Twas the night before a new release of FDA guidelines
Not a developer was stirring waiting on the sidelines;
The keyboards were hung by the monitors with care,
In hopes that interoperability soon would be there;

The physicians were nestled all snug in their beds,
While visions of Vinod Khosla danced in their heads;
And UX with their wire frames, and agile scrums
Had settled down with new problems but did not succumb.

When out in the office there arose such a clatter
New healthcare policies that really do matter
Away to the window I could only deduce
Tore open the shutters – hey meaningful use

The moon on my mobile phone my fingers did tap
Gave me comfort in seeing a new treatment app
When what to my wonderment a transformation
A process and method for new innovation

With a lots of health challenges and new informatics
I knew in a moment it was solved with mathematics
More rapid than standards and new care models
And a whistle and shout – no more waddles or dawdles

Now ONC, now PHI, and EHR
On HIT, on HHS and EMR
To the top of the challenges and problems we face
Now dash away, dash away and let us keep pace

Their eyes — how they twinkled, the patients did say
New help and better outcomes now that’s the way
Technology enabling and helping with costs
Payers and providers the message not lost

They sprang to their iOS, Android and Windows 8
Away they all flew new apps, wow that’s great!
And the delivery team exclaim as they moved with great stealth
Happy Holidays to all and to all Good Health!!

The challenges in healthcare are big -

• 5% of patients accounting for 50% of costs
• FDA regulatory is continuing to evolve
• Improving outcomes and reducing cost are key performance measures
• Security and privacy concerns exist
• Interoperability and the development of standards continue to stifle progress in some areas

2012 brought lots of change and 2013 promises to bring much more. In this holiday season we are reflecting on the work we’ve done and the work that is to come and find ourselves humbled by the impact that we’ve had with our customers on the lives of millions and the healthcare eco-system. We look forward to working and collaborating with others that are tackling the big and important healthcare problems because it makes a difference in the world.

On behalf of the Pathfinder team, we wish you and yours a blessed, peaceful holiday season.

Poem by:  Ted Wallhaus

I attended the 2012 mHealth Summit in Washington DC earlier this week and came away impressed with the how fast things are moving in this space.

The conference itself, now in it’s fourth year, has grown to over 3800 attendees and over 300 exhibitors. Major players like Kaiser Permanente, Intermountain Healthcare, Aetna, United Healthcare, Mayo Clinic, Qualcomm and Johnson and Johnson were well represented, as were startups, service providers, physicians and government agencies. These organizations are beginning to recognize the transformative power of mobile on the healthcare sector and are putting serious money and manpower into their mobile efforts.

A couple of trends stood out to me from this year’s conference:

Changes to Reimbursement are Here Already

Just before the conference, a study came out claiming that 31 million patients were already enrolled in Accountable Care Organizations (ACOs) in which reimbursement is tied to population health. While there is some debate about the findings, they certainly brought home that changes to reimbursement models are not purely theoretical, or something for the distant future.

There was a lot of discussion on readmissions, the patient centered medical home, and meaningful use. Whether patients are in an ACO or not, changes to reimbursement are are already here and impacting hospitals, clinicians and patients, and those changes will only accelerate.

Reimbursement Changes Spurring Innovation

These reimbursement changes are spurring outcome and cost focused innovation both inside and outside the hospital. While much can be done to improve effectiveness within hospitals (see Atul Gawande’s recent analogy between healthcare and the cheesecake factory) there is likely even more opportunity outside the hospital, through patient behavior change and earlier, more frequent feedback between physicians, patients, and machines. More on the machines part later.

The Promise of Mobile

This is one area where Mobile really shows a lot of promise:

• A lot of health issues can’t be scheduled. They can happen at any time. For patients and physician, the ability to share anywhere, anytime makes sense – it fits into how they live and work
• iOS and Android smartphones and tablets fit the bill: They’re personal, always on, always connected, and really easy to use.
• Penetration of iPhones and Android smartphones in United States is now at 48%, with 50% year on year growth as smartphones crowd out feature phones.
• There are over 2 billion Bluetooth enabled devices, and 1.5 billion wifi enabled devices. Many of them are wearable and more and more are healthcare related. New types of sensors are being invented that capture more and more diagnostic information and transmit them via mobile devices to the cloud.

Experiments in Patient Engagement.

Mobile provides great tools for patient engagement, but most organizations are in the early stages of grappling with how to use them, and there’s a lot of confusion and conflicting information out there. For example, one panelist claimed that it was impossible to get more than 11% of patients over 65 to use mobile apps to engage, only to be immediately contradicted by an audience member from Montana who suggested that in his experience providing financial incentives like copay reimbursements worked wonders with seniors.

The good news is there are lots of data driven experiments and learnings being shared, including work in persuasive design and the dynamics of social networks, so I expect lots of progress in this area.

Platforms and Big Data

Of course you need better integration to get all of this data together, analyze it and provide meaningful information where it’s needed.

Integrated groups like Kaiser Permanente and Intermountain have a head start on all of this – they’ve been dealing with patient engagement and reimbursement for population health, have data on this, and are actively using that data to improve outcomes for their populations.

But there’s lots of room to improve on the current state of integration. That’s where platforms like Qualcomm Life’s 2net and Aetna’s CarePass come in.

The 2net Platform is a cloud-based system designed to be universally-interoperable with different medical devices and applications, enabling end-to-end wireless connectivity while allowing medical device users and their physicians or caregivers to easily access biometric data, with two-way connection capabilities and a broad spectrum of connection options.

Aetna’s CarePass takes this one step further. The platform enables consumers to share information across apps and create a personalized, coherent experience to manage their whole health, from getting care to staying well, all with one sign-on. Aetna has integrated a number of their own apps, like iTriage, Medicity and ActiveHealth Management.

For Aetna, this fits into their vision to build out the infrastructure platform for ACOs and get as many providers and consumers onto the platform as possible.

Which brings us back to reimbursement and regulatory changes. The MHealth Summit provided a great look at the state of MHealth in 2012, a glimpse of where we are going, and of the challenges we still face. I can’t wait to see where we go in 2013.

Mobile
Our clients continue to innovate in their use of mobile technology. Many of our projects now involve developing mobile applications on iPhones, iPads and Android smartphones and tablets. Projects this year have included:

• Heart monitoring solutions involving wearable sensors, bluetooth communication to android devices, cloud based predictive analytics and real time alerting
• Apps for patients managing chronic diseases
• Apps and devices providing clinicians with diagnostic support in operating rooms and on the hospital floor.

Staying Agile in an FDA Regulated Environment
Our approach to making extraordinary healthcare apps relies on a few key ingredients:

• Developing a deep understanding of customers, users and their problems
• Applying great technical and design talent to solve them
• Using analytics and fast feedback cycles to continuously improve engagement and effectiveness.

Quite a number of the products we develop are considered Class II and Class III medical devices and require clearance or approval by the FDA. Applying an agile approach in this environment poses significant challenges, but carries great benefits for quality, speed and market viability,

We’ve met these challenges by developing a quality management system that conforms to the IEC 62304 standard for software development supported by the FDA, and have integrated our process to our clients quality management and hazard analysis processes.

This effort culminated in a series of passed audits on our quality management system this summer.

Scaling Lean Innovation in the Enterprise
2012 saw tremendous progress in our lean innovation practice. Our summer lean startup teaching program, the Chicago Lean Startup Challenge taught 107 teams how to accelerate from Idea to traction. The videos from our Semifinalists tell a great story of how much you can accomplish in 8 short weeks.

We’ve been collaborating with a number of enterprise customers to apply the lean innovation approach at scale, using innovation accounting and stage metrics within a portfolio management approach. This approach allows our customers to make better investment decisions on their innovation portfolio and develop more disruptive innovations faster. We’ll have lots more to share on this in the coming months.

We’re proud of what our clients have been able to accomplish in 2012, and are excited about what we can accomplish together in 2013.

In my work helping companies practice lean innovation, I talk to a lot of folks who are launching mobile products and they chose to build a native app instead of a mobile web app.  For those readers who aren’t sure what that means, a native app is one that you 
download from an app store, whereas a mobile web app is a web application built using responsive design that you pin to your homescreen.   For those of you who have iOS 6 on your phone and use Google Maps, that’s a mobile web app.

When I think about all of the things that one does when they launch a product, I start thinking that a native app may not the best choice.  I ask two questions:

1. Does the user have to use the app offline?
2. Do you need to use specific phone features that you cannot tap into from a web app, such as the accelerometer or the camera flash?

If the answer to either of those questions is yes, then you need to do a native app, but if both are no, I would recommend thinking about launching a mobile web app first.  Here is why:

Native apps are not optimal for fast learning

I have helped launch many, many products in my career and I have never launched the right product on day 1.  When it gets into the customer’s hand, there are a lot of things that we learn are needed and have to change.  Sometimes there are heinous defects that wedon’t find until there are a lot more folks beating on it.  Having to go through the app store slows down that learning because it takes a while to get every change through.  Murphy’s Law always plays out – when you have a really bad defect, it takes forever to get through the app store, the bad reviews keep coming in and those reviews stay around a long time.  And there are folks who won’t update the app.  Development for native apps takes longer than web apps, so that hinders learning as well.   A/B testing is really painful on native apps, but it can be accomplished easily by a non-technical person in a web app.

Native apps have more onboarding friction

I can send someone an email to a web app and after 1 click they can be using my app.  For a native app, I have to send them to the app store, then one has to download it, and then they have to open it.  Each one of those extra steps has a half-life, where a prospective customer can fall out of the onboarding funnel.  Because it happens in the app store and on your device, you have no idea which step is causing them to abandon.  Also, you cannot put a parameter on the link, so from an analytics standpoint, you have no idea what marketing channel caused a download.

I am not saying that native apps are not a good idea.  However, I think when a product launches, you need to focus on getting engaged users; so suboptimal platforms for learning and onboarding friction are things you might want to eliminate from your launch.  You can always build a native app later.

Selling mobile applications is far more difficult than selling SaaS applications. Currently, there are over 732,609 available apps to download.  As of September of 2012, the iPhone App Store averaged 394 new apps every day. The Android Market averaged 243. Long gone are the days of throwing an app up into an app store and watching the dollars flow.

We launch a lot of mobile applications for our customers, and one of the things we’ve found is that in order to achieve success, you need to start marketing before you start building, and that your marketing efforts may be greater than your development effort.

Topics covered include: 
- The many different marketing channels you can use to market your app

• The pros and cons of each channel
• How to instrument your mobile business so you can make data driven decisions.
• How to create ways of looking at your prospective customer’s actions to inform how you market to them.
• How to determine how your customers are using the product to drive future sales.
• A 21 step marketing plan for your mobile apps.

It’s a rapidly evolving field, so if there are additional techniques that work for you, please share them in the comments.

While a mobile app may do a lot of things, it’s essential to design the app so it feels simple to the user at any moment during its use. But how do you generate ideas that will make an app simple?

Try the following approach. List the top ten features you want in your app. These should be the most important things that characterize your app. If you have more than ten that’s OK, but try to come up with at least ten.

Once you have ten (or more) features listed, pick the top three. Now from the top three, pick the top one. Next, set a timer for 15 minutes. Draw some concepts of your app so it only does the top one feature. You may want to use index cards or pre-printed storyboard sheets to capture your ideas. After 15 minutes is up, reset the clock for another 15 minutes and create a new design that contains the top three features.

Obviously, you may do many variations on this exercise. Despite the details, the idea at work here is the same. By introducing constraints (number of features and time), the mind tends to be more focused and often more creative when generating ideas. When one feature is viewed as most important above all others, the design will favor that feature. By trying another feature as the top one, you will likely get different ideas.

Try this exercise on your own or challenge your team to come up with designs. Your time investment will be small but the outcome can be quite effective.

Healthbox is a new Chicago based healthcare centric accelerator program that started it’s inaugural class of ten startups earlier in January. For three months, these teams will share space and ideas in Chicago, where they will push toward the next stage of development.

The principles of the Lean Startup Method apply to any innovator developing a new product or business with extreme uncertainty indifferent to the size of the project or industry. The healthcare industry has significant change on the horizon and stakeholders hungry for the solutions of tomorrow, there has never been a better time for innovation and collaboration. Using customer development and experiments with fast feedback loops can help to guide medical trailblazers toward valuable solutions for all the stakeholders in the field.

Consider this the opening volley in our campaign for Lean Branding, the argument that branding has to follow the same course as customer and product development. More on this later. First a good argument on why you shouldn’t just plaster your brand over any and every aspect of your app or webapp.

Jonathan Anderson has a great post over at UX Magazine entitled Your Logo Is Making Me Sick. In it he argues that using a company’s logo or brand as the most striking part of a critical failure or error message is a common self inflicted wound and should be avoided.

Years ago, my mother got a nasty case of food poisoning from an order of chicken tikka at a restaurant. For years after that, if I’d sneak up behind her and say, “Chicken tikka!” she’d crumple into a bout of dry heaves.

Funny and informative. Give it a read.

Most efforts to boost innovation focus on generating or capturing new ideas. Yet for most companies, this is not where the problem lies. Instead the problem lies in determining which of those ideas can be successfully scaled into profitable new lines of business. Most companies place big bets on the wrong ideas for the wrong reasons. As a consequence, 9 out of 10 new products fail.

We’ve been collaborating with a number of large enterprises who are pioneering the use of lean startup techniques to make better investment decisions and reduce the risks of new product failure. Through this work, a new model has started to emerge that promises to turbocharge enterprise innovation efforts to generate explosive growth.

Next Sunday at Tech Week, Chicago’s largest digital innovation conference, I’ll be sharing some of our lessons learned in a talk titled Building a Better Enterprise Innovation Engine.

Here’s what I’ll cover:

• How a lean innovation approach provides a more efficient way to determine which ideas merit further development and to rapidly bring the right ones to product/market fit.
• How business model analysis, rapid cycles of hypothesis testing using minimal experiments and feedback from real customers can help you decide when to pivot, when to persevere, and when to allocate your innovation budget to other ideas.
• How to manage an innovation portfolio to maximize returns
• How to staff an innovation department

If you’re interested, you can sign up at Techweek – the lineup of speakers is very impressive. You can use discount code twspeakers_30 to save $115 on admission.

If you’re unable to attend but would like to find out more, drop us a line.