Silicon gurney: EHR go-lives turn hospitals into software shops
Hospitals invest so much money in EHR implementations that it changes the very nature of their organization. And that means they need to think about operating more like a software company than just a hospital.
If $100 million sounds like an exorbitant or even unrealistic ticket for an electronic health records platform, in fact, consider that Kaiser Permanente, Mayo Clinic and Partners HealthCare have publicly acknowledged spending an order of magnitude more than that — while other hospitals such as Scripps Health, Lehigh Valley Health Network, Lahey Hospital Medical Center and Lifespan revealed budgets bigger than $100 million. And that’s just to rattle off a fistful.
“The day you made that investment you became a software vendor,” said David Chou, CIO of Children’s Mercy Hospital Kansas City. “We all need to think like software companies because we are both hospital and software shop.”
EHR vendors and the patient experience
Thinking like a software vendor — if not technically becoming one of sorts as some hospitals are, in fact, doing today — starts with considering clinicians, administrators, executives and, really, all employees to be actual customers and then serving them as such.
When Microsoft is working on a new operating system, for instance, it gives early versions to customers willing to test the software and offer feedback that Microsoft then incorporates into subsequent incarnations and it keeps that circle spinning through the product’s development lifecycle.
The secret sauce: iterative development.
That’s software-speak but it also happens in medicine with new devices, new drugs, new standards of care, according to Adrian Zai, MD, the clinical director of population informatics at Massachusetts General Hospital’s Laboratory of Computer Science.
“Iterative technology development,” Zai said. “It’s the exact same model as medicine.”
Indeed, Leora Horwitz, MD brings a medical perspective to innovation at NYU Langone Medical Center, where she directs its Center for Healthcare Innovation and Delivery Science.
Horwitz recommended that technologists pick the user-centered interventions that can have the biggest impact and incorporate front-line input, then offer evidence to clinicians and other users to prove that the software is working.
“Be sure you actually know what the problem is before you rush off and try to solve it,” Horwitz explained.
She recounted a project to create a dashboard showing how many patients were discharged by noon every day as a shiny new object, just one entirely missing the point that better and more useful data to display would be the urgently-needed information about emergency department wait times and exactly which beds are open right now.
“Expect things to go wrong,” Horwitz cautioned. “Things go wrong all the time.”
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That’s a fair point. Not every hospital is exactly equipped to mimic a software company, according to HIMSS Analytics global vice president John Daniels.
“But hospitals do have to provide some level of support for those EHR users and that takes a new thought process and resources,” Daniels said. “I have even seen some create their own capabilities, build in-house software born out of a specific need they have but couldn’t find on the market or didn’t want to pay for and then turn around and monetize it through a business strategy.”
Example: Zai has been building software products since 2000, including working on a system that his previous employer Partners HealthCare ultimately brought to market and Mass General licensed in 2012.
Amazon, Uber changing behavior
Adopting a software vendor’s mindset is actually not about technology for technology’s sake and, instead, hospitals should focus more on what users need than simply creating slick new systems.
“High value technology interventions,” NYU Langone’s Horwitz said, “will become sticky and last for years.”
That’s the hard part. IT, however, is well-suited to spearhead the metamorphosis because tech shops are in the middle of the entire hospital ecosystem enough to understand how the data flows and can work better than any other department with not just the information management but also security and senior leadership that are going to be critical in establishing a software vendor mindset.
Chou recommended taking into account how people actually tap non-health technologies, such as launching Lyft and Uber on a smartphone at the same time to find the best ride for the lowest price available at a precise point in time.
“IT has to provide a great experience for doctors and all other users. Think about how Amazon makes you change your behavior, think about how Uber changes your behavior,” Chou said. “From a healthcare perspective: How do you create that experience so that people come to you instead of a competitor?”