Why you need to clinically validate your #healthtech.

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Quoted failure rates of #healthtech start-ups are almost as hysterical as the millions said start-ups are said to be receiving. Numbers vary vastly from 44% to 70%. The actual numbers don’t really matter (unless you are one of the investors or workers losing out), the real issue of how to avoid this happening in the first place in #digitalhealth. #Healthtech projects which have clinicians behind them do well both in the private and public sector; they have inbuilt clinical validation from the start. This is why you too should think about doing it. 

So that the #healthtech actually works.

It may seem an obvious point, but many digital health “solutions” fail because they are not in fact a solution. They are a product which is developed by non-healthcare professionals to answer a perceived need. Innovative technology is showcased brilliantly at industry events but then is either rejected or fails when it comes to the medical profession.

Bias in medicine is a dangerous thing, and as clinicians, we are continually being put in our places by patients who don’t conform to expectations. There has been much talk about Babylon’s diagnosing a woman as having anxiety instead of a heart attack, pointed out incidentally on #medtwitter. However, this is just one of many examples of bias which can mean that your non-clinically validate #healthtech not only doesn’t work but also becomes a liability. And as with Babylon, word spreads fast in the medical community. How many #healthtech developers are employing data scientists to look at potentially dangerous biases in their algorithms?

So that doctors support your #healthtech.

Lack of clinical take-up leads to a lot of “doctors will just have to get used to changing their practise whether they like it or not” comments, implying that they are stuck in their ways. This overlooks the fact that doctors, by definition, are lifelong learners, adapting their clinical practice on a daily basis. Every patient you see is a risk-balance assessment of what works best for that patient based on current evidence but also your own professional opinion. Healthcare professionals are your toughest critics because they are the ones who see the #clinicalreality and the aspects which you don’t. No man is an island and no patient is just one disease.

When you diagnose a patient, you do so not just by looking at a set of tests and variables such as heart rate, but by speaking and looking at the patient. The questions often seem random to a layperson, but sometimes the examination is even superfluous. I know I’m not the only person who has gone back into a cubicle to put a stethoscope on for the patient’s benefit as I’d already understood what was going on by the time we’d finished talking. Just how many #digitalhealth people realise that by the time you are ordering the tests, you are often just confirming the diagnosis. When you “treat” a patient, you do so not just following a protocol but based on many other factors.

However, there are many frustrations which we know technology could help with; having access to all the correct patient information, reducing the decision burden by incorporating protocols. So speak to your target clinicians. Now. Often. In their clinical setting. What they will tell you is that they will enthusiastically take on validated and evidence-based #healthtech which answers their needs. In fact, they will probably be able to tell you what you need to do to make your #digitalhealth technology work. Sometimes they have already done it themselves, and you can work with them.

So that patients go to their doctors asking for your #digitalhealth solutions.

And if you speak to the doctors, and nurses, and healthcare assistants, and receptionists, and porters, don’t stop there. Patients, especially chronic patients, have a very clear idea as to what works, what doesn’t work and which of their #digitalhealth needs aren’t being met. There is a whole #wearenotwaiting movement where type 1 diabetes patients have been going faster than the industry at developing openAPS or open artificial pancreas systems and glucose monitoring. After many years of being treated as dangerous mavericks, they are now being incorporated into paediatric diabetes care in major NHS hospitals. Even the fact that they are not FDA approved has not put off parents and doctors using them. That is what “disruptive” in #healthtech really means. Meanwhile, Medtronic and others who provide the “official” solutions, have recognised the fact that it makes more sense to employ directly the #wearenotwaiting developers rather than play catch-up.

Even patients who are not digitally savvy will be quick to tell you why they will or won’t use an app or technology. And often these are for very different reasons to the doctors. Maybe it is because they are more affected by the short-term side effects of a medication whose dose needs to be changed than targets- and they have to be able to access that information quickly. It may be that your amazing frailty support system doesn’t recognise the fact that being part of the #silvereconomy doesn’t mean being bedbound, and that they too want to go places in the world with no internet connection. Patients are whole persons whose disease lives with them once they leave the consulting room, and any treatment, digital or traditional, needs to take that into account.

So that you can expand into the community.

It is fair to say that in an era of influencers, traditional advertising is being rethought to reflect the age-old concept that you are more likely to follow the recommendation of someone you trust that the manufacturer. Doctors, suspicious as they are (!), prefer to hear about new medications and developments in medicine from other doctors. Pharmaceutical companies have long recognised this fact and this is another advantage of clinically validating your product. You speak the language of your target users, and once clinicians are prepared to listen, it can be a useful two-way conversation and is the way you get your #digitalhealth product to a clinical setting.

Patients too ask friends and family for advice. The reason that the instruction to only take medication which has been prescribed for you is precisely because people still take their family member’s medications for something which may or may not be a similar disease. Once you have patients with a vested interest, then others will follow. The way to do that is to listen, speak to and answer their needs.

It’s an exciting time to be in medicine, both as a professional and a patient or carer. It is in everyone’s interest in making sure that the progress in #healthtech works first time round….and keeps on working and being relevant.

Published by Dr Alice Byram

Emergency and family medicine physician offering individualised health solutions. Special interest #digital health.

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