GUEST POST from Arlen Meyers

These days, you can’t be a hipster without being a -preneur. They come in all sizes and shapes. Ganjapreneurs sell pot or pot derivatives. Technopreneurs do online anything. And then there are the doctorpreneurs, physician entrepreneurs or medpreneurs.

The list gets even more confusing since there are so many different kinds and definitions. Here is a brief lexicon to help understand the different kinds of physician entrepreneurs:

1. Innerpreneurs: Doctors who have the DNA to be great entrepreneurs, but either don’t realize it or have had the creativity beat out of them during their medical training. Some have bought into the myth that doctors make lousy business people. Here are 10 reasons why.

2. Entrepreneurs: Those who pursue opportunity with scarce resources under conditions of uncertainty with the goal of creating user defined value through the deployment of innovation. They are frequently misunderstood.

3. Intrapreneurs: Employed physicians trying to act like entrepreneurs. They require a special set of survival skills, like political savvy and pursuing opportunities that are not traditional and that require unlearning.

4. Wannapreneurs: Physicians who want to be part of the upside but don’t want to contribute. Their mantra is “Here’s my idea. Just send me the checks”. Here are 10 ways to spot them.

5. Philanthropreneurs: Physicians trying to improve the human condition with active investments, not donations

6. Psychopreneurs: Entrepreneurs with entrepreneurial psychopathology, Here is how to speak to a narcissistic physician entrepreneur.

7. Leaderpreneurs: They lead innovators, not manage innovation systems

8. Ganjapreneurs: Cannabusiness tycoons

9. Medical student Antsypreneurs: Medical student graduates who forgo taking a residency to go to work for or create their own startup

10. APEs: Academic physician entrepreneurs

11. Edupreneurs: Entrepreneurs changing medical school and residency education

12. Non-sick care technopreneurs: Usually someone who is a service provider, technologist or investor, without a previous biomedical background. Here are common reasons why these kinds of entrepreneurs fail.

The nice thing is that if you are tired of making all that money, you can be a Zenpreneur.

Trumpreneurs are another type,but we will have to wait and see how long it stays in the dictionary.

Are they born, made or self made?

Here’s what it takes to be a successful physician entrepreneur. There are many choices so be happy and choose wisely. All you have to do is look it up.

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GUEST POST from Arlen Meyers

Most of us are familiar with the story and moral of the Emperor’s New Clothes. People reference it to express when many people believe something that is not true. It is also mentioned to express something as untrue. These days, it has taken on particulary new meanings and, it seems, appear in the headlines daily. For many reasons, sometimes personal, sometimes political and practical, it results in people not telling truth to authority or failing to challenge the conventional wisdom as fake news.

There are many examples of how the emperor or the emperess has no clothes, the most recent being Therantology and the tale of Elizabeth Holmes. Employees and stakeholders of startups and non-profits can fall victim to the syndrome, which, given the rise of founder power and companies staying private longer, is spreading.

Some signs and symptoms of Founder’s Syndrome are:

• The organization is largely associated with one key person
• Strategy and planning are limited, infrastructure is weak or undefined
• Decisions are made reactively, often in a vacuum, and with a lack of collaboration and buy-in
• Few systems and processes are in place or implemented, problems tend to repeat
• Lack of communication
• Irregular staff meetings that focus on tasks assignments, crisis management, and troop-rallying
• Motivation is primarily through fear and guilt; employees may be afraid of the founder
• Excessive micromanagement and squashing of new ideas
• Capable employees feel unable to effectively contribute
• Leader is unwilling to ask for or accept help, and there is no succession plan
• Support people (advisors, staff, Board members, etc.) are chosen primarily based on their loyalty to the leader instead of for their skills, knowledge, and experience
• Organizational focus is more on serving the leader than the mission

In the startup world, it shows when:

• A founder intent on keeping total control of decision making and intellectual property rights for their technology.
• Already “has all of the answers”. They are reluctant to take input from others, even top experts.
• Often fail to share information about the inner details of their projects.
• They often have a deep seated (and mostly unconscious) psychological need to be the center of the operation, and to be recognized.
• Often tacitly believe that the value and elegance of the invention makes its widespread adoption inevitable, and that it will change the world.
• Don’t believe they need partners or help if it involves giving up any measure of control.

Treatment largely rests with eliminating enablement and having the courage to expose the truth and fix what’s wrong:

• Speak up. Be firm and direct, but not mean or vindictive. Use concrete examples to illustrate Founder’s Syndrome symptoms and point out ongoing issues that are holding the organization back.
• Offer support. Most founders have played an integral role in organizational success and achieved some pretty great things. Acknowledge them for that. But also recognize that they may need professional mentorship to help pinpoint problems and transition to a new leadership model. They might also need reassurance that it’s okay to ask for help.
• Ask for help. Just as no one person should have too much power in an organization, no one person should be expected to solve tough organizational problems. Seek outside experts as needed. Involve all key leaders and managers in the change process. Consider conducting staff and customer surveys to gather additional observations and feedback from all levels.
• Get back to your mission. Remember why the company started. Revisit or redefine core company values and how they relate to the work. Remind everyone that achieving the vision is more important than any one person, but that everyone in the organization is critical to making it happen.
• Motivate through collaboration and collective buy-in. It’s time to get the entire team back on track and working toward the same goals. It’s also time to start taking advantage of your talented staff. Ask for ideas and get good at not immediately swatting them down.
• Go from reactive to proactive. Once you’ve focused back in on the mission, it’s time to set goals, build infrastructure, and put processes in place, then start planning for the future. Strategic planning. Workforce planning. Succession planning. Sales processes. Customer service processes. Project management. Having these systems in place will create a model that is more sustainable and predictable— and way less stressful.
• Monitor your progress. Determine your success indicators and monitor them religiously.
• Embrace your new culture. If you’ve done things right, you just might feel like you’re working in a whole new company. In a very good way. Take those positive changes and make them part of your organizational DNA.
• Don’t commit career suicide. A head on assault on the founder is dangerous to your career health unless you have a strong enough relationship based on trust.
• Build a coalition and take action to be good rebels. Google employees recently walked out to protest the company’s handling of sexual harrassment and their “unethical and thoughtless decision making”
• Learn how to practice intrapreneurship. A core skill is perfecting office politics.

Innovation takes courage, not just from the leaderpreneur, but from the followers as well. Founder’s syndrome, like fatigue, can make cowards of us all. But, when your white coat gets the pink slip when the company runs out of money or is exposed for fraud and deception, remember that, like bullying, there are no innocent bystanders and you might be one of them.

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GUEST POST from Arlen Meyers

There are large variations in US sickcare. Surgery rates for a given condition vary depending on where you live and the costs are all over the map too. When it comes to outcomes, the numbers are hard to come by for any given doctor, so who knows? But, with advances in data acquistion and analytics, treatment metrics will, at least theoretically, regress towards the mean and medical quality will become become less variable and more and more commoditized. That’s good news for patients but an increasing challenge for physicians and surgeons.

For many low acuity and preventive services, like immunizations or prescribing drugs for easily diagnosed or common conditions, alternative care delivery channels like retail based clinics and other non-traditional points of care have accelerated commoditized care.

There are several main drivers of Commoditycare:

1. The internationalization of care. People, money, doctors, and technologies, be they drugs, devices, digital health products, or innovative business processes, are seamlessly moving around the world, facilitated by cheap, inexpensive information and communications technologies and cheap transportation.

2. Global innovation. Entrepreneurs are creating products and services in the smallest places to the biggest clusters, driven by community-based innovation networks. The results are commoditized healthcare products.

3. Transparency. Data creates value and making that data transparent drives commoditization and revenues to the winners. Package pricing, EMR information sharing, and outcomes repositories are 3 examples of how international patients and payers can find those who are separating themselves from the crowd.

4. Consumerization. The power has shifted from the caregivers to the patients. Shared decision-making, particularly for preference-sensitive conditions, has replaced the paternalistic, doctor-driven care model.

5. DIY (Do-It-Yourself) medicine. Patients now have access to information, products, and services affording them the ability to diagnose and treat themselves. Examples include more and more over the counter medicine, online and home based diagnostic tests, and digital health products that have disintermediated care providers and replaced high-priced, difficult-to-access products with cheap, easy-to-use ones.

6. Standardization of care and outcomes driven by value. Variations in care inputs that result in little or no difference in outputs results in waste, complications, side effects, and cost. Evidence-based protocols and care models are increasingly addressing those variations in an effort to minimize unacceptable deviations from the norm.

7. Cheap startup costs. It has never been easier or cheaper to start a company, particularly in digital health. As a result, we are seeing a plethora of startup companies plying their wares to an international market of patients seeking access to high quality care at an affordable price.

8. The death of loyalty. Patients are becoming increasingly satisfied with “good enough” when it comes to quality and are willing to sacrifice loyalty to a doctor or product to get it. They are placing increasing importance on non-quality value factors like access, speed, experience, service, and price.

9. Competition. Hospitals are turning into systems and consolidating to take advantage of economies of scale and the reduced cost of streamlined back end business processes. Care channel substitutes, like retail-based clinics, are creating the “retailization” of healthcare, further threatening the office-based primary care model. Telemedicine platforms can deliver iCare at the push of a button or the click of a mouse.

10. The failure of companies and doctors to innovate. Few doctors or hospitals have an entrepreneurial mindset. Instead of innovating, they tinker. Oren Hariri, in his book, Break from the Pack, cited 10 reasons why companies create mediocre, me-too, commoditized products. They have a compulsion to cut costs, to cut prices, to make incremental improvements, to increase sales and marketing budgets, to grow from quarter to quarter, to control growth, to rely on unreliable market research and focus groups, to join the crowd and embrace fads, to protect their businesses with legal and accounting gimmicks, and to give the impression that they are generating progress, not value.

11. The Amedzon effect

12. Resistance to change in sick care and retail pharmacy.

13. Brand maturation Are you still paying $3.00 for a cup of coffee at Starbucks instead of .65 for a senior coffee at McDonalds? Maybe Starbucks should run their stores like your university hospital system. Even then, it’s hard to find a place to charge your phone.

So, what should be your strategy to separate yourself and be the best of the rest?

1. Innovate by creating new delivery channels that meet or exceed the expectations of patients based on the value factors they prioritize like speed, experience,convenience, personalized service and timeliness.

2. Get better at patient/customer/consumer segmentation and focus on those who are willing and able to pay and get access to the value differentiators you offer.

3. Measure everything and promote how you are better. Drive out waste.

4. Focus on service and experience. Eliminate waiting.

5. Migrate from high tech to high touch in every practice touch point, starting with your website, social media or patient communications portals

6. Practice state of the art medicine, avoiding Type 1 and Type 2 technology adoption errors.

7. Practice digical care.

8. Lead innovators, don’t manage innovation in your practice

9. Focus on cash flow and value pricing. Customers are paying for convenience.

10. Retake control and restore the joy to medicine. Happy doctors make happy patients. Smile more.

In the world of commoditycare, the keys to the kingdom belong to the low cost provider. Large, consolidated integrated networks, like the Walmeds or Amedzons of the world, might be able to win at that game, but, I suspect, it is not where most docs want to be. Most patients don’t either.

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GUEST POST from Arlen Meyers

If you had an idea for a medical device, would you know where to go at work to get help commercializing or deploying it in your organization? Most of the time, based on my experience, the answer is no.

Giffford Pinchot, who originated the term “intrapreneur”, has suggested that you rate your organization in several domains to see whether your innovation future looks bright or bleek. The elements of your organization’s innovation readiness include:

1. Transmission of vision and strategic intent
2. Tolerance for risk, failure and mistakes
3. Support for intrapreneurs
4. Managers who support innovation
5. Empowered cross functional teams
6. Decision making by the doers
7. Discretionary time to innovate
8. Attention on the new, not the now
9. Self- selection
10. No early hand offs to managers
11. Internal boundary crossing
12. Strong organizational culture of support
13. Focus on customers
14. Choice of internal suppliers
15. Measurement of innovation
16. Transparency and truth
17. Good treatment of people
18. Ethical and professional
19. Swinging for singles, not home runs
20. Robust external open networks

Given that there are a small number of hidden innovation gems on the medical staff or faculty, engaging them, getting them interested and moving them to action requires a carefully crafted and executed strategy. Whether you work in an academic or non-academic setting, here are some questions you should ask to assess your organization’s innovation IQ.

Is there structure, process and leadership in place to help me commercialize my idea? What are the underlying assumptions and beliefs that drive the result?

Most major research universities have technology transfer managers and processes in place to help faculty move their commercial ideas forward. The initial steps typically involve determining whether the invention or discovery passes certain technical, legal, intellectual property ,and market hurdles. If that’s the case, then technology transfer managers work with faculty or staff to identify potential licensees, like drug or device companies, or, with business development or spinout managers, who work with inventors interested in creating a separate company.

In community hospitals and systems, even large ones with many hospitals, large R/D budgets and hundreds of staff, there is typically no innovation management system or a designated executive to lead it. At best, some of the pieces are outsourced or inventors are referred to members of the hospital network or community with some experience. Usually, though, you’re on your own.

When it comes to innovation, does my organization have a process to move the medical staff from awareness to intention to decision to action?

There are several ways to internally market to staff to make them aware of what innovation is and how to participate in the creative process. Newletters, websites, emails, educational events and other tools help to create awareness and inform the staff about intiatives and opportunities to contribute.

What has your organization done to remove the barriers to participation and create incentives to innovate?

We all can identify things that get in the way. Common ones are , “I don’t have enough time to do this given my clinical and administrative duties” or, “This is not why I became a doctor”. However, without a culture or ecosystem that enables those who are interested, ideas will usually fade into the woodwork or medical staff will leave.

Does your workplace celebrate success and cheer the champions?

Nothing succeeds like success… if people know about it. Awards dinners, articles and press releases and other devices are great ways to highlight the accomplishments of peers and get others excited.

Are there robust internal and external networks?

Information rheology i.e. how information flows within and without the walls of your workplace, is a key determinant of intrapreneurial success. The ability to find a mentor is a good way to measure network strengths.

Is the there a culture that accepts risk and failure?

Some cultures are based on rules, while others take a more flexible approach to reconciling the inevitable conflicts between creativity and control in the face of scarce resources. Do you feel comfortable telling truth to authority?

Where is your innovation horizon focus. Check your calendar for the last week measure how much time you spent on innovation initiative that were driven by the now, the next or the new.

The first type of innovation is necessary (and is almost always underway) because your products and offerings can’t sit still. You must find ways to cut costs, make your delivery more efficient and tinker around the edges of existing products.

The second type of innovation is probably the least understood, because too many companies don’t understand what their competitors are doing, and are often shocked by the offerings of new entrants. Companies need to do a lot more preventative innovation, from a defensive point of view, to ward off new entrants and sustain or grow market share.

Everyone acknowledges the importance of creative innovation – that is, the creation of a completely new offering that radically changes the competitive landscape – but few truly know how to do it or are willing to commit the resources to do it.

The general rule of thumb answer is 70:20:10. Seventy percent of your innovation effort should go into evolution, 20% into preventative and so on.

Here are four kinds of corporate innovators

Healthcare innovation, whether it is process, goods or services, is a combined bottom-up and top-down effort that requires an enabling, user friendly environment. If you think you are working in a place that is not designed for innovation, you can lead, follow or get out of the way. The choice is yours.

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GUEST POST from Arlen Meyers

Life science entrepreneurship is the pursuit of opportunity with scarce, uncontrolled resources with the goal of creating customer/user-defined value through the deployment of biomedical and clinical innovation. Innovation can come in many forms, not just products and services.There are many new exciting business opportunities for innovators to develop and commercialize their new products and services.

However, the life science innovation roadmap is risky, expensive and time consuming. To be successful, bioentrepreneurs whether healthcare professionals, scientists, engineers, investors or service providers,need to work as a team with their organizations to overcomethe multiple hurdles taking their ideas to the market and patients.The process is neither linear nor predictable and outcomes are never guaranteed. In addition, because of global macroeconomic conditions, investors are unwilling to gamble on unproven technologies in a more hostile regulatory and legal environment. Consequently,commercializing bioscience discoveries is becoming more and more difficult. However, innovators still thrive.Where are some of these exciting business opportunities for bioentrepreneurs?

An initial understanding of the changes happening in US healthcare is the first step in identifying potential market opportunities. Here are but a few:

1. Major and continual healthcare policy reforms

2. Migration away from fee for service payment

3. Consumerization, commoditization, internationalization, customization and digitization of care.

4. Changing from a sick care system to a preventive and wellness system

5. Defined benefit to defined contribution health insurance coverage

6. Rightsizing the healthcare workforce

7. Do it yourself medicine (DIY)

8. Mobile and digical (physical and digital) care delivery models

9. The growth of employed physicians

10. Innovation management systems and increasing attention to health entrepreneurship.

11. Increasing demand for high touch care

12. Increasing discontinuity of cares changing quickly. All of these changes present biomedical and healthcare entrepreneurs opportunities to create new products,services, models and platforms. Patients are taking more control of funding and contributing to basic and clinical research using the internet and social media and the Iiternet and social media continues to play a bigger and bigger role in healthcare marketing and delivery.

The drivers of physician international entrepreneurship include:

1. Fear: Doctors are afraid they will suffer the professional, personal and economic consequences if they don’t adapt to change
2. Greed: Physician incomes are threatened by innovation and new business models
3. Necessity: Most doctors in industrialized countries have a relatively high standard of living. They did not bother themselves with innovation or entrepreneurship because they didn’t have to.
4. The innovation imperative: The pace of change has accelerated and markets and employers are demanding more with less
5. Generational demands: Medical students and residents are questioning their career decisions and demanding that schools provide them with the innovation and entrepreneurship education and training knowledge, skills and attitudes they need to thrive after graduation and throughout their careers
6. The shifting doctor-patient relationship: Technology and DIY medicine is disintermediating doctors and fundamentally altering the doctor-patient relationship
7. Resources: The internet, local ecosystems, accelerators and access to early stage capital has made it easier to start a business or develop an idea. People are connecting to the global economy.
8. Portfolio careers: The sick care gig economy is growing and the future of work is changing. Fewer are committing to one lifetime career or job, including clinical medicine
9. Opportunities: With change, comes opportunities and those few doctors with an entrepreneurial mindset are actively pursuing them.The opportunities in health entrepreneurship are sizable and physician entrepreneurs are increasing well positioned to capitalize on them.
10. Culture: The culture of medicine is changing and encouraging creativity and innovation
11. Politics: Access to quality care at an affordable price is in high demand as middle classes grow in developing countries. Not providing it leads to social upheaval and political instability.
12. Budget deficits: The demand for care is almost infinite. However, the supply is limited. Consequently, policy makers and markets are looking for ways to improve outcomes at a lower cost through the deployment of innovation.
13. Youth unemployment: Restless unemployed, educated citizens are demanding jobs and ways to use their talents.
14. Economic development: Innovation and entrepreneurship is fuel that that feeds the engines of economic development in emerging economies. like Africa.
15. Globalization: People, money and technology go where they are treated best, regardless of location.

The entrepreneurial mindset is something that should be cultivated early in childhood, for many reasons.

The future of medical innovation and entrepreneurship is bright and physician entrepreneurs around the world are eager to participate.  So are their children.

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GUEST POST from Arlen Meyers

My parents were traditionalists. I’m a boomer. I work with a lot of Gen-Xers. I teach a lot of millennials. We are all trying to understand each other and adapt to how we teach and learn.

Some teachers have to deal with helicopter parents more than the kids.

Since we are all, mostly, products of our environment and the cyclical events of history, we all look at the world through that lens and, unless you have the right optician, you can have a hard time seeing what’s in front of you. Plus, we all change as we get older so, in many ways, generational stereotyping is stupid.

Here is how I have changed my lens prescription:

1. Make it personal. Link learning to experience.
2. Embrace technologies, but don’t let technologies get in the way of learning. Hey! Stop checking your cell phone while you are reading this. You will learn more if you take notes by hand and it shows respect for the instructor.
3. Prune to fit. Limited attention spans means you have to hit the high points and list them in 2 minutes, like what I’m doing in this post.
4. Practice what you teach. You just can’t fool those folks and they will see through your hierarchical facade. In fact, those that do really do teach and students really like a view of your real world and making connections to working domain experts so they can get jobs.
5. Be social. The org chart these days looks more like a network
6. Demand the same respect for your outlook the same way others demand you value theirs. Play nice together
7. Use immediate access to information to your advantage. Why memorize anything when it’s at the tip of your thumbs on your mobile device? Move from recall to interpretation to problem solving to wicked problems that have no real solutions. Flip the classroom and use the lectures as the start, not the end.
8. Encourage creativity and drive out fear
9. Learn to engage using educational technologies that improve learning like reflective questions, hierarchical learning, role playing, video and gamification and team based learning.
10. Learn to give and receive feedback. Radical candor is the feedback flavor of the month. Glasses are not the only thing you need as you get older. You will also need a better way to hear and listen. It’s a two way street.
11. If you want to learn something, try to teach it. The problem with expertise is that it doesn’t necessarily come paired with an openness to new ideas.
12. Create a space to give students time to think instead of falling into the trap of filling every moment with lessons, practice, trips, sleepovers and homework.
13. Unless a student has a learning disability, make students turn off their cell phones and laptops during class, since research shows you learn and retain more by taking hand written notes
14. Use PPT presentations as little as possible. Class should be a creative exercise, not a funeral after death by Powerpoint
15. Every class should the right mix of informing, entertaining and interacting. The most impactful interventions for student success are someone who cares, experiential learning and , in the case of adults, repetition, repetition, repetition.
16. Find a millennial to be your mentor, particularly to keep you in touch with trends and technology
17. One thing you can count on is that regardless of age, everyone wants to be valued. If the way you are managing the older or younger members of your team is overtly or subliminally signaling that you don’t value them, you will see the symptoms of hurt feelings: resistance, disengagement, anger, or insubordination. Start by engaging each person in a conversation that demonstrates that you’re interested in their thoughts. For an older worker, try these options: “How have you seen the organization evolve during your time here?” “You know the culture well — what do you think will be the secret of success in this transformation?” “What worries you most about the new approach?” Then listen carefully to what you learn.

Here are some more tips:

Teaching to learn requires learning to teach. Unfortunately, most of us think it is easy, everyone can do it and we should not pay for it. It’s time to get our hearing and seeing prescriptions checked.

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GUEST POST from Arlen Meyers

There are many definitions of innovation. In my view, there is a qualitative and quantitative component that helps to determine whether something is innovative as defined by users.

The qualitative component is newness i.e whether someone is new or is old done in a new way. The quantitative component is the multiple of user defined value created when compared to competitive offerings or the status quo. Research indicates that it takes at least a 5x multiple of user defined value to get a customer to switch form one product to the next. I’ve arbitrary set 10x as the metric to define whether something is innovative. So has Google in their 10x rule.

Here’s what the novelty-value matrix looks like?

As you can see, you want to be in the upper right hand corner. The upper left hand corner is for solutions looking for problems that create no substantial value.

Now that you know the definition of innovation, here are 10 things you should know about it.

1. You need to lead innovators, not manage innovation

2. Innovative universities and organizations are not necessarily entrepreneurial

3. Patients and other stakeholders are your main source of opportunity to create innovation.

4. Big Device should change their R/D models

5. You need an Innovation Management System to create impact

6. You need to clarify your innovation expectations and encourge innovators to go beyond them or dial them back. Sometimes tinkering is the first step towards something bigger.

7. Have you validated your business model assumptions?

8. Rules create ecosystems. Ecosystems drive innovative business models. Think, TV, the Internet, electric cars.

9. Stop blowing innovation smoke and raise your innovation bar

10. Create user defined value through the deployment of innovation, not just companies

The difference between creativity, inventiveness, entrepreneurship and innovation also depends on where you land on the continuum. Creatives come up with lost of ideas, however many fail to reduce them to practice (invent), let alone pursue opportunity to create user define value (entrepreneurship) that reaches the 10x hurdle(innovation).

Ideas are different from inventions, improvements and innovations. Be sure you don’t kid yourself and lump them together.

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GUEST POST from Arlen Meyers

Medical and health entrepreneurship, the pursuit of opportunity with scare resources with the goal of creating user defined value through the deployment of biomedical and clinical innovation, is growing quickly. After many years of either ignoring opportunities or being sidelined, physician entrepreneurs are finally throwing their hats in the ring. 

There are two basic categories of medical entrepreneurship-biomedical and clinical. There are significant differences in the innovation pathways for the two:

1. Intellectual property protection usually is of more importance in biomedical entrepreneurship.

2. Regulatory approval can be a long, expensive and risky process for drugs and devices.

3. Reimbursement and payment for biomedical innovations are often dependent on getting the appropriate codes and third party payments at high enough amounts to generate a profit.

4. Business models differ and are constantly changing.

5. The amount of capital necessary to get a drug or device to market is frequently higher than health innovation by several orders of magnitude.

6. The FDA may not have jurisdiction over many health innovations, for example a digital health app that is not deemed to be a medical device but rather something that provides information and education to users.

7. The customers vary depending on whether you are deploying a biomedical or health product.

8. Validating your business model using lean startup methodologies will vary and can be more challenging for biomedical innovators.

9. Biomedical entrepreneurship often requires a different skill set than health entrepreneurship.

10. Biomedical entrepreneurship is riskier.

Health or clinical entrepreneurs focus their activities on digital health, care delivery models, business or clinical processes, or policy. Furthermore, digital health can be further subdivided into segments:

1. Remote sensing and wearables
2. Telemedicine
3. Data analytics and intelligence, predictive modeling
4. Health and wellness behavior modification tools
5. Bioinformatics tools (-omics)
6. Medical social media
7. Digitized health record platforms
8. Patient -physician patient portals
9. DIY diagnostics, compliance and treatments
10. Decision support systems

Unlike bioimedical entrepreneurs who are trying to get drugs, devices, diagnostics,vaccines and biologics to patients, digipreneurs have to face the facts that:

1. There is a difference between an industry and a market. Those companies that provide products and services comprise the industry. The customers who use those products and are looking for ways to get a particular job done are the market. However, both the digital health industry and digital health users are a complex combination of providers, payers, industry partners in interface technology industries and patients, some of whom are customers or consumers while others are influencers.

2. Like all investors, digital health investors are looking for the highest rate of return with the least amount of risk. Given the foggy legal, regulatory and reimbursement atmosphere, it’s too early to tell which dogs will eat the food. There has already been high profile digital health failures, roll ups, IPOs and consolidation as the industry and markets continue to mature.

3. Most digital health technologies have not been clinically validated nor are they required to do so. However, other regulatory agencies, like the FTC or the Consumer Products Safety Commission, are wary about digital health product claims that are not supported by research.

4. The FDA continues to offer periodic guidance documents and regulations that contribute to a level of uncertainty when it comes to defining what is a medical device and what is not. That makes the hair stand up on the back of investor’s necks.

5. Given the multiple stakeholders in healthcare — payers, providers, patients, partners and others — it’s hard to target any one customer. Several need to see the value for any given product or service.

6. The industry is too new and there is too little research to know which customers/ patients/ stakeholders will adopt a product and why.

7. Scale trumps innovation. The single most important characteristic of those companies that have received substantial follow-on investments are those that have scaled their customer rate rapidly by at least 70 percent a year.

8. Doctors don’t have the information they need to know whether to prescribe or use a given digital health technology.

9. Most doctors don’t get paid to use digital health technologies, they disrupt workflow, and there are nagging behavioral and emotional barriers to adoption by both patients and their families and their doctors.

10. There are significant confidentiality, security and data privacy issues still lurking.

11. Patent protection is not as important in digital health as it is in biopharma or medtech. Things move much more quickly, the product life cycles are much shorter and time is of the essence when it comes to getting adaption and penetration in the patient/consumer or medical community.

12. Business models are evolving and change on a regular basis, sensitive to the protean tastes of Internet junkies.

13. Digital health clusters consist of many of the same parts as biomedical and clinical clusters. However, since digital health resides at the interface of information, communications and sick care, there are other elements such as cybersecurity, big data and analytics, blockchain and artificial intelligence as well as other metaclusters.

14. Investors in digital health are different from investors in biomedical technologies and industries

15. Drugs, devices and digital health are converging so, sometimes, there are significant overlaps in product development

Here is a guided tour of the Denver-Boulder startup tech cluster. What’s in your asset map?

For these and other reasons, non-sickcare entrepreneurs fail despite their previous track records of success in other consumer markets.

Here is the story about how many came together to create the Colorado digital health cluster.

Digital health is the new New Thing. Like all new things, it is surrounded by hype and hope. Whether digital health can bend the cost curve and help patients or is just another tech bubble remains to be seen. Digital health entrepreneurs need to do their due diligence with both eyes open and their wallets protected until they are convinced they can overcome the risks.

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GUEST POST from Arlen Meyers

Each day, more and more things get connected, creating an event bigger and bigger smart world creating more and more data that makes us more and more vulnerable to cyberattacks and intrusions.

Apple has unveiled the Watch Series 4 at its annual event at the Apple Park in San Francisco. The new Apple watch – cleared by the Food and Drug Administration of the USA – will allow users to take an Electrocardiogram or ECG. Apple’s Jeff Williams said that the the Watch can detect irregular heartbeat, low heart rate.

What’s more, men, materials and machines are colliding with AI, analytics, cloud computing, fog computing,blockchain and mobile technologies increasing the levels of compexity as the cyber nervous system evolves.

Here is the basic science course on remote sensing. Here is what you need to know about the embryology.

The IoT World Forum Reference Model describes the layers in IoT system

There are four primary areas of IoT impact:

1. Enhanced business insights
2. Operational efficiencies
3. New revenue streams
4. Improved processes

The consequence is that the internet of medical things (IoMT) creates big challenges and opportunities to cut costs, improve outcomes and the doctor and patient experience. Here are some themes emerging:

1.Collisions of men, machines and materials impacting business models

2. Workforce development challenges to deliver a diverse IoMT competent talent pipeline

3. Cybersecurity challenges

4. AI and machine learning integration

5. Creating and protecting the appropriate networking infrastructure

6. Using the IoMT to solve immediate problems v informing future products and service development

7. The battle for 5G deployment

8. International business competitive issues

9. The migration of product companies into XaaS companies

10. The changing role of CIOs and CSIOs

11. Navigating the data development roadmap

12. Using the IoMT to transform sick care to healthcare by moving from reporting to prescribing to predicting to preventing

13. Deciding which data need to go to the cloud or can remain closer to the ground, in the fog

14. How to make poor data into usable data so you don’t get GIGO

15. How to change dumb assets in to smart assets by converting data to value

16. How to dismantle data silos and minimize adverse outcomes to other stakeholders

17. What happens when the patient owns the data?

18. How do we create a standard interoperable platform for the IoMT?

19. How to remove the barriers to dissemination and implementation of the IoMT?

20. When does remote sensing move from being constructive to being creepy?

21. How leaders can move from fashionistas (buying the latest shiny new object and then moving on) to champions (thoughtful deployment and scaling)?

22. How to use the IoMT as part of the complex process of changing doctor and patient behavior?

23. Navigating from thinking big to starting small to scaling fast with a minimal cost of failure

24. Learning from industries outside of sick care, since sick care can’t be fixed from inside

25. Changing the reimbursement, intellectual property and regulatory environment of the IoMT. The Food and Drug Administration (FDA) is working to strengthen the cybersecurity of medical devices in the wake of computer-hacking threats.

All of this may seem a bit overwhelming because it is. However, those who are fighting the 4th industrial revolution to win won’t wait for you to catch your breath. They are too busy measuring it via an e-meter dose inhaler, capturing your data, and adjusting your insurance rates based on the probability of how your asthma is responding to the last bronchodilator you just puffed.

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GUEST POST from Arlen Meyers

Physician burnout is pervasive and appears to be worsening. In fact, in some specialties, residents are burned out even before they have spent their first day in practice. But, they are not alone since burnout happens in many industries other than medicine.

Burnout is considered to have a range of symptoms. There is no agreement which of those are part of it and which ones are not. But all definitions given so far have in common that the symptoms are regarded as being the consequence of stressful activities in or outside the job. One possible source of stress outside the job is caring for a family member, for example.

Three main areas of symptoms are considered to be signs of burnout syndrome:

• Emotional exhaustion: People affected feel drained and exhausted, overloaded, tired and low, and do not have enough energy. Physical symptoms include pain or problems with the stomach or bowel.
• Alienation from (job-related) activities: People affected find their jobs increasingly negative and frustrating. They may develop a cynical attitude towards their work environment and their colleagues. They may, at the same time, increasingly distance themselves emotionally, and disengage themselves from their work.
• Reduced performance: Burnout mainly affects everyday tasks at work, at home or when caring for family members. People with burnout regard their activities very negatively, find it hard to concentrate, are listless and experience a lack of creativity.

Burnout can also be described as “the extinction of motivation or incentive, especially where one’s devotion to a cause or relationship fails to produce the desired results,” and is a stress-related state and there are multiple causes.

Burn out interventions and prevention programs both at the personal and organizational level are successful 80% of the time. However, both personal and organizational interventions are better than either alone, and the results tend to fatigue over time.

Mentors, coaches, sponsors and colleagues might help, but , you need to understand the roles each one plays and when and how to engage them. Here is what to do when your boss refuses to be your sponsor.

Mentors are accountability partners who help you stay on track to meet your goals. They are hard to find and the lack of a mentor is an oft quoted reason for entrepreneurial failure. Many entrepreneurs have a hard time finding the right mentor for various reasons. Mentors help your personal development.

Here are some tips on being a good mentor. It starts with building a genuine relationship.

Sponsors are different from mentors. Their job is to run cover for you in your organization and help you find the scarce resources intrapreneurs need to succeed. They are making an investment in your idea, and, like every investor, they expect a return within a defined time.

Colleagues are people you work with that you admire and can emulate. They are not friends, but rather a honest sounding board. They set an example by their actions. There are many reasons why colleagues make good mentors or confidantes.

Coaches The goal of the coach is to facilitate learning, focus, and results. Coaches are trained in the strategies for achieving the results specific to their domain of coaching. Although they may not have experience generating the results you are looking for in themselves, they should have experience generating these results in other people or organizations. Coaches teach you a skill.

Many of you who are reading this don’t have a mentor. But, here are some ways to change that.

Here are some best practices for mentors and mentees.

Whether you are an employed physician, a community practitioner, a budding CEO of a biomedical or health startup or an intrapreneur, you need help as an antidote to the stress. Take the time to cultivate the right relationship with the right person in the right role and thank your lucky stars you found them.

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