Michael

Micheal is the founder of a healthcare software product, and has a background in clinical psychology & research.

Micheal's product helps manage the mental health of at-risk individuals - people suffering from depression, alcohol abuse, etc. The main focus of the product is case management - which fills the same role as medical record software, but for mental health. Case files include very similar things to health records - session notes (visitation notes), communications, and action plans. His product also provides a screening service - which lets you quickly check patients for any risks (e.g., depression, anxiety, drug dependencies, alcohol dependencies.

The product is used both in healthcare, but also in welfare. It's used in both clinical settings, hospitals, and by the NZ Police. It's used across sectors as mental health can easily be affected by welfare - e.g., dysfunctional families or poverty can affect depression, anxiety, or suicide risk. The New Zealand Police use it to screen people for Alcohol Use Disorder.

He started by writing best practice guidelines and books for clinical psychology, but the implementation and uptake of the practices were patchy. So they decided to focus on implementing best practice into the software itself. This helps ensure that it happens, and is done correctly - and by individuals without nuanced training, particularly at the initial stages.

They decided to build the tool as when they started over a decade ago; there wasn't anything on the market which fitted their needs. There was software for use in a clinical setting (such as a hospital), but it was rudimentary, and faster to just do on paper. But most importantly they needed something which could be used by social workers, in the context of welfare.

They saw the opportunity to build an innovative product which ensured best practice would be followed, and blend the world of welfare and mental health.

The first challenge was ensuring you have the right people on your team - people who will take the risk, and stay with you on what is a long, difficult road. Financially, innovative healthcare software isn't super profitable, and they have run out of money a few times.

The second challenge was a lack of institutional support. Both regarding financial support, and other things such as business development, marketing etc. He said it's common to find people who want to use your product, but its hard to find people who want to support the continual development of it.

For example, they started as a research project at a New Zealand University, but as they were dealing with active patients, it was seen as better if it was a separate company. This meant they couldn't benefit from the University's innovation support programs. The New Zealand Health IT Board was nice to him, but provided no help - the board is dominated by individuals who are part of large health IT companies.

He does not see it as a level playing field, and there is nothing to help facilitate and support the development of innovative ideas in healthcare. They have received much more institutional support from the welfare sector, such as ACC & Police Departments.

One innovative feature of the product is that it's designed to be used across institutions - the case file is shared with all individuals working on the patient's case. They all have the same view, and nobody is in the dark about information. I asked him why he specifically designed it like this.

He had two reasons - firstly, he has worked across both welfare and healthcare sectors, and was tired of the 'ping-pong' treatment of patients - being referred from institution to institution. Some people justify it with an order of treatment - e.g. you can't treat depression until you treat the alcohol disorder, but it's just untrue, and the literature now agrees.

Secondly, when they started the idea of a client-centric management was only becoming popular. It has yet to become a key theory, but they think it will. They have also been looking at research which shows that the patient themselves should be an active participant in their case, not just welfare/health workers.

Their product is designed at its core to work with multiple users. One feature they're developing is a holistic graph of a patient's needs - so you can visually see the state of their health, housing, mental health, family environment, etc. This is designed to give everybody in contact with the patient perspective of where the gaps are.

He noted that variety was a challenge of designing it this way - different institutions have different ways of doing things, and different ways to record information (and different standard information requirements). He noted variety is huge in healthcare, and it's probably only going to get worse as more technology advances. They simply have to work with institutions to find solutions. They have developed a principle for development - if a user needs some features built, they'll make it available for all users. This changes the relationship from a customer, to partner - and promotes their users to work together to finding funding for common needs.

The other challenge was patch protection - often big vendors try to hold onto a specific type of institution (eg MedTech in primary care). If you're building a product to work across different types of institutions, you have to compete with a larger variety of big companies. He noted that the products with the largest market shares were fantastic when they first came out - but they don't keep up and get old, while pretending to stay innovative. He described this quite succinctly:

"The gentrification of software"

He did note that the people purchasing software kept using old software because they can be confident in its functionality. They are acutely aware of the risk of new software, or systems - but they have traded confidence for a lack of innovation.

He had two points to make about managing risk:

When they were first starting out, the developer they were working with locked them out of the running system and demanded more payment. They were totally caught, as they were managing a population of suicidal kids. Later on, they followed the legal process and ensured action was taken, but they initially had to pay the money to get access back, as there was nothing they could do. This taught them the lesson that you need to work with really ethical people, and they need to protect how the system is deployed and running - including using multiple developers.

His other point was that at the end of the day nobody is going to help you (financially). You need to be prepared to carry on for nothing, or know to give up.

I found these answers most interesting out of the entire interview. Managing risk in the world of software development means reducing the chance of failure, or error - but in Micheal's own experience the biggest risk has nothing to do with that - they were human action, and financial failure.

Their product does a fantastic job at turning information into insight which is relevant to the user. I asked him how do you know how to do this, he said it comes down to experience and research.

Key Takeaways