Editor’s note: This guest post was written by Dave Chase, the CEO of Avado.com, a patient portal & relationship management company that was a TechCrunch Disrupt finalist. Previously he was a management consultant for Accenture’s healthcare practice and founder of Microsoft’s Health platform business. You can follow him on Twitter @chasedave.
Image is courtesy of Wikimedia Commons.
I know of no industry where technology is as despised as it is in healthcare. It’s telling that it took government money to incentivize healthcare providers to finally do what virtually every other industry has done — apply information technology to streamline processes. “Established technology is being given a federally funded new lease on life,” athenahealth CEO Jonathan Bush said. “Traditional health software now is on Medicare, being kept alive like grandma.” Bush dubs this program as the “cash for clunkers” program for health IT leaving no doubt what his opinion is regarding the legacy vendors’ solutions.
While one might dismiss this coming from a company with a dog in the fight, the feeling is nearly universal amongst doctors who are the most important users (besides patients who are almost completely ignored). Perhaps the best evidence of how abysmal legacy healthIT is, is that even the market leader is having trouble getting medical practices to adopt their software despite huge subsidies from large health systems. In the course of discussions with large health systems, they often proudly shared the deployment of a mega EMR and how they were offering subsidies to affiliated physicians to adopt the same system. When pressed about how broadly it was being adopted by non-employee physicians (i.e., MDs who have a choice), the penetration was staggeringly low — 2/10 of one percent was the average of those who shared figures. This was despite the fact that they were subsidizing 85% of the cost (the maximum allowed by Stark Law).
When I’ve spoken with physicians who have rejected the entreaties from their affiliated health systems, it’s more than the expense (even after a massive subsidy, it’s still several thousand dollars plus monthly costs). Rather, the complexity and lack of user friendliness is the bigger driver.
HealthIT Vendors Reflect Flawed Reimbursement Model
All of this begs the question, “why is HealthIT so bad that massive government and health system subsidies are required to drive adoption?” And how can this possibly be good news? Let me address the issues and then I’ll conclude with the good news. While it may seem easy to bash legacy HealthIT vendors, my experience has been that vendors reflect their customers. I would take this a step further. In the case of healthcare, customers reflect the reimbursement model. It’s a reimbursement model that is so broken Americans pay nearly twice as much as other countries to get inferior outcomes.
The “do more, bill more” reimbursement model in the U.S. has been at the root of healthcare’s hyperinflation (fun fact: while what we spend on all other goods and services has increased 8x since the 60’s, healthcare costs have skyrocketed 274x). The byproduct is a focus on activity rather than value/outcome, the primary IT focus has been how you can get more bills out faster. Despite the fact that most physicians call the patient the most important member of the care team, in reality, the “patient” as architected into most HealthIT has been little more than a vessel to attach billing codes to.
More recently, there’s been a drive to add so-called Patient Portals to involve the patient. However, these have been more driven by marketing objectives than truly rethinking the care delivery model. Making the patients central in a system designed for optimizing billing is even less likely than Yahoo or Microsoft surpassing Facebook in social networking. Both require a different architecture from the ground up. As I wrote earlier, EMR portals are like driving a 747 to the grocery store — it can get you there but it’s going to be far more expensive and complex than necessary.
Convoluted Decisions Processes Have Killed Great Products
When I’m asked why I didn’t get back in to healthcare sooner, I share with them a story from my past. I was at a well recognized hospital implementing their patient accounting system and we needed to decide the unique patient identifier scheme. It’s an important decision, but they were in year seven of debating what the new scheme should be! It may seem like an absurd example, but it’s indicative of how interminable and almost crazy the decision processes can be in a health system. It virtually guarantees that the only companies that can survive those processes are incumbent vendors — breakthrough young companies die on the vine waiting those processes out. If you wonder why MUMPS is still widely used in healthcare, it’s because old vendors, and old technology persists in healthcare.
Separation of Consumptive User and Economic Buyer
The role of Chief Medical Informatics Officer (CMIO) is relatively new and long overdue. The idea is a senior level physician plays an integral role in IT decision processes. However, there are still many scenarios where the people who will actually use software are a great distance from those who pay for the software. In other industries, the rise of SaaS software has closed or eliminated this gap where you see individuals and departments not waiting around for IT to pick something that they don’t want to use. Rather, they can directly contract with the technology company. This has only just begun in healthcare.
There was a parallel scenario 10-15 years ago when multi-million dollar CRM implementations from companies like Siebel weren’t embraced the way Salesforce.com has been embraced today. A key driver of this is the user of Salesforce.com is often only a step removed from the purchaser.
One Item For Which HealthIT Vendors are Fully Responsible
Most of the items above put the root cause at the provider level. However, there persists one insidious practice. There are various ways to ensure customers stick around as long as possible — lock-in or loyalty. Successful SaaS businesses are built on the loyalty model. Rather than holding data hostage or locking customers into long agreements, they believe that the more freedom you give customers, the more loyal they become (assuming you deliver the goods). In contrast, there’s still the old model of lock-in used in many HealthIT vendors. For example, they make it expensive and/or difficult to get access to data in a system to keep any in-house or 3rd party built system from being integrated. These vendors pull it over on naive customers by telling them that it’s a ton of work when it’s only a ton of work if that vendor is incompetent. Like escaping an abusive relationship, healthcare providers must take action or else they reward that behavior.
The Good News
Tectonic shifts are underway. Smart healthcare providers are trying to avoid making the same mistakes newspaper companies made in the late 90’s. For those of us used to the convoluted, interminable decision processes of the past, it is breathtaking to see the decision processes of today. As I detailed in the Rise of Nimble Medicine, not only are entrepreneurial ventures popping up like weeds, healthcare providers are getting far more aggressive about trying new models without doing the equivalent of organizing the Roman Legions.
Naturally, when a project is hugely expensive and will take months to implement, it’s going to lead to a longer decision process. However, the principles we see in agile software development, are spreading to healthcare delivery. I’ve seen scenarios, such as in telehealth, where the time from initially seeing technology to moving into implementation takes less than a week. The startups that are adept at finding the nimble organizations will have great success. The reward for healthcare providers in rationalizing their decision processes is they will no longer have to settle for rigid software that is difficult to implement.
The best news for healthtech startups is that, by definition, legacy HealthIT is optimized around the flawed reimbursement model of the past. The disruptive innovators instinctually know that they will either have to build their own software (if there isn’t off-the-shelf software) or they can work with software companies that allow them to be nimble. There is universal agreement that anything less than a fundamental redesign of healthcare will fall short in solving the most important problem the U.S. and the world faces — spiraling healthcare costs.
Money Ball for Medicine – Business Models for Healthcare