Over the past few years, the government imposed copious regulations on healthcare providers, most of which are supposed to reduce costs, improve access to care, and consumerize the patient experience. Prior to 2009, the federal government was far less involved in driving the national healthcare agenda, and thus provider IT budgets, innovation, and research and development agendas among healthcare IT vendors.
This is, in theory (and according to the government), a good idea. Prior to the introduction of the HITECH act in 2009, IT adoption in healthcare was abysmal. The government has most certainly succeeded in driving IT adoption in the name of the triple aim. But this has two key side effects that directly impact the rate at which innovation can be introduced into the healthcare provider community.
The first side effect of government-driven innovation is that all of the vendors are building the exact same features and functions to adhere to the government requirements. This is the exact antithesis of capitalism, which is designed to allow companies to innovate on their own terms; right now, every healthcare IT vendor is innovating on the government’s terms. This is massively inefficient at a macroeconomic level, and stifles experimentation and innovation, which is ultimately bad for providers and patients.
But the second side effect is actually much more nuanced and profound. Because the federal government is driving an aggressive health IT adoption schedule, healthcare providers aren’t experimenting as much as they otherwise would. Today, the greatest bottleneck to providers embarking on a new project is not money, brain power, or infrastructure. Rather, providers are limited in their ability to adopt new technologies by their bandwidth to absorb change. It is simply not possible to undertake more than a handful of initiatives at one time; management can’t coordinate the projects, IT can’t prepare the infrastructure, and the staff can’t adjust workflows or attend training rapidly enough while caring for patients.
As the government drives change, they are literally eating up providers’ ability to innovate on any terms other than the government’s. Prominent CIOs like John Halamka from BIDMC have articulated the challenge of keeping up with government mandates, and the need to actually set aside resources to innovate outside of government mandates.
Thus is the problem with health IT entrepreneurship today. Solving painful economic or patient-safety problems is simply not top of mind for CIOs, even if these initiatives broadly align with accountable care models. They are focused on what the government has told them to focus on, and not much else. Obviously, existing healthcare IT vendors are tackling the government mandates; it’s unlikely an under-capitalized startup without brand recognition can beat the legacy vendors when the basis of competition is so clear: do what the government tells you. Startups thrive when they can asymmetrically compete with legacy incumbents.
Google beat Microsoft by recognizing search was more important than the operating system; Apple beat Microsoft by recognizing mobile was more important than the desktop; SalesForce beat Oracle and SAP because they recognized the benefits of the cloud over on-premise deployments; Voalte is challenging Vocera because they recognized the power of the smartphone long before Vocera did. There are countless examples in and out of healthcare. Startups win when they compete on new, asymmetric terms. Startups never win by going head to head with the incumbent.
We are in an era of change in healthcare. It’s obvious that risk based models will become the dominant care delivery model, and this is creating enormous opportunity for startups to enter the space. Unfortunately, the government is largely dictating the scope and themes of risk-based care delivery, which is many ways actually stifling innovation.
Thus is the problem for health IT entrepreneurship today. Despite all of the ongoing change in healthcare, it’s actually harder than ever before to change healthcare delivery things as a startup. There is simply not enough attention of bandwidth to go around. When CIOs have strict project schedules that stretch out 18 months, how can startups break in? Startups can’t survive 18 month cycles.
Thus the is paradox of innovation: the more of it you’re told to innovate, the less you can actually innovate.
Today I was talking with a healthcare IT vendor which really needs to integrate deeply with an EHR to be valuable. Without that integration the product is not nearly as useful for doctors. Therefore we started talking about their current EHR integration and the potential for future EHR integrations. At that point he asked me what I thought about the coming Epic App Store (officially called the Epic App Exchange).
In case you missed it, I wrote about the Epic App Store over on Hospital EMR and EHR. I cover what’s been said about the Epic App Store (not much from Epic itself) and make some predictions. However, today’s conversation solidified my predictions.
Epic has always been open to working with their customers and a tech partner to integrate something with Epic. Basically, the customer is king and so if the customer wants the integration, Epic will provide the SDK that’s needed for the integration and make it possible for the customer to do what they need. Everyone’s known that if you want to integrate with Epic, then you need to work through a customer.
With this in mind, I believe the Epic app store is a way for Epic to allow for distribution of these apps that have been created by their customers (often with a tech partner) to other Epic customers.
Basically, this is in line with Judy’s focus on the customer. Some might say that this focus is great. Hard to argue with Epic’s success. However, this approach misses out on the opportunity of the Epic app store facilitating entrepreneurial innovators to build something on top of Epic that their customers didn’t even know they wanted yet.
Epics current strategy is more in line with staying the entrenched incumbent. Real transformation comes when you provide a platform for innovation that goes beyond yourself and your customers. I hope one day Epic sees this vision and really roles out an open app store. Until then, the Epic connected customer applications are going to have a bit of a monopoly selling their add on services to Epic customers.
I’ll admit that I’m far from an expert on the challenges and inequities of women in the workforce. I think that everyone that knows me knows that I love working with women and I love strong empowered women. It’s what I hope my daughter will become one day. I’m proud that the Healthcare IT Marketing and PR conference was the first conference to be listed with over 50% female speakers.
I recently saw a stat that there were more CEO’s of the top 1500 companies named “John” (5.3%) than there are women CEOs (4.1%). That’s particularly disturbing since my name is John. It highlighted to me how solving the issues of gender inequality in the workplace is incredibly complex and challenging.
While I admit I don’t have all the answers, I was interested to hear these 5 suggestions for women from Kathryn Stecco, MD.
Women considering entrepreneurial initiatives in medical technology should follow these basic principles.
- Start with a big idea that solves a big problem: A new business must start with a powerful idea for a product or service that fills a real unmet need. Market is everything.
- Pursue a practical solution: Focus on products that are safe, effective and easy to use for both physician and patient. If the product doesn’t make physicians’ lives easier, they won’t use it. The product must produce meaningful clinical data that speaks for itself.
- Build relationships – early – with clinicians: Medical entrepreneurs must be out in the field developing ties with physicians and getting their input early in the design process. No matter how well designed your product or how impressive your patents, physicians will have the last word on the usefulness of your product. They are vital to your success.
- Be prepared to shift gears: Don’t fall into the trap of becoming so enamored of an idea or a product that you lose sight of its real likelihood of succeeding in the marketplace. You must have the flexibility to move on to something else when changes in the environment cause the ground to shift under your feet and your plans to be upended.
- Enjoy the ride! Successful entrepreneurs make adversity the energy that fuels their creativity. They don’t learn their most valuable lessons in the classroom but in the trenches. They thrive on the long hours, the unpredictability, the rush that comes from building something important and valuable.
Maybe some of these ideas will help some women who are working in the medical device industry. It’s a small thing for sure, but maybe if we all do small things to improve the opportunities for women those small things will turn into something great.
The following is a guest post by Vishal Gandhi, CEO of ClinicSpectrum as part of the Cost Effective Healthcare Workflow Series of blog posts. Follow and engage with him on Twitter @ClinicSpectrum and @csvishal2222.
In healthcare we love to talk about ways we use technology with patients. We chart patient visits in the Electronic Medical Record. We schedule and bill patients and insurance companies from a Practice Management System. We interact with patients through a patient portal. All of these technologies can be great, but how come we don’t talk more about the way technology can improve how we run our practices and manage our employees?
One example of this is using technology to improve your HR. We see this in many other industries and at a few of the large hospital organizations, but for the most part healthcare hasn’t benefited from great HR practices that utilize technology. As healthcare organizations continue to consolidate, it’s going to be extremely important that every healthcare organization has a well designed human resource program to train, track, and retain key employees.
Let’s look at three areas you can use technology empowered HR practices to track, manage, and improve your human resource efforts:
Employee Growth Milestones
Are you creating a growth plan for your employees? Do you have a system that tracks that growth plan for your employees? If you don’t have either of these, then you’re missing out on a big opportunity. By setting growth milestones or goals for your employees you inspire them to be better and do more. Plus, employees love to know that there are opportunities to grow within your organization and a clear plan of how that growth can be achieved. However, along with setting these milestones, you also have to have a way to track how your employees are doing in their efforts to achieve these milestones. Otherwise, there’s no reason to set a growth milestone if you’re not going to evaluate it later.
Healthcare Human Resouce Management
While you could do this milestone tracking on paper or in a set of Word documents, we know what happens to those documents. They get filed away and forgotten. The better option is to use an employee management system which integrates these growth milestones into your employee’s performance milestones. Then, you can see how an employee’s performance corresponds to their growth milestones. Plus, with an integrated package, you can regularly be reminded of those growth milestones.
Employee Performance Milestone
Now that you’re setting growth milestones for your employees, let’s consider how you can track an employee’s performance. Doing so will encourage better performance and will provide you a way to reward those employees who are delivering great results and work with those employees who aren’t progressing towards their growth milestones.
A great example of this is with your medical billing staff. Using technology you can track the performance of that medical billing staff. How many insurance checks did they do? How many claims are they processing? How many collections phone calls did they complete? Each of these items illustrates how well that medical billing staff is performing their job’s duties. By integrating this tracking into your human resource management system, you have an objective way to evaluate and reward your employees.
Employee Benchmarking and Productivity
Now that your employees have a set of growth milestones and you have the ability to track their performance, you can effectively benchmark your staff and evaluate their productivity. Once again, while this can be done on paper, it’s much more effective and efficient with technology.
Benchmarking your employees against their peers is incredibly valuable because it helps a manager evaluate which employees might need more help and which employees deserve to be rewarded for their hard work. Without these benchmarks, we have to base our evaluations on how we feel and that can often be wrong.
A great human resource management software can facilitate an improved HR program for your employees. Doing so is extremely important to your organization so you can retain their key employees. Human resource management software gives the best employees a roadmap for how to be rewarded in regular performance evaluations. On the other hand, it also helps an organization evaluate their poorly performing employees so they can either help them improve or let them go. Healthcare organizations that choose not to utilize technology in their human resource management efforts are likely to lose their best employees as they fall behind their competitors. That’s a recipe for disaster in the competitive healthcare environment.
The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. Check out their healthcare Human Resource management module, HRMSpectrum to help improve your HR management efforts.
The other day I had a really great chat with Khaled El Emam, PhD, CEO and Founder of Privacy Analytics. We had a wide ranging discussion about healthcare data analytics and healthcare data privacy. These are two of the most important topics in the healthcare industry right now and no doubt will be extremely important topics at healthcare conferences happening all through the year.
In our discussion, Khaled talked about what I think are the three most important challenges with healthcare data:
I thought this was a most fantastic way to frame the discussion around data and I think healthcare is lacking in all 3 areas. If we don’t get our heads around all 3 pillars of good data, we’ll never realize the benefits associated with healthcare data.
Khaled also commented to me that 80% of healthcare analytics today is simple analytics. That means that only 20% of our current analysis requires complex analytics. I’m sure he was just giving a ballpark number to illustrate the point that we’re still extremely early on in the application of analytics to healthcare.
One side of me says that maybe we’re lacking a bit of ambition when it comes to leveraging the very best analytics to benefit healthcare. However, I also realize that it means that there’s still a lot of low hanging fruit out there that can benefit healthcare with even just simple analytics. Why should we go after the complex analytics when there’s still so much value to healthcare in simple analytics.
All of this is more of a framework for discussion around analytics. I’m sure I’ll be considering every healthcare analytics I see based on the challenges of data integrity, security and quality.