GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

AI, machine learning, neural networks and deep learning are the new, new thing. Applications in medicine are potentially vast and, as most things on the upside of the hype cycle, there is a proliferation of papers, conferences , webinars and organizations trying to stay ahead of the curve. Doing so , however, means you are on the leading edge to the trough of disillusionment.

Despite advances in computer technology and other parts of the 4th industrial revolution, there are many barriers to overcome before machine learning crosses the chasm. Here are some things you should know about dissemination and implementation, and innovation diffusion basics.

There are four basic categories of barriers: 1) technical, 2) human factors, 3) environmental, including legal, regulatory, ethical, political, societal and economic determinants and 4) business model barriers to entry.

TECHNICAL

A recent Deloitte report highlighted the technical barriers. Here are the vectors of progress:

Explainability, for example, is a barrier. Say one can predict the onset of Type 2 diabetes. It’s one thing to say that we think there’s a propensity but, typically the next question is “Why?” Most algorithms don’t, but we make sure that if we provide a prediction we can also answer those types of questions.

In a paper published in Science, researchers raise the prospect of “adversarial attacks” — manipulations that can change the behavior of A.I. systems using tiny pieces of digital data. By changing a few pixels on a lung scan, for instance, someone could fool an A.I. system into seeing an illness that is not really there, or not seeing one that is.

Software developers and regulators must consider such scenarios, as they build and evaluate A.I. technologies in the years to come, the authors argue. The concern is less that hackers might cause patients to be misdiagnosed, although that potential exists. More likely is that doctors, hospitals and other organizations could manipulate the A.I. in billing or insurance software in an effort to maximize the money coming their way.

Measuring and reporting results is another barrier since there are lies, damned lies and AI statistics.

HUMAN FACTORS

Human factors, like how and whether doctors will use AI technologies, can be reduced to the ABCDEs of technology adoption. Research suggests the reasons more ideas from open innovation aren’t being adopted are political and cultural, not technical. Multiple gatekeepers, skepticism regarding anything “not invented here,” and turf wars all hold back adoption.

Attitudes: While the evidence may point one way, there is an attitude about whether the evidence pertains to a particular patient or is a reflection of a general bias against “cook book medicine”

Biased Behavior: We’re all creatures of habit and they are hard to change. Particularly for surgeons, the switching costs of adopting a new technology and running the risk of exposure to complications, lawsuits and hassles simply isn’t worth the effort.

Cognition: Doctors may be unaware of a changing standard, guideline or recommendation, given the enormous amount of information produced on a daily basis, or might have an incomplete understanding of the literature. Some may simply feel the guidelines are wrong or don not apply to a particular patient or clinical situation and just reject them outright.

Denial: Doctors sometimes deny that their results are suboptimal and in need of improvement, based on “the last case”. More commonly, they are unwilling or unable to track short term and long term outcomes to see if their results conform to standards.

Emotions: Perhaps the strongest motivator, fear of reprisals or malpractice suits, greed driving the use of inappropriate technologies that drive revenue, the need for peer acceptance to “do what everyone else is doing” or ego driving the opposite need to be on the cutting edge and winning the medical technology arms race or create a perceived marketing competitive advantage.

In addition, medical schools, graduate medical education and graduate schools are not doing enough to train knowledge workers how to be more effective.

ETHICS/LEGAL/REGULATORY/IP

The UK House of Lords Select Committee on Artificial Intelligence has asked the Law Commission to investigate whether UK law is “sufficient” when systems malfunction or cause harm to users.

The recommendation comes as part of a report by the 13-member committee on the “economic, ethical and social implications of advances in artificial intelligence”.

One of the recommendations of the report is for a cross-sector AI Code to be established, which can be adopted nationally, and internationally. The Committee’s suggested five principles for such a code are:

1. Artificial intelligence should be developed for the common good and benefit of humanity.
2. Artificial intelligence should operate on principles of intelligibility and fairness.
3. Artificial intelligence should not be used to diminish the data rights or privacy of individuals, families or communities.
4. All citizens should have the right to be educated to enable them to flourish mentally, emotionally and economically alongside artificial intelligence.
5. The autonomous power to hurt, destroy or deceive human beings should never be vested in artificial intelligence.

The Nuffield Council on Bioethics identified the ethical and societal issues as:

1. Reliability and safety
2. Transparency and accountability
3. Data bias, fairness and equity
4. Effects of patients
5. Trust
6. Effects on healthcare professionals
7. Data privacy and security
8. Malicious use of AI

Finally. the parts of the environmental SWOT analysis are more wild cards in the game.

Here are the issues under discussion about patenting AI products and services.

Here are some other legal concerns.

ENVIRONMENTAL AND BUSINESS MODEL BARRIERS TO ENTRY

Startup developers of commercial AI applications operate in a competitive market. They compete with the data available to them and meet a market need for AI applications for midsize companies, which, in turn, enables those companies to compete with larger companies that often develop AI applications internally.

Some healthcare organizations contend that it’s financial constraints that provide limitations. Lack of dollars makes it difficult for all but the most advanced and lucrative healthcare organizations to put machine learning or artificial intelligence in place to make the most of the data. There are many more practical barriers contributing to the AI divide.

Here are some regulatory and reimbursement issues.

AI dissemination and implementation faces some NASSSy hurdles (The acronym stands for Nonadoption, Abandonment and Challenges to the Scale-up, Spread and Sustainability

Artificial intelligence in medicine is advancing rapidly. However, for it to grow at scale and provide the promised value will depend on how quickly the barriers fall.

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GUEST POST from Arlen Meyers

Steve Blank describes how companies grow in three phases-search, build and grow. In the first step, the goal of a startup is to search for a repeatable and scalable business model.Building means changing into a company that can scale by growing customers/users/payers at a rate that allows the company to:achieve positive cash flow (make more money than it spends) and/or generate users at a rate that can be monetized.Grown up companies have achieved liquidity (an IPO, or has been bought or merged into a larger company event) and is growing by repeatable processes. The full suite of Key Performance Indicators (KPI’s) processes and procedures are in place.

I describe it as Fail it. Nail it. Scale it. Sale it.

Unfortunately, when founders and start up entrepreneurs grow up, they have few places to turn and are on their own. Most start up accelerators kick them out the nest after 90 days. Accelerators seem work when they follow best practices. Some don’t.

Many confuse accelerators with incubators (sometimes called generators or some other kind of whateverators). Here are some differences.

According to a recent analysis, we need scalerators now more than ever, since while the number of new businesses created since the Great Recession is increasing, the number that reach scale are not those that do hire fewer employees than in the past.

The share of private firms less than a year old has dropped from more than 12% during much of the 1980s to only about 8% since 2010. In 2014, the most recent year of data, the startup rate was the second-lowest on record, after 2010, according to Census Bureau figures released last month, so there’s little sign of a postrecession rebound.

To fill that gap, we need scalerators, designed to provide the knowledge, skills, attitudes, resources, networks and mentors entrepreneurs need to build and grow their companies. Biomedical and health scalerators can be mostly virtual, inviting participants back home from time to time for a home cooked meal gathered around the dinner table.

The core components of the Lean Startup methodology are 1) creating a minimal viable product, 2) using the customer discovery process, and 3)creating and validating the business model canvas. Here are the parts of the Lean Scaleup methodology:

The Lean Scaleup Methodology:

1. Maximally profitable product

2. Customer optimization process

3. Business model sensing and modification

4. Not so smart money to fuel growth

5. Letting people on the bus off at the next stop

6. A new way to keep score

7. Wardrobe change

8. Profitable growth KPIs/scorecards/dashboards

9. A new org chart

10. From testing to traction and avoiding the distraction of traction.

11. Building high performance teams. Sometimes they are virtual, sometimes they are global.

12. Corporate governance and founder-board-investor issues

The business model would also be different from accelerators, since the model has already been validated, requiring innovative investment schemes to provide the right incentives for growth given the more advanced stage of risk and reward potential.

Finally, given the unique requirements for human subjects trial design and execution, the participants in biomedical and health scalerators need to come from expanded domains like public health, biostatistics, epidemiology and translational reasearch in addition to the business and investment communities. Growing companies have different needs when it comes to leadership, manufacturing at scale, sales and marketing, human resources and financing.

Here are some differences between the two:

Startups:

• Have one goal: hit p/m fit
• Must take big risks
• Make you feel directly responsible
• Have higher highs and lower lows
• Are a lifestyle, not just a job

Big companies:

• Have “made it” to some extent
• Focus on growing what’s already successful
• Will be more risk-averse
• Wear the burden of higher expectations
• Take more time to try and do things for the long-term

Startups need people who:

• Operate with good intuition
• Are well-rounded, jack-of-all-trades
• Are proactive, don’t mind ambiguity
• Possess a healthy dose of optimism

Big companies want people who:

• Are team players
• Will raise the bar in a specific dimension
• Are high potential in the long-term
• Are strong connectors, good at aligning and connecting groups

Startups make you feel awesome when:

• You move like a synchronized swim team
• You continuously launch shit
• You witness direct impact of your creation
• You realize how much you’ve learned

Big companies make you feel awesome when:

• You realize you’re having an impact on millions of people
• Your company invests in ambitious missions because it has resources to
• Someone spends time to invest in your career growth
• You get to try a lot of different projects

Startups make you feel sucky when:

• No one uses what you build
• There are struggles because no one is an expert
• Nobody invests in you
• There’s personal drama / conflict
• You are constrained

Big companies make you feel sucky when:

• There are too many involved in decision making, and it feels hard to get anything done
• You feel a looser connection to what your company is shipping
• You no longer have context on everything going on
• There will be decisions that have ripple affects that affect you negatively

Accelerators need to rethink their models and practice what they teach. Many have peaked at their life cycle and risk going out of business. Maybe we need more euthanators instead.

Building a start up is like designing and manufacturing a machine that works and does what it is supposed to do. Scaleups are machines that have high performance. Grownups are machines that run faster than all the other machines. So, building scalesups takes:

1. Making sure all the parts are working
2. Synchronizing all the systems
3. Maintaining the parts to be sure they don’t wear out
4. Finding the right driver and high performance mechanics
5. Putting the right OILS and lubricants in the machine
6. Being sure that the machine gets the most miles/gallon as possible
7. Insuring the machine against risks and accidents
8. Building a better machine as time goes by
9. Building value into the machine since someone might want to buy it from you some day
10. Money to run the machines

Life science technology commercialization, like medicine, is a series of hand offs. In the present environment, incubators hand off to accelerators/clinical “innovation centers” who can then hand them off to scalerators . However, like clinical medicine, there are gaps that lead to dropped handoffs with resulting morbidity and mortality.

Millenials have been living in their parent’s basements for too long. We need to provide a place for scaleups to live on their own without cutting the essential parental bonds and guidance they desperately need to be successful. The good news is that some are on board already.

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GUEST POST from Arlen Meyers

Analysts are abuzz about deals like the acquisition of AOl by Verizon. The conventional wisdom seems to be the synergies will be around using AOL videostreaming delivered over Verizon pipes using mobile devices. Looming in the back ground is the question of how this platform can be used in sick care and preventive medicine.  The next shoe has dropped with the announcement that Verizon is buying Yahoo for $4.83 billion. They want the advertising revenue for their video platform.

The next big consolidation happened when AT & T bought Time-Warner. Then, CenturyLink acquired Level 3.

Here is how 5G will impact sick care.

In a bid to make a bigger telemedicine play, telecommunications giant Comcast decides to move from merely being a Doctor on Demand customer to buy the business. It will offer telemedicine as a premium cable service so that customers can communicate with healthcare professionals in their homes, with chronic conditions and mental health being of particular interest. Comcast is teaming up with one of the nation’s largest Blue Cross health insurers, Independence Health Group, to launch a new consumer-oriented health-care technology platform.

Will other cable companies follow suit?

This is probably not the last news we will hear about consolidation and convergence of  healthcare, telecommunications, media and mobile. With medicine moving from bricks and mortar to an expanded digical model-digital and physical- health communications and media companies will become integral parts of care delivery, information and education. After all, 6.8B people in the world have a cell phone.

Digital health is over. Sickcare ICT has taken it’s place and new models have emerged to claim market dominance.

Global Verizoncare will create both challenges and opportunities and open up many markets in developing countries with emerging middle classes demanding access to state of the art care and technology. Particularly for those in remote and difficult to access areas outside of the megacities, the hope is that Communicare will improve access, reduce costs, raise quality and the human experience.

PwC research suggests that information and communications technology companies (ICTs) have created value using 5 different strategies:

1. Category leaders.These companies focus on building a dominant position in a relatively narrow product or service category. They use that position to shape and influence the supply markets and sales and delivery channels in that category. A key indicator of this strategy is the positioning of a company’s products and services.

2. Consolidators.These companies lead their category through repeated acquisitions. They roll up other companies to provide consumers with access to a platform of products and services, or simply to offer a product lineup that could be assembled no other way.

3.Innovators. These companies continually develop and introduce new and creative products or services to the market. Investment in R&D is the primary indicator of this strategy.

4.Solutions customizers. Companies following this strategy make use of insight and market intelligence to offer tailored products or services that address customers’ specific

5. Value players. These companies seek enterprise business by lowering the costs of competitive services.

In addition, videoanalytics will become an integral part of monitoring and changing doctor and patient behavior.

Do you have an innovation strategy?

As interface technology companies like Google, Apple, AT&T, and media content and delivery companies, like Comcast and Dish, get more involved in sickcare, it will present many challenges and opportunities:

1. Integrating different business models. Some suggest that if you want to see the future of sickcare, then look at the changing business models of newspapers and cable. Why pay for channels you don’t watch?

2. Resolving the cultural differences of disparate industries

3. Educating and training Doctors 2.0 in how to use evolving technologies

4. How to address the data issues and implement solutions.

5. Cybersecurity, confidentiality and security

6. Overlapping, and sometimes, conflicting ecosystems

7. The legal and regulatory environment of disparate industries and trying to resolve them. The FDA is not the only or most imporant regulator. Get inside the head of the FCC instead.

8. Intellectual property conflicts

9. A new investment landscape that will take time to take hold

10. Barriers to adaption and penetration in the medical community

11. Closing the sick care digital divide

12. Integrating ICT into the EMR whole product solution

So far, US telecom carriers have struggled to make it work, while others have seen more success.

The impact will not stop at sick care. Google has already made an impact on crowdsourced public health and epidemiology.

How would Microsoft design EMRs?What does Apple have in mind in buying personal health data startup Glimpse?

Other interface collaborations are positively electrifying

Sick care coherence and convergence will continue to evolve across industries, technologies and markets and doctors will have to learn how to practice medicine using many new tools and delivery channels. Practicing Coherentcare will be challenge.

Sick care is starting to look a lot more like a pumps and pipes business. The doctor treating a patient will be only the first episode of what will probably be a long running prime time show. The goal is to consolidate broadband care and make it anywhere care, moving from telesickcare to telehealthcare.

Here is what Verizon is thinking about the customer experience.

Sickcare is no longer one industry, but many and will continue to grow as such.

You’ve got telehealth, shopgirl.

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GUEST POST from Arlen Meyers

I think doctors have linkedout. Others have offered reasons why. Some disagree claiming that 1M doctors and nurses are on Linkedin. While that may be true, as the owner of a group that is approaching 30,000 members, I’ve observed:

1. Linkedin is mostly about finding a job. It does not fit the needs of doctors. Unless, that is, you didn’t match or a tired of medicine and looking for your next gig.

2. Social media sites are a useful way to educate, inform, market, build networks and communities of interest and build a business or start one. Most doctors are not interested in those things.

3. Doctors don’t have the time to actively engage to the extent they need to to be effective.

4. There are many competitive physician networks that offer more of a value proposition.

5. Doctors like to hang out with other doctors and feel uncomfortable expanding their networks outside of medicine.

6. They are afraid of liability risks and are just learning about how to use social media correctly.

7. Using Linkedin is a great way to build international networks. However, 10% will be talkers and the other 90% will be gawkers.

8. Linkedin can be used as a freemium business model. However there are risks and unless you offer a lot to premium members, it will fail.

9. Doctors use professional and specialty associations as advocates, as ineffective as some think they are. Not much get’s done on Linkedin.

10. The opportunity costs of their time is high. They don’t want to waste what little time they have left each day surfing on Linkedin

On the other hand, the kind folks at Linkedin have been sending me suggestions, based on my search history, that I connect with more MD/MBAs, so maybe I’m missing something.

That is unfortunate because in addition to not getting sales and marketing, doctors also don’t seem to understand that Linkedinnovation i.e. bottom up collaborative online innovation networks is the main model for creating and adding value. Here are some reasons why Linkedin can help you:

1. Finding a job if you are a biomedical graduate student of a health professional looking for a non-clinical job

2. International graduates looking to connect with US colleagues

3. A place to post a blog to create awareness and build individual brand equity

4. A place to build a collaborative online innovation network and announce meetings

5. A place for physician entrepreneurs to connect to service providers, investors, other entrepreneurs and innovation stakeholders

6. A place to learn from others, particularly those outside of your industry

7. A place to mentor someone else

8. A place to get business intelligence about your competitors

9. A place to monitor trends, threats and opportunities

10. A place to share with other social media sites

Building a network takes time and persistence and you should make it an entrepreneurial habit. Here are the best ways to use social media to build your network.

Here are the most common mistakes made by bioscientists, engineers and medical professionals.

Plus, those over 65 who are more engaged on social media, like Facebook or Linkedin, are healthier and seem to have less cognitive decline, although one might not be causative of the other.

You can tell doctors on Linkedin who are as unengaged as they are where they work. Their profiles have no picture. Some have no last name. Most don’t complete their profiles and make you guess who they are, where they live and what they do. They make you struggle to connect with them. Sound familiar?

Getting doctors engaged on Linkedin is as difficult as it is at the hospital. While it can be a useful tool, most clinicians will be Linkedout and not engaged.

Of course, now that Microsoft has bought Linkedin, all that might change. But, given how sick care workers think and behave, it will still take a while for the majority of biomedical scientists and sick care workers to engage.

 
Image Credit: Pixabay

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GUEST POST from Arlen Meyers

Doctors aren’t feeling the love. Many are discouraged, frustrated and angry. They discourage their children from growing up to be doctors. They drop out or burn out. Perhaps, if those who employ and regulate doctors treated them more like customers instead of provider cogs in an impersonal system, they would feel a whole lot better.

Happy employees make happy customers and doctors are no different. No sector is immune.

For example, if employers treated their employed doctors like customers they would start by doing a physician customer satisfaction/engagement inventory. Here are some suggested questions:

1. Definitions of engagement vary, but it generally includes pride, loyalty, and commitment. When engagement scores are low, physicians take little pride in the hospital, would not recommend it to a job-seeking colleague, and believe that the hospital’s mission and vision are not in sync the needs of patients. On the other hand, engaged physicians are more likely to perform better in every area, including patient care, education, and research, which benefits everyone. Using this definition, how would you rate your level of engagement (1-low, 10-high)

2. What do you think if the biggest barrier to physician engagement? Lack of transparency? Adminstrator-physician conflict and misalignment? Differing metrics for doctors and administrators? Corporatization of medicine? Others?

3. Do I know what is expected of me at work?

4. Do I have the materials and equipment I need to do my work right?

5. At work, do I have the opportunity to do what I do best every day?

6. In the last seven days, have I received recognition or praise for doing good work?

7. Does my supervisor, or someone at work, seem to care about me as a person?

8. Is there someone at work who encourages my development?

9. Do I have the freedom to take risks?

10. Is this a learning organization that excels at innovation?

Here are some ways to measure physician engagement outputs:

1. The number of idea or invention disclosures and whether they do it more than once
2. How eager they are to engage in conflict resolution
3. Whether they cover each other’s back
4. How they talk about your organization and treat fellow employees
5. Attrition rates. Measure the footsteps out the door
6. How often they volunteer to do things and actually show up and do them
7. How often they do things out of pure self-interest instead of organizational interest
8. What they talk about on the grapevine
9. Trust levels
10. The quality and quantity of internal and external networks.

Based on the responses, then focus on solutions:

`1. Create solutions for the jobs doctors need to get done, eliminate the pains it takes to get them done and create a whole product solution that exceeds their expectations.

2. Create metrics to measure the results, like alignment, execution, engagement and satisfaction.

3. Use data analytics to measure compliance and positive outcomes and create a personalized doctor experience.

4. Use e-marketing and behavioral economic techniques to reward and encourage positive behaviors

5. Turn employees into advocates and brand allies by showing them attention, affection and appreciation.

6. Translate doctor customer satisfaction into patient customer satisfaction

7. Lead innovators instead of managing innovation

8. Create policies and procedures that are user friendly

9. Create a sandbox that is fun

10. Practice open innovation

11. Give them the education and training they need to move from being knowledge technicians to strategic thinkers

12. Eliminate useless mandates, administrivia and non-value adding health IT chores

13, Practice corporate emotional intelligence

14. These techniques apply not just to health systems, but BIG PHARMA and BIG DEVICE as well as they go “beyond the pill” and transforming med tech to techmed. For example, here are five strategic efforts can help biopharma medical affairs teams master customer engagement in the digital age. They can be reduced to the 5Cs: 1)Knowing the customer and subsegments, 2) creating communication channels, 3) distributing content, 4) determining and measuring the culmination or results of your efforts and , 5) continuous engagment improvement based on your findings.

15. Give them the tools they need to win the 4th industrial revolution.

If you really want to get fancy, create a sample group that gets the intervention and compare it to a control group that did not and remeasure satisfaction/engagement at an appropriate time after your intervention is complete.

Sick care practices its share of stupid business tricks. They don’t seem to understand that happy, sustainably engaged doctors make happy, sustainably engaged patients and that, in most instances, you can’t have one without the other. Ultimately, it is the players on the field who score the points, not the coaches on the sidelines.

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GUEST POST from Arlen Meyers

Biomedical entrepreneurship is the pursuit of opportunity under conditions of uncertainty with scarce resources with the goal of creating stakeholder defined value through the deployment of innovation using a VAST business model. Consequently, there are many ways to practice entrepreneurship without doing it full time and without necessarily creating a new company. The goals are stated to be better quality, lower costs, equitable access, a better patient and doctor experience and improved efficiencies and effectiveness of business and operational processes.

However, the fruits of our entrepreneurial labors in sickcare are neither equitably available nor equitably disseminated.

Taking DNA testing, for example. Seizing on the surging popularity of at-home DNA testing kits, top academic medical institutions are opening clinics that promise to probe much deeper into your DNA — if you’re willing to pay hundreds or even thousands of dollars out of pocket to learn about disease risks that may be lurking in your genes.

Health care inequality is when one group of people in an economy are in much worse health than another group. In the United States, health inequality is correlated with income inequality. Research has found that the higher your income, the better your health.

Envision biomedical entrepreneurs working to create a world without sick care inequities. What will it take?

1. Resolving the ethics of business with the ethics of medicine
2. Changing the rules
3. Patient and physician education, engagement and enablement
4. Measuring the impact of innovation and entrepreneurship on underserved populations
5. More diversity and inclusion in innovation ecosystems, including clinical trials
6. Recognizing the differences between equity, inclusion and diversity
7. A systems engineering approach to the causes of disparate health outcomes
8. Changing patient and physician behavior
9. Monitoring and modifying the adverse impact and unintended consequences of technology
10. Eliminating technology adoption errors
11. Reforming medical education and training
12. Measuring equitable innovation outcomes, dissemination and implementation, not process
13. Viewing biomedical entrepreneurship as a social enterprise
14. Practicing reverse innovation
15. Changing mindsets
16. Avoid iceberg innovation
17. Overcoming unconscious bias and racism in decision making
18. Interprofessional entrepreneurship
19. Acclerators and scalerators designed to launch products and services that serve diverse populations equitably
20. Social enterprise sickcare startup funding

Inequality is a major social policy problem. Until and unless we address how sick care entrepreneurs create products and services that are equitably created, developed, launched and disseminated, we continue to be part of the problem, not the solution. Some say the future is now, just not evenly distributed. Keeping it that way is not a sustainable future.

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GUEST POST from Arlen Meyers

Doctors looking for nonclinical careers often think of consulting for medical-device, delivery-platform or pharmaceutical companies as a viable transition career option. Some doctors favor working with smaller, startup or early-stage companies because they want to avoid the rat race they are trying to escape and want some freedom. If you are thinking of consulting to a startup or early-stage company, serving as an advisor, on the management team or board of directors, just having initials after your name won’t mean much. You will have to deliver the value that startup CEOs are looking for: money, marketing, making something, management, manpower, mentors, monitoring the environment and mergers and acquisitions.

Money

In most instances, the company has already crafted its plan of attack, has validated it with a few customers and is moving along according to its business plan with a management team that is experienced, but at this stage of the game, needs capital to get to the next level. Unfortunately, when approaching private-equity or venture capitalists, the usual response is “too early and too much technical or regulatory risk.” The team scales back its expectations for raising capital, reducing it to about $500,000 to $1 million, and seeks investments from high-net-worth individuals such as doctors or angel investors. That’s where you come in. The team wants you to use your network to raise money from colleagues, friends or others who might be interested in the idea or who practice in the specialty.

Marketing/social Media

In addition to money, they also want you to use your network to connect them to potential customers, strategic partners or other advisers who can help place the product, reduce barriers to use or lend a favorable ear to the product offering. Your job is to bypass the gatekeepers, connect the leadership team to the decisionmakers and put in a good word. You are also expected to use your brand equity to create buzz on the internet and inform and educate stakeholders.

Management

Once you have earned your stripes, then—and usually only then—will early-stage companies be interested in your being on a scientific or business advisory board, or more certainly, the board of directors. They want to test whether you can deliver, whether you are someone who plays nice with others and whether you can help them meet their next critical success factor.

Making Something

New product development requires an intimate understanding of the problems customers face when doing their jobs. Doctors are in a unique position to provide that intelligence and know where to go to identify those affected.

Monitoring the environment

One of your jobs is to be the eyes and ears of medicine and biotechnology and report threats and opportunities to the leadership team. Telling truth to authority is a required skill.

Manpower

You were hired because you are connected. That means you have access to a big network of talented people looking for jobs and eager to work for companies that come recommended from trusted resources. Winning the war for talent is an insider’s game and you are in the right place to help win it.

Maturity

Perhaps the most valuable but least rewarded contribution is the clinical and business judgement derived from years of experience. While difficult to measure, instincts and that gut feeling are invaluable if they contribute to preventing the wrong move or step.

Mentoring

Teachers educate. Coaches teach a skill. Mentors help with personal development. Advisors help with business strategy and execution. Sometime you have to act like all of them depending on the situation.

Mergers and Acquisitions

Companies grow organically or through mergers and acquisitions. One role an advisor can play is to connect the management team with potential strategic partners or M/A targets and help with the due diligence process.

Consequently, when you are interviewing for an advisory role, be sure to cover these bases:

1. Whether you are a good fit
2. Whether and when you can help achieve the company’s next critical benchmark
3. What role you will play in the company and for how long
4. Whether you will have any conflicts of interest
5. Approval from the other founders to participate
6. Compensation
7. Metrics attributable and trackable to your contributions
8. Expectations about timelines and benchmarks
9. How you will work with other members of team, particularly in communications, business development and engagement tactics
10. Tax consequences of any equity arrangements

Another consideration is whether a given company is a startup, a scale up or a grown up company. The goal of a startup is to find a scaleable and repeatable business model that typically generates less than $1M in revenue. The goal of a scale up is to generate revenue from aboub $1M-5M or 10M. The skills required to do so are different in one situation v the next. For example, startups need people to create the right product-market fit and a minimall viable product or pilot. Scale ups mostly need management, money and marketing. Grown ups need monitoring to avoid being left behind by other startups that will steal their market share or technologies that make them non-viable.

There are significant gaps in the knowledge, skills, abilities and competencies of doctors who are interested in working with companies, whether it be as a part-time consultant or full full time chief medical officer. Some of those are:

1. Product development

2. Strategic thinking

3. Sales and marketing

4. Financing new ventures

5. Integrating digital health solutions into existing workflow

6. Legacy EMR integration and basic technical aspects of health information technologies

7. Overcoming the barriers to clinical dissemination and implementation

8. Measuring the scaleable impact of an intervention

9. Business development

10. Leaderpreneurship

Here are some things to think about before joining a startup

Here is CMO School for Dummies

Boards of directors have a fiduciary responsibility, unlike advisors, and governing AI and innovation in the 4th industrial revolution has taken a front row seat along with compliance, compensation and competitive strategy.

Bioentrepreneurs can be in independent practice, be part of a startup team trying to build a scalable company, be social entrepreneurs, work for someone else (intrapreneurs), or more recently, be an independent contractor working as a 1099 consultant. If you decide to be the last of these, then deliver the seven M’s. Unlike medicine, you won’t get paid just for effort. You will get paid for execution and delivery. Here are some ways to monetize your network.

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GUEST POST from Arlen Meyers

A business school colleague recently said that academics, frustratingly, are more about process than outcomes, and, that, occasionally, the process results in favorable outcomes. When processes are designed and portrayed as efforts to create innovative outcomes with out results, it’s called innovation theater. Some cynics call it strategic planning.

He was referring to organizational culture— the set of values, beliefs, and behaviors that determine “how things get done” in an organization. It is the job of leaderpreneurs to create, scale and sustain a organizational culture of innovation.

But organizational innovation only happens when intrapreneurs i.e. employees with an entrepreneurial mindset trying to act like entrepreneurs, are able to work in and engage with a culture of innovation with the goal or creating stakeholder defined value through the deployment of innovation. There needs to be structure, process, culture and leaderpreneurs driving favorable outcomes.

Most of us know toxic, anti-entrepreneurial work cultures when we work in them, or, maybe, contribute to them. But, how do we know we are getting the results we want? Like the saying goes, you get what you measure . Try measuring 1. Program/rollout engagement KPIs

2. Storytelling that celebrates champions and teams

3. Behaviors that reflect change

4. Financial, operational, sales and marketing metrics

5. Economic development and technology transfer metrics

6. Stakeholder conversion rates

7. Employee engagement rates

8. ROII (return on innovation investment)

9. Multiples of user defined value compared to competitive offerings or the status quo

10. Burnout and turnover rates

Or, just ask yourself one simple question. Would you recommend where you work as a place to innovate to a family member, friend or colleague? This cultural innovation net promoter score should tell the tale.

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GUEST POST from Arlen Meyers

The NSF iCorps experience is a 7 week program that is designed to help scientists, engineers and health professionals commercialize their ideas, or give them a merciful death, based on evidence garnered during a customer discovery interview process.

I recently participated as part of a team composed of an entrepreneurial lead, a principal investigator, and an industry expert. The idea is to validate hypotheses on your business model canvas, or reject them and pivot.

Here are some of the more common rookie mistakes:

1. Too many customer segments
2. Defining an industry segment, not a person, as the customer
3. Creating a value proposition that is about features of your solution, not the benefits to the customer segment and trying to be all things to all segments. Here are the B2B elements of value.
4. Not quantifying the customer pain and what they would be willing to pay to get rid of it
5. Not understanding the customer archetype or persona such that you can walk in their shoes
6. Mistaking a technology for a product for a business
7. Grossly underestimating the barriers to adoption and penetration and the ability to cross the chasm to the early majority from the innovators and early adoptors
8. Not appreciating the cost of customer acquisition in the different kinds of markets, particularly when there are more and more well healed incumbents
9. Wasting a lot of time trying to understand an industry ecosystem because you don’t have the right mentor to guide and inform you
10. Not planning on how you are going to keep and grow customers once you get them
11. Not creating a unique value proposition for each segment
12. Ignoring the non-technical value factors that make customers want your product.
13. Built to sell or license as the primary revenue generator. The goal is to get someone to buy your value, not sell it.
14. False negative or false positive conclusions based on biased interpretation of information derived at interviews.
15. Not interviewing people face to face but instead by phone.

To be successful, every business model needs to be VAST 

1. Validity Regardless or which elements of your model you choose, they have to be valid. In other words, the dogs have to eat the food. When the dog won’t eat the food, you’ll have to change your approach and try again.

2. Automaticity At the very start of planning your venture, you should think about how you are going to work on your business, not in it. Reducing hands on time to manage operations will give you more time to lead the company and create strategies for growth and give you more personal time to enjoy the fruits of your success. Outsourcing, automating or using technologies to ramp up operations, sourcing and distribution is a key part of scaling, and something that investors want to see…which brings us to the next piece.

3. Scalability Your business model is primarily a way to create a business machine that can produce an infinite number of products. Think of it as a device that takes in customers and creates profits out the other end and can do so at quicker and quicker speeds.

4. Time and Traction Finally, your model need to create as much profit as quickly as possible with a growing customer base that is loyal to your brand.

Most of the time, with experience, these mistakes get corrected as you go through the process of experimentation and data analysis. But, why waste the first 3 weeks making them when, with some forethought, you can avoid them?

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