I want to begin by sharing well-known information for the sake of comparison. Both the Apple and Google Android platforms welcome the introduction of new and (sometimes) highly valuable functionality through plug-n-play applications built by completely different companies.
You know that already.
Healthcare IT companies welcome you to pay them great sums of money for enhancements to their closed systems. This is on top of substantial maintenance fees that may or may not lead to hoped-for updates in a timely fashion. (With all due respect to the just-announced CommonWell Health Alliance, Meaningful Use does mandate interoperability. The participants are, in effect, marketing what they have to do anyway to try to differentiate themselves from Epic.)
The respective results of these two divergent approaches are probably also familiar to you.
Consumer technology has taken over the planet and altered almost every aspect of our lives. These companies and industries have flourished by knowing what customers will want before those same customers feel even a faint whiff of desire. We are both witnesses to and beneficiaries of dazzling speed-to-solution successes.
Back on planet health IT, the American College of Physicians reports that the percentage of doctors who are “very dissatisfied” with their EHRs has risen by 15 percent since 2010; in a poll, 39 percent said they would not recommend their EHR to colleagues and 38 percent said they would not buy the same system again.
I will argue that the difference between health IT and every other progressive, mature industry is the application of open source, open standards and, most importantly, open platforms. These platforms supporting interoperability and substitutability have enabled Apple and Google—and NOAA weather data, the Facebook Developer Platform, Amazon Web Services, Salesforce, Twitter, eBay, etc.—to drive innovation and competition instead of stifling it. They have created markets where everyone wins—the client, the application developer and the platform company.
The keys to open platforms are application programming interfaces (APIs) through which a platform-building company (i.e., Apple, Google) welcomes the contributions of clients and other companies. The more elegant the API, the more it can support true interoperability.
Apple Incorporated has grown to be among the most valuable and most envied companies on earth. Its products are ubiquitous and beloved by many of their users. Last year, the firm generated nearly $26 billion in profits on revenues of $108 billion. When physicians and others working in health care discuss the lessons that the medical establishment can learn from these types of corporate successes, the conversations almost always revolve around the promise of information technologies, such as electronic record keeping or electronic prescription writing, and the need for increased use of these in medical practice. While these technologies are important, the most valuable lesson from Apple’s success is a demonstration of the power of empathy and the subsequent need for health care providers to emotional connect with our patients.
It is widely known that Steve Jobs and Steve Wozniak built the first Apple computer in Steve Jobs’ garage; what is not as widely known is that they quickly brought in a third partner, Mike Markkula, to join and guide the company. He began by writing a one page statement entitled “The Apple Marketing Philosophy”. This philosophy stressed only three key components of bedrock company principles; the first and most important was empathy.
Who am I? Why am I here? Does it really matter anyway? Bestselling business author and corporate historian Jim Collins(“From Good to Great”, “Built to Last: Successful Habits of Visionary Companies ”) has made a career by asking executives unused to such introspective philosophical questions to stop and think about the fundamental assumptions at work in their businesses. Collins has found that the most successful companies (think Google, Apple, Microsoft, probably notFacebook) learn to ask the key questions that keep them focused on what they’re supposed to be doing and teach them to avoid making the mistakes that cause lesser, more mortal companies to trip up over their own feet. Not long ago THCB was on hand to catch Collins and bestselling author (“Getting Things Done”) David Allen speak at an exclusive invitation-only healthcare forum hosted by the Denver-based Breakaway group. In this interview, Breakaway group CEO Charles Fred talks with THCB founder Matthew Holt about his organization’s innovative and very successful approach to teaching healthcare professionals to work with new technologies.
The future direction of American health care is unclear. Certainly the cost trend as it exists is unsustainable with health care costs being a major concern of the private sector, the government, and individuals. How does the nation manage costs while ensuring high quality medical care, access, and service? Proposals include increasing competition among insurers, providers, and hospitals to drive down prices or giving more financial responsibility to patients via higher deductibles and co-pays with the belief that they will demand price transparency, shop around for the best price, and as a result slow health care costs.
What if both ideas are wrong?
While it is possible these plans might work, I cannot help but notice the similarities in the challenges for patients in navigating the health care system and consumers figuring out how to purchase and use technology. Walk into your neighborhood electronics store. Individuals are overwhelmed with the number of product choices, manufacturers, differences in technical specifications and features. In the majority of situations, consumers are unsure of what they are purchasing. They want something that just works, whether surfing the internet, making home movies, or being connected with loved ones. The gap in knowledge between an expert and a consumer is great and often unintentional and unapparent.
Within the technology world, there are two groups of thought. The first group offers technology in a closed system, like Apple, where the focus has been on just making things work. There are a limited number of product types and designs. For example, its current smartphone, the iPhone 4 comes in only two types. Aside from the base memory of 16 GB or 32 GB and two different prices, the phones are otherwise identical in features with the same apps, cameras, and ability to record video. Although the specifications are available for anyone to see, the focus is rarely on the technical elements of the products themselves and more on what they can do for you. Walk into any Apple retail store and the products are situated by function. Staff ask not how much computing horsepower, storage space, or CPU speed one needs, but what one plans on using the smartphone or computer for.Continue reading…
In case you’ve been preserved in amber the past month, there’s been lots of excitement in technology circles about the iPad – as well as other tablet computers – and how they’ll transform (take your pick): games and word processing and movies and magazines and newspapers and music composition.
But there hasn’t been a great deal said about their possible usefulness in healthcare.
In truth, healthcare has a horrible record with technology. Medical technology, after all, is one of the principle reasons that annual healthcare costs in the U.S. are at $2.5 trillion, and climbing. The CT scan may beguile radiologists and diagnosticians, but it’s also a horribly inefficient technology (it doesn’t scale, there’s no price transparency, etc.). In short, everything that technology is good for in the rest of the universe – lowering costs, reducing expertise – it has exactly the opposite effect in healthcare and medicine.
There have been attempts here or there to introduce consumer-style tools to medicine. Dozens of companies, for instance, offered versions of the Palm Pilot that promised to recognize a physician’s unique needs. But too often these one-off gadgets fell into the wrong quadrant of the efficiency and expense matrix. And the fact that pagers are long dead in every corner of the world except in hospitals serves as yet more proof that healthcare is a bizarro world when it comes to technology.
And consumer-facing tools have fared just as poorly. Fancy set-top boxes that promise to connect patients to their doctors via telemedicine, and cumbersome monitoring devices for people with diabetes or other chronic conditions haven’t exactly inspired confidence.
So: enter the iPad. Does it have a chance?
Yes, and for two reasons. The first is this: In the past healthcare technology has always been about the hardware – building a box that promises to do something, and then trying to educate patients or providers on how to use the box. That hasn’t worked because of bad interface design; the mission was complexity, not simplicity. But the tablets, and the iPad in particular, are designed to be as simple as possible (just one button). They’re not really about the hardware, at all – in fact, if these tools work as promised, the hardware disappears. The device will let users engage with information immediately, without having to negotiate a cumbersome interface. Indeed, the device itself vanishes and the user connects directly with the experience. That’s a powerful shift, and it has great potential for health.Continue reading…