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 and safe 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 our healthcare industry go where it wants and needs to go faster and without the pain of earlier transitions.
This two-part blog aims to start a conversation about what inhibits change and how to make it happen better. Part 1 describes the environment in which we’re all operating, while part 2 lays out startup approaches worth adopting. 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 today.
Laying the foundation for Health IT
It was only 10 years ago that the health IT industry received a significant push into the spotlight with the implementation of the HITECH Act. Since then, we’ve seen health IT move from a, mainly EHR-driven, $2 billion dollar industry to an estimated $28 billion industry that has extended to include EHRs, cloud-based applications, and consulting. EHRs went from being used in roughly 25% of healthcare organizations to being a critical part of the technology strategy in over 96% of healthcare organizations (per ONC and AHA). Given those numbers, it’s safe to say that the implementation of these policies was incredibly successful in driving the adoption of EHRs. However, at the time the HITECH Act was written, no one could have predicted how dramatically our relationship with technology would change and how that would impact expectations today.
While the healthcare industry was implementing EHRs that would become their core database, we underwent a fundamental cultural shift in the role technology plays in our daily lives. In the past 10 years we’ve seen 7 iPhones and countless Android models, started to read both news and books on digital screens, moved from owning CDs and DVDs to paying for streaming media via companies like Netflix and Spotify, and have seen widespread adoption of asynchronous communication with friends, family, companies, and even potential dates over social media services such as Snapchat, Facebook, Twitter, and Tinder. We’ve entered an on-demand world where we see technology as something that we expect to be available to make things 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 leaving people feeling like we’re living in the past with healthcare. It’s is creating a dissonance between the expectations of healthcare consumers and the 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. While patients want to use an app of their choice to access their healthcare data, 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 while also holding healthcare organizations accountable to data breaches as perpetrators, not victims. There is a fundamental gap that has resulted in technology companies feeling frustrated at the barriers and, comparatively, the slow pace of adoption that they face in the healthcare sector as the industry tries to reconcile the role they 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. I wrote a few years ago about how health IT is in its awkward teenage years but now it’s more like a child star going through puberty in the public eye. Health IT is an industry that is moving from a behind-the-scenes function to the front and center as an emerging hot, new technology field. Rock Health reports that almost $8 billion was invested into digital health start-ups in the last year alone 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
One of the big trends already emerging in 2019 is patients that are more actively exercising their power as consumers. The health insurance marketplace was one of the first times insurers had to provide more affordable options based on what an individual may want, not just what was provided by an employer. Additionally, as we’ve seen the debt carried by Americans creep up to $13 trillion, it’s a logical evolution that the population would become more savvy consumers. Unfortunately, today’s status quo makes it next to impossible for a patient, regardless of desire, to make financially prudent healthcare decisions. One great hope of digital health technology is that it will empower the patient and finally make this possible.
Patients not only want the chance to make sure that they’re not overpaying for healthcare, but they also want the choice to receive healthcare on their terms. They want to be able to email their doctors, schedule their own appointments, and access past test results from their phone. They want technology that tracks when they took their pills, what their latest glucose level is, and education they can watch on-demand. They want to be able to communicate with clinicians as they meet activity or weight-loss goals. Patients are finally finding tools and ways to take control of their health and they want to be able to collaborate with their doctor in ways previously unavailable to them.
New Delivery Models
On top of that, the traditional healthcare organization is facing increased competition from new and different healthcare models like CVS Minute Clinics’ “quality healthcare on your schedule” and OneMedical’s technology-led primary care services that have the goal of “changing the way you go to your doctor”. 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. Additionally, new 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 be geared to niche groups right now, they are a beacon 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, patient-friendly, and provider approved.
Physician “Burnout” / Moral Injury
As healthcare starts to understand more about what people expect, we need to keep in mind the pervasive role that technology plays in everyone’s lives and that our doctors and nurses don’t check their personal experiences at the door. Millions of people use apps on their phone as alarm clocks, fitness trackers, and as a primary means of accessing services such as music streaming, ride-sharing, and banking. It’s also likely that you made a specific choice about the apps you have installed on your phone. Don’t like the pre-installed alarm clock? There are plenty more options in the app store that range from a simple alarm clock to ones that can track and analyze your sleep habits. We are in an era where the choice of technology is something that we expect and not having that choice feels outdated. Unless you’re in healthcare.
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 enough for a hospital to get a patient well enough to go home. They also need to ensure that the patient is following their discharge instructions and getting the outpatient treatment that they need to stay well while also taking into account the impact that their social determinants of health can have on a patient’s ability to do this. But how do you manage a patient’s care when they’re at home?
Technology is one of the easiest and cost-efficient ways to do this. For patients that have access to a computer, tablet, or smartphone, you can prescribe an app for them to use to document pertinent information or to set up reminders. For patients that don’t have this access or ability, you can still use technology to communicate with care extenders from home health clinicians to telephone-based care management. In either case, having 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.