As more software companies turn their focus on healthcare, Product Managers who are new to the industry will notice the intricacies that make building, launching, and maintaining a product in healthcare different. Healthcare is one of the most unique industries in terms of regulation, data sensitivity, and social impact, which pushes product teams to take novel approaches to typical “playbooks” that exist. While healthcare’s strict privacy rules, high costs, and siloed software systems can make it seem like an unattractive industry to work in, that is just why more of us need to help. The outcomes of improving anything from health data analysis to back office efficiencies all impact care in some way, and can ultimately improve the health of our society. That is the ultimate pay off. I hope to provide a little bit of insight into some challenges you’ll face as a PdM in healthcare, preparing you to build healthcare products for the first time.
Note: My experience is primarily in building products for hospitals in the context of registration, patient flow, and back office operations.
Secure environments and sensitive data
Hospitals take security very seriously. Everything from how the building is organized, to where their patient data is stored, to privacy agreements with patients create a complex security apparatus that makes it difficult to obtain the typical data sets about your users that you’re accustomed to. For example, you may have trouble finding a usage analytics tool/framework that works for you and your customers. In many cases, simply using Google Analytics will not be viable out-of-the-box, especially without a BAA in place with Google. Although it may be unintentional, there is a potential that some of the monitoring may pick up PHI in certain events, and even if that is cleared on your end, hospital security teams may have issues with that data going to Google. In more secure settings, hospitals may even want you to operate in an on-prem/off-net setting, eliminating your ability to use conventional tools to collect usage data in the cloud. This challenge is both a technical and communication hurdle.
Be proactive about all things security and data. Setting up environments and analysis tools in non-compliant ways will only cause more pain transitioning later and when having conversations with potential customers. When it comes to collecting usage data, consider using a hosted solution (piwik), or a home-grown solution if needed, and do it early. If you want to get metrics that are based on the PHI (Protected Health Information) that you’re collecting, this will require more secure analysis infrastructure (for instance we have a separate HIPAA compliant, AWS cloud with Zeppelin to do analysis), so plan ahead. I also cannot understate the value of in-depth security documentation describing your architecture/data collection practices. This will save you hours of phone calls with security teams and make you seem more legitimate to potential customers.
Complex and siloed health data
If you’re new to healthcare and plan to build something that leverages patient data, be prepared to spend a significant amount of time learning about the different data protocols (HL7, FHIR, etc) and terminology sets (SNOMED, LOINC, CPT, DRG, ICD, etc). These standards are in place to classify and label information, however many of these are not used in standard ways, creating issues for non-experts when trying to leverage the data. Connecting to sources of this raw data is often difficult, and each hospital will use slightly different system configurations and prefer a different connection method. For instance, some hospitals that want to leverage HL7 will have to pay upwards of $10,000 to set up an interface for your product that will allow HL7 to flow bidirectional. Also note that these are some of the challenges just to read this information. When writing back to a patient’s record, you’ll need to be even more careful managing patient data.
Besides establishing analysis environments early, its important to define your end goal for your data analysis upfront. This will help you focus on the specific data types that you really need to understand and will give you the capacity to dive deep. For instance, if you want to do analysis on different diagnoses that patients have and your data is coming via HL7, you’ll need to first learn to parse the HL7 to the correct segment, then to decipher the content in that segment (likely an ICD code for consistency). Knowing where you want to end up will guide you to work through learning these different conventions one at a time, and to not overwhelm your team with the dozens of other terminology sets at once.
Live Feedback Nurses,
doctors, and anyone working in a hospital setting for that matter, are extremely busy (not to mention, there aren’t enough of them). They are also working directly with patients or with patient data throughout the day, so it can be challenging to find a time and place to meet with a user/potential user for feedback. Product teams will have to do a little extra work to get feedback from these specialized users/customers.
As with any product, there is no substitute for getting out in the field, but with healthcare specifically, this may be the only time you get with your target users/customers. Spend as much time as you can at hospitals with customers or prospective customers, asking questions, observing, and meeting with as many departments as you can. Go on sales meetings, installations, or even exploratory conversations if you can get them. Although we all have our own experience in healthcare settings, being there for research, not as a patient, will give you a different perspective. I personally found this to be a little awkward at first, but the insights and empathy for your users that you’ll gain is invaluable. Always be cognizant of the fact that “once you’ve seen one hospital, you’ve seen one hospital;” they all operate a little differently, and you’ll gain new insights from each conversation.
Validating New Product Ideas
It’s hard to validate B2HC (Business to Healthcare) ideas with traditional B2C techniques. Hospitals are hesitant to try “just any” software they find on the internet, and it’s tough to reach the right audience with a simple landing/sign-up page to gauge interest. To make any progress, you’re going to have to get more hands-on.
First, if you have any existing customers, leverage any time with them to validate your new ideas. For everything from sales decks to demos, you existing customers will be a great starting place for validation. When presenting a new concept in a healthcare setting, whether it’s a mockup or a prototype, I recommend making it feel as real as possible. No need to lie about progress or waste too much time on working software, but presenting something that seems incomplete may limit your ability to gain traction in your conversation with a risk-averse healthcare customer. We’ve used many techniques from Ash Maurya’s “Running Lean” over the years, particularly the problem and solution interviews.
Always have the patient in mind. A fair amount of my time has been building products or features that a patient never interacts with. Our customers typically evaluate the ROI of these products by how they reduce costs in some way. In the end this eventually translates to better patient experience and outcomes. Remember that at some point, everyone is a patient. Focus on the end goal of health.