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Entrepreneurial Concepts For Patient Empowerment

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Michael Friebe Editor

Novel Innovation
Design for the
Future of Health
Entrepreneurial Concepts for
Patient Empowerment and
Health Democratization
Novel Innovation Design for the Future
of Health
Michael Friebe
Editor

Novel Innovation Design

for the Future of Health
Entrepreneurial Concepts for Patient
Empowerment and Health
Democratization
Editor
Michael Friebe
IDTM Recklinghausen,
Otto-von-Guericke University
Magdeburg, Germany

ISBN 978-3-031-08190-3 ISBN 978-3-031-08191-0 (eBook)

https://doi.org/10.1007/978-3-031-08191-0

# The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland
AG 2022
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
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The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
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This book is dedicated to my parents and
YOU
“You know the greatest danger facing us is
ourselves, an irrational fear of the unknown.
But there’s no such thing as the unknown —
only things temporarily hidden, temporarily
not understood.”
—Captain James T. Kirk
This is a short but also difficult page. Nobody
typically reads the DEDICATION and nobody
really remembers who was listed here.
But it is a page that the author writes last
and—considering the amount of text—spends
the most time on.
This book in essence is mainly dedicated to
YOU, who holds it right now as a real
physical book or as a digital version. The
reason? Well, YOU must be someone who
wants to create health-related innovation and
has a purpose. And YOU see that there are a
lot of global challenges related to WELL
BEING and GOOD HEALTH that cannot be
solved with the current focus of healthcare
provision and the currently applied
methodologies and mindsets.
And of course this book is also dedicated to
the ones that are close to me, that have helped
and supported me for decades, that have
stimulated me, and that have challenged me in
my private and professional life.
I really appreciate and love you . . . I may not
have told you yet or not often enough and I am
sorry for that.
You know me and you accept me that way.
Please stick around and help me!
Thank You!
—Michael Friebe
Foreword

Let’s put the power of exponential technologies into patient’s hands and revolution-
ize how we live.
We are edging closer towards a dramatically extended healthspan.
Where “100 years old can become the new 60”
—Peter Diamandis, MD

Rethink Health Innovation Generation with Exponential

Technology Convergence

Accelerating advancement of exponential technologies is actually old news.

So, what’s the new news in 2022 and useful for health innovators?
That formerly independent waves of exponentially accelerating technology are
beginning to converge with other independent waves of exponentially accelerating
technology.
In other words, these waves are starting to overlap—stacking atop one another,
producing tsunami-sized behemoths that threaten to wash away (read: “reinvent”)
almost every industry in their path.
For example, the speed of drug development is accelerating—not only because
biotechnology (sequencing, CRISPR, etc.) is progressing at an exponential rate, but
because AI, quantum computing, and other exponentials are converging on the field.
When an innovation creates a new market and washes away an existing one, we
use the term “disruptive innovation,” such as when silicon chips replaced vacuum
tubes at the beginning of the digital age. That was a disruptive innovation.
It is pretty clear that no industry is immune to these developments.
Why would that therefore not be true for the healthcare business? Big data +
machine and federated learning, novel sensors, 5G, gene information, and 3D
printing will undoubtedly cause a disruption of how healthcare is seen and
performed and also where it takes place. And with that disruption we will most
likely see an adapted and completely changed health business model. More home
care, more prevention and prediction, a higher health personalization, and an

vii
viii Foreword

increased participation of the individual will help to identify and fix health problems
long before they are noticeable or even diagnosable. Do we then still need the
amount of hospital beds that we have today? Do we still need the same sick-care
financing that covers the treatment and therapy cost?
And ultimately that should lead to developing new ways to fight diseases
associated with aging leading to an increased health longevity.
As an entrepreneur, being able to see around the corner of tomorrow and being
agile enough to adapt is critical to your success.
What you should remember as you think about how to leverage these new
business models is that the rate at which technology is accelerating is itself
accelerating.
Yet even in this dynamic environment, countless businesses are still anchored by
a mentality of maintaining—competing solely on operational execution.
But as an innovator and entrepreneur, it’s more vital than ever that you leverage
these business models for success in the decades ahead.
Each one is a revolutionary way of creating value—each is a force for
acceleration.
All of this requires a novel look on education and educating, and this book will
possibly help to solve some of the big challenges in and around global health through
creating awareness, helping to develop an exponential mind, and providing a
valuable toolset for innovators.

Peter Diamandis, MD Recently named by Fortune as one of the “World’s 50

Greatest Leaders,” Peter H. Diamandis is the founder and executive chairman
of the XPRIZE Foundation, which leads the world in designing and operating
large-scale incentive competitions. He is also the executive founder of Singu-
larity University, a graduate-level Silicon Valley institution that counsels the
world's leaders on exponentially growing technologies. As an entrepreneur,
Diamandis has started over 20 companies in the areas of longevity, space,
venture capital and education. He is co-founder of BOLD Capital Partners, a
venture fund with $250M investing in exponential technologies, and co-

(continued)
Foreword ix

founder and Vice Chairman of Celularity, Inc., a cellular therapeutics com-

pany. He is also a New York Times Bestselling author of three books:
Abundance—The Future Is Better Than You Think, BOLD—How to go
Big, Create Wealth & Impact the World and The Future is Faster Than You
Think. Contact: [email protected]

XPRIZE Foundation Peter Diamandis

Culver City, CA, USA
SINGULARITY University
Santa Clara, CA, USA
Foreword

We have to challenge, disrupt, and find new solutions to make healthcare more
affordable, more accessible, and ultimately more equitable.
—Prof. Shafi Ahmed, MD

The Exciting Future of Surgery . . . but that Is Not the Primary

Concern of the Future of Health

I started writing this foreword with a perspective on the future of surgery, as I am a

practicing surgeon. The new concept of digital surgery follows on from the longer
journey of digital health, and it is incredible and reassuring to see the recent
developments in this field globally with international teams solving important
problems.
It is safe to assume that some of these will actually be translated to the patient’s
bedside over the next few years. Augmented and virtual reality, combined with
artificial intelligence, will help a surgeon plan and navigate a complex procedure
more safely. Semi-autonomous surgery is almost at a touching distance and becom-
ing a reality. The rapid expansion of surgical robots and improvements in connec-
tivity may guide us to the point of the surgical singularity and to the Shangri La of a
fully autonomous operation.
Is that good or bad?
Well, if you argue from a patient’s perspective—and that is the point of view that
one should always have—with a proven better accuracy and efficacy, that is fairly
easy to answer. However, we are not quite there yet, but I am of the firm belief that it
will not take much longer. From a perspective of a surgeon, there may be a concern
that it will remove the need for surgeons, but I am convinced that these technologies
will actually enhance and augment our work and remove variation and improve
outcomes that are driven by data. There will always be a need for surgeons in
decision making and judgment which are essential and require a myriad of skills
including empathy and communication. Surgeons will be vital in emergency cases,
or for very complicated procedures that the AI-powered robot is not yet trained for

xi
xii Foreword

and to importantly manage complications. This brings me neatly to the global health
workforce shortages and to highlight that clinical education has not yet completely
embraced immersive technologies and simulation. We will naturally repurpose our
roles as surgeons similar to the radiologist embracing AI diagnostic tools.
I am also someone who has close ties to many lower income nations. What I see
as health needs there has nothing to do with the incremental developments that we
are working on in the countries with established healthcare systems. I am deeply
concerned about the lack of access to advanced technologies there and the associated
cost of providing them. Only a small percentage of the population can actually afford
the health offerings. We need to rethink our current approach of making incremental
developments and move toward a more disruptive approach that would lead to a
democratization of health. I am also encouraged by those same countries that
understand frugal innovation as well as having the foresight and determination to
leapfrog Western health systems by thinking outside conventional attitudes to health
and care delivery.
We should constantly question the current healthcare business model as we can
and need to do better. We need to shift much more toward health monitoring and
prevention.
The future of health must be working from a patient’s perspective, addressing the
big challenges, using the power of exponential technologies, and developing needed
tools in interdisciplinary and global teams. The book is a great starting point for
rethinking the current process of health innovation.

Prof. Shafi Ahmed, MD, is a world renowned, multi award winning surgeon,
teacher, futurist, innovator, and entrepreneur. He is a 3x TEDx speaker and is
faculty at Singularity University. He has delivered over 250 keynotes in 30
countries.
After studying medicine at Kings College Hospital Medical School
London, he completed his surgical training in London. Ahmed is currently a

(continued)
Foreword xiii

Laparoscopic Colorectal surgeon specialising in colorectal cancer at The

Royal London and St Bartholomew’s Hospitals.
His mission is to merge the world of medicine, global education, and virtual
and augmented reality to democratize and scale surgical education to make it
affordable and accessible to everyone using the power of connectivity to allow
equitable surgical care. Contact: [email protected]

Barts Health NHS Trust Shafi Ahmed

London, UK
Royal College of Surgeons
London, UK
Medical Realities
London, UK
Foreword

Longevity medicine is the epitome of a sustainable disruption in healthcare

innovation, characterized by symbiotically inclusive interdisciplinarity of clinical
medicine, gerosciences, AI, and computational science, potentiated by collaborative
ecosystem with the public health, industry, and governance.
—Prof. Evelyne Yehudit Bischof, MD

Longevity Medicine as a Symbiosis and Catalysator of Health

Innovation and Technology

The health sector’s core demands shifted thanks to the massive advancements in
reactive medicine, facilitated and accelerated by progressive novel technologies, and
a resulting lifespan extension. The silver tsunami arrived in most of the
demographics; the global health burden is dominated by chronic diseases of old age.
Health innovations in sick care and early prevention have already reached a solid
niveau, and further developments will now focus on striving excellence, such as in
interventional robotics, targeted therapies, and enhanced imaging. AI is virtually
ubiquitous in all health sectors.
With the rapid ascent of AI and ML, especially deep learning, as well as federal
and transfer learning, fundamental tools were given to enrich the nascent field of
longevity medicine: AI-based precision medicine that aims at expanding the healthy
lifespan by identifying the risks of diseases and mitigating and eliminating them.
Uniquely inclusive, multimodal, and interdisciplinary, this field is ultimately the
future of health innovation – and the future is now. Artificial and human intelligence
will need to converge more efficiently toward optimization of individual
biological age.
Various stakeholders, including the industry, are as essential and partaking in
shaping healthcare and implementing strategic applications as now. This is due to the
granularity and permeability of key arenas: computational and AI science,
gerosciences, medicine, and engineering. Combined with social AI maturity and
increasing demand for personalization in diagnostics and therapies, innovators will

xv
xvi Foreword

embrace the enchanting challenge to forge on the existing data collection modalities,
e.g., POC, continuous monitoring, NLP, and multiomics, and create integration
strategies towards new trajectories and improved AI-developed algorithms.
Innovation requires new responsibilities for all, especially to clinicians like
myself who also engage as scientists, academic tutors, and public health advisors.
In the present technological perpetuum mobile, it is imperative to work along
executors and assure that sustainability, credibility, and safety is assured for what
we all share: the will to achieve healthy longevity and lifespan with minimal to no
age-related diseases.
As a longevity physician, leading my patients and educating peers and
stakeholders such as investors, insurances, or policy makers often includes
illustrating the opportunities, limitations, and perspective of healthcare innovations.
This book offers a compilation of valuable themes, equipping the reader with
information, trends, skills, and resources necessary to navigate and excel in health
innovation.

Prof. Evelyne Yehudit Bischof, MD, is an Associate Professor at Shanghai

University of Medicine and Health Sciences and a visiting associate professor
at the Tel Aviv University School of Medicine. Other assignments are delegate
doctor of the Israeli Consulate China, Shanghai; Chief physician Internal
medicine University Hospital of Jiatong School of Medicine Renji, Shanghai;
Longevity concierge physician Human Longevity Inc., San Diego; Scientific
physician at International Center for Multimorbidity and Complexity in Medi-
cine (ICMC), Universität Zürich, Schweiz. Evelyne is an internal medicine
specialist and longevity physician, trained a.e. at Harvard Medical School
affiliated hospitals (Mass General Hospital, Beth Israel MD, Dana Farber)
and Columbia University NYC. She is a specialist in internal medicine, with
research focus on Artificial Intelligence (AI) and digital health, especially in
the fields of oncology, preventative and precision medicine, biogerontology,
and geronto-oncology. She published over 90 peer-reviewed papers and is a

(continued)
Foreword xvii

frequent speaker at scientific and medical conferences in Asia and in Europe.

Contact: [email protected]

Shanghai University of Medicine Evelyne Yehudit Bischof

and Health Sciences, International
Center for Multimorbidity and Complexity
in Medicine (ICMC), Universität Zürich
Zurich, Switzerland
Preface

Innovation Design for the Future of Health

Entrepreneurial Concepts for Patient Empowerment and Health

Democratization

If you believe that global healthcare and health delivery is fine, that we have no real
challenges to solve in that space, and that we should continue to exclusively focus on
diagnosing and subsequently treating sick people with more and more complicated
and expensive devices and processes . . . then thank you for buying this book, but it is
not really meant for you!
For everyone else “Thank You” for allowing me to take you on a journey from
current healthcare services and delivery processes to a future of health vision.
In a high-income country you may say that everything is actually working well
when we are sick. You are right and that service should continue to become better,
more efficient, personalized, and more patient centric. The digital health transforma-
tion process will for sure provide tools to clinicians and patients that will likely
empower the patient significantly and create a changed and more equal patient–
doctor relation. That is good!
Rethink, if you are not from one of the high-income nations and empathize with
the possible issues of low-income nations if you are situated in a rather wealthy
environment.
We likely will have technologies available that will allow us to predict and
prevent many diseases before they are noticeable, we will be able to increase our
healthy lifespan (longevity), and we will be able to benefit from novel prevention
and treatment strategies. This in turn will trigger new segments and new business
models, especially since these may be rather inexpensive and not require a doctor
input anymore. So we may need a new “INNOVATION DESIGN for the FUTURE
of HEALTH.”
The best recipe to achieve meaningful regional and global solutions is to stimulate
entrepreneurship. A core element of the book is therefore to present “Entrepreneur-
ial Concepts for Patient Empowerment and Health Democratization.”

xix
xx Preface

Fig. 1 Left: The needs and the determinants of personal health are not really aligned with the actual
healthcare delivery processes and goals, and the great challenges around health are also not
effectively dealt with. Right: A core concept of the book is to stimulate entrepreneurial activities

Figure 1 on the left shows the main determinants of personal health, how
healthcare delivery looks like, and the major challenges that we need to address,
and on the right the different entrepreneurial (or intrapreneurial) starting points and
the issues that this venture has to deal with. The book attempts to provide
methodologies that should prepare for the needed future thinking and for an expo-
nential mindset. This will likely increase your odds of developing successful and
impactful products and services.
The book is complemented by articles of leading experts that will provide some
relevant health innovation-related insights that are provided as chapters in the
following main parts:

• General Introduction about “What is Wrong with Health?” and “What Should the
Future of Health be?” (Part I: Chaps. 1–5).
• Followed by “Exponential Medicine + Technologies + Mindset” (Part II: Chaps.
6–10) and “Future Health Value Propositions” (Part III: Chaps. 11–17).
• After that we start with “Innovation Methodology Basics” (Part IV: Chaps. 18–
22) and discuss “Ethical Design Considerations for Health Innovations” (Part V:
Chap. 23).
• The next two parts follow with a more generic title of “Health Innovation Design”
(Part VI: Chaps. 24–26) and a more specific presentation of the “Purpose
Launchpad Health” (Part VII: Chap. 27).
• “Health Leadership, Skills and other Methodologies” is covered in the
succeeding part (Part VIII: Chaps. 28–31), followed by
• The important part on “Health Entrepreneurship” (Part IX: Chaps. 32–39).
• Several European and Corporate “Health Innovation Education and Incubation”
(Part X: Chaps. 40–48) setups are then presented as case examples and the book
closes with
• A summary presentation and explanation of the “Purpose Launchpad Health:
Toolset Templates and Principles” (Part XI: Chap. 49).
Preface xxi

Fig. 2 Left: The main innovation method presented—Purpose Launchpad Health (based on
Purpose Launchpad developed by Francisco Palao and the Purpose Alliance (www.
purposealliance.com)). 8 Segments and many tools—all of which will be presented and discussed.
Right: a typical agile iteration process based on the Lean Startup principle that is a core element of
understanding the problem and creating something that actually has a validated need

I was very much inspired by the innovation laws of Peter Diamandis (see
instructions and download link at https://www.diamandis.com/blog/how-you-can-
use-peters-laws), especially these three, while all other ones listed are awesome as
well and make you think about the future and your current role in shaping the future.

1. The best way to predict the future is to create it yourself!

2. When given a choice. . . take both!!
3. Do it by the BOOK, but be the AUTHOR (or in my case the EDITOR and main
AUTHOR).

And as a former university professor I also like another one very much “Bureau-
cracy is an obstacle to be conquered with persistence, confidence and a bulldozer
when necessary.”
I firmly believe that we also need to adjust/rethink our current education system
that is often too siloed and does not focus on creating impact. So I hope that the book
is also used for teaching health technology innovation design in a classroom setup.
For details on how to do that (also hybrid or completely online), see Chaps. 40–42.
Figure 2 shows the core innovation framework used in this book, the Purpose
Launchpad Health (PLH) based on the great work of Francisco Palao, and many
international contributors (the editor being one of them).
This framework will be explained and discussed in detail, with examples and by
providing all the used templates (Part XI).
I finish this preface with a list of the key innovation principles of this book:

• Use agile and iterative approaches to validate hypotheses and assumptions in all
aspects.
• Whenever possible think 10x not 10%—question the current setup!
• Experimentation (product, customer, business model, . . .) is key to a successful
implementation of a novel product or process idea.
xxii Preface

• Put yourself often in the position of the core user / patient and try to see the
situation from their point of view (EMPATHIZE).
• Do not start building before defining and evaluating the problem that you are
trying to address.
• Good questions are most important—if you ask the right questions you will find
the answers!
• Embrace failure or invalidating ideas and with that focus on the LEARNING.
• Write everything down for a learning history and to be able to go back when
needed. Especially important for the regulatory approval process of health
products.
• Come up with many solution ideas—do not limit yourself to the first one that you
fall in love with.
• Use minimal viable prototypes (MVP) for validation checks and customer
experiments.
• Evaluate alternative solutions based on their DESIRABILITY (Is there a verifi-
able customer need?), FEASIBILITY (Can we build solutions that will actually be
working and satisfying these needs?), and VIABILITY/SUSTAINABILITY (Can
we do that within a business model? . . . or do we envision a new one? . . . and can
we do that within a sustainable future business model?).
• Have a (massive transformative) purpose combined with a longer-term vision, a
shorter term mission, and a definition of the organizations core values. Or in
other words: have a great futuristic and far-reaching plan, which is too big for
you at the moment and too far away, but also come up with realistic milestones on
how you want to reach that.

The book will address all these points in the different parts and chapters.

Enjoy the reading and learning . . .

. . . and a big Thank You to all the Contributors!

Recklinghausen and Magdeburg Michael Friebe

Germany
Acknowledgments

A big “thank you” to all the contributors—you all did a great job, you said very
quickly “yes” after I asked you, and you are all pretty much in line with the core
principles of the book.
Prof. Dr. Nassir Navab from the Technical University München (TUM), Chair of
Computer Aided Medical Procedures, needs to be mentioned and acknowledged. An
incredible innovative researcher who showed a great openness towards the positive
impact of nonprofessional academics, who also has been a decade-long supporter for
me in research (TUM-IAS fellowship), and who has been part of several entrepre-
neurial ventures with me.
The lecture that I started there is still taught every semester with over
500 graduates in the meantime (thanks to Dr. Jörg Traub for continuing it and for
being a friend) and over 25 startups. He stimulated me to apply for a full-time
professorship, and the Otto-von-Guericke-University in Magdeburg eventually
appointed me as research professor. The 5 years there were extremely productive,
I learned a lot, still have many friends and supporters there, and am still closely
connected to the medical faculty as honorary professor. It opened my eyes however
with respect to needed reforms and adjustments for research perspectives (only
talking about healthtech related), value propositions, and education of health
innovators. To me it is more clear than ever that meaningful transformation and
innovations require a multidisciplinary environment with low bureaucratic burden. It
is very difficult however—maybe even impossible—for normal universities to be
agile enough to adapt to the changing environments. But while my time at the
university—coming from two decades of being an entrepreneur and CEO—was a
rather frustrating reality check, it was also one of the main triggers for this book.
For stimulating foresight, for introducing novel concepts, and for generally
influencing my thinking and acting I want to acknowledge Singularity University,
A360, Exponential Medicine, OpenExO, Purpose Alliance, Syntropic Enterprise,
Growth Institute, and the Healthcaptains—many of the book contributors are part of
at least one of these organizations.
I need to mention the influence of friends and collaborators in academia from IIT
Kharagpur India, Misr University of Science and Technology Egypt, Queensland
University of Technology Brisbane/Australia, and since 2022 the AGH University
of Science and Technology in Krakow Poland . . . and equally important the

xxiii
xxiv Acknowledgments

connections and ongoing discussions with industry and here specifically Siemens
Healthineers (Innovation Think Tank and the MRI and Advanced Therapies Busi-
ness Units), GE Healthcare (Edison Accelerator and the Chief Medical Office
EMEA), Brainlab, Visus, Olympus, BBraun Aesculap, Bracco, and many startup
companies with their great ideas and motivated founders . . . and finally the profes-
sional organizations and networking setups MedEcon Ruhr, IEEE EMBS, SPIE,
RSNA, MedTec Pharma, Business Angel Network Deutschland (BAND), CARS,
and EWG.
Isabella Geiger and Stefan Hellwig, my coworkers, and co-shareholders have
helped and supported me and my crazy ideas for close to 30 years now. Thanks a lot
for the trust and confidence.
And finally I have to acknowledge the contributions of my wife Peggy. You will
not find any article from her, but you can be ensured that without her this book would
not have been finished.
Contents

Part I What Is Wrong with Health? What Should the Future

of Health Be?
1 INNOVATION DESIGN for the FUTURE of HEALTH . . . . . . . . . 3
Michael Friebe
2 Health Innovations from an Innovators’ Perspective . . . . . . . . . . . . 13
Michael Friebe
3 From SICKCARE to HEALTHCARE to HEALTH . . . . . . . . . . . . 23
Michael Friebe
4 Future Look on Health: Opportunities . . . . . . . . . . . . . . . . . . . . . . 33
Michael Friebe
5 Navigating Towards a Future of “One Health” . . . . . . . . . . . . . . . . 51
Henri Michael von Blanquet and Michael Friebe

Part II Exponential Medicine + Technologies + Mindset

6 Exponential Technologies for an Exponential Medicine . . . . . . . . . . 63
Michael Friebe
7 Exponential Medicine: Challenges of Human Spaceflight
Bringing Innovations for Earth—A Case Study . . . . . . . . . . . . . . . 71
T. Smith, A. Peterman, and D. Donoviel
8 Healthy Longevity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Beatrice Barbazzeni
9 The Science of Health Longevity . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Beatrice Barbazzeni
10 Space Healthtech: Innovation Base for Longevity . . . . . . . . . . . . . . 95
Thi Hien Nguyen

xxv
xxvi Contents

Part III Future Health Value Propositions

11 Healthcare the Melting Pot of Technology, Humanity,
and Confusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Paul Epping and Michael Friebe
12 Democratize Health Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Julia Hitzbleck
13 Health Innovation Process: Definitions and Short Methodology
Introductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Michael Friebe
14 Prevention, Prediction, Personalization, and Participation as Key
Components in Future Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Beatrice Barbazzeni and Michael Friebe
15 Digital Health Business Models: Transformation Is on the
Horizon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Dominik Böhler
16 Value Propositions for Future Health Developments: Digital,
Portable, Connected, Experience-Enhancing, Supportive,
Patient-Centric, and Affordable . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Beatrice Barbazzeni
17 (Digital) Patient Journey and Empowerment: Digital Twin . . . . . . . 169
Dominik Böhler and Michael Friebe

Part IV Innovation Methodology Basics

18 Stanford Biodesign as Base: Empathy and Patient Centricity as the
Main Driver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Holger Fritzsche
19 Purpose Launchpad Methodology: Introduction . . . . . . . . . . . . . . . 189
Oliver Morbach and Michael Friebe
20 Design Thinking for Innovations in Healthcare . . . . . . . . . . . . . . . . 207
Dietmar Georg Wiedemann and Michael Friebe
21 VPC to BMC to Exponential Canvas: Canvas Interconnectivity
for Exponential Scaling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Katarzyna Heryan
22 Innovation Methodology I3 EME: Awareness for Biomedical
Engineers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Holger Fritzsche
Contents xxvii

Part V Ethics + Health Innovation

23 Integrating Ethical Considerations into Innovation Design . . . . . . . 253
Sabrina Breyer and Christian Herzog

Part VI Health Innovation Design

24 Case Studies Used Throughout the Book: Innovation Categories
Explained . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Michael Friebe
25 Why Is Healthcare Different with Respect to Innovation and
Entrepreneurial Activities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Sys Zoffmann Glud
26 Purpose Launchpad Health (PLH) Methodology Introduction . . . . 299
Michael Friebe, Julia Hitzbleck, Dietmar Wiedemann,
and Oliver Morbach

Part VII Purpose Launchpad Health

27 Purpose Launchpad Health: Exploration and Evaluation
Phases—Actual Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Michael Friebe and Oliver Morbach

Part VIII Health Leadership, Skills and other Methodologies

28 Soft Skills Needed for Problem Understanding and Innovation
Generation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Sys Zoffmann Glud
29 Leadership in Healthcare: A Novel Approach. Healthcare
Executives’ Traits, Styles, and Approaches . . . . . . . . . . . . . . . . . . . 369
Beatrice Barbazzeni
30 Future Skills Framework in Healthcare . . . . . . . . . . . . . . . . . . . . . 381
David Matusiewicz and Jochen A. Werner
31 Porter’s Five Forces Analysis: Quo Vadis Immunotherapy
Industry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
Joachim Maartens and Dietmar W. Hutmacher

Part IX Health Entrepreneurship

32 Global Health Markets and Their Different Needs . . . . . . . . . . . . . 411
Jörg Traub
33 Patient: Health Relation and Digital Health Entrepreneurship . . . . 419
Thorsten Hagemann
xxviii Contents

34 Health Start-Up: Create Impact and be Investment Ready

Intra- and Entre-Preneurs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
Michael Friebe
35 Regulatory Issues for Health Innovations . . . . . . . . . . . . . . . . . . . . 443
Axel Boese
36 Innovation Think Tank Frameworks for Resolving “The
Innovator’s Dilemma” in Healthcare . . . . . . . . . . . . . . . . . . . . . . . . 451
Sultan Haider
37 A Primer on Patents and IP for Health Innovations . . . . . . . . . . . . 465
Michael Friebe
38 Successfully Implementing Ambidexterity in the Medical
Industry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477
Gunther Wobser
39 Reverse Innovation: Circumvent Digital Health Transformation
Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485
Michael Friebe

Part X Health Innovation Education and Incubation

40 Health Innovation Design: “CAMPing” for the Unmet Clinical
Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 499
Jörg Traub
41 Health Technology Innovation Generation (HTIG) Lecture and
Project Classes at AGH University . . . . . . . . . . . . . . . . . . . . . . . . . 507
Katarzyna Heryan and Michael Friebe
42 Health Innovation Design at a University: INKA INNOLAB
at Otto-von-Guericke-University . . . . . . . . . . . . . . . . . . . . . . . . . . . 529
Holger Fritzsche
43 Clinical Innovation at Acibadem Biodesign Center . . . . . . . . . . . . . 537
Ata Akın, Erdi Dirilen, Kutalp Kurt, and Esra Bal
44 Example of a Needs-Driven Innovation Training Program:
The BioMedical Design Novo Nordisk Foundation Fellowship
Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 549
Sys Zoffmann Glud
45 Addressing the Healthcare Needs with Innovation Think Tank
Global Infrastructure and its Methodology . . . . . . . . . . . . . . . . . . . 557
Sultan Haider
Contents xxix

46 The Power of a Collaborative Ecosystem: Introducing the

Edison™ Accelerator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 567
Jan Beger and Mathias Goyen
47 HealthTec Networks and Clusters (Global): Innovation Clusters
in Medtech in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575
Jörg Traub
48 Leadership-Compass: “Networking and Synapting Empowered
by Health Captains” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 585
Henri Michael von Blanquet

Part XI Purpose Launchpad Health: Toolset Templates and Principles

49 PLH Templates and Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . 599
Michael Friebe
List of Abbreviations

10X 10 times (thinking)

3D Three-dimensional . . .e.g., 3D printer
4PH Prediction, prevention, personalization, participation health
6D Digital, disappointment, disrupt, dematerialize, demonetize,
democratize
ABC Acibadem Biodesign Center
ACTH Adrenocorticotropic hormone
AI Artificial Intelligence
AT Assistive Technologies
AUC Area under the curve
BCAA Branched-chain amino acids
BD2K Big data to knowledge
BLSS Bioregenerative life support system
BMC Business Model Canvas
BME Biomedical Engineering
BME IDEA Biomedical Engineering, Innovation, Design, and Entrepreneurship
Alliance
BOSI Builder, Opportunist, Specialist, Innovator (bosidna.com)
CAGR Compounded annual growth rate
CB Certified Body (regulatory)
CCC China Compulsory Certification
CDMO Contract design and manufacturing organization
CDS Clinical decision support
CE Conformité Européenne
CER Clinical evaluation report
CoG Cost of goods
CPT Current Procedural Terminology (for Medical Reimbursement)
CQC China Quality Certification
CQC Care Quality Commission
CRISPR Clustered regularly interspaced short palindromic repeats
CRO Clinical Research Organization
CT Computed Tomography
CTP Cell Therapy Product

xxxi
xxxii List of Abbreviations

CV-19 COVID-19
CVD Cardiovascular Diseases
DACH Germany (D), Austria (A), Switzerland (CH)
DiGa Digitale Gesundheitsanwendung (Digital Health App)
DIY Do it yourself
DL Deep Learning
DNA Desoxyribonucleic Acid
DR Dietary Restrictions
DRG Diagnostic Related Case Groups (for Medical Reimbursement)
ECG Electrocardiogram
ECTS European Credit Transfer and Accumulation System
EDV Expertise development Program
EHR Electronic Health Record
ENT Ear, Nose, Throat
ePA Elektronische Patientenakte (electronic medical record)
EPO European Patent Office
EuGH European Court
EVP Ethically viable Product
EXO Exponential Organisations (www.openexo.com)
FCC Federal Communications Commission
FDA Food and Drug Administration
FDR False Discovery Rate
GDP Gross Domestic Product
GE General Electric Corporation
GM General Management
HALE Health adjusted life expectancy
HCP Healthcare Provider
HIN High Income Nation
HMW How might we
I3-EME Identify Invent Implement with Engineers Medical Staff and
Economics
ICER Institute of Clinical and Economic Review
ICT Information and Communications Technology
IEEE Institute of Electrical and Electronics Engineers
IGT Image guided Therapies
IoT Internet of Things
IP + IPR Intellectual Property Rights
IPO Initial Public Offering
ISO International Organization for Standards
IT Information Ttechnology
ITT Innovation Think Tank
IUD Intrauterine Device
KOL Key Opinion Leader
LDH Lactate Dehydrogenase
LEO Low Earth Orbit
List of Abbreviations xxxiii

LIN Low-income Nation

MDR Medical Device Regulation
mHealth Mobile Health
MIC Ministry of Internal Affairs (Regulatory Body in Japan)
ML Machine Learning
MRI Magnetic Resonance Imaging
MTP Massive Transformative Purpose
MVMV Moonshot, Vision, Mission, Values
MVP Minimum Viable Prototype (sometimes also product)
NASA North American Space Agency
NB Notified Body (regulatory)
NCD Noncommunicable Diseases
NHS National Health Service (UK)
NICE National Institute of Health and Care Excellence
NIH National Institutes of Health (US)
OECD Organisation for Economic Co-operation and Development
OEM Original Equipment Manufacturer
OKR Objectives and Key Results
OPSP One-Page Strategic Plan (Growth Institute)
P4 Prediction, Prevention, Personalization, Participation
PCR Polymerase Chain reaction
PCT Patent Cooperation Treaty
PL Purpose Launchpad
PLB Purpose Launchpad Board
PLH Purpose Launchpad Health
PLM Purpose Launchpad Mood
PLP Purpose Launchpad Points
PLP Purpose Launchpad Progress
POC Proof of concept
QALY Quality-adjusted life year
QM Quality Management
QMH Quality Management Handbook
QMS Quality Management System
R&D Research and Development
RA Regulatory Affairs
RIH Responsible Innovation in Health
RM Risk Management
ROC Receiver Operating Characteristics
ROS Reactive Oxygen Species
RRI Responsible Research and Innovation
SDG Sustainable Development Goals (United Nations)
SOD Superoxide dismutase
SPE Solar particle event
T2I2 Technological Innovations in Therapy and Imaging
TD Technical documentation
xxxiv List of Abbreviations

TRISH Translation Research Institute for Space Health

UN United Nations
USD United States Dollar
VDI Verein deutscher Ingenieure (Association of German Engineers)
VPC Value Proposition Canvas
WHO World Health Organization
WIPO World Intellectual Property Organization
WMH Wearable Health Monitor
 Part I
What Is Wrong with Health? What Should
the Future of Health Be?
INNOVATION DESIGN for the FUTURE
of HEALTH 1
Michael Friebe

Abstract

This chapter describes in further detail the motivations to write this book. It also
shows how the author, with a background as a medical technology entrepreneur
and also as a university professor, developed his belief that we need a different
approach to health innovation. A new and agile approach powered by a set of
human skills that are not taught at universities is required. So one of the intents for
this book is to accompany teaching on Healthtech Innovation Generation at
universities, but also to show novel innovation methods for entrepreneurs and
also intrapreneurial activities. And finally to stimulate rethinking the current
health innovation processes and goals.

Keywords

Exponential medicine · Global health challenges · Biomedical engineering

curriculum · Planetary health · Individual health

M. Friebe (*)
AGH University of Science and Technology, Krakow, Poland
Otto-von-Guericke University, Magdeburg, Germany
IDTM GmbH, Recklinghausen, Germany
FOM University of Applied Science, Center for Innovation and Business Development, Essen,
Germany
e-mail: [email protected]

# The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 3

M. Friebe (ed.), Novel Innovation Design for the Future of Health,
https://doi.org/10.1007/978-3-031-08191-0_1
4 M. Friebe

What will you learn in this chapter?

• A personal journey towards rethinking Health Innovation goals and
towards health democratization
• An overview of the Health Challenges, Individual Health needs, and likely
developments
• The definition of Innovation in the Health context
• The problem with the need for disruption and the lack of business model to
support that
• Exponential technology developments and their impact on health
innovations

Let me start by summing up the last 30 years of my professional life.

After completing a Bachelor in Engineering in 1988, I took the opportunity to
leave Germany for the Bay Area and eventually stayed for 5 years.
On my return, I started a company that was operating mobile diagnostic equip-
ment, combined with the sale of accessories. Eventually we invested in diagnostic
imaging centres and in radiology start-ups in Germany and neighbouring countries.
So, we were providing a service and invested in companies that were reimbursed for
their products and services!
From 2010, I became more involved in teaching and health research, which led to
5 years as a full-time research professor. Over the last 10 years, I have been involved
in more than 35 start-ups and have also been an investor. I would certainly say that
this has not been a normal, one-dimensional life!
However, it was in my role of a distinguished lecturer for the Engineering in
Medicine and Biology Society (EMBS) of the IEEE [1] that my mindset towards
health innovation changed and with that, my motivations and personal goals.
As part of that assignment I was teaching and, indirectly through the teamwork in
these lectures, experienced the healthcare systems and problems that existed in
Jordan, Turkey, India, Tunisia, Australia, Egypt, and several other countries. What
I learned and experienced was that: in many countries, healthcare is a privilege that
only few can really afford; frequently, in areas that are disconnected from an urban
metropolis, no decent service is available; and finally, the needs for innovation differ
from country to country and even among regions in the same country.
Whereas before I was exclusively seeking out unmet clinical needs in Germany or
the USA, I now became more interested in trying to identify problem areas in the
health delivery process whose resolution would benefit individuals, rather than only
look for business opportunities related to health.
In rural India, the question of whether an artificial intelligence and sensor-based
homecare device is better than a doctor is irrelevant, if no doctor is available or a
personal visit to a doctor is unaffordable. In such health populations, low-cost,
portable, and connected devices could make a huge difference. In “developed”
nations, the value propositions of health innovations are often not primarily
concerned with the needs of the patient and society, but emphasize on whether and
1 INNOVATION DESIGN for the FUTURE of HEALTH 5

how a new device or process fits into existing business models of health service
reimbursements.
Exposure to the exponential organization concept (OpenExO—www.openexo.
com; Singularity University—www.su.org; Exponential Medicine—https://
singularityhub.com/exponential-medicine/) and to a novel purpose-oriented
innovation methodology (www.purposelaunchpad.com) had a significant influence
on my thinking—and doing!
And the final stimulus came from my time as a full-time university professor
teaching biomedical engineering students.
Their ideas for innovations had to be based on previously identified and validated
health-related problems and their mission was to translate outputs from the research
lab into entrepreneurial ventures or to connect and work with industry.
In this process, I was shocked to see and realize how far degree-based education
falls short in equipping students to anticipate and address future needs: the research
system and funding in the medtech/healthtech area are almost exclusively focused on
incremental innovation.
Future Health requires a new and agile approach to innovation, powered by a set
of human skills that are not taught at universities. So one of the intents for this book
is to accompany teaching on Healthtech Innovation Generation [2].
In first place, the book is intended as a HOW-TO resource and guide for potential
or active Innovators in this space, whether they work in a start-up or are
entrepreneurs in a larger organization.
I believe the book’s content could also provide helpful guidance for health
politicians. And, of course, I would be thrilled if it could stimulate needed change
in the education sector.
Today’s education system is just like the healthcare segment, unfortunately: very
siloed and in need of deep reform, not only to match current needs, but to become
agile in its ability to adjust to future developments.
My hope is that the book will stimulate a change in teaching, towards future- and
purpose-oriented problem-solving, in generating needs-driven innovation, and, by
engaging students more actively in these more effective processes, in bringing about
that change in behaviour.
The book will NOT provide deep science, the objective is to stimulate innovation
that actually benefits the individual, including as a patient. We will be discussing
“purpose” a lot, will be talking about exponential mindsets, as well as the application
of exponential or deep technologies in enabling and delivering novel health
approaches that not only treat you well when you are sick, but focus maximum
attention, effort, and investment in developing tools and processes that act before
you actually get sick [3].
In the current approach to healthcare most of the available resources are focused
on building up care facilities that diagnose, treat, and help you recover after therapy.
Prevention-based medicine will need to be organized entirely differently.
Its infrastructure will be improved continuously and clinicians will have the best
tools available to ensure accurate, precise treatment with the fastest recovery poten-
tial and the least side effects.
6 M. Friebe

We know that, through early detection, a majority of all health problems could
have been prevented entirely, or at least the severity of a treatment would have been
reduced.
Let us assume that only a portion of these negative events could be avoided in the
next decades. What would that mean for health infrastructure (e.g. hospitals, hospital
beds, clinical staff needs, health-related costs), for health insurance, for primary and
secondary care?
The technology developments of the last decade, and especially, combinations of
different digital technologies, e.g. artificial intelligence, miniaturized sensors,
genetic information, gene editing, 3D printing, more, and more autonomous robotics
(we call these combinations “convergence”) are making rapidly growing sources and
volumes of information more accessible and available, very often at very little cost
[4–6].
Well, here we have a problem!
Innovation has an invention component and a commercial component.
If these technology-driven innovations with a high potential for disruption
(bringing radical change to existing approaches and business models) are not
providing a return on investment, why do them?
First, it is clear that there is room for the development of new and attractive
business models.
But the existing system needs to be flexible enough to allow these developments
to land. The current healthcare systems are far from being agile because existing
business models are based on diagnosing and treating a sick person. You go to your
primary care physician typically when you are sick (sitting with many other sick
patients in the same room does not make you healthier!). When a diagnosis is unclear
you are sent to a specialist, perhaps via a radiologist who provides diagnostic
imaging to confirm or invalidate certain potential causes.
After that, you receive treatment (exercise, dietary, a minor surgical procedure,
pharmaceuticals, physical therapy, . . .) or are sent to a hospital for a more extensive
therapy, which could include surgery (hopefully using minimally-invasive
approaches). Once you are released from the hospital you may receive the further
treatment as outlined initially.
In this system, the hospital infrastructure needs sick patients, to sustain itself.
Healthy people provide currently no or little revenue—from the patient, or
health insurers, or government health agencies—for healthcare providers
In many countries you can—or are forced to—sign up for health insurance that
covers the high costs in case of you get sick and need care, precisely for the same
reason that you take up other insurance policies. You do not really expect your house
to burn down or your car to be damaged, but in the unlikely event that this happens
you are covered. So insurance mitigates the effects of a potential negative event. And
health insurance works in the same way: your hope and intention is that you stay
healthy and do not need to go to a doctor or a hospital. Healthy people paying into
the system subsidize the costs incurred by sick patients. In general this a good and
empathetic approach to balancing a portfolio of health risk but does not result in
better population health.
1 INNOVATION DESIGN for the FUTURE of HEALTH 7

This book and the author is NOT against innovation to improve diagnosis,
therapy, and treatments. Of course, we should work to continuously improve the
quality of healthcare services and the efficiency and effectiveness of health delivery
including patients and clinician experiences within that system.
But what is proposed is to put the patient, not the delivery system, at the centre of
all activity.
The most important goal should be to significantly lower the cost of healthcare
services. Not by 3% or 5%, but by 75% or 90%! Only with a dramatic reduction in
cost disruptive approaches will be implemented. Buckminster Fuller said “You never
change things by fighting the existing reality. To change something build a new
model that makes the existing one obsolete”!
Unfortunately, the medtech and healthtech industry has no real interest or incen-
tive to do this. Understandably: commercial organizations need to produce a gross
margin (revenue minus direct cost of materials and manufacturing) that is suffi-
ciently high to cover total operational expenses for engineering, sales, buildings,
infrastructure, and other costs. With a significant cost reduction more systems can
potentially be placed, but it is unlikely that this will produce the same gross margin
in absolute value.

Disrupting Health and Healthcare with system change is revolutionary; many

would resist changing what is currently in place. But that is always the case when
existing stakeholders are concerned that they could lose out. Nor do Investors
typically like Disruption because it brings business models that are unknown,
novel, and unproven [2, 7–9].
While disruption is needed and should be a goal to work towards, a step approach
is recommended: implementing incremental innovations but based on a clearly
defined purpose and a vision to which all subscribe. And the purpose of our activities
should not only be to create new innovations for billable health services that benefit
the health providers and other involved stakeholders, but to do this in ways that are
based on what a patient wants and what creates benefit for that patient.
The subtitle of the book “Entrepreneurial Strategies and Development Concepts
towards Patient Empowerment and Health Democratisation” already indicates what
I believe is needed (entrepreneurship) to transform the current system and what the
8 M. Friebe

goals of that transformation should be. Both Health Entrepreneurship and Digital
Health will be addressed in several chapters.
We will also present concepts and important aspects of planetary and sustainable
health plus other determinants of individual health.
Figure 1.1 shows these Health Determinants, spanning the current problem
spaces in the 2020s healthcare systems in most western nations and some of the
open global challenges.
Noting, from that figure, that Individual Health depends only to 15% on the
quality of the healthcare system. What would happen if we spent more attention and
money on the 85%?
Future opportunity to innovate will undoubtedly also come from research in
advanced understanding of molecular and biological processes [3], and, while the
innovation methodologies are also applicable to this science as well, this book will
not cover them explicitly (Fig. 1.2).
We are very aware that, for many, the vision of the book may seem far out in the
future and that realities do not support all of the innovation ideas presented [8]. How-
ever, we believe in the imperative of educating future health innovators about novel,
purpose-oriented thinking and innovation generation resulting in ways that allow
people to manage their own health [9].
In taking the path of applying exponential technologies to address open health
challenges and future needs, we cannot predict WHEN WILL IT HAPPEN and
WHAT WILL IT LEAD TO [2]. But the past has shown that disruption quickly turns
industries around, creates new players, and eliminates existing organizations that
were not willing or prepared to adjust for emerging change.
The hope is that we will reach the goal of HEALTH DEMOCRATIZATION,
where everyone on this planet has access to tools, devices, and deep-tech that allow
personalized prevention and prediction.
Not every step is easy, but the results give even small teams the power to change
the world in a faster and more impactful way than traditional business ever
could [10].
The book will provide several individual parts,

• an overview of Health Innovation Needs

• insights into exponential technologies and deep-tech for health applications
• an introduction to relevant novel innovation methodologies dedicated or adapted
to the health segment
• perspectives on future-oriented healthtech education, ethical considerations
• entrepreneurial issues, with examples of global innovation setups and
• an outlook on digital health, exponential medicine, space health and its transfer
back to earth

Every chapter provides 3–4 points at the beginning on what will be covered and
concludes with 5–10 key learning points and take-home messages at the end.
Depending on your previous knowledge, innovation situation, and environment
(student, health innovator, start-up entrepreneur, intrapreneur) you may also be
 1
INNOVATION DESIGN for the FUTURE of HEALTH

Fig. 1.1 Individual Health depends on several Health Determinants, but only to 15% on the quality of the health system (top left). And the systems of most
developed nations come with many issues that future innovation should address (top right). However, many health challenges remain unsolved especially on a
global level (bottom)
9
10 M. Friebe

Fig. 1.2 [from 2] Exponential Technologies and their implications on the Future of Health cannot
be exactly predicted (as anything in the future), but they will lead to a disruption, which in effect
will bring new delivery and business models. The figure shows the 6D’s (Peter Diamandis—[10])
applied to FUTURE HEALTHCARE NEEDS. Exponential technologies (that all have to have a
digitally base and are digitally scalable), going through a disappointment phase (underperforming
based on expectations and predictions), eventually leading to a disruption replacing existing
approaches and technologies. Dematerialization (making things smaller), Demonetization
(affordability increase) then lead to Democratization (availability for Everyone on this planet) of
HEALTH

interested in only certain parts and/or chapters, which also means that there will
occasionally be some content repetition from previous chapters or parts.
The main innovation methodology that is presented and used in an adapted health
innovation form is based on PURPOSE LAUNCHPAD, developed by Francisco
Palao and other collaborator and authors (the editor of this book and several authors
are some of them).
These awesome groups have also developed a PURPOSE MANIFESTO with a
massive transformative purpose (MTP), beliefs, values, and principles as a possible
guiding principle for our actions and innovation work in the future. This is truly
inspiring for me and my future work and maybe it is for you as well (see Fig. 1.3).
I very much thank all contributors of this book for their support.
1 INNOVATION DESIGN for the FUTURE of HEALTH 11

Fig. 1.3 The PURPOSE MANIFESTO with Massive Transformative Purpose, beliefs, values, and
principles (www.purposemanifesto.org)

Take-Home Messages
• Planetary Health is one important determinant of individual health and the
health of society.
• Socio-economics is another.
• The quality of the current healthcare system has a relatively small influence
on individual health (on average!).
• In most developed (apologies for that qualifying statement) countries the
healthcare business model is primarily based on billing for medical or
related health services—for people who are not well (also known as
“sickcare”).
• Currently, novel devices and systems are developed mainly for quality
improvements and to enable novel and more advanced or more accurate
diagnosis and therapies.
• The big challenges of future healthcare (very high cost and therefore not
affordable for a large part of the global population, unequal access, changes
in demographics, uneven quality, . . .) can only be addressed with system
changes and rethinking of the entire health paradigm (dramatically lower-
ing costs, increasing homecare, becoming more data-based).
• A novel Health Innovation methodology is proposed as a core part of this
book. This is purpose based and oriented towards patient benefit.
• Diagnosis and treatment will continue to be improved, but Medicine needs
to implement and be driven by new metrics and new areas of focus:
Precision and Personalized | Patient Centric | Value Based.
12 M. Friebe

References
1. Friebe M (2019) What is it like to be an IEEE EMBS distinguished lecturer? https://www.embs.
org/pulse/articles/what-is-it-like-to-be-an-ieee-embs-distinguished-lecturer/
2. Friebe M (2020) Healthcare in need of innovation: exponential technology and biomedical
entrepreneurship as solution providers (Keynote Paper). Proc. SPIE 11315, Medical Imaging
2020: Image-Guided Procedures, Robotic Interventions, and Modeling, 113150T (16 March
2020). https://doi.org/10.1117/12.2556776
3. Joshi I (2017) Waiting for deep medicine. Lancet 2019(393):1193–1194. https://doi.org/10.
1016/S0140-6736(19)30579-3
4. Dhavan A et al (2015) Current and future challenges in point-of-care technologies: a paradigm-
shift in affordable global healthcare with personalized and preventive medicine. IEEE J Transl
Eng Health Med 3:2800110
5. Kraft D (2016) The future of healthcare is arriving — 8 exciting areas to watch. https://
singularityhub.com/2016/08/22/exponential-medicine-2016-the-future-of-healthcare-is-com
ing-faster-than-you-think/
6. Diamandis P (2016) Disrupting todays healthcare system. http://www.diamandis.com/blog/
disruptingtodays-healthcare-system
7. Christensen C, Bohmer R, Kenagy J (2000) Will disruptive innovations cure health care? Harv
Bus Rev Sept–Oct 2000 issue. https://hbr.org/2000/09/will-disruptiveinnovations-cure-health-
care
8. Friebe M (2017) International Healthcare Vision 2037. New technologies, educational goals
and entrepreneurial challenges. Otto-von-Guericke-Universität, Magdeburg. ISBN: 978-3-
944722-59-7
9. Christensen C, Waldeck A, Fogg R (2017) The innovation health care really needs: help people
manage their own health. Harv Bus Rev. https://hbr.org/2017/10/the-innovation-health-care-
really-needs-help-people-manage-their-own-health?autocomplete¼true
10. Diamandis P (2016) The 6 D’s. https://www.diamandis.com/blog/the-6ds

Michael Friebe received the B.Sc. degree in electrical engineer-

ing, the M.Sc. degree in technology management from Golden
Gate University, San Francisco, and the Ph.D. degree in medical
physics in Germany. He spent 5 years in San Francisco, as a
Research and Design Engineer with an MRI and ultrasound device
manufacturer. He is a German citizen with expertise in diagnostic
imaging and image-guided therapies, as a/an Founder/Innovator/
CEO/Investor and a Scientist. He is also a Research Fellow with
the Technical University of Munich, Munich; an Adjunct Profes-
sor with the Queensland University of Technology, Brisbane; and
a honorary Professor of image-guided therapies with Otto von
Guericke University, Magdeburg, Germany. Since 2022, he has
been a Professor of biomedical engineering innovation with the
AGH University of Science and Technology, Krakow, Poland. He
is a listed inventor of more than 80 patents and has authored over
200 papers, and was part of over 35 Medical Technology Start-
Ups. He is a Board Member of four medical technology start-up
companies and an investment partner of a MedTec-fund. From
2016 to 2018, he was a Distinguished Lecturer of the IEEE EMBC
teaching innovation generation and MedTec entrepreneurship. He
is also a coach and trainer for OpenExO, and a master Launchpad
mentor for the Purpose Alliance.
Health Innovations from an Innovators’
Perspective 2
Michael Friebe

Abstract

Innovation is the translation of technologies and inventions to a market. There are

different starting and obviously different ending points. And with exponential and
converging technologies, huge challenges in health delivery to solve, and the
need for a novel approach to health, there are a lot of opportunities for health
innovators. This paper will discuss some of the innovation starting points (indi-
vidual turned entrepreneur, innovator, intrapreneur, and entrepreneur turned
intrapreneur), the differences and areas where the health innovation process
differs significantly from other industries. And it will present the core principles
of the book. Having a purpose is an important starting point for most innovation
activities, but even more when you deal with health-related issues and identifying
solutions. The economic scaling and growth for health-related innovations is
typically more expensive, takes more time, and requires more patience from all
involved, especially from the innovators and investors. And with the expected
massive changes in all aspects of health (service, delivery, move to prevention,
needed cost reduction, ageing population, and many more) you need to have a
disruptive/radical vision (10 years) towards reaching your purpose, with interme-
diate more traditional and incremental intermediaries (2–3 years).

M. Friebe (*)
AGH University of Science and Technology, Krakow, Poland
Otto-von-Guericke University, Magdeburg, Germany
IDTM GmbH, Recklinghausen, Germany
FOM University of Applied Science, Center for Innovation and Business Development, Essen,
Germany
e-mail: [email protected]

# The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 13

M. Friebe (ed.), Novel Innovation Design for the Future of Health,
https://doi.org/10.1007/978-3-031-08191-0_2
14 M. Friebe

Keywords

Health entrepreneur · Health intrapreneur · Health innovation process · Health

disruption · Edge business · Core business · Innovation principles · Minimal
viable prototype · Massive transformative purpose

What will you learn in this chapter?

• The organization of the book
• The core principles of this book with respect to health innovation
• Who should read it

2.1 Introduction

There are several differences—at least they currently are, maybe changing in the
near future—when you compare the translation of inventions/ideas/concepts in the
health space with other industries. Health is the ultimate good and important to
everyone, health is also a big business, and it deals with humans that could be
harmed or even die because of wrong diagnosis, monitoring, and therapeutical
treatments.
Our current system of evidence-based medicine and regulatory approval has the
goal of maximizing the benefits with ensuring least harm. This approach however is
based on the current way of delivering health services and using medical technology
products, when you are sick. That will hopefully change!

2.2 Motivation

Your motivation, to read this book and apply the concepts, could be (actually they
should be anyway) based on a purpose, but they could also initially be stimulated by
your experiences in the health system, because you were working on novel concepts
and were thinking about making something bigger out of it, or because you are an
insider working for a medical technology/pharmtech/biotech company or are
employed in healthcare operations.
Everyone’s goal (economically, and with respect to solving open and unmet
clinical/health issues) is to create a PAINKILLER for a BURNING PROBLEM.
The experience has shown that especially technologically oriented potential
innovators are often not checking the problem in depth and immediately apply
their technological expertise to build something based on not validated assumptions.
In the education and research “industry” (universities) this is typically even worse.
Technical departments at universities have a specific technical expertise and clinical
2 Health Innovations from an Innovators’ Perspective 15

departments a specific clinical expertise. Putting these two together will create a
solution for the narrow clinical problem identified by the clinicians with the dedi-
cated technological expertise of the engineers.
What is rarely asked is:

• How could this described/identified problem be prevented all together?

• Is there a global need for the solution?
• What are alternative solutions?
• And many more that could lead to solutions outside the current healthcare setup

What we, therefore, propose is to have a global look and dare to have a vision that
moves diagnosis and treatment/therapy from the current place of health delivery to a
less expensive and more patient-friendly one (e.g. from secondary care to
homecare—much cheaper with a higher quality of life).
Also, what is a problem in the USA, for example, could not be a problem at all in
other countries or vice versa? Do not limit yourself!
Figure 2.1 shows some of the different starting points. You may have gotten
exposed to a health-related problem or issue because you believe you have found a
health problem that needs to be urgently solved. It could also be that you have a
personal motivation to address health challenges or issues. You find yourself in the
HEALTH INNOVATOR/ENTREPRENEUR part on the left of Fig. 2.1. You would
dive deep into the problem in a PATIENT/USER EMPATHIZE phase and come up
with hypotheses and many ideas that need to be (in)validated. You would run many
customer experiments with crude prototypes. That process goes relatively fast, is
focused on iterative learning using agile methodologies, and does not cost much.
Many project ideas and initiatives do not survive that phase because the problem is
not really a problem, the motivation has dropped, or there is not enough support to
continue. The next phase requires a team, a good enough project plan and value
propositions packaged in a future vision to convince early investors. The goal would
be to further validate the ideas and create solutions that allow you to find early
“paying” customers/users. “Crossing the chasm” is the title of a book that describes
the need and presents concept on how to move from a very small number of “crazy”
early users to create an attractive product and offering for the majority customers
[1]. This phase requires much more capital, a larger team and many start-ups and
projects will not reach that phase. And then you need to scale your operations and
maybe even create new markets and additional products.
The difference for an intrapreneur/innovator within an existing, most likely
successful medical technology or health delivery organization is that it comes with
an established business and customer base. The new idea needs to fit into this
existing operation (CORE). The innovation is probably with respect to improving
the current offering or by extending the product to new markets or customers. These
companies have existing expertise in developing, producing, marketing and will
likely follow a typical waterfall approach to translate the ideas to their existing
customer base. For many product improvement ideas this is the most reasonable
method.
 16

Fig. 2.1 Three possible scenarios of health innovation starting points. An innovator (person/team) that will become an entrepreneur on the left (RED). Many
ideas are reduced in agile and iterative learning and validation processes, further reduced in a subsequent start-up phase. At the same time the staff and financing
needs to go up to eventually achieve a sustainable operation. You could also come from within an existing organization (INTRAPRENEUR (ORANGE) with a
M. Friebe

goal to develop a new product or product improvement that fits to the existing offering (CORE business compatibility). The development and translation process
is typically following a waterfall principle. And in case the new concepts require a new business model or address a customer that is not being served by the
organization (EDGE business) this may then lead to a spin-out with much the same problems and issues as the ENTREPRENEUR
2 Health Innovations from an Innovators’ Perspective 17

Fig. 2.2 We use the differentiation CORE and EDGE particularly when speaking about innovation
that comes from within established companies or organizations. Some of them (EDGE) are not
related to the current operation and business model and should either be discarded, sold, or
externally pursued in a new entity

And in case that the intrapreneurial activity turns out innovation approaches that
are not in line with the existing business model and operational setup of the
organization (EDGE) then there is still the option of spinning a company out.
Important difference here, this new company needs to act and develop like a real
start-up and needs to be detached from the mother organization. If that is not the
case, it will act, behave, and argue just like the mother. It could be a little easier for
these companies to get started, as they may get initial funding from the mother. We
typically distinguish here between LINKED EDGE (disruptive and scalable business
model that uses the mother companies assets—e.g. manufacturing capabilities, some
engineering, research cooperations) and PURE EDGE (completely interdependent
with respect to the mother company). Also the CORE opportunities can be further
classified into EDGE-CORE, BLUE CORE, and PURE CORE depending on
whether it is unique to the mother company, can be used in other organizations, or
is a product that highlights one or few specific features while reducing others.
Something that is called VALUE INNOVATION in a BLUE OCEAN strategy
(Value Innovation ¼ simultaneous pursuit of differentiation and low cost leading
to increased value for both the buyers and the company). See Fig. 2.2 for a short
explanation and some criteria.
But all concepts/methods that we present should be applicable for all these
scenarios as they are all based on some important core principles.

2.3 Core Principles of the Book

The core principles of the book are presented in somewhat sequential order, but this
does not mean that the first ones are the most important ones. All are important!
Please check compliance and ensure that you revisit them regularly. The bold and
18 M. Friebe

underlined word combinations may help in the future to remember. They are also
listed again in the following chapters.
• Use of agile and iterative approaches to validate hypotheses and assumptions in
all aspects—means that if you use a tool that is presented, check and (in)validate,
apply the learnings, change or adapt your plan and concepts, and define new
experiments to help you advance. Create feedback loops with your team,
customers/users, partners.
• Whenever possible think 103 (how can we improve, reduce, increase by a factor
of 10 or more). With this approach you are forced to rethink existing solutions. If
your goal is to improve, reduce, increase something by 10%, you will automati-
cally look at which parameter can be tweaked to achieve that and may never
discover impactful concepts.
• Experimentation is key. With experimentation we do not mean a science experi-
ment (even though that could also be valuable especially for checking the
technical feasibility), but rather a customer or user related verification one. Do
not do experiments that you already know the results off and not experiments that
will not change anything on whether they are validated or not.
• Put yourself often in the position of the core user/patient and try to see the
situation from their point of view. Of course that needs to be validated in
experiments. But it is the starting point of virtually all innovation methodologies
presented in this book (EMPATHIZE in Design Thinking, IDENTIFY in
BIODESIGN and I3-EME, CUSTOMER segment in Purpose Launchpad Health,
MEASURE in LEAN STARTUP) [2–8].
• Do not start building before you have gone through some initial steps of defining
and evaluating the problem that you are trying to address (What is the real
problem? Who are the customers? Who are the decision makers? What will
happen with the problem solution with the introduction of novel technologies?)
• Good questions are most important—if you ask the right questions you will find
the answers! This is also the base for the insightful customer interviews. Do not
seriously (you can though for opening the conversation) ask questions for which
you already know (not assume) the answers and do not seriously ask questions
(again, you can for conversational purposes) that do not change anything.
• Embrace failure or invalidating ideas and with that focus on LEARNING.
Every time you falsify a hypotheses you should be happy.
• Write everything down for a learning history and to be able to go back at a later
point to revisit and recheck. Things change and what was considered not a
feasible idea could be 3 or 5 years later with changed environmental conditions,
different foci, and advanced technologies.
• Come up with many solution ideas—do not limit yourself to the first one that
you fell in love with. Always ask and find out for yourself, your team, your
supervisor, your professor on whether an idea actually solves a patients’ or
health stakeholders’ problems and on whether it can create an impact.
• Use Minimal Viable Prototypes (MVP) for validation checks, customer
experiments, . . . The purpose of these MVP is to find out what the customer
values the most or likes the best. They do not have to be functional, but they
2 Health Innovations from an Innovators’ Perspective 19

should show and allow to understand a particular feature or value proposition.

They could be physical (paper/carton or 3D printed models) or picture based
(cartoons or drawings, movie animations, product and software simulations).
• Prototyping (MVP and functional prototypes) is the process of building quick,
cheap, and rough study models. The goal is to evaluate alternative solutions
based on their DESIRABILITY (Is there a verifiable customer need?), FEASI-
BILITY (Can we build solutions that will actually be working and satisfying
these needs?), and VIABILITY (Can we do that within an existing business
model? . . . or do we need a new one?).
• Have a guiding (massive transformative) purpose for the company/
organizations’ work combined with a longer-term vision, a shorter term mission
and a definition of the organizations’ core values is an essential motivator.

2.4 What Are the Book’s Limitations?

While we believe that entrepreneurial activities will probably be most impactful with
respect to transforming the healthcare setup, we will not be able to cover the aspect
of actually starting a company and with that to discuss financing and other project
and company management options that are important for that. We will provide some
sub-chapters that cover individual elements however.
Steve Blank described a start-up as a temporary setup in search of a sustainable
business model. In the Health space that typically requires a regulatory approved and
certified product.
Depending on the product, its intended use (e.g. EASY: health style product
measuring certain physiological parameters; COMPLICATED: sensor based Digital
Health product/software for diagnosis and monitoring; VERY COMPLICATED:
anything that is placed for a longer period of time inside the human body for
diagnosis/monitoring/therapy) this can take several years, and will cost many
millions (USD/€). What we want to provide you with is to define such a business
model and get enough insights to make you somewhat confident, excited, and
motivated to take that step. We also want to provide you a toolset that allows you
to analyse and summarize the needs and the opportunities with your approach,
formulate a future vision, and with that have a good base to communicate with
potential investors.
And, we believe that the current education with respect to the above-mentioned
core principles and health innovation needs requires a reset.

Take-Home Messages
• The intention to create a PAINKILLER for a BURNING PROBLEM is a
key motivation for Health Innovation activities.

(continued)
20 M. Friebe

• Unfortunately the PAINKILLER that is developed is too often not solving a

large enough problem/need.
• Agile and iterative methodologies are key to finding and defining the
problem.
• 10 thinking is a core principle of disruptive and radical innovation.
• Entrepreneur/Intrapreneur (CORE and EDGE) needs will be covered in
the book.
• Start-up financing and presentations or other important aspects beyond the
Exploration and Evaluation/Validation phase will not be covered in depth.

References
1. Moore C, McKenna R (2006) Crossing the chasm: marketing and selling high-tech products to
mainstream customers. ISBN-13: 978-0062353948
2. d.school, Hasso Plattner Institute of Design at Stanford: An Introduction to Design Thinking
Process Guide (2013). https://web.stanford.edu/~mshanks/MichaelShanks/files/509554.pdf.
Retrieved 3 March 2022
3. Yock P, Zenios S, Makower J (2015) Biodesign: the process of innovating medical technologies,
2nd edn. Cambridge University Press, Cambridge. ISBN-13: 978-1107087354
4. Fritzsche H, Boese A, Friebe M (2021) From ‘bench to bedside and back’: rethinking MedTec
innovation and technology transfer through a dedicated Makerlab. J Health Des 6(2):382–390
5. Palao F (2021) Purpose Launchpad Guide V 2.0. https://www.purposelaunchpad.com/
methodology. Retrieved 10 March 2022. V 1.0 also available at https://www.scribd.com/
document/486477523/Purpose-Launchpad. Retrieved 10 March 2022
6. Friebe M, Fritzsche H, Morbach O, Heryan K (2022) The PLH – Purpose Launchpad Health –
Meta-methodology to explore problems and evaluate solutions for biomedical engineering
impact creation. IEEE EMBC Conference Paper, July 2022 (not published yet)
7. Ries E (2011) The lean startup: how today’s entrepreneurs use continuous innovation to create
radically successful businesses. ISBN-13: 978-0307887894
8. Blank S, Dorf B (2020) The startup owner’s manual: the step-by-step guide for building a great
company. Wiley. ISBN-13: 978-1119690689

Michael Friebe received the B.Sc. degree in electrical engineer-

ing, the M.Sc. degree in technology management from Golden
Gate University, San Francisco, and the Ph.D. degree in medical
physics in Germany. He spent 5 years in San Francisco, as a
Research and Design Engineer with an MRI and ultrasound device
manufacturer. He is a German citizen with expertise in diagnostic
imaging and image-guided therapies, as a/an Founder/Innovator/
CEO/Investor and a Scientist. He is also a Research Fellow with
the Technical University of Munich, Munich; an Adjunct Profes-
sor with the Queensland University of Technology, Brisbane; and
a honorary Professor of image-guided therapies with Otto von
Guericke University, Magdeburg, Germany. Since 2022, he has
been a Professor of biomedical engineering innovation with the
AGH University of Science and Technology, Krakow, Poland. He
2 Health Innovations from an Innovators’ Perspective 21

is a listed inventor of more than 80 patents and has authored over

200 papers, and was part of over 35 Medical Technology Start-
Ups. He is a Board Member of four medical technology start-up
companies and an investment partner of a MedTec-fund. From
2016 to 2018, he was a Distinguished Lecturer of the IEEE EMBC
teaching innovation generation and MedTec entrepreneurship. He
is also a coach and trainer for OpenExO, and a master Launchpad
mentor for the Purpose Alliance.
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