Despite the many advances in technology, one of the most important parts of our lives – healthcare – continues to be a cautious and slow adopter. This is not because of the shortage of relevant technologies (quite the contrary, a lot of innovation geared at this space has taken place); rather, it is due to the healthcare industry itself, which is difficult to work with due to its complicated legislation, resistance from healthcare institutions and professionals and the tight funding conditions that most public healthcare institutions are subject to. It is also the case that outside the large-scale and traditional IT environment, the healthcare industry lacks a strong collaboration model with the world of technology innovation. Investing in healthcare needs to take a long-term perspective and requires great knowledge of the inherent challenges that will be faced. The high tech industry, on the other hand, has little patience. Tech companies, including those that are excited by recent big data opportunities should be warned: it takes a battle to get your teeth into the healthcare sweet spot.

1. Healthcare
and
Technology:
a
difficult
marriage
by
Beatrice
Shepherd,
B
Spot
Consulting
Despite
the
many
advances
in
technology,
one
of
the
most
important
parts
of
our
lives
–
healthcare
–
continues
to
be
a
cautious
and
slow
adopter.
This
is
not
because
of
the
shortage
of
relevant
technologies
(quite
the
contrary,
a
lot
of
innovation
geared
at
this
space
has
taken
place);
rather,
it
is
due
to
the
healthcare
industry
itself,
which
is
difficult
to
work
with
due
to
its
complicated
legislation,
resistance
from
healthcare
institutions
and
professionals
and
the
tight
funding
conditions
that
most
public
healthcare
institutions
are
subject
to.
It
is
also
the
case
that
outside
the
large-­‐scale
and
traditional
IT
environment,
the
healthcare
industry
lacks
a
strong
collaboration
model
with
the
world
of
technology
innovation.
Investing
in
healthcare
needs
to
take
a
long-­‐term
perspective
and
requires
great
knowledge
of
the
inherent
challenges
that
will
be
faced.
The
high
tech
industry,
on
the
other
hand,
has
little
patience.
Tech
companies,
including
those
that
are
excited
by
recent
big
data
opportunities
should
be
warned:
it
takes
a
battle
to
get
your
teeth
into
the
healthcare
sweet
spot.
My
health
records
to
not
belong
to
me
One
of
my
biggest
frustrations
with
healthcare
is
the
fact
that
my
health
records
do
not
actually
belong
to
me.
Each
time
we
go
to
a
doctor
or
dentist
they
keep
our
records.
Every
time
you
go
visit
a
new
doctor,
a
new
layer
of
information
about
our
health
is
being
created
and
stored
somewhere
else.
In
some
places
it
is
stored
in
digital
form
and
in
other
places
it
is
still
handwritten
and
stored
in
a
paper
copy
file.
There
is
no
exchange
of
information
between
healthcare
institutions
and
professionals
and
there
is
no
tracking
system
of
our
state
of
health.
My
family
and
I
have
lived
in
5
different
countries
over
the
last
15
years.
My
2
kids
have
been
born
in
2
different
countries
and,
consequently,
many
different
doctors
and
clinics
have
stored
our
medical
records.
Thankfully,
we
are
very
healthy,
but
I
still
went
to
the
trouble
of
retrieving
all
those
records
from
past
doctors
and
dentists.
Now
we
have
a
box
of
papers
at
home
with
our
health
history
that
I
now
need
to
find
the
time
to
sift
through
and
organise.
I
really
wish

2. I
could
use
software
to
help
me
do
that
for
me
so
that
each
time
I
required
medical
assistance
of
any
sort,
the
records
would
be
uploaded
to
any
device
of
my
choosing
and
the
analytics
capability
would
use
(for
example)
my
medication
records
to
cross
reference
with
new
data
on
that
sickness,
prevention
techniques,
availability
of
healthcare
institutions
and
doctors
specialised
in
that
sickness
that
are
near
me
and
so
on.
To
create
such
a
software,
or
service,
is
not
that
difficult
from
a
technical
perspective,
so
why
do
we
still
not
have
it?
Healthcare
habits
have
changed
over
time
Our
grandparents´–
and
even
our
parents´
-­‐
generations
were
not
as
“mobile”
as
we
have
been.
Many
of
them
knew
their
doctors
all
their
lives
and
trusted
their
judgments.
While
this
may
still
the
case
in
smaller
towns
and
villages,
in
larger
urban
areas,
this
doctor-­‐patient
intimacy
is
now
practically
impossible
because
of
the
large
volumes
of
people
living
in
cities,
the
staffing
model
that
hospitals
use,
and
the
constant
financial
pressure
the
industry
is
under
which
leads
to
cut-­‐
backs
and
staff
changes
and
a
greater
and
greater
push
for
efficiency,
sometimes
at
the
expense
of
quality.
While
the
reality
of
the
healthcare
industry
varies
country
by
country,
we
all
sometimes
end
up
having
to
wait
for
days,
or
weeks,
or
months
for
specific
treatments
and
we
do
not
know
who
will,
in
the
end,
treat
us.
This
change
in
“the
way
things
are
done”
means
that
the
responsibility
for
managing
our
health
(and
for
keeping
our
healthcare
records
in
order)
falls
squarely
on
us
as
individuals.
Current
legislation
complicates
matters
The
second
challenge
is
legislation.
In
Europe,
because
of
the
data
protection
act,
we
have
the
right
to
obtain
our
health
records.
However,
doing
so
is
not
so
easy
in
practice.
For
example,
in
the
UK
we
need
to
apply
to
the
health
authority,
wait
for
their
decision
(21
days)
and
then
hope
they
actually
have
it
stored.
Only
then
do
you
get
another
date
when
you
can
go
get
what
you
need.
In
my
case
half
of
the
records
that
are
held
at
2
different
hospitals
in
London
were
never
found.
What
a
hassle!
There
is
also
the
whole
issue
with
storing
that
information.
If
we
just
keep
it
in
a
box
in
the
attic
then
that
is
fine,
but
if
we
want
to
make
good
use
in
order
to
manage
our
wellbeing
then
the
problems
start.
The
danger
of
our
health
records
being
stolen
(in
the
digital
world)
or
accidently
exposed
publicly
is
real
and
for
companies
this
is
a
major
legal
hurdle
and
potential
embarrassment.
I
suspect
this
was
the
real
reason
why
Google
gave
up
on
their
idea
of
Google
Health.
Google
Health
was
a
personal
health
record
service
that
started
in
2008
and
was
closed
down
in
2011.
The
service
allowed
Google
health
users
to
store
and
manage
information
including
health
conditions,
drug
allergies
and
lab
results.
Once
entered,
Google
Health
used
the
information
to
provide
the
user
with
a
merged
health
record.
Google
Health
could
import
medical
and/or
drug
prescription
information
from
doctors,
clinics,
etc.
Google
Health
was
an
opt-­‐in
service,
meaning
it
could
only
access
medical
information
volunteered
by
individuals.
It
did
not
retrieve
any
part
of
a
person's
medical
records
without
his
or
her
explicit
consent
and
action.
The
official
reason
Google
gave
for

3. abandoning
the
project
was
the
lack
of
widespread
adoption,
but
the
more
likely
reason
was
the
company´s
fear
of
getting
into
trouble
with
the
law.
The
company,
which
makes
money
from
data
about
us,
probably
has
figured
out
that
they
will
not
able
to
protect
privacy
-­‐
think
of
all
the
NSA-­‐related
scandals.
So,
either
people
did
indeed
not
trust
Google
and
the
service
consequently
failed
to
attract
enough
customers,
or
Google
realised
that
it
was
risking
too
much.
Healthcare
is
a
nightmare
for
business
One
very
common
problem
I
have
faced
in
my
consulting
work
in
the
healthcare
industry
has
been
the
lack
of
collaboration
with
other
industries,
including
IT.
While
technology
companies
move
fast
and
rapidly
create
new
products,
services
and
solutions,
the
healthcare
industry
moves
more
slowly
due
to
its
bureaucracies,
legislation
and
public-­‐private
tensions.
While
these
industry
characteristics
are
something
that
the
large
medical
devices,
IT
and
communication
solutions
and
integrator
players
have
learnt
to
deal
with,
niche
and
innovate
players
are
often
off
the
radar
screen
and
unable
to
get
their
voices
heard.
In
fact,
these
inherent
challenges,
can
lead
these
types
of
companies
to
prioritise
other
industries
to
focus
their
technical
and
commercial
efforts
on
and
so
it
happens
to
be
that
the
healthcare
industry
can
end
up
missing
out
on
potentially
very
interesting
and
innovate
ideas
to
improve
its
performance.
Big
data
breaks
through
the
silence
In
the
last
couple
of
years
we
have
witnessed
a
massive
jump
in
investment
in
technology
to
be
used
in
healthcare.
According
to
Mercom
Capital
Group,
USD
3
billion
was
invested
in
big
data
technologies
to
be
used
in
healthcare
in
2013.
That
applies
to
all
disciplines
from
pharma,
medical
devices
to
personal
healthcare
management.
There
is
no
doubt
that
big
data
has
created
enormous
opportunities
to
improve
healthcare
disciplines
as
well
as
make
lots
of
money
for
tech
companies.
Yet,
by
way
of
example,
while
there
are
already
100,000
new
mobile
health
apps
available,
you
will
need
to
hold
you
breath
because,
on
the
23rd
of
July,
Federal
Trade
Commissioner
Julie
Brill
expressed
concern
about
the
way
apps
on
smartphones
and
mobile
devices
are
collecting
sensitive
health
data,
and
how
some
of
that
information
may
then
be
shared
with
third
parties.
So
this
is
just
the
beginning
of
a
long
journey
for
tech
companies
to
bring
their
innovating
health
ideas
to
the
market;
a
market
that
is
protected
by
its
incumbents,
which
is
very
emotional
because
this
is
not
about
buying
new
smartphone
but
about
fiddling
with
our
health
and
which
is
highly
regulated.
Pharma
in
particular
is
very
aggressive,
so
if
you
have
an
idea
that
would
chop
down
the
number
of
people
taking
aspirin,
you´d
better
think
twice
if
you
want
to
start
that
battle.
Theoretically
it
should
be
easier
to
bring
innovations
to
the
healthcare
industry
in
the
US
(compared
to
Europe)
because
it
is
predominantly
private.
However,
reality
tells
us
something
else.
Anne
Wojcicki,
the
CEO
of
3andMe
from
Silicon
Valley,
learnt
the
hard
way.
For
$99,
the
company
could
analyse
key
components

4. of
a
person’s
DNA
from
a
vial
of
saliva.
The
FDA
prevented
selling
that
service
because
by
selling
consumers
a
test
and
health
reports
that
outlined
their
chances
of
getting
dozens
of
diseases,
plus
their
likely
response
to
various
drugs,
23andMe
was
effectively
selling
a
medical
device
and
that
requires
explicit
approval.
The
FDA
said
23andMe
hadn’t
come
close
to
providing
enough
evidence
that
its
test
provides
accurate,
reliable
health
assessments.
Now,
Ms.
Wojcicki
needs
to
resolve
this
issue
with
the
FDA,
something
that
should
have
been
dealt
with
from
the
outset
and
certainly
before
launching
a
TV
ad
campaign.
What
business
model
to
apply?
The
next
challenge
is
with
the
business
model.
How
to
sell
it?
There
is
a
danger
that
an
app
for
mobile
phones
or
tablets
organising
and
managing
our
health
records
and
wellbeing
will
be
misused
and
marginalised.
So,
while
the
service
provider
route
is
the
fastest
way
to
market,
it
may
not
be
the
most
effective.
The
other
option
is
to
take
an
example
from
the
pharma
industry
and
collaborate
with
some
of
the
stakeholders
listed
here:
lawmakers,
medical
professionals,
healthcare
institutions,
the
public
sector,
the
insurance
industry,
other
healthcare
providers,
medical
devices
players
and
patients.
While
this
is
no
doubt
a
much
longer
and
more
complicated
route
to
market,
it
will
surely
lead
to
more
sustainable
results.
Decisions
on
how
to
package
and
price
the
software
and
services
will
be
a
walk
in
the
park
compared
to
the
business
model-­‐related
issues.
Re-­‐educating
patients
Lastly,
but
not
less
importantly,
there
is
the
need
to
educate
people
to
be
in
control
of
their
own
health
and
to
use
technology
for
that
purpose.
We
are
so
used
to
the
current
system
and
to
our
blind
obedience
to
the
healthcare
system
(“the
doctor
said
…”).
This
habit
is
something
the
pharma
companies
leverage
when
promoting
their
drugs
though
doctors
(in
many
countries
receive
bonuses
from
pharma
companies
to
suggest
to
their
patients
to
use
their
products).
It
will
take
quite
a
bit
of
effort
to
re-­‐educate
people,
increase
awareness
and
change
habits.
Again,
in
order
to
be
more
effective
it
could
be
done
in
collaboration
with
other
organisations,
especially
in
the
public
sector,
where
there
is
a
strong
interest
and
driver
based
on
the
potential
for
cost
savings.
Pioneers
are
out
there
already
Apart
from
Google
there
are
dozens
of
other
companies
coming
up
with
technology
solutions
for
people
to
manage
their
health.
One
of
the
latest
and
most
exciting
propositions
comes
from
a
start-­‐up
called
BaseHealth.
This
San
Francisco-­‐based
company
came
up
with
health-­‐management
software
that
integrates
diet,
exercise,
genetic
tests,
and
medical
records,
then
calculates
a
patient’s
risk
for
more
than
40
diseases
—
including
type
2
diabetes,
lung
cancer,
and
Alzheimer’s
disease
—
and
suggests
ways
to
lower
the
risk
of
developing
them.
Also
Apple
and
Samsung
and
a
growing
number
of
other
companies
will
be
offering
services
to
manage
our
healthcare.
While
the
healthcare
industry

5. may
be
a
nightmare,
it
is
also
a
potential
goldmine
for
business
and
hopefully
we
will
eventually
have
the
ability
to
make
choices
about
robust
solutions
that
are
accepted
and
endorsed
by
the
industry.
It
is
high
time
to
use
the
technology
we
already
have
and
use
it
to
keep
us
improving
in
an
aspect
of
our
life
that
is
fundamentally
important:
our
own
and
our
families’
health.
For
more
information
please
reach
out
to
beatrice@bspotconsulting.com
Follow
on
Twitter:
@BeatriceSpot
“Opportunities
for
technology
companies
in
the
healthcare
market”
presentation
free
to
download
will
be
available
in
July
at
www.bspotconsulting.com