idea-004 · desirability deck
Every slide states a condition that would have to be true, then reports where it stands using the candidate file's own claim and its own confidence tag. A deck never upgrades a tag, invents a number, or recommends anything, and there is no ask slide.
The chair: the parents of a jaundiced newborn in the first week of life, and the discharging clinician deciding whether that baby goes home under a light or stays.
How to read this: every slide is a condition, not a conclusion. A bracketed claim reference points into knowledge-base/candidates/idea-004.md — the number is the claim's position in its ## Claims list, the tag is copied from it and never adjusted here. A [no claim] marker means nothing in the file speaks to the condition at all. See docs/deck-spec.md.
What changed since the 2026-08-25 build: the research lane supplied most of the evidence this deck previously listed as missing — a sourced birth denominator, two US birth-cohort studies, two meta-analyses of home phototherapy outcomes, a first-in-human wearable pilot, a qualitative implementation study naming the barriers, and a physician survey. Nearly all of it is unconfirmed, because a literature scan can locate a paper but never appraise one. Rebuilt from the file, not patched.
Would have to be true: A meaningful number of US newborns of 35+ weeks with in-band bilirubin are, today, kept in hospital or brought back to hospital for phototherapy — an inpatient episode that exists only to hold a baby under a light.
Where it stands: The denominator is now sourced rather than estimated: US births totalled 3,628,934 in 2024, up 1% on 2023 [claim 36: unconfirmed], replacing the Generator's round figure [claim 7: unconfirmed]. The eligible band has two US cohort studies behind it — a Kaiser Permanente Northern California series of 148,162 infants at 35+ weeks [claim 37: unconfirmed] and a 9-clinic review of 359 newborns discharged with total serum bilirubin just below the treatment threshold [claim 38: unconfirmed]. What is still missing is the specific thing this slide asserts: that the eligible band is treated as inpatients today [claim 17: unconfirmed], and the shares that turn births into episodes [claim 8: unconfirmed], [claim 9: unconfirmed]. One adjacent datum sharpens the size of the opportunity and cuts against it at once: a survey of Canadian paediatricians found only 12% of respondents worked at a centre offering home phototherapy at all [claim 43: unconfirmed] — a large unserved space, or a settled clinical preference, and the abstract does not say which, nor is it US.
What would settle it: HCUP NRD readmission records for neonatal jaundice, for how much of that treatment is inpatient today — the one leg the research lane did not reach.
If it's false: There is no problem to move out of hospital, and Factor 3 (TAM) and Factor 9 (strategic fit) lose their premise before any device question is reached.
Would have to be true: Two parents in the first week postpartum would have to keep a light-emitting wrap on their newborn for most of the day, feed and settle around it, and deliver enough irradiance-hours to matter — without a nurse in the room.
Where it stands: Still unbacked for this device [claim 18: unconfirmed], but there is now a first-in-human result for the form factor, and it is the most directly relevant new evidence on this deck: in a pilot of a wearable phototherapy device in 12 near-term/term neonates, phototherapy completed within 48 hours in 83% (10 of 12), while 2 of 12 were switched to conventional intensive phototherapy because bilirubin kept rising despite wearable treatment [claim 41: unconfirmed]. That is a small study and not this candidate's device, and it is unconfirmed because nothing here can appraise it. It is also exactly the failure mode the file names as this product's device-specific risk [claim 14: unconfirmed] — under-dosing — and the first empirical sighting of it in a wearable.
What would settle it: An instrumented prospective series comparing prescribed against delivered irradiance-hours per episode — which the onboard radiometer is designed to measure and is therefore the cheapest real evidence this product can generate about itself. Then structured interviews with parents who have completed a current home phototherapy episode.
If it's false: The product delivers less dose than the hospital it replaces, which is a safety story rather than a convenience story, and Factor 6 (mechanism and clinical risk) goes to its floor.
Would have to be true: A discharging clinician would have to accept responsibility for an in-band infant treated at home without adding a monitoring claim, a DME supplier would have to put a unit at the door same-day, and a payer's prior authorization would have to clear inside the clinical window.
Where it stands: The clinician half is unmoved and remains this deck's load-bearing condition [claim 19: unconfirmed]. What is new is a direct study of what actually blocks implementation: a qualitative study of 21 healthcare professionals and 10 parents identified lack of reimbursement options and difficulty reaching all relevant healthcare professionals for education as the main barriers to home phototherapy [claim 42: unconfirmed]. Read that against this candidate's structure: the first named barrier is the viability deck's problem, not the device's. Adoption levels are correspondingly low [claim 43: unconfirmed]. And the safety record clinicians would be weighing is not blank — the same survey recorded 15 physicians (3%) reporting 21 adverse-event cases associated with home phototherapy in 12 months, most resulting in admission or readmission for inpatient phototherapy, with no serious adverse events reported [claim 43: unconfirmed].
What would settle it: Interviews with US birth-hospital discharge nurses and general pediatricians on what they do with in-band infants today and what would change it — the qualitative study above is not US and cannot evidence US clinician behaviour; DME supplier interviews on delivery windows; prior-auth turnaround from a published state Medicaid DME manual.
If it's false: The consent chain breaks at its weakest link and the device is irrelevant — this is the slide where a better device wins least.
Would have to be true: The family's total burden — anxiety about a home-treated jaundiced newborn, the follow-up serum draw, the equipment in the house, and any out-of-pocket share — would have to stay below the burden of the inpatient stay it replaces.
Where it stands: Family out-of-pocket exposure is still unbacked [claim 21: unconfirmed]. What the file now has is the other side of the ledger, and it is small: HCPCS E0202 carries a Louisiana Medicaid DMEPOS payment of $33.71, alongside a second, lower entry of $30.90 [claim 44: unconfirmed] — one state's schedule, from a vendor-neutral primary document, and the first real payment figure anywhere in this file. It is not the national DMEPOS allowable, which remains unchecked [claim 5: unconfirmed]. Note also what the published base cannot supply: the 2026 systematic review of 31 studies found no studies evaluating cost-effectiveness at all [claim 40: unconfirmed], so the economic argument for families will not come from the literature.
What would settle it: A state Medicaid member cost-share rule for E0202; a named commercial benefit design for DME rental in the first month of life. Both are human-attached reads.
If it's false: A cost-shifting product rather than a burden-reducing one, and families decline it at the door — which no clearance and no code can fix.
Would have to be true: The clinician would have to see home phototherapy as guideline-consistent for this band, and both clinician and family would have to accept a dose record — irradiance times time — as the reassurance they get, because this product offers no bilirubin number.
Where it stands: Whether the 2022 AAP guideline addresses home phototherapy is still unchecked [claim 20: unconfirmed] and still the cheapest single act on this deck — a free published document no connector here can read and any person can. Two new findings complicate the guideline-cover argument in an interesting way. First, the outcome base is thin: a 2026 review of 31 studies found a pooled hospital (re)admission rate of 3.5% (95% CI 2.2-5.3%) after home phototherapy but rated evidence quality low for all outcomes [claim 40: unconfirmed]. Second, guideline cover may not drive behaviour anyway: in a 2026 survey of US birthing hospitals, only 24% reported obtaining a transcutaneous bilirubin measurement at least 24 hours after stopping phototherapy as the 2022 AAP guideline recommends [claim 45: unconfirmed]. A product whose adoption case rests on guideline consistency is selling into a field that follows this guideline unevenly.
What would settle it: A human reading the 2022 AAP guideline for its home-phototherapy language. Then ten discharge clinicians shown a mock dose-and-adherence report and asked what they would do differently on seeing it [claim 33: unconfirmed].
If it's false: Adoption depends on individual clinician appetite rather than guideline cover, and the differentiator this product is built around is documentation nobody reads — which cuts against the file's unbenchmarked time-to-revenue assumption [claim 16: unconfirmed].
Would have to be true: Twenty structured interviews — ten discharge clinicians, ten families through a current home phototherapy episode — would have to come back with the same account of the problem this product assumes.
Where it stands: Still no primary research, and the research lane's own record of trying is instructive: the parent-preference question was written up as "unanswerable as stated", and what was researched instead was its revealed-behaviour twin — the readmission and adverse-event rates recorded as [claim 39: unconfirmed], [claim 40: unconfirmed] and [claim 43: unconfirmed] [claim 49: unconfirmed]. That is the correct move and it does not substitute for asking.
What would settle it: The interviews themselves. There is no cheaper substitute and no connector that stands in for them — which is the finding, not an obstacle.
If it's false: The idea is a supply-side artifact: a device answering a problem statement no user described.
Every condition above with nothing verified behind it.
The rubric scores none of this. Nine factors, and not one asks whether a user wants the thing. The file's three verified claims all concern permission: the launch classification [claim 1: verified], the predicate pool and its labels [claim 2: verified], and the classification of a route the candidate is not currently taking [claim 31: verified]. Fourteen new claims since the last build added real substance to this deck and moved no tag.
If only one thing from this chair could be checked: whether discharging clinicians and general pediatricians will substitute home phototherapy for inpatient treatment in the eligible band without an added home bilirubin measurement [claim 19: unconfirmed].
It survives the week's evidence, and two new findings tighten it. A qualitative implementation study names reaching clinicians for education as one of the two main barriers to home phototherapy [claim 42: unconfirmed], and adoption where it has been measured is low [claim 43: unconfirmed]. It is also the condition this candidate's own central design choice creates — excluding bilirubin measurement to stay on an existing predicate [claim 1: verified] — so a deliberate de-risking move on the regulatory side reappears as risk on the user side. Parent capability doesn't matter if nobody prescribes; the cost questions don't arise; the dose record has no reader.
Naming it is not a recommendation, a gate, or a kill.