Sculley: Domain expertise just as critical as technology in healthcare

By: Neil Versel | Jan 19, 2012        

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Neil_Versel_LargeMobile and wireless health are trying hard to win over a public that at best is skeptical, but more likely has no idea what this stuff actually is.

As I argued in my previous column, most people don’t get the whole concept of connected health, but explaining it in simple terms could change that. I also said that there hasn’t been enough distinction made between healthcare and consumer health/wellness when it comes to mobility.

Apparently, I’m not alone.

No less an authority than John Sculley, former CEO of both Apple and PepsiCo, suggested that consumer-facing products like Google Health and Jawbone’s UP have failed because developers did not understand the market they were targeting or the hypercomplex healthcare industry as a whole.

Making his first appearance at International CES since 1993 to speak at the Digital Health Summit portion of the massive consumer electronics show last week, Sculley said that some companies have put too much emphasis on style over substance.

“The thing that is missing is getting the people with the domain expertise aligned with the people with technological know-how to turn ideas into branded services,” said Sculley, who famously clashed with Steve Jobs over whether Apple should discontinue the iconic Apple II computer in favor of the up-and-coming Macintosh, as Jobs had preferred. “You have to have domain expertise in addition to technical know-how,” Sculley added.

“You never compromise on the user experience,” he said.

Interestingly, reDesign Mobile analyst Rocky Agrawal recently wondered in a VentureBeat commentary whether Silicon Valley innovators were “too smart for their own good,” building products more suited for their own small world rather than for the masses. It is not unlike what I said in a controversial column last summer.

And healthcare is different from pretty much every other industry in that consumers often expect others to pick up the tab since they are generally isolated from the true cost of products and services, and that people have become conditioned to outmoded ways of thinking when it comes to health information. “This is not a typical Silicon Valley problem,” Sculley noted last week.

Hoping to effect some kind of change, Sculley now is putting his considerable amount of money where his mouth is. The Digital Health Summit showcased one firm Sculley invested in, Audax Health, a Washington-based start-up “social Web company” founded by 22-year-old Grant Verstandig, who endured seven surgeries in a 20-month period after wrecking his knee while playing lacrosse.

Audax hosts specialized communities that bring in social and condition-specific networks as well as elements of online gaming to help people find answers to health questions. I have no idea if it will succeed, but the fact that Sculley and Verstandig apparently understand that healthcare is not like other industries is a good start.

Sculley also has financial stakes in telehealth company MDLiveCare, which provides e-visits and 24/7 access to nurses for a monthly fee, and in Watermark Medical, a company that provides home-based diagnostic testing and treatment services for sleep apnea. MDLiveCare can help people schedule doctor visits, too, à la ZocDoc.

MobiHealthNews reported on some of these investments back in September, as well as on Sculley’s involvement with MisfitWearables, founded by Sonny Vu, who also created Agamatrix. MisfitWearables hasn’t said exactly what it is doing, but Sculley said it “probably has something to do with sensors.”

The real breakthrough in consumer health information, according to Sculley, will come when wearable sensors send wireless data to “big data analytics” that connects with electronic health records and personal health records, with privacy protected. People’s data may be mined to sell advertising to them, but the advertising will be targeted to their true health concerns, Sculley said.

We aren’t there yet, but it looks like we’re heading that way. Those companies that figure out how to make the connections without overwhelming the consumer with technical minutiae and for the right price will win. The others will get left in the dustbin of history as academic case studies.

Or, as Sculley put it, paraphrasing Albert Einstein, “You don’t really understand something complex unless you can explain it in a simple way.”

  • John boden

    As I watched John Scully speak at the Digital Health Summit last week in the CES show I was grateful to hear him say what has been so obvious to those of us that have years of experience in the real world with feet on the ground and who carry the callouses to prove it. My specific field is in eldercare and the informal family caregivers that help them.  An area that is crying out for the help that these new technologies can provide even though almost no even knows the technology actually exists. When you match that with the almost universal failure of the companies with the technology to sell it into this needy market, the need to add real world experience is blatantly obvious. But even with all my jumping up and down in the back of the classroom to get the attention of those who can make the difference, I go unheard.  It makes me want to cry.
    The technology is proven. I first saw this technology in use with VA in their Rural Health Initiative study in 2003. They are now using it with 65,000 veterans and making the veterans lives and their informal caregiver’s lives much better. This, even as the original study showed, it can save the VA 75¢ of every$1.00 they were spending to provide them care.
    I hope now that John Scully, so rightly respected and who is standing at the front of the class, will be heard loud and clear. “What is missing is that real experience must be added to the technology engineering.” This is the change that will burst the dam that has been keeping the river of better, more efficient, technologies from flowing to meet the huge need that is out there waiting for help.
    Get someone on your team that can bring you their real world experience which is needed for success.
    It does not matter how great the technology is if no one is using it.

  • John boden

    Sorry, I spelled John Sculley’s name wrong.

  • Rebecca Coelius

    One thing I struggle with is the balance between a need for domain expertise with not being so integrated into the culture of medicine and the health care industry that you can’t see disruptive solutions to problems. How long working in the trenches is long enough to say you have good intuition about the system and its failings, without spending too many of the most creative and flexible years of your life climbing the training or academic ladder? What about the fact that most of us complete our residency in our early to late 30s, and still have no experience whatsoever in starting or running a company, or in a setting where the overwhelming majority of Americans receive care? (since this is NOT in the academic centers where we train). The average entrepreneur age is 37, so we have lost almost half of our productive entrepreneurial time before ever stepping foot in a health care setting other than an academic or community hospital training program. Most MDs are also pretty distanced from regulations and how their reimbursement rates are set by the RUC, so can’t provide a ton of insight into how these affect product regulation and monetization. 

    I think MDs/insiders are fantastic at sustaining innovations that make the work flow or payment mechanisms for what they have been trained to do more efficient and effective. Less sure we (and I say this as a soon to be MD) always think as well outside our current reality to truly new ways of understanding how people can live more healthy lives both before and after disease strikes, and I think its because we spend an immense amount of time inside the hospital and clinic bubble. (Of course there are exceptions.)

     Something else I find interesting is that the overwhelming majority of MD entrepreneurs haven’t actually practiced medicine in years because they started to believe they couldn’t truly change anything from the inside out. Alternatively I see startups choose Chief Medical Officers who have a really specific prestigious subspeciality, even if that subspecialty has nothing to do with their company. This is confusing to me, given what a narrow view this person has of the medical field.