, at discharge.
  • Engaging with the data: although real-time monitoring is not required for our platform, we see that when patients know they are being remotely monitored, they are more likely to track their data (and are thrilled with the experience!)
  • Full organizational buy-in: not just frontline staff, but executives prioritizing the initiative’s success

However all this success and engagement starts with a single belief: that you believe patients can and want to be empowered

Organizations are regularly surprised by the level of adoption and engagement by their patients. It turns out if you believe in it, your patients will too.

How else are we underestimating patients? Maybe it’s time to re-think those other assumptions too.

Why haven’t we seen a single front door for healthcare?

Why has tech forced most industries (eg retail, TV) to innovate or die, yet the same can’t be said for healthcare?

In retail, Amazon leveraged tech to own the digital front door for online retail – aggregating consumer demand and product supply.

In TV/film, Netflix leveraged tech to own the digital front door for entertainment – aggregating consumer demand and content supply.

Amazon and Netflix won based on superior consumer experiences and results – and they had to win on these dimensions because switching costs are low and consumers have choice. No longer are local retailers or TV stations in control. Deliver better results at a lower cost or be at risk of going under.

So why haven’t we seen the Amazon of healthcare?

It’s taken so long that even Amazon now wants to be the Amazon of healthcare!

Rather in healthcare, we see both high performing and low performing providers deliver a fair amount of care. Quality and patient safety can vary widely even in the same city (sometimes in the same hospital).

Patient demand does not aggregate to a few main players. Patients and consumers are not simply flocking to providers who will deliver better patient experience and outcomes, which would force lower performing providers to raise their game. 

We have hundreds of fragmented health systems and thousands of fragmented providers delivering variation in care and therefore variation in patient outcomes.

What’s so different about healthcare? Why can’t a few players outcompete the rest by delivering better outcomes and patient experiences?

A few reasons come to mind:

1. Humans still deliver a lot of care, which means improvements in the “product” don’t scale: Amazon and Netflix can automate 99% of the service. Make an improvement in the tech and every consumer immediately benefits. However, software can’t replace a surgeon operating on you or a nurse caring for you (yet!). A learning acquired by one doctor won’t instantaneously copy to every other doctor (although I suspect some futurists would tell me that this is inevitable! Star Trek’s holographic doctor, anyone?).

Also, providers enjoy autonomy and some are unwilling to standardize how they deliver care to match new evidence-based best practices – even if the data shows it’s better for patient outcomes. Why? Humans just don’t like changing how they do things. Humans (especially physicians) want autonomy. So the best providers and how they operate can’t be easily scaled. 

2. Brick and mortar still matter which means less competition in less profitable regions: Unlike retail and TV, there is still a huge component of in-person healthcare delivery. You can’t digitize the best hospital facilities and the majority of in-person care. Physical care will remain a big part of healthcare. How much competition is there to deliver high quality care in the lowest density and hardest to reach geographies? A lot less than in major cities. Netflix’s cost and care delivery structure doesn’t change whether it’s serving a consumer in rural Alabama or New York City – but a health system’s would.

3. Perverse financial incentives: Much of healthcare is still heavily fee-for-service. This not only limits high reliability, high quality care from being prioritized as a market differentiator, but this also means there are a lack of guardrails to stop those who put profits before patients. For example, I recently heard about ophthalmologists who prioritize patients on the cataract surgery waitlist based on who was upsold on more expensive lenses. I also heard about radiologists who bring patients back on two different visits for imaging so they can bill twice, even though it can all be done in one visit. Can you imagine the customer churn if Amazon forced us to make multiple orders with duplicate shipping fees? While I believe most providers have good intentions, we are all familiar with providers who do need guardrails. As long as incentives remain misaligned, better consumer experience and results won’t be prioritized.

The critical question: Do we WANT the Amazon of healthcare?

Even if one or a few players could be the steward for healthcare delivery, would patients and consumers truly be better off? Or do the high switching costs of changing providers mean more competition is better to keep providers honest? Would less competition drive up pricing and thus costs (especially in the U.S.)?

It’s not the end of the world if Netflix dominates TV and film – we can live just fine if the quality of streaming deteriorates over time.

However when it comes to healthcare and the high switching costs of moving providers, it’s not okay if there is a single front door for healthcare and quality and cost deteriorates.

One to watch will be Kaiser Permanente and their plan to build the front door for healthcare as a health system, instead of as a consumer company like Amazon. Just last week we saw KP’s big move acquiring Geisinger and announcing that more consolidation is on the way – with the aim of leveraging their know-how and scale to accelerate the path to value-based care.

Will improved quality at a lower cost finally be a true market differentiator?

I hope KP is right because at the end of the day, healthcare is about achieving better human health.

As more health systems consolidate and technology advances, the front door for healthcare will become the frontier on which health systems compete. Due to financial constraints, many will focus in the near term on consumerism and convenience, but I believe those who can deliver high reliability, cost-effective care at scale will win longterm.

Because ultimately in healthcare, the product we must deliver isn’t simply access to care – the product we must deliver is better health for all.

The potential for Chatbots & Large Language Models (LLM) to revolutionize the Healthcare Provider experience

OpenAI released ChatGPT one month ago and already this next generation chatbot built on a sophisticated Large Language Model (LLM) has taken the world by storm. If you haven’t yet, I urge you to give it a try – it WILL blow your mind!

Chatbots are not new, but a few key traits have made ChatGPT and its underlying LLM particularly impressive:

  1. Breadth of knowledge: It is trained on such a large data set that it can converse on almost any topic, from philosophy to film to science
  2. Ability to synthesize information and generate insights in a human-like way: You can ask it any questions or give it a prompt/instruction, and the thoughtfulness and quality of the response is stunningly good.

Let’s start with a simple case. Compare asking Google vs. ChatGPT the same question. Whereas Google Search takes you to the most relevant website, ChatGPT actually provides a direct answer.

Pretty nifty, huh? But that’s not even the best part. Where it REALLY gets magical is when you give ChatGPT a “prompt” or specific instructions.

For example: What might a Digital Care Journey company like SeamlessMD look like if it were built for 1900’s healthcare? Even I might have trouble answering a creative question like that. No big deal for ChatGPT though! (Note that I provided zero context about SeamlessMD)

Holy guacamole, am I right?!

So what could Large Language Models and Chatbots mean for healthcare providers?

There’s been an explosion of consumer/patient-facing chatbot startups and innovations in the last few years, especially since the pandemic – e.g. chatbots to triage COVID-19 symptoms, schedule appointments, etc. Certainly even more advanced chatbots built on Large Language Models (LLMs) will emerge to tackle the patient consumer experience.

However, for this article, I want to focus more on the opportunity for LLMs to dramatically improve the clinician experience. Why?

  1. Hospitals and health systems are facing major staff shortages and clinician burnout issues
  2. Improving frontline clinician workflow issues with LLMs is lower hanging fruit than the complexity of getting patients to engage with LLMs (and the complexity of getting clinicians to buy-in to providing a patient-facing clinical solution too!)

So suppose that health system innovators, startups and even EHRs start to build Chatbots & LLMs to improve the provider experience. What possible use cases might emerge?

I expect low hanging fruit to be focused on saving clinicians time: either reducing time spent searching for information in the patient chart or minimizing effort on documentation. For example:

  1. Fast discovery of patient information: “What allergies does this patient have?” “What medications is this patient on?” “Is this patient on any blood thinners?”
  2. Streamlined clinical documentation and medical letters: “Draft a progress note based on today’s findings” “Draft a consult note based on today’s visit”
  3. Summarize trends in clinical and test data: “Review the imaging reports from the last 3 chest CTs and create a table that lists the tumour size by date of CT scan”

How will Chatbots / LLMs for providers be built? What will be the dynamic between startups, health system innovators and EHRs?

As with any disruptive digital health idea, I expect many innovators will try to build in this space. Most successful commercialization will probably come from startups, and there will be some tension with the EHRs who will also realize this feature should be core to their strategic priorities.

The most likely outcome? Perhaps some M&A in a few years where EHRs acquire the relevant AI talent and potentially a proven, integrated LLM-based solution.

That said, I am most interested to see which major EHRs will have the conviction and ability to recruit the AI engineering talent to build this in-house. Some will try to partner with big tech (most likely Google or Microsoft/Nuance), however it’s risky to delegate a potentially existential innovation to a third party for who this is not materially important to their core business. In many ways, given that LLMs/Chatbot interfaces would be best suited as tightly integrated experiences into both the EHR interface and the underlying data it houses (and other data systems it connects to), it could be in the EHRs best interest to develop it natively in-house.

The EHR that figures this out and dramatically improves clinician experience/satisfaction could have a major competitive advantage for the next 10+ years.

And if you still aren’t sold on whether Chatbots built on Large Language Models could transform how providers deliver care, don’t take my word for it. Even ChatGPT agrees:

What Healthcare taught me about a Team-First mentality

In medical school, a classmate texted me:

“Hey – I’m on my surgery rotation, and the chief resident says you’re the best medical student they’ve ever had. What did you do? Because I want to get into this program and I’d love to impress them.”

I was surprised. This was a highly competitive specialty that I had no interest in pursuing.

So I hadn’t done the typical things a student might do to impress. I didn’t study a lot to showcase my knowledge. I wasn’t overly keen in the operating room to demonstrate my technical potential. I didn’t try to start discussions on the latest research in that specialty to show my enthusiasm.

I asked myself: what did I actually do?

And that’s when I realized what I was mostly doing was putting the team first.

I did whatever I could to help the team mover faster, save time and get home to their families sooner.

I took initiative to get all the “scut work” done and done well, so the team could spend their time operating at the top of their expertise – performing surgery, managing post-op recovery, etc.

I memorized how the team documented their notes, and wrote all of their notes n their preferred format. I would help get the patient and the operating room prepped for surgery. I would literally pick up the trash. I would do it all of this before anyone asked, and I never complained.

Of course that meant less face time with the surgeons and residents, and losing opportunities to assist with surgeries – but that didn’t matter to me.

To be clear, I was still getting great clinical training. I got to spend lots of time assisting in surgery. I had more opportunities to suture than ever before.

But I would always do what would help the team before satisfying any of my own personal interests. Whereas other students, especially those trying to get into the specialty, were more focused on getting more face time with the team, more operating room time and trying to stand out.

Why was my approach better received? Because ultimately residency programs are high-performing teams, and they too want to “hire” individuals who also put the team first.

It’s counter-intuitive, but while conventional wisdom is for students to stand out by putting themselves in the spotlight, the reality is you could stand out by putting the team first – since many people weren’t doing that.

This lesson has strongly shaped how I think about building our team at SeamlessMD. Being Team-First is a value we look for in potential team members and that we expect across the organization.

We put the best interests of our company ahead of our individual goals. We help team members solve problems, even if it doesn’t benefit us individually. In our Monday All-Hands meetings, we have a ritual called “Shoutouts” where people gives kudos to team members who went out of their way to help them.

Improving patient care is incredibly hard – whether it’s taking care of patients in the hospital, or bringing Digital Health solutions to market. Prioritizing personal egos and individual interests can lead to misaligned and slow-moving teams. Achieving big missions like ours in healthcare can only happen if everyone is aligned on being Team-First – so we can move quickly, nimbly and together.

Digital Health must enhance – but not disrupt – the Provider-Patient relationship

One of my most memorable experiences as a 3rd year med student was caring for John.

John was a 50-year old patient with metastatic lung cancer. His prognosis was poor – he only had a few months to live.

Never smoked. No real risk factors. Just really bad luck.

John was admitted to the hospital after coming to the ER with severe pain. We were going to do our best to help control his pain, and then help him get back home.

I was John’s primary care team member during his stay. I saw him daily.

John was understandably angry and frustrated with his situation. He was short with members of the care team. He wouldn’t talk to most people.

I ended up being one of the few care team members John was cordial with. Being able to communicate with John was critical for us to improve his pain and get him home safely.

About a week later, we discharged John to the community.

Fast forward a few weeks, and I was doing an overnight call shift. In the early hours of the morning, I was called to do a consult for a patient in the ER.

It was John.

He looked much worse this time. His pain was even more uncontrolled. He could barely talk and no one was with him. It would’ve impossible to get a full medical history on him.

Fortunately, I didn’t have to. I probably knew John’s story and medical history better than any single person in the hospital that night.

I talked to him briefly and then got him admitted. During his stay, I worked with John, his family and our social work team as he made his decision to transfer to a hospice care center, so he would be better supported in his final months.

When I think back to that day in the ER, I feel grateful that I was the person on call that night. I can’t imagine how much worse John’s experience as a patient would have been if someone else had been on call.

It’s also been a regular reminder to me of how important an on-going Provider-Patient relationship is.

When providers have a pre-existing relationship with a patient, they can deliver better care because they have far more context.

One of the things I’m most proud of with SeamlessMD is that we don’t disrupt the Provider-Patient relationship. Instead, we enhance it, by allowing a patient’s own care team to extend their care beyond the four walls of the clinic or hospital.

If a patient is recovering after surgery, it’s much better for the patient if her surgical team is monitoring her symptoms and recovery – because if there are early signs of post-operative complications, her surgical team has far more context for what to expect with her specific recovery, and can treat her situation more appropriately.

Or in John’s case: imagine if his own palliative care team was monitoring his pain remotely, and could manage his pain at the earliest sign of trouble.

Over the past few years, there’s been a lot of hype about Digital Health and Virtual Care. Especially virtual care solutions built on the premise of patients speaking with the first clinician available.

This works great for low-risk or urgent care issues – e.g. rashes, UTIs, etc.

But this is not an effective approach for patients with complex chronic diseases or patients going through an acute episode of care (e.g. surgery, recent hospital discharge, etc.) – where being managed by a consistent care team with context is critical for patients to have the best health outcomes.

For the latter situations, excellent patient care is not a commodity that can be accomplished between a patient and any random provider. It’s a function of both excellent clinical skills AND applying those clinical skills in the context of that specific patient’s healthcare journey. This is especially important when caring for our most at-risk patients.

There’s a place in healthcare for both types of solutions. I just hope with the “coolness” of convenient, urgent care Digital Health solutions, that we don’t forget the importance of solutions that enhance Provider-Patient relationships – especially for patients at-risk who need care the most.

How to cure “Pilotitis” in Digital Health

When we started SeamlessMD to deliver digital care journeys for patients, we did many hospital pilots.

Before involving hospital executives, clinical teams told us we needed to do a pilot to prove the ROI. No one wanted to engage hospital leadership at all until we had data in hand. We were regularly told “if we show we can reduce readmissions, the hospital will definitely buy this.”

It makes sense, right? Let’s start quickly, prove it out and then blow everyone away with incredible results.

So we’d do the pilot. Together, we’d invest a lot of time and energy implementing the platform. We’d run a 6 to 12 month pilot. Then we’d stop the initiative and wait while the hospital did an outcomes analysis.

Often the clinical teams would return with incredible results, such as 50% reductions in ED visits or readmissions. Often statistically significant.

And then we’d finally get that big meeting to present to hospital leadership. Sometimes even the hospital CEO would show up. We’d show those amazing improvement in outcomes. And then…

Nothing. No hospital purchase. No continued benefit to patients.

I remember one hospital CEO (who himself is a physician) telling me:

“Josh, these results are fantastic! And I can see how SeamlessMD is great for patients too. But actually, reducing readmissions isn’t a priority for us…

At first you think it’s an anomaly. But after a while, it’s a pattern.

Pilotitis

The Advisory Board defines “pilotitis” as:

Pilotitis (noun) – “the act of continuously pursuing small health care projects but never scaling them, leading to duplication and short-lived benefits.”

I first heard the term from health tech entrepreneur Geoffrey Clapp in 2014 when he was delivering a health tech keynote. We all laughed, but every Digital Health advocate eventually realizes over time that pilotitis is no laughing matter.

Do a Google Search on “pilotitis” and, lo and behold, you find mainly healthcare webpages. So perhaps pilotitis is only a disease in our industry. Or perhaps it’s a healthcare term, poking fun at medical lingo. That said, I rarely hear colleagues in other industries getting frustrated with pilots, so it’s more likely to be a healthcare disease.

Within health systems, I suspect folks have a Love-Hate relationship with pilots. On the one hand, pilots in theory seem like a nimble way to deliver a proof of concept before investing further. On the other, so many fizzle out even if the results are good.

Unfortunately, pilotitis causes many problems:

  • Wasted time and money: Both hospital staff and companies invest significant resources and time (sometimes over a year!) on an initiative that was never set up for success.
  • Decline in morale: It’s one thing if a pilot fails because the results aren’t good. It’s worse if you delivered on your promise, but the initiative dies anyways. Which leads to…
  • Slower innovation in the future: The next time something innovative is worth exploring, why would frontline providers or companies care to try? I’ve seen folks on both sides of the table become cynical and move on from trying to innovate in healthcare. This is sad because improving healthcare is so important and meaningful! We can’t keep losing people.
  • Failed pilots due to poor implementation support: Sometimes pilots fail, not because the innovation wasn’t good, but because the execution was poor. A “pilot” is sometimes not taken seriously, sometimes treated like a “research study” where the results only matter to one researcher, etc. Operational initiatives with strong executive support are taken more seriously by staff and the full potential of the innovation is unleashed.

What causes Pilotitis?

In order to cure a disease, you need to treat the cause.

The #1 cause of pilotitis is that you’re trying to solve a problem that’s not a top 3 priority for your organization. (Note that the number 3 is a bit arbitrary – the key thing is that your innovation solves a problem that a key executive really, really cares about)

If you understand that concept, everything else falls into place. Every other aspect of pilotitis is a result of this.

If you’re not solving a problem that’s a top 3 priority for an organization, then you:

  • Won’t have an executive sponsor: It’s not that the Chief Quality Officer doesn’t care about your amazing pilot results reducing readmissions. She’s genuinely impressed! BUT, the CEO has tasked her with cutting length of stay by 1 day this year, so that’s what she cares most about. And that leads to… 👇
  • Won’t have access to funding: Because if your Chief Quality Officer isn’t going to pound the table at the leadership team meeting, saying your pilot results MUST be scaled across the hospital, then why would the CEO ask the CFO take out his cheque book? And that leads to… 👇
  • A pat on the back – but no support to transition from Pilot to Operational initiative: Which leads to confusion and disappointment for the well-intentioned frontline hospital staff and mission-driven digital health company.

So how do you treat Pilotitis?

Fortunately, there is a straightforward treatment for pilotitis. Unfortunately, it’s not an easy treatment to administer:

Achieve Innovation-Priority Fit:

Get executive alignment and buy-in BEFORE implementing the innovation

That’s right – take your vision to your VPs and CXOs, and see if it solves a top 3 problem they care about.

What if you DON’T have Innovation-Priority Fit?

Alright, I see you rolling your eyes at me! Like I said, it’s not an easy treatment to administer. And you’re right, it could go horribly wrong. Sure, let me count the ways:

  • You lose your champion: Some folks just won’t feel comfortable knocking on the door of a VP or CXO without results in hand. For some of them, this is their first time engaging an executive – are they ready to spend their social capital on your innovation?
  • The approval process is delayed: Getting a meeting with certain VPs and CXOs could take a few months – especially if your champion doesn’t have existing relationships. And your champion could get demotivated from the work it takes to network across the organization, so they ask themselves: How important is this pilot really?
  • The executives say “No, this is NOT a priority – at least, right now”: And in fact, they might squash your initiative entirely, and your pilot that otherwise would have gone unnoticed can’t even happen at all.

Sounds awful, but here’s why it’s a good thing: If you don’t have Innovation-Priority Fit, then the organization was never going to support your innovation after the pilot, no matter how good your results were. It sucks to hear, but wouldn’t you want to know the truth before you put in those months of blood, sweat and tears?

Just remember that priorities DO change. What’s not a priority this year can be a priority next year. I’ve see it in my own organization. We’re currently implementing a solution that was brought up three years ago, but it simply wasn’t a priority at the time. It’s not that it wasn’t a good idea – of course it was, it was being used by other organizations. But it wasn’t a priority for US just yet!

I’ve even seen health system priorities change just because a key executive changes. A new executive comes into the organization who is motivated to make your priority her priority – and BOOM, your innovation suddenly matters!

So to health system innovators: don’t give up just yet. But maybe put it on hold for the rest of this year. Just please don’t take it personally. Innovation is hard and timing matters.

And to digital health companies: don’t take it personally. What’s not a priority at one organization, may be the #1 priority at another organization. Just keep asking.

What happens if you DO have Innovation-Priority Fit?

However, let’s say your innovation DOES solve a top 3 priority for hospital leadership. This is when the magic happens. Then you often:

  • Get clarity on what results you need to prove: Let’s say reducing readmissions is a priority – well, what amount of improvement matters? If the CEO says a 10% reduction is meaningful, then you know what to aim for.
  • Get feedback on broader success criteria: Turns out that there are all kinds of other priorities you never knew about. Your innovation might also improve patient satisfaction scores? Now you’ve got the Chief Experience Officer engaged.
  • Get funding immediately: Even for relatively new innovations, if you’re solving a problem the health system is desperate to solve, the health system will just buy the solution. There’s always funding for true priorities.
  • Get to go bigger sooner: An executive who is highly motivated to solve this problem would rather just roll your innovation out more broadly, instead of starting with a tiny pilot.
  • Get operational, day-to-day support: Because your solution helps address a priority, the executive team WANTS you to succeed. So they’ll often give you more resources – e.g. a project manager to support the day to day of your initiative. Gosh, wouldn’t that have de-risked the pilot you were planning to manage as a side project?
  • Get the whole organization behind you: Because your initiative is addressing a priority, your initiative de-facto becomes important to the organization. Everyone around you is going to be asked to make it successful. People will be aligned to drive results.
  • Get on-going engagement from executives: Your leadership team will WANT to stay engaged throughout. They’ll want to sit in on the quarterly update. They’ll want to know what they can do to help overcome obstacles that show up. Now you’re all in this together.
  • Have a clear path to long-term sustainability: Since your innovation aligns with an established priority, and your leadership team is both financially and emotionally invested in your innovation – if you achieve your goals, then it’s a no-brainer for the innovation to continue and scale across the organization.

When there is true Innovation-Priority Fit, the probability of long-term success is dramatically higher.

So before you embark on months (or years) of Pilots, go pound on the door of your VPs and CXOs. Find out if your innovation solves a top 3 priority. Be even way more successful if it is. Save those blood, sweat and tears if it isn’t.

SeamlessMD’s Mission: Right Care, Right Patient, Right Time

“We’ve designed the healthcare system to make it easy for healthier patients to get care. But we make it hard for our sickest, most complex patients – who need care the most – to get the care they need.”

This was a stunning realization for me. 🤯

When I heard this quote, I was in my second year of medical school, and I was helping an academic hospital uncover barriers to their physicians doing house calls for the homebound elderly.

For clinicians being trained today, house calls must sound like something from another world. In the 1930’s physician house calls represented 40% of patient encounters, but by the 1980’s, it declined to below 1%.

He might be the only one today

But physician house calls are crucial for a specific part of our population. The homebound elderly are unable to seek primary care in the clinic due to physical, cognitive or psychosocial barriers. One third lack a family physician.

Why aren’t physicians doing house calls anymore?

When I surveyed physicians, the top three barriers to doing house calls were:

  • Time: You can see far more patients in an office setting, since you wouldn’t need to travel to and from patient homes
  • Reimbursement: Although house calls may be slightly better reimbursed per visit, your compensation in the office setting is greater due to much higher volume. Plus, it’s more convenient (no travel).
  • Safety: There is both a perceived and real physical risk of delivering care in an unfamiliar physical environment.

In a primarily fee for service environment, it’s unsurprising that over the past century, medicine gravitated towards the office based environment. But this focus on clinic-based care, combined with a growing population, has resulted in major healthcare problems – not only for patients who face barriers to comprehensive medical care, but also for the sustainability of our healthcare system at large.

The homebound elderly are more likely to be severely disabled, with multiple chronic conditions – and their complex chronic conditions are often poorly managed. When problems arise, it’s rarely caught early. When these patients get ill, they must rely on an ambulance trip to the ER – resulting in many preventable ER visits and readmissions, and much higher healthcare costs.

Association of Changing Hospital Readmission Rates With Mortality Rates  After Hospital Discharge - American Nurse Today
Without access to care in the home, our homebound elderly end up relying on hospitals for most of their care

How big is the need?

As an example, in the U.S., there are more than 2 million homebound elderly – with the need growing during the COVID-19 pandemic.

Researchers at Mount Sinai found that the proportion of elderly who were homebound more than doubled 5% → 13% in 2020. It’s unclear if this increase has been sustained since, however some level of increase has likely remained since the elderly are at higher risk of severe illness from COVID-19, and thus remain at home.

Proportion of Community-Dwelling Older Homebound Adults Aged 70 Years or Older, 2011-2020
Figure. Proportion of Community-Dwelling Older Homebound Adults Aged 70 Years or Older, 2011-2020.

I remember when my principal investigator (PI), a family physician, took me on a few house calls. It gave me perspective on the barriers I heard from physicians. At the same time, it underscored the importance of what my PI was trying to build with her house calls program: these patients needed more accessible, proactive care in the community.

Getting back to the story

Which brings me back to the quote at the top of this story.

I had been presenting my findings to my hospital’s innovation center that focused on caring for complex patients. An internal medicine physician raised what I quoted above, about the crazy reality that our healthier patients have no problem walking into our office-based practices, but our sicker, homebound elderly patients – who need care the most – can’t stroll into the office, and thus are the least likely to get medical care.

It was such an obvious observation in retrospect, but something we often fail to think about as a healthcare system.

Dick Wolf Surprise GIF by Wolf Entertainment

So what’s the solution?

I didn’t believe then or now that just increasing the number of in-person house calls is the only solution (although it’s part of it). The world has changed in many ways over the past decades, and our approach to care delivery needs to keep in step. And while telemedicine has certainly bridged some of the gap, it’s only one part of the solution.

What was clear is that there’s so much more we could do for not only this population, but all patients, if we could bring care into the home – especially between visits.

That belief and that work was what kick-started my trip down the rabbit hole into hospital readmissions, and quality and patient safety as a whole – which ultimately led to starting SeamlessMD.

SeamlessMD’s mission is “to ensure every patient gets the right care at the right time.”

Most care is delivered within the four walls of a hospital or clinic. But 95% of the patient journey happens at home in the community, when patients are not in front of their care team.

Getting every patients the right care at the right time means helping healthcare providers extend their reach to patients in the community – but in a way that is scalable for clinicians (we can’t expect providers to monitor every patient every second of the day). It also means empowering patients to be partners in their care, making it easier for patients to stay on track with their care plans and empowered to track their own health status.

At SeamlessMD, we believe Digital Health is a huge enabler in making this possible – it’s why we do what we do.

At the same time, we aren’t naive to believe Digital Health solves this completely (there are certainly some patients, including homebound elderly, who are not digital savvy!). We still need non-digital avenues to reach a subset of patients, or for when higher levels of care are required. We also need further evolution of our reimbursement model to incentivize better health outcomes, and therefore, more care at home. Our system must be re-designed to make it easier for healthcare teams to deliver the best care possible.

That said, time and time again, I’ve found our healthcare partners pleasantly surprised to see that patient adoption and engagement with Digital Health, especially among the elderly, is far higher than what they were expecting. Ultimately, I do believe digital access and savviness will only rise over time – so we are building for the future as much as we are for the present.

Technology GIF by Brittlestar
Technology will be more accessible, easier to use (and safer!) over time

When I first studied house calls ten years ago, solutions like SeamlessMD didn’t exist – so our healthcare system has come a long way since then. While I believe we’re still in early innings of the Digital Health transformation, and it’s still very much an uphill battle, the changes in our growing population show that our mission is more important and relevant than ever.

So let’s keep building! 🚀🚀🚀

Why Clinician Buy-in is Central to Digital Health Transformation

It was a summer day seven years ago. We had closed our 1st U.S. hospital customer for SeamlessMD and I couldn’t be more ecstatic. Unfortunately, our excitement was short-lived.

We “implemented” our solution, but patient enrollment was going poorly. When we went on-site to investigate, we learned that surgeons were pushing back against patients getting access to the platform.

We were confused: why would the hospital buy our solution if they didn’t want to use it?

Speaking to surgeons, we learned they were upset for not being included in the evaluation and implementation process. As SeamlessMD is a Digital Care Journey platform, it was being used to guide patients pre and post-surgery – including educating the patients on how to prepare, how to manage recovery issues, etc. Certainly, this included delivering instructions and workflows the surgeons wanted to be aligned on!

So we reflected on what happened until that point.

First, the sales process – how did that transpire? A quality leader learned about SeamlessMD, and she got hospital executives to buy-in to the solution – but no front-line clinicians were consulted.

Second, the implementation – what happened there? We compounded the problem by implementing the solution with the quality team and other clinicians – but without any surgeon champions.

Although we tried very hard to collaborate with the surgeons going forward, it was too late – the bridge had been burned. Unsurprisingly, patient enrollment continued to be poor, and the customer didn’t renew.

The partnership must be setup for success even before the sale

We learned a really big lesson that transformed how we sold and implemented SeamlessMD going forward.

We learned to build into the buying process a requirement that all key stakeholders – especially key clinician champions whose teams are often most impacted by a Digital Health solution – are engaged and bought-in.

And those same key clinical stakeholders must be part of the implementation – informing how clinical content protocols are incorporated or clinician workflows are impacted.

Clinician buy-in → patient buy-in

There are also second-order benefits to engaging clinicians early on. When they are involved from Day 1, clinicians feel a greater sense of ownership for the initiative. This makes them far more likely to care about the initiative’s success and promote it to patients.

This is critical because a patient’s engagement with Digital Health is highly dependent on the trust their own clinicians place in it. When clinicians are bought-in, their patients are too!

Exec buy-in matters less than clinician buy-in

I often tell people:

“It doesn’t matter if the CEO of a health system wants to buy a solution, it won’t be successful unless there are true clinical champions bought-in.”

Sure you might close a deal, but when the implementation inevitably fails, we’ll have wasted everyone’s time.

When it comes to Digital Health transformation, both the health system and company want the initiative to succeed. Healthcare has long, complex sales cycles – there’s little benefit to either party to close a deal and have it setup for failure.

So don’t skip this step. Clinicians must be at the heart of any Digital Health transformation. The success of Digital Health depends on it!

Dear Digital Health startups: Clinical must be core to your Team DNA

Yesterday I learned about yet another of our health system customers who presented results at a major conference, demonstrating reductions in readmissions by 50% and length of stay by 20%. We had no idea! We only found out thanks to Twitter.

Over 30 clinical studies or evaluations have been done by our health system partners demonstrating how SeamlessMD was used to reduce costs, length of stay, readmissions, etc. across a wide variety of clinical areas, such as orthopedics, cardiac, women’s health and many more.

Despite never sponsoring a clinical trial ourselves (this is truly the work of our customer partners!), we have amassed stronger and more clinical evidence than any other company in the market. Similar companies have surely done as many implementations as we have, and yet, the difference in results produced is stark.

Today it’s easier than ever to “build a digital health app” – but it’s NOT any easier to build one that improves patient outcomes

As someone who left medicine to work on digital health for nine years now, I can tell you it’s not hard to “build an app” for patients that has all the “features” that providers want in a Digital Care Journey platform – e.g.  reminders, symptom tracking, remote monitoring, etc.

What is hard is delivering a solution that patients actually use and drives a meaningful improvement in outcomes – across any clinical area, not just one or two.

So how are we consistently producing better outcomes than the rest?

It’s a good question, and one that I’ve asked myself several times a year. 

The truth is that it’s not one magical feature. We didn’t just wake up one day, build something new, and better outcomes just started rolling in.

Ultimately, I believe it’s because our team construction is wildly different from every other company in our space. We have far more clinical DNA.

Most Digital Health SaaS companies have the typical software team stack – engineers, designers, product managers, customer success managers, sales, marketing, etc.

Instead, we took the contrarian route in digital health and focused more on the “health” and less on the “digital” in our team construction.

At SeamlessMD, 23% of our team has clinical experience. Whoa!

Over the years, our team has included folks from medicine, nursing, pharmacy, dietetics and health communications. 

These folks are highly involved with designing and improving the patient experience, developing our evidence-based care journeys and working directly with providers to customize clinical content and workflows. It’s like having our customer partners working inside our company, all the time.

Contrast that with most companies in our space where there is maybe a clinical co-founder or a clinical advisory board. In reality, these companies have very few folks with clinical experience working in the trenches, every day, with the product team and customers.

“The team you build is the company you build”

– Vinod Khosla

I love this quote by Vinod Khosla because it accurately portrays the importance of team construction. Our clinical team has deeply shaped so many aspects of our product and customer engagement, most of which never came from some original plan.

It’s these clinical folks that invested deeply in an evidence-based approach – not only in terms of the clinical content, but also in how it’s delivered, such as infusing evidence-based methodologies for adult learning, health literacy and behaviour change theory into the patient user experience. 

And what happens when providers meet our team with such strong clinical DNA? Magic happens.

Not only does our clinical DNA make our product and company better, but it increases clinician buy-in and confidence – leading to more success and stronger partnerships.

A customer once told me:

“When I heard we were implementing your solution, I had some mistrust at the beginning because, in my experience, you’re usually talking to an IT person who has no clue what we as clinicians are saying. 

Instead, I was impressed with your clinical team, to have someone who completely understood our needs and goals, and could deliver it in a way that patients understand.”

As many digital health solutions fail to deliver on improving outcomes, the market is waking up to the realization that solutions must be measured on evidence, not feature lists. 

Two digital health solutions with the same “features” can have wildly different approaches to designing those features, resulting in wildly different patient engagement and clinical outcomes.

In the same way that health systems are led by interprofessional teams – clinical, administrative, digital/IT and many more – so too must digital health startups mirror that makeup of team DNA. 

Because when they don’t, we may be left with “yet another digital health app” that was full of promise but fails to deliver.