David Putrino Hacking Health How to Make Money and Save Lives in the HealthTech World Hacking Health David Putrino Hacking Health How to Make Money and Save Lives in the HealthTech World 123 David Putrino Icahn School of Medicine at Mount Sinai New York, NY USA ISBN 978-3-319-71618-3 ISBN 978-3-319-71619-0 (eBook) https://doi.org/10.1007/978-3-319-71619-0 Library of Congress Control Number: 2017959313 © Springer International Publishing AG 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland To Dr. Jean F. Coppola, who taught me how, when, and why to use technology to enrich communities and impact public health. Your vision, passion and friendship will be greatly missed. Acknowledgements Writing any sort of book tends to be a fairly solitary and selfish endurance event. As such, I am incredibly fortunate to have an incredible support network of wonderful people who helped me through this process. Thanks to these people, I even man- aged to have a bit of fun writing this one, and I hope some of that comes through to you all. I am especially grateful to the following: To my wife, Rose, for putting up with all of the complaining, late nights and early mornings with (mostly) good humor and lots of love. To my parents and brothers for bringing me up in a loving, supportive, and enriched environment that has kept me curious, confident, and motivated over the years. To Nichole, John, Bunny, David, Robin, Marta, Phil, and Rachel for patiently sifting through all of the disorganized thoughts that made up my first drafts, helping me to make this thing readable. To Rusty, Brandy, and Brad for all of their amazing reading recommendations. To Flux, for his amazing animations. To our dog, Brasky, for taking me for daily walks. vii Contents Part I Nuts and Bolts 1 Introduction—Why Me? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2 Constructing Your Idea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 I Want to Develop an App that Helps People to Recover from a Total Knee Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 A Patient-Centered Product . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 A Caregiver-Centered Product . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 3 Forming Your Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 4 The Usual Suspects: Members of Your HealthTech Team . . . . . . . . 27 Chief Executive Officer (CEO) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Engineer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 End-User . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Designer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Scientist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Regulatory Expert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Part II Case Studies 5 The Big Corporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 6 The Small Startup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 7 The Social Good Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 8 The Human Performance Division . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Epilogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Reading List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 ix About the Author David Putrino is physical therapist with a Ph.D. in Neuroscience. He worked as a clinician in Australia, before moving to the USA to study computational neuro- science at Harvard Medical School, MIT, and NYU. He has served as a Faculty Member at Weill Cornell Medicine and Burke Medical Research Institute. He is currently the Director of Rehabilitation Innovation for the Mt Sinai Health System and an Assistant Professor of Rehabilitation Medicine at the Icahn School of Medicine at Mt Sinai. He works to develop innovative technology solutions for individuals in need of better healthcare accessibility. He consults with the Red Bull’s High Performance division, using evidence-based technologies to study and improve athletic performance. In his spare time, he volunteers for Not Impossible Labs, a group that creates disruptive technological solutions for high-impact humanitarian problems. In addition to a number of academic publications, many of David’s projects have been featured on ABC, Sports Illustrated, the Wall Street Journal, the BBC, Time Magazine, Wired Magazine, and the LA Times to name just a few. He lives in Brooklyn with his wife and dog. xi Part I Nuts and Bolts “I was taught that the way of progress was neither swift nor easy” —Marie Curie I was eight years old, laid out flat on a big rug in the living room of my parents’ home in Western Australia. I was watching Star Trek IV (circa 1986) with my brothers: It’s the one where Captain Kirk takes his crew back in time so they can save the whales. I was completely enthralled…even at eight years of age, I was already a massive nerd. There’s this fantastic scene in the movie: Pavel Chekov, the Navigator of the U.S.S Enterprise, has sustained a head injury and lies comatose in a 1986-era hospital in San Francisco. Chekov is in a lot of trouble—the surgeons in the hospital are looking to drill a hole in his skull so that they can relieve the pressure on his brain. He is at the mercy of twentieth-century medicine, and things are looking real bad. Just as the “primitive” surgeons are preparing to scramble our favorite navigator’s brains, the hilariously sassy Doctor Leonard McCoy sweeps into the operating room majestically. He brutally excoriates the surgical team and pulls a couple of small devices out of his pocket—the first effortlessly diagnoses the problem: a burst blood vessel in the brain; the second heals the damage in a matter of moments. Chekov is fully recovered, McCoy takes a final jab at the barbarism of 1986’s medical prowess, and they leave the operating room in triumph. Fast forward more than 30 years on from that fateful scene in Star Trek, and I’m ready to admit that TV may have lied to us. Health technology is on the brink of a revolution that we sorely need, but we’re yet to hear the first shots fired. Most healthcare experts acknowledge that the unprecedented rate of global aging will place overwhelming strain on health resources. Traditional models of healthcare delivery will prove inadequate for dealing with the sheer volume of individuals who will be in need of quality care. The healthcare industry is facing an enormous gap in its ability to deliver care to a large number of underserved individuals. Technology presents the field with an unprecedented ability to bridge this gap. Many different and fascinating fields have emerged in response to the realization that pairing technology and healthcare may be beneficial: health technology (HealthTech), biodesign, electronic health (eHealth), bioengineering, biotechnology, digital health (dHealth), mobile health (mHealth), telemedicine, and telehealth just to name a few. 2 Part I: Nuts and Bolts To keep things simple, this book will use the term “HealthTech” from here on out. Of all of the terms/fields listed above, I feel that HealthTech is the one that is broad enough to encompass all of the flavors of products and entrepreneurs that this book will reach and help. The arrival of the HealthTech field has also created a burgeoning marketplace: The current global value of this industry is estimated at $85 billion (as you read these words, this number has already grown), which will continue to grow to an estimated $300 billion by 2022. Big numbers, right? These numbers alone have inspired many people to drop everything and get involved in HealthTech start-ups. In addition, there’s an altruistic component to all of this, which means that HealthTech is also attracting a host of entrepreneurs and investors who are prone to soul-searching and/or self-loathing about their unapologetically capitalist lifestyles. Many of these ethically conflicted, tortured souls are flocking to the HealthTech marketplace because they see the opportunity “do some good and help people in a way that is still good business.” From my perspective, I welcome this influx of experienced entrepreneurs, because the field certainly needs the help of a group of people with strong business experience. Now, onto the bad news: Despite the size of the marketplace, HealthTech start-ups experience a much higher failure rate than a typical tech start-up. According to a recent contribution to Forbes, only 2% of HealthTech start-ups actually reach the point of revenue or adoption. I think that it is important to really highlight this statistic: We’re not even talking about commercial success here— we’re simply talking about a point where a HealthTech product reaches a mar- ketplace where it can be bought and sold. This should be a frightening and sobering statistic for anyone who is involved in a HealthTech start-up right now. The pri- mary reason for this prodigious failure rate relates to the misconception that creating a HealthTech product is the same as developing any other tech product. The purpose of this book is to guide readers through the steps and logistics that are unique to the development of a successful HealthTech product. We will cover the “basic anatomy” of a HealthTech team and discuss the essential core compe- tencies needed for effective HealthTech product development, including where one can find individuals with these competencies. In addition, a discussion of ethics in the HealthTech arena is crucial to this book—not just medicolegal ethics, but also business ethics, so we will certainly spend some time on that topic. The importance of strong team dynamics within a HealthTech start-up will be explored, and how gaining a fundamental understanding of each team member’s individual motiva- tions is crucial to the success of a project. Finally, we will cover a series of case studies that document some of my personal interactions with many companies that are attempting to make the move into the HealthTech ecosystem. These case studies will document both successes and failures of large-, small-, and middle-sized ventures. The purpose of the case studies will be to deconstruct each project, and provide an overall summary of the particular type of HealthTech venture that each case study represented, detail what went right or wrong, and provide a