Why do doctors leave full-time medical practice to become entrepreneurs? Many of them do so to solve systemic issues plaguing healthcare.

This series includes four doctors from the US, UK and Spain explain their experiences with healthcare IT during their clinical practice, and their motivation to develop technological solutions for healthcare.

F081 Doctors in digital health series 1/4: The Digitome, Digital Health for COVID-19 and a new approach to medication adherence (Daniel Kraft)

Daniel Kraft is the founder and Chair of Exponential Medicine - a program with the goal to 'un-silo' thinking and unleash cross-disciplinary innovation across healthcare by bringing together thought leaders and forward thinking clinicians and innovators to explore potentials to reshape health and medicine with technology.

Daniel is a Stanford and Harvard trained physician-scientist, inventor and innovator with over 25 years of experience in clinical practice, biomedical research and healthcare innovation.

Among other things, Dr. Kraft founded IntelliMedicine, focused on enabling connected, data driven, and integrated personalized medicine. He is also the inventor of the MarrowMiner, an FDA approved device for the minimally invasive harvest of bone marrow, and founded RegenMed Systems, a company developing technologies to enable adult stem cell based regenerative therapies. One of his last missions is also to turn his website digital.health into a medical digital health formulary, where doctors could search for clinically approved and reliable digital health solutions to prescribe to their patients.

Some questions addressed:

• You are well known in the digital health community as the founder and Chair of Exponential Medicine. But you actually have 25 years of experience in clinical practice. What year did you stop working in clinical practice? 

• On a scale from 1 to 10, how happy are you that you don’t have deal with healthcare IT on a daily basis in the clinical practice?

• What memories do you have on technology in medicine in your early days of clinical practice? Not sure this is a fair question because you do follow latest tech advancement more closely than most doctors. 

• In 2018 you presented you company Intellimedicine on the TED stage. “ ‘IntelliMeds’ will match the individual’s needs, combining multiple medications into a single capsule in personalized doses, and providing the ability to adjust dosing and combinations based on patient data, improving adherence and health outcomes.” The idea is to have all medications a patient is taking in cartridges and based on the daily measurements supported by AI analysis, the machine would produce one pill the patient would take that day, and that one pill would replace 5 to 10 pills an older patient with chronic conditions and co-morbidities currently needs to take to manage all his co-morbidities and healthcare issues. How far is the development today? 

• The idea is appealing, what did you find so far as to how to combine medications that have different routes of administration and are packed differently because that impact where and where they are released in the body? For example will it ever be possible to combine a medication that needs to be given rectally, with an oral medication with a modified release, a subcutaneous medication and something that needs to be given as an IV? 

• How do you test this kind of a solution given that medications need to go through clinical trials and this is impossible to put in a clinical trial because the pill is literally different for each patient if you want to adapt it to his specific personal attributes? 

• New medications are cocktails of drugs - in his 2015 TED Talk Russ Altman - a Big data techno-optimist and internist talked about the unknown field of drug to drug interactions - he described how big data analysis showed significant glucose-changing signals in people taking an antidepressant and a cholesterol medication, where each drug alone did not change glucose, but together they did. 

• Do you think it is possible, that despite the greatness of the idea about intelligent one pill cocktails, this would turn out to be medically/biologically impossible to create? 

• As a physician, how worried are you about too fast reopening of the US during the ongoing COVID-19 epidemic?

F082 Doctors in digital health series 2/4: Managing task management in healthcare - “It’s about the patient, not paperwork” (Michael Docktor)

Michael Docktor is a GI pediatric specialist from Boston’s Children’s Hospital who designed a task management app to enable better coordination between healthcare and administrative workers who take care of all the bureaucracy and care entailed in treatment of every patient. Dock.Health is a simple, HIPAA compliant task management and collaboration platform designed for healthcare.

With over a decade of clinical practice and helping to build the culture of innovation at the preeminent children’s hospital, Michael has been at the forefront of the design and implementation of health technology. From his work in the Innovation and Digital Health Accelerator to serving as faculty in Clinical Informatics, Michael has been part of or led many cutting edge initiatives from implementing secure messaging, mobile EHR, and voice enabling mobile technologies to develop a virtual reality platform for customizable patient education.

Some questions addressed:

• Given your Surname, Did you always want to know you’ll be a doctor?  

• You have a long history in your passion for digital health. It all began in the early days of your - you were pushing for more innovation to be used in clinical practice and became Director of Clinical Mobile Solutions in 2013.  You later founded the faculty of Boston Children's Hospital Clinical Informatics fellowship, which aims at exposing trainees to clinical mobile solutions and innovation in health IT.  You were later Clinical director and liaison to the Innovation and Digital Health Accelerator. Can you take us through the journey of the cultural shift that has happened in the hospital around technology? How have digital solutions begun entering the clinical space?

• You began working in clinical practice right around the time when HITECH act was passed - a part of the stimulus package to drive EHR adoption in the US. What are your memories of the consequences of that act? How did things look like in the clinical practice IT wise when you started and how did they start changing afterward? 

• Random question: As a GI doctor - why does it matter so much depending on the doctor, how painful a colonoscopy is going to be? What is the role of technology you see in exams like that? 

• From the Chief of Innovation Perspective: how did you approach technology adoption inside the hospital? Age differences, interest, specialty can all be factors affecting how open an individual will be to adopting and learning about new solutions? So how did you get doctors aboard?

• Before we get to Dock.Health, a startup you are dedicated to 100% of the time at the moment, I want to stick to some other tech-related solutions you are working on:  Since 2018 you are helping at the Health Voyager Project which is a customizable, virtual reality platform that allows clinicians to create personalized immersive experiences for their patients to better understand their health and findings during procedures. The platform represents a customizable, VR software system utilizing a smartphone or tablet computer to portray personalized surgical or procedural findings as well as representations of normal anatomy. The use of such technology for eliciting medical understanding and patient satisfaction can have many practical and clinical applications for a variety of disease states and patient populations. Can you share what the discovery journey for that solution was like? 

• Dock.Health is a HIPAA compliant task manager. In order to understand how it works, can you explain what an admission looks like in a US hospital, what forms, consents need to be signed, how much bureaucracy is involved?  

• Why couldn’t you use any of the existing task managers? Trello, Asana…? 

• We’re well into the Coronavirus crisis - what impacts do you see and expect in the future in terms of funding for digital health startups? On the hospital levels - are hospitals going to be less inclined in investing in outside the hospital startups to retain capital for internal development they can leverage from? Perhaps in dock.health’s case - what ties the startup to Boston’s Children’s Hospital given that it was developed there? 

F083 Doctors in digital health 3/4: Connecting specialists and primary care doctors for faster, better patient care (Owain Hughes)

British surgeon Owain Rhys Hughes built Cinapsis in 2019 to fix inefficiencies in the referrals system and make it easier for GPs to access specialist expertise immediately. Through a dedicated platform they could seek real-time second opinions: slashing accident and emergency referrals, reducing unnecessary appointments and dramatically improving patient experience.

Some questions addressed:

• Why did you choose to study medicine and why surgery? 

• How long were you in clinical practice?

• What were your experiences with technology in the early days - the amount of paper users and the number of calls made for coordination?

• The NHS has a reputation of being a really good healthcare system in general, however, I’ve heard people complain it can take up to several weeks to get a GP appointment, which explains where the idea for Babylon - a smart AI-based system offering consultations to patients came about. From your perspective: what are the strengths and weaknesses of the NHS? 

• How would you assess the state of digital health adoption in the UK? The NHS is at the beginning of a fast digital transformation. The importance of investments and strategic approach towards digitization has been recognized on various levels: in 2016 Robert Wachter did an analysis of the system, last year Eric Topol prepared a comprehensive review Preparing the healthcare workforce to deliver the digital future. The NHS App is available, citizens and health professionals can access over 70 apps that have been assessed and approved via the NHS Apps Library. The NHS has established a global digital exemplar program, which basically means 16 NHS Trusts were chosen as exemplars of digital transformation and should attract other Trusts towards the change as well.

• There seems to be quite a lot going on: In February 2019 Matt Hancock banned the use of pagers in the NHS, giving Trusts until September 2020 to put plans and infrastructure in place. In 2019 Eric Topol prepared a review about the digital NHS and what it will take to modernize the system. One of his remarks was about data literacy - tackling the difference between members of the workforce based on their age. Any observations, thoughts? 

• Cinapsis is improving the referral process from primary to secondary care, by giving GPs the option to connect to specialists already when the patient is in their office. How did COVID-19 affect your development? 

• Do you think development of a startup in healthcare is easier for you because you are a doctor and your targeted users - doctors, can see you as more credible then they would see a salesperson without a medical background? 

• You built Cinapsis in 2019 to fix inefficiencies in the referrals system and make it easier for GPs to access specialist expertise immediately. Through a dedicated platform they could seek real-time second opinions: slashing accident and emergency referrals, reducing unnecessary appointments and dramatically improving patient experience. The benefit is obvious for the patient and the doctor. How do you get consultants aboard? Are these contractual workers that still work in the NHS? Can we explain how their daily routine looks like? 

• What is the business model? How are these consultations paid for? Can you explain your story to this day (how did the product discovery look like, what were the biggest struggles, how did you establish collaboration with the NHS, etc)

F084 Doctors in digital health 4/4: Mediquo: Whatsapp for healthcare (Guillem Serra)

Guillem Serra is a serial entrepreneur coming from a family of doctors. His mother, father, grandfather and great grandfather were doctors, which made it easy for Guillem to go study medicine given his familiarity with the profession. Besides medicine, he studied math and during his medical studies, discovered, that for him, medicine was actually boring. Today, he is a Physician and Mathematician with deep knowledge in the eHealth market, MedTech, and startups in the field of medicine. He founded several digital health startups and is an investor and board member to many startups. His first company MediQuo is a "Whatsapp for healthcare" - a platform enabling patients to chat with doctors and specialists 24 hours a day, 7 days a week, in a secure way, with all the tools and compliance needed for healthcare.

Some questions addressed:

- You come from a family of doctors, you studied medicine, but then decided not to work in the medical practice. For starters, what's your story? (Would be great if you could say again what you told me about the legacy of medicine in the family etc.) 

- While you were still studying to be a doctor - what memories do you have of EHRs and other technological solutions for data capturing and practicing medicine? 

- MediQuo is a teleconsultation provider. The obvious question in these unprecedented times is - what trends are you seeing since the beginning of the pandemic? Did you have to adapt your business? (For example, in March, ZOOM had 200 million daily meeting participants (not DAU). In April following month, this figure had risen to 300 million.  This compares to 10 million in December 2019)

- How exactly does MediQuo works - does the patient always talk with the same doctor? how is the consultation translated to a medical record/medical information that is added to the patient's medical record? 

- How much did you have to localize the solution? 

 - Can you describe the discovery process and testing of the app? How much emphasis was on the user experience and user journey?  

- You are amongst the top health apps in Spain and Latam. Any other specific local apps you can mention that you thought/think were addressing important or very locally specific problems?

 - Can you make a comparison between countries and your observations of how COVID-19 impacted countries you are active in?

- You are present in Spain and in South America. What kind of differences are you noticing culture-wise, with respect to the attitude of people towards health, the healthcare system, and communication platforms? 

- How different were your go-to-market strategies? How different are attitudes of doctors to new technologies and telemedicine? At the same time, how does availability to tech such as smartphones differ based on the country in South America, if you compare that to Spain? 

- You're based in Spain. How would you assess the healthcare system in Spain, levels of digitization? The response to the current crisis?