Learning To Entrepreneur – The Hard Way

My name is Fares, and I somehow became a recognised health tech entrepreneur.

About two years ago, I had to undergo surgery and was prescribed lots of different medicines. Antibiotics, painkillers, you name it. It was a fairly painful experience keeping track of the medicines I was taking, and my parents were always worried about me because they live abroad. And that’s where my journey started.

In the summer of 2016, I applied to Kings20, the King’s College London Accelerator with my venture The Medic App. The app was a medication reminder designed for carers to help them schedule track medication reminders for their loved ones. This solved the two problems I knew I had: my parents wouldn’t be worried about me because they could see me taking my medicines, and I would not forget to take my medicines again.

I was accepted, and during the year in which I was part of the program, my venture raised over £30,000 of equity-free funding. This kept fuelling my belief that I had a great idea.

Solution Mode

Lots of money and a year later, I had a beta app with a few dozen testers. We were ecstatic and saw that as a massive success. We were also just accepted at the NatWest Entrepreneurial Spark (E-Spark) accelerator program to start in August 2017.

When I joined, they asked me these questions:

  • Can you describe your customer persona?
  • Can you tell me how many people are using your app that are not actually friends or family?
  • How many random strangers have you shown the app to?
  • What is your value proposition?
  • How much money/time/effort are you actually saving your users?
  • Would people actually even pay for this?
  • Have you asked random people if they would pay for this?

The answers were a mixture of probably not, almost none, and I don’t know. That’s when one of accelerator managers at E-Spark took me aside told me: “Switch-off solution mode, and go talk to people”. That was a turning point in my entrepreneurial journey.

When people asked me why I was building Medic App, I always said that it was because the care sector was lacking technology. We were innovating in pizza delivery faster than we were innovating in health and care. Focusing on the problem means if one solution isn’t good enough, another solution could be. That mindset was really difficult to achieve for me.

Not only that, I knew I was solving a problem. I could prove it because I was solving that problem for myself! The question I should have been asking is: was I solving that problem for others as well? Did they even recognise it as a problem?

Problem Mode

When I was demoing the app to friends and family, I found out that one of my colleagues works as a part time carer. She told me she wished she could use my app for her work, as she has to fill in paperwork when she gives people their medicine. That got me curious and I wondered, is that a problem I can focus on solving?

Now, the old me would have just dived in and started building something, the way I did with The Medic App. Instead, I wrote a list of twenty assumptions on a whiteboard (for example, we assumed that care managers are tech savvy). We needed to validate these assumptions, so I tracked down the emails of over a thousand people in the home care industry, and emailed them all offering a coffee for half an hour of their time (hoping that not all of them reply, I was still a student after all).

You’d be surprised how many people were willing to help. Here’s what I learned from them: 380,000 people in the UK receive care at home. As part of their care, a lot of paperwork gets filled out by care staff. There’s a form for everything: medicine, food, even repositioning someone in their bed. The majority of these companies don’t check paperwork for 9 to 12 weeks. This creates mountains of paperwork with no oversight, meaning mistakes aren’t discovered for weeks unless the care receiver suffers as a result of that.

At this point, I’ve spoken to a few dozen care managers, a few dozen carers and have validated all of my assumptions. But still, we didn’t go ahead and build. We already had an idea for a solution, but first we first designed mockups and went to show it to potential companies and offering them a free trial. All of the ones who saw the demo said yes.

Today, we’re building a digital platform to transform the paperwork into a to-do list which carers can tick off on their smartphones. Our solution gives care managers a direct and immediate view of what goes on in their clients homes, and alerts them of any serious issues or missed visits immediately.

Key Learnings

A lot of us entrepreneurs start off being in love with our solutions so much, we forget that these solutions aren’t meant for us. They’re meant to help and change the lives of other people, and they need to have a say in it too if they’re the ones you expect to be using your app, or product, or service. Your favourite products, shops and restaurants probably email you every once in a while asking you how they’re doing. It’s no different at all to you going to ask your potential customers: am I going about this the way I should?

And if you keep listening, you’ll probably end up doing just fine.

Fares Alaboud is a passionate and dedicated social entrepreneur and a skilled software engineer, with several accolades celebrating a still young career. Currently pursuing a PhD in Artificial Intelligence, Fares has gained a broad understanding of the social care sector, and used this to found his startup, Medic.

WhatsApp in the NHS – Framing the problem

By  Joel Schamroth and Lucinda Scharff

With 1960s technology the status quo for communication in hospitals, it is no surprise that the NHS has a WhatsApp problem. The recent article by O’Sullivan and colleagues (1) published by the BMJ further emphasises the point. Instant messenger use is widespread and deeply ingrained in the workings of the modern NHS.

 Our own UK wide data supports that of our Irish colleagues. Gathering data from over 60 trusts we found that 91.9% of doctors surveyed reported using some form of external instant messaging app at work. More importantly 83.3% had sent or received an instant message containing patient identifiable data (PID).

Headlines about ‘rampant use of WhatsApp’ will garner clicks and attention, but this needs further examination. Discussing ‘clinical information’ is a broad term, which must be unpacked if we are to understand how WhatsApp is being used, when this is inappropriate and how we provide clinicians with solutions.

 In many cases, WhatsApp simply replaces the informal verbal communications within teams. It’s no secret that hospitals have become increasingly busy (2), with teams often spread across multiple wards. Decisions must be made at a faster rate, with colleagues who are not physically present. The minutes saved by sending a quick message to a colleague asking whether the CT has been done yet are invaluable, when one considers that the alternative requires finding a landline, sending the bleep and interrupting their workflow. These communications would never have been documented in the patient record, and whilst they relate to a particular patient, do not need to contain PID. However the anonymisation involved – initials, bed numbers, used by doctors on instant messaging services means there is room for error.

 WhatsApp becomes significantly problematic when PID is in play. Here, WhatsApp encroaches on the existing formal communication systems where record keeping and a paper trail are deemed essential. The same motivation for WhatsApp use, speed, is again often critical. There are numerous anecdotal incidences of patients being transferred for urgent Primary Percutaneous Coronary Intervention based on WhatsApp images of ECGs, because doing so is faster and more immediately accessible compared to faxing or emailing. The lack of a paper trail and transparency around this decision is a common example of how off-licence use of instant messaging apps can be highly problematic.

So how can we solve this? The intensity and complexity of modern healthcare demands communication solutions that offer the speed and utility that doctors have come to expect from instant messengers such as WhatsApp.

As Dr Matt Morgan says in his article WhatsApp Doc?

“Restricting their (Message Apps) use is fine but there must be a viable alternative provided”.

However this mandates a tool that is designed specifically for this purpose, with the appropriate safety measures to ensure patient data remains secure. In other industries, platforms like Slack provide seamless communication between teams which can be adapted and tailored to the needs of the organisation using it. The frontline staff of the NHS are long overdue a similar solution.

Because we felt very strongly that WhatsApp had the potential to put patient data at risk  we decided to become  part of the solution to this problem.  So together with a team of software developers we have created a mobile instant-messaging app which we called Forward.

We are not the only start-up doing this and our app like other bleep replacements being developed, such as  iBleep  being piloted in Warrington Hospital,  seeks to keep the best bits of  WhatsApp which is its speed and simplicity but in a way that is secure and does not put patient data at risk.

We are happy that others are also trying to solve the problems with using bleeps, as we feel that the more  start-ups like us there are  who are working to solve this problem then the better chance we  have at doing it.  As if we don’t then clinicians will keep using WhatsApp and this issue will persist.”

Conflicts of Interest. Authors Joel Schamroth and Lucinda Scharff are junior doctors who also work for Forward, a mobile application offering compliant, secure instant messaging for clinical teams.

 

How tech can combat NHS prescription fraud

by Stephen Bourke

Analysis published last week by the NHS estimates that £1.25bn of fraud is being committed each year by patients, staff and contractors. That’s around 1% of the NHS budget.

Patients who falsely claim exemption from the NHS prescription charge, alone, are costing the taxpayer at least £200 million a year.

These kinds of unnecessary financial burdens on an already overstretched NHS have been described as “despicable” by Sue Frith, the chief executive of the NHS Counter Fraud Agency.

A flawed system
When dispensing free NHS medications, pharmacists largely rely on people’s honesty. If exempt from paying prescription fees, patients present an exemption certificate, sign the back of the prescription form to say that they are exempt of any charge, or both.

Because the NHS Business Services Authority only runs checks after a free prescription has been issued, additional administrative costs are incurred chasing up fraud cases.

The roll out of the electronic prescription service across England will remove some of the vulnerabilities inherent in paper-based prescriptions – pharmacists will have to record data such as whether a prescription charge was levied, type of prescription exemption claimed by a patient, and whether evidence of exemption was seen by the pharmacist.

However, the Royal Pharmaceutical Society says asking pharmacists to police prescriptions could harm patient trust. But this need not be the case.

The tech solution

Prescription fraud saps vital resources away from front-line services and will ultimately cost lives. But what is more frustrating is that the tools to combat NHS fraud, particularly prescription fraud, already exist.

(Click on image to enlarge it)

Echo users, for example, can request their medications for free through our app. Before we process a prescription order, users are automatically asked whether they’re exempt from prescription fees. If so, they click on the appropriate exemption category and then are requested to photograph and upload evidence of their exemption. We use a machine-assisted checking algorithm to parse data, such as expiry dates, and have patent-pending optical character recognition that facilitates fast and accurate checking.

The collection of such evidence has been integrated into the Echo user journey, as standard, thereby reducing the chances of exemption fraud and reducing related costs for the NHS. This process also reduces the administrative burden of the pharmacist, removing the need for them to collect such data.

Most importantly, Echo completely removes the need for those awkward conversations between pharmacists and patients about providing evidence for prescription exemptions. No pharmacist wants to ask their patients to prove how much they earn or whether they are on tax credits. Echo, therefore, can stop the erosion of trust that such conversations cause.

Using this kind of data is not just about reducing fraud, it also has the power to greatly improve the patient experience and give them access to the most cost-effective health services. For example, Echo can track how often a patient orders a particular prescription and advise them directly through the app if it’s cheaper for them to buy a prescription pre-payment certificate (which is usually most cost-effective if patients order four or more prescriptions every three months or if they order 13 or more prescription each year).

There is no reason why such technologies cannot be integrated into NHS services more widely to help reduce the costs of prescription fraud, funnel this money back to the front-line services, and improve patient outcomes across the country.

Stephen Bourke, CXO and cofounder of Echo – Stephen successfully launched the pioneering digital health business LloydsPharmacy Online Doctor in Ireland and Australia. Prior to that he worked as a Head of Strategy for BT. He holds a masters in marketing from the Vlerick Business School and a bachelor’s degree in economics and philosophy from University College Dublin.

 

 

Quantum Computing And Health Care

By Adrian Raudaschl

Over the last two decades, advancements in medicine and biomedical research have been vastly improved thanks to the continuous increases in computer processing.

As we begin to enter an age of personalised healthcare, dependent on genomics, individual physiology and pharmacokinetics the need to take huge amounts of data and process it in a format for clinical use will become more urgent. Quantum computing may be our best tool for achieving this.

A single bit can be both a ’1’ and a ’0’ at the same time – also known as a quantum bit or ‘qubit’.

The computer you are using today processes information using a series of sequential 1’s and 0’s or ‘bits’. A quantum computer (QC) takes advantage of an usual observation in quantum physics which means that a single bit can be both a ’1’ and a ’0’ at the same time – also known as a quantum bit or ‘qubit’. Thats a bit crazy right? How can something be two states at the same time? Well it gets stranger – when a qubit is observed it will resolve to either a ‘1’ or a ‘0’, which means you only ever see a single state (almost as if the universe knows we are watching it).

If all this is going over your head don’t worry, quantum physics is hard to digest even for the brightest minds, and much of what is happening now is still research.

I highly recommended watching this video to get an idea of how this superposition concept works with electrons:

We can essentially trick the universe into creating a super powerful computer

What is important to understand here is that by taking advantage of this ‘superposition’ principle we can essentially trick the universe into creating a super powerful computer capable of processing multiple pieces of data all at the same time! That basically means we can process allot of more in a fraction of the time and start finding ways of applying huge amounts of data in real-time.

For those still with us I found the following video by Kurzgesagt to be a delightful of helping to get my head around QC’s:

You can even learn the quantum computing basics by trying quantum computing on IBM Cloud.

Medical Applications of Quantum Computers

Radiotherapy

Radiation therapy is the most widely-used form of treatment for cancers. Radiation beams are used to destroy cancerous cells or at least stop them multiplying.

Devising a radiation plan is to minimise damage to surrounding healthy tissue and body parts is a very complicated optimisation problem with thousands of variables. To arrive at the optimal radiation plan requires many simulations until an optimal solution is determined. With a quantum computer, the horizon of possibilities that can be considered between each simulation is much broader. This allows us to run multiple simulations simultaneously and develop an optimal plan faster 1, 2.

Drug Research

Molecular comparison is an important process in early-phase drug design and discovery. Today, companies can run hundreds of millions of comparisons on classical computers; however, they are limited only to molecules up to a certain size that a classical computer can actually compute. As quantum computers become more readily available, it will be possible to compare molecules that are much larger, which opens the door for more pharmaceutical advancements and cures for a range of diseases.

This has the potential to save years of development time and billions of dollars required to bring a drug to market 3.

Drug Interactions

Quantum computing allows us to model complex molecular interactions at an atomic level. This will be particularly important for medical research and drug discovery. Soon, we’ll be able to model all 20,000+ proteins encoded in the human genome and start to simulate their interactions with models of existing drugs or new drugs that haven’t been invented yet 4, 5.

Diagnostics

Artificial Intelligence

There is a growing trend of applying machine learning to aid with patient diagnostics. Much of machine learning is about “pattern recognition.” Algorithms crunch large datasets of patient information to find signals in the noise, and the goal is to leverage comparisons made to help identify a diagnosis.

With quantum computing, we’ll be able to do this processing orders of magnitude more effectively than with classical computing. Quantum computing will allow doctors to compare much, much more data in parallel, simultaneously, and all permutations of that data, to discover the best patterns that describe it.

This will lead to fundamentally more powerful forms of AI much more quickly than we expect. 4, 5

Disease Screening

Using a method known as the bio-barcode assay, we can now detect disease-specific “biomarkers,” in our blood using gold nanoparticles, which are visible using MRI technology and have unique quantum properties that allow them to attach to disease-fighting cells. These gold nanoparticles are completely safe for human use. This method is also cheaper, more flexible, and more accurate than conventional alternatives.

Mikhail Lukin, a physics professor at Harvard, is also working on manipulating nanoscale particles of diamond for similar purposes. He hopes to eventually use diamond particles, to take images of human cells from the inside and detect disease without exposing patients to radiation. It seems he has already managed to do this to detect neural activity 6, 7.

Imaging

Quantum sensors can also improve MRI machine’s by allowing for ultra-precise measurements. Quantum-based MRI could be used to look at single molecules or groups of molecules instead of the entire body, giving clinicians a far more accurate picture.

)ther quantum-based techniques are also being developed to treat diseases. For example, gold nanoparticles can be “programmed” to build up only in tumour cells, allowing for precise imaging as well as laser destruction of the tumour, without harming healthy cells.

Healthcare Data

People want to protect their health data for obvious reasons, so it’s important to consider all the ways that it can be hacked.

ID Quantique is a company using the strange quirks of quantum phenomena to protect our data in an ultra-secure fashion. Using quantum entanglement in one of the most practical applications of the phenomenon to date, quantum cryptography prevents data from being viewed by anyone other than the intended recipient.

Innovations built on the principles of quantum mechanics hold the potential to affect health care on nearly every level, from diagnosis and treatment to data storage and transmission 7.

Genomic Medicine

Techniques such as laser microscopy that is built on the principles of quantum mechanics 8. And using quantum computers, we can more quickly sequence DNA and solve other Big Data problems in health care. This opens up the possibility of personalized medicine based on individuals’ unique genetic makeup.

Protein Folding

Proteins are the basic building blocks of life. Malfunction of a given protein is frequently due to its being wrongly folded.

While the chemical composition of proteins is quite well known, their physical structure is much less well understood. Obtaining more detailed knowledge of the way proteins are folded can help lead to the development of new therapies and medicines.  

A quantum computer will in theory be able to simultaneously test a huge number of possible protein fold structures and identify the most promising ones 1.

Closing Thoughts

Quantum mechanics is a field of science which is inherently astounding, and computing capabilities offered by it is just the tip of the iceberg.

We need to keep a close eye on quantum technology and its application for health care. We’re on the cusp of some thrilling advancements, and we should all educate ourselves on how quantum technology will transform health care in the not-so-distant future.

I hope this has been a useful introduction…

“If you think you understand quantum mechanics, you don’t understand quantum mechanics.” Richard Feynman

About the Author

Dr Adrian Raudaschl is a medical doctor turned product manager. While working in the NHS (National Health Service) he created apps and games to help patients learn more about medical conditions. This demonstrated to Adrian the power great tools have to help people in times when they need it most. Currently he works with children, parents and healthcare professionals to create exciting medical apps and games, which both educate and delight users. Dr Raudaschl is a firm believer in the accessibility of medical information for everyone.

 

Bibliography

  1. https://hackernoon.com/quantum-computing-explained-a114999299ca
  2. Possible Medical and Biomedical Uses of Quantum Computing . NeuroQuantology. September 2011 | Vol 9 | Issue 3 | Page 596‐600. https://www.neuroquantology.com/index.php/journal/article/view/412/440

References

  1. QUANTUM COMPUTING SET TO REVOLUTIONISE THE HEALTH SECTOR. Atelier. Accessed 14/10/17. https://atelier.bnpparibas/en/health/article/quantum-computing-set-revolutionise-health-sector
  2. D-Wave. Accessed 14/10/17. https://www.dwavesys.com/quantum-computing/applications
  3. BIOGEN, 1QBIT AND ACCENTURE:PIONEERING QUANTUM COMPUTING IN R&D. Accenture. Accessed 14/10/17. https://www.accenture.com/us-en/success-biogen-quantum-computing-advance-drug-discovery
  4. Massive Disruption Is Coming With Quantum Computing. singularityhub.com. Accessed 14/10/17. https://singularityhub.com/2016/10/10/massive-disruption-quantum-computing/
  5. How IBM Universal Quantum Computing Impacts HIT Infrastructure. HIT Infrastructure. Accessed 14/10/17. https://hitinfrastructure.com/news/how-ibm-universal-quantum-computing-impacts-hit-infrastructure
  6. Researchers trace neural activity by using quantum sensors. Phys.org. Accessed 14/10/17. https://phys.org/news/2016-12-neural-quantum-sensors.html
  7. 4 Ways That Quantum Technology Could Transform Health Care. Fast Company. Accessed 14/10/17. https://www.fastcompany.com/3016530/4-ways-that-quantum-technology-could-transform-health-care
  8. Quantum physics sheds light on cells. ABC Science. Accessed 14/10/17. http://www.abc.net.au/science/articles/2013/02/04/3681478.htm