I was recently at an event in Zurich for start-ups in digital health. The purpose was to connect start-ups with service providers, investors, and industry partners. During the event, we heard some futurespectives from experts, founders, and thought leaders. Very plainly I would summarise it as being an app from where you (individual, not necessarily patient) manage anything related to your health - data (e.g. exercises data, vaccination data, past healthcare interactions and active prescriptions), proactive care (e.g. risk assessments and recommendations) and reactive care (e.g. primary care, specialist care and prescriptions). Perhaps there are more categories relevant to health, but that is not the point of this blog post.
At no point in time, envisioning the future, did we discuss accessibility.
What is accessibility?
With accessibility, I refer to designing solutions (not even single products or single services anymore) that can be used and accessed by people with disabilities. Disabilities in general reflect vision, hearing, mobility, dexterity impairments (and more). Worth mentioning is that this is not binary - you can for example have a slight visual impairment.
To include people with disabilities is a human and societal aspect of inclusion and ensures that everyone has equal access to care. If you are working in healthcare you definitely know about the concept of co-morbidities and multi morbidity. This also means that for the far majority of healthcare needs, you can expect a percentage of your addressable market to have some sort of disability. This concept is also deeply rooted in user-centric design where you try to design your solutions around the user (or patient) ensuring better and available care.
Why is it important for digital health?
There are probably many more reasons than what I will list - but I will focus on my initial reaction to why I believe this is important.
Addressable market: You all know the TAM SAM SOM analysis. Well, not being (or planning to be) accessible in healthcare could mean that you are significantly shrinking your SAM from the get-go. You can of course pivot later on.
Market access: Want to get reimbursed? In some markets, you won’t be able to as tender requirements will specify them (e.g. Sweden), or other market-specific reimbursement requirements (another example is DiGa in Germany). These types of requirements tend to not disappear, but expand (markets, strictness, specifications).
Future-Proofing: There are many guiding principles out there on how you should run your start-up - typically focused on running as lean as possible with the product (I have to mention “MVP” and “good enough”), but it is wise to have some sort of consideration of where the product needs to be in the future. If you know that you would like to play in the reimbursement landscape, it’s probably wise to account for this early on as a more mature product will require significant work to become accessible if no foundation exists.
Compliance & Regulation: To be approved as a medical device, regulatory bodies will more often than not ask for accessibility (some even require it - e.g. FDA). It’s not simply enough to say that your intended user group are people with Arthritis (as an example) and to not have an accessible app (expected mobility & dexterity impairments). You have to provide validation evidence that this user group (and expected sub-user groups) actually can use your product safely and effectively. Furthermore, this also goes into medical risk management - what medical risks occur when you’re not accessible.
Of course, you - the start-up, the scale up, the corporate, the VC, the innovation incubator - might not care about a potentially small percentage of the addressable market, lack the capacity to take it on, consider other topics of higher importance, not wanting to take on the investment cost, lack the appropriate funding and more. This is of course something to respect and account for as well.
However, if we as a community are envisioning and building healthcare 2.0 with technology, why would we leave a part of humanity stuck with healthcare 1.0?
If there is feedback & interest, we will go deeper into how you can think about accessibility, where to start, and what approach to take (I’m a strong champion for pragmatism).