There’s a lot of improvements and innovation going on within the NHS and healthcare as a whole. It is about time to get an insider’s opinions on the current NHS healthcare systems and how health tech will be disrupting the healthcare industry. In this case study, Sheffield University medical student Jessica White, met with Dr Kit Latham, CEO of drfocused at his office in Bermondsey.
Kit shares his journey and valuable insights on how he ended up transitioning from medicine to a CEO of a health tech startup solving healthcare’s tech problems. He also shares his experiences on how he successfully crowdfunded to get his business off the ground.
Please could you explain a bit about your background, and the path you took to get where you are today?
Yes sure, so I did my undergraduate in Medicine at Leeds with an intercalated degree in International Health and Development. I had a specific interest in how social enterprise could be used to help healthcare and also the intersection between business, healthcare and aid work. When I graduated I started working in A+E, doing my F1 and F2 in Yorkshire, then worked for 2 years as a locum.
I enjoyed A+E a lot but there were other things I wanted to learn and do, so for me it didn’t make sense to go in to A+E training at the time. I took some time out and did a part time Masters at UCL in Technology Entrepreneurship, whilst still being a locum.
I also did the London Business School Summer Entrepreneurship, an abbreviated academic programme to teach people the fundamentals of how to start up a small scalable venture.
Next was the Lean Launch Pad, a 12 week programme at Imperial College London, taught by Steve Blank, the ‘God father’ of entrepreneurship as a discipline, a really cool guy too! He’s a Californian.. super laid back. When we got together weekly, they really grilled us on what we’d done that week. Typically you were supposed to be doing interviews with people in the business sector that you’re interested in, asking them meaningful questions to learn more about building your own business model. I did all of those things and at the time I wasn’t sure exactly what I wanted to do.
“Frankly I was glad to have a bit of a break from full time medicine.“
I started to focus in on ideas that weren’t directly related to medicine but were still in the broad sphere of healthcare. I played around with a couple of ideas, but there wasn’t anything that I thought I really wanted to devote myself too.
In the second year of my masters, I met a fantastic developer Artem, who did the course as well. He’s a genius and speaks 5 languages including Chinese, Spanish and Russian, as well 10 programming languages. We formed a team and at the time it was when the junior doctors strikes were going on. I was very angry about how doctors were treated in that dispute and I’d also been quite frustrated by the amount on bureaucracy and wasted time we’re subjected to as doctors. You spend so much time filling in the same forms again and again. For example going into the HR of a trust you’ve worked in for years, to sign a different form really explaining all the same information they already have. In A+E you also see the same thing, constantly entering the same data again and again on different systems because there’s no communication between different software programmes.
I guess to summarise my main frustrations were wasted time, duplication of effort and the fact that even though doctors are forced to be doing an ever increasing workload and were getting at the time, an 11% pay cut, our time wasn’t being recognised as valuable. Maybe people would say our time is valuable, but actually, if you look at what they do, not what they say, they don’t put things in place to minimise the amount of faff and wasted time.
Now that’s not a problem that’s unique to the UK, unfortunately, every healthcare system that digitises sees a big drop in the productivity of their doctors. What I mean by that is say you’re running a hospital, all your records are on paper, but you think you need to digitise these as paper is out, if you do that, your doctors will slow down between 20 and 40%, so the amount of clinical work they can do is reduced by a large amount.
Why is that, is that because they’re unable to access information as quickly as they would need?
That is the very expensive question, there’s multiple reasons for it but typically its usability. Software has come a long way since the early days when you used a software system and everything was confusing, clicking through lots of menus. Now there’s a lot of work that goes into the apps that you have on your phone, to make it so you have to do as little as possible. Amazon were the first people to pioneer this in the consumer tech space.
They found that for every additional step from someone having the idea to buy something, and actually clicking to make the order, they would lose customers. They pioneered ‘one click ordering’ and became the world’s biggest retailer.
Unfortunately the people making software for doctors didn’t have the same pressure to improve usability. They didn’t feel it because they weren’t using the software.
Doctors felt it because every time they had to add a patient for example, they had to click through about 15 menu’s, entering the same data again and again, in-between different systems. It was confusing to navigate, and it was slow, meaning duplication of effort.
It’s been noticed that NHS systems used by doctors seem to be quite behind when it comes to the evolution of technology, is that correct?
So it’s a real problem, what you’ve identified is quite correct. Medical software is about 15 years behind consumer software in other industries, 15 years in software times is an eon. I thought maybe there’s an opportunity in that. My insight, if I’ve had an insight, and time will tell, is that doctors time is very valuable and they’re forced to do a lot of things that aren’t productive. This is often because the people designing the technology they use aren’t the people using it. They don’t see where the shortcuts are to allow doctors to see more patients and be more productive in a way that’s way less frustrating to them. Essentially I want to eliminate the pointless work doctors are currently forced to do as much as possible, to try and make that happen.
During the doctors disputes, it came about that doctors were going to have to fill in a form every time they were finishing late; an Exception report.
I have heard about this, I can imagine that people aren’t filling them in as they take too much time?
Precisely. So we made a free Exception Reporting app that allows doctors to make the report in about 17 seconds, a bit more if you want to write more. It was a good concept and I really felt that I was doing the right thing and that it made sense. I was left with a product that was free for the doctors, and I’d hoped hospitals would see it as a way to reduce the amount of unplanned over time they would have, and perhaps save money.
What the hospitals actually thought was that it would make it easier for doctors to claim overtime and they weren’t very interested in that. Unfortunately we weren’t able to gain much traction for that, and frankly, it was a very useful lesson for me to learn, that at the time was quite low stakes in the grand scheme of things.
How did you go about your start-up after this?
We made a video talking about how doctors get a lot of their time wasted. We were getting across that If anyone can make software that doesn’t waste their time then there’s potential for a great productivity increase for both the hospital and health system. Anyone that could do that, would also have a big competitive advantage over people that can’t.
We crowdfunded and found investors, some of whom were professional investors and interested in health tech, others were doctors who had seen what we’d done with Exception Reporting and wanted to be part of what we were building. It was great and we raised around £300,000 which obviously is a lot money, but compared to the budgets of people making a lot of the clinical software like Epic and Cerner, that money was a drop in the ocean.
So, we decided to go into an area that we knew we could be competitive in. We wanted to make it our mission to take all of the things that doctors have to do to be employed that are annoying and boring, and make those much easier for them. By doing so we also want to make it much easier for the employers, as that’s what we got wrong the first time with exception reporting.
What is it that drfocused does to do this?
The Medic passport makes it very easy for doctors to sign up to get employed somewhere, to change jobs and to keep all of their compliance up to date throughout the year. For the employers, we supply them with the fastest way to sign up doctors, to keep their doctors up to date and also manage their compliance.
Who are you approaching to get your product out there?
At the moment we’re going to the people who have the biggest need for what we’re building, which is people that are hiring doctors quickly. If you’ve heard of Babylon health and Push Doctor, we’ve been looking at partnering with the newer smaller versions of these, who want to get a lot of doctors quickly. The plan is to work up the food chain, as it typically takes 7 years to sell software to the NHS. I would love to help NHS doctors, because I was one and the majority of the doctors in this country are NHS. I cannot however mortgage the entire future of the company, by going through the necessary but long period of time it takes to sell IT to the NHS. Our plan is to get sufficient revenue from smaller or private providers to enable us to bid for those contracts, and to take the hits if it takes a longer.
With the Crowdfunding that you mentioned, what platform did you use to do this?
We used CrowdCube. Seedrs is the other big one that some of our peers used.
How did you find the experience of crowdfunding?
It took longer than we expected, and it was harder than expected. When I started doing this I found people often would say things to the point they would become a cliché. Unfortunately after finding out that they are all true, we set up a rule in drfocused that if 3 smart people tell us the same thing then we have to listen to it. It seems like a very obvious thing, but you have so much advice from everyone when you start, some people that are worth listening to and others that don’t have that much experience.
The cliché that we learnt about fundraising was that it is much harder than you expect and it will take twice as long. We thought we’ll do it in half the time and it will be easier for us, because we’ll work extra hard and use all best tactics. Partly that was the necessary optimism you have to have because I think if we knew how hard it would’ve been right from the start, we would’ve thought long and hard about whether this was the journey we wanted to go on.
It was difficult as we were unsure about what the future would hold. We knew either we’d have a company that would be worth something and we could make the things we wanted to make and help in the way we wanted to help… or we’d have nothing. I always believed in my heart of hearts we would do it, but that didn’t help me sleep!
How long did it take from starting with Crowd cube to when you had access to the money?
About 6 months.
Did you give equity away when you crowdfunded?
Yes, we used an equity crowdfunding platform so you give away shares in exchange for money essentially. You allow people to invest and you compensate them with shares in the business. There’s also non-equity crowdfunding sites such as Kickstarter and that’s great, but it tends to work best for physical products that are under a certain value, and doesn’t seem to be what most start-ups do.
I guess with that, you would have less people interested if they aren’t able to gain from it?
Far less, and actually one of the other business clichés that 3 smart people told us, was that it’s better to have a small part of a big thing than a big part of nothing. Meaning if you can raise the money, even if you have to give some equity then you’re still left with something, but if you don’t raise the money and you have all the equity, you have nothing.
Am I right to say you were interested in Health tech from very early on in your career?
Maybe. I’d been interested in technology working as a systems administrator for a couple of small businesses fixing computers and I’d enjoyed technology. I’d never got massively into programming or anything like that, which I regret now. In medical school I think I was quite confused about what I wanted to do, I didn’t feel like I fitted in with those that knew they wanted to go on a very academic track. I knew for whatever reason I was going to need flexibility, and the ability to control what I was doing and when to some degree.
I noticed you were part of the Doctors Digital Collective, when did that come about?
I was interested in tech and crucially I thought that doctors were getting left behind in technology. There’s this saying that ‘software will eat the world’ meaning that most of the things that we do now as humans, ultimately will be done by a machine.
Essentially I felt that technology and the future was coming, so you could do one of two things; stand still then when it arrives you say ‘wow I couldn’t of predicted this’, or you accept it’s coming and you train yourself to exist in that paradigm. I feel that the best people to control the future of medical technology are doctors… they are the best trained and have both an ethical and moral duty, as well as some form of aesthetic connection to what it means to heal and be a doctor.
Hacks such as those that made most of the original electronic patient systems tend build tools for doctors to use that just aren’t good enough. This is what happens when the people who make the tools for clinical practice aren’t the ones who have to use them. It could be like the early history of medicine, when all of the innovations were made by the people who were using them, as they were so close to the problem and that’s why it appeared to them.
This is what I wanted, I wanted doctors to be empowered so that if they were faced with a problem in medicine, and a technological solution came to them, they would feel that they can fix it and have people around them to give them advice. I set up the Doctors Digital Collective with friends that felt similarly, and even just scratching the surface lightly you realise there are so many doctors that are just sitting on great ideas they’ve had.
That’s why I did and still do believe something like the Doctors Digital Collective group was necessary. Unfortunately I’ve not spent as much time as I’d have liked on it, but there have been positive steps made.
There is now a Faculty of Clinical Informatics which is teaching doctors to take on roles specifically in medical software. Hospitals also now take on a CCIO which is Chief Clinical Informatics Officer, someone who has a medical background and is also involved in the IT of the hospital.
Did you have any other ideas that didn’t get to this point?
Yes, the Exception Reporting was one, and we also made a secure app based messaging…Whats-app for doctors essentially. Firstly everybody has had that idea and is trying to implement it, and secondly it wasn’t what we wanted to be doing, it didn’t help doctors sufficiently for it to be what we wanted to focus on.
When did you first start drfocused?
April of 2016. It was in a different form though, as we were called Appraiseme and focusing on appraisals. I still want to fix appraisals, as I feel that’s another area where a lot of doctors are forced to waste their time gathering evidence for revalidation. The GMC do acknowledge this and appreciate it is adding to the reasons why doctors are going to work abroad, so you never know this may still be an avenue for us.
What point are you at now with drfocused … is it being used currently?
Yes, so we are working with 5 providers now, in the beta phase – implementing and testing. We’ll be fully live by September, so it is very exciting and a very busy time for us. The plan is to get as many partners using the Medic passport as we can, and to quickly get it to a level that’s flexible enough and sufficiently affordable for the NHS and GP surgeries to use.
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