In 2006, New York Times award winning columnist Thomas Friedman released a seminal book called The World is Flat: A Brief History of the Twenty-First Century. The book was a best seller and helped readers understand both the good and the bad of globalization. When explaining the title, Friedman said,

“My use of the word ‘flat’ does not mean equal (as in ‘equal incomes’) and never did. It means equalizing, because the flattening forces are empowering more and more individuals today to reach farther, faster, deeper, and cheaper than ever before, and that is equalizing power — and equalizing opportunity by giving so many more people the tools and ability to connect, compete and collaborate.”

That “flattening” came first to manufacturing but has now finally come to healthcare.

The partners at Get-to-Market Health have had direct exposure to healthcare delivery and how technology supports patient outcomes in over twenty-five countries around the world. We have seen firsthand how healthcare is practiced, paid for, and improved in developed, developing and lower middle-income countries.

Wide variations still exist in how care is delivered around the world, but technology is driving a consistency hardly imaginable even a decade ago. Importantly, it is not just a US to rest-of-world transfer anymore, with global healthcare technology innovators making exciting contributions.

Some of the most impressive healthcare AI work we have come across is from organizations in Israel, Australia, and the UK. With EMR technology, an Italian company, Dedalus, has systems deployed in forty countries, followed by Cerner/Oracle with twenty-five and Meditech with twenty-three. When it comes to medical devices, the US still drives the market as evidenced by the growing worldwide adoption of robotic surgery, extracorporeal membrane oxygenation (ECMO) procedures and hand-held ultrasound.

However, innovators outside the US can point to the creation of crucial medical procedures like transcatheter aortic valve replacement (TVAR) developed at the University Hospital of Rouen in France that has saved over 400,000 lives. Even data suppliers to healthcare technology companies like Definitive Healthcare are getting in the global game by acquiring a Swedish company, Monoci, to further support their global life sciences business. Finally, the critical mRNA vaccine platform was pioneered at the University of Pennsylvania, but researchers around the world built on it to battle COVID and other viruses.

Back to Friedman’s point about “flat doesn’t mean equal.” Healthcare delivery in lower middle-income countries is certainly different from how it is rendered in Western Europe and North America. However, many of the newest technologies and techniques to improve care are now available at some level around the world. That was not the case when Friedman authored his book in 2006. Six examples to make the point:

  • As of today, portable MRI technology which first received FDA approval in 2020 is deployed in fifteen countries
  • High quality EMR’s are now available in most countries and typically found in the top tier health systems in even the poorest countries
  • Medical tourism is projected to be a $35B business in 2022,and the US is not one of the top twenty destinations
  • Once Amazon closes on its One Medical acquisition and converts it to the Amazon way of doing things, it is easy to imagine it spreading to the other thirteen countries Amazon operates in today
  • Recognizing that a global approach to auditing and monitoring the manufacturing of medical devices could improve safety and oversight on an international scale, the Medical Device Single Audit Program (MDSAP) is streamlining device certification around the world
  • We work with several healthcare technology companies who count development and support team members located “offshore” as a key part of their organization

Get-to-Market Health partners have worked with over a dozen companies taking healthcare technology across international boundaries, and we have some key takeaways to share:

  • When you bring your healthcare technology to another country, take off your domestic blinders and have eyes wide open to new ways to deliver your solutions to solve local problems. Leaving your biases and assumptions at the border will serve you well.
  • After careful research and analysis, we have come to better understand the positive impact distributors and partners can have as you take your product global. Distributor partners have unique insights, market presence and can often help you with regulatory and cultural challenges.
  • Bring your A-game to solve for important regulatory issues. Regulatory process and documentation are critical, and there is no short cut to getting it right. You will need solid inhouse talent, and you will need to hire a notified body or local representative to help with your navigation.
  • Every country is different, and you will need to be especially sensitive to cultural issues around marketing, selling, and supporting. This goes well beyond translation to include rules on how you can do outreach and what works in each country.
  • Logistics matter, and you need to work hard to make sure your people, product and support infrastructure all get where they need to be.
  • And despite the title of this blog, healthcare is still local, and you will need to work extra hard to create local presence, key opinion leaders, and loyal lighthouse customers.

There is much work to do to make the healthcare world truly flat, but clearly, the advancement of high-quality healthcare technology is an unstoppable wave around the globe.



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