Today’s healthcare environment continues to be an industry in the throes of massive transformation. Value-based care may be a buzzword, but no one can argue it’s having disruptive impact on healthcare organizations across the country. Paying for care based on actual outcomes is a huge shift in the business model for healthcare, and requires faster access to information and efficient paths to engage with patients. Beyond the shift in payment models, physicians and nurses are also calling for better tools to treat patients. In fact a recent paper in the Journal of the American Medical Association a Stanford Professor stated “de-implementing the EHR could actively enhance care in many clinical scenarios.” This may be an over statement but I view this as a failure to support care providers with better technology to do their jobs.
The good news is we all want this to change. CIO’s, CMIO’s and the newest role in the healthcare organization, the Chief Innovation Officer, are all seeking new technologies that can and will deliver great value to their organizations. At the same time, however, they are hampered by the internal difficulties that come with trying to pass things “through the queue” within an IT organization to give it priority. For example, the typical cost of deploying a new product into a hospital can be between $200,000 and more than $500,000 if you take into account all of the resources that come from within the IT team to support it. If each potential service needed to support that size of investment, it would have to be a critical product that was fully proven prior to making that level of investment.
There’s the issue. You can’t be agile if you must fully prove out your opportunity before taking some initial steps. Let’s say that a cardiologist intuitively understands that she can treat patients faster if she has a few key data points and sequences their care according to specific plans that she uses. She wants to see that data in a dashboard, select care plans, and use a simple app to get specific data points from patients under her care during a 90-day period following their surgery. Creating a first version of this type of application, otherwise known as a minimum viable product (or MVP), could be a fairly efficient investment to make on its own for an IT department using an in-house or external development team. However, getting the data into the application and hosting that data in a HIPAA-compliant service is where things begin to slow down and cost begins to spiral out of control.
Important questions come up in accessing data that can slow the process to a stand still in current organizations:
• What EHR are they using and how is data mapped?
• What output formats are easily available?
• How will the data be merged from the new service with the EHR data to see one patient view?
• Is there a pre-integration data set for testing?
• How will security be handled post-launch? Are you HIPAA certified?
Technical infrastructure not designed for this purpose introduces barriers that stop the process from moving into agile development toward an “MVP” or first phase deployment. Traditional EHR’s that contain the data needed were not structured for this purpose, so it’s hard to retrofit them for this need.
What’s needed are more flexible systems designed for “test and learn” processes and more robust data output if we are to help innovation flourish in healthcare. Interoperable systems that have well formed API’s will make this process much more agile as we create and test new approaches to care delivery. Having data and systems that move quickly from test to deployment is also critical. Ultimately, being agile means getting to the first phase of a workable product that can test the hypothesis of your idea, then move it into an iterative development cycle without doing the heavy lifting of deep integrations each time you want to try something new.
This approach has worked very well in other industries as API’s eat the world and cloud-based platforms continue to make it more cost effective to scale complex solutions. Companies like Twilio are proving this to be true with massive success. In the cable TV industry, my prior company N2 Broadband created API’s that speeded interoperability in the video-on-demand marketplace and helped to drive down the cost of technology by 80% in a period of 4 years. Companies like Twilio have had success in driving access to communications services like VOIP and mobile messaging. In the healthcare vertical, Mana Health has designed its ManaCloud interoperable platform as a central, scalable platform for launching new digital services, with API’s at the core. Other initiatives like the Argonaut Project and FHIR are seeing great traction as well to create standards that we can use to bring down the cost of integration. These will allow us to integrate and test best of breed technologies in machine learning, mobile engagement, and work-flow quickly in an agile framework. Healthcare providers should be planning to put these kinds of solutions into their technology infrastructure to speed the path of innovation across their organizations this year. By doing this, we will truly impact the quality and cost of healthcare through better use of technology. It’s not a choice anymore it’s a necessity.