Lately, I’ve become more and more interested in what will really move the needle in healthcare IT. Plus, I’ve been thinking through how most health IT companies approach their solutions and how the methods we’ve been using for years are failing so many patients in healthcare. As part of this analysis I’ve been discovering a need for healthcare IT companies to spend more time and focus on the behavioral side of things than they do today.
Much of my thinking has been influenced by Melissa McCool and her work creating her company, STI Innovations. Plus, this thinking was extended in a number of conversations at HIMSS including my meeting with Wanda Health. While Wanda Health uses things like machine learning and healthcare analytics, I was most interested by their efforts to actually influence the behaviors of patients. These companies are making efforts to understand the unique needs of each patient and their situation so they can engage them in a way that will actually achieve the desired result.
This type of approach is dramatically different than so many healthcare IT companies out there. I believe most healthcare IT companies currently take 2 approaches to building a company: Process Automation and Trial and Error.
Process Automation Companies
This class of healthcare IT company is one that wants to use technology to make a healthcare process more efficient. That’s not to say that they do make that process more efficient. Just that their goal is to make the process more efficient. Sometimes all that they actually do is make the process electronic. They don’t necessarily achieve the efficiency goal. However, the best ones do make healthcare more efficient. Most EHR vendors fit into this category of company, but there are hundreds of other health IT companies that just want to use technology to make your life a little more efficient.
There’s nothing wrong with these companies. More efficiency is a great thing that can have all sorts of great tangential impacts. However, this is very different than a company that’s focused on actually improving the care that’s provided patients. What happens sometimes with process automation companies is that they back their way into doing more than just process automation. Their main goal when they start isn’t to improve patient care, but they often back into that goal as their system matures. We all hope this is what will happen with EHR vendors. It’s happening with some of them already, but not nearly as quick as most of us would like.
Trial and Error Companies
A trial and error healthcare IT company is one that believes some use of technology will improve care, so they build a product and try it out and see what happens. This type of company has been extremely successful in the general silicon valley startup world. They create a hypothesis, try it out, adjust their hypothesis, try it out again, and so forth.
The trial and error style company will sometimes back into something that’s clinically relevant. As they go through this trial and error process, they’ll discover that whatever they were doing might improve things for 20% of people in their trial. So, they double down on those 20% and see how they can expand that 20% to 30% by tweaking what they were already doing.
What’s usually missing with the trial and error approach is that once they find the 20%, they just try and suck the life out of that 20%. They don’t worry about the other 80% that didn’t respond. 20% (or whatever the specific number) is enough for them to improve the status quo and so they build a business around that 20% improvement and generally don’t think about the other 80%.
Once again the Trial and Error companies may back themselves into a solution that works well for patients. Sometimes they hit magical numbers, but they’re usually backing into the solution rather than really working to understand the problem and creating a solution that fixes the wide variety of problems that exist across the majority of patients. This category of companies is likely why someone came up with the term pilotitus on Twitter to describe healthcare’s propensity to do lots of pilots, but stop there.
Really Moving the Needle
I’ve become more and more convinced that if we really want to move the needle on healthcare, we have to take a different approach than the two described above. Sure, the new approach will include some process automation and there will be some trial and error involved. However, to really move the needle in healthcare I think we need to do a much better job understanding the unique patient needs and why the 80% of patients aren’t responding to the technology and methodologies that are currently being thrown at them.
I can say this with some authority since I am a techguy by background (and on Twitter). In technology we often get pretty lazy and don’t dive into the details of why the technology’s not helping. This requires a deep understanding of behavioral science that most tech people don’t want to tackle. It’s much easier to just automate something or to try something and see if it works. It’s much harder to understand the underpinnings of patient and provider decision making so you can craft a product that actually improves that decision making.
I’ll make the reverse analogy. If you’re a programmer, you know that not all programmers are created equal. You have the newbie programmers that make something work and you have the expert programmers that design something in such an elegant way that it can handle anything that’s thrown at it with incredible efficiency. Right now our technology solutions in healthcare feel like a bunch of newbies that make something work. We need more tech companies to dive into the deep and become experts on behavior change if we want to see healthcare IT companies taking things to the next level. Otherwise, like in programming we’re going to have so much accrued technical debt that it’s going to be hard to unravel the situation.
One final word of caution. While we need more companies that invest in this type of deep understanding of healthcare’s challenges, we also need healthcare organizations that are willing to buy and work with these companies. That takes some bravery from both the companies who want to solve hard problems and the healthcare organizations that aren’t just looking for the quick fix.