Half a Decade in Digital Health - What's Really Changed?

Back in 2013, D Health was founded to help its diverse membership to navigate changes which digital was unleashing. In an interview published to its members, Dominic Pride looks back on what's changed in the last half a decade.

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D Health: Dominic, you’ve been in the digital health business for a while now, firstly with the Sound Horizon and now with Upstart. What do you think have been the major changes since you started out?

DP: Half a decade feels like another world away. 2013 was the year that Eric Topol published “The Creative Destruction of Medicine” - and most of what he said would happen has actually come true. We’re living it now.

On a personal level I remember it was five years ago this month when a successful - but rather conservative - VC blasted into wearables on a panel.  He called them “branded toys.” arguing they should stay in the fashion market as they had no part to play in medicine. Fast forward five years and we have Fitbit’s 25 million active users who will shortly have access to Twine’s HIPAA-compliant platform. That can make a meaningful contribution to prevention and management of preventable non-communicable diseases. That’s how disruption works - it comes from the bottom up, not top-down.

D Health: The dotcom phenomenon seems like a lifetime away where boom and bust turned into scale and then into normality but where on its journey do you think digital health sector is?

Globally, health has been slow to change until now. I was there when Napster hit the music business, and I went on to join one of those boom-bust internet startup. The landscape in all media - across music, TV, movies and game - is now unrecognisable whereas health looks pretty much the same from the outside.  We think what’s going on in banking right now with PSD2 and Open Banking is very much the way health will move.

D Health: You have obviously changed your business given your new company and new brand. To what extent was that a reaction to changes in the digital health market?

DP: You’re right - it was much more than a rebrand.  First off we had to ditch the old name as it spoke to our media heritage. The truth is, health is late in being disrupted by digital but it’s now happening at the speed and scale which was predicted five years ago.  Clients in health were wrestling with disruptive challenges and asked us to come up with strategy in weeks, rather than months. With Upstart we’ve put everything behind a model which does just that.

D Health: We engage in a little strategy at D Health on occasion but Upstart has a slightly different take. Why have you developed your approach for the sector?

DP: In every sector we see incumbents struggling to deal with disruptive new entrants to their market. It’s happening in financial services, transport and now health.  Our approach to strategy is a way to get a grip on what’s going on and formulate a response which can get you moving.  It changes fear into action.

Our technique is called Breakthrough Strategy - we’re using the tools and principles that high-growth companies use to create breakthrough products, and applying them to strategy.

D Health: Of course, we have unusual dynamics in the digital health sector. How do you see the threat-cum-opportunity for our existing actors?

DP: You can see it as threat and opportunity at the same time.  On the one side you have non-health players wanting a slice of this business. Look at what happened last month - Amazon teamed up with JP Morgan to tackle health affordability in the US, and Apple introduced personal health records. Both of them are massive, disruptive plays. And the Fitbit / Twine connection is massive as consumer tech is now legitimate in preventative health which consumes 80% of health costs.

Across the spectrum - from treating acute illness to staying well - there is more demand for services than can be satisfied, and the current “break - fix” model of health systems is not going to solve it. Business model innovation and partnerships will have to join biomedicine to solve these challenges, but ultimately the market will be much bigger. So it's a threat to the status quo but an opportunity to improve outcomes. 

D Health: What would you recommend people in legacy health tech such as pharma and medical devices be doing?

DP: They should be doing more than passively just tracking events. Being aware of what’s going on is good, but it’s pointless unless you actually do something.  What we’ve seen in every industry. - from media to telecoms to transport - is that the sooner you open up, collaborate and play a part in the new economy the better.  That starts with admitting to a problem and committing to dealing with it. And good old M&A is not the only strategy here.

D Health: That’s not going to sit well with the risk-averse health industry.

DP: I’m aware of that. You can hear the sound of cultures clash as conservative doctors meet risk-taking investors.  But there was a time when doing nothing never got you fired. We’re approaching the time when doing nothing - while everything changes around you - is nothing short of negligent. And that’s where we come in - helping people do something.

D Health: One final thing, what’s an Instigator ?

DP: Instigation can be a pejorative term - it’s a synonym for ringleader, troublemaker. But I was at a seminar last year on Computational Creativity - the concept of how computers will even take over creative tasks such as painting and songwriting. In that, Alex Jenkins of Contagious predicts that one thing that that will remain human is “the job of instigating, starting something and seeing the need to make it happen.”  I’m hoping my job as an instigator is safe for a while.

"Call Out the Instigator - ' Cos There's Something In The Air"