Startups, Patents, and Me

This morning, Mobihealth news reported that Bosch Healthcare has sued three companies on alleged infringements of the Health Hero patent portfolio. Although I don't know the details of the lawsuit beyond what is reported, my former role as COO/CTO and author of several patents for Health Hero resulted in me waking to numerous emails asking me what I thought. There was even one that asked me if I felt like I had "blood on my hands." I searched around the bed for a horse head.

Of course, I had three options.

1. Keep my mouth shut
2. Reply "no comment"
3. Blog about my opinion

A smart person would have chosen one of the first two options.

The Caveat
Before I get to my biggest issue, let me be clear that I'm not against patents, only their abuse. Our patent portfolio saved us many times, and was, as a defensive mechanism, a brilliant device. It gave some people confidence to choose us in a competitive situation, for example, with Panasonic. It lead to a license with Philips Electronics and others, who were going to run over the top of us without it. It made us better partners to McKesson, and certainly enhanced our valuation. Most of the credit for the depth and size of the patent portfolio goes to Steve Brown, who started patenting many of these core ideas long before there was a Health Hero Network. If you look closely, priority dates go back to 1992. That's amazing foresight, and also why some of the claims which look "obvious" today are actually shockingly predictive. 

On Startups and Healthcare
My disappointment is predictable and obvious. Bosch is litigating MedApps, Waldo, and Express MD Solutions. These are hardly brand name companies. You only need to look at my dedication to Rock Health or view AngelList page to know I believe Healthcare and Technology (in general) are both best served by supporting entrepreneurs and startups.  Most will fail. Some will change the world. But there is nothing more motivating, exciting, and encouraging than seeing experts of all kinds coming together to solve real problems that scare other people away.

There is a sign that hangs at the doorway to Rock Health, paraphrasing something I wrote in response to a different topic, but it sums up the point of view.

(Credit to Ryan Panchadsaram for the layout and design)

Every "big" company has to decide how to work within its ecosystem. Most simply ignore it, outside large conferences and events. There are some who focus supporting the ecosystem, through the availability of APIs, Hackathons, incubation sponsorships, and other vehicles. There are, of course, also those that choose not to ignore it, and not to support it, but consciously attack. Nothing wrong with that either, but who you choose to pick on matters. I'm uneasy not so much with patent litigation, but with the targeted companies.  I hope the community does not quickly forget this action next time someone offers a conference sponsorship or speaking engagement.

Lawsuits like these have, much to the determent of true progress, become the new normal. With a sigh, I read through the quotes from Bosch defending the process:

"We feel it is important to demonstrate that IP is important, and not just to our company"

Does anyone - and I'm serious, is there a single person - who feels that this demonstrated IP was necessary for other companies? Did you read the article and think "thank you for clarifying that for me, I had no idea IP was important."

Just say it - you have a patent, the system allows you to protect it, and clearly there is some competitive threat from the market you feel the need to defend yourself. Okay, that's fine and within your rights. But when you start to talk about making a demonstration of someone, here's what I read: "We're going to take someone out behind the shed to make a point. We picked someone we know can't fight us with dollars or time, and we're sending a message to the rest of the market." When it's three startups with barely any traction, it's hard to read it any other way.

Now, I have no idea if there's a misquote in there or not, but read this one (emphasis added):

"Bosch is open to working with those companies that are interested in securing this technology through a licensing agreement."

I've got a better idea. Build something people want, and technology licensing won't require a shotgun. Again, I don't know the details, but if this is really about forcing severely outdated technology down the throats of others, that's an even more horrible state. I hope that's misquoted and pure patent license is on the table, if nothing else.

Bosch and Health Hero are better than this. There was a time when we built great, patient-centered solutions to real problems, and there are still so many high-quality people there who are, in the end, only motivated to fix a broken healthcare system. But this can't go without comment – the very companies being litigated against could be the next Health Hero, and the market, the healthcare system, and our patients deserve better. I want Bosch and HealthHero to be great, and I'm sure they can again rise to that greatness, but this is not the path.

While this "demonstration" may be Bosch's right, that doesn't make it right.

How I Stopped Worrying and Love [the name] mHealth

Matthew Holt is very outspoken about his dislike of the name "mHealth" or "Mobile Health".

Although we've traveled in the same circles, both professionally and geographically, for many years (and share a love of EPL, no less), I've never met Matthew.  I have only been able to consume his displeasure in Twitter comments, such as these:

This always left me wondering, do Matthew and I share the same concerns, or is this something else?  Over the last few weeks I've tapped into my network to try to understand the comments, as everyone from my former VCs, employees and friends seem to have a connection to Matthew.  Thankfully, this week, Matthew answered it himself in a recent post to the Healthcare 2.0 blog. This won't surprise you if you know me, but I've got an opinion on his post.

Matthew's key point is that the terms mHealth and Mobile Health limits us to a specific device, such as a mobile phone:

"Calling something mHealth traps it to a device, in particular a cell phone, and ignores the rest of the ecosystem of the technology and culture that the cell phone is but one part of"

I personally don't share that point of view. Some of you may even go further and say  "ah, but at the Mobile Health conference this week, fitbit, dailyfeats, and zamzee all presented, and they do not use a mobile phone!" The reality is, the conference was dominated by SMS and mobile-phone solutions. This is not at all a bad thing, as we saw some wonderfully innovative work. But if you were to oversimplify Matthew's comment to "phone or not phone", you would miss the bigger point, which is the ecosystem and platforms. Specifically, he called it “unplatforms.” 

This is where Matthew and I violently agree.

I'm a platform guy. I believe in systems-thinking. Haley Joel Osment sees dead people, I see platforms and ecosystems. It's what I love, and that was my last role at Bosch, spearheading a new Telehealth Platform.

To that end, I believe one thing that was missing from the Mobile Health conference was the impact on mobile to the caregiver, a key part of the ecosystem. This is something I personally really missed the boat on at Health Hero. Tying a caregiver to a computer screen is a rather ridiculous idea, given this is the industry that made the pager market. That said, when I tweeted that idea of the role of the professional in mHealth, I got a lot of backlash, a lot of "mHealth is about patient empowerment, nothing more". I hope that's not true, or we're missing a good part of how we can improve the health industry with mobile technology.

Naming and terminology, especially in Healthcare, can be analyzed and debated to endlessly - I sometimes think debating mission statements is less painful, if you can believe that. These activities usually resulting in terminology that is either very narrow and specific, or so vague that it has no meaning. As an industry, we have not done a good job of creating a nomenclature that is inclusive of the ecosystem.

For example, I am personally fascinated by the use of Television for providing healthcare and worked on many prototypes in my spare time. Despite the struggles of Motiva, I am sure there is opportunity here. But what to call it? Telehealth? Taken, but who knows what it really means. Telecare? Taken, and differently on different continents! tHealth? Dear lord. I'm already exhausted. (Speaking of which, if I step out of my "Patient Centered Medical Home", is it my "Patient Centered Medical Yard?") Someone will come up with a clever name, and we'll follow along. This only highlights the point that the Television-based solution is but a part of an overall ecosystem, and the clever naming of the solution is far less important than it's systematized impact.

Now, do no misinterpret my point - naming does matter, especially as we, as an industry, achieve scale and impact. Naming is particularly important when it removes our attention from the integrated delivery of care across the ecosystem.

For twelve years at Health Hero, I called our solution everything from "Telehealth" to "Remote Patient Monitoring" and everything in-between. If you want to see someone make a face that looks like they just stepped in something nasty, tell a German during the due-diligence process that you provide "Remote Patient Monitoring" - the idea that patients want to be monitored may seem creepy to someone in the United States, but is down-right blasphemous in more privacy-sensitive cultures like the EU.

I have a somewhat "lighter" story that illustrates the same point. I spent a lot of time in Germany at Bosch Headquarters and UK launching NHS after the Bosch acquisition. I spent so much time, that I came back to to States and once asked someone at Starbucks to "please give me my handy". My advice to you: Don't do that in San Francisco.

As we increase the role of the consumer in their care, these names and terms really do matter. They need to be culturally and globally sensitive, provide a brand and market concept with an aspirational vision, and most importantly, provide simplicity. If I cannot explain to you, the patient, what we do in thirty seconds, why would you even try it?

At the same time, as a group of people trying to effect how care is delivered, let's not lose site of the fact that whatever we call it today will, over time, be adapted and change, and it's far more important that we don't forget the importance of the system of care and the role of our processes, technologies, and people in the healthcare ecosystem.

Update #1: Fixed a few wording and typos based on feedback, mutual friend told me Matthew prefers Matthew to Matt, so fixed all the "Matt" references

You know you have a great team when....

You know you have a great team when, on your way our the door, they hit you where it hurts.

And you laugh hysterically at it.

See, yesterday was my last day at a job I've had for twelve years, for a startup we founded that had it's downs (see 2001-2003, Bubble Bursting Bingo) and ups (we grew it to the largest remote patient monitoring company in the world, and sold it to Robert Bosch Healthcare). In otherwords, a long, winding path that evokes significant emotion. Plus, I'm a sap.

I planned on writing about this decision, and transition, today - probably something slightly depressing or at least highly contemplative, fueled by an Indie-Rock Soundtrack straight out of a teen angst movie ⁽¹⁾.  Thankfully, my amazing team of people at Health Hero/Robert Bosch Healthcare provided me with unexpected, but very welcome, comic relief.

You may already know I'm the world's second biggest Red Sox fan. This is probably a good opportunity to remind you that all Red Sox fans think they are the world's second biggest fan (Johnny Pesky of course, being in the top slot. And don't give me any of this Jerry Remy crap, either.)  The only thing you need to know about this being a Red Sox fan is that 25% (off season), 50% (in season), and 75% (playoffs or any head-to-head game) of a Red Sox fan's life is dedicated to hating the Yankees.

You'll be able to really enjoy this now, in context - this was even more funny because my car was vandalized earlier this month, so my first reply was "oh crap, not again". Here's what I found yesterday when I started lugging boxes out to my car (a few more after the break as well).

Over the years, I've had a lot of different people work for me, and I've been blessed with great programmers and developers, designers, marketers, nurses, clinicians, accountants, business developers - but more importantly, the best people. Yesterday, they proved it yet again. They made me laugh a bit on a day that could have been sad or depressing, and once again, picked me up.

I hope my future teams are as great as the ones I've had at Health Hero/Robert Bosch Healthcare, because these are top-notch people first, and professionals second. You know who you are - thanks for adding laughter to a tough day. And sadly, I can't fire you anymore. But I'll have my revenge!

Here are some more pics:

My favorite part about this, of course, is 2004 is the first year since 1918 that we finally won a World Series, after the EPIC comeback against the Yankees. My people are really smart, but their MLB history is a little weak.

For what it's worth, I also did that to a Wily Mo Pena card.

I find myself saying this over and over, but once again, Dewey Evans deserves better.

(1) For the record, I'll probably still write that piece. Someone cue up the Ben Harper and William Fitzsimmons!