Thumbthing Writings by Bob Spryn, and Roderic Campbell, iOS Engineers and founders at Thumbworks

How we’ll get a ubiquitous EMR through disruption

A Social Disruption

For those of you that have been around long enough to remember any of the significant tech booms, you start seeing patterns in the behavior of incumbents and disrupters. Between 2002 and about 2011 there was a bit of a boom in social technology. Livejournal, Facebook, MySpace, Bebo, Friendster, AOL, Apple’s Ping (remember that one?) and many many others were vying for your eyes for advertising purposes. For some time it seemed like the leader baton was held by Friendster, then of course MySpace won the game, until they didn’t. Now obviously Facebook is a behemoth in social, and more importantly, many non-social spaces.

What’s most interesting about all of the interplay was that none of the serious social players were directly owned by any of what I’ll call incumbents. For instance, Microsoft, by all measures they were the winner in consumer computing for over a decade. They were a bit light on the search game with MSN Search. Google took that crown by investing heavily in search. Microsoft also more or less missed the social media revolution of the 2000s in that they never really had a sizable social play besides Hotmail until their massive $240M investment in Facebook in 2007. Not to single out Microsoft, Google gave social media the ole college try, but Orkut failed to achieve traction outside of very specific markets and Google Plus failed to any sizeable active userbase. Apple had Ping, a social network based on musical interests, but it was an awkward, half-hearted try by a company that clearly didn’t understand social.

To the credit of the above referenced social networks, they tried, they really did. They saw the writing on the wall, whether it be Microsoft and their attempt at search, or Google and their attempts at social, and they put something out there. Ultimately due to a myriad of forces, a smaller disruptive was able to take over. The once tiny Google (yes believe it or not they were small at one time) took search from Microsoft and other players, and Facebook (also small at one time) took social from everyone.

Other notable examples of old giants missing the boat on new technologies include Kodak and Xerox with digital imaging, printers and personal computing. A quick google search will give you a good feeling of the missed opportunities by incumbents.

This theme here is what people call disruption. In most or all of the cases described, the disruption was brought about by a smaller, more nimble competitor, with nothing to lose. Incumbents on the other hand, have stakeholders that they need to answer to, or proven and safe business models that need to be nurtured. To use a sports analogy, many times a winning incumbent will “protect their lead”, instead of continuing to try and score. The stakeholders have a vote in what decisions are made and may be risk averse thereby sticking with the safe business model that they know works. These incumbents have legacy systems in an existing category, which are their bread and butter. Shifting away from making billions to an unproven, high risk vertical is seemingly foolish. On the other hand, smaller nimble startups have a finite downside and a near infinite upside. This motivation allows them to make decisions that bigger companies may not make, take the risks that yield the massive payoffs and ultimately dethrone today’s leader.

When ecosystems change through new technologies and incumbents choose not to adapt, massive opportunities for disruption present themselves. So the important questions you should be asking are:

  1. Which industry is ripe for disruption?

  2. In this industry, what does the incumbent/newcomer space look like?

  3. What’s going to happen?

Which industry is ripe for disruption?

If you’ve seen a doctor in the last 5-10 years, the delta between how we interact with them and how we interact with friends, co-workers, cab drivers, restaurants, amusement parks or pretty much any other industry is drastic. A few examples:

For these and many other reasons, smart money is on the health space being the next big disruption.

In this industry, what does the incumbent/newcomer space look like?

I’m just going to say it, the elephant in the room is Epic. They’re the current winner in the EHR and medical space in general, but not by as much as I would have expected before researching it a bit. The numbers in fact show quite a fragmented space. Epic is certainly winning in the space, but not by much. There seems to be many competitors with double digit market shares, that take up the remaining market. By contrast, in the mobile space, we generally think of there really being 2 players in the space. Android and iOS, each somewhat catering to different demographics.

The newcomers are similar to the players in the social networking/search/advertising era. Google with Verily and Google Fit, Microsoft with Health Vault, and IBM with their enterprise health showing, a tent pole in their Mobile First initiative, are all making a play at storing health and fitness data and as a natural extension of their current offerings.. Box, a disruptor the last time around, given their size and position on the enterprise space, are more than formidable in their healthcare offerings. Apple’s HealthKit stands out as the only platform that isn’t designed for the cloud; instead privacy is their foremost objective.

In contrast with the small nimble startups of the previously mentioned disruptions, these are incredibly well financially backed or extremely profitable companies. But there are similarities. they’ve got very aggressive takes on what they think should happen with your most personal data. I think this is setting us up for a big shift.

What’s going to happen?

The disruption happens when the newcomer has a skill or ability that the incumbent doesn’t have or can’t learn. The incumbents don’t seem to be enacting change at a pace that the newcomers are able to pull in their markets. And the newcomers are moving into the health space.

The most interesting and concrete case from my perspective is the use of Apple’s HealthKit. HealthKit is a database that lives on your phone and nowhere else. You can certainly allow apps to access certain parts of your HealthKit data to third party apps, but you’re in control of the access. If your doctor asks for it, give them access through an app that you control. Do you want to be part of a large research study on how your activity affects your long term health that could help millions make daily habit changes that will have a positive impact on their life? Given the researchers all of your fitness, dietary, sleep and caffeine data through an app.

HealthKit keeps you in control. This is what matters with our most intimate information.

With the prediction that Apple’s HealthKit is how people will organize their health information we start to see a progression in the direction of standards and best practices rising from this. People will need to develop solutions that work with Apple products, consumers that do not have apple products may need to come up with a solution to manage their information on an Apple sanctioned device. These are premium products that will all but have a market mandate that people buy them. The regulatory bodies will have a cow, but the side effects of this will be amazing for consumers, doctors, patients, and administrative bodies. Costs will drop, price transparency will be a thing. Value of treatment will rise. This is what we want and the disruption brought on by products like HealthKit are going to get us there.