Looking At Field Service Through Google Glass

This post originally appeared on Field Technologies Online.

Why do enterprise customers of capital equipment demand guaranteed uptime? Because the capital equipment is mission critical to these organizations’ revenue streams; when the capital equipment isn’t working, the organization is bleeding money and literally dying. Worse, nonfunctional equipment can put peoples’ safety at risk (e.g. patient safety in hospitals when diagnostic machines are down). So when mission-critical equipment isn’t working, businesses cannot function correctly. Executives quickly (and rightly) grow frustrated and money is burned. In other words, time-to-resolution (TTR) is critical in field service.

Therefore, buyers of capital equipment spend extraordinary amounts of capital to purchase service contracts that ensure maximum uptime. In turn, equipment manufacturers spend extraordinary amounts of capital to satisfy service level agreements (SLAs) to guarantee that uptime. These SLAs are supported by highly trained, specialized support teams who either fly to–or are located near–the customer’s capital equipment for one simple reason: if things break, someone needs to be on site fast.

What if they didn’t have to be on site? What if the customer could be supported remotely by a centrally located expert? Google Glass and other smart glasses are making this a reality.

Why Glass? Why Not Mobile?

For mobile, hands-on workers, smartphones and tablets promised a new paradigm in information access, process control, and remote support. To a certain degree, these devices have delivered. From an information perspective, workers equipped with mobile devices are better equipped than ever before. But smartphones and tablets suffer from one critical problem: they obstruct the worker’s process. All the functionality in the world is somewhat less helpful to a worker if they’re constantly interrupting their work to glance at, tap, and swipe on their tablet. Most notably, using video for remote collaboration is somewhat less useful if the tech must hold a phone in front of their workspace, occupying one hand and obstructing their view.
Glass, then, is the natural solution to this problem. It brings all the capability of the smartphone to the field, without the obstructions. Glass is voice activated, lightweight, and stays out of the field of view. Most importantly of all, the front facing camera means that a Glass-wearer can share their point of view with anyone, while maintaining their focus and the use of their hands. Every pair of hands in the field now has access to the expertise of the entire organization, in real time.

Perhaps more interestingly, this model can be extended directly to the customer. Particular for field service and repair of capital equipment, this has powerful effects: dramatically improved time to resolution, and lower cost to provide the service.

An Example: Diagnostics In Action

Acme corporation manufactures MRIs for use in hospitals. Pines Hospital in Smithville has an MRI from Acme. It runs about 12 hours per day and generates a total revenue for the hospital of $225,000 each day (or $15k/hour). Last Friday at 8:30AM, the MRI broke at Pines Hospital. It took 3 hours and 40 minutes before an Acme service technician could arrive and fix it. During that 3 hours and 45 minutes, Pines hospital lost $15,000 * 3.67 = $55,000.

Why did it take so long to fix the MRI? Because it took three hours for the nearest ACME support representative to make it from his home in Houston to Smithville. Upon arriving, the field service technician opened the back panel on the MRI, reset the device, re-installed the system settings, and ran a few tests to ensure the MRI was correctly connected back to all of the ancillary imaging and scheduling system. The diagnostic and repair process took just 20 minutes.

Enter Glass: The Next Generation of Field Service

Meanwhile, in an alternate universe, Acme had equipped their technicians with Glass.
In this alternate universe, things occurred differently when the MRI went down. Instead of calling on a telephone, the local Pines Hospital radiology technician put on a pair of Glass and initiated a video call. In seconds, the radiology technician was showing the ACME technical representative exactly what he was seeing and hearing as he walked around the MRI. With guidance from the remote Acme technician, the radiology technician fixed the MRI machine in 40 minutes. Although it took the radiology technician twice as long to complete the actual repair, there was no time lost in transport or logistics. In this alternate universe, Pines hospital only lost $15,000 * .67 = $10,000.

In other words, remote service workflows, powered by Glass, drove material savings for Pines hospital! Plus, the shorter overall downtime kept the hospital running smoothly: patients received diagnoses on time, staff went home on time, and schedules weren’t pushed out.

From Example To Reality

This alternate universe is becoming reality! Already, industry leaders are adopting Glass to enhance their field service organizations–equipping both technicians and customers. At Pristine, we’re pioneering this reality, building software for Glass to power new field service workflows based on the “Wearable Worker.” Our customers are lowering costs, shortening time to resolution, and bringing ever more positive experiences to their customers. That’s the next generation of field service in action. Drop us a line to learn more.

3 Little Known Features Of Google Glass

features google glassIt seems like every time you turn on the TV or hop on the internet, there’s a new story involving Google Glass and other Smart Glasses. Google Glass in particular has been available for a couple years now; and though consumers have been slow to adopt Google’s eyewear (and other Smart Glasses), enterprise companies are starting to test them, and realize the benefits they bring to business operations. You can read some more Enterprise benefits here on our website.

Beyond the smartphone integrations, cameras, and basic augmented reality, there are a few cool things Glass can do that you might not know about. With that, here are three little known features about the most prominent of all Smart Glasses–Google Glass:

1. Voice Control

Most people know that Glass has a touchpad on the side of the device for user input. Additionally, there’s a common misconception that that Glass is controlled by your eye movements. But, fewer people realize that Glass is controlled by your voice and head gestures. You can nod your head to wake up the Glass, and speak commands to open applications or trigger actions.

Having the ability to control a computer hands-free challenges many assumptions of human-computer interaction. With the status quo shattered,  it’s possible to completely rethink how computers fit into business operations–for instance, how different would field service be if first line workers didn’t have to glance to their smartphones or tablets?

2. Live Speech Translation

Google Glass offers near real-time speech translation between 30 languages. This feature offers an amazing realm of possibilities as glass-wearers in a geographically disparate environments can more easily communicate with each other. Imagine the gaps that can be bridged between, for instance, factory engineers in China and design engineers n the United States. With Glass, these two functions can communicate easily to resolve equipment issues or discuss improvements. The possibilities are endless!

3. Seamless, POV Video Collaboration

Google Glass isn’t just about instant, hands free information though. Consider perhaps the most fundamental feature of all: the front-mounted camera. Glass provides a “third eye” that can be leveraged for live video collaboration to solve difficult problems. Why not FaceTime or Skype on a smartphone, then? Only smart eyewear like Glass provides a live broadcast of exactly what you are seeing to the remote viewer. This is powerful for technicians, virtual tour guides and anyone else wanting to share something live to colleagues, friends or family. Those employees in China and the United States? They are not only able to talk to each other, but can also see what is being discussed!

So, with the capabilities of smart glasses to make information available hands-free, help workers across the globe communicate, and enable powerful, collaborative connections, how can Glass revolutionize your business?

5 Reasons Google Glass Will Revolutionize Your Industry

google-glass-revolutionary-industryBy now, most people know of Google Glass as a computer, disguised as a pair of glasses, with a tiny display just above your right eye. Despite the consumer keeping Glass at arm’s length, enterprise companies are coming around, realizing that Glass will eventually be a major tool in support and collaboration in their businesses. We agree, and here’s what we see:

1. Google Glass will expedite response times – Imagine a scenario where a Boeing 777 encounters a glitch while on the ground in Singapore. The local MRO team identifies the issue but the repair will require a specialist’s input. The specialist for this issue is based in Seattle, Washington, so the airline can either ground the aircraft until the specialist can fly to Singapore to diagnose and fix the issue, or fly the aircraft to the specialist!

Consider the alternative: placing a pair of Google Glass with a local technician, enabling the specialist to “beam in” to the situation in Singapore and immediately see the issue at hand. With the guidance of the expert, the plan can be fixed more quickly. In this scenario, flight operations run more smoothly for the airline, and customers get to their destinations with fewer delays.

Plus, because airplanes only generate revenue in flight, each hour of downtime represents a significant amount of money lost (in fact more more than $50 billion per year). So by reducing what once took at days to resolve has to mere minutes saves significant sums of money for all parties.

2. Google Glass will reduce expertise cost – Keeping in line with the aircraft scenario, each airline has a limited number of expert technicians available to maintain their fleet. This holds true across industries, where the time to resolution of a complex issue is limited by the number of qualified technicians to resolve that issue. However, not every issue requires a top tier technician.

In many situations, all a qualified lower level technician needs is a little guidance from an expert to resolve a case. With Google Glass, these experts can be remotely present wherever they need to be, and lend their expertise to front-line workers. In other words, wearable collaboration directly reduces the cost of expertise.

3. Google Glass are hands free – Computers have changed the world in large part thanks to the internet, and in turn, instant access to information. This has been taken even further with the surge in smartphones. But smartphones are not ideal in many technical environments because they are not hands free. Indeed in many cases a tablet or phone presents a real distraction for the worker, despite the value of information available.

With Google Glass, a front-line field worker can still have instant access to the information they need, while keeping their hands free to complete the task at hand. Put simply, would you want your surgeon or your electrician working with one of their hands or two?

4. Google Glass will reduce risk in dangerous situations – Multidisciplinary teams in dangerous environments face a serious problem: they often need only one or a few pairs of hands, but many brains’ worth of knowledge. What if the combined knowledge of an entire team could inform the hands-on work of one person, keeping the rest of the team out of harm’s way?

Consider bomb disposal units. In these types of situations it is obviously preferred to send in one person instead of a whole team. Not only would this technician be able to transmit exactly what he or she is seeing, he or she could also do all of this hands free. Obviously in dangerous bomb situations a person could not be holding a camera in one hand and working with the other; they need both of their hands and not being worried about a camera to properly execute the task at hand.

5. Google Glass will generate significant ROI – It’s fairly simple, really. Creating support, issue resolution, and training that’s faster and cheaper improves margins, is a marketable competitive advantage, and increases customers satisfaction. Companies that leverage Google Glass into their workflow to accomplish these goals will thus see success in the form of increased margins and profits.

Companies will be able to resolve issues faster and better all while not having to hire additional top-tier technicians. Top tier technicians will simply be used more efficiently. They will go from being technicians to mangers who are experts in their related field.

The above predictions may inspire your curiosity, or you may already know exactly how you’ll use Glass in your business. Either way, drop us a line, we’d love to learn how we can help.

Are Physicians Forever Destined to be Slaves to Desktop Computers?

This post originally appeared on the Capterra Blog

Over the past 50 years, computers have evolved dramatically. In the 1950s, most computers were the size of a room. By the late 1970s, a computer could fit on a desk. By the late 1990s, laptops could fit in a normal-sized bag. By the late 2000s, a computer could fit in one’s pocket. And now in 2014, a computer can now rest comfortably on one’s face: see Google Glass.

Clinicians are highly mobile workers. They are on their feet for most of the day walking many miles. When they sit down to interact with patients, they want to direct their undivided attention to the patient.

Before the advent of meaningful use and the rise of EMRs, clinicians could look at patients and hold a clipboard in hand to document findings. Templates were dense but highly functional. The input mechanism – the pen – offered superb granularity, control, and flexibility (though at the expense of legibility and reportability).

Then federal government instituted the Meaningful Use program, which has forced computers on physicians, many of whom didn’t want to switch from their paper-based documentation styles. Although computers solve some problems that paper-based solutions could never accommodate, they have created problems pertaining to usability, flexibility, and lack of physician-patient interaction.

Why have physicians come to resent desktop computers and EMRs so much? Desktop computers were designed for white-collar, stationary workers. The primary input mechanisms – the keyboard and mouse – are robust and granular, but extremely inflexible in terms of physical human-computer interaction. The desktop was never designed to accommodate the ergonomic needs of mobile healthcare workers.

Tablets… The Dream That Never Was

When the iPad was announced in April 2010, many saw an opportunity to rectify all of the wrong-doings of the desktop. The iPad looked and felt like a digital clipboard. It could be held the same way and was approximately the same size. Many heralded the iPad as the tool that would save medicine from desktop hell.

A few years later, we’ve learned that the iPad is not an adequate desktop or clipboard replacement. Although it holds immense promise at first glance, it simply isn’t robust enough:

  • Typing on the software keyboard is woefully inadequate for complex narratives.
  • Structured fields that require date/number/list pickers are cumbersome and slow.
  • The human finger isn’t nearly as precise as a mouse, and as such, digital forms can’t be as dense as paper based forms.

Will healthcare providers be slaves to desktops forever? I think not.

Enter Smart Glasses

Google Glass is by far the most widely recognized set of smart glasses that’s commercially available. But there are many others: ODG, Vuzix, Atheer. Samsung, Sony and others are also rumored to be building smart glasses.

Glass was designed for the mobile worker. It’s handsfree and omnipresent. It knows when it’s being worn so it doesn’t require the user to authenticate (type in a password) upon each use. It is transparent and out of the way. Rather than force awkward manipulation and ergonomics, Glasses finally free physicians to focus on the patient at hand and maintain sterility.

Although the screen is still small and the user input mechanisms limited, the form factor holds great potential. In the next few years, we’ll see massive innovation in optical technologies that will accommodate massive screens and granular hand-tracking technologies for precise data manipulation and selection. Coupled with ever-improving voice-recognition and natural language processing technologies, Glasses will come to be an integral part of the physician workflows.

Indeed, Google Glass is already being adopted by many of the top US hospitals: UC Irvine, UCSF, Stanford, Dignity Health, University of Washington, Beth Israel Deaconess, Sutter Health, Brown, Brigham and Women’s, UCLA, Banner Health, and more. Although none of these institutions have deployed full-blown EMRs on Glass, they are inching towards it.

Of course, the evolution and deployment of Glasses will be slower than desired. Although the hardware is quickly evolving, it will take several years before EMR vendors redesign EMRs around the new form factor. Some will be slower than others, and many will make horrible design decisions as they adopt desktop and mobile design conventions to Glasses rather than Glasses-native design conventions.

But even still, the potential is exciting. Most new form factors are met with great resistance. Almost nobody outside of Apple recognized the potential of the iPhone at launch and indeed it was highly criticized for its lack of traditional smartphone features. Many thought the iPad was doomed to fail because it was just an oversized iPod Touch.

Similarly, many don’t yet see the massive potential that Google Glasses offer, but as hardware and applications evolve, the value will become clearer and the potential realized.

Doctors, you won’t be slaves to your desktops forever.

The Pristine Story: Glass Certified Partners!

We’re very pleased to announce that Pristine is now a Glass Certified Partner!

From our birth as a company, we’ve dedicated ourselves to delivering wearable solutions that make a meaningful impact. Joining the Glass at Work program fuels our drive to bring Glass to the enterprise, powering wearable workers in healthcare and beyond.

For more, see the official announcement embedded below:

The Pristine Story: Venturing Forth

We’re thrilled to announce today that we’ve raised $5.4 million in Series A financing!

I speak for our entire team when I say that we’re incredibly excited about this milestone, and we’re ready to put this new financing to work. In service of that mission, we’re very glad to be working with our lead investors at S3 Ventures here in Austin to capitalize on our early success, expand our team, continue building our groundbreaking products, and grow our business in healthcare and beyond. The official press is copied below.

If you’re an avid reader of the Pristine story, you know that the last 18 months or so have been a whirlwind for us. Not so long ago, the notion of Google Glass in healthcare seemed fanciful to many. Now, that very notion is seen as a potential game-changer in healthcare delivery. I can’t thank our team enough for everything they’ve sacrificed to make this happen.

Mirroring Glass’s growth, Pristine too has come a long way in the last year and a half, as a company. We’ve gone from our first pilot to dozens of clients, from just Patrick and I to a great (and growing) team of 15, and (in true startup form) from my living room to a real office (pictures coming soon)!

As we open the next chapter of the Pristine story, I’d like to take this opportunity to thank all of you who have helped us along the way. We couldn’t have done it without you!

Stay tuned, we have a lot more coming.

– Kyle

P.S. We’re hiring! Send us your finest engineers and business folks, and send them fast. We’ve got a lot of work to do.



Pristine raises $5.4 Million in Series A funding

Led by S3 Ventures, funding will fuel growth of HIPAA-Compliant enterprise communication solutions for Google Glass



Pristine, developers of the only HIPAA-compliant video streaming and checklist solutions for Google Glass, announced today that it has raised $5.4 million in Series A financing. Austin-based S3 Ventures led the oversubscribed round, which also included Capital Factory, HealthFundr, and a syndicate of strategic clients. This new financing enables the company to expand its R&D, sales, marketing, and operations teams, supporting the company’s rapid growth.

“The team at S3 has pioneered cutting-edge developments in medical devices, enterprise health IT solutions, and more,” said Kyle Samani, cofounder and CEO of Pristine. “With our rapid growth, we are thrilled to have partners with a strong track record of guiding early stage companies to success.”

Pristine was born from a common refrain in healthcare: “Hey, can you come over here and look at this?” In response, the company developed EyeSight, the first commercially available, HIPAA-compliant telepresence platform for Google Glass. EyeSight is also finding success outside of healthcare, working with pharmaceutical, medical device, and manufacturing companies on remote support and training applications.

“Wearable technologies like Google Glass are revolutionizing how healthcare is delivered, and the Pristine platform is the market leader,” said Brian R. Smith, Managing Director at S3 Ventures. “Current customers are raving about the product, and we are excited to partner with Pristine to continue innovating in healthcare, as well as remote support applications in other industries.”

“We have deployed EyeSight in ERs, ORs, ICUs, ambulances, and even patients’ homes,” added Samani. “We understand that security is paramount. There is a lot of misinformation about Glass and privacy out in the wild; we have gone the extra mile to guarantee security and control for our clients. Our utmost focus on security will fuel our growth as we scale our wearable communication technology throughout healthcare and across other industries.”


About Pristine

Pristine is pioneering the next generation of telepresence in healthcare and other industries. EyeSight, Pristine’s flagship app, enables HIPAA-compliant audio/video streaming across every platform–Mac, PC, iPhone, iPad, Android, Google Glass, and other smart glass devices.  EyeSight is currently in use for patient care across ERs, ORs, ICUs, ambulances, as well as in medical education and medical device service. More information can be found at www.pristine.io, pristine.io/blog, and by following @PristineIO on Twitter.

About S3 Ventures

S3 Ventures is an earlier stage venture firm with $185 million under management. The firm is focused on information technology solutions that solve large business problems and in medical devices that improve the human condition. S3 invests primarily in the formative stages of a company and partners with the team to help focus methodically on what it takes to build a successful company. For more information about S3, visit http://www.s3vc.com.

The Pristine Story: TEDMED Edition

It’s been an exciting few weeks since our last update!

We just got back from the TEDMED conference in San Francisco, where we had the privilege of attending and exhibiting as a HIVE startup. We’re honored to have been selected to participate. The conference was a blast, and the TEDMED community provided some fascinating conversations.

Read on to find out what else we’ve been up to…

EyeSight Gets a Facelift!

We’re continuing to build great new features for EyeSight, so it seemed fitting to give our flagship platform a fresh visual identity as well! Aside from a new logo, we’re also preparing new UI designs for our apps, plus we’ve given our website a visual update as well!

Team Growth

As adoption of Glass continues to build, our team continues to grow! Since our last dispatch, we’ve added two new members to our team. We’re thrilled to welcome Casey Coleman to our Client Success team and Aisha Shaikh as our Operations Coordinator.

Engineering Update

Our engineers are, as always, hard at work building new features and infrastructure for EyeSight. But that doesn’t stop them from contributing useful tools to the community and offering deep dive explainers on The Looking Glass, our technology blog.

We’re Hiring!

Itching to join our team, or know someone who is?

We’ve got several open positions on our careers page, across engineering, operations, sales, and client success. Spread the word, and help us build our team!

Fall conference season is ramping up, and we’re ramping right up with it! Be sure to keep an eye out for us in the coming months. We’ll be at:

…and more. Stay tuned for updates on our current and future whereabouts.

And with that, we’ll close out this installment of the Pristine Story–stay tuned for more! We’ll be updating you a little more frequently going forward as we pick up the pace here at Pristine HQ.

Until next time,

Kyle and the Pristine Team

Aligning Incentives Across Disparate P&Ls

At Pristine, our solutions typically span multiple avenues of care.

In exploring these multidisciplinary use cases, we’ve encountered a unique phenomenon: incentives to improve care coordination rarely align when disparate P&Ls accrue to different players across the continuum of care.

In other words, split P&Ls pose a risk to care coordination and ultimately, to outcomes.

How does this play out in the real world?


Most health systems do not own or operate their own ambulances (Atlantic Health System and NS-LIJ being notable exceptions). Instead, ambulances are typically run by local governments or private companies. Why is this a problem? Many of the most critically ill patients arrive to hospitals via ambulance. Many of these patients are are in time-critical conditions. Ambulances should have the best tools to help save those patients and improve outcomes and suffering. All of the care that ambulances provide should be coordinated with the receiving hospital.

However, ambulances, especially publicly-operated ambulances, run on extremely tight margins; they can’t afford to invest in many new technologies. Hospitals won’t invest in tools for ambulances – even for at-risk patients – since hospitals won’t actually control the deployment of the technology to ensure they impact outcomes for at-risk patients.

But what if hospitals owned the ambulances that fed the hospitals? In this model, as hospitals move towards risk-based care-delivery models, incentives will be aligned to deploy mobile technologies into ambulances to improve time-to-care, diagnostics, and even triage patients to avoid hospitalizations entirely. Specifically, what if every ambulance was equipped with a mobile X ray, CT, EKG, ultrasound, and a suite of standard diagnostic tools (blood pressure, thermometer, stethoscope, etc? Upon arriving at a non-emergent patient’s home, the paramedics could locally diagnose and triage the patient with a virtual physician’s input and avoid non-essential ER admissions.

But that can only happen if incentives – specifically P&Ls – are aligned across the continuum of care.

Outsourced physician Management Services (e.g., EmCare)

Many hospitals contract with physician groups to staff service lines in the hospital. Although these groups provide real value – e.g., more flexible hours and operational processes – than employed physicians these groups also break up how P&Ls are accrued.

For example, many anesthesiologists align as a group to contract with hospitals. Within their practice, these MDs may find a new automated anesthesia monitor that enables more effective management of residents and CRNAs across multiple ORs. In turn, anesthesiologists should be able to extend the MD:mid-level ratio, drive improvement in patient safety, and make more money. But, concerns about damage, theft, and losing the hospital contract render these same anesthesiologists unlikely to ever buy the equipment themselves. Hospitals will also be reluctant to invest since they won’t accrue the financial benefits of improved labor productivity since the financial benefits accrue to the anesthesiologist group, not the hospital.

But Modularization Works In Other Industries

Indeed, most value-chain centric industries are highly modular. Each layer of the value chain can independently optimize itself and control how it interacts with the layers of the value chain above and below it. A few examples:

In the movie value chain, movie production studios don’t own and operate theaters; theaters are independent

In the retail value chain, retailers usually don’t act as distributors, and distributors don’t usually act as producers

With the exception of Apple (who by no means control the entire value chain), most of the computing value chain is modular; retailers like Best Buy have no hand in chipset design, chipset manufacturing, OEM design, OEM manufacturing, operating systems, Internet infrastructure, internet service providers, or cloud services.

Modularization In Healthcare Delivery: Can it work?

Healthcare delivery is not a linear value chain. Each player in the healthcare delivery system doesn’t build incremental, linear value on top of its suppliers. Rather, healthcare delivery involves the coordination of a breadth of disparate resources to A) diagnose, B) treat, and, C) manage chronic conditions / maintain wellness (these are the three different businesses that Clayton Christensen astutely observes in his excellent book, The Innovator’s Prescription).

Healthcare could perhaps be modularized if a certain set of providers acted to diagnose a patient, then handed off the patient to another set of providers for treatment, who in turn would transfer the patient to another set of providers whose job it was to manage ongoing chronic care. However, this arrangement is only tenable if: 1) the boundaries between these three different businesses are clear and distinct, and 2) the providers in each have a high degree of confidence in the “output” from their “suppliers” (e.g., an accurate diagnosis).

What are your thoughts? Have you seen other scenarios where disparate P&Ls lead to mis-aligned incentives? Have you seen risk-based payment models that successfully bridge disparate P&Ls? Tweet us @pristineio and let us know…

If You Can’t Beat Them, Fund Them

In Where Does It Hurt, Athenahealth CEO Jonathan Bush explicitly calls out a number of businesses that are disrupting hospitals. Specifically, these businesses are performing a single function – e.g. labs, imaging, birthing, urgent care – at a much lower cost with higher quality than general-purpose hospitals. These modular businesses are disrupting hospitals by ruthlessly focusing all of their operations around a single service line to optimize quality and reduce costs. This stands in stark contrast to hospitals, which generally try to be all things to all people (the antithesis of entrepreneurship and general business practices).

I’ve previously outlined how healthcare providers are struggling as they shift to risk-bearing reimbursement models. They’re straddling two dramatically different business models as they try to transform their businesses from fee-for-service to risk-bearing. Inverting a business with thousands of employees and billions of dollars worth of assets and processes is nearly impossible. This is even more challenging in a highly uncertain and fast-changing regulatory environment.

But what if there was a better way?

In the Innovator’s Solution, author Clayton Christensen describes how multi-billion dollar companies such as Apple, IBM, Johnson and Johnson, and Intuit have disrupted themselves. When faced with disruptive changes in their respective businesses, these incumbents disrupted themselves by:

  • Funding a separate operating division with its own P&L
  • In physically removed location
  • With dedicated employees who have no responsibilities to the old business model.

This formula by no means guarantees success, but it creates an environment in which the disruptive division can potentially save the business as a whole, so long as the disrupting business has the operating freedom to disrupt the parent. Employees shouldn’t be bound to the processes, assets, and values of the old business model.

How can providers disrupt themselves?

How can providers, in particular large hospitals and health systems, adopt Christensen’s disruption framework? By funding their disruptors! This strategy drives value across a number of dimensions:

  1. Hospital management will have the opportunity to learn about the operational expertise necessary to modularize their existing operations at a lower cost
  2. Hospital management will have access to insider information about their own disruption that they would otherwise lack. They can in turn use this information to make smarter decisions about their own businesses, and potentially buy out the disruptees if they become too disruptive.
  3. Drive inbound referrals from the periphery to the hubs
  4. Generate a financial return

A practical example:

My company, Pristine, recently spent some time learning about urgent care centers. We wanted to sell urgent care centers a lightweight telehealth platform so they could beam specialists and hospitalists into the urgent care center. This would allow the urgent care center to generate more revenue by avoiding “leakage” while also generating more revenue for the consulting specialist, guaranteeing more referral traffic to the host hospital, and providing the patient a more convenient experience. All parties would win. The idea was perfect in theory, except…

We discovered that non-hospital owned urgent care centers generally dislike hospitals, and are in fact too proud of the quality of care they provide to patients at much lower cost. These urgent care centers know that they’re disrupting hospitals, but are holding that against the hospitals as a reason not to align interests. Similarly, the hospitals view the urgent care centers as a competitive threat and have no desire to do business with them.

The more I think about this situation, the more I’m convinced that hospitals should invest in their disruptors. A financial tie will massage the hard feelings that exist and create an opportunity in which community resources can be most effectively coordinated across the continuum of care. As we move towards risk-based models, hospitals will need to drive patients to the most capitally efficient cost center that can diagnose and treat the patient.

What are your thoughts? Do you know of any major health systems investing in their disruptors? Or of any health systems that are outright trying to disrupt themselves by establishing modular service lines themselves? (Banner Health and University of Arizona are doing this to some extent!)

How Can We Address the Supply-Demand Imbalance for Neurologists?

Stroke may be the most tragic of all medical emergencies, because it can so readily be treated.

For each minute a stroke patient is untreated, nearly two million brain cells die. Across ~800,000 US cases a year, these accumulated minutes are a leading cause of death and irreversible disability.

20% of the US population lives outside of major metropolitan areas. And yet, the vast majority of neurologists that can treat strokes with tPA (the only FDA-cleared drug to treat stroke patients) live in major metropolitan areas.

Having a stroke outside of a major metropolitan area is a recipe for disaster.

Only about 5% of stroke patients receive tPA, yet it’s estimated that 40-75% are eligible for tPA. So, why are tPA administration rates so low for a drug that’s been FDA-cleared since the late 90s? Although there are a number of operational challenges associated with administering TPA, the biggest barrier to tPA administration is lack of access to neurologists who are willing to administer tPA (there is some legal risk associated with administering tPA so many neurologists simply choose not to be on call for strokes).

So how can healthcare enterprises address the supply-demand imbalance? How can health systems get neurologists to patients in need in a timely fashion? Tele-stroke appears to be the best solution. By breaking down geographic barriers, we can dramatically increase the pool of available neurologists for a given patient in need.

Tele-stroke networks are forming around the country. These networks are comprised of hubs (usually accredited Comprehensive Stroke Centers) that are typically located in major metropolitan areas and spokes (located in suburbs or in rural areas). The spokes contract with the hubs who provide tele-stroke coverage to the spokes. The neurologists typically live in the cities and are affiliated with the hubs; as part of their agreements with the major city hospital, the neurologists agree to be available on call to consult with the spokes via tele-stroke technologies.

In the tele-stroke center model, everyone wins: neurologists see patients that they otherwise wouldn’t have and generate additional revenue; spoke hospitals keep patients that they would have otherwise had to transfer out; hub hospitals win by guaranteeing a flow of transfers from their spokes; and of course, patients win by getting faster access to the crucial neurologists who will ultimately save their lives.

So, why isn’t tele-stroke ubiquitous?

The telemedicine systems that power tele-stroke networks are expensive.

The high cost and large capital expense associated with implementing these systems slows and in many cases prevents formation of tele-stroke networks.

At Pristine, we’re breaking down barriers with our cloud-based EyeSight platform. EyeSight is our HIPAA-compliant, cloud-based platform that’s dramatically more affordable and easier to implement and use than legacy tele-stroke solutions.

Legacy telemedicine systems are prohibitively expensive, costing tens of thousands of dollars per hardware end-point per year!

At a fraction of the price, Pristine offers a software platform that works with just about any device. Want to use iPads in telestroke? Great. Want to put Google Glass in your ambulances for prehospital care? Even better. Run EyeSight on your existing carts? Sure, go for it!

We’re seeing rapid adoption of our technologies for use in tele-stroke and other clinical service lines. Although we’re just 16 months old, we already have more than 17 paying clients. One of the key reasons for our remarkable growth has been that we can deliver a turn-key solution in a matter of weeks at $0 capex, with EyeSight.

We are excited to democratize telemedicine, and bring tele-stroke to the masses. Patients deserve it.