The Ebola crisis in Texas has tested our nation’s health care system in many ways, exposing weaknesses and potential breakdowns. In particular, the incident with the first diagnosed Ebola patient at Texas Health Presbyterian underscores a fundamental issue with information liquidity between providers, their care teams, and across the continuum of care. The ability to share information effectively is critical not just in responding to health care crises like Ebola — but also in delivering great, cost-effective care.
As athenahealth CEO Jonathan Bush said in an interview with CNBC earlier this month:
“The worst supply chain in our society is the health information supply chain. It’s just a wonderfully poignant example, [a] reminder of how disconnected our health care system is. … The hyperbole should not be directed at Epic or those guys at Health Texas. The hyperbole has to be directed at the fact that health care is islands of information trying to separately manage a massively complex network.”
Health care providers and consumers are increasingly using mobile technology to exchange information. Many health IT providers readily acknowledge that some level of oversight is required to ensure patient safety and privacy protections, but many providers question whether the FDA is the right agency for the job and want to see the FDASIA recommendations.
Can the FDA, with its already limited resources and lengthy review cycles, regulate the fast-moving health IT industry? Should it? Health IT is fundamentally different from a medical device in many ways. For oversight purposes, the key differentiator between the two is the opportunity for clinical intervention in the use of health IT. Many medical devices interact directly with the patient (such as an infusion pump or pacemaker). Most health IT, on the other hand, merely provides information to clinicians, who ultimately make independent, experienced care decisions. Physicians are informed, but not controlled, by the information. This leads to a vast difference in the patient risk proposition and rigid regulatory oversight is not appropriate.
Advocates of a broad health IT oversight framework – which encompasses mobile health IT – are urging the FDA to delay release of its final guidance, particularly in light of a July 2012 Congressional mandate for the creation of a comprehensive oversight framework that avoids regulatory duplication.
But some mobile medical application developers are pressing the FDA to move forward immediately, believing its guidance will reduce the regulatory uncertainty that they believe is stifling innovation and investment in some aspects of mHealth.
Over the 11 years I spent building the network at Epocrates, I learned a lot about physician behavior, motivation and the use of incentives. And while influencing nearly 50% of U.S. physicians to use a product requires that it meet a true need, fit into their workflow and be extremely easy to use – building one of the most trusted brands in healthcare goes beyond the product. It’s about being fanatical about understanding your users, engaging them at the right time, helping them support you and ultimately creating incredible loyalty.
Though we had a very analytical approach to user acquisition and brand strategy, I want to focus this article on something more fundamental – behavioral psychology. Truly understanding not just physician behavior but human behavior was core to the business at Epocrates and permeated throughout our business, marketing and product strategy. We focused early on in engaging physicians as consumers – B2C rather than B2B. Though a significant percentage of MDs are characterized as “small business owners”, we saw them as consumers first – hence, understanding human behavior, motivation, and influence drove product adoption and usage.
I was reminded of this recently listening to Dr. Robert Cialdini, speak at the 4th Annual Consumer Medicine Summit. If you haven’t read it, “Influence: The Psychology of Persuasion” is one of those dog eared marketing “bibles” that has remained on my shelf for years because its lessons on how to influence people are universal and timeless. In fact, I made it required reading for some members of my team. (Future postings on other favorites such as Nudge and Predictably Irrational, coming soon!).
I met with Bob Quinn the CTO and Geoff Rutledge, the CMO, of Epocrates at HIMSS last week. The company has a big footprint in mobile (and web) reference content for physicians. The big news is that it’s looking to move into an EMR product. Bob and Geoff explain what they do and where they’re going.