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I am a newbie to Healthcare. I jumped into Mobile Health after 10 years of building enterprise defense systems and social media apps. From a TechCrunch Disrupt launch and SXSW booth babes, I sunk into the world of glucose meters, EHR’s, and FDA.   

How has it been?  well, different.  Awesome different.

• An Industry in Flux
  In Why Software is Eating the World, Marc Andressen shows how software has taken over one industry at a time and points out Healthcare and education as the industries next up for fundamental software-based transformation.
  I’d argue that software did transform Healthcare with the introduction of EMR’s (ask Todd Park, founder of Athenahealth and the recently appointed Obama’s CTO)
  but it is also true that it is ready for another disruption.  The US Healthcare industry is entering a perfect storm: apps putting health-decisions in the hands of users, doctors having more choices in how they spend their time, and the incentive structure shifting from pay-per-visit towards pay-for-performance: your doc will make more money if you are healthier; Imagine that…
  
  
• The Cause. 
  One thing I’ve missed since my days in the army is the ability to raise my head and see the flag hanging up high. It reminded me why I’m doing whatever tedious task I was banging my head against. Working in Mobile Health, every interaction with a patient (for me especially with Type-1 diabetics) was a humbling experience that reenergized me and reminded my why I’m here.  Social check-ins are awesome but they just don’t have the same effect on me…

• Constraints or Why I Love Regulation.
  Operating under constraints gets the best out of people, period (I like the example from Startup Nation, where Intel Israel under Dov Frohman kept its chip production going in 1991 under Iraqi missile attack).  Constraints force creativity and out-of-the-box thinking, and healthcare is abundant with constraints: complex value chain, sky-high barriers to entry, regulatory pains-in-the-butt, you name it. 
  And I love it!!  that’s exactly why so many players are staying away and why the vacuum awaits entrepreneurs.

So this is the perfect place to be in as entrepreneurs: tons of moving pieces, uncertainty, and shifting incentive structures.  Large companies can’t move fast enough to adjust.  Startups can.

In “The Rise of Electronic Medicine”, published by MIT Technology Review on Sept 1st 2011, John Halamka predicts that in the future, electronic health records will become increasingly modular, and that such modularity will (finally) unleash innovation in healthcare.

Although I agree with Dr. Halamka about the importance of software modularity, the current regulatory environment does not allow for it, and time is running out to provide feedback to the FDA on this issue (deadline is October 19th).

Take for example a software system that operates a peripheral blood pressure cuff. Today, the entire system would be classified as an accessory to a Class-2 medical device. However, if there was a binary software module that would handle the Class-2 functionality, (serving as a “Proxy” to the blood pressure cuff) and that proxy module was created by the manufacturer of the blood pressure cuff and approved by the FDA, then the rest of the system can be developed without being directly affected by the module.

Now that opens the systems to innovation! Other software developers would be able to develop their own modules that coexist alongside the regulated modules while avoiding the risk of becoming regulated themselves.

At the FDA workshop on Mobile Medical Apps back in September, I argued (on behalf of the mHealth Regulatory Coalition) that Software Modularity and Reusable Software principles should be applied in mHealth regulation. In the context of Dr. Halamka’s post, these principles should be applied in regulation of Health IT in general.

In essence, the argument is that software in any HIT system can be split to modules, so only functionality that requires regulation gets regulated, and other modules can be regulated independently.  In fact, this is very similar to the FAA’s regulation of “Reusable Software”, that allows for reuse of regulated software, for example, a GPS system (chapter 12).

Arjun Moorthy made some good points in his post “Don’t be a manager early in your career”. Ones of the benefits of serving in the Israeli tech units (before going to college) is that often people get to manage others at very young age - as early as 19.  Here are a few thoughts to those of you out there considering to take a management role early in your career:

• Technical credibility is indeed a must for any product manager in a technology company. That said, if you know that you want to be more market facing in your career, i.e. in sales, marketing, or business development, there is no reason to spend 3 years writing code.
  
• Start your “final” career as soon as possible. I spent four years between the ages 21-25 managing developers (with 2.5 years of development prior to that). I consider these last four in an engineering management role an unnecessarily long period of time. Two years would have been plenty. Managing developers is a very unique management path that I would recommend to very few people. In the world of Agile, the need for such management “overhead” is decreasing rapidly. If you want to be technical - be technical and write code. If you want to be a manager - pursue a product role, marketing or biz dev, and get out of engineering. 
• Making a career switch at 26-28 is a costly practice. “Iterate” quickly on your roles - if you don’t enjoy engineering, switch now. Don’t wait to get an MBA in 3-4 years; you’ll be starting your management growth from scratch and will lose precious years.