By DAVE LEVIN, MD
The 2019 Health 2.0 conference just wrapped up after several days of compelling presentations, panels, and networking. As in the past, attendees were a cross section of the industry: providers, payers, health IT (HIT) companies, investors, and others who are passionate about innovation in healthcare.
One of the more refreshing themes of the conference was an emphasis on how health IT can enable the delivery of services. This is a welcome perspective as too often organizations believe that simply deploying technology will solve their problems. In my 30+ years in healthcare, I’ve never seen that work. What does work is careful attention to the iron triad of people, process, and technology. Neglect one of these and you will fall short of your goals. Framing opportunities as services that are enabled and enhanced by technology helps us avoid the common pitfall of believing “Tech = Solution” and forces us to account for process and people.
Provider Burn-out and Health IT
Several sessions focused on the impact technology is having on end-users, especially clinicians. One session featured a “reverse-pitch” where practicing physicians “pitched” to health IT experts on the challenges they face, especially with EHRs, and what they need in order to do their job and have a life. This was summed up elegantly by a physician participant as, “Please make all the stupid sh*t stop!” There’s increasing evidence that the deployment of EHRs is a major factor for clinician burnout and the impassioned pleas of the attendees resonated throughout the conference.
Other sessions explored how to we might address these problems with improvements in user-interface design, workflow, and interoperability. Demonstrations of advanced technologies like voice-driven interfaces, artificial intelligence, enhanced communications, and smart devices show where we are headed and hold out the promise of a more efficient and pleasing HIT for providers and patients.
I’m freaking excited about all of this. The opportunity to deploy impactful technology is growing. Many of these technologies and approaches are well established in other industries which provides confidence and a useful starting point in thinking about how to apply them to healthcare. I’m also excited about the potential to “stitch” various technologies together for even greater impact. Match a smart device with powerful analytics, dashboards with striking visualization, and deep integration into workflow to make that information actionable, and you get a multiplier effect: the whole is greater than the sum of the parts.
I’m excited but I am also concerned. There are serious barriers to overcome in the pursuit of better HIT.
Chief among these is interoperability. Too many apps look great in a demo but fail to live up to their full promise because they do not fit into the end-user’s workflow. Primarily, this is about deep integration with the current generation of EHRs, which essentially own the “clinical desktop” – at least for now. In most cases these apps need to both read and write data into the EHR and be visually seamless – few are living up to that standard at this time. Integration technology, especially the adoption of APIs, will be key to future success.
Another major concern is “on-premise” deployment models. This legacy, from the days before cloud computing dominates healthcare and is a major impediment to advanced IT. The cloud has evolved from “someone’s hard drive in the sky” to sophisticated services that support building and deploying advanced applications. Key activities like assembling and manipulating large, diverse data sets, or delivering consumer-like experiences over large geographic areas cannot be done “on-prem.” And, the cost of cloud computing continues to drop while the power of these services increases due to competition among major players like Amazon, Google, and Microsoft. “On-prem” approaches simply cannot offer the same value, which is creating pressure for developers and health systems to migrate to cloud solutions.
Developers and health systems need to consider these challenges and develop solid plans for dealing with cloud-based solutions and proving robust integration from the start. Failing to do so will come back to haunt them sooner or later in the form of unanticipated delays and less than effective implementations. Addressing these challenges up front will increase the resiliency of providers, HIT staff, and organizations as a whole.
Dave Levin, MD, is the Chief Medical Officer for Datica and is a nationally recognized speaker, author, and the former CMIO for the Cleveland Clinic.