Author Archives: Arlen Meyers

About Arlen Meyers

Arlen Meyers, MD, MBA is an emeritus professor at the University of Colorado School of Medicine, an instructor at the University of Colorado-Denver Business School and cofounding President and CEO of the Society of Physician Entrepreneurs at www.sopenet.org. Follow along onSubstack.

How to fund your biomedical startup

GUEST POST from Arlen Meyers

The most frequently asked question most inexperienced physician entrepreneurs ask is, “How do I find investors?”. The facts are that, according to the Angel Capital Association, only 2 percent of entrepreneurs are able to pry much-needed cash from the tight hands of angel investors, and less than a half of a percent raise money from venture capitalists, according to Price Waterhouse study.

Structural changes in the venture capital industry makes it harder to find seed stage money and investors who are willing and able to lead deals. The result is a seed stage gap.

So, what’s a biofounder to do?

Obviously, there is a lot of advice on how to raise seed stage money, but here are some recurrent themes concerning the strategy and tactics involved:

Strategy

1. Be sure your idea is ready for investor prime time–i.e. you have the pieces in place and have validated most of the elements of the your business model. The ultimate validation of your model will be if you have paying customers already.

2. Fight the right kind of investor who identifies with your idea during the right stage of development. Not all investors are the same. Some favor certain industries or products, some have personal connection, some want early stage, some want later stage. Do your homework. Here are the various stages of startup funding.

3. Explore alternative and new forms of funding, such as investor, charity or product/service crowdfunding, corporoate venture, state andlocal grants and university based endowments and investment funds.

.4. Network, network, network.

5. Fail early, often, and for as little cost as possible.

6. Self-fund or bootstrap for as long as possible. Build as much value into your idea as possible before shopping it to investors.

7. Consider customer-funded business models if possible.

8. Have a fundraising plan, just like a marketing plan or financial plan, and execute it

.9. Get the right people on the bus as soon as possible.

10. Find the cheapest, smartest capital (not necessarily money) to get to your next critical success factor.

Be sure you have a fundraising plan and follow these steps.

Tactics

Now that you have some strategy, here are some nuts and bolts:

1. Network, network, network.

2. Create a one-page executive summary, a 3-minute video, a website with a button “for investors” and a 10-slide Powerpoint presentation.

3. Sell to the heart, not to the head and be sure your pitch is investor ready.

4. Be sure you have the right story teller on the team.

5. Create social media buzz about your product or service as part of your plan. You know you are successful when an investor says, “Oh, I’ve heard of you.”

6. Apply for non-diluting sources of capital like SBIR/STTR, state and local eco-devo grants, international research, and development collaborations, etc.

7. Explore accelerators, generators, and incubators that have the right model for you.

8. Find out who funded your competitors and contact them.

9. Think big, but start small demonstrating customer traction with pilots.

10. Network,network, network. Even when you are networking, you might be mingling with the wrong people. There are 15 sources that you should cultivate who can make introductions or ease the way to meet investors.

Here are 10 other places to look for money:

You should also look into investor crowd funding. Here are the pros and cons.

Here are some tips on how to find angel investors:

  1. Use personal networking. The best angels you will find are the ones who know you personally, or know a member of your team or advisory board. If a potential investor gets to know you BEFORE you are asking for money, your credibility and investment probability will be improved by an order of magnitude.
  2. Entice angels to play along. Of course, angels are really mortals. They want to make a difference. Asking an angel to work with your company in an advisory role is a great way to establish a relationship that may lead to a cash investment. If you impress the angel, it will likely make her at least an archangel (advocate) when it comes to funding.
  3. Court local angel groups. Since angel investors most often focus only in their own geographic area, it’s most effective to court the local group, or even make a guest appearance with an archangel. If you can earn an archangel’s confidence, he or she will invite you to pitch the group, and you’ll have an edge in the voting.
  4. Mine national databases. If you are still alone, submit your application to the leading online website national databases of angel investors, Gust (USA) and National Angel Capital Association (Canada). These sites have arrangements with hundreds of local groups and individual investors that you might otherwise have missed. You might also check angel funds that target bioscience or digital health ideas or raise money from doctors for doctors.

Gust (formerly AngelSoft). This is perhaps the most widely-used source of information on angel investor groups across the world, run by the “Father of Angel Investing in New York,” David Rose. This software platform is used by many local angel organizations for managing deal flow.

Gust claims to have facilitated over $1 billion of investments in 500,000 startups to date, via connection through their platform to over 70,000 angel investors in 190 countries. As an entrepreneur, you simply use their investor search engine to find appropriate investors for your business according to location, industry interest, and other relevant criteria.

AngelListThis is another very popular website for raising equity or debt investments for startups. It was founded back in 2010 by Naval Ravikant and Babak Nivi of Venture Hacks, which is also a great place to visit for startup advice.

AngelList has featured over 3 million businesses for potential investors in a format that is, effectively, a social network for entrepreneurs and angels. They claim to have already raised over $560 million for 1400 startups, primarily in the US and Europe. In addition, they serve as a jobs available site for 24,000 startups.

Keiretsu Forum. This one claims to be the world’s largest single angel investor network, with 2500 accredited investor members throughout 52 chapters on 3 continents. Since its founding in 2000, its members have invested over $800 million dollars in over 800 companies in technology, consumer products, healthcare/life sciences, real estate and other segments with high growth potential.

The Founding Chapter is in Silicon Valley, California, (naturally). A caveat is that this is a for-profit organization, so fees to present may be significant.

USA Angel Investment Network. This group claims to be the largest angel investment community in the world. They have already raised $300 million for startups in the US and across the world. A caveat is that this network doesn’t offer a personal touch, as it only facilitates the exchange of contact information, so the matchmaking is left up to you.

The reach is very broad, with a network has 30 branches extending to 80 different countries. They have over 785,000 registered members with 140,000 investors and 650,000 entrepreneurs.

Angel Capital Association (ACA). The ACA is the angel industry alliance, which now includes a directory to more than 240 angel groups and 13,000 individual angels across North America. ACA member angel groups represent more than 10,000 accredited investors and are funding approximately 800 new companies each year, and managing an ongoing portfolio of more than 5,000 companies throughout North America. Here are some facts about angels:

  • Angels are still predominantly men, but the number of women angels has been increasing – 22 percent of angels are women and 30 percent of new angels are women;
  • Angels are based everywhere, not just in the Silicon Valley, Boston and New York;
  • Most angels are experienced entrepreneurs;
  • Median investment size is $25,000; and
  • A typical angel has a portfolio of 11 companies, with large variation depending on how long the angel has been investing.
  1. Remember angels beget angels. That means that once you get the first one, he or she becomes your best advocate for finding more. Investment angels don’t like to travel alone, so they will bring in others if they can (it’s called share the risk).
  2. Don’t forget passive angels. These are angel investors who are private, meaning they don’t go to meetings, but will invest if someone they trust brings them an attractive opportunity. Find the right investment advisor, or member of your advisory board, and the “match-making” will happen.

Apply for an SBIR/STTR grant for non-equity diluting funding. If you are successful, then apply for matching grants if they are offered in your state.

Apply to be part of an iCorps team.

Be sure you have a financial model is credible

Finding seed funding for your idea is as much about when and if as where and how. It takes planning, preparation and practice and having realistic expectations about how few companies actually are funded by VCs, angels and crowd funding platforms. Be sure you have done your homework, crafted, and validated your business model canvas and done some experiments before giving up control to investors. Good luck with your venture.

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Technician, manager, leader or entrepreneur?

GUEST POST from Arlen Meyers

Michael Gerber , in his book The E-myth Physician, says that doctors can assume three basic roles: technicians, managers or entrepreneurs.

A 2013 AMA report notes that 53.2 percent of all physicians surveyed were self-employed, and 60 percent of physicians worked in practices wholly owned by physicians. Less than half of practicing physicians own their own practice, according to 2016 data collected in a nationally representative survey of 3,500 U.S.-based physicians who provide at least 20 hours of patient care per week and are not employed by the federal government.

2016 marks the first year in which physician practice ownership is no longer the majority arrangement. According to data drawn from the AMA’s Physician Practice Benchmark Surveys, 47.1 percent of physicians are practice owners. The same percentage of physicians are employed, while 5.9 percent are independent contractors.

More and more doctors are becoming employees of hospital systems. Most of the latter will be technicians. Most of the former, independent physicians, will have to move up the value chain, being entrepreneurs, to thrive,let alone survive.

Technicians are doers who play by the rules and are concerned with generating revenue by doing things to solve problems. Given the evolution of medical cyberintelligence, knowledge technicians are a dying breed.

Managers are resource optimizers who make the rules and are concerned with maximizing efficiency. They do things right.

Leaders provide vision, direction and inspiration. They do the right thing and are guided by personal values and exhibit emotional intelligence to succeed.

Leaderpreneurs lead innovators, not manage innovation systems.

Entrepreneurs innovate, making the old rules obsolete by creating new business models and are concerned with building equity. They create user defined value through the deployment of innovation using a VAST business model.

Any of the above five can be leaders, but their focus and objectives are different and require different skill sets and aptitudes. Unfortunately, since few physicians have an entrepreneurial mindset, let alone a leaderpreneurial mindset, those dwindling numbers who elect to go into private practice without an entrepreneurial mindset will continue to struggle and have a hard time adapting to a rapidly changing and challenging healthcare environment. Innovation starts with mindset.

The entrepreneurial mindset is different from the clinical mindset.

Knowledge technicians are an endangered species and must evolve from domain expertise to credibility to leading execution, engagement and alignment to strategic thinking, leading organizations that have organizational ambidexterity i.e. simultaneously creating the now, the next and new.

Thoughts drive emotions and emotions drive behavior. It is the basis of cognitive behavioral therapy. The key to survival in today’s private practice is not in squeezing another nickel out of your overhead. It’s adopting an entrepreneurial mindset. Most likely you won’t learn that in your formal training.

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What it Takes to be a Biomedical or Clinical Entrepreneur

GUEST POST from Arlen Meyers

Biomedical or clinical entrepreneurs are not just doctors, scientists and engineers who create businesses.

Instead, they are those who pursue opportunity with scarce resources under conditions of uncertainty with the goal of creating user defined value through the deployment of biomedical or clinical innovation. As such they can assume many roles in the value creation pipeline such as technopreneurs, intrapreneurs (employees acting like entrepreneurs) ,social entrepreneurs, investors or small-medium size business owners.

Almost every health professional, scientist and engineer has a good idea. Unfortunately, that is all it will be because they don’t know what to do with their idea and the are unlikely to learn how during their formal training. Here are some tips on what to do next.

Here are some thoughts about who they are and what it takes.

Some key attributes are :

1. Mindset Innovation starts with the right mindset.

2. Talent

3. Opportunity

4. Luck

5. Knowledge, skills and attitudes. Unfortunately, doctors get duped into thinking that getting an MBA gives them the right to call themselves physician entrepreneurs. More often, they are trained to be managers.

6. Networks and becoming part of the expanding network universe

7. Mentors and sponsors and knowing the difference and how to find them

8. Resources

9. Experience. Here are some tips on how to get started as a physician entrepreneur.

10. Emotional internal motivation

11. Social and emotional support networks

12. A sandbox where they can play and experiment

13. Humility

14. Coning down off the mountain. What got you to where you are now won’t get you to where you want to go.

15. Finding your blind spots.

16. Making it personal but not taking it personally.

17. A personal brand

18. At first, be a problem seeker not a problem solver

19. Entrepreneurial habits

20. Strategic thinking

Learning this “hidden curriculum” should start in elementary school and continue as part of lifelong learning.

Very few medical schools or resident training programs, if any, teach medical students or residents the business of science and medicine and that is a big mistake, since learning how to create user defined value is as important and difficult as practicing state of the art medicine. The curriculum is the traditional one, guided by learning objectives and the secret one, including network development, people skills and learning how to play the game, which, in my opinion, is a bigger determinant of success than the grades on your transcript.

Unfortunately, few doctors, scientists or engineers have the package. But, those that do are creating great things for patients, themselves, their regional economies and US global competitiveness.

 
Image credit: So Tyred

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Why Your Organizational Innovation Initiative Will Fail

GUEST POST from Arlen Meyers

There are many reasons why your startup will fail, but the main ones are 1) you create a product or service no one wants to buy, and 2) you do not have a profitable and VAST business model.

Likewise, there are many reasons why your corporate or organizational innovation initiative will fail. Most of the time it’s due to a mismatch between the innovator’s entrepreneurial mindset and the organization’s innovation culture.

Some have described the Innovator’s DNA.  Others note characteristics of the entrepreneurial mindset:

  1. Personal growth relates to the size of the challenge, not the size of the kingdom. What motivates real innovators is the more exciting challenge, not the number of people reporting to them. The ‘size of the difference’ they will make is more inspiring than the ‘size of the business.’ They relish getting out of their comfort zone, and into the unknown.
  2. The new direction is the challenge, not the destination. The challenge is the transformation vehicle for true innovators, and not a performance goal. They focus on legacy creation, not legacy protection. They ignore failures and are constantly looking at the progress made. They treat innovations reviews like performance reviews.
  3. Be an attacker of forces holding people back, not a defender. Real innovators start by questioning the world order rather than conforming to it. They begin by confronting the forces holding everyone back, rather than living with it. The forces include mindset gravity, organization gravity, industry gravity, country gravity, and cultural gravity.
  4. New insights come from a quest for questions, not a quest for answers. This discovery mindset searching for new questions drives real innovators away from more of the same. They fundamentally become value seekers; they look for value in every experience, in every conversation. They don’t seek prescriptions, they seek possibilities.
  5. Stakeholders must be connected into the new reality, not convinced. True innovators tip stakeholders into adopting and even co-owning the orbit-shifting idea. They go about tipping the heart first, assuming the mind will follow. They seek smart people, who openly express their doubts, and then collaborate to overcome them.
  6. Work from the challenge backward, rather than capability forward. Overcoming execution obstacles is combating dilution, not compromising, for these innovators. Their mindset is not ‘if-then’ but ‘how and how else?’ They convert problems to opportunities, and often the original idea grows far bigger than the starting promise
  7. Getting rid of your victim mentality.
  8. Having the discipline to practice the discipline
  9. You relish the role of leading the charge. Being a visionary or an idea person is not enough; you have to be anxious to jump in and get your hands dirty. Most success stories in business are not about envisioning the next big thing, but about making that change happen. Investors and strategic partners look for entrepreneurs who can execute.
  10. Able to balance right-brain and left-brain activities. Most technical entrepreneurs are left-brain logical thinkers, even perfectionists. Yet every business today needs a focus on visualization, creativity, relationships, and collaboration, which are normally in the domain of right-brainers. Successful and happy entrepreneurs have that rare whole-brain focus.
  11. Enjoy being outside your comfort zone. New businesses are an adventure into the unknown. You need to be mentally prepared to enjoy the roller coaster ride, rather than face it holding your breath with your teeth gritted at every turn. Only then can you enjoy the thrill of victory when you survive a major turn, and be energized for the next one.
  12. Proactively seek input, but make your own decisions. Great entrepreneurs seek out critical customers and industry experts, and actively listen, but are not afraid to trust their own judgment as well. Ultimately they accept the responsibility of “the buck stops here,” meaning they live by their own decisions, and never make excuses.
  13. Willing and able to do a little bit of everything. Technology experts tend to have a very deep level of knowledge, but not very wide. If your real interests are not very broad, then building a business will likely be frustrating and expensive. Startups have limited resources, so the founders have to enjoy trying things, and learning from their mistakes.
  14. Viewed by others as a successful problem solver. The best ideas for a new business are solutions to a real customer problem, rather than great ideas looking for a market. Creating a new business means tackling one difficult problem after another, until success suddenly appears. Entrepreneurs see problems as milestones to success, not barriers.
  15. Don’t demand or expect immediate gratification. Seth Godin once said “The average overnight success in business takes six years,” and he is an optimist. For some entrepreneurs that success is financial, and for others it is a legacy of good deeds. Because it takes so long to get there, it is important to be happy with the journey.

Creating a culture of innovation must include SALT and PRICES

Strategy

Alignment

Leadership

Teams

 

Process

Recognition

Incentives

Champions

Encouragement

Structure

When these two are in synch, like two hands shaking, great things happen. When they are not, things get ugly and, in some instances, people lose their jobs. Or, at least they should and be replaced with effective leaderpreneurs.

 
Image credit: So Tyred

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Doctors as trusted advisors

GUEST POST from Arlen Meyers

Doctors do three basic things. In their role as healers, they make decisions, they do procedures and they communicate with patients as a source of information and guidance.

The 4th industrial revolution and the digitization of sickcare, powered by the technologies and forces of global cyberintelligence and the emerging cyber nervous system has radically altered how doctors do their jobs.

Clinical decision support systems (CDSS) powered by artificial intelligence and other data science techniques significantly improves outcomes in several specialty areas. Studies of CDSS indicate improvement in preventive services, appropriate care, and clinical and cost outcomes with strong evidence for CDSS effectiveness in process measures. Increasing provider adherence to CDSS recommendations is essential in improving CDSS effectiveness, and factors that influence adherence are currently under study.

Robotics, AI, virtual reality, augmented reality and smart ORs are transforming the operative experience for both surgical teams and patients.

Even communicating medical information, expressing empathy and guiding patients towards the right decision for them and their family members has become digitized towards more high tech and less high touch.

That said, forces are creating a counter movement of patient customers craving trusted intermediaries.

  1. Clinical care is increasing in complexity making it more difficult to sort out the details
  2. The pace of change is happening faster than the ability of people to cope with it causing change fatigue and diseases of despair
  3. Social media has contributed to the death of expertise
  4. Clinical care has evolved from one on one to a team collaborative effort whereby medical care teams work with patient and family support teams and communities
  5. Sick care is migrating gradually to health care and disease prevention
  6. Both patients and doctors are struggling to become data literate to understand the meaning and and avoid the pitfalls of what comes from the internet of medical things
  7. Customers are fed up with the lack of personalized service and terrible user and purchasing experiences while, the same time, having to do more the work to create more profit for the seller.
  8. While personalized/precision medicine is the latest techno-rage, the corporatization and consolidation of BIG MEDICINE leads to more impersonalization of small care
  9. The invisible hand is a cruel one, creating significant inequalities in outcomes and health opportunities, leaving many stranded and reaching for a hand up, even when they are too young or small to do so.
  10. Social isolation, behavorial disorders, frustration, violence and burn out are pervasive

Despite being able to buy or research almost any service or product on the internet, people still use wealth managers, plan trips using travel agents and hire service professionals. Some even still trust regular taxi drivers and doctors to safely transport them on their care journey.

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Patient digital health entrepreneurs

GUEST POST from Arlen Meyers

Health entrepreneurship is the pursuit of opportunity using scarce resources under conditions of uncertainty. The goal is to create user defined value through the deployment of health innovation using a VAST business model. Those who embrace the entrepreneurial mindset and practice entrepreneurial habits hold the keys to the kingdom when it comes to improved sick care and health outcomes. In fact, it is unlikely that any independent practitioner or group can survive, let alone thrive,without moving to an entrepreneurial role from a being a knowledge technician. That does not mean you have to start a company. It means that everything you do has to create user defined value. No move should be wasted.

The space between the data and the doctor is being filled quickly with navigators, advocates and “infomediaries”. As responsibility for health outcomes increasingly shifts from doctors to patients, they become, in a sense, patient entrepreneurs, in possession of an asset-their data- creating value (better disease management and prevention) through the deployment and adoption of innovation. The result will be more DIY medicine and all that goes with it.

Think of APIs as tunnels into the clinical data warehouses that have been created by EHRs. Think of third parties as new and existing IT powerhouses — including the likes of Apple, Amazon, and Google — that have been authorized by patients to act as data stewards on their behalf.

We are not only democratizing care. We are democratizing and decentralizing value creation and funding. We are creating prosumers and accidental entrepreneurs.

What the result will be is anybody’s guess, but what is clear is that the rules, ecosystems, business models and technologies are inevitably facilitating more patient involvement, engagement and responsibility.

Amedzon has recently announced a service that will allow AI based algorithms to be applied to EMR data. Would you charge someone a fee to do that and place restrictions on its use if you owned your data?

Silicon Valley startup Open Health Network, which develops AI-based applications for healthcare organizations like UCSF, Sanofi and Cornell University has launched a new product meant to use blockchain technology to allow patients to manage and monetize their medical data. If successful patients will be able to sell their assets on the PDX. a NASDAQ for patient data.

The Institute of Medicine (IOM) has proposed a streamlined set of 15 core measures that they say represent the most vital signs for tracking progress toward improved health and healthcare in the United States.

They are:

  • Life expectancy
  • Well-being
  • Overweight and obesity
  • Addictive behavior
  • Unintended pregnancy
  • Healthy communities
  • Preventive services
  • Care access
  • Patient safety
  • Evidence-based care
  • Care match with patient goals
  • Personal spending burden
  • Population spending burden
  • Individual engagement
  • Community engagement

Like all entrepreneurs, to succeed in sick care entrepreneurship, patients will need education, resources (low interest loans or seed stage funding), networks (connected to sick care professionals to inform their thinking and design), mentors, experience and peer to peer support. While is it nice to see more and more health professionals and educators embracing biomedical innovation and entrepreneurship, most patients are still standing on the sidelines or recovering in the ICU. However, things are changing and we need to remove the barriers to patient entrepreneurship so they can, like health professionals, get their ideas to other patients.

Apple has changed the game with HealthKit expanding how we do human genotyping and how we do clinical trials. My Retina Tracker, an online registry for patients with retina diseases to store their medial records and provide anonymous data to researchers.

The monetary value of information about a single person’s online and offline activity may reach $10 a month by 2025 in the U.S. For further insights, read “Tomorrow’s Data Heroes.”

Is it unlikely that we will be able to move the needle on most of these without the involvement of patient entrepreneurs , patient scientists and doctors assuming more of their traditional role as teachers, not just healers. Remember, docere is the Latin word for teacher and don’t forget those pediatric patient entrepreneurs.

 

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Why Your Startup Will Fail

GUEST POST from Arlen Meyers

The vast majority of startups will fail and the numbers are even higher in biomedicine due to the numerous risks involved in getting a product or service to patients in a highly regulated industry that involves human subject and clinical trials. Add to that the many barriers to adoption, dissemination, diffusion and implementation and why clinical trial results don’t translate into clinical use, and you can see why things are so risky.

However, Peter Drucker, in his book Innovation and Entrepreneurship (1985) pointed out several common reasons:

  1. MARKET-PRODUCT FIT: lack of market focus, the wrong product market fit, poor missing a customer segment
  2. MONEY: poor cash flow management not having an adequate plan or a non-viable business model to generate the necessary capital for growth
  3. MANAGEMENT TALENT: not having the right people and advisors doing what they do best and who are willing to tell truth to authority
  4. MATURITY: A founding entrepreneur who know his or her place in the scaling company and is willing to step away or down from the primary leadership role

I would add:

5. MODEL: the lack of a VAST business model.

6. MARKETING: Not doing what it takes to find the innovators and early majority and crossing the chasm

7. MANPOWER: not scaling the enterprise with the right people on the bus sitting in the right seats who can work in high performance teams

8. MONITORING: Missing a major market, demographic or technological shift

9. MINDSET: Not having an entrepreneurial mindset

10. MISSING YOUR BLIND SPOTS: Not making yourself disappear fast enough

The root causes are 1) you offer a product or service no one wants to pay for, and 2) you don’t have a VAST business model. Examples in sick care include digital health, medical marijuana, medtech, biopharma and care delivery products.

All of these wounds are self inflicted and can be prevented by proper planning and money and people management when you start your company. It starts with understanding your customer, creating a product that solves their problem, and executing a business model that is reproducible and scalable and that adjusts to changing market conditions.

If you begin with the end in mind i.e. a grown up and anticipate the stages of scale up and startup working backwards, you should be able to envision what you will need to succeed from the beginning.

 

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Drivers of medical student non-clinical careers

GUEST POST from Arlen Meyers

For the past few years, the media has been highlighting what many of us have been seeing-medical students and residents are dropping out of clinical medicine to pursue non-clinical careers. To many, particularly the medical education establishment, this is disturbing. To others, it is exciting. To most with craniorectal inversion syndrome, it is a passing fad that is but a small blip on the screen that can be ignored.

The drivers of the phenomenon are many:

  1. Student debt burden and the long education and training requirements
  2. A toxic education culture
  3. Decreasing attractiveness of practicing clinical medicine
  4. Decreasing compensation given the long work hour requirements
  5. High burnout rates
  6. More and more alternative non-clinical career opportunities that enable doctors to leverage their talents
  7. Lack of faculty support and flexibility in medical school education programs for students interested in physician entrepreneurship and non-clinical careers
  8. The rise of digital health and sick care startups
  9. The demand for physician input early in the all phases of new product development
  10. Constantly evolving new jobs in industry
  11. The rise of the clinical medical management establishment creating physician administrators

12. Care delivery substitutes, such as nurse practitioners and physician assistants and new business models that are increasingly disintermediating doctors

13. Generational attitudes about work, work-life balance and meaning.

The solutions, I believe, are basically two-fold- 1)re-engineer clinical medicine to make it more attractive to practice, and 2) offer non-clinical career tracks to those who want to add value through the deployment of innovation in ways other than seeing patients face to face for their entire professional career.

Here are the principles that should guide medical education reform. We need MD/MBEs not more MD/MBAs and more entrepreneurial medical schools.

The shift is already happening. Medical schools, unfortunately, have been slow to respond. Technology, the 4th industrial revolution and demographics are driving change. In the end, money, technology and talent go where they are treated best.

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PROMIS v RPM

GUEST POST from Arlen Meyers

Remote patient monitoring (RPM) is a technology to enable monitoring of patients outside of conventional clinical settings (e.g. in the home), which may increase access to care and decrease healthcare delivery costs. Examples include sensors in patients, sensors in or on things (internet of things) or remote measuring devices using telecommunications technologies like smart bathroom scales to measure the weight of patients with congestive heart failure.

PROMIS, on the other hand , refers to patient reported outcomes measurement information systems and typically requires patients to manually input data on a desktop or mobile device. (ePRO).

One complements the other. In general, PRMs measure signs or response to treatment, physiological parameters (heart rate) or analytes (blood glucose), while PROMIS measures symptoms or symptom scores like pain, anxiety, or difficulty breathing. Increasingly, we are seeing technologies that disintermediate the patient reporting requirement and , instead, automatically measure and report data to central repositories or electronic medical records.

But, all this data, data everywhere creates big challenges requiring big solutions.

That said, as part of the 4th industrial revolution, we will see increasing development of tools that integrate and make sense out of materials (graphene and nanomaterials), machines (3-D printers, robots), medicine and computer memory, speed, storage and intelligence.

For example, suppose you are a patient with some form of inflammatory bowel disease, like Crohn’s disease or ulcerative colitis, and you are taking a very expensive drug to treat it. How do you and your doctor know that it is still working? You will swallow a remote patient monitor to measure bowel structure and function and you will use your iPhone to report symptoms that will determine whether you should continue to take the medicine or change to something else.

In coming years, patient-reported measures are expected to play a more prominent role in assessing performance and determining the comparative effectiveness of different treatments, in part because of a growing emphasis on patient-centered care and value-based payment approaches.

Now, Amedzon wants you to use Alexa to track your health.

The anatomy and physiology of remote sensing creates big possibilities to intervene and innovate at multiple points of the system with applications in basic, applied and translational research, development, commercialization, dissemination and implementation. Balancing high tech with high touch while improving doctor and patient engagement to improve quality while reducing costs is the PROMIS.

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AI in surgery: potential and problems

GUEST POST from Arlen Meyers

Artificial intelligence, like most industries, is diffusing in sick care. Applications in surgery are emerging and can generally be categorized as :

  1. Surgical training and education
  2. Preoperative assessment and diagnosis and clinical decision support
  3. Intraoperative surgical performance and quality improvement
  4. Smart OR’s and environment
  5. Postoperative care and complication risk assessment and predication
  6. Workflow improvement, like OR start time and turnover efficiencies
  7. Surgical robotics
  8. VR and AR and 3-D printing
  9. Telerobotic and teleproctored surgery
  10. Human subject trial recruitment and execution

Many of these applications are in the research or demonstration phase and will take a while to become the standard of care or achieve widespread dissemination and implementation.

Biomedical AIntrepreneurhship describes the practice of creating AI products and services to solve bioscience (drugs and devices) and clinical problems. As such, it is the pursuit of opportunity under conditions of uncertainty using scarce resources with the goal of creating user defined value through the design, development and deployment of biomedical innovations that use a predominantly AI backbone, platform or foundation that have a VAST business model. It is a subsegment of digital health products and services.

The use of AI in medicine is evolving rapidly. Here are some updates:

  1. Educational platforms, meetings, conferences and magazines
  2. Robust investment into development and M/A
  3. Coherent applications combining AI, medtech and biopharma
  4. Increasing concerns and attention to the ethical, societal, education, manpower development and economic impact of AI in medicine
  5. How AI is contributing to the 4th industrial revolution
  6. The intersection of AI and robotics
  7. The intersection of AI and blockchain
  8. The impact and perils of decentralized, DIY medicine
  9. Cybersecurity and confidentiality concerns. If you are not worried yet, read this too.
  10. Concerns and strategies to make transparent algorithms and mitigate AI bias and “eliminate black box bias”.
  11. Stories and organizations about physician AIntrepreneurs.
  12. Regulatory, legal and reimbursement challenges

13. Convergence of AI into medical device and biopharma Current emerging applications appear to fall into three main categories:

14. Smart speakers in the OR and examining rooms

Management of chronic diseases – Companies are using machine learning to monitor patients using sensors and to automate the delivery of treatment using connected mobile apps (Example: Diabetes and automated insulin delivery).

Medical imaging – Companies are integrating AI-driven platforms in medical scanning devices to improve image clarity and clinical outcomes by reducing exposure to radiation (Example: GE Healthcare CT scans for liver and kidney lesions).

AI and Internet of Things (IoT) – Companies are integrating AI and IoT to better monitor patient adherence to treatment protocols and to improve clinical outcomes (Example: Philips Healthcare solution for continuous monitoring of patients in critical condition).

As artificial intelligence projects roll out, organizations will need to rethink the definition of the “work” that people will do. The future of work will become one of the largest agenda items for policy makers, corporate executives and social economists, says Sanjay Srivastava, chief digital officer at Genpact, a professional services firm focusing on digital transformation. Here is how doctors and patients can win the 4th industrial revolution.

What is the secret sauce of successful innovators like AIntrepreneurs? They strive to innovate in ways that would have a major impact on markets and society, e.g changing sick care to health care or making the sick care workforce more efficient and effective, and they revamped how their organizations pursued innovation and brought their capabilities together in a single “architecture.” That will mean medtech transforming to techmed will require changing how to collaborate with doctors and patients.

Will AI put society on autopilot? Will surgeons lose their skills in the age of automation?Where is the evidence that robotic surgery adds value and when?

Here are some of the barriers we will need to overcome.

Why is the gap between companies’ AI ambition and their actual adoption so large? The answer is not primarily technical. It is organizational and cultural. A massive skills and language gap has emerged between key organizational decision makers and their “AI teams.” It is a barrier that promises to stall, delay, or sink algorithmic innovations. And it is growing, not shrinking. The problem is that healthcare professionals are from Venus and technologists are from Mars. They have different mindsets and how they communicate.

Here are emerging data security and risk management trends.

Those products and services that add value, particularly those that drive down costs and do not interfere with workflow, have a higher chance of success. Those that don’t will be relegated to the shiny new object pile and red bagged for disposal.

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