What Is Your Future Of Medicine?

We are holding ourselves back from visionary changes.

The business of our practices and careers often gets in the way of our visionary thinking of the future. In medicine, this seems to be more true than other sectors of our society. Our medical practices of today closely resemble the medical practices of 20 or even 30 years ago.

For the most part, medical practices all look the same. The front door of the practice opens to a waiting room filled with some variety of magazines, chairs and a large glass window that separates the “practice” from the patients. Patients are called back to the exam room and pass through hallways that are narrow and poorly decorated with wallpaper or generic art on the wall. And the exam rooms all look and feel the same: poor natural light and a large exam table placed in the middle of the room.

As well, the process of the medical visit is largely unchanged from decades past. The doctor walks in, sits in her designated chair and speaks with the patient for a few minutes before performing a physical exam and writing prescriptions and/ or lab/x-ray orders. (On a side note, have you ever wondered why the lab report of today looks exactly like the lab report of decades ago? Hasn’t technology changed how we view data?)

We do this over and over. We have been doing this over and over the same way for way too long. One of the problems with figuring out how to create a better health care infa-structure is that we cannot get the current/old/tried-and-true medical visit model out of our brains. We are literally stuck here (and there) because we continually feel that the way we are practicing is the best way because that is how doctors practice medicine. Over and over and over.

I feel that we would do ourselves and our industry a service by throwing away this model and starting fresh. Let’s face it, the modern society we live in right now is very different than 20 years ago. Back then we did not even have the internet, the iPhone or Facebook. 20 years ago we communicated with our patients solely by face to face appointments in our offices. The same offices we are using now.

In order for us to truly make progress, then, we have to reinvent how medicine can be practiced. Here are six visions I have that will make for a better medical practice, improve patient outcome and boost physician job satisfaction (in order from the most practical to the most visionary):

1. Embrace the virtual visit: patients don’t have time anymore to drive through traffic and wait in our waiting rooms and exam rooms anymore. They have questions right now and we have the technology to embrace this. Ask all of your patients to get a Skype account and then offer virtual visits and charge the patient for this convenience. They will love it. And so will you.

2. Take down the glass: this is a pet-peeve of mine. The glass partition creates an immediate sense of imbalance in the waiting room. Far better is to create an open waiting room where patients feel on equal footing with the practice staff. Staff can be trained to communicate so HIPAA violations do not occur. Why not add a pinball machine and coffee bar? Add free WiFi. Make the waiting room a place where patients don’t mind waiting, but actually enjoy the break in their day.

3. Offer Home/ Work visits: This goes back to idea #1. Do you really need a central office anymore? Would you serve your time better by working from home and making periodic house calls while employing virtual visits most of the time? There is so much wasted time in the office. We get interrupted all the time with this phone call or that fax. Wouldn’t your own time be better served if you could focus on one thing at a time? This would certainly free up time to focus on the other aspects of your life and career that you enjoy pursuing. So much of the office is devoted to running the office that many times our own personal goals are left out.

4. Create a Social Health Network: right now this is the big push with out society--belonging, joining and participating in different social media outlets. I think this reflects our desires to connect first. The problem with many of the social media venues is that we end up reaching out as opposed to actually interacting. Facebook and Twitter are great for developing a fan base, but not so good at focusing on the fans. By creating a Social Health Network, we could each have our panels of patients that we could interact with in more of a community way. This would allow us to interact on the individual level and at the community level. Employing a Social Health Network would also allow our patients to interact with each other. I think that having more of a niche network is exactly what people are longing for--more personal and deeper connections.

5. Redesign Lab Reports: have you seen Flipboard on the iPad? This is where we need to move medicine communication. The visual information our current lab reports provide is so boring and plain. There is no visual dimension to these reports. Far better would be to generate digital reports that are fluid and are actually enjoyable for the patient to interact with. Right now we have trained our society to detest looking at their lab reports because they are boring and don’t provide any visual information. But what would happen if we created digital lab reports that were full of color and motion?

6. Merge our virtual health and real health worlds: We are raising our children in the digital era with great emphasis on the virtual world that trumps reality. Video games, streaming movies, iTunes music, apps, you get my point. So why not take advantage of this and create a virtual health world? Much like the Sims game, we could all create virtual profiles of ourselves that we “play around” with. With the advent of monitoring devices on our mobile phones (sleep cycles, heart rate variabilities, pedometers, etc.) it is now easy to access information about ourselves we never could before. We could stream that type of information to our virtual selves: it appears you have not reached deep sleep for 3 nights in a row--how about trying some Melatonin or Ambien? We would then watch what happens with our virtual selves when we tried this. By combining real data into a virtual world, we would be able to see how our bodies react and respond to different tweaks and changes. As doctors, we could then communicate with our virtual patients in this game-like world as well, providing an extra level of support. By combining our virtual and real worlds we would bring an element of fun and style that is currently missing in medical practice.

One of the major obstacles in reforming our health care system is that we are stuck using the same tried and true methods of practicing medicine. I think we will only be able to break through and create a better system for patients and ourselves when we scrap our impressions of how patients are seen and how we practice medicine.

So what are your visions for the future of medicine?

2011 Medical Fusion Conference Faculty and Agenda

At every Medical Fusion Conference we attempt to cover the most pertinent topics for clinical physicians who are attempting to branch out from their clinical careers.  

For 2011, we've once again assembled a stellar faculty comprised of leaders in many diverse niches from around the country, and have included many hot topics that physicians should be exposed to in this ever-changing healthcare environment.

Our 2011 faculty list was recently published here on Freelance MD, but we've added a few more names so I've decided to list our entire 2011 Medical Fusion Conference faculty once again.  Many of these faculty members are authors here on Freelance MD so you can read about their backgrounds and perspectives here. I'm also listing our agenda below so you can get an idea of what's going to be discussed at this year's event.  Remember, the 2011 Medical Fusion Conference is November 11-13, 2011 and space is limited.  If you're interested in attending you can register online or call 866-924-7969 .

Our 2011 Medical Fusion Conference faculty:

• Dr. Barry Silbaugh, President of the American College of Physician Executives
• Ashley Wendel, founder of High Agility Healthcare
• Dr. Setu Mazumdar, founder of Lotus Wealth Solutions
• Dr. Steven Knope, author of Concierge Medicine: A New System to Get the Best Healthcare
• Jeff Barson, founder Surface Medical, MedicalSpaMD.com and FreelanceMD.com
• Dr. Gary Taff, real estate investor
• Dr. Julie Silver, Chief Editor of Harvard Health Publications
• Dr. Mike Woo-Ming, internet entrepreneur
• Dr. Kenneth Cohn, independent consultant and founder of HealthcareCollaboration.com
• Dr. Gautam Gulati, Senior VP of Digitas Health
• Dr. Steven Peskin, Executive VP and CMO of MediMedia
• Dr. Alan Neuren, disability review consultant
• Tannus Quatre, Principal at Vantage Clinical Solutions

Our conference topics this year are wide-ranging and cover many niches within and around clinical medicine.  Our 2011 agenda is the following:

Friday, November 11th

8:00-9:00  Leaving the Tribe, Silbaugh

9:00-10:00  Physician Career Transition, Wendel

10:00-10:30  Break

10:30-11:30  Prescriptions for Financial Success, Mazumdar

11:30-12:30  Living and Working Abroad, Bledsoe

12:30-2:00  Lunch

2:00-3:00  Concierge Medicine, Knope

3:00-4:00  Cosmetic Medicine Profits Blueprint, Barson

4:00-5:00  Real Estate Investing, Taff

5:00-6:00  Should You Get Your MBA?, Cohn

6:00-7:30  Accelerator I

Saturday, November 12th

8:00-9:00  Writing & Publishing I, Silver

9:00-10:00  Writing & Publishing II, Silver

10:00-10:30  Break

10:30-11:30  Internet Entrepreneurship I, Woo-Ming

11:30-12:30  Internet Entrepreneurship II,  Woo-Ming

12:30-2:30  Lunch

2:30-3:30  Product Development, Silver

3:30-4:30  How to be a Rockstar Physician, Barson

4:30-5:30  Independent Consulting, Cohn

5:30-7:00  Accelerator II

Sunday, November 13th

8:00-9:00  Believe Me: The Importance of Building an Unforgettable Brand, Gulati

9:00-10:00  Careers for Physicians in Managed Care and Health Insurance, Peskin

10:00-10:30  Break

10:30-11:30  Introduction to Disability Review, Neuren

11:30-12:30  Online Marketing for Physicians: The Essentials, Quatre

I wanted to make sure I highlighted our two Accelerator sessions at the end of each day.  Our Accelerators are some of our most popular times spent at the Medical Fusion Conference since each faculty and mentor has a table, and participants are allowed to wander from faculty member to faculty member and ask any and all questions of the speakers.  No other event allows you this much face-time with nationally known leaders.  Our participants raved about our Accelerator sessions in 2010 and we know that our 2011 participants will also enjoy this time.  

As you can see from our faculty list and our agenda, Medical Fusion participants will be given exposure to a wide array of interesting topics and significant time with our stellar faculty.  There's no event like the Medical Fusion Conference and there's only one Medical Fusion Conference in 2011: November 11-13, at the Aria Resort & Casino in Las Vegas. Register today to ensure your place at the most exciting and invigorating medical conference in the country.

Physician Creativity & Disruptive Innovation In Medicine

Making way for your creativity.

Whoever said “a creative mind is rarely a tidy mind” was on to something. Who hasn’t had a great idea for a new product that they are sure would make them rich? Whether it’s a new medical device that fills a client need or a new service that will increase your revenues, how do we know what really makes an idea “great”? Why do certain bad ideas get to market and great ideas never make it to market?

Inventions that have taken a forward-thinking approach at their very beginning often appear backwards in their thinking given a few years (or decades) of retrospect. For example, what about the birth of individually packaged goods, which made food both convenient and transportable? Was anyone thinking about how all the materials they were using were creating more waste for landfills? The side effects of our creative ideas can’t always be anticipated. 

Innovation flourishes when there is a desire to make our world stronger, faster, cheaper, convenient and more beautiful. These are the desires that keep the most creative innovators inspired. But, some of the most innovative ideas and solutions we imagine can create other problems as a result.

The best way to reduce the risk of negative side effects is to follow a series of “filters and qualifiers” that will help separate the brilliant long-term solutions from the quick fixes and the genuine needs from the flash-in-the-pan fads.

Certainly medicine and health care has it's own set of filters, but there are basics that apply across all playing fields. Following are a blend of the best practices from the world of medicine, architecture and social entrepreneurialism. You can use these with confidence when fleshing out your ideas. Review them, use them and embrace them – they will save you both time and money. 

Step 1:  Take the time to understand your market

This step starts with the simple question “Is my product idea needed”?  If a product or service already exists in the market, then your products must truly be better, cheaper, or more convenient to be successful. And in some cases, it would need to be better and cheaper to catch the consumers’ attention.

When considering this question even further – in terms of production, quality and sustainability – you can easily determine if the product or service is deserving of the required resources.

Step 2:  Think beyond your lifetime

Some of the most socially responsible and successful companies look out 20 – 30 years before commercializing a product.  They may over-engineer a product, far beyond the initial scope, in order to open the way for future revisions or adjustments.  For example, an architect may design a project making use of reclaimed materials and energy-generating materials in anticipation of future advancements and needs. 

Step 3:  You are a resource too

When considering product success and sustainability, you need to think beyond the actual materials that will be required.  You need to ask yourself, “How committed am I to this idea?  Will I be as excited and passionate about this product in 5 years as I am today”?  Personal sustainability can no be underestimated because your idea’s success will need you year after year

Step 4:  Happiness counts

Some ideas may be difficult to measure in terms of social responsibility.  For example, how would the launch of another dermal filler be considered “good for the people”?  So instead, some projects – like amusement parks or comic books – should be measured in how much happiness will result from their use. 

If an idea doesn’t pass the social responsibility test, then run it through the “happiness quotient”.  Will your product or service bring more happiness and joy to the world?  If not, then scrap the idea.

Step 5:  The buck stops here

One of the hardest parts of evaluating an idea is assigning a dollar amount to our vision.  It has been proven that there is a direct correlation between a project’s profitability and it’s sustainability.   While some products make a boatload of money over 6 months and then disappear (think Pet Rock…), the ideas most of us have are those with real legs that will be profitable year after year.  Do the financials, understand your profit potential and evaluate your risks. 

Now go innovate!

How To Do An Organizational Innovation Audit

Innovation in medical settings needs an environment that facilitates its development. Here's what to look for where you work.

If you had an idea for a medical device, would you know where to go at work to get help commercializing it? Most of the time, based on my experience at www.venturequestltd.com, an innovation management consulting company, the answer is no.

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?

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.

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.

What With All You ER Docs Starting Things?

Everywhere I look, there's another ER application.

When I'm at a cocktail party, one of the questions I get asked the most is , "What made you become an ENT doctor?" My thought is that medical students make their career decisions based on a lot of factors, but perhaps the one that stands out the most is the "personality" of the specialty they choose.  Take the following quiz by matching the word with the specialty:

A. Jock                                            A. Cardiothoracic surgeon

B. God                                            B. Psychiatrist

C. Looking for answers                  C. ENT doc

D. Geeky gadgeteer                       D. Orthopod

E. Life Styler                                   E. Emergency Medicine Specialist

One of the great things about working with SoPE (http://www.sopenet.org) is I get to hear about a lot of great innovative ideas. Lately, it seems, I've met more ER docs with great ideas than I can recall.

One , www.scribesstat.com, assigns pre-med scribes to ER docs to enter data into the EMR, thus making them more efficient.  Another, www.itriage.com, is a mobile health triage app that directs patients to the right place at the right time, and even gives you wait times in the ER or ambulatory facility you choose. Another ER doc wants to revisit an old infatuation with marine biology and commercialize products that come from the sea. As we all know by now, Bledsoe created this website and runs medical conferences looking for polar bears in Canada.

What's with these people? Can any of you out there help me understand this?

I think the rest of us can learn a lot from these life-stylers. Give yourself a present if you got that answer right.

How To Turn An Idea Into An Invention: Step 1

Medical invention is dependant upon being attuned to potential, and taking action.

Many important medical devices were invented by physicians. Charles Dotter was a radiologist who, in 1964, accidentally recanalized an occluded right iliac artery by passing a percutaneously introduced catheter retrogradely through the occlusion to perform an abdominal aortogram in a patient with renal artery stenosis. He immediately saw the benefit of his discovery and went on to invent angioplasty, which revolutionized cardiology and created the specialty of interventional cardiology.

For reasons unknown, Dr. Dotter failed to obtain any patents on his invention. The cardiologist Gruentzig went on to perform the technique in coronary arteries and is the one that seems to get the credit for angioplasty while Dotter is relatively unknown. Sadly, Dotter never bothered patenting his big invention and thus never made a dime on it.

Most of the physicians I know have had at least one good patentable idea in their career. Sometimes it is worth getting a patent; often it is not. Regardless of the potential financial benefit, an issued patent looks good on your CV and a patent plaque might look good on your office wall. Finally, an issued patent is recognition that you were (probably) the first to find a particular creative solution to a problem.

No better example of this last benefit can be given than the incandescent light bulb. Most Americans believe that Thomas Edison invented it. In fact, the fundamental idea, of a glowing filament in a vacuum, was published by a pharmacist named Swan and the idea of replacing the vacuum with nitrogen was due to an electrician named Sawyer. Edison, however, manufactured the first bulbs and “loaned money” to an alcoholic patent examiner who gave him some critical patents. Ergo, Edison gets the credit that he never deserved.

Be alert the next time you have a good idea in your practice. Or, when you recognize the need for a new device or procedure. Never stop thinking about how a medical device, you use, could be improved. Above all, don’t censor yourself by assuming that someone else has already thought of your idea. Write your ideas down in a special notebook, which you keep near your desk. Otherwise the ideas will slip your mind. Pick an upcoming slow or off day in the next month and make a note in your calendar to revisit your latest idea.

Being A Medical Entrepreneur Is Risky Business: Spotting The Landmines

Your job as an medical entrepreneur is to kill your idea early and often.

The innovation landscape is littered with buzzwords describing the impact of new ideas: earth-shattering, killer-app, disruptive, blockbuster, game-changer. Your idea, invention or discovery might be one of them. However, before you get ahead of yourself, or full of yourself, take time to do a high-level risk assessment. In this exercise, your goal is to kill your idea early and often and continually ask "Why shouldn't I kill this idea now?"

In bioinnovation, the risk categories generally include:

1. TECHNICAL RISK: Will my invention or discovery do what I claim it will do?

2. FUNDING RISK: Will I be able to get the money to do what I want to do when I want to do it?

3. INTELLECTUAL PROPERTY RISK: Will I be able to protect the intellectual property I create, control it,  and defend it?

4. EXECUTION/TEAM RISK: Will I be able to surround myself with experienced exectives who wil be able to execute our business plan?

5. MARKET RISK: Is their a large enough unmet need that will continue to grow and be profitable?

6. INDUSTRY RISK: Will the industry continue to grow and be immune from threat of substitutes, competitors, shifting supplier and buyer power?

7. BUSINESS MODEL RISK: Will your proposed business model, i.e., how you will make money, work?

8. REVENUE MODEL RISK: Are your assumptions about number of leads, conversion ratios, units sold, revenue/unit and repeat business valid, or are you betting on "only" .1% of the China market?

9. COST RISK: Are your fixed and variable cost projections reasonable?

10. REGULATORY AND REIMBURSEMENT RISK: Will you be able to get FDA approval and get someone to pay for your drug , device or diagnostic before the money runs out?

Give yourself 1-10 points for each category.

70-100: You've got a shot

50-70: Sounds like you have more work to do

<50: Don't give up your day job.

Performing this risk analysis before moving ahead with a formal feasibility plan (forget the business plan, dude, you are SO not there yet) will help you avoid spending time, effort and lots of money on an idea that was DOA from the beginning. The last thing you want to hear is your spouse telling you "I told you so".