5 of healthcare's hardest nuts to crack
1. THE MODERN PHARMACEUTICAL COMPANY
The problem? Picking up the pace
If startups are speedboats, big businesses are cruise ships. This is how Kent Bradley, founder of BTN Advisors, describes the players in healthcare innovation.
The speedboat is agile and entrepreneurial, but can only fit so many people and has only so much gas. On the other hand, the cruise ship boasts deep resources and competencies, yet often requires extensive compliance and oversight. They both can get to the destination, but at different speeds.
But don't confuse slow with risk averse, notes Judy Sewards, VP, head of digital strategy and data innovation at Pfizer. “Skeptics like to say that pharma is not innovative, that it is an old and clunky industry. However, I would say we are one of the most innovative industries, and one that has driven continuous breakthroughs in health,” she explains.
See also: What 10 innovation teams look like
When the estimated cost of getting a new drug approved is pegged at $2.6 billion, it is hard to argue that pharma does not take risk. However, the high stakes tend to happen on the R&D side of the operation where, Sewards says, “We know how to explore ambitious possibilities when looking at a disease, design studies to learn how a potential medicine might best meet unmet patient needs, and have a systematic framework to bring that medicine to the patients who need them.”
So what happens when the risk is not in a molecule, but in a device, an app, or machine learning as part of digital transformation? Typically these activities happen within an innovation team on the commercial operations side of the organization, which is notorious for reducing risk, and rightly so. Once a drug has crossed the approval chasm, a lot more is on the line.
This is precisely where things slow down for the modern pharmaceutical. But Sewards sees a path forward.
“By borrowing the principles from our scientific model of focus, iterative experimentation, which requires curiosity and patience, and planning for success and applying it to digital innovation, pharma has the opportunity to be a leader in shaping healthcare transformation,” she explains.
However, Sewards cautions, don't feel like you have to go it alone. “Today, we are not a technology company, we are a medicines company,” she notes.
“Therefore, part of our success depends on our ability to partner effectively with those companies and institutions that are pioneering new digital and data solutions and exploring together what these solutions might enable in the future,” she continues.
In this situation, the cruise ship opts to engage with a few speedboats. “By working together on behalf of patients, we can marry domain and functional expertise to more rapidly find meaningful solutions and also pull it through into action,” Sewards adds.
2. ANY LARGE HEALTHCARE ORGANIZATION
The problem? Developing a data-driven culture
Data is, and always has been, the lifeblood of business. What we know, when we know it, and what we can do with it has the potential to create a significant competitive advantage for the data-driven life-sciences organization.
But who owns data in the 21st century organization? Where does it live? And how is it shared?
These are the organizational and behavioral questions facing many pharmaceutical executives tasked with building next-generation data and machine learning teams that just might hold the next medical breakthrough.
“Given that technology is now generating more data than we have ever had — from the dramatic increase in the use of EMRs to the use of mobile devices — we have more data from more sources,” explains Aman Bhandari, executive director, center for observational and real-world evidence (CORE), Merck.
“This data will create more opportunity for a more holistic point of view of disease and public health, but it will also bring tremendous methodological challenges,” he continues.
And all too often, the data and technology live in completely different parts of the same organization.
“If we want to drive novel science, it is critical to have a thesis for how you will use all of your data along with a tech stack that will enable your goals. Data and technology are so interwoven today, to think of them separately is a mistake,” notes Bhandari.
To create a truly data-driven culture, executives such as Bhandari look to models outside of their industry — albeit cautiously. While numerous big tech companies are eager to play in healthcare, the rules are different.
Bhandari says it is one thing for a tech company in Silicon Valley to look at sales data and be off by 1%, and another thing for a healthcare company to be off 1% in a key metric.
“In healthcare data, you have to be incredibly precise and have the highest standards,” he explains.
Fortunately, Carl Anderson, VP, head of data and analytics at the hospitality company WeWork, created a playbook that is adaptable to any industry, including highly regulated pharma. In Creating a Data-Driven Organization, Anderson details how shared values, such as transparency, data literacy, and experimentation, help organizations use data to affect impact and results.
Taking inspiration from others who have built data science-driven organizations such as Anderson, Bhandari and his colleagues are using various approaches for the larger organization to embrace and make use of data.
“Having an open and transparent approach helps you build a stronger and more impactful culture,” says Bhandari.
3. THE CLINIC
The problem? Integrating patient data into the workflow
For Dr. Daniel Kraft, chair of medicine for Singularity University and founder and executive director of the Exponential Medicine conference, data is nothing if not integrated into the healthcare professional's workflow. It is this last mile of the delivery of care where many data-driven innovations fall flat.
The quintessential early adopter, Kraft says the challenge is not the technology. Roughly one year ago, some forms of Epic's electronic medical record gained the capability to intake Apple HealthKit data from a patient.
For example, Kraft can log into his Stanford Health Care app and allow it to connect to his iPhone. On the clinician side, his doctor is able to see his steps, sleep, and glucometer data. “This is a frame shift,” explains Kraft. “He can now see my outside life.”
The real challenge, argues Kraft, is moving from a reactive model with intermittent data to a proactive model with free flowing data.
“The nut to crack is how to make data useful through machine learning so the three high-risk patients are identifiable,” he continues. “We need to figure out how to take all of this new data — sometimes coming from the consumer and sometimes from the clinician — and make it part of clinical care.”
Designing for workflow requires an appreciation of the human factors at play. If a physician needs to open a new app, the likelihood of it happening is very low. “No one wants to log into your Fitbit app,” Kraft says. Rather, he recommends that innovators storyboard how their solution is seamlessly incorporated in the healthcare professional's day.
Incentives can help. “If the data flows to the EMR, is it going to be covered? Can he bill for a virtual checkup?” asks Kraft.
So while organizations such as Kaiser Permanente and Geisinger Health System are moving toward this model, Kraft would like to see Medicaid and Medicare as having great potential to move the market. While this may seem far off, he points out the NHS now prescribes apps and devices to manage chronic diseases such as diabetes and heart disease in England.
Astellas is one example of a drugmaker that has used an innovation challenge to come up with new ideas.
The problem? Insiders know too much
Healthcare is increasingly recognizing the value of bringing outside thinking in by investing in opportunities to reach the edges of the innovation ecosystem, where the most unique perspectives and freshest ideas often reside. From hackathons to accelerators to corporate investment funds, the hunt is on for the next big idea and the team likely to make it a reality.
But what if transformational solutions don't just come from outside healthcare, but from people who never thought about health at all?
“My biggest skill was that I knew nothing about healthcare,” explains Naveen Jain, founder and CEO of Viome, a wellness company that aims to give people the clearest picture of their wellness through an artificial intelligence engine that makes personalized diet recommendations based on an assessment of health at the molecular level.
“If you take someone who knows healthcare, they can improve it 10% to 15%. But if you want to improve it 100%, you need to know nothing,” he states.
It would be easy to dismiss entrepreneurs such as Jain. Except this is the same entrepreneur who founded companies such as Infospace and Intelius, and he most recently cofounded Moon Express, the only privately funded company approved by the U.S. government to travel beyond Earth's orbit and land on the moon, slated to happen in 2017.
While searching for the next disruptive thing, Jain observed the tools of modern medicine were designed to address 20th century health problems, which were primarily infectious disease and acute care. Now in the 21st century, these tools don't successfully address chronic disease. In fact, they may even be causing it, posits Jain.
It was around this time he stumbled upon federally developed technology deployed to understand exactly what happens inside the body when exposed to biological warfare. It occurred to Jain this same technology could be utilized to provide an analysis of one's personal metabolome and microbiome.
He is not alone. Prior to founding Flatiron Health, Nat Turner and Zach Weinberg were better known for selling their internet startup, Invite Media, to Google. Today, Flatiron has raised more than $300 million to improve cancer care, and it was recently named a Tech Pioneer by the World Economic Forum.
Photo credit: Gilles Frydman
5. MUCH OF THE DRUG INDUSTRY
The problem? R&D has become dehumanized
No matter how many patient journeys are commissioned each year, how many innovation shops are retained for human-centered design research, or how many chief patient officers are hired, healthcare is still at a loss to truly know the patient.
And it's not just patients. “The whole system has dehumanized all aspects of medicine,” explains Gilles Frydman, founder of the Association of Cancer Online Resources (ACOR) and cofounder of Smart Patients. “When is the last time you saw a picture of the person who discovered the molecule?”
Frydman is on a quest to change this. When tackling a complicated problem, he utilizes a simple process. And the simplest way to better understand real people is to see them. “Medicine is about real people,” he says. “And a picture is worth a thousand words.”
Following 20 years of work in cancer advocacy, Frydman notes the images — literal and figurative — that executives have of stage 4 cancer patients are not accurate. And so he embarked on a mission to set the record straight by producing portraits of real people with cancer, some of which appear on pharmaceutical company websites.
While this sounds simple enough, real pictures of real people are often a no-no for big pharma.
“They are afraid of the lack of control. What are these people going to do or say? Or how will they look?” Frydman explains. Of course, much of this comes from the fear of legal or regulatory action. “The FDA has forced everyone involved with treatments to be super careful,” he continues, adding they “try to protect patients without asking them how or if they want to be protected.”
And so everything becomes standardized. Stock images of actors replace real people in marketing. Or even better, stick figure illustrations assume the role of everyday people.
However, his clients are special, Frydman says. They are a new breed of healthcare executive that is doubling down on re-humanizing medicine by valuing all of the people involved in producing the drug, and not just the drug. True to his French roots, Frydman says, “As long as medicine is run exclusively as a business,” we will never truly understand the patient.
Sara Holoubek is CEO of Luminary Labs. (Luminary Labs has commercial relationships with Merck and Pfizer.)