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Internationalizing healthcare solutions

By 24 de setembro de 2015 Gestão, Mercado

Throughout the world, longer living populations require affordable care that is outside the scope of pension and health plans. Created in a world when people lived much less, they now face the challenge to provide service for a much broader population than when designed.
Everywhere, innovation is taking place, aiming to provide better, cheaper and more accessible health. Big Data, IoT, Wearables, and so many other new tech produce quality data as never before. Communication tools enable patient-doctor interactions, increasing accessibility. Money is pouring into ventures of all sorts, and a whole new cohort of thinkers is gathering around health and life sciences industry.

But isn’t change taking too long? We´ve just seen a single product change the way we behave as a society in less than a decade. Smartphones, created by Jobs in 2007, are more present in the world than toothbrushes.
Why we do not see the same in healthcare?

Data on patients becomes easier to obtain, alongside with tools to work huge amounts of data, enabling better management and medical knowledge.

But first these new ideas have to be used.  Still in labs, in pilot projects or in the startup communities, all these new things need users, like you and me. And to get these is not as simple.

Health and healthcare differ broadly from other industries, and its peculiarities may be wrongly perceived as innovation blocks. Some blocks are real, other are characteristics one has to take into account when designing or evaluating solutions.

 
Local aspects
The challenge is global, and everyone is looking for solutions that could be deployed world-wide. But one must be aware of the highly diverse ways healthcare systems operate throughout the globe.

Usually locally delivered, under different regulatory frameworks, healthcare imposes to truly international solutions a larger chunk of flexibility than other supply chains.

You will have to comply with different sets of rules and procedures in each implementation, sometimes changing even your business models assumptions.

E.g., a successful Pakistanis’ model based on web conferencing could not be implemented in Brazil, due to local Medical Council regulation blocking electronic patient-doctor consultations. Nurses in Brazil cannot do all procedures a nurse in the US can, so a patient-care solution will require more physicians, i.e, additional costs and a much higher growth limitation. A solution in chronic management that successfully works in the Eastern world would be much less appealing in India, where diseases are considered by many as a consequence of previous
lives.

Things are done different in different countries, and different people with different ways require different solutions.
Regulation

Health is one of the most regulated market environments. For those new in the field, usually coming from less regulated areas, regulation may be perceived as a waste and an innovation block.

We are dealing with life itself, and we all need to be informed and protected of potentially harmful innovations. Drugs, treatments, therapies, they all go through a long road of checks and balances before they hit widespread adoption. This process protects all of us, has been used for decades and is perceived as a safe way to introduce innovation. Even with all regulation on trials, evidence and medical practice, everyone knows a horror history about a new drug or treatment with a daring and unpredicted side-effect.

Why should we change this process with any new technology? Besides, wouldn´t you feel safer (and thus more likely to use) if a new app or device has a FDA/CEE approval? And why should your doctor recommend it for you, if no one has attested its worth? Regulation in health provides two essential things for adoption: assurance that it won´t harm you and also that it is not just some new digital sort of snake oil.

The only “but” is that this process is slow. It takes years to conduct clinical trials, publish and disseminate results. Change this is essential to secure and foster real advances in a timeframe compatible with the foreseen challenges. Digital technologies can contribute significantly to both efficiency and efficacy of current healthcare practices, as they did with every other industry and supply chain over the last 50 years. But this adds to current state of most regulatory bodies a new threat, to regulate for an uncertain future and interact with much faster-paced industries.

Misconceptions on apps and such.
It’s good to see things that worked on other industries (such as gamification and social networking) being transferred into healthcare, but one must understand the differences and have the right mindset.

One central point is business models. Take for example measuring success / value, and defining how to grow in a sustainable way.
If a diabetes aid app or a wearable tracking device has its value measured in low churn rates or long customer retention, it shows a really bad performance, being dropped 3 to 6 months after adoption. But if you measure it in terms of their impact on patients´ awareness and education, it is a success. Since awareness and education reflect on treatment outcomes, tangible value is created to those hurt by long term patient costs, like health provider and insurance companies.

On growth, one need caution when setting goals and objectives. We got used to see unicorns coming out of nowhere, changing the ways whole sectors operate in just a few years. Uber is one of the most recent and may see in it a model of what could be done in healthcare. On this article, Mr. Bradley Merrill Thompson, an attorney from Washington D.C., discusses why Uber´s business model may not work for medical apps.

Ways to speed up internationalization
Although barriers are high, there may be ways to avoid them and disseminate innovation.
A possibility is to rely on the current academic system to deploy it internationally, building peer-to-peer academic support networks. Pharmaceutical industry has successfully done that throughout the years, and people coming from other fields could learn from them.
Medical organizations like Alzheimer International Association congregate Key Opinion Leaders from all over the world and bring them together at least once a year. Medical journals authors and reviewers form a network of experts already in place. Engineers and businessmen could use these as channels to quickly form an international team with people that know each other and are used to collaborate.

Creating such an international team becomes easier every day. Just like everybody else, physicians have embraced collaboration and sharing as part of their private and professional lives. As result, it is much easier to find talented, open to innovation and tech-savvy people among them.

These academic networks may provide patients the same assurance a regulation agency seal provides. We all live now in personal brand and collaboration times, but the academic world has always been such. KoL´s are brand names, carefully built over many years.
Building an international scientific/academic team, and bringing together with product/service design teams, can save lots of both time and money. Local experts can help checking if and how business model assumptions apply locally in their home countries, besides acting like local champions.

Another suggestion is to remember that health and medicine are evidence based. So, if you want to deploy a medical app or system internationally with academic support, you should test it clinically, seeing medical research costs as part of the product mix. Trials are costly and time consuming, but they provide hard data, are published and disseminated among those who can help most in wide spreading healthcare innovation, physicians. You may build your solution considering clinical tests requirements in early product design, facilitating the trials, accelerating results and reducing your innovation’s TTM.

Yes, healthcare is complex, and we should have Einstein´s quote in mind: “Everything should be made as simple as possible but not simpler”. Let´s embrace its complexity or face the burdens, either as patients, consumers or tax-payers.

Portal Saúde Business

About Portal Saúde Business

Formar e informar o executivo de saúde é o que fazemos todos os dias. Há mais de 15 anos desenvolvendo um conteúdo proprietário e centrado nos principais gestores do país, acompanhamos as notícias e tendências que impactarão no dia-a-dia dos hospitais, operadoras, centros diagnósticos, farmacêuticas e clínicas do país.

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