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Healthcare Fastlane Journey (So far...)

A detailed account of a Fastlane process...

Chromozone

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Hello!

Just thought I'd post a progress thread. I feel indebted to MJ for writing such great books and really want to give something back (as if taking my money wasn't enough! :p) !

The Millionaire Fastlane really changed my life when I read it one and a half years ago. Unscripted has just blown my mind once again! Although I'm not a millionaire yet, I've started to get some "orange gumballs" recently and I'm going to keep going until I reach my goals - i.e. the Fastlane.

Just a bit of background

I'm a 30 year old, second generation Indian living in England. My dad's a doctor and so am I! No, that doesn't mean I was forced into becoming a doctor - luckily I've never suffered with a victim mentality and have always taken responsibility for my life. I truly wanted to be an MD since I was a wee lad.

I think having immigrant parents gave me a really strong work ethic and seeing where they've come from and how far they've gone in life is actually super inspiring.

I didn't always have a strong work ethic though... When I was in school and college I was the one always messing around who still got good grades. Teachers hated me because of this and as a result, despite my grades I was given insanely bad references and got rejected from medical school 8 times! I was so determined to study medicine that I ended up going to a random Eastern European country for six years to get my MD.

"The whole educational and professional training system is a very elaborate filter, which just weeds out people who are too independent, and who think for themselves, and who don't know how to be submissive, and so on -- because they're dysfunctional to the institutions." - Noam Chomsky

That was and still is the hardest thing I've ever done. No one spoke English (I couldn't even buy friking uncarbonated water for the first two weeks!), I experienced a ton of racism and humiliation, and as the country used to be communist their education system is designed as a way to make you conform and suck up as much time as possible. When I first got there I thought the whole "medical school" was a scam! There was an >80% fail rate. I worked my face off for 6 years to get my MD. Talk about a slap of reality!

I promised myself that one day I would become successful after that experience!

The Beginning

Everyone knows that there's load of stuff broken in the world of medicine. I came across a problem that seemed so simple to solve that I just had to pursuit it. I figured out a solution in my head and realised that I would use it as a patient and as a doctor for my patients.

At this point I was just a junior doctor in a hospital setting. I tried to get in touch with anyone that could point me in the right direction to get started. I tried to get in touch with the hospital managers, the CEOs, the "Innovation Team" (which comprised of some old lady who hadn't heard of this newfangled thing called "The Internet"...).

I was persistent. I needed to figure out how to get started and although some of these top tier people at the hospital feigned interest from time to time, no one gave a damn.

"Be genuine, be remarkable, be worth connecting with." - Seth Godin

I managed to find out about someone who is in charge of innovation for the whole of the NHS (National Health System). I started to research him and then one day he tweeted that he was going to give a talk on the other side of the country to a small number of people.

I finished a night shift, slept for two hours and drove to the other side of the country to try and meet him. I was so desperate at this point just to get started.

I'll never forget one specific moment. When I got to my hotel to freshen up and get dressed into my suit, I just stared at myself in the mirror. I honestly felt like such a loser at this point and nearly decided not to go! I figured that I came this far so I might as well just bite the bullet.

It's funny how our brain always stops us from putting ourselves out there, even if it will result in a much better life. What's the worst that could happen? He could tell me to scram, but that's already happened a countless number of times by countless other people!

After his talk, I finally managed to get in front of the man himself, who to my surprise was absolutely flattered that I had traveled so far just to meet him! Within one day he introduced me to all the contacts I needed to at least get started on my project and not be sued/put in prison.

MVP

Prior to getting the green light I already knew what my MVP would need to look like. I started to learn to code during my free time. I wasn't progressing quickly enough.....I realised that I couldn't trust my code to handle patient confidential and sensitive data. I want to help people, not harm them! Damn!

Side note: I was working in the ED when I was studying for my professional exams, working out five times a week, learning to code, reading books and it's also when I found the time to drive to the other side of the country to meet the Innovation lead. I laugh at people when they say they "don't have the time"! Your actions reveal what you really want in life, not the garbage that you may mutter from time to time; "one day I'll....".

I decided to go down the contracted developer root instead. Learning the basics of coding is very important and handy though! So just go ahead and learn as it's not that hard to be honest.

Codecademy are good. Udemy have some very good "full stack" tutorials which go on sale from time to time. So I spent £10 on a course which taught HTML, CSS, Java, PHP etc. Then just watch tons of YouTube videos which show people coding.

I put down most of my cash into my MVP. It was another leap of faith. I figured that I would need to pass all my exams from that point in the first attempt or I would have to take out a loan to finish my training. (Luckily I passed everything first attempt).

As we were approaching the end of the build for our MVP, I still hadn't found any hospital / healthcare setting that would use it! Literally the week we finished building I managed to find somewhere that wanted to use it as a trial! I felt so relieved at this point! We launched in Jan 17.

Over the next month we got some really impressive data which proved my assumptions. I kept on iterating the product with my developers.

Searching For Product Market Fit

At this point the developers were really bought into the idea and were very keen on joining me. We were getting a lot of attention and also were being approached by large health IT companies to integrate with them.

Unfortunately talks fell apart when we sat down to talk about joint venture contracts and shareholder agreements. I was going to split everything equally, so that I would retain 1/3. They were happy with this, but when I said that at some point we would all need to quit our jobs and go all in they said that they "couldn't".

I asked what metric they would need to achieve for them to go all in, but they said that they never would! Can you believe this? They make around 20K every year, but they didn't want to join even if we could get to a stage where they could have more money? I moved on at this point and found another developer who has been very good up to now who will likely join full time if we get to a certain level of revenue.

I think this is the best way to get a developer on board. Do something interesting, challenging, meaningful. Get traction, be convincing, be genuine, have tons of credibility and domain mastery, with tons of connections. You'll get a lot of interest from developers who want to join if you do this. As MJ always says in his books - people are always focused on "events" not process. Imagine going to a developer and saying; "I've built this, we're in this hospital, we've got this data, after a month we're already in major talks with these healthcare providers". Most developers I've met have leaped at the chance, because most people want to be "chosen" as it's an "event" from them. This way you can pick the best developers as well.

Soon after our initial launch we were approached by a specific type of healthcare provider who now wants to use our app in a bit of a different way. They've paid for us to build some more features and when we launch within the next 6 weeks, we will officially have a decent amount of revenue coming in. However, it's the data that I'm mainly after. The data at this point is worth more than than the revenue, because it will let me push this system into all the other providers who are struggling with the same problems.

We're also now in talks with some large government organisations now to integrate our services and be one of the official apps (meaning we'll be used nationally).

We're continuing to push ahead with our initial vision which could have a massive impact (magnitude) and also have be used by lots of patients throughout the country (scale). As I'm now a senior doctor, I can really push ahead with ideas that I couldn't before (barrier to entry is insanely high. Good luck trying to do what I'm doing if you're not an MD and have real domain experience to boot!)

This next year is going to really reveal if I have a chance of being really successful. I will keep posting updates! I am so driven to succeed. Either this works or I die, it's that simple.

Not sure if this was helpful for anyone, but I just want to stress that I was just like every other junior doctor when I started. No one would listen at all, but you can't ever give up. The market is what wins at the end of the day. The market shouldn't be confused with the incumbent industry that you're trying to change.
 
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Scot

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Awesome introduction to the forum. Not only do you have a great story of working your a$$ off, you've also applied that mentality to break into the fastlane.

My slowlane job is in the healthcare space too, so I definitely recognize how insanely high the barrier to entry is here.

Massive rep+ for sure.
 

Chromozone

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Thanks for reading Scot!

I have to say that once you've broken down that barrier to actually start a healthcare company in the uk, it's a totally different world!

The circle of people who create change in the UK is very small and so once you're in that circle things are just easy to really execute.

I think anyone working in an incumbent industry will have a similar experience when trying to start.

People like the idea of what you're going to do, but want evidence. Well, how are you mean to get evidence if no one wants to take the leap and use your product or service?

However, once you get that evidence, meet certain regulations etc, it's a whole different ball game!
 

Chromozone

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I had another meeting with a government organisation yesterday. This is an organisation which is meant to oversee all the technology used in the national health service.

When I launched my MVP, I honestly didn't know if I was breaking the law, because there's so much red tape. After talking with them yesterday.....I still don't know if I'm breaking the law! The "head of apps" basically said my technology was months ahead (translation in a government organisation = years ahead) of what their legislation can currently deal with.

This is worrying and confusing, because obviously you don't want to be too far ahead of your time. However in this case, my technology isn't too far ahead of other industries - it's just that the NHS is so backwards.

They basically said just to continue doing what I'm doing. I explained that I've got a major sale coming up next month. It still seems I can go ahead as long as I have all my legal documents in order!

On the plus side I've been asked to help them design their approval system (which currently consists of >250 questions! :oops::wideyed:) and this should assure that my app is one of the first to be officially approved.
 
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Scot

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I had another meeting with National Health Service (NHS) Digital yesterday. This is a government organisation which is meant to oversee all the technology used in the national health service.

When I launched my MVP, I honestly didn't know if I was breaking the law, because there's so much red tape. After talking with NHS Digital yesterday.....I still don't know if I'm breaking the law! The "head of apps" basically said my technology was months ahead (translation in a government organisation = years ahead) of what NHS legislation can currently deal with.

This is worrying and confusing, because obviously you don't want to be too far ahead of your time. However in this case, my technology isn't too far ahead of other industries - it's just that the NHS is so backwards.

They basically said just to continue doing what I'm doing. I explained that I've got a major sale coming up next month. It still seems I can go ahead as long as I have all my legal documents in order!

On the plus side NHS Digital have asked me to help them design their approval system (which currently consists of >250 questions! :oops::wideyed:) and this should assure that my app is one of the first to be officially approved.


That's awesome!

When dealing with things like this, have all your legal stuff ready, but proceed with a "ask for forgiveness, not permission" approach.
 

Chromozone

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Hey!

Completely agree re; having the legal stuff at the ready.

It's a really dreadful feeling the night before a new launch though! The stuff we're handling can have a real negative impact on patients if we mess it up. It always feels like I'm about to get sued!
 

NFT

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When I was in school and college I was the one always messing around who still got good grades.

Virtual high five!

Really nice introduction. I especially agree with what you said about time. Everyone gets the same 24h each day, its just a matter of how one uses them.
"I dont have time" means "It is not a priority right now" because if it would be very important to people, they could find time to do it!

Keep going, you are making great progress!
 
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Chromozone

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Thanks NFT!

I think I messed about at school so much because I could kind of always see through the garbage that was being taught!

What I find really interesting though is that a lot of people who have spent a long time in education get into the mindset that there's a "trick" to becoming successful. (I hope I also haven't fallen into this trap!)

At school there's always a "trick" to getting a good grade. For example, by memorising the answers, instead of understanding the questions...But I've found in entrepreneurship, that there really isn't a trick. You just have to make something that people really like and want to give you money for.
 

NFT

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Exactly!! I just finished school and I have to say it was a pain in the a$$. The amount of bias going on is really annoying.
But anyways, not our problem anymore.

Agreed, there is really no shortcut in entrepreneurship, although a lot of people think otherwise.
"Here, just buy this product and earn 7000€ a month without effort"
Product costs 200 bucks, unbelievable that people can't see through this shit.
 

Chromozone

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Totally agree.

The worrying thing for people who have been in education a long time though is that they actually confuse "the process" with "the trick" or "the event" like MJ calls it.

People who have been in education for a long time think the real world is all about jumping through hoops. Get a good grade, be in the football team, play a musical instrument and so on.

For example, I know a lot of other doctors who are trying to start their own businesses. They generally come up with an idea, get an "MVP" out (a trick to put something out there to make money fast, instead of trying to learn about the market), raise money (another trick to reassure themselves that they're right, even though they're still not near to a sale!), hire a team (another trick which allows you to call yourself a CEO) etc etc. All of this looks like actual "process" to the outside world and to themselves, but it's just a massive trick!
 
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NFT

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What goes around comes around. Surely most of those "CEOs" won't achieve anything worth speaking of.
 

Brewer07

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Awesome post. Really nice to see another healthcare worker around here (I'm a pharmacist).
When I launched my MVP, I honestly didn't know if I was breaking the law, because there's so much red tape. After talking with them yesterday.....I still don't know if I'm breaking the law! The "head of apps" basically said my technology was months ahead (translation in a government organisation = years ahead) of what their legislation can currently deal with.

This is worrying and confusing, because obviously you don't want to be too far ahead of your time. However in this case, my technology isn't too far ahead of other industries - it's just that the NHS is so backwards.

A common theme around the states is two industries remain which still haven't truly been "disrupted" by technology: airlines and healthcare. Would you say it is the same in the UK?

I'm excited to follow your journey and learn more about your product/service. I love following technological innovation in healthcare!
 

Chromozone

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A common theme around the states is two industries remain which still haven't truly been "disrupted" by technology: airlines and healthcare. Would you say it is the same in the UK?

Thank you both for reading. It means a lot to me!

If you had read my initial post a week earlier, I actually named the "Government Organisation" I was talking to! Unfortunately, they keep tabs on where they are mentioned on the Internet! They rang me in the middle of one of my afternoon clinics last week and demanded that I remove the name of their organisation from my posts here and on my personal blog! I had to stop seeing patients and delete / amend stuff! I think this shows how strict they are on everything!

Having said that, I think enterprise software, including health is an incredible opportunity right now. The consumer world has really been changed already and now these large incumbent industries are ripe (and ready!) for change. In the next decade things are going to massively change in healthcare and it's very exciting to be involved with this stuff in the NHS.

In other news I just had an amazing weekend at an event I was invited to in London. I got to meet the CEOs of some major VC firms in London as well as Angels and CEOs of medical companies with billions of dollars in turnover. I've now been introduced to a hospital and some other services who may want to use my app. This is a great opportunity to sell more of my product and as it's a warm introduction I may be able to move really fast.

I also had a crash course in accountancy by a gentleman who successfully built his company and exited via an IPO. He had some great stories but he really opened my eyes to all the tax relief I have not been claiming on!

For anyone that's reading this in the UK I just wanted to pass on two things/offers.

1) I just found out that in the UK if you have invested money into a venture, that you are allowed a 50% tax refund from the government. I had no idea, but all the money I used to bootstrap my idea, I can claim 50% back! Everyone from the UK NEEDS to look at this link immediately: EISA

2) If anyone in the UK is thinking of doing any healthcare innovation / products etc, then please do get in touch with me. I'm super well connected and if your product is going to make things better for patients then I would be more than happy to introduce you to the relevant people.


:smile2:
 

Kwikbitz

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Hi Chromozone.

To quote you "If anyone in the UK is thinking of doing any healthcare innovation / products etc, then please do get in touch with me. I'm super well connected and if your product is going to make things better for patients then I would be more than happy to introduce you to the relevant people."

Yes I have such a product - all be it simple (very) and intended to be affordable to all. Here is a brief summary -

The product, called YQ (think about it) is a digital virtual reception that delivers a cost benefit to healthcare professionals - making patient check-ins more efficient, increasing time available for patient care & satisfaction. YQ is a real time patient self service check-in that has been designed to quickly obtain all the relevant information needed from a patient prior to consultation.

Patients check-in then simply follow "ATM" style steps (routes) for the medical attention they need.

YQ starts by obtaining the basic patient details - name and age. Then as the patient travels their YQ route they click buttons to answer "YQ prompts".

The answers to the "YQ prompts" are generated from YQ's internal (and maintained) database which contains over 35,000 unique branded and generic prescription drug names*, over 5000 known medical conditions together with lists of known allergies, vaccinations and health checks.

An example of a YQ route would be:

What type of problem is there e.g.
How serious is the problem?
What are the symptoms?
Is the patient currently taking any prescription medication - if so which?
Does the patient have any pre-existing medical condition/s - if so which?
Does the patient have any allergies - if so which?
The patient reviews their information and completes the YQ check in process.

Throughout the simple "ATM" style check-in process YQ provides healthcare professionals with a live, real-time data feed for their current EMR / Appointment system with all the relevant information they need.

* All prescription drugs listed within YQ are authorised for use by either the FDA, NICE or the EMA and updated on a monthly basis

OK, not in the UK, but am British - (OK Welsh but...) and over the channel in the Med (Greece) - I have introduced the system to our local Health Clinic and seen it in operation - there is a bit more than the description given - e.g. multi lingual etc. Example of operation I saw yesterday was a Tourist with a allergic reaction to a bite cream (don't know which one but think it contained Penicillin) that had been bought at a pharmacy - using YQ (The patient used Italian as a 'their interface' and Doctor Greek as 'their interface') - this (the patients allergic reaction) would have been avoided because YQ asks questions like that - time saved, great patient care and increased satisfaction - 'next please' :)

I too have tried with NO luck with CEO's Digital Health etc .. so good for you and seriously good luck with all

YQ
 

Chromozone

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Hi Kwikbitz! Nice to meet you.

Congratulations on already getting your product used! This is no small feat!

I would say that if you want more clinics to pay for your product then you need to give them something that they see massively helping them. There are two ways how you can prove that you're massively helping them. Either by increasing efficiency or by increasing revenue. Increasing revenue is an order of magnitude better than increasing efficiency.

Getting data from the clinic you're in should be able to give you the metrics you need to expand. If there aren't some really impressive metrics, you may need to adjust your plan. You're in a very good position if you've already launched somewhere!

The CEO's etc are generally detached from the actual problems on the front lines of healthcare. They only understand metrics. So get those metrics and put together a strong Health Economics case!

Keep us posted! Would love to hear how things progress! I need to up my game! :)
 
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Kwikbitz

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Hi Chromozone,

Thanks for the vote of confidence :)

Naturally metrics will/do play an important part as I agree 'CEO's etc are generally detached from the actual problems on the front lines of healthcare' to be cynical in healthcare I see more 'detached from the actual problems' in general and more concerned with $ than care but that's just me being cynical where I am not cynical it they believe that 'just because it's a healthcare product' it must be expensive or else we will not look at it ..... - OK cynical again.

'If there aren't some really impressive metrics ...' You'd love our clinic - how much time do you want to spend with a patient? Think NHS ... then forget that. It's small, staffed etc but I would guess if they see 30 - 50 patients a day they would be over worked :) and it's open 24 hours ... Next step is actually the regional hospital here now that gets quiet a bit busier.

But enough of my woes :) To add to your comment ' Either by increasing efficiency or by increasing revenue. Increasing revenue is an order of magnitude better than increasing efficiency. ' It has the ability to do 'both' how many receptionists can 'fit' into reception and how often do care staff get involved in 'admin/reception' type duties ... No how many PC tablets can you get into a small reception point? a lot more - medical receptionist salary - you would know better than me - vs cost of tablet ... gives you both an increase in efficiency as the system - being real time (think in terms of 100m/s) response time in the data feed between patient and the healthcare professional's feed, plus the ability to get all the right info prior to consultation increases the time available for the 'actual' consultation. Increasing patient F2F time increases patient turnover - increases revenue.

No we do not expect YQ to replace receptionists (or the need for them) but what we do see is a tool that can maximise their time and that of the care team.
 

Chromozone

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Hey!

Yes the people at the top in healthcare really do seem from a different world a lot of the time!

As George Orwell once wrote: "In our society, those who have the best knowledge of what is happening are also those who are furthest from seeing the world as it is. In general, the greater the understanding, the greater the delusion; the more intelligent, the less sane."

In any case, I've recently become the co-owner of a clinic in the UK. So have a look at things from my perspective; if I can reduce staff (i.e. employ less people) to do the same work then I'm all in. One less receptionist for example would be an extra 16K or so for the practice. However, until I get to that point of employing less people it's costing me the same amount of money plus paying for an extra piece of tech.

However, there are lots of ways for clinics and hospitals to maximise revenue in the UK. Have a chat with your clinic to find out where their revenue stream actually comes from. Can your product help maximise the metrics so that they get paid more for doing less?

In the UK funding is a little complex, but following the money, understanding how hospitals and clinics get funded is key because it will allow you to iterate and pivot so that your product will do what the owners of the clinic want - to make more money!
 

Chromozone

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Just as an example. In the UK, we get bonuses in our clinics if we give a certain percentage of our patients an influenza vaccine. If your innovation automated this process when they walked in to the clinic then it would bring in a lot of money. There are other ways we handle this at the moment in the UK. But it's just an example of how you can actually generate revenue.
 
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Kwikbitz

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Hi (again) Chromozone,, good reply :) and one that makes me smile a lot. 'revenue,revenue,revenue'

Have a chat with your clinic to find out where their revenue stream actually comes from.

Whislt I slightly jest 'revenue stream' what revenue stream? No seriously this is a more like the 'old NHS' you need treated - cost from Gov't funds (well if there are any over here in Greece :))

Can your product help maximise the metrics so that they get paid more for doing less?

I would twist your statement they can do more in less time and with less stress/hastle for the same $ -

But when you say '... plus paying for an extra piece of tech' I can see that, but I'm talking of a product that when available to buy (i.e. open market rather than trialer's) will be priced i.r.o. £50 - £75 per year per clinic NOT per user though have a version for hospital type establishments that costs more.

In the UK funding is a little complex .... Tell me about it :) - all too aware of that fact and the fact there is never enough funding :)
 

Kwikbitz

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Just as an example. In the UK, we get bonuses in our clinics if we give a certain percentage of our patients an influenza vaccine. If your innovation automated this process when they walked in to the clinic then it would bring in a lot of money. There are other ways we handle this at the moment in the UK. But it's just an example of how you can actually generate revenue.
God (pardon my language) of course it can .. it could even 'pinpoint' prescription drugs, speed heath checks (and improve attendance) and much more ... Oh and 'broadcast' news/articles etc from/for the clinic events etc.
 

Chromozone

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Hi Kwikbitz!

These are good questions! And trust me, I had the same thought process when I started my company! It's only as I've gotten more involved and gained more seniority that all of this stuff came to light.

The UK also is a government funded healthcare system, however money isn't just given per patient treated. There are a lot of metrics, different regional goals, health outcomes that are in place. If these targets are hit then more revenue will be supplied.

An example in a hospital: If you break your hip, you need to get your neck of femur fracture proforma filled out correctly. At the end of the year this number is audited and if a certain percentage is reached, then it's a bonus for the hospital. This is in place, as mortality rates increase if these forms are not filled out within the first twenty four hours.

An example in the clinic: If you check all diabetics hba1c (sugar levels) once a year, the clinic will get more money given for reaching targets.

An example at the local comissioning level: Can we reduce the overall amount of opioids (morphine based meds) being prescribed. If so we'll get more money.

These are all needs that will make people more money and they would be more than happy to pay you for your product. Again, have a chat with the clinic - how do they get funded? What are the ways they can increase revenue?

The problem with efficiency and the reason increasing revenue is an order of magnitude better is because it's hard to convince people that efficiency alone is worth doing.
 
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Chromozone

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Just thought I'd post another update regarding my app and what I have learnt since I last posted.

I've recently closed a deal to launch my app in a 70,000 patient clinic. Very excited about this. I need to give some training to the staff there and then we'll be unleashing it on their patients in the first week of October. Cannot wait to see what happens. Some of the owners of the clinic are on the board of the local health board, so if I can do a good job for them it should start to spread and be used in more and more clinics.

Apart from this, I've recently become a partner in my own clinic, which is allowing me to test my app and continue to iterate at a much quicker speed.

I wanted to share some insights for anyone looking at doing SAAS or medical software below. Really hope that this is useful for people, I wish someone had told me this stuff before I started! :)

Get Your Hands on the P&L! Follow the Money.

I already had a good idea about how clinics in the UK get paid, but since becoming a partner I've been able to really scrutinise the P&L statements of my clinic. In my experience it becomes painfully obvious what problems there are in a clinic/a business if you look at these statements. Anything you can do to increase the profits of a business means that businesses will literally go out of the way to try your product, even if it's not yet an ideal solution yet.

Should You Integrate?

My app is not integrated with other pieces of healthcare software at present. I think that I will need to integrate in the future, but currently I believe that I can integrate in an organic way (i.e continue to sell more of the software and use the revenue from the business to buy the (expensive) APIs and integrate). I believe that I've gotten away without integration for the time being, because I'm solving a real problem for myself and my customers.

From what I have seen with other startups in healthcare, if you integrate without proving that you are generating cash, integration will kill your business as it takes up a lot of resources to get all the certification needed for integration and then even more resources to work with such complex APIs.

In my opinion it's best to make a viable business if possible and then go for integration. If you're profitable then you have a lot more to help you bargain as well. For example, the 70,000 patient clinic we will be launching with want my software integrated and they would be happy to switch EPRs (Electronic Patient Records) to get full functionality. I'm planning on using this as a bargaining chip when I am serious about integration. I am already in talks with an EPR regarding integration, but I'm just really honing the product first, which I feel is the right thing to do for now..

Which Language?!

Another thing that I've realised has helped me a tone are the languages that my app is written in. Honestly, I got really lucky with which languages were used, as I didn't initially even bring it up with my developers when I started. I just told them to build what I discussed with them. They ended up writing my app in Javascript, PHP, MySQL. In retrospect this has been great. PHP and MySQL are the most common back end languages/databases which makes it very easy to scale and hire for my app. It has allowed me to get quotes from a ton of different people and consider outsourcing etc.

I figure that I, as an entrepreneur should focus on sales, scaling and hiring as needed. As PHP and MySQL are so common I've had a very easy experience on getting quotes and building my app so far. I feel that I would have struggled a lot more to build and hire as quick as I have if I chose for example Ruby as back end and Mongo as the database.

My theory is that the app is working and doing its job for the time being. There is some spaghettification in the code base at the moment, but I think it will only break if I get much bigger. When it's much bigger I will be in a position to hire full time developers in any case.

So my advice to myself would have been: go with PHP, MySQL and don't worry about scaling. Move fast and get sales.

How Do I Get Software Into Incumbent Organisations?

I wish someone had told me this following bit of advice a loooong time ago!

Over the last few months I've been meeting more and more people and talking about my app with anyone that will listen. What's interesting is hearing stories from "back in the day". More senior clinicians have been telling me about how the first EPRs came to being in the UK and how the large companies came to being worth 100's of millions of pounds today. The thing is that you won't be able to find this info by Googling - it's been lost to history. So, I'm not sure if I'm the first person writing about this on the net! Haha!

The first major EPR in England did something really clever. Back in the 80s clinics didn't even have computers. So not only did the EPR have to get clinics to use new technology but they needed to buy them computers as well! It seems that what they did was approach the large pharma companies and explain to them that if clinics used IT, then the pharma companies would be supplied data about drug use from the clinics. In the end the pharma companies ended up paying for all the computers! I've met the founder of the first EPR used in the UK and he is a beast of an entrepreneur and a great guy. I can't imagine what he must have gone through to pull this off!

Later on other EPRs came along, but they came along as then the government put in a defined way to get accredited to become a EPR - basically the government wanted more competition in the market place.

What I've realised is that there are always government plans and initiatives. Entrepreneurs just need to find out what they are and solve the problems the government/incumbents want solving. It's basically your way in and a way to get sales, backing and funding.

In the UK healthcare system a good place to start would be by reading the Five Year Forward View. If you can come up with ways to help the government/healthcare system to carry out their plans you will get a ton of support and backing from everyone.

Bit of a long post, but hopefully useful to fellow Fastlaners. :)
 

Genius01

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Hi Chromozone, how has your app fared on this last quarter (since your last update in September).
Any new updates?
 

Chromozone

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Hi Chromozone, how has your app fared on this last quarter (since your last update in September).
Any new updates?

Gosh, it's been a while since I posted! :O

It's been going really well, thank you! I've got all the pilots etc that I need now. And before 2017 was over we hit 2,500 patients registered and using the app.

Now it's a case of gathering some more data and building a couple more features. The app will be able to do exactly what it needs to by end of Feb / beginning of Mar. After this I'll be in a position to start doing some more selling.

The wonderful thing is that even if no other clinics buy the app and it's only used in my own clinic then I earn an extra £15K - £20K a year, so the software will pay for itself after a very short period of time.

One last thing of note: I was struggling a lot with pricing previously. But I came across a great book called "Don't Just Roll the Dice". It's a free pdf made by RedGate: ( Don't Just Roll the Dice - Redgate Software ). I'd really recommend reading this, it really helped me get a few things straight in my head.

I'll be sure to post some more news in a couple of months - that's when things will start t get interesting. :)
 
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Genius01

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Gosh, it's been a while since I posted! :O

It's been going really well, thank you! I've got all the pilots etc that I need now. And before 2017 was over we hit 2,500 patients registered and using the app.

Now it's a case of gathering some more data and building a couple more features. The app will be able to do exactly what it needs to by end of Feb / beginning of Mar. After this I'll be in a position to start doing some more selling.

The wonderful thing is that even if no other clinics buy the app and it's only used in my own clinic then I earn an extra £15K - £20K a year, so the software will pay for itself after a very short period of time.

One last thing of note: I was struggling a lot with pricing previously. But I came across a great book called "Don't Just Roll the Dice". It's a free pdf made by RedGate: ( Don't Just Roll the Dice - Redgate Software ). I'd really recommend reading this, it really helped me get a few things straight in my head.

I'll be sure to post some more news in a couple of months - that's when things will start t get interesting. :)
That's great! Happy to hear that.
Wish you more spectacular growth going forward into this year.
 

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