NHS Startup Part XVI – Thoughts On Integration

As integration with some of the large NHS IT suppliers comes closer and closer I am thinking more and more in-depth about what is the best way forward.

Integration when I first started my business seemed to be the holy grail!  It seemed to be the panacea to all of my problems.  However, as it was not feasible to integrate initially (most of the large IT suppliers don’t want to integrate as they want to own a monopoly, I didn’t have the contacts at that point to even begin discussions with the large suppliers to integrate and we still hadn’t tested out our assumptions / if our product would even work) I decided to take a massive leap of faith and build a stand alone system.

Being a stand alone system has loads of advantages.  The APIs for most of the legacy software in the NHS are hard to use, have poor functionality and limits what you can do.  It also locks you into a system which is inherently broken and can’t keep up with the demands of modern medicine – If the existing systems were so good, then my company wouldn’t exist!  It also prohibits you from using third-party apps which you want to incorporate into your service as they are not approved by the NHS.

Not being integrated allows you to be super lean, iterate, build new phases, do A/B testing and so on.  The flexibility and the speed simply wouldn’t be possible with integration.

This is the dilemma in my mind: We’ve managed to launch our product in several surgeries now and next month we’ll be launching our service to a massive 70,000 patient company.  This all occurred within a six month time period (our product first launched at the end of Dec 16/beginning of Jan 17).  This leads me to believe that it is possible to grow the business without integration.

So why integrate?  It will open up a massive distribution channel.  EMIS who are very keen to get integration going, own >50% of the primary care EPR market.  TPP who I should be able to integrate with as well own about 30% of the market.  This would mean that integration would allow us to scale enormously.  Integration also means that we wouldn’t need to worry about a lot of scaling issues which may arise otherwise.

Well this sounds amazing!  But what are the down sides?  The down sides is that you’ve essentially given over control of your whole company!!!!  Is that really the best way forward?

image28

A graph showing what happened to many websites after Google’s search engine update (Panda Update)

Giving over control of distribution is a big risk.  It’s like relying on google to provide all your web traffic or depending on amazon to sell your products.  One rule break, one update of an algorithm and you’re dead!

In effect, one of these big IT companies may just decide to kill my company for the hell of it.

I don’t think a strong foundation of a company can be built on someone else selling for you.  Entrepreneurs take responsibility for their own success, I am not prepared to give that over.

The other thing I’ve realised is that being an integrated app in someone elses system will really reduce the amount of money we may possibly be able to make in the long run.  In the short run it will provide a big boost in revenue, but not so much in the long run.

“Back of the envelope” maths is important.  If I solely rely on integration for distribution, I realised that hypothetically we would be making in the tens of thousands of pounds a month.  However, without integration and with control of our own distribution, we could be making in the hundreds of thousands of pounds a month.  Theoretically an order of magnitude difference!  Too hard to ignore.

So, here is the new strategy for my startup!

We integrate.  But, we provide very limited functionality with the integrated version so that people can get a taste of what we can do.  Want the full version?  Then you’ll need to dump your existing system which is garbage anyway and switch over to ours instead if you want to really increase your revenue and improve inefficiencies!

This seems like the wise move for the time being and the definite way forward in my particular case.

Integration no longer seems like the panacea I once thought.

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