Dissonance and expectation gaps. Culture lags. Data sharing versus data protecting. Whichever side of the industry you’re on, chances are you’re feeling frustrated with IT in healthcare, where the pace of innovation is slow and the memories of painful transitions are vivid. Almost everyone agrees that digital health is a benefit to their organization and to their patients. Yet systems, culture, history, beliefs, and habits make it difficult to figure out how to actually make the adaptations needed for better digital health. Innovation teams at healthcare organizations around the country are paving the path by creating models for effective digital transformation strategies. And as a company leading the charge to improve interoperability, we’ve observed that some lessons learned in the startup world may help the healthcare industry evolve faster and more seamlessly.
In this post, we’ll explore the recent history of health IT, and then look at current forces that make today very different from 2008, when EHR adoption kicked into overdrive and set us down the path we find ourselves in today.
Laying the foundation for Health IT
While the healthcare industry was implementing EHRs that would become their core database, consumers underwent a fundamental cultural shift in the role technology plays in our daily lives. In the past 10 years we’ve seen countless new technologies disrupt how we consume content, communicate with the world around us, and share data. In an on-demand world, we now see technology as an ever-present tool to make our lives easier and more efficient. Why wouldn’t we expect technology to be used in the same way to manage our healthcare?
This has led to an expectation gap that leaves consumers feeling like we’re living in the past with healthcare. It’s creating a dissonance between the expectations of healthcare consumers and industry-held beliefs and constructs, also known as a cultural lag. This lag results in a much slower pace of innovation and adoption in healthcare than other industries, which is confusing and frustrating from the patient lens.
For example, patients expect to be able to use an app of their choice to access their healthcare data. In light of this cultural shift, healthcare organizations are needing to reassess their role as the steward of this data to balance legal and ethical requirements of protecting PHI, while not being accused of data blocking. Culturally, our society is in a place where we’ve overwhelmingly decided that it’s more important to us to be able to control and access our data as we choose. In the same vein, consumers are also holding healthcare organizations accountable to data breaches as the responsible party, not victims. There is a fundamental gap that has resulted in technology companies feeling frustrated at the barriers. This is especially driven by the slow pace of adoption that they face in the healthcare sector as the industry tries to reconcile the role they now play as an aggregator of patient data.
Forces changing healthcare delivery
While healthcare was laying the foundation of its technology infrastructure, the rest of the world was rapidly adopting a personalized technology experience in the palm of their hands. Just as healthcare was ready to look up from the hard work of getting EHR systems implemented and optimized, they were hit with a wave of new demands. Health IT is an industry that is moving from a behind-the-scenes function to the front and center as an emerging new technology field. Rock Health reported that over $29 billion was invested into digital health start-ups in 2021, and MarketWatch estimates that the health IT industry will climb to $120 billion by 2023. There is a potential to make real, tangible change, and healthcare might finally be ready for it.
Here are some of the notable changes that make today different from 10 years ago:
The Patient Perspective
A steady trend that has emerged since the onset of Covid-19 is patients that are more actively exercising their power as consumers. The introduction of the health insurance marketplace was one of the first times insurers had to provide more affordable options to individuals outside of employer-sponsored plans. Additionally, as inflation and cost of living have risen while wages have remained stagnant, consumers have had to become more savvy and scrappy with their spending habits, including with their healthcare decisions. Surging labor costs and thinner hospital and health network profit margins make it next to impossible for a patient, regardless of desire, to make financially prudent healthcare decisions. While funding has slowed in 2022, 2021 saw an almost doubled investment over 2020 for US-based digital health startups. Despite economic challenges, digital health technology is a beacon of hope for patients to have access to faster, better, and cheaper healthcare.
Patients not only want access to more affordable healthcare healthcare, but they also want the choice to receive care on their own terms. They want the ability to communicate with their doctors, easily schedule their own appointments, and access test results from their phone. They want technology that tracks when they took medication, what their latest glucose level is, and how they’re meeting activity or weight-loss goals. Patients are finally finding tools to take control of their health, and they desire ways to communicate and collaborate with their care team in ways previously unimaginable.
New Delivery Models
The traditional healthcare organization is facing increased competition from new and differentiated healthcare models like CVS Minute Clinics and OneMedical’s technology-led primary care services. Both of these models are examples of how healthcare services are beginning to make the move to a retail mindset to continue to attract and retain patients. Companies such as 23andMe and Exact Science’s Cologuard are creating a consumer-driven approach to allowing people to opt-in to learn more about specific facets of their health from their homes.
While these services may currently be geared to niche groups, they are a signal of the changes we can expect as blue chip companies like Apple, Amazon, Microsoft, and Google throw their hat in the ring with highly publicized healthcare divisions. A clear expectation is being set that technology is the way that we will transform healthcare delivery practices to be more cost-efficient and patient-centric.
Physician “Burnout” / Moral Injury
It’s been well documented that clinicians, particularly physicians, are feeling the pain of transitioning to EHRs. For many, making the change to a fully electronic record was the biggest practice change they have ever made, and likely will make, in their careers. The overwhelming feedback is clear – EHRs are not meeting their needs, and they want to be able to choose technology that does. If you’re used to controlling your home thermostat, doorbell, lights, and maybe even giving your dog a treat from your phone while you’re at work, why would you be willing to accept anything but the technology that enables you to provide the best care to your patients? While this call has been heard loud and clear, and the market has rushed to bring forth countless solutions designed to answer physicians’ calls, we are still very early when it comes to adoption. It will take some time for winners to emerge and best and breed solutions, backed by satisfied physicians, to attain mass adoption.
Beyond the Four Walls
The healthcare industry has made a big investment in moving to a value-based care model, both in terms of reimbursement structure as well as medical practice. We recognize that it’s no longer adequate for a hospital to simply provide basic care to warrant a discharge. Care providers also need to ensure that the patient is following their discharge instructions and receiving the outpatient treatment that they need to stay. In the same vein, clinicians need to take into account the impact that social determinants of health can have on a patient’s ability to self-manage their care. But how do you oversee a patient’s care when they’re at home?
Technology is one of the easiest and most cost-efficient ways to achieve this outcome. For patients that have access to a mobile device and internet, physicians can prescribe an app for them to use to document and transmit pertinent information, or to set up reminders to complete tasks like taking medication. For patients that don’t have this access or ability, providers can still use technology to communicate with care extenders from home health clinicians to telephone-based care management. The ability to use technology enables medical professionals to extend their reach past the four walls of their healthcare institution.
These forces combine to create an environment where innovation in healthcare is not simply a desire – it is a requirement. We must create a world where technology works for patients and providers. Anything less simply will not be accepted.
This blog was updated from a previous post published on April 29, 2019