Perspectives on Working with Healthcare Systems for Digital Start Up Companies | Part 2

Perspectives on Working with Healthcare Systems for Digital Start Up Companies | Part 2
Brian Van Winkle
Shahid Shah


In this two-part series, we examine several common misconceptions
made by health tech start-up companies in working with Health Systems and
offers advice on how to recognize and address each. From approaching systems
with a solution-first mentality to not understanding the context in which
health systems work, we look to provide constructive criticisms meant to
support more effective partnerships between health systems and digital tech

and Reactions from the Industry

Understand the Current System Environment We Are Working In: In some cases,
technology solutions are barricading healthcare systems inside.  In other
cases, they are allowing us to seamlessly interact with other systems.  Typically, large healthcare systems have a
combination of both. For outside solutions to be effective,
start-ups need to be intimately familiar with the existing (and on-the-horizon)
systems that healthcare organizations are using or contemplating.  Rarely
will a solution not have to interact with existing software solutions – and
this goes well beyond just the EMR. 


Have an Integration Plan: A
stand-alone solution, which doesn’t tie to one or more of the healthcare
institutions key systems of record (SoR) or systems of engagement (SoE) is a
useless solution. Your solution should be able to stand alone in the first few
weeks, as users begin to use it and get familiar with its capabilities.
However, as soon as value is realized
(not necessarily achieved), it’s crucial that your solution support either SMART on FHIR, FHIR,
HL7v2.x, or all of the above. If you don’t have a believable integration story
fully worked out, you’re not ready to launch into the health system market. Go
back and do your homework.  

Having a Clinician Is Nice, But Not Enough: The physician, nurse, or other clinician on your team helps credibility but we also understand the incentives associated with selling solutions, and this takes away from the altruism you think we will blindly swallow. And they are rarely businessmen or women who understand both the complexities of solving a problem that isn’t theirs and starting, let alone, running a company. Pair an MD with an MBA? Now we’re talking.


Create a Balanced Team: If you’re selling
clinically facing solutions, you need to ensure clinicians are on the product
development team or senior product management leadership. Beyond the product,
the value of a clinician is limited, unless the clinician on your team has been
a department head with P&L responsibility, or significant budgeting or
procurement experience. When building your “dream team,” combine sales
professionals who understand the sales cycle with business development
professionals who deeply comprehend the health system procurement process, and
product professionals who know the clinicians’ jobs inside and out. The best
product people may be your clinicians, but they need to be trained in design thinking and
product management if they’re in leadership roles. The educational background
and degrees your staff hold are generally not important (because they won’t be
credentialed), but the skills they possess along with real-world experience
across a number of facets is key.

You Probably Won’t Be Around in 3 to 5 years There is a harsh
reality that we need to grapple with if we want to have a mature relationship
with you.  You probably won’t be with us for very long.  Yes, we recognize that if you partner with us
there is a much greater chance of survival, but our healthcare systems does not
want to be the life support that keeps you breathing.  I’ve seen too many
situations where healthcare systems “invest” in start-up solutions,
only to have that solution not succeed elsewhere.  The result is a bad relationship where the
two parties have become so reliant on each other that they can’t break up (the
start-up for money, the healthcare system for sunk costs,
not rational, and transition costs, rational). If healthcare systems were an
investment firm (and indeed, some of them are), they would see hundreds of
solutions only to pick a few.  Healthcare
systems don’t have time for this, so are picking 1 from a handful at most.  This is bound to fail.  Because of this reality, start-ups need to
not just show us that they will survive and thrive without us, but that if they
don’t, that there is a logical transition to the next solution, and then the


Have Failure Based and Success-Based Objections Health systems have reasonable fears about startups for many good reasons:
questions around whether the solution can handle user requirements, whether the
solution is high enough quality, whether the solution can scale to a high
number of users, whether the solution can be integrated with the EHR, and so
on. Most of the fears are failure-based
– meaning, will the startup fail one
or more of their promises? But, there are also success-based fears: if the solution works, will the company be
around for a while; if the solution works, will the health system maintain the
attention and receive the support
it requires, and in case the solution works and the company disappears how will
get our data out and be able to maintain the solution on our own? As
entrepreneurs we’re often good at handling failure objections but we have to be
great at talking about success-based objections. For example, you could offer
source code in case the company goes out of business; you could offer extended
support plans with third party integrators for attention, and you can offer an
easy way for them get access to their data, rules, and other information
they’ve put into your solution.

Pulling those numbers for you to prove your solution is harder
than it sounds
Healthcare systems are obsessed with data, indeed it is
fundamental to research and demonstrating clinical efficacy for clinical
approaches and interventions.  And healthcare systems are becoming more
and more proficient at reporting and analyzing traditional metrics such
as mortality rates, infection rates, prevalence of avoidable errors, among
others.  But we’ve only recently developed the ability to perform deep
trend analysis on large data sets (don’t think big data, think spreadsheets).  Traditional
mechanisms for healthcare
systems have been to rely on “Tracers”, the act of following sample
random encounters through the health system to document whether the course of
care was handled appropriately.  The
point is, data analytics is an evolving competency and we are still just
learning to crawl.  And data availability and analysis of the impact on
new emerging solutions designed to improve access, efficiencies, and decrease
operational burden is still new, especially when that analysis is on a digital
technology. Start-ups need to understand that the data request they need to
prove their solution sometimes is just not possible. Those data requests can be
guides for long term goals to improve our analytic approaches or solutions.
 For now, unless the system has a strong and resource analytics
department, you’ll have to rely on what we have, an answer no one should be
satisfied with*. 


Use OKR Decision Making Frameworks to Negotiate Objectives Health systems are obsessed with data, but sometimes they’re focused on
the wrong kind of data: process
measures instead of outcomes measures. The smartest startups these days
build their products using the Objectives and Key Results (OKR) decision-making
and operational excellence framework. If you build your solution with OKRs in
mind, then you and the health system can negotiate the objectives (“O”) in
general and specific expectations as key results (“KRs”). What’s nice about
OKRs is that they are not subjective plus they require data-driven and
evidence-based approach to understanding whether a solution is worthy of
implementation and further expansion (scaling). Instead of using time-based
roadmaps and implementation schedules you should negotiate objectives- and
accomplishments-based roadmaps and schedules. With strict actionable and
accountable accomplishments described as OKRs for both the health system and
the startup, the solution can be far easier to build consensus around and get
the permissions necessary for deployment.

* we know this answer flies in the face of a system’s need
to see impact on clinical outcomes. this is the elephant in the room when
digital medicine collides with the need for clinical rigor


While it’s important to know how healthcare systems think, and
what might resonate with them, it’s just as important to maintain your
independence in thinking and approach.  This is what makes you so
valuable.  Indeed, other industries have
already benefited from “fresh” thinking approaches, and it’s well known that Healthcare is in desperate need of this infusion
of “other side” perspective. While just a small step, we hope our perspectives
can help you know how healthcare systems think. But just be careful, we
wouldn’t want you to start thinking like

Brian Van Winkle, MBA works with clinicians and health systems to tackle status quo thinking. He focuses on bringing the most innovative solutions and digital technologies to our hospitals to re-imagine how we provide and consume health. 

Shahid Shah, M.Sc. is an award-winning Government 2.0, Health IT, Bio IT & digital Medical Device Inventor & CTO with over 28 years of technology strategy, architecture, engineering, entrepreneurship, speaking, and writing experience.