Silicon Valley often misses the point of healthcare

By: Neil Versel | Jul 20, 2011        

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Neil VerselThere are few places with such a high concentration of conceited, arrogant know-it-alls than Washington, D.C., but Silicon Valley may best even the Beltway gang. I’ve seen a lot of bluster, a lot of unearned publicity, plenty of buzzwords and, in many cases, little actual success in winning over customers or addressing a real problem in healthcare.

Sure, there are exceptions. With the iPad, Cupertino, Calif.-based Apple has captured the imagination—and the dollars—of perhaps a quarter of all physicians in the U.S. Practice Fusion, of San Francisco, has shaken up the ambulatory EMR market by offering a free, advertising-supported product that has successfully targeted a badly underserved segment, namely small physician practices. And Epocrates, based in San Mateo, Calif., claims 1.3 million users for its mobile and point-of-care medical reference and educational tools.

But there have been plenty of failures, too, some of the spectacular variety. Fitting into the latter category is Google Health, the personal health record that Google has decided to abandon after four uneven years of trying to figure out how to fix healthcare.

My hunch tells me Google never really had a plan to make anything out of Google Health. I’m thinking back to the 2007 World Health Care Congress in Washington, when Google was rumored to be developing some sort of PHR product. Adam Bosworth, then a Google vice president, gave a stirring speech about how his mother died due to a series of medical errors, exacerbated by multiple breakdowns in communication between her healthcare providers. He then asked attendees to tell him and other members of the “Google health team” problems they were looking to solve.

I took that to mean, “We want you to do our R&D for us, and do it for free. And we’ll fix everything because we’re Google.”

It took almost a year, until February 2008, when then-Google CEO Eric Schmidt gave a keynote address on the final day of the annual HIMSS conference in Orlando, Fla. There, Schmidt outlined his vision for Google Health before an audience I heard was estimated at 6,000 people. (But months later, a Google spokesperson denied to me that Schmidt actually “introduced” Google Health at HIMSS08. The official introduction didn’t actually take place, I was told, until May 2008. Whatever.)

Like so many other “untethered” PHRs—not directly connected to an EMR—Google Health was unable to build critical mass. “There has been adoption among certain groups of users like tech-savvy patients and their caregivers, and more recently fitness and wellness enthusiasts. But we haven’t found a way to translate that limited usage into widespread adoption in the daily health routines of millions of people. That’s why we’ve made the difficult decision to discontinue the Google Health service,” Google said in the blog post that announced the wind-down of Google Health.

Google posted the news at 11:01 a.m. PDT on June 24. That’s after 2 p.m. on the east coast, late afternoon on a summer Friday, when plenty of people have already checked out for the weekend, either mentally or physically. In one last stroke of self-flagellation, the post referred to Google Health and Google PowerMeter—another service the Internet search giant is shutting down—as “trailblazers in their respective categories.”

Sorry, Google didn’t blaze any trails in PHRs. The real trailblazers are the dozens of other, smaller companies that have been working on various forms of PHRs for as long as 20 years. Some names: Access Strategies, CapMed, ActiveHealth Management, MEDecision, Health Capable, MyMedLab, NoMoreClipboard.com, Good Health Network.

I could continue, but I’ve said plenty about Google already. There are other Silicon Valley culprits. After Bosworth left Google, he started up Keas. In February 2010, at the first mHealth Initiative conference, Bosworth gave a rather convincing argument about why Keas would be different from Google Health, Microsoft Health Vault or other PHRs because it incorporated care planning and actionable advice.

Keas got a publicity bump from a puff piece in the New York Times. But the product never caught on with the public. Perhaps it was the company’s moniker, named for the kea (pronounced “kay-ah”), a bird native to New Zealand. I’ve heard Bosworth pronounce Keas like “case,” but it’s pretty easy to mistake it for “keys” or, worse, “chaos,” not exactly the image one wants to project for a health product. And I wonder why Silicon Valley seems disconnected from the real world.

Last week at the Healthcare Unbound conference in San Diego, I saw yet another example of Silicon Valley arrogance, courtesy of mobile health and health 2.0 incubator-accelerator Rock Health. Rock Health, founded by Harvard Business School students and alumni and based in San Francisco, has a goal of bringing non-healthcare technological thinking to healthcare.

“We are trying to focus on the technology itself and are looking to find technologists,” Managing Director Halle Tecco told MobiHealthNews in March. “We are trying to bring in really great developers and programmers and encourage experimentation and out-of-the-box thinking about healthcare.” OK, that makes some sense. Healthcare is a broken industry and could use some disruptive innovation.

But it’s possible to go too far. On a panel at Healthcare Unbound, Tecco made a point of noting that Rock Health only had one person on staff with any healthcare experience at all. She showed slides illustrating the laid-back atmosphere at Rock headquarters, as if that has anything at all to do with addressing the many problems healthcare faces.

Tecco repeatedly referred to investments as “plays,” suggesting that Rock Health is little more than an investment house with no clear understanding of the emotional aspects of healthcare. She stated that consumers are “obsessed with data,” which is why she believes that m-health is becoming more location-based, more passive, more data-driven and more user-friendly.

Mobile health is moving in all those directions, but not because consumers are obsessed with data. The problem is, with a couple of exceptions, Rock Health so far has been targeting the young end of the market. It’s a demographic that includes many without health insurance, and even those who are insured can’t always be counted on to take care of their own health. Those that do probably are more interested in fitness apps than in actual healthcare. That’s good, but that’s not where the bulk of the country’s $2.5 trillion in annual healthcare costs come from. The frail elderly and people with chronic diseases are the expensive patients.

As I reported last week, companies like Ideal Life, based in Toronto, and Great Call, from San Diego, have found success in producing easy-to-use technologies that simplify the lives of the old and sick. Silicon Valley has some smart, innovative people, but sometimes it seems like they are, as critics of former President George W. Bush liked to say, “all hat and no cattle.”

Healthcare needs better.

  • http://www.facebook.com/profile.php?id=691213750 Francisco Javier Guerrero

    While I agree in principle that Healthcare is a much more complex business to enter as an online or mobile start-up, the argument that innovation cannot come from people outside of the Healthcare-Insurance complex is not really backed by the facts.  Quite frankly, the digital innovations so far in healthcare have come from the outside of the industry. (e.g. as you mentioned, Practice Fusion, has both health industry and non-industry people) And yes, just like in any industry, there are those with traction and those without.  Even the real trailblazers you mentioned have found a hard time in the industry. 

     It is true that consumers dont want ‘data for data’s sake’ they want it packaged and presented in an useful way, comparable, even shareable as needed.   Innovation can and will come from the outside, and has been for the last decade.  The larger point is that now start-ups are approaching the complexity of healthcare from different angles and I’m sure all of us in Health start-ups know our knowledge limitations with respect to health care, and have procured advisors to assist us.  To dismiss this powerful trend in the basis of the experience of who decides to start a company seems a bit short-sighted.

  • http://geoffclapp.blogspot.com/ Geoffrey Clapp

    The healthcare market will do well to accept all comers who want to tackle this massive challenge. 

    Yes, we’ll get some carpetbaggers, yes, we will get some horrible failures, but we’re talking about the most important market in the world. We’re competing for talent with every startup, every incubator, and every wild-eyed idea out there – not just in Silicon Valley, but in every city and state in the US – from Boulder to Boston. The idea we can attract intelligent people to the space to help us solve these problems, people like Adam and Halle? Fantastic. That’s a great thing. Let them in, let them fail, and let them succeed. Who cares where they sit, where they are from, or how they want to do it?

    *If they are wrong, the market is merciless.*

     If they are right, they might just help crack this problem. So what’s the issue? 

    The analogy with Washington DC bureaucrats just doesn’t hold up, because there are no similar market forces. Maybe you don’t like how they are doing it, but it’s not as if status quo is getting us anywhere. So what if they fail? The *greatest* markets in the world are marked by competition and innovation…and failure. 

    So be it Boston, New York, or Silicon Valley – bring on your big thinkers and people who want to make change to healthcare. One of them will help us change the healthcare world, and this will be a great success.

    (Full Disclosure: There are a lot of Silicon Valley healthcare companies who actually have had success in Healthcare, like ours, and some that are on the verge of doing so, like HealthTap and PracticeFusion. For every failure, there are great stories too. But that’s not as great a headline.)

  • Andy Schoonover (VRI)

    Simple, easy to use is key. Silicon Valley has been way to focused on “cool”. Cool doesn’t fly with 80 year olds with 5 comorbidities, where most of our healthcare dollars are being spent.

  • Multiplyd

    While I think your argument about Silicon Valley overall is a bit over the top,  I agree with your assessment of Rock Health. Good writeup!

  • http://twitter.com/pmcape Patrick Murphy

    The basic conflict that I see right now is Silicon Valley’s focus on trying to turn healthcare into a consumer driven industry with consumer apps/devices etc… The money doesn’t really flow from the consumer’s pockets like other industries and that isn’t changing any time soon.  The largest dollars  and the biggest opportunities flow through government, insurance, and the healthcare organizations.  Disrupting and creating dramatic efficiencies within the hundreds of individual business processes within this healthcare ecosystem is much more complex. It is doable but one needs to be looking at the problem from the perspective of business process improvement. IPAD was fortunate to stumble upon the fact that Physicians saw how that device could improve their work life. 

  • http://twitter.com/askmanny Manny Hernandez

    I think you are mixing a LOT of things together in a single article. I agree that Google Health didn’t seem to be poised for success since early on. But I don’t quite understand why you would attack Bosworth and Keas the way you do (they changed their business model, last time I checked, focusing on employers and not direct-to-patient) or downplay the importance of incubators such as Rock Health.

    Disclaimer: I am part of the panel of judges for the Data Design Diabetes Innovation Challenge and I believe these kinds of initiatives are one way to encourage more solutions (and better) solutions to our space.

  • http://www.facebook.com/people/Jim-Bloedau/100000100425754 Jim Bloedau

    Neil, thanks for a historically correct and sober perspective about how hype cycles and technology can seduce the well intentioned developer.  Go easy on them, they are where innovation comes from and healthcare needs it.  Conversely, go hard on them for not seeking experienced council from history and people who have actually been involved in patient care and have seen a market cycle or two. Keep pushing  the mantra “easy-to-use technologies that simplify the lives of the old and sick,” adding, “…and the lives of those who care for them.”  Keep hoping for products that help both the sick and well to get more connected with their health-we can’t depend on someone else doing it for us, which is what most of “old healthcare” is predicated on. Fight the good fight.

    Jim

  • http://matthewtendler.tumblr.com/ Matthew Tendler

    Rock Health and Massive Health are trying to create a “revolution” of consumer-driven healthcare…not an “evolution” of traditional healthcare. Their goals aren’t to work their apps into the current system and there’s plenty of money in Silicon Valley for them to give these apps away for free and create absolutely new revenue streams. THAT IS TRUE DISRUPTION.

  • inchoate but earnest

    Too many of the would-be health tech innovators have as their “customer” the small cadre of investors who might pave the way to their liquidity event, rather than people who have some kind of health care “job to be done”. Were it otherwise, their descriptions of the applications they are working on or supporting would be about the specifics of what they are working on, rather than merely simultaneously arrogant and inane pronouncements about “medicine needing a design renaissance” and “powering the next generation of the digital health ecosystem” as if they were actually producing “medicine” or “ecosystems”.

    Health care ain’t Facebook, kids. For people to give you your due, you’ll have to actually solve a health problem, or remove a health obstacle, however simple, that actually affects numbers of real people – rather than merely insisting you’ve done so via distribution and promotion of some reskinned database application.

  • http://ducknetweb.blogspot.com/ Medicalquack

    Good article Neil and kudos on being one “that gets it” in healthcare.  You touched on a lot of topics here, some of the same things I tend to talk about as well.  For quite a while I have asked those who write these blazing reviews on PHRs about which one they use…ummm,…well…”I’m going to look at one and get one real soon” is somewhat the tone I hear from the “experts” who write these articles.  I don’t even know if the Surgeon General uses the Surgeon General’s PHR:)  We have no role models and today with Dr. Halamka with his post with leaving the CIO role at Harvard Medical continues to show the levels of burn out among Health IT executives.  The man has to also have a life and I get that but we lose some real leadership here but hope he keeps his blog going as there’s not a better cheerleader and source of intelligence and a “hands on” person in the business. 

    You are right about the hill with the world of “digital illiteracy” we have to deal with and they just don’t get it.   In the meantime, we have technologies bursting at the seams with software that few or nobody will use with consumer Health IT, I write about it all the time.  I made a post about a year ago about the topic called “Innovation without collaboration is fouling up the US Healthcare System” and it is heavily read and true. 

    All the chat about the FDA, they are looking for engineers too like everyone else when it comes to medical devices and we have the digital illiterates on the hill that think can find solution for this, good luck as it’s just not so as the “non participants” in consumer Health IT are the biggest downfall we have. 

    I think we are lacking true balance in the US with technology and “tangibles” and we seem to lack producing the latter.  We can’t base our entire economy on “algorithms”.  They have their place and I enjoy using a lot of of the social networks but we still need balance. 

    Another area nobody seems to address adequately is the area which I have been following and writing about for a couple years now is what I call “subsidiary watch”.  Don’t think this is important, think again.  Being a former develoepr I think talk a little bit about this here on how companies are combining, selling and using data differently than we did even 2 years ago.  It’s the 800# gorilla nobody wants to touch or maybe acknowledge, but it’s there.  Even judges get caught up in conflicts of interest on stocks they have owned for years as with an acquisition, the entire scope of the business changes a bit. 

    I am also amazed at the press that Google Health is receiving, for a product that few utilized, why all the press?  Of course I can understand why they chose to move in different directions but again most everyone writing about Google Health never even tried it, so go figure.  It just seems to circle back to making a lot of noise once more. 

    I agree there are some good exceptions that have done good things and had their act together like Practice Fusion and Epocrates and hope Epocrates decides to support the Windows phone as I miss having the reference on my phone and always have their search link on my blog for readers to use. 

    Consumers are not going to use even half the technologies that are coming out and earlier this year I attended the Israel Convention in Los Angeles and it was intense networking but saw something different here with a lot more collaboration going on than what we see out of the Silicon Valley, serious networking and learned about their “labs” to where companies are encouraged to work together to create solutions  that do “more than one thing” and the idea here is to create multi task software solutions that have “value”.  I see so much of what is created that lacks value, at least in the eye of the consumer and heck I find developers that don’t even use their owns stuff.

    There’s a lot to think about on the table and balance is a big part of it along with lawmakers that can get past talking about abortions for health care laws as well.  I think they default to this topic when lost:)  We have a lot of math being marketed beyond what I can really do and read this one on credit scores being used to determine if you will be compliant patient and take your meds.

    http://ducknetweb.blogspot.com/2011/06/fico-analytics-press-release-marketing.html

    Science and healthcare has not caught up to the technologies of the financial district and thus we have this imbalance and when we go to battle with taking a knife to a machine gun battle, well we all know who wins there.  I believe it’s time to do a bit more than write a few algorithms and throw it out there and see if it sticks if you will.  It seems we have a lot of that going on today and if channeled and collaborated a bit better, maybe we would see progress defined a little better.  Intersting too how I have collaborated with a NYU professor who wrote the book I promote all the time too on my blog, “Proofiness, the Dark Side of Mathematical Deception”, check it out and give it a read if you have not seen it as it helps me keep me balanced with the reality of how math is both used and sadly abused at times.  It’s sad that side has to exist, but it does but thank goodness there are more on the other side I think. 

    Ok have had my say and you can agree or disagree but that’s where I am today after blogging about all of this for the last 4 years:)

  • http://www.facebook.com/BarbSchubert Barbara Schubert

    Andy:  You hit the nail right on the head!

  • georgemargelis

    You are so right Neil. Healthcare is so much more than cool devices and cool apps. You need to understand what the issues the individual who is sick is facing, and try and solve them. Whilst information is important, it is not the be all and end all in healthcare. Its taking that information and making it relevant to the patient’s problem. 
    One example is the fascination with mhealth EKG applications. It has diagnostic value, but once you know a patient has an arrhythmia then just displaying it repeatedly doesn’t improve the patient’s status. Linking it to medication compliance, symptom recognition, lifestyle changes, behaviour modification can make a difference. Whenever I see a ehealth company without at least a couple of healthcare professionals deeply involved, I think here we go again……

  • DrChrisPaton

    Epocrates is a great example of innovation coming from outside the system. Their product took off because doctors could buy themselves a palm pilot and use their product without needing to involve the hospital at all.

    There are a lot of ways of using technology to potentially remove costs and improve patient care and I think there is a lot of good work being done here. But the really innovative and fast growing companies will be ones like ePocrates and PracticeFusion, that come from outside the current ecosystem.

    I’ve never heard anyone from Rock Health speak or heard much about them, but fostering a stimulating environment where young entrepreneurs can develop disruptive innovations for the health sector sounds like a reasonable way to approach the problem.

    Much of the cost of healthcare comes from unhealthy lifestyles developed at a young age. If young innovators can create solutions to the problem of people making unhealthy lifestyle choices, we’ll save a lot more money (and people will be a lot healthier) than if we only innovate at the treatment end.

    The trend for treating conditions in old age is that they will get more sophisticated and more expensive. People will live with chronic conditions for longer but will spend more on healthcare costs doing so. The real way to save money is to ensure that people can live healthily for longer. Targeting young people with preventative tools is a good way to do this. The tools will need to be “cool” and faddy, but does that really matter if it gets young people interested in keeping fit and well?

    Hype is annoying and arrogance more so, but energy and excitement directed at solving healthcare problems seems to me to be a good thing.

  • http://blogs.forbes.com/danmunro/ Dan Munro

    Seems a tad too narrow in terms of criticism – which I don’t think is warranted for either Halle or Adam (or Google for that matter).  I’ve met Adam – haven’t met Halle – but I do hope to at some point.  

    Google needs no defending – but they aren’t the first to fail in a category (PHR) that itself is struggling to find real consumer value.  I also suspect they’ll be back. The larger criticism I see (and warranted) is that while healthcare startups are growing in numbers – we’re still a very small fraction (3%) of the startup ecosystem.  GIGAOM ran an interesting post last month – The New Startup Ecosystem (full post here: http://bitly.com/l010iu  - and then the smaller portion of the infographic below).  It’s probably even lower than 3% if you take out the single funding of Massive Health ($2.5M) – but either way – it’s not healthy.  

    Personally, I applaud Rock Health for 2 simple reasons.  It’s the first healthcare focused accelerator/incubator, AND it takes ZERO dilution.  That’s pretty compelling/unique – in the heart of a climate (and geo) that typically takes 5% or 6% without blinking an eye.  That’s also one of the reasons they had 350+ applications for the first cohort.  My only criticism is that there aren’t enough of them (at least nationally).  I would argue (and have in other posts) that we need 10 Rock Health programs in each of the major U.S. metros.  Total cost – less than $5M.  That would fund 100 healthcare startups – in *very* short order.  Would all of those be great companies?  No.  Would all of those be worthy of incubation?  Probably not.  Would all survive? No way – BUT – we would begin to attract the kind of talent that is much needed for innovating in healthcare.   

    I don’t think it makes much sense to single out either Halle or Adam.  They’re both actively innovating in healthcare.  Will either succeed?  It’s just way too early to call either effort a success or failure – which is (by definition) the hallmark of innovation.  Knowing first-hand just how hard that is – I do applaud their personal efforts.

  • Daniel

    Innovation and support for innovation is always important and needed. Rock Health is extremely supportive to healthcare startups.

    Daniel, cofounder drchrono

  • http://gplus.to/schlif Adam Schlifke

    Although a lot of the time and attention in the healthcare investment community these days is focused on the consumer/wellness side, there is a much bigger and more difficult problem to solve on the clinical side: how do we engage the patient that has many medical problems and has no interest in using the latest software application or medical device? At the end of the day, we must change patient health behavior and in order to do that effectively we must understand how the complicated and perverse-incentive filled healthcare system works. I encourage any entrepreneur who is looking to solve some of these clinical problems to involve clinicians in the process (and yes, I am biased).

  • http://kevinlmcmahon.com/ Kevin L McMahon

    Whatever the opinion on how Neil chose to wrote the piece he does appear to have started a real conversation. And that my friends is one thing that’s been missing for years. If I had to pick one thing to contribute as someone who’s been at it for over a decade it’s to reiterate there has been a lot of wasted investment due to ego and/or naiveté regardless of where the money or developers come from. 

    Because healthcare is so fractured solving ‘the problem’ is too simplistic. And even now with new legislation going into effect in Texas on 9/1/11 mandating Medicaid payments to doctors for providing remote patient support beyond phone and fax, the details are a long way from being finalized. Depending on how this gets implemented we may have to add Texas to the list of culprits.

    You see, patient-focused health information technology has been practical since at least 2003 with results publishing every year showing effectiveness depending on how it is applied. Sorry, no real need for traditional VC investments to build the stuff that requires huge investment. Given the abbreviated time frame for the exit within the VC model, that tech that is in a mature state ready to deploy is complete and has often been developed without VC investment by the same ‘outsiders profile’ that Rock Health is championing into the fight (prediction: eventually they will bring in health industry experts).

    With payment arrangements coming into place since 2009 (ie – open ended contracts with Blue Cross Blue Shield and other large payers) the traditional model of paying doctors for health related devices and procedures is panning out. Granted there are more effective models depending on the disease state you are trying to address (eg – diabetes education and self-care, medication adherence, etc..). Regardless, the investment opportunity now is to invest in campaigns that change hearts and minds of doctors who will be willing to prescribe or at least encourage their patients to use the new stuff plus convincing patients that they should try it. Long term use (which translates to recurring revenue streams) will depend on the ‘give-get ratio’ for doctors and patients.

    According to what I’ve been witnessing in the market lately, the focus of investors from everywhere is circa 2000 on the build side and not at all on using investment to solve the adoption challenge (lobby payers, lobby doctors and convince average Joe patient with health problems rather than targeting a fitness freak profile which is what I’m watching). Unless a big slice of this new investment is infused into the stuff that’s ready now, we’re simply wasting money and delaying further that which was ready almost 10 years ago.

  • Mark Feinholz

    unless we can bend the trend, today’s cool are 15 to 20 years away from swamping the system. somebody needs to focus on changing the culture of personal responsibility and ownership of health. Silicon valley can do that.

  • deetelecare

    A good point, but you have to deal with today’s reality and today’s users as well–or else you won’t be in the position to fix the ‘cool folk.’

    Neil, love your acidic take on the hype machine that Silicon Valley is.

  • deetelecare

    Or 50 year olds with two chronic conditions that are manageable, but they aren’t ‘cool enough’ to be of interest to the Valley types, who live on another planet from most of us and show little interest in the hoi polloi.  It just doesn’t make for cool drinks parties!

    There are quite a few of us commenting who’ve been through a few ‘next big things’, now have no interest in the drinks parties or in coolness, just in getting scarce financing for products and services that work to help sick people live healthier and more independently NOW.

  • David Hold

    Bravo finaly I hear somebody calling it as it is. I have been a fiancial consultant in the health care industry and it is a known fact that the industry needs help. It is broken and it needs fixing. Considering that as you said this is almost a 3 trillion dollar market coupled with the new health reform every Tom Dick and Harry got into the “fixing” the industry. Very few have any hands on  knowledge of what is wrong with it and they feel that technology will solve everything. Disruptive technology is definetly needed considering that the existing estabilishment has no intention the resolve the issues status quo is perfect for them. We have spent the last for years developing a product that will adress these issues and I can tell you it is an uohill battle. The products that we have encountered as you said is developed by techies without consideration for the end users. The common theory we are smarter than everybody we will build it and they will come. They totaly discregarded the millions of elderly who are actualy in the need of this services who actualy generate this autragous expenses that 60% of them are computer illiterate, that a sick person has no patience to mess around with sophisticated aplication etc.The ssytems have to be also cost effective and interactive. A lot of the systems that we reviewed from large corporation are exactly the opposite of all this principals and it is natural considering that they must justify for the exesive charge that they proposing to charge. One that comes to mind is a medication management software that we were looking to integrate in our Global System that was written by Microsoft looking at the patent it started out as follows “we will develop a bottle that will be able to signal to our sotware any change in weight at which time the sotware will …..” this is the point i stoped reading. did the code writter ever consider what kind of retooling or expense would be involved to do this? Maybe it is Startreck time but not now.This is the point that we decided to develop our own system that is simple and cost effective.This is exactly as I said sotware people without any consideration or indebt knowledge of the needs writte applications that are irrelevent. One other major problem with their attitude that they are so used to data generation that they feel that if they make the data available people will used it. As a result is a one way data storage facility that they have. They totaly discergard interactivity and allowing the healthcare professional the interact with the data and make decisioions based on it. They rely on providing him with it and let him react to it. If you look at from a practical point of view you have a doctor who sees 30 to 40 patients a day and now you want to inundate him with irelavent information to sift through to find what he needs. Ergo interactivity why not let him estabilish the parameters for his patients nad then provide him with only the data that falls out of the predetermined parameters. That is exactly what we did in our apllications. Oh and than let’s not forget the other colprtits the telecoms who are right now after grant (your and minetax dollars) in trying to convince us that in orther to deliver better health care in the rural areas we need band with so they can tax us with this millions of dollars woth of irelevant infrastructure construction. They fail to point out the falacy of their proposal just consider  they are telling us that in order to deliver proper care n especially in the rural areas we need this extensive band with what they fail to tell you that once this band with is up there is no financial justification to put a million dollar piece of medical equipment into a small rural hospital or clinic and that the solution is here right now. If you have a telephone which we know that even the most remote areas do you can provide remote and preventive medicine so if a complication comes up you would have enough time to transport that patient to a center where the sophistication exists to treat him.
    As I said destructive will work but we have to address it properly

    David Hold
    CFO
    The Tele Home Care Solution Company
    Dhold@thcscompany.com

  • optumInsight

    The only disruption that will occur will be for Rock Health and Massive Health’s investors.  There WON’T be any sustainable revenue streams with their approaches.  They aren’t creating truly NEW streams of revenue.  All the money that is available to be spent on healthcare is only growing from tax revenues by way of ObamaCare, most of which will be spent on aiding costs at the point of service, not a distracting app.  Those tax revenues aren’t being made available to subsidize Silicon Valley’s technophiliacs R&D. That money is going towards paying physicians and facilities. Those players are the revenue stream to focus on.  Google Health failed because Google and like-minded tech pros and investors don’t understand the healthcare environment.  It’s about CARE first.  PHR’s are best maintained within a healthcare setting at a patient’s primary care physician’s office, not via a patient’s personal computer.  Patients get lazy and have moody motivations to carefully or carelessly manager their own data.  PHR providers need to work closer with physicians and hospitals to further patient care.  After all, patient care is a major portion of what HIPAA’s intent has always been … It’ll take a collective “force-feed” effort by government agencies and treating physicians and facilities to get patients to consider electronic PHR services.  I personally don’t use them simply because they pop up and go under.  Google did not need to shutter Google Health.  It needed to restructure its approach.

    - j

  • http://matthewtendler.tumblr.com/ Matthew Tendler

    We now have a growing number of very smart people in Silicon Valley creating apps to help patients and these developers are getting paid on a large scale in various ways. As well, they are creating revenue that does not revolve around tax revenues and reimbursements. I fail to see how that is not disruptive… 

    Now, whether you think that this idea is viable or not is completely irrelevant to my earlier post where I state that what these Valley developers are trying to do is admirable and WILL (and has) help millions of americans become healthier at extremely low costs. 

    Here’s the case study: The first app I co-founded was created completely bootstrapped, took us a few months to really make robust, and now has over 6.5 million BG logs uploaded with a reported (non-scientific) average BG decrease in Type 2 diabetics of 10%. The app is free. We created new kinds of strategic partnerships and premium add-ons to create substantial, sustainable revenue. And no, we do not offer reimbursement, and no, we did not request tax revenues by way of Obamacare. I’m very interested to hear why this model can’t be replicated on a larger scale by other developers who A) have much deeper pockets than I do and B) are much smarter than me.

  • http://geoffclapp.blogspot.com/ Geoffrey Clapp

    Kevin,

    Across the board I really liked you comment and think you had interesting points (especially on the adoption side, that was very thought provoking chicken or egg problem). Thank you for it. 

    You also wrote:  ”(prediction: eventually they will bring in health industry experts).”This is part of my issue with the original piece, that it leads people to believe that Rock Health has no interest in Healthcare people, but just look at their team page and their mentor pages (links below). Clearly, that’s not the case – lots of MDs, lots of pharma, but also lots of tech and VCs.

    http://rockhealth.com/team/

    http://rockhealth.com/mentors/

    I’ve got no affiliation with Rock Health at all. I’ve just got an issue that two people (Adam and Halle) who are actually trying to make change (even if it’s in a nutbag crazy way), were attacked on silly terms (the name of the company? the words she used?) *and* used to symbolize a whole region. We’ve got bigger problems than if someone can pronounce “Keas” (for the record I can’t either, and Neil and I agree that I have no clue what the name means…)There was a huge opportunity here for more, but as you and others said, at least it got the conversation moving. This is good.

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  • David

    Great discussion here.  There’s a timely SV Forum.org meeting on Mobile Health on August 4th at 6:30 pm in Palo Alto.  See www/svforum.org/MobileSIG and http://www.meetup.com/SVForum-MobileInternetSIG/events/27055021/.

    The topic is large, so we’ll be focusing on data entry into mobile devices.  I’m going to set the stage with an overview.  Rajiv Mehta of Bhageera, Inc. will describe Self-Quantification and his Tonic iPhone app.  Dr. Justin Graham, CMIO of NorthBay Healthcare will provide the practitioner’s perspective.  Arrive early to see demos of the iHealth blood pressure cuff and HealthPAL from MedApps.

  • http://twitter.com/vwward Vic Ward

    I teach people over 55, how to get the most from their mobile devices. None are designed for our use.  

    I started MyPersonalPhone because I realized mobile devices like computers before them were just introduced, sold and left to the buyer to figure out.

    I’m convinced the future of health care could be with the individuals using their mobile devices. I spotted two encouraging products in the post, a medicine management app that might work and something for people with diabetes. I’ll check them out, maybe add them to my courses. 

    So far the medical profession and the app developers haven’t asked the people I help two questions. What would you use? What would be the best way to make it available to you?

    Think about privacy. We don’t trust anyone with our personal health information (Google and Microsoft??).

    Think tiny screens — ease of use and voice control.

    Thanks for the discussion of a vital topic.

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