🦄 vol. 34

potter (our guest feature) chats about innovation in healthcare

introducing this week’s feature: potter –one of the coolest people in healthcare– is a young medical doctor, currently working in mpumalanga. when he’s not saving lives (or playing quidditch 😜), he’s spending time working on an early-stage digital health startup. and if that isn’t impressive enough, he’ll be starting a masters of public health at johns hopkins university later this year!

healthcare and its innovation paradox 😵‍💫

I was once told that “it’s easier to send an HD video from space than it is to send an electronic medical record to the hospital across the road”. This is, of course, (mostly) a joke but it speaks volumes of the fragmentation of healthcare and the plight of innovators trying to change it. 

The mad rush of the “warp speed” vaccine and drug development, as well as the rapid rollout of telehealth and digital therapeutics necessitated by the COVID-19 pandemic highlighted how healthcare has lagged behind the digital reinvention of other industries. Like most things in healthcare, the reasons for this are complex and impossible to be considered in isolation, but let’s take a shot at breaking it down. 

Low hanging fruit 🍎

Some days, nothing changes for a patient in hospital. It’s on those days, when I painstakingly rewrite the exact same thing I wrote yesterday, that I think to myself: there must be an easier way to do this. While South African doctors try to decipher the handwriting of other doctors’ notes or referrals, electronic medical records and digital health represent $26 billion and $14 billion global markets, respectively. Healthcare has a lot of “low-hanging fruit”, with countless opportunities for simplifications and optimisations in workflows: 

• Vula Mobile, one of just a handful of successful digital health startups in South Africa, is an app that allows doctors to send digital patient referrals to one another. While the innovation of Vula is seemingly straightforward, their route to market has been anything but that. Founded in 2014, the app now has over 20,000 active users and over 500,000 referrals.

• Wardworx, think Trello for doctors, is a simple task-management app that has positively transformed the work of many young doctors. While it is difficult to demonstrate the impact tools like this have on patient outcomes, making doctors more productive should be considered a no-brainer. 

• CareConnect Health Information Exchange has launched a revolutionary (at least in South Africa) tool to unify electronic medical records between patients, providers and payers. Despite its obvious benefit to patient care, it has been years in the making and is currently only being implemented in the private sector. 

Barrier to entry 🚧

Hospitals and health systems are highly regulated. Whether it be regulation over approved products and services or tight control over healthcare data, the web of regulations that need to be overcome to innovate in healthcare is intimidating, to say the least. 

Moreover, with a private sector of providers and financers that is dominated by a handful of large firms, and a Medical Schemes Act that makes most private health insurance products prohibitively expensive to over 80% of the country, there is very little market share up for grabs. 

If you plan to pick from the cornucopia of low-hanging fruit in the public health sector, be prepared to face the opaque (and often corrupt) government tender process. 

Finally, while a lack of start-up funding is endemic to all industries in South Africa, with the kind of regulatory hurdles highlighted above, you can’t blame investors for not being particularly bullish on healthcare.

The burden of proof 🔬

With literal human lives at stake, introducing changes to a health system requires rigorous validation through research. For example, a new medical therapy should rightfully go through the long process of clinical trials before it is introduced to the public. Bypassing this may result in adverse outcomes if the therapy is harmful, or catastrophic financial losses on a dud therapy that actually has no benefit to the patient (see Theranos for a guide to misleading investors). In many cases though, this burden of proof can stifle innovation in areas of healthcare that perhaps do not need to be held to the same standard. 

Many workflow innovations are simply aimed at making the work of a clinician more efficient so that they can have more time with each patient or on other more important tasks.  

Mobilising a change in culture  🏃🏃🏃

The well-worn startup trope of “move fast and break things” is not generally well-received in healthcare. Healthcare moves slowly. Practices in medicine are deeply entrenched. Moreover, in a highly resource-constrained setting like ours, the workplace ethos in hospitals across the country tends to be “oh well, this is just how it is” as opposed to “surely there’s a better way to do this”. 

The movement toward value-based healthcare is well underway in South Africa. However, without a drastic culture shift in the way that innovation and entrepreneurship is received and utilised, we are unlikely to see effective change. We have a lot to learn from the way that other countries are tackling this from different angles. However, our system is unique and retrofitting another country’s successes is certainly not the opportunity. We have the opportunity to leverage Africa’s nascent health and tech spaces to create something purpose-built for our landscape. In broad (and over-simplified) strokes, this may be achieved with 4 key approaches:  

1. 🌱 Grassroots: equip students and health workers to not just be expert cogs in a dysfunctional system, but to be experts in recognising system failures as opportunities rather than obstacles. 

2. 💡 Bottom-up: creating channels and support to encourage micro-innovations at all levels of healthcare. 

3. 🤝 Collaborative market: a transparent marketplace of business opportunities and government tenders for the translation of research and innovation. 

4. 🚦 Rethinking regulation: a consortium of academics, policymakers and business leaders tasked with tailoring regulations to facilitate easier and quicker testing and roll-out of new products and services.

potter

after reading potter’s piece, karl did some digging and found that in 2021, ~9.2% of investment deals in africa were in the healthcare sector, and ~22% of those were in south africa. in 2020 and 2019, healthcare had a similar slice of the pie with 9.8% (24) and 8.1% (10) of the continent’s deals respectively

potter thinks the debunking of the 10,000 steps per day goal set by your smartwatch should be talked about more

sash is seriously enjoying a16z’s podcast

if you’re interested in intermittent fasting, matt suggests taking a look at this newly published paper