Co-founder and CEO at FOLUP and 30 Day Health, Simon Spurr, talks about the importance of patient-centred eHealth and what startups need to do to survive and thrive in today’s health tech industry. 

Tell us about your healthcare background and why the health tech space is so appealing to you.

I’ve been involved in the healthcare sector, mostly in South Africa but for a short period in the UK, for almost 15 years, from working for Discovery Health and Aon Consulting to my own ventures. Along the way I met some like-minded colleagues and interesting tech people and found myself shift to the digital health space.

What draws me to technology is the ability to be able to put the patient at the centre of their healthcare experience; to give them better control and empower them. Traditionally, the patient is removed from most of the processes of their healthcare and is typically the last person to have access to their own information. When a patient seeks out health services, they are often left to their own devices to find appropriate follow-up care because there is no effective referral model. This, coupled with the fact that they don’t have access to their information, makes it a very challenging environment and often leads to poor outcomes.

Both products that we’ve launched, FOLUP and Care Delivery, have a strong focus on the patient by giving them the ability to track and monitor their health as well as to find the best, most appropriate care. My goal is to enable healthcare practitioners to work with their patients on a more collaborative basis.

We last spoke to you in 2014 about FOLUP. Can you give us an update on the platform?

The FOLUP platform is a very sophisticated and well established Personal Health Record that allows the user to capture and digitise their health data. There are close to 20,000 patients using the platform now, and it has been very helpful for specific groups of patients like diabetics who are required to capture their glucose readings every day. FOLUP allows them to digitise their information, secure it, and then give the practitioner access to the information seamlessly via the platform.

We’ve spent a lot of time focusing on a partner-centric model where we can collaborate with other technology platforms that add more value to the information, and that gives a better end-to-end solution for the patient.

Over the last 12 months we were actively looking for partners to integrate our technology. This led to us partnering with Healthspace, a fantastic electronic health record (EHR) that gives clinicians a tool to be able to engage with their patients; capture clinical notes; write up and transmit scripts; view pathology and radiology results; and create referrals, bookings, etc. We’ve recently done a full integration with Healthspace, and FOLUP is now an extension of that platform. So while Healthspace is focused at point-of-care to empower the clinician, FOLUP then becomes an extension to allow the patient to continue to self-monitor, outside of their consultations, and then feed that information back into their EHR.

We have also partnered with an online booking and scheduling platform, DocDiary, which enables any user to find and make appointments with healthcare practitioners and effectively manage their health appointments. This integration means that patients can now connect, schedule and manage their healthcare information easily and securely.

Why are partnerships so important in eHealth?

The digital health space is a very young and immature industry which has resulted in a lot of technology being developed in isolation. But as the industry matures people are coming to realise that the collaborative effect is vital to sustainability. Solutions that aren’t interoperable are just making the healthcare system more fragmented with pockets of data and silos of information. Until we collaborate to create valuable solutions for our markets, the data remains, to a large extent, meaningless.

What advice would you give health tech companies when looking for a partner to integrate with?

You need to really know and understand what your strategy is; define exactly what your end goal is as a business, and then work from there. It’s important to realise that you can’t achieve everything that you need to achieve in your own platform unless you have significant funding behind you and large institutional partners with extensive user bases. So understand where your strengths and weaknesses are, and then find partners who have synergistic technologies.

Bringing technology together can be complicated because platforms are built in different ways and architectures are often different. Therefore you need to build your technology in a way that is “system agnostic” to make sure your architecture is able to plug into other technologies over time. I think that was one of the things that we did really well at the beginning with both FOLUP and Care Delivery because we saw the need to plug into different platforms and third party integrative components (e.g. wearable devices). We understood the need for a third party gateway and open APIs to be able to exchange data. However, I think a lot of companies are failing in that and are building isolated solutions that don’t connect to other platforms easily, and then having to rebuild the architecture again.

Tell us about your latest initiative from 30 Day Health, the Care Delivery app.

For some time, my US-based co-founder in FOLUP, Dr Geoffrey Appelboom, and I conceptualised the idea of trying to tackle the high hospital readmission rate. There’s a “revolving door effect” where patients are kept in institutional care, leave, and then return, for a number of reasons. In 2014 $17 billion was spent on readmission rates in the US alone. After doing some analysis and breaking down the numbers we found that close to 70% of all readmissions could easily be avoided by doing relatively simple things like changing a wound dressing or sticking to your medication regime more effectively.

So we conceptualised the idea for managing the patient for the first 30 days post discharge and addressing the readmission problem, and hence developed Care Delivery. The Care Delivery platform gives patients the ability to find appropriate home-based care, clinical or non-clinical, that can assist and support them with basic essentials at a very low cost in a really easy and straightforward manner, and for the purpose of avoiding hospital readmission.

The patient’s portal gives them the ability to find, request, book and pay for the services of a healthcare provider. In the healthcare provider portal, healthcare workers are able to capture patient information such as notes and metrics, etc. There’s also a dynamic form builder in the backend, so we’re helping to completely digitise note taking and patient assessment for out-of-hospital visits.

Care Delivery has only been live for a couple of weeks, but we’ve already started doing transactions which is fantastic and a testament to the need. Our practitioner database is growing nicely and patients are registering on a daily basis. We’ve got some really unique functionality that we will be developing, and we are also constantly looking for new partners and members to join our team in order to bring better coordinated care to the patient.

How do you envision Care Delivery to impact the public health population, if at all?

Care Delivery is an enabler that connects the patient to a healthcare provider. The fact that we have significant tech to geo-locate, process payments and capture information is really secondary to the fact that our goal is to enable ways for a patient to bring care to them.

From a revenue perspective, our primary target market, at least initially, is the private sector patients who are paying for these services anyway, but give them the ability to claim back if they have a medical insurer that allows them to do so. But there is certainly no barrier to working with any funder to use the system. We can easily create a model for a healthcare funder, whether it’s a medical aid or a public clinic, to fund services in Care Delivery where the patient doesn’t actually pay for the service. This can be done by using a one-time pin or a voucher code. We ultimately want to be as agnostic as possible and be in that conduit of care across the market.

What’s your advice to aspiring innovators on surviving the health tech industry?

I often meet young entrepreneurs who are looking for advice and who ask me if they are doing the right thing by going out on their own. My answer to them is that you may never know!  But what I can say is that as an entrepreneur you need to make sure that you’ve got enough cash flow to survive for at least a year. Make sure you are financially secure because the way that you foresee your business in the beginning, and how you end up, is quite often two totally different outcomes. The entrepreneur needs to eat, sleep and breathe his business 24/7/365. If you’re not passionate about it and what you are doing, no-one else will be.

What I’m seeing a lot of in the South African market is a traditional model that focuses on building your solution for the market that you know, and developing it in a very isolated way. So it goes back to what I was saying earlier about the interoperability side; people need to really start working together. You need to understand what your market is, build a solution for the market needs and throw everything you can into it.

Also look to where you can partner with others who have built solutions that you can extrapolate growth from and penetrate other markets. I don’t think that it’s necessarily done that well in the South African market because we are centred on our own technology or our own businesses and we ignore the partner model. In the US it’s a completely different way of thinking, they’ve embraced the concept that if there’s someone who’s built a piece of technology it can be added to yours so you don’t have to reinvent the wheel – partner with them.

Do you think SA has the skills to develop the local eHealth industry further?

I think that we have the skills necessary right now in some specific areas to accelerate growth. From a technology development perspective, there are some very good local developers, but there are also some really big voids in the development skill set. So it would be fantastic if there were better government initiatives to fund the enhancement of these skills.

We desperately need programmes, institutions and training and accreditation facilities to invest in developing technology skills. While there are some initiatives underway, they are small-scale and isolated. From a government perspective, there needs to be a greater focus on up-skilling people and providing training facilities.

The barrier to entry for a lot of people wanting to work in developing and programming is actually the hardware, i.e. not having a computer as well as connectivity. So there’s got to be a focused approach to making the hardware available and free training courses. Let people start coding at an early age; I think there’s so much potential in this market, not just in healthcare but in every sector.

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