I am excited to present two innovative sessions during ASU's inaugural Innovation Week 2020.   The first session, "Getting to the Heart of the Problem", examines the role of the problem statement as the foundation for enabling innovative thinking.  I've been passionate about the framing of powerful and user empathic problem statements since first hearing of this concept from the late Clayton Christiansen.

The second session, "Ideating for Breakthroughs", walks through several ideation methods that I've used during innovation workshops with great success.  To give you a taste of one of the techniques, I've created a short tool snippet for you to view.

ASU Innovation Week runs from December 7, 2020 to January 8, 2021.

As federal politicians debate over who pays for healthcare, far too little attention is paid to one central, non-partisan, agreement:  Healthcare in the U.S. costs too much.

At the Arizona Technology Council's MedTech Monthly meeting in April sponsored by iTether, U.S. Rep. David Schweikert (AZ District 6) spoke not about changes to, or the repeal of, the ACA or any counter plan proposed by the opposition party, but instead about what needs to be done to disrupt health care costs.

Representative Schweikert provided several examples of digital health solutions available today that would dramatically reduce costs but are encumbered by regulations, licensing standards, and reimbursement models designed to protect incumbent systems supported by lobbies like the American Hospital Association (Ranked #5 in 2018 for lobbying spending with close to $24 million) as well as many others in health care with a stake in healthcare spending. (Note: These lobbies today are gearing up today to kill any move towards a single payer system.)

As an example of the kind of cost saving, future-forward, solutions discussed, consider the AdviNOW Medical solution available in 12 Safeway stores in Arizona which employs artificial intelligence and augmented reality to augment clinical staffing.  Given a set of conditions collected from self-administered diagnostic tools, artificial intelligence (AI) provides a doctor or nurse with a short list of probable diagnosis and corresponding care plans.

Who is allowed to make a diagnosis and prescribe a care plan is regulated by Scope of Practice regulations which falls under state jurisdiction.  These regulations, ostensibly established to protect patients from unlicensed care, can also impede progress towards equivalent (and potentially greater) accuracy, accessibility, and cost-effectiveness in health care.

While Safeway's program is impressive, given the extensively connected world of today there is no reason you should need to leave the comfort of your home to get a diagnosis and prescription. While not everyone may be ready to have an AI solution replace their primary care physician, there are a great many potential patients who agree that the convenience of this solution is more desirable and cost-effective than the age-old tradition of making a potentially days or weeks later appointment to visit a doctor's office. The advantages of serving rural and even remote areas are exponentially more significant, especially in traditionally under-served communities. Further, remotely accessible AI-based solutions would take cost and burden out of the healthcare system, especially our over-utilized emergency rooms, especially given an impending shortage in physicians as baby boomers age out of the workforce,

Our best hope in disrupting healthcare costs lies in legislators who are willing to support bi-partisan policies that remove barriers to innovative healthcare solutions. A starting place might be with Scope of Practice Policies.

I researched to learn what the Arizona legislature is doing in support of reducing healthcare costs through changes to Scope of Practice, and spotted two bills that are on the right path:

SB 1089: Current law requires that insurance policies include coverage for certain healthcare services that are delivered through telemedicine if such healthcare services would be covered when delivered through in-person consultation between the healthcare provider and the policyholder. Telemedicine coverage may be limited to the healthcare providers that belong to an insurer's provider network. SB 1089 expands the definition of telemedicine to include asynchronous store-and-forward technologies and remote patient monitoring technologies and becomes effective Jan 1, 2021.

HB 2068  Signed on 4/16/2019, addresses clinical Nurse Specialists prescribing authority.  The legislation allows a clinical nurse specialist (CNS) to prescribe and dispense pharmacological agents if the CNS has met educational and training requirements and holds a national certification.  The passing of this bill reduces cost by providing increased autonomy to fill gaps in healthcare in specific situations.: "Advanced practice nurses provide this service at a lower cost than an all-physician workforce would allow. Public health is better served by removing the barriers to full CNS practice."

You can learn about what policies are being proposed in your state that expand the scope of practice through Legislative Search provided by Scope of Practice.org.

In a blog last year, I posted that it sometimes takes years for new policies to get a hearing and that it is essential that healthcare entrepreneurs be aware of evolving politics and policy initiatives and be ready to take advantage. The policies above had the backing of lobby groups whose voices caused these initiatives to be heard. Arizona Entrepreneurs can take advantage groups like The Arizona Technology Council to network and connect with policymakers to push for a change regulations, licensing standards, and reimbursement models to allow for more efficient, and ultimately more effective, healthcare delivery.

What did I learn by attending MedTech's monthly meeting? Disrupting the cost of healthcare has less to do with who pays and more to do with pushing our local legislatures to drive policies that will expand access, demand high-quality, and reduce the cost of healthcare.

Before you engage with developers to create your mobile application, consider ... how you will you know if the application is delivering results?  Do you have a clear idea of what success looks like? A first step is to determine how the application offers value.  And not just to you and your business, to be successful, it must provide value to all of its users.

Start by making a list of everyone that you want to engage with the application, directly and indirectly.  Let's say that you are creating an application to track wellness goals that communicate client status to a wellness coach.  Your list of users should at the very least include:

• The primary target audience of the person who is downloading and using the app. (User)
• Secondary audiences that are interacting with the person using the app, in this case, the wellness coach (Support)
• The organization that has the budget for creating and maintaining the application (Application owner)

The best way to know what users value is to ask them.  Then document the goals of each user group and come up with a set of quantifiable measures for how the application should assist in achieving each.  For example:

• Clients / Users:  "I need to stay motivated to achieve my wellness goals."
• Health Coaches:  "I need to be able to create wellness plans for multiple clients and keep track of their progress and interact with each one of them."
• Application Owner:  "We need to keep the cost of maintaining this application low.  Customer data needs to be kept secure.  Since our business model is evolving, we need to be able to make frequent software updates in response to user requests."

Put together a list of quantitative and qualitative measures for each of your users' goals.  Then determine how you will measure it.  Make sure that you have an easy way to track and measure your success indicators.  If they are too hard to capture, you'll either not track it or end up spending to much time on it.  Avoid creating additional applications to track and report  data until you are sure that the data is valuable and needed over the long term. 
 
Next, put a strategy in place for how you will ensure that you have a plan to mitigate value loss.  What will you do if users are not interacting with the application?  Often forgotten is a plan for monitoring success and strategies or mitigating problems.     What can you put in place to prevent a problem and what do you plan to do to react if the application is not meeting the goals?  

Even if you are not an application development expert, taking the time to think through each of these areas will make it easier for you to discuss your requirements with whomever you hire to develop the technology. And being sure of how the application creates value is a step that will help avert disappointing results, and costly redo's in the future.

​A friend of mine who owns a small healthcare related business is exploring the addition of a mobile application to support business operations.  She asked me what she should consider as she studied solutions.  I came up with eight considerations that frequently get overlooked that I thought I'd share.  Over the next several blog posts, I'll drill down into each of these:

    1. Be clear on the problem you'd like to solve
    2. Identify the expected quantifiable value.
    3. Understand the architecture requirements
    4. Assess competitive positioning
    5. Prototype & test to refine before going full scale
    6. Understand whom you need to influence for adoption and come up with a plan
    7. Have a governance plan in place, so you are ready to manage your technology investment
    8. It's not all about the technology, put in place the necessary complementary strategies that needed to ensure success

Be clear on the problem

 What's the problem that you are solving?  One of the many reasons technology solutions fail is due to a poorly understood and scoped problem. Framing a problem statement will at a minimum help you get clear on what application features are necessary, and which are not because they don't directly solve the problem.  Moreover, you may even set yourself up for discovering other, non-technology options that address the issue.  A common pitfall is that we get caught up into thinking that the lack of the solution, in the case a mobile application, is the problem.  It just might be so, but if you don't have your problem clearly defined you are at risk of at the very least, scope creep by way of lots of additional features that add cost and complexity.  Once you have a clearly defined problem statement, you can use it to evaluate whether your solution solves the problem and if it does, what solution features are needed.  

For example, my statement "The problem is I can't track how many calories I consume each day"  implies that the only way to solve this problem is providing a solution that tracks calories but doesn't get to the true need.  Digging into the "why" we might find out that this issue is health.  Re-framing this statement to "My bio-metrics indicate that I am at risk of diabetes" focuses on the real need "to be healthy and avoid diabetes" which may or may not be related to the number of calories consumed.   To help guide you to a strong problem statement:

1. Start by describing the situation that exists today. (unhealthy weight, high triglyceride levels, lack of exercise, etc.)   
2. Identify the people involved  (pre-diabetic patient, physician).  
3. Where and when does the problem occur? (Patients of the clinic, detected during annual wellness exams).  
4. What is at risk if nothing were to change and no solution implemented? (Progression to diabetes).  
5. What are you assuming about the situation described?  (Patient's poor diet is causing the problem, the patient would change diet if they were more aware of eating habits)
6. Consider your assumptions, what if the opposite was true?  How would you approach the problem?

In my next blog, I will dig into value.  

On the same day that I attended ASU's Hacking the Human conference and Expo, I attended the Arizona Speaker Series where I heard former Vice President Joe Biden state that many significant changes and scientific advancements over the past few decades have come through academic research.  With ASU's College of Nursing and Health Innovation's (CONHI) and HEALab's event, I got the opportunity to see how the Valley's entrepreneurs have benefited from ASU's research and support to drive much-needed advancement in health care. 

The local start-ups and researchers on the agenda talked about health care trends enabled by big data, cloud, artificial intelligence (AI), virtual and augmented reality and the internet of things (IoT).  To kick things off, Chris Yoo, whose firm Systems Imagination develops algorithms used in Artificial Intelligence applications, brought up the issue that is top of mind related to Hacking Humans - Gene-edited babies?   Should there be a boundary set for innovation in health care?   On the use of artificial intelligence to solve health care problems, George Runger, Ph.D. and chair of the Department of Biomedical Informatics, spoke of Gartner's trough of disillusionment and the challenge of integrating new technologies with clinical workflows and other factors that cause new technology to lose its luster.  

Moving on to where Phoenix start-ups are making traction, Kent Dicks of Life 365, is using AI integrated with mobile health solutions to create opportunities for personalized health incentives that will lead to greater patient engagement.   Joe Hitt of GoX Studio had a fantastic example of how wearable robotics make it possible for robot-assisted physical productivity that reduces the risk of workplace injury.   R&D company, Saccadous, uses virtual reality eye-tracking technology to inexpensively diagnose, research or track such things as Traumatic Brain Injury (TBI), Alzheimer's, Parkinson's, and the effectiveness of ADHD medications.  

The solution that blew me away was AdviNow's self-guided healthcare clinic that is being piloted with Akos Med Clinics in Safeway with plans to roll out to 50 Arizona locations by June 2019.  The solution integrates AI that provides a probabilistic diagnosis with an augmented reality application that guides the patient through the use of FDA approved diagnostics tools (blood pressure cuff, thermometer, pulse oximeter, and others) to create a self-guided patient visit to assist in streamlining the patient intake and diagnosis process.  The AI assisted diagnosis is submitted to a telehealth physician who sees the patient to work out a care plan or next steps.  The automation is expected to eliminate much of the time that they spend today on documentation so Physicians can spend more time with the patient, even if virtually.  

AdviNow's solution partnership with Safeway and Akos exemplifies a point made by Kent Dicks of Life 365 "people want to consume healthcare on their terms" and "solutions have to be fully integrated."  For mobile health, Life 365's solutions and collaborations are just that:  fully integrated.  Additionally, Dicks believes that to be successful, mobile health solutions outside of the hospital have to be disposable so that the provider/payer does not have the cost and overhead of managing equipment returns.  

After the conference, I perused the poster boards ASU's CONHI freshman class presented on their innovative solutions to healthcare problems.  I was excited to see all of the extremely well thought out solutions presented by FRESHMAN students to today's health care problems.  So I think that Joe Biden is right, we will see advancement in healthcare driven by the next generation of innovative thinkers and supported by advanced educational systems.  

Yesterday's Transnational Perspectives on Culture and Collaboration to Improve Population Health panel provided insight into the strategies healthcare providers are implementing to address the population needs of today and the challenges faced.   While the U.S. healthcare system may be the most expensive in the world, Sir Malcolm Grant, Founding chairman of the National Health Services of England, pointed out that healthcare systems worldwide are facing similar challenges due to longer lifespans and shifting demographics and other factors.  The panel members spoke to the need to collaborate across entities to identify and implement structures that are centered on outcomes rather than rewarding healthcare providers based on the number of procedures and visits.    Rather than treating individual symptoms, whole person health is critical and requires designing healthcare delivery systems and facilities around a whole person process.  As an example; Steve Purves, CEO Maricopa Integrated Health System, is doubling investment in behavioral health and sees an opportunity to use artificial intelligence to link vulnerable patients to social services.  Bob Meyer, CEO Phoenix Children's Hospital is focused on how to coordinate care across a patient's entire life; from inception to adult care.  

There are plenty of barriers to getting to a better state.   Wyatt Decker, Mayo Clinic, pointed out artificial intelligence and genomics could be hugely helpful in reducing costs while improving outcomes.  But there is a gap between the knowledge provided by these technologies and implementation of the knowledge to improve an outcome. Until physicians have a process for what to do with the data provided by these technologies, no value is delivered.  Additionally, barriers such as costly mega-sized hospitals, out-dated technology, silo'd payment structures, inter-operability of data, and culture impedes progress.  Tom Betlach, Arizona Health Care Cost Containment System, pointed out that shifting the design of healthcare delivery sometimes means that the healthcare organization has to do the right thing now, assuming the costs rather than waiting for policy changes.  And, deeply embedded cultures reluctant to adopt new technologies due to perceived risk slow down new initiatives.   Linda Hunt's, CEO Dignity Health Arizona, call to action:  "We have a workforce trained in old ways.  We need to help them think differently...they need to be educated differently."  

I am proud to be a part of ASU's Master of Healthcare Innovation  as we strive to prepare students to take on a transformative role in healthcare.  Thanks to ASU's Knowledge Enterprise Development for pulling together this panel of leaders in Arizona's Healthcare and providing a collaborative opportunity to ASU and the healthcare community.  

Last week I attended a Pop-Up conference on the Future of AI in Healthcare presented by Arizona State University's (ASU) Health Entrepreneur Accelerator Lab (HEALab) and Systems Imagination Inc.  It was awesome to see how Arizona is coming along as a hub for entrepreneurship, particularly at the intersection of bioscience and artificial intelligence (AI).  The pop-up presentations provided valuable insight into four areas of consideration when it comes to the delivery of value with AI particularly in healthcare:  Technology, Politics & Policy, Social Acceptance, and Organizations.  

Technology

Aural Analytics is an Arizona start-up that uses AI to provide objective measures of brain health.  This patient-focused application received the 2017 Scrip Award for the best technological development in clinical trials.  The AI engine searches for subtle, but clinically relevant changes in brain health.  This is a super cool use of AI that is already producing results for clinical trials and neurological research.   And, according to a company representative, this is a company that is already turning a profit.   Hybridchart  is a Software as a Service (SaaS) application designed by an Arizona physician that offers to solve the issue of multiple disconnected electronic medical records within a single care provider entity.  Both companies presented solutions that provide compelling opportunities for improving patient experience, improving population health, and reducing the cost of care.  

Politics and Policy

Gary Marchant, Lincoln Professor of Law, Ethics, and Technology and Faculty Director of Science & Innovation at the Sandra Day O'Connor College of Law gave us insight into the litigious nature of technology.  Gary pointed out to us that the public holds technology to a higher standard of quality than humans.  He provided an example of how a self-driving car that may, in fact, be safer and have fewer accidents than a human-driven vehicle is more likely to be sued when something goes wrong.  George Runger, Chair of Departments of Biomedical Informatics and Biomedical Diagnostics, pointed out that the FDA has greater expectations of technology solutions than existing physician standard of care.  Case in point:  The FDA required accuracy for skin cancer recognition needs to be at the level of accuracy that a dermatologist will provide or higher.  All of this slows down the adoption of new technology in healthcare.  With AI, models need to be developed using real data to improve performance.  The challenge is how do you get sufficient data to improve accuracy and yet pass public and FDA scrutiny while the AI algorithm is learning?

Another eye-opener, at least for me, was the prominent role that local government plays in healthcare delivery.   According to the National Conference of State Legislatures, our 50 state legislatures make thousands of health policy decisions every year (Ballotpedia.org).  The decisions include not only budget appropriations, but also; which services are covered by insurance, and how personal healthcare information is managed.  Heather Carter, Arizona House of Representatives, Clinical Assistant Professor, ASU College of Nursing and Health Innovation, provided an example of recently passed bill H.B. 2042 that expanded insurance coverage requirements delivered through telemedicine.  A bill to extend telemedicine coverage to urology failed to pass for 4 years in a row until it got written into the H.B. 2042.  A bill addressing the recent opiate hot topic of pain medicine and substance abuse.  Heather's point was that entrepreneurs need to consider policy and politics early in their strategy development.  And be prepared to communicate the value of the technology to local politicians and their constituents.  

Social Acceptance

Woven in throughout the panel discussions was the subject of privacy and security.   The public demands innovation in healthcare, but naturally, privacy is a concern.  And public concern informs policy and motivates policymakers.  For Artificial intelligence applications to effective, patients and consumers need to be willing to share data.  Otherwise, the application's algorithms can't learn and become more and more accurate.  New privacy legislation will likely be put forth to address the concerns elevated by the Facebook and Cambridge Analytica scandal.  The spillover into the healthcare domain and how new privacy and security policies will impact the advancement of AI solutions is still to be seen.

Organizations
​
Frequently forgotten is the importance of the healthcare organizations that need to not only adopt new technologies but also adapt to them.  Silo's within a healthcare organization impede the delivery of value especially when new technology is implemented without consideration for workflow and organizational structure.  According to the consulting firm McKinsey, executives tend to focus too much on individual initiatives and not on how the business must change.  McKinsey suggests that in the digital world, in order to think holistically organizations should organize around customer journeys.

This year's pop-up event presented by ASU's HEALab and Systems Imagination, Inc, provided not only a view into the Artificial Intelligence work of the many schools and colleges of ASU, but also excellent insights into social, political and organizational considerations for the delivery of  entrepreneurial success and value back to our community of healthcare providers and consumers.  I look forward to seeing ASU's influence on technology and healthcare at HEALab's next event!

Most athletes understand the value of hiring a coach to help you get to the next level.  I learned this years ago as an amateur athlete when I decided to see how far I could progress as a mountain and road bike racer.  With the specific guidance provided by my coach, I was able to attain levels of performance that would not have been possible if I had tried to figure it out on my own.  

As I transition from the corporate world, I am again realizing the value of a coach.  This time it is in the form of a transition coach.   Here are 3 ways that you can get benefit from a coach:

Perspective
It's not necessary that your coach be a Professional Athlete, a CEO, or even someone from your field of interest.   A coach provides value by having an outside-in perspective.  From the experience of coaching others, they have learned what works and can apply what they've learned to your situation.  They are also good at pointing out your blind spots and deficiencies, as well as; where you have strengths that you can build upon.  A top-ranked professional mountain biker explained to me once that she was taking coaching from another mountain biker skilled at downhill racing as she explained: "as much as I thought I knew everything I needed to know, she gave me a new perspective that motivated me to try things that I would never have otherwise".  

Accountability
You are held accountable to your manager by the fact that at some point he or she is going to write your review.  When you hire a coach, you are taking a first step towards holding yourself accountable to the goals that you set for yourself.  When I was coached for bicycle racing, I was compelled to follow through on my training program because 1) I paid good money for it,  2) I did not want to have to make excuses to my coach during my weekly coaching sessions, and 3) I wanted to see the results in my next event.  My transition coach compels me to be accountable in the same way.  

Connections & Resources
My mountain bike coach gave me advice on how to prepare for an event with the right nutrition and equipment.  And even more importantly, connected me with other racers with similar goals and aspirations so that I could train with them. Training with other motivated racers pushed my skills and fitness as we encouraged each other and shared experiences.  A well-connected transition coach will provide you with a wealth of resources to assist you as you explore new opportunities.  The most powerful of which may be the connections to communities of like-minded individuals

When you are wondering what your next professional-you looks like, don't go it alone.  Find a good coach that will help you with perspective, keep you on track with your goals, and connect you to the right resources to get you to that next place.  ​

I used to think of myself as a runner.  To keep myself inspired, I would enter 10 and 5k running races.  While running the race, I would see many of the same faces as we all ran at about the same pace.  I viewed them as both my competition and my support as while we would be hell bent on beating each other to the finish line, we also shouted (or grunted between breaths) words of encouragement to each other.   

Then a friend introduced me to mountain biking. I live in the Arizona desert.  There are rocks, cactus and rattle snakes on the trails. Scary, but I took it on and gained a few scars. Then even scarier, another friend told me "you have a mountain bike, your should enter a race."  Life was forever changed.

I showed up at my first mountain bike race in my Umbro soccer shorts and a running event commemorative t-shirt.  I looked and felt like a goofball.  Dressed in their team cycling outfits (kits), everyone else looked like a professional athlete to me.  Needless to say, I was intimidated.  

Unlike in running races where there is a mass start of all ages and genders, mountain bike races have age and category race starts.  I line up in the Beginner Masters Women Category which meant that thanks to Title IX, I am one of the oldest female competitors. (more about Title IX in a future post).  We nervously size each other up and with the sound of a shotgun, off we go.  I was sure that I would finish dead last, but I didn't.  My years of running gave me a foundation of fitness that offset my lack of mountain bike riding skills, at least at the beginner level.  At the finish we congratulated each other and exchanged phone numbers so that we could ride and learn from each other.  It was the start of a 20+ year relationship with a sport that I love and with people that are a permanent part of my community.

With Gritty Revolution I am at a new and different starting line.  The path forward is new, exciting and exhilarating.  I am building once again on a strong foundation of skills developed over the last 3 decades.  A (R)Evolution.  As my mountain bike wheels rolled over hills and rocks, I've imagined a blog where I share my thoughts on how the sport of mountain biking influenced my evolution from a nonathletic, shy girly-girl to an empowered athletic leader.  I hope to share everything that I've learned on the bike that has translated to business and my slice of the universe.