Keep It Simple, Stupid!

This post was originally featured on EMRandHIPAA.

There are an enormous number of startups trying to solve the medication adherence problem. Broadly speaking, these startups are trying to solve the problem through three avenues:

1) Hardware, i.e. smart pill bottles

2) Semi-intelligent software driven reminders

3) Patient education

The most effective solutions are likely to incorporate all three.

The hardware space has been the most interesting simply because of the variety of solutions cropping up.AdhereTech and CleverCap have developed unique pill bottles that control and monitor dispensing via proprietary smart pill bottles. They also incorporate software for notifications. Unfortunately, all smart pill bottle makers are bounded by FDA regulations because they physically control medications through a combination of hardware and software. FDA regulations will slow time rollout of these solutions to market and create enormous new expense.

I recently learned about PillPack, a startup that just raised $4M. They compete asymmetrically in the medication adherence by not making any hardware at all!

The problem with the pill bottle is that there are dozens of pills in a single container. Measuring and controlling output and consumption is intrinsically a difficult problem. PillPack solves these problems by simply averting the issue entirely. PillPack pre-packs pills by dose. This is particularly valuable because they pre-pack multiple kinds of medications that need to be taken at the same time.

PillPack doesn’t yet have any intelligent software that monitors when medications are taken. But with granular packaging, sensing and controlling the medications becomes dramatically easier than ever before. I suspect this will the marquee feature of PillPack 2.0. Once they add the ability to detect when a pack is opened, they can begin adding intelligent software alerts and reminders to patients and their families.

PillPack has a far more lucrative distribution strategy than companies who have to produce and distribute hardware. PillPack can scale their customer base incredibly quickly through B2C marketing. B2C marketing isn’t easy; Pillpack faces a significant challenge in terms of patient and provider education, but it’s one that’s definitely addressable. If PillPack’s service is as good as I think it is, they should develop incredibly happy customers, which will lead to recurring revenues and strong referrals.

The moment I saw Pillpack, I immediately recognized it as one of those “duh” business. We’re going to look back in 10 years and wonder why this wasn’t always around. Their solution solves so many of the pain points around taking medications on time and is coupled with a lucrative business model that feeds off of recurring revenues from long term customers.

The genius of their business is that they are tackling the medication adherence problem from a unique angle: packaging and distribution. They’ve bundled that solution into a simple and elegant package (pun intended) that helps patients avoid the pain of the modern US healthcare system: going to the pharmacy, fighting with the pharmacist, and manually tracking when to take how much of each medication.

Full disclosure: I have no relationship(s) with PillPack.

The Blinding Power of Monopolistic Hegemony

I am an incredibly lucky founder. My startup, Pristine, is piggy backing off of the success of Google, and even Apple, in many profound ways.

Pre-iPhone, people could only conceive computers as Windows-like desktops. A computer was not a microprocessor running an operating system, but rather a keyboard, mouse, monitor, and Windows.

Why? Why would people – not just laymen, but even technologists – allow themselves to be fooled by Microsoft into thinking that computers could only exist as Microsoft envisioned them? The simple answer is that desktop-bound Windows computers were the only form factor the world knew. People hadn’t seen them manifest as touchscreen cellphones, so they couldn’t imagine them as such.

The iPhone changed everything. Android accelerated the mobile revolution. And people’s eyes were opened to the fact that computers aren’t bounded to Windows.

Then the iPad happened, and the general public learned that tablets don’t have to be bounded by desktop-centric UI elements such as scroll bars, small buttons, and right clicks. With the iPhone as a foundation, the iPad accelerated the shift away from Microsoft’s vision of computing.

Because of the success of the iPhone and iPad with consumers and in healthcare, Pristine has been incredibly blessed to find a larger-than-expected niche of folks that simply accept that the eyeware form factor will change computing at the point of care. We’re seeing interest not just from IT staff, but doctors, nurses, and even administrators. It’s been incredible to see how receptive medical professionals have been to Pristine.

With hindsight, it’s easy to say “duh” about the iPhone. But pre-iPhone, the future of mobile computing looked bleak. Microsoft skewed the world’s perceptions: because they adapted desktop Windows to mobile, including a stylus and start menu, people never experienced computers that weren’t molded after desktop Windows. Had the iPhone and iPad not happened, Pristine would not be seeing the early success that it has been.

Microsoft’s hegemony over technology for the better part of 20 years is perhaps the single greatest form of destruction of value since the inception of the modern technology era.Although the proliferation of the monotonous Windows accelerated PC adoption by instituting uniformity, it subsequently slowed innovation in the world’s most innovative sector. This is only possible to assess now that the hegemony has been broken.

The power of hegemony is clear: an inability to understand how the world can function any other way. Now I understand why suppressive governments – such as those in Iran, Saudi Arabia, and North Korea – prevent their populations from interacting with Western Cultures and ideas. People can’t know if they don’t know.

Crowdsourced Calendar Management

Crowdsourced Calendar Management

Busy executives hate managing their own calendars. Emailing back and forth to find mutually agreeable times, creating calendar invites, and scheduling time conference systems is time consuming and mind numbing.

Executive assistants tend to take care of this kind of a thing so that executives don't have to. It makes a lot of sense.

As a seed funded startup that's just beginning to generate revenue, Pristine can't justify spending cash on an office manager or executive assistant (although cheaper alternatives such as Zirtual are compelling). At the same time, I am super busy and attending meetings all day:

I used to manage my calendar myself. I hated it. But I found a way to outsource 90%+ of my calendar management to.... the crowd....for free!

Google Calendar has a function that creates a unique URL that allows anyone to share their calendar publicly without sharing any details. This allows others to see one's schedule for scheduling purposes without compromising the potentially sensitive information contained in one's calendar. I placed that URL in my email signature, and whenever I need to schedule a meeting, I simply point folks to the link in my signature. I win because I don't have to think about calendar invites anymore, and the other party wins since they spend less time emailing back and forth.

I have outsourced my calendar to the public. I love it. Here's a screenshot that can get you started to set this up for yourself.

Adopting The Right UX Perspective

Adopting The Right UX Perspective

UX is about just that, user experience. Not software design, but the experience that the user feels. While watching a promotional video for a new calendar app, Peek, I just realized my perspective on UX was too software centric.

About 38 seconds into this video, the girl taps on an item (the hour picker), to go into a submenu (choose which hour of the day). Instead of two separate taps on two screens, Peek implemented a tap and hold, follow by a slide across the screen the desired location, and release.

This UX model of tap, hold, slide, and release (THSR)  won't work in many places. In this case, the THSR model works because the submenu has a few unique characteristics:

1) Simple menu with a fixed number of easily understood choices
2) Frequently used (by a heavy calendar user)
3) Is a "one and done" list

As I've thought about software designs that I interact with, I've usually thought in terms of taps and swipes. Peek demonstrates that my frame of reference didn't capture the subtleties of how the user actually interacts with the app. I should have been thinking in terms of touches and removals. A tap is a touch and a removal.

Had I been responsible for designing the UX in Peek, I would likely have implemented the following:

tap
remove
move finger to new screen location
tap
remove

Peek implemented:

tap
move finger to new screen location
remove

Genius. Peek removed 2 steps from a 5 step process.

Moral of the story: in UX, break everything down into the most granular steps possible. Rather than thinking about the design of the software, think about each physical and mental process the user must walk through in order to derive value from the software.

The Pristine Story: Pivot. Revenue!

Since the last episode of the Pristine Story, we pivoted and hit our most important milestone to date: revenue! We are increasingly focusing on mobile healthcare settings such as the ER, emergency response, and wound care. We deployed EyeSight with our first partner, Wound Care Advantage (WCA), to power telemedicine wound care consults between hospitals and outpatient wound care centers. The deployment went smoothly. This quote from Pete, IT Director at WCA sums up our experiences:

"You all came out and it just worked. I've seen smoke and mirrors, but your presentation was superb. I can tell when I'm being sold smoke and mirrors. But it just worked. You guys came out and said it, and then did it, instead of selling it. It was awesome."

We are incredibly excited about our partnership with WCA. We'll be working with them to roll out EyeSight across their client base. Our development and training teams have been working around the clock for the last few weeks to ensure seamless deployments. Thank you team.

Pristine will be at the annual HIMSS Conference, Feb 23 - 27 in Orlando, FL. We'll be in the Startup Showcase in Hall E at Booth 7293. We'll be running live demos, so please come by and say hello!

New Website

We revamped our website to reflect a pivot in our market strategy. And as a new year's resolution, one of our mobile developers, Aaron, started the Pristine Engineering Blog, an outlet for our engineers to discuss how we solve problems at Pristine. Please check out our new website and blog and let us know what you think. We would love to hear your feedback.

Team Growth

We'd like to welcome aboard our newest member of the team, Brett Hogan, who's working with Devin to lead our client success stories. Brett has been at Accenture for the last 5 years working exclusively in health IT. With Brett aboard, we now have 10 FTEs.

Of course, we're still hiring. We're looking for more project manager/trainers to work in client success, outside sales(wo)men, a product marketing manager, an iOS/Android mobile developer, and an operations engineer to manage our cloud deployments. You can apply at our new careers site.

Blogging and Wrap Up

I recently started writing for EMRandHIPAA, one of the largest health IT publications on the web, where I'll continue to write at my sweet spot: the intersection of healthcare, technology, economics, business models, and policy. I'm thrilled to get my writing in front of more people than ever before, and to work closely with John Lynn, the founder of EMRandHIPAA.

My opening post for EMRandHIPAA - How Much Of The Healthcare Business Is Healthcare? - is one of the best I've ever written. Check it out, leave a comment, and provide feedback. Nothing makes my day like hearing good things about my writing (other than Pristine's success).