Healthcare Redux
“In truth, no private company would have been capable of developing a project like the Internet, which required years of R&D efforts spread out over scores of far-flung agencies, and which began to take off only after decades of investment. Visionary infrastructure projects such as this are part of what has allowed our economy to grow so much in the past century.”
Michael Moyer, Technology Editor of Scientific American in response to Gordon Crovitz’s revisionist Wall Street Journal editorial on the birth of the Internet.
In the recent days, weeks and months, much has been written against platforms who choose to protect their data, namely Twitter and Craigslist. The self-righteous protectors of the weak and flailing (like LinkedIn and PadMapper) have lined up to pen one caustic essay after another questioning how these “free” and “open” platforms could possibly stand in the way of a quasi-competitor potentially benefiting financially from their data.
The irony is that both Twitter and Craigslist were flukes of circumstance, began as side projects which subsequently went viral. Both are paradigms of simplicity replete with user-initiated conventions and norms. Neither was intended to become a household name nor anticipated the number of scandals which would result as byproducts from their successes.
Many other darlings of the Silicon Valley have similar humble beginnings, including Apple, Facebook and Google. The commonality of all these companies is that the interest of the masses caused their exponential growth. They didn’t set out to change the world nor did they necessarily have lofty goals and aspirations. In spite, or perhaps because, of this, they succeeded. They were not artificially incubated, they were thrown out into the world. They grew and scaled. From a bootstrapped start, they are now some of the most valuable and influential companies in the world.
All of these companies have spawned ecosystems around them, enriching not just themselves and other developers but companies designed to profit off the platforms they created. They each inched their way into the hourly lives of hundreds of millions of worldwide individuals. They have all made mistakes and missteps, most of them touting products perpetually in beta. Due to their utility, their user bases have forgiven their faults.
Around the same time Craigslist and Google were being born, two companies located 400 miles due south of the Valley also came into being. But their products weren’t consumer facing nor did they have the luxury of launching beta items which skirted privacy or security issues. From the beginning they knew that if their products turned faulty, people would die.
The Virtual Pediatric Intensive Care Unit (or VPICU) was conceived by a group of doctors gathering almost 14 years ago, recognising the need for introducing technology to help identify patterns and solve difficult cases from afar. They understood the numerous obstacles in their path; including the lack of uniformity of data in different hospitals and departments and the lack of technological recording solutions. They created a vision for medical informatics, starting in with a single department: the pediatric intensive care unit. The group envisioned a system that identified common patterns in patients across the country and assisted doctors in diagnoses.
After many false starts and growing pains, VPICU has achieved many of the goals of the forming committee. They’ve linked together all Children’s Hospitals in the United States and others. It records every piece of patient data automatically. As a dynamic database, it assists the attending physician in a diagnosis and identifying solutions that may have been helpful in other similar cases.
That isn’t all. As a secure linked database, the VPICU allows researchers to do previously impossible research and epidemiological trials. The project is far from complete. In an interview with the Kernel, founding member and director Dr Randall Wetzel said his vision included a complete digital medical record from birth, including every EKG and every blood test from every hospital visit. A true medical informatic solution helps the patient and the entire eco-system. “We take a family history when talking to a new patient, why shouldn’t we know that patient’s entire personal history?” To that end, he organises MucMD (pronounced “muck-med”), an upcoming conference dedicated to the “meaningful use of complex medical data”.
In the decade and a half since the inception, they’ve created a solution which saves lives and cut back on time and mistakes. Hundreds of articles have been written with the assistance of the VPICU system. Data is now complete and uniform in all the hospitals across the system. That said, Dr Wetzel admitted complete digitisation process for all departments in every hospital will be long, arduous and expensive.
It is partially owned by a conglomerate of hospitals, constantly investing money to further the future of informatic medicine.
Zynx Health is another technology company which provides “evidence-based clinical decision support solutions“ for hospitals and clinics. They help their clients reduce costs and improve patient care quality. An acknowledged leader in the field, it was founded in 1996 by medical professionals, including the President and Chief Executive Officer Dr Scott Weingarten, MD, MPH. According to their own numbers, in 2011, Zynx products were present for clinical decision support for almost 2000 nationwide hospitals in the United States. It’s UK-based sister company “Map of Medicine” is employed by over 50 local NHS medical communities, and was designed by two London doctors.
Most patients would never know about either of the aforementioned companies. Because they aren’t meant for the patient. They were designed by medical professionals for medical professionals.
As Michael Moyer stated in his above-quoted essay about the history of the Internet, most companies are unable to invest decades of research and development and untold millions in the products which 99% of the beneficiaries will have no idea of their existence. These companies were never intended to “disrupt” the healthcare industry but rather remove a lot of the existing friction from the $2.5 trillion behemoth. It is not an industry keen on shortcuts or upstarts wishing to skirt regulations, because those regulations are what keep patients alive and breathing.
According to an informational document from the California Biomedical Research Association, it takes an average of 12 years for a new drug to progress from the lab to the patient. During that period, it undergoes a stringent battery of trials on both animal and human subjects. In the United States, the Federal Drug Administration (FDA) heavily regulates any introduction of a new medicine to market. The entire process, on average, costs $359 million, or roughly 35 per cent of an Instagram.
To compare healthcare startups with social, search or hardware startups is akin to equating oranges with cake. The stakes are higher. The lead time is longer. The chance of success is not tied to an unforeseeable trend. And the astronomical returns in 4 years are improbable for venture capital funds like Andreessen Horowitz.
While VPICU and Zynx are saving lives, Facebook is enabling virtual farming and the Apple iPhone is helping closeted gay athletes and trainers locate temporary companionship whilst in London for the Olympic games.