The push for digital tools in clinical systems continues to gain momentum. The global medical technology market is expected to be valued at $529.8 billion by 2022, and a recent study by the American Medical Association found that 85% of surveyed physicians anticipate that digital tools will improve patient care. The same study also found that 89% of surveyed physicians want to be responsible for, or consulted about, the adoption of digital health solutions into their practices.
Yet, digital health innovation mostly occurs in technical silos that exclude clinicians from the development process. In fact, the graveyard of health care innovation is lined with stories of brilliant technologies that failed to address a true clinical need — for either physicians or patients. Evidence shows decreased patient risk and increased technology adoption when physicians participate in designing, deploying, and integrating these technologies. But for that participation to be most effective, these physicians need to speak the language of product development when they work with engineers and other members of the development team, and they must have a basic understanding of the product’s technical aspects to understand what is and isn’t possible.
The communication gap between physicians and engineers is widely acknowledged, and often leads to the creation of technologies that do not address a true clinical need or fit within clinical workflow, consequently failing to garner the physician support required for widespread adoption.
The usability and functionality challenges of electronic health records (EHR), for example, are often linked to the communication gap between clinicians and the tech wizards who built the EHR platforms.
Much of clinicians’ frustration with the time-consuming task of EHR data entry and the lack of actionable information from EHR data streams can be attributed to the developers’ poor understanding of clinical workflow and the lack of “right personnel” (that is, a combination of clinical and IT experts) involved in building and maintaining EHR systems. EHRs are a perfect example of a well-intended digital health tool that often simply missed the mark on what clinicians needed.
How can physicians learn to speak the language of innovation and claim a role for themselves within the innovation ecosystem? We suggest integrating product management education into the clinical curriculum.
The Physician as Product Manager in the Innovation Ecosystem
The product development triangle involves three players: the user, the business, and the developer, with the product at the center. The product manager works in the white spaces within the triangle, translating the needs of the user into terms that the developer can understand and fulfill, and enabling the business to market the product and close the loop back to the user.
For clinical technology products, we believe this product manager role requires the particular expertise of physicians, because products that don’t fulfill their clinical needs will fail, and non-physicians simply are not in a position to understand those needs. But physicians lack training in some key product management functions: specifically, how to translate a need into product requirements, communicate these requirements to developers, work with those developers to refine the product, and manage the process of bringing it to market.
Integrating product management education into clinical training will help physicians structure their thinking and communication skills to facilitate collaboration with engineers and build technologies that best meet clinical needs. This type of education could join business and informatics, two areas that an increasing number of medical schools are integrating into their curricula.
Structure of a Product Management Curriculum for Clinical Training
A few medical school curricula have embraced some aspects of the type of training we have in mind. Design thinking has been piloted at the JeffDESIGN program at Sidney Kimmel Medical College of Thomas Jefferson University, and the Design Institute for Health at the University of Texas at Austin, a collaboration between its Dell Medical School and its College of Fine Arts. Integrating design into medical training has been shown to improve medical students’ ability to innovate in response to tough challenges in health care, and to increase problem-solving aptitude.
Incorporating management training into medical education is also gaining ground. The number of MD/MBA programs has been increasing each year and management skills are in demand among today’s clinicians. As Yale economist Fiona Scott Morton articulates, physicians need management training to understand how to appropriately allocate resources, a critical skill in ensuring that available resources deliver high value.
Neither design thinking training nor management education is sufficient on its own, however. Co-designing a digital health technology involves both identifying an opportunity and prototyping a solution (design thinking) and evaluating the opportunity cost of integrating this technology into the health system (management).
How should a product management curriculum be structured to make it as relevant as possible to clinicians-in-training? There are four key components to product management:
- Opportunity Identification — Students learn to identify a clinical need (the “market opportunity”) and evaluate whether a potential technology would appropriately address this need (its “market fit”). Considerations such as cost, quality, and safety are important in this
- Design — Students learn the fundamentals of User Experience (UX) This includes understanding the needs of the patient (using tools such as empathy maps), translating these needs into technical features, and using methods like storyboarding to understand a user’s experience.
- Testing — Students learn different approaches to testing (e.g., A/B testing) to see if the technology fills the clinical need without disrupting
- Deployment — Students learn to make pricing decisions and evaluate the financial and quality implications of the
The simple scenario below demonstrates how this curriculum would help a physician tackle a real clinical need in tandem with an engineer and a business lead:
We envision an elective course, or set of courses, available to medical students, residents, and practicing physicians, focused on the application of product management techniques in clinical settings and designed to empower them to start thinking in these terms at the beginning of their careers.
We believe that such a course would be most effective if it were jointly run between an academic medical center and an affiliated business and/or engineering school. Such an approach would work better as a semester course than as a clinical rotation, so that it would last long enough to allow students to function as a product manager for the development of a real product, and would allow medical students to work with business and/or engineering students.
We believe there is also an opportunity to train practicing physicians, who have a deeper understanding of health systems and more robust clinical experience. Residents could study product development and management through an area of distinction, or elective pathway. For example, in the UCSF Internal Medicine program, residents can choose among six pathways to supplement their clinical training experience, and can use dedicated time to pursue training and experiences in these areas. For physicians who have completed their training, the course could be incorporated into months during which they are not attending on an inpatient service, as most physicians only attend on an inpatient service for a set number of weeks per year.
Potential challenges to implementation include:
- the difficulty of sustaining students’ engagement in the product development ecosystem beyond the course commitment, due to busy clinical schedules; and
- the need to differentiate material from that of general product management courses offered at business schools and to develop curriculum material with a clinical focus.
These challenges can be addressed by having the students work on a specific product to address a clinical need that interests them.
Impact of Product Management Training on Health Care Operations
The impact of such a training program on physicians and the downstream operations of health care could be significant:
- Physicians understand their own needs, and those of their patients, better than non-physician product developers, and their involvement can help break down the silos that often impede the development of well-targeted products.
- Because physicians play a major role in guiding adoption of new digital health technologies, their early involvement makes it more likely that they will advocate for the technology to be sustainably adopted, and for scarce funds to be allocated for it.
- Acting as product managers can empower physicians to understand how to translate their vast clinical experience into meaningful change.
- Beyond the altruistic benefits of creating meaningful improvement in health care, training physicians to be product managers can also empower them to share in the profits of successful ventures, by launching their own businesses, by serving in a product management role at an existing venture, or by gaining the skills to become part-time consultants to health care companies.
For digital health innovation to meet the needs of patients and providers, it is necessary for physicians to play a key role in its design, development, and delivery. Incorporating product management into the medical curriculum will ensure students are well equipped to play this role.