The Promise of Digital Medicine

Big news for us at Reflexion Health this week. The FDA declared our first product, Vera; “cleared” and ready to market to healthcare providers and patients as a medical device. It’s an important milestone for our company, and importantly, it’s another piece of evidence that a new industry – Digital Medicine – is taking off. It’s caused me to step back and think more concretely on what we’re doing up to now, and what principles should guide us as a company as we move on to our next phase of growth.

As chronic disease becomes an increasingly dominant scourge on our lives and our pocketbooks, we will need  to find ways to help people make important, sustained changes in their behavior that will help them manage– and sometimes cure– that disease.

While the Life Science & Medical Device industries will continue to drive impressive innovation — at their core, they both represent efforts to do things to “objects” and to “patients.” Medicine can create bio-chemical reactions that lower blood pressure or cholesterol and implanted devices can keep your heart beating, or replace an aching joint. But at their core, neither of them really expect anything of their beneficiaries other than maybe popping pills down the hatch.  They both see “patients” as a passive object.

Digital Medicine takes a different approach. It empowers patients with information, encouragement, coaching and feedback from often times previously unavailable or inaccessible data to help them take a more active role in their care and more easily reach and, in many cases, exceed, their goals. Where patients previously felt uninformed and totally dependent on “professionals” we can now leave them feeling educated and able to assume their role as the most important person on their health team.

However, we can go further and be bolder. We need products that are purpose built for medicine, that contemplate the complexity of both disease and the health care system it needs to be used within. This can move us beyond software that is interesting, ancillary footnotes of clinical medicine towards something that becomes as fundamental to the practice of medicine as pills and procedures.

We see Vera as one of these pioneering products.

As we step back to reflect on our progress to date, and our path forward there are 8 lessons learned– or more accurately are learning — that come to mind. We figured blogging about them is a good way to let others understand our foundation, and see if a little transparency can’t nudge us to walk the walk at Reflexion Health.

  1. Make people’s lives better. This starts principally with helping them get well as fast as possible. But we should always strive to contemplate the entire person. See them as a primary contributor to their well-being, not an object to treat; and recognize that helping empower patients to overcome fear, confusion, and boredom can make an enormous difference medically.

  2. Engagement is tough — stick with it. Too many stakeholders in health care take this for granted. Countless times, doctors and administrators see the first five minutes of our demo and say “got it.” They assume patients will use it, and then they move on to talking to us about our price, our logistics, how they could use this to cut out costs, or whether we integrate with their other IT

    They’re wrong though. We haven’t “gotten” patient engagement. At our best deployments, people are performing over seventy percent of their prescribed physical therapy.  They are recovering well, and being discharged faster than we would have expected at our most optimistic, able to return to their lives. But we still bore too many patients. Our platform takes too long to learn for some, or fails to contextualize our prescription into their lives. We get support calls that are downright embarrassing (for us, not the users). Even if our customers don’t demand it during the sale — we need to get better. Much better if we’re to achieve our goals.

  1. Be humble. No matter how convinced we can transform an industry and lay waste to some disease, remember that pathology & medicine sit at the nexus of one of the world’s most complex systems (human beings) and industries (health care). Our products can’t just “fix” it. But they can help; we think a lot. We should never forget that we’re building something that fits into (and at time disrupts) a much, much larger system. No product is an island, or a panacea. Or a panacea on an island.

  2. Digital +. Software will increasingly be core to creating powerful diagnostic and therapeutic products. But don’t be afraid if you need to sling more than just code. 30% of our users do not have a computer in their home. Over 50% don’t have a stable Wi-Fi connection to enable our telemedicine offerings. Don’t even ask us about Kinect penetration! Let’s not wait around longing for the world we wish existed — or the one that might in a few years. Let’s solve the problems as they exist. In our case it means manufacturing and distributing a “kit” that requires nothing more technologically from patients than space and electricity– while demanding an enormous amount of their time and focus to complete their rehab. For other companies it will mean inventing sensors, or employing a lot of clinicians or coaches. That hardware and/or people investment is not violating some maxim of Silicon Valley’s Success Path– it’s recognizing what it takes to build a digital medicine business.

  3. Help clinicians do their jobs better. Sure, some Digital Medicine will serve to neatly “strip out labor costs” — code words for replace people with technology. But many times, for Digital Medicine I’d say most times, the really tricky stuff is going to require trained, effective and empowered clinicians to move the needle. Let’s build products that make their lives easier & their therapy more effective. Enterprise software has consumerized. Medical products need to focus on both users (people and clinicians) and the objectives (better treatment), not on administrators or billers.

  4. Bring evidence — If we believe software can “eat” health care, let’s not hide from it. Bring the best clinical research to bear to test and prove software can help diagnose and treat disease and improve the lives of patients. But don’t stop there. Companies like Google perform thousands of A/B tests a day. The future of Digital Medicine is not a one & done type of trial. That is just the beginning. We need to instrument usage, continuously improve, and personalize to patients– while being honest about what we have proven, and what we still hope to demonstrate.

  5. Include communities. Digital Medicine shouldn’t exist by itself, it should understand that health and health care is delivered within the context of patients, families, friends, and different clinicians. Respect privacy, but allow for patients to connect their medicine with their lives when and where they want it to.

  6. Focus on the sick. Costs are centered in tricky, high-cost, comorbid patients. Don’t think for a second designing a slick product for the 24 year old technologist is going to help us tackle these challenges. Aim higher. 84 year olds with CHF, COPD & no support at home; or at least someone with a serious injury they are rehabbing. The healthiest half of American consumes only 2% of our healthcare dollars. To make a difference in medicine, we need products that can be prescribed to the sickest of us.

by Reflexion Health