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Orthopedic surgeon describes his tech ventures as an Internet entrepreneur

Issue: February 2013

ByMatthew J. DiPaola, MD

ByOrrin I. Franko, MD

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For this month’s column, we interviewed Randale C. Sechrest, MD, an orthopedic surgeon and founder of eOrthopod.com. 

Orrin I. Franko, MD; and Matthew DiPaola, MD

Matthew DiPaola, MD; and Orrin I. Franko, MD: Tell us how you decided to start your website eOrthopod? What is it, and what is your mission?

Randale C. Sechrest, MD: Medical Multimedia Group, the parent company of eOrthopod.com, has been around since the early 1990s. The company was created to use the new computer visualization tools to help patients understand the complexities of musculoskeletal conditions and treatment. eOrthopod.com is a logical extension of that mission. The appearance of the “public” Internet in the mid 1990s drastically changed the distribution of the content, but the overarching goal is the same: to use computer technologies to help patients understand the complexities of musculoskeletal conditions and treatment. Today, eOrthopod.com uses a combination of Internet-based technologies to accomplish this goal. These include text, medical illustration, medical animation and video.

DiPaola and Franko: You are a surgeon by training. What new skills did you have to learn to take on this venture? Were you tech savvy from the beginning?

Matthew DiPaola

Sechrest: I was not tech savvy from the start. Most of what I have learned about technology arose organically as I learned more about computers and software initially, and then continued to learn about the power of networked information as the Internet evolved over the last 2 decades. I have had both the incentive and the opportunity to learn a lot of new things — several programming languages, Unix system administration and video production to mention just a few. One of the greatest benefits that the Internet has created is a huge network of on-demand, self-serve resources for learning. You can find robust resources to learn just about anything if you have the inclination and time.

DiPaola and Franko: Speak, in general, about how you see online patient education changing the current paradigm in terms of how surgeons communicate with patients.

Sechrest: I see the evolution of that huge network of on-demand, self-serve resources for learning continuing to grow in both scope and quality. That, I think, is a given. Patients have access to an enormous amount of information that they can obtain on their own. The physician is no longer the sole broker of that information. The transparency that accrues from all that information changes the power structure significantly and incentivizes the physician to enter into a conversation with the patient in order to establish a trust relationship. I am not suggesting that the trust relationship is something new in the physician-patient relationship, but in the past it was pretty opaque and the conversation was pretty much one-way. The trust was based on role status and credentials.

Better informed patients are beginning to demand a two-way conversation and a bigger role in the decision making process. Physicians are probably going to find that they not only need to improve their face-to-face communications skills, but also better harness the power of the asynchronous communication that is inherently part of the Internet. We have come to expect a higher level of engagement and responsiveness from every other product or service that we purchase. That includes the large amount of information available about the product/service prior to the purchase as well as the online access to ongoing information to maximize the use of the product/service after the purchase. Amazon.com is probably the best example of the power of that approach. Amazon.com sells commodities, but it has wrapped an incredible amount of “information service” around those commodities. That makes it the preferred vendor of the commodities it sells.

We are a long way from this approach in health care, and there are clearly different risks and potential pitfalls in health care that do not exist in retailing commodities. But, the core concept is still valid. One must understand the distinction between the core product/service and the information services that wrap around and add value to the product/service. We have tended to see all the value we provide as contained in our technical skill. But, there are a great many information services that the orthopedist will eventually need to “wrap around” the core service — the technical skill of being a surgeon. Engagement to educate and inform the patient is just one of those information services.

DiPaola and Franko: Is it an advantage or disadvantage being a surgeon and becoming an Internet entrepreneur?

Orrin I. Franko

Sechrest: A little of both. Being a surgeon requires an incredible amount of attention and focus, so does being an entrepreneur. While the domain expertise a surgeon brings to the endeavor may be valuable, the training required and the experience of being a surgeon does not equip one to be an entrepreneur. Surgeons tend to think their hard-earned expertise is transferable to nearly anything, but that is simply not the case. The tech space is a much different landscape than the surgical suite.

DiPaola and Franko: Speak about your experience collaborating with others on technology development. How do you go about forging those relationships?

Sechrest: We are a virtual company. I employ and work with individuals I have never met face-to-face. Not only can you learn just about anything on the Internet these days, you can find just about any type of expertise that you need and create a temporary (or indefinite) working relationship to get a project done. It has never been easier to find, engage and work with various companies to create fluid partnerships as part of a larger business ecosystem. The transparency enabled by the availability of information via the Internet makes it easier to research and identify potential partners and establish working relationships rapidly.

Randale C. Sechrest

DiPaola and Franko: What are three of your top mobile apps and how do you use them?

Sechrest: My day job is managing large electronic health record implementations, and I travel a great deal. That means I live on my smartphone. I could not survive without an app that allowed me to manage my airline reservations for my preferred airlines. Email is still the killer app for the Internet, and the mobile Internet is no different. We sometimes forget that email is an app and that it has not been available as an effective means of communication on mobile for that long. But, I would probably venture a guess that for most of us, email is still the most used app on our smartphones. Finally, there is Evernote. Evernote is the equivalent of the moleskin notebook and Google all rolled into one. It is hard to name an application that has combined the benefits of the desktop and mobile into an application that works so well in both environments.

DiPaola and Franko: If there was one app you wish you had, but does not yet exist, what would it be?  

Sechrest: It would not be an app, it would be Google Glass. The major limitation of the mobile platform is screen real estate. The computing power of the 5-inch form factor of the smartphone does not seem to be a limitation at this point. Input using voice and gesture are good right now and continue to evolve. But, there is a clear need for better visualization capabilities to move beyond the limitations of the smartphone and turn the smartphone into a true mobile computing device. That being said, we may find that the constant distraction of having such a device will be detrimental — think texting while driving.

DiPaola and Franko: Any words of advice for orthopedic surgeons wishing to build something in the tech space for which they see a need?

Sechrest: If you are interested in getting into the tech space, you need to critically evaluate at what level you want to jump in. Given the demands of practice, you need to make a realistic appraisal of the time that you are willing to devote to the venture. It is deceptively easy to create a company based on an idea; it is much harder to let go. These projects have a way of taking on a life of their own and demanding more time and energy. Rather than jump in as a principal in a venture at the start-up level, it might make more sense to partner with folks who are experienced in technology and focused on the medical industry to see your ideas come to fruition. The Internet space is no longer the wild, wild west it once was. It is the domain expertise that you bring to the endeavor that represents the value you bring to the table.

DiPaola and Franko: What are some of your greatest challenges and rewards in your tech ventures?

Sechrest: The greatest challenge is keeping up with the rapid rate of change in the space during the last 2 decades. There have been monumental shifts in how we access and process information. If you simply stop and think about the impact of “search” and all the innovation that has spawned, it is truly mind-boggling. Keeping up with understanding the conceptual underpinnings of information management is a full-time job. The biggest reward is also the rapid rate of change — there is never a dull moment.