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Back to Basics: What is Design Thinking?

Back to Basics: What is Design Thinking?

by | Jun 3, 2020 | Innovation, Tips, Tricks, & Tools

Last week, I published a post with a very simple goal – define innovation so we can stop debating what it means and start doing it.

The response was amazing.  So, I figured that this week I would tackle another buzzword – Design thinking.

We’ve all heard it and we’ve probably all said it but, like “innovation’ we probably all have a different definition for it.  In fact, in the last few months alone I’ve heard it used as a synonym for brainstorming, for customer interviews, and for sketching while talking.  Those things are all part of Design thinking but they aren’t the entirety of Design thinking.

 

What I tell my clients

When a client asks if we’re “doing Design thinking,” here’s what I say;

“Yes, because Design thinking is a way of solving problems that puts customers and stakeholders, not your organization, at the center of the process and seeks to produce solutions that create, capture, and deliver value to your customers, stakeholders, and your company.”

 

The Basics
  • What: One could consider the official definition of Design thinking to come from Tim Brown, Executive Char of IDEO, who stated that “Design Thinking is a human-centered approach to innovation that draws from the designer’s toolkit to integrate the needs of people, the possibilities of technology, and the requirements for business success”
  • Why: Useful in solving “wicked problems,” problems that are ill-defined or tricky and for which pre-existing rules and domain knowledge will be of limited or no help (or potentially detrimental)
  • How:
    • Inspiration: Understand the problem by building empathy with stakeholders (deeply understand their functional, emotional, and social Jobs to be Done) and document that understanding in a brief that outlines goals (ideal end state), bounds (elements to be avoided), and benchmarks against which progress can be measured
    • Ideation: Generate ideas using brainstorming to develop a vast quantity of ideas (divergent thinking) and then home in on the ideas at the intersection of desirability, feasibility, and viability that best fit the brief (convergent thinking)
    • Implementation: Prototype ideas so that they can be tested, evaluated, iterated, and refined in partnership with customers and stakeholders, ensuring that humans remain at the center of the process.
  • When: At the start of any R&D or development process
    • Traditionally, design was involved only in the late stages of development work, primarily to improve a solution’s functionality or aesthetic. Design Thinking’s ability to pull the designer mindset into the earliest phases of development is, perhaps, one of the biggest impacts it has made on business and technical fields
  • Where: Can be done anywhere BUT, because it is a human-centered approach, it must involve multiple human beings through the process
  • Who: Anyone who is willing to adopt a “beginner’s mind,” an attitude of openness to new possibilities, curiosity about the problem and the people with it, and humility to be surprised and even wrong

 

Important Points & Fun Facts
  • Design Thinking IS a human-centered design approach. This means that it seeks to develop solutions to problems by involving the human perspective at every single step of the process
  • Design thinking is NOT synonymous with user-centered design though user-centered design could be considered a subset of Design Thinking because it gives attention to usability goals and the user experience

 

  • Design Thinking was NOT invented by IDEO, but I would argue that they have done more to popularize it and bring it into the mainstream, especially into business management practices, than any other person or firm.
  • Design Thinking IS the product of 50+ years of academic and practical study and application. Here’s some fun facts:
    • 1935: The practice of Design thinking was first established by John Dewey as the melding of aesthetics and engineering principles
    • 1959: The term “Design thinking” was coined by John E. Arnold in his book Creative Engineering
    • 1991: the first symposium on Design Thinking was held at Delft University in the Netherlands
    • 2000s: Design thinking is widely adopted as an innovation approach thanks to books by Richard Florida (2002), Daniel Pink (2006), Roger Martin (2007), Tim Brown (2009), and Thomas Lockwood (2010)
    • 2005: Stanford’s d.school begins teaching Design thinking as a general approach to innovation

 

  • Design Thinking is NOT just for radical/breakthrough/disruptive innovation
  • Design Thinking IS useful for all types of innovation (something different that creates value) resulting from wicked problems. In fact, as far back as 1959, John E. Arnold identified four types of innovation that could benefit from a Design thinking approach:
    1. Novel functionality, i.e. solutions that satisfy a novel need or solutions that satisfy an old need in an entirely new way
    2. Higher performance levels of a solution
    3. Lower production costs
    4. Increased salability

 

If you want to learn more…

As noted above, there are lots of resources available to those who are deeply curious about Design thinking.  I recommend starting with Tim Brown’s 2008 HBR article, Design Thinking, and then diving into IDEO’s extremely helpful and beautifully designed website dedicated entirely to Design thinking.

 

Here’s what I’d like to learn…
  • Was this helpful in clarifying what Design Thinking is?
  • What, if anything, surprised you?
  • What else would you like to know?

 

Drop your thoughts in the comments or shoot me an email at robyn@milezero.io

Back to Basics: What is Innovation?

Back to Basics: What is Innovation?

by | May 27, 2020 | Innovation

When I worked on P&G’s WalMart sales team, one of my bosses was a big guy with an even bigger personality.  He shared his opinions loudly and broadly and one of his opinions was that we needed to stop using the word “breakthrough.”

“If I have to hear one more time about some new ‘breakthrough’ soap, I will throw you out of this office myself!” he would bellow.

Years later, I can’t help but wonder what he would think of the word “innovation.”

In May 2012, The Wall Street Journal published an article positing that, as the word “innovation” increased in usage, it decreased in meaning.  The accompanying infographic said it all:

  • 33,528: Times “innovation” was mentioned in quarterly and annual reports in the previous year
  • 255: Books published in the last 90 days with “innovation” in the title
  • 43%: Executive who say that their company has a Chief Innovation Officer or similar role
  • 28%: Business schools with “innovation,” “innovate,” or “innovative” in their mission statements

That may seem like a lot but, remember, that data is nearly 8 YEARS OLD!

The desire for and investment in Innovation in all its forms – accelerators, incubators, startup/venture studios, corporate venture capital teams – has only grown since 2012.

While this may seem like a good thing, the fact that the success rate of innovations hasn’t changed, means that most people react to “innovation” the same way my boss reacted to “breakthrough” – if you bring it up, they throw you out.

To avoid getting thrown out of offices, one of the first thing I do with my clients when we begin working to build innovation into an enduring capability within their companies, is re-establish what innovation is and is not.

Innovation IS something different that creates value.

When people hear the term “innovation,” they tend to think of new-to-the-world gadgets that fundamentally change how we live our lives.  Yes AND it’s many other things, too.  Let’s break down the definition:

  • “Something” includes products and technology, it also includes services, processes, revenue models, and loads of other things. Consider this, many would argue, quite convincingly, that the Toyota Production System was one of the biggest innovations of the 20th century
  • “Different” often surprises people. After all, even Merriam Webster defines innovation as “something new.” But here’s the thing, one of the most commonly cited innovations, the iPhone, wasn’t “new.”  Even Steve Jobs admitted it when he said, in his keynote speech, that Apple was introducing three products – a widescreen iPod with touch controls, a mobile phone, and an internet connected device.  The iPhone was, however, different because it combined those three devices into one.
  • “Creates value” is probably the most important part of the definition. All innovations solve problems.  Solving problems creates value.  If you solve a big problem, either because it’s a problem lots of people have or it’s a very painful problem a few people have or something in-between, you create a lot of value for others and for yourself.
Innovation IS NOT a one-size-fits-all term.

Think of it this way, both a Kia and a Maserati are cars, but you wouldn’t expect to pay Kia’s price tag and get a Maserati (and vice versa).  Similarly, both a convertible and a pick-up truck are automobiles, but you wouldn’t use your convertible to carry building equipment to a construction site.

With a definition as broad as the one above, it’s possible for “innovation’ to become even more meaningless as it gets applied to more things.  That’s why it’s important to identify different types of innovation.

There’s no universally accepted set of innovation types, which is why I recommend companies consider defining at least three types that reflect their business and forward-looking strategies.

One of the most common set of innovation categories is based on the degree of change required for implementation:

  • Core Innovation requires minimal or no change to the current business model (customers, offerings, revenue model, resources and processes). Also known as Continuous or Incremental Innovation, this is the unglamorous but deeply important work of constantly improving what you do and how you do it.
  • Adjacent Innovation changes a significant change to at least one element of your business model. It could be changing who you serve, like expanding from interventional cardiologists to general cardiologists, what you offer, like P&G’s expansion into “durable goods” when it launched Swiffer, or how you offer or deliver it.
  • Radical innovation is the stuff that gets all the press. These innovations fundamentally change the business, like IBM moving from computers to business services.  These innovations are high-risk and require a lot of time, money, and patience to see to fruition.  This type of innovation is also called “Breakthrough” but, for obvious reasons, I shy away from that term.

There are many things that need to be done to shift innovation from buzzword to business capability. Defining innovation AND at least three different types is only the first step in moving from innovation theory and theater to building innovation into a true capability that drives sustainable growth.

Or, as I would tell my old boss, “It’s the first step.  But it’s a breakthrough one.”

Originally published on December 30, 2019 on Forbes.com

What’s next for higher ed? Mt Holyoke gave us a hint. In the 1980s.

What’s next for higher ed? Mt Holyoke gave us a hint. In the 1980s.

by | May 21, 2020 | Customer Centricity, Stories & Examples, Strategy

D-Day is less than 2 weeks away. On June 1, high school seniors and recent graduates will decide which, if any college to attend in the Fall. But, for most, they still won’t know where they’ll be living first semester.

Higher education, like so many other industries, has been rocked by the Coronavirus pandemic – classes are taught entirely on-line, students moved out of dorms and back home months before they planned, campuses are closed, and thousands of employees have been laid off or furloughed.

Like most other industries, colleges and universities have scrambled to respond and to prepare for what’s next.  Most pushed Decision Day back a month, from May 1 to June 1, to give prospective students more time to learn about schools offering admission and to assess their own ability to pay for and attend schools when classes resume.

But colleges and universities are facing a challenge that most industries are not.

Their customers are rebelling.  They are filing lawsuits.  They are asking a fundamental question, “What does my tuition actually buy?”

Before the pandemic, people though they knew.

It was only 30 years ago that most high school graduates opted to go to college.  According to research from the Georgetown Center on Education and the Workforce, in 1970, only 26% of middle-class workers had any post-high school education.  By 1992, it had jumped to 56% and 62% in 2018.

Today, prospective students, and their families believe that a college education is the cost of entry to a middle-class life.  You hear it in the Jobs to be Done (problems to be solved, goals to be achieved) they express when you ask why they want to go to college:

  • “I want to get a good job when I graduate” – functional Job to be Done
  • “I want to make a good living” – functional Job to be Done
  • “I want to have more independence” – Emotional Job to be Done (i.e. how I want to feel)
  • “I want to be part of something bigger than myself” – Social Job to be Done (i.e. how I want others to see me).

In response, colleges invested huge sums of money to convince students and their families that they offer the best solution to all of these Jobs to be Done.

  • Functional Jobs to be Done:. “I want to get a good job when I graduate” and “I want to make a good living”
    • Elements of the “College Solution”
      • Strong reputation
      • World-class education
      • Renowned faculty
      • Access to alumni network
      • Active Career services department
      • Relationships with employers
  • Emotional Job to be Done: “I want to have more independence”
    • Elements of the “College Solution”
      • Location near a major metro area or a fun college town
      • Access to student housing
      • Access to food
  • Social Job to be Done: “I want to be part of something bigger than myself”
    • Elements of the “College Solution”
      • Student clubs
      • Social clubs
      • Diverse student population
      • Championship athletics
      • Great living facilities

These elements and more are marketed in beautiful glossy brochures, recruiting roadshows, and campus tours.

The message is clear, “All of this and more could be yours if you are accepted and willing to pay.” And pay the students and their families did.

But here’s the rub.

When America went on lock-down in mid-March, colleges and universities were forced to close their campuses and send home students.  Classes were moved to virtual settings with little to no training to help faculty adjust to the new format. Overnight, almost all the elements of the “College solution” disappeared or were compromised, leaving a list that looks like this:

  • Functional Jobs to be Done:. “I want to get a good job when I graduate” and “I want to make a good living”
    • Elements of the “College Solution”
      • Strong reputation
      • World-class education*
      • Renowned faculty
      • Access to alumni network*
      • Active Career services department*
      • Relationships with employers*
  • Emotional Job to be Done: “I want to have more independence”
    • Elements of the “College Solution” – n/a
  • Social Job to be Done: “I want to be part of something bigger than myself”
    • Elements of the “College Solution” – n/a

(* = significantly compromised due to moving to a virtual setting or to economic conditions)

Yet the price of the “College solution” did not change. What happens when the customer thinks they’re paying for one thing (long list of elements) and the seller gives them something less (short list of elements) and refuses to refund a portion of their money? Lawsuits. As Mark Schaffer, the parent of a George Washington University student, explained in his Washington Post Oped:

“When my daughter was deciding where to go to college, we were persuaded by George Washington University’s promises of an extraordinary on-campus experience. The school’s recruiting materials tout a dazzling array of opportunities — to engage one-on-one with renowned faculty, join more than 450 clubs and organizations, or explore passions in high-tech labs, vast libraries, and state-of-the-art study spaces.

The university promises that living at the school opens the door to “world-class” internships, lifelong friendships with neighbors and roommates, and the chance to “become a part of the nation’s capital and make a difference in it every day.” In exchange, GWU expects around $30,000 per semester.   As college campuses across the country have shut down to slow the spread of the novel coronavirus, most schools, including GWU, have offered only online classes since mid-March. The reason for the shift is not the schools’ fault. But this remote education is nowhere near the caliber of the on-campus experience students were promised. For this reason, I and other GWU parents have requested a partial refund of this semester’s tuition and fees.   Unfortunately — and offensively — the university has refused these requests. This is why I am suing GWU for damages to compensate my family for losses suffered because of the school’s breach of contract, and why I am seeking to represent all families similarly harmed by the school through a class action.”

What happens in the Fall is unclear

As lawsuits against GWU, Northwestern, University of Chicago, NYU, Columbia, and other schools wind their ways through the legal system, everyone is scrambling to figure out what happens in the Fall. Most schools haven’t made decisions and the few schools that have seem to be falling into 3 buckets:

  • Return to pre-pandemic normal by resuming all on-campus classes, activities, and operations: Brown University (as advocated by their president in a NYT Oped), Purdue University
  • Proceed cautiously with a phased approach to resuming on-campus operations, classes, and living: UC Berkeley
  • Stayed closed and continue virtual classes: California State University (the largest university system in the US)

Students are also struggling with their decisions.  Without clarity as to what the Fall semester looks like and certainty as to their families’ financial means due to the economic downturn and rising unemployment, many students are considering taking a gap year or enrolling in a lower-cost option, such as a community college or public university.

What happens in 2021 and beyond is much easier to predict.

Certainly, the impact of decisions made about the Fall semester will reverberate for years to come as colleges cope with lost revenue from enrollment and a fairly high fixed costs base.

But the greater impact will come from students’ and families’ sudden awareness of the Mt. Holyoke Phenomenon and the role it’s played in their decision making.

First witnessed in the 1980s, the “Mt. Holyoke Phenomenon” reveals that  “charging higher tuition leads to a greater number of applicants, as well as academically higher quality applicants.”

The impact of this phenomenon is simple – higher tuition attracts better students, better students demand better education and experiences, better education and experiences improve the school’s brand, a better brand means schools can raise tuition and make more money.

Given that college tuition has increased 260% since 1980, compared to the 120% increase in all consumer items, it’s reasonable to assume that, more and more, tuition is buying access to the college’s reputation.

And, as the lawsuits and declining enrollments suggest, people thought skyrocketing tuition paid for a lot more and, suddenly aware that it doesn’t, may no longer be willing to pay the premium.

The result will re-shape higher education as we know it.

Instead of getting into the most prestigious school possible and relying on financial aid and loans to pay for it, high school seniors will consider a wider variety of post-high school options, including:

  • Trade schools which lead to high-paying and highly in demand skilled work
  • Community colleges that grant Associate’s degrees and/or a path to transfer to a 4-year college
  • Co-op programs that allow them to gain work experience at the same time as a college degree

Colleges, too, will step away from their all (on-campus) or nothing solution to offer a wider portfolio of options.  In fact, some schools already have:

  • Miami University has several campuses, one in Oxford offering a traditional, residential 4-year experience, and two other campuses nearby that offer part-time associates and bachelor’s degrees
  • Harvard University offers a traditional 4-year college education, and undergraduate and graduate degrees through the nonresidential Harvard Extension School, and online certificates through Harvard X
  • SNHU famously offers online and campus degree programs and a special “Military Experience” that offers generous tuition discounts, credit transfers, and support programs to active duty military and their spouses

 It will take years for demand (what students want and are willing to pay for) and supply (what colleges and universities can offer) to reach equilibrium.  But that equilibrium will look very different than it does today.  Mt Holyoke taught us that in the 1980s.  The coronavirus reminded us.

Isaac Newton Knows What’s Next for Air Travel

Isaac Newton Knows What’s Next for Air Travel

by | May 13, 2020 | Customer Centricity, Innovation, Stories & Examples, Strategy

I took my last flight on Friday, March 13, two days after the president’s first address to the nation about COVID-19.

It was a JetBlue flight from Charlotte, NC back home to Boston.  And it was awesome!

Setting aside the fact that I was wearing disposable gloves and wiping down every surface with Clorox wipes, I felt like I was flying private. I was the only person in my row, with no one in the row ahead of or behind me.  Snacks and drinks were plentiful.  The stewards were friendly and attentive.  Even the boarding process was swift and orderly.

But when stay-at-home orders went into effect the following Monday and I shared my travel story with clients, they were aghast.  How could I take such risks?  Did I feel safe?  Did I wear a mask?

Their reactions surprised me.  After all, these executives are frequent travelers, even road warriors they travel so much.  Yet the fear in their voices revealed a changing perception of travel.  What was once a necessary evil for work and an efficient solution for vacation had, in just 3 days, become a senseless risk.

In the 2 months since that flight, the airline industry has been rocked.  Consider:

  • 94% drop in US commercial airlines’ passenger volume
  • 80% decrease in US private jet flights
  • 75% decrease in the number of worldwide commercial flights per day
  • 80% decline in the global daily number of flight searches
  • 61% increase in the amount of time between booking and traveling

That last stat – 61% increase in the amount of time between booking and traveling – indicates that people don’t expect to fly any time soon.  But is that expectation a reaction to the drastic measures taken to flatten the curve or is it a sign of changing travel habits?

Many experts and industry associations are looking to data about the airline industry’s recovery post-9/11 and the 2008 global financial crisis.  According to data from Airlines for America, it took 3 years for passenger volume and revenue to return to pre-9/11 levels and approximately 7 years to recover to pre-2008 financial crisis levels.

Here’s the harsh truth – we cannot possibly know what will happen next.  9/11 and the 2008 financial crisis were fundamentally different events than what we’re experiencing now.

So while I understand why people are looking to these past events – data offers a sense of comfort and control over the future – using data from them is pointless.  It offers a warm snuggly illusion that things won’t change that much and a return to the old days is inevitable.

Instead of looking to the past for answers, we need to look to physics.

Newton’s 3rd Law, to be precise.  It states that for every action, there is an equal and opposite reaction.

By looking at the actions that airlines, and regulatory and legislative bodies, are currently considering, it’s possible to predict customers’ equal and opposite reactions and, as a result, what the new normal could look like.

Photo by Nadine Shaabana on Unsplash

Action: Travelers who cross state or country borders must quarantine for 14-days unless they can prove that they are COVID-19 negative
Reaction: People will limit their travel to within their home states or countries

Most US states and many countries have 14-day mandatory quarantines in place for people traveling into their jurisdictions.  Given that most trips last less than two weeks, these restrictions essentially make most travel impractical.

Some places, like Hong Kong and Vienna, are trying to lessen that barrier by testing arriving passengers at the airport and, if they test negative for COVID-19, exempting them from quarantine.

But until a vaccine is widely available, “travel is likely to return first to domestic markets with ‘staycations,’ then to a country’s nearest neighbors before expanding across regions, and then finally across continents to welcome the return of journeys to long-haul international destinations,” according to Cecilia Rodriguez, a senior contributor to Forbes.

Photo by Dino Reichmuth on Unsplash

Action: Prices increase due to fewer flights, reduced capacity
Reaction: Demand decreases as vacations become road trips and business travelers continue to use virtual meeting technology

According to research by Longwoods International, a research firm focused on the tourism industry, 82% of people traveling in the next 6 months have changed their travel plans.  22% of these people have changed from flying to driving. “Our clients are a little hesitant to get on an airplane right now,” Jessica Griscavage, director of marketing at McCabe World Travel in McLean, Virginia, told CNBC. “We’re already preparing for the drive market for the remainder of the year, and probably into 2021.”

In conversations I’ve had with business clients, the shift isn’t from air to road travel, the shift is more drastic – from traveling to not traveling.  For most large companies, business hasn’t stopped or even slowed. Instead, it’s shifted to technologies like Zoom and Microsoft Teams.  As people become more comfortable working “virtually,” these solutions will become far more attractive and just as effective as hopping on a plane.

Photo by CDC on Unsplash

Action: 4-hour pre-flight processing to ensure that all bags are sanitized, and all passengers are healthy
Reaction: Business travelers will choose private flights or fractional jet ownership over commercial air travel

The average business trip is approximately 3 days long according to Travel Leaders Corporate, an award-winning leader in business travel.  With most days packed with meetings, executives will have neither the time nor the patience to devote half-a-day to check-in, security and health screening, and boarding.

Instead, they’ll opt for private or private-like offerings such as NetJets that offer an expedited check-in, screening, and boarding process.

Photo by JC Gellidon on Unsplash

Action: Longer flight turnarounds due to the need to sanitize planes
Reaction: Demand (and prices) for direct flights will increase while demand to get to places that don’t offer direct flights will decrease

Consultants often joke about the “Misery Tax” – the premium that clients in hard reach location have to pay to make it “worth the firm’s wile” to serve them.  Although that may seem crass, there’s no debating that direct flights are significantly easier and less painful than ones that require connections.

The pain of connecting flights, however, is likely to go through the roof as the 30-minute turn-around times that airlines have been chasing become nearly impossible due to increased cleaning and sanitation guidelines.  Gone will be the days when travelers worried about making their connections.  Instead, they’ll worry about how to fill the hours between flights.

In fact, it’s likely that the misery of a given itinerary will shift from being a “tax” passed on to clients to a filter that business and leisure travelers will use when deciding where to travel.

Photo by Sharon McCutcheon on Unsplash

Action: Airlines will use the need for more screening and sanitizing to justify more fees
Reaction: People will fly only when needed, instead opting for other, cheaper, and easier convenient options.

With $82B in additional revenue from add-on fees, airlines aren’t going to pull back from charging for “extras.”  Instead, the need for more passenger screening, social distancing, and control over what is allowed in the cabin, will inspire even more add-on fees.

For example, airline industry consulting firm, Simplifying, predicts that airlines will no longer allow passengers to pick their seats but will instead assign seats to ensure proper social distancing and offer passengers the opportunity to pay for premium seats and/or keep the seat next to them empty.

Other options under consideration are banning carry-on baggage (which conveniently increases the number of bags checked and therefore the revenue from checked-bag fees) and selling safety kits containing face masks, disposable gloves, and cleaning wipes.

Already tired of being nickel-and-dimed, travelers are unlikely to willingly pay extra for required services and, as a result, are more likely to be open to alternatives such as car trips or virtual face-to-face meetings.

Photo by JESHOOTS.COM on Unsplash

There will always be demand for air travel.
But it may take generations for demand to pre-COVID levels.

Unlike 2001 and 2008, air travelers have options beyond commercial air carriers.  Wealthy and business travelers can opt for private jets or services offering fractional ownership.  Businesses, already eager to cut costs, will be more open to virtual face-to-face meetings.  Families can re-discover the adventure of road trips and the creativity of staycations.

It is the availability of these comparable options combined with the invisible threat of disease that will cause people to re-think their habits and default options and slow the airline industry’s recovery.  If it ever fully recovers at all.

5 Unexpected Uses of Telemedicine and How They May Help You

5 Unexpected Uses of Telemedicine and How They May Help You

by | May 6, 2020 | Innovation, Stories & Examples

There is more to telemedicine – the exchange of medical information from one site to another through electronic communication to improve a patient’s health – than virtual visits with physicians.

Specialists like dentists, orthodontists, ophthalmologists, psychologists, and even veterinarians are using telemedicine solutions during the pandemic.

Like their physician counterparts, many resisted virtual visits until it became the only way to continue to care for patients and stay in business, as stay-at-home orders expanded from weeks to months.

Here’s a quick run-down of telemedicine’s use in other specialties and what the road ahead could look like for each.

DENTISTRY

Where we are now

According to the American Dental Association, since early March, 79% of dentistry practices closed except for emergency procedures, and another 18% closed completely.

This isn’t surprising given how COVID-19 is transmitted but, for patients in pain, it can be hard to know what constitutes a true emergency and what can be managed at home.  Helping patients figure out what needs immediate attention and what can wait seems to be tele-dentistry’s sweet spot.

“Research indicates that 80% of acute dental concerns can be addressed at home without an in-person visit,” explains Chelsea Acosta Patel, Head of Wally Experience at Wally Health, a dental care start-up based in Boston.  “Using technology, dentists can triage issues and care for patients while keeping them out of the chair.”

Where we go from here

The bigger, long-term opportunity, according to Patel, may be in preventative care by creating and monitoring at-home preventive care solutions across the patient dental journey.

“Most dentists don’t have the tools to keep an ongoing pulse with patients.  They just assume that if a patient has an issue or a question, they’ll call the office.  Teledentistry solutions enable dentists to develop customized, ongoing touchpoints to help patients remain healthy and catch potential issues early. This improves the patient’s experience, drives loyalty and word of mouth (pun intended) for the dentist, creating a virtuous oral health cycle.”

ORTHODONTICS

Where we are now

While Dentists need a way to answer questions, triage issues, and provide follow-up care, Orthodontists have a more pressing need – to make sure their patients’ jaws continue to develop and their teeth continue to move in the right way.

“We serve a vulnerable pediatric population whose jaws are developing.  The adjustments we make as part of their treatment affect that growth and development,” explains Dr. Adam Welmerink of Welmerink Orthodontics in Reno Nevada.  “When we realized this would be more than a 2-week shutdown, we needed a way to keep our patients safe, make sure their appliances weren’t doing any harm, and ensure their treatment was progressing as planned,”

Through services like Orthodontic Screening Kit (OSK), patients receive instructions on how to take photos and upload them to the OSK site for review by their orthodontists.  Of course, the orthodontist’s ability to assess the patient’s need is determined by the quality of the photos, but, at a minimum, the service creates an opportunity for orthodontists to reconnect with their patients and give them guidance on signs that could trigger an in-office visit.

Where we go from here

Telemedicine in orthodontics, like many other specialties, will likely continue to be used to triage issues or to serve patients in remote rural areas.

“Many of our patients live in rural areas, with some driving 2 hours for a 10-minute appointment.  We’ll probably continue to use (OSK) to see if they need to come in.  And I could see using it in a limited capacity to triage patients who call with an emergency to assess if they can treat the issue at home or if they need to come in.” Dr. Welmerink mused.  “Honestly, time-wise, it’s quicker to see a patient in the office. But this is great for right now.”

OPTHALMOLOGY & OPTOMETRTRY

Where we are now

Telemedicine’s use as a way to calm patients and triage concerns, deciding whether or not an in-office visit is required, continues with eye care.

“It is certainly a way to reassure patients that we are there for them, which is most important in these scary times,” NYC optometrist Dr. Susan Resnick told All About Vision.

While reassurance is important, most eye care professionals agree that telemedicine’s use is extremely limited.  Proper eye care requires pupil dilation and specialized tools to accurately identify problems like glaucoma or assess the health of optic nerves and retinas.

Where we go from here

Despite its limitations, Dr. Resnick sees value in continuing to use telemedicine, “We will continue to utilize this platform whenever necessary.  We do not view it as a disruptor or threat, but rather as a way to bolster our practice.”

Not everyone agrees.

“I’m not terribly enthusiastic (about remote eye exams),” Illinois ophthalmologist Dr. Benjamin Ticho told All About Vision.  “There’s going to be too many mistakes.  Plus, it diminishes the warmth and personality of the interaction.  For many patients, a good doctor visit is a pleasant social occasion, and for many doctors, that’s part of why we went into medicine.”

MENTAL HEALTH

Where we are now

The data is staggering.

Before the crisis, 20% of US adults lived with mental illness but less than half received treatment according to federal statistics.

In the last two weeks of March, 45% of US adults felt that worry and stress related to COVID-19 were harming their mental health.  It’s likely that number has increased as stay-at-home orders extend, and job losses and furloughs increase.

Yet the adoption of telemedicine to address mental health concerns has been slow.  A phenomenon that is far from new.  Case in point – over a decade ago, Congress excluded mental health providers from a $30M investment in digitizing patient health records.  Even now, as CMS, private insurers, and state regulators are easing restrictions and increasing reimbursement for telemedicine to treat physical concerns, similar attention and flexibility have not been shown to mental health concerns.

As a result, “(providers) are kind of trying everything right now and seeing what can work,” John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical Center told Politico.

Where we go from here

More than other specialties, the jury is out on what happens next with regards to telemedicine for mental health.

On one hand, “so much of counseling has to do with body language, being physically present in the room, intonation,” Lynn Linde for the American Counseling Association told Politco.  “Sometimes, that’s lost when you don’t have a good internet connection, or one of your starts getting garbled.”

On the other, this could be a “tipping point for the way we practice,” said Peter Yellowlees, a professor of clinical psychiatry at the University of California, Davis and former president of the American Telemedicine Association.

Optum, a division of UnitedHealth, seems to be betting on the latter.  Last week it announced that it was in talks to acquire AbleTo, a New York-based virtual therapy provider for $470M, or 10x forward revenue.

VETERINARY CARE

Where we are now

If telemedicine is good enough for humans, it’s good enough for our animal companions.

A relatively new addition to the specialties offering telemedicine solutions, only a handful of companies are currently playing in this field.  TeleVet, a “Texas-based, digitally optimized company focused on veterinary care,” is one.

Before the outbreak, TeleVet was in use in 1000 clinics across the US and even closed a $2M seed round in January.

“We can check for infections such as ear infections or drainage from either a still picture or a video, or even a live video conference with the owner,” Dr. Amy Garrou as Houston-area vet explained to Innovation Map. “The platform has been useful because we can do any of those consultations and get the information we need to manage the case without the pet owner having to come into the clinic.”

Where we go from here

Like dentistry, orthodontics, and eye care, telemedicine’s use in the Veterinary space is a boon for providers and patients at a time when it’s not safe to be in a crowded office.  But as restrictions lift, like the other health care fields, it’s likely to be used primarily to answer questions, triage concerns, and perform post-surgery check-ups.

 

THE CLINICAL APPLICATIONS ARE DIFFERENT BUT  THE ROAD AHEAD IS THE SAME.

Yes, telemedicine is an incredible tool to have in our collective healthcare toolkit.  Its use across medical specialties is evidence that it fills a need for clinicians (provide care for my patients) and patients (address my concerns).

In “normal” times, those needs are well addressed by in-office visits, retail clinics, and urgent care.  It is only in very specific circumstances, like when medical professionals cannot easily or safely see patients in-person, that existing solutions fall short and telemedicine becomes the most attractive option.

However, telemedicine only became an available option when regulators relaxed rules, insurers increased reimbursement, and patients accepted emails and video-chats as treatment.

It took a pandemic to create the confluence of circumstances required for physicians, dentists, orthodontists, eye care professionals, mental health caregivers, veterinarians, and other clinicians to begin or expand the use of telemedicine.  It’s their experience, and the experiences and decisions of other players in the healthcare ecosystem, that will lead them back to the office and the hands-on care that is both desired and required.