Innovation in healthcare IT is dead (hopefully only temporarily)

Ok, maybe not dead but certainly in a coma and on life support.

I just got back from HIMSS ’10 in Atlanta. While the energy was great, the people I met were very cool, and the venue and staff made the event quite enjoyable, I left underwhelmed by the substance of what’s being offered and a little worried about one of my favorite industries (health IT). Since I spend plenty of time outside of healthcare IT doing technology strategy work in the financial, web 2.0, and government sectors I see many business plans and new product offerings regularly.

I am continually amazed by what’s coming out in other industries but I’m afraid that CCHIT over the past few years and the government’s recent involvement in meaningful use and certification has made our health IT industry focus on checklists and “common denominator” design and development. At HIMSS, and probably not through the fault of vendors alone, the majority of what I saw and heard about was meaningful use and certification and not innovation and new ways of solving common health IT problems. If you look at the 25 primary meaningful use requirements do you see anything in the list that would actually spur innovation to help reduce cost or improve quality? Or, did it do the opposite and set the bar in a way as to make sure that if vendors just produced an electronic typewriter and the government mandated its use that you’ll over time reduce costs in healthcare?

In private conversations with vendor after vendor I kept hearing a common theme: all our customers, sales folks, marketing folks, product requirements folks, etc. want to talk about is the 25 initial meaningful use (MU) items. They said they haven’t talked about anything else for months. They also said that they see 2009, 2010, and 2011 probably being consumed with just MU and certification discussions and associated work. It’s like the oxygen has been sucked out of the room by MU. MU is clearly important, but at what cost?

I’m afraid we’ll end up with our own “lost decade” after people realize that the building of minimal electronic typewriters (EMRs that meet MU) won’t actually solve our cost or quality problems. We will go through billions of dollars and end up with more physicians and hospitals using computers (which would have happened anyway at a natural pace without any government involvement). What we won’t have is the collective intelligence of the community working on innovation — they’ll just be focusing on making sure they meet the checklist items instead of thinking of new business models and techniques that can compete in the marketplace. Because all new technology or technique will need to be put through the MU and certification wringer young entrepreneurs will not be looking at healthcare as the place to innovate; strategists and angel investors will be telling people not to get into the market because it’s too expensive (like we tell people not to get into med devices).

I hope that I’m completely wrong, but I’m probably not.

Here’s a case in point. The Telemedicine 2.0, Health 2.0, and mHealth (mobile health) movements are pretty strong and vibrant. As an advisory board member on several of these companies I’ve been in meetings where even their sales, product managers, developers, etc are being asked to spend time looking at MU and certification. Some of the Health 2.0 and mHealth companies don’t even have viable business models yet, can’t afford to finish their products and bring them to market easily, and aren’t getting enough investor attention but they have to think about MU and certification? Instead of focusing on customers and making money, countless hours are being expended at most companies worrying about things that shouldn’t matter to a startup and that’s harming innovation.

MU and certification are here and they aren’t going anywhere so there’s no point complaining about it. The question is how to deal with it effectively and keep people focused on what is known versus what is conjecture. With all the rush to get the first certification we’ve forgotten about maintenance releases. What about agile systems that need to be updated regularly (like cloud providers) — will they need to be re-certified for each release? These are simple questions that are being discussed in meetings ad nauseum even though there’s very little information to answer the questions.

If you’re an executive, product manager, marketing person, part of the sales staff, or a developer, what do you think about innovation in the midst of MU and certification? How are you handling it and what advice would you give to your peers?

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37 thoughts on “Innovation in healthcare IT is dead (hopefully only temporarily)

  1. Pingback: MEMS, MOEMS, RF-MEMS, Measurements, Micro and Nano Material … | Microtechnology Science Applied

  2. Pingback: ICMCC News Page » Innovation in healthcare IT is dead (hopefully only temporarily)

  3. Great read. I think the other side of the equation is not the death of innovation, rather the extinction of innovators. There are huge executable opportunities available to COOs to take healthcare from an 0.2 model to 2.0. What I don't understand is if the problem is that they don't get it, are afraid to fail, or don't want to get it.

    The dearth of innovators is only exceeded by the thousands who strive for mediocrity. Is it truly so much additional work to be better? All non-innovators, your train has left the station.

    1. Great points, Paul. From my anecdotal interviews and discussions with CIOs they all pretty much get it but in many cases vendors are holding them hostage (unable to connect to new systems, etc). Most of the health system CIOs I've met are just as good as their non-healthcare industry counterparts. The problem is that there are structural issues with health IT systems that have been left untended for so long that it's taking time to do anything about it.

      Unlike most businesses, where the introduction of technology that might fail might mean some money might be squandered, at hopitals and bad technology might actually harm human beings. So, caution is certainly warranted and the “afraid to fail” comment is applicable but for good reason.

  4. Shahid:

    I disagree strongly with this assessment. The ONC and CMS guidelines have created a vision for HIT which is far broader and more challenging than the one created by the industry itself, and enforced by CCHIT (a regulatory agency that had been “captured” by the very industry it was supposed to regulate).

    If the legacy HIT vendors quit grumbling and start focusing on innovative ways to achieve this new vision, they and and the constituents they serve will be far better off in 10 years than they are now. If they don't, the innovators will crush them in the marketplace (and thankfully, their constitutents STILL will be better off than they are now).

    A free, Web-based EHR like ours is just one example of many exciting innovations we saw on display at HIMSS. There is real progress in mHealth as well, and that's just for starters.

    Frankly I'm getting tired of hearing from the nattering nabobs of negativism who project such pessimism for the sector. This is a time to stay positive…and in some cases, perhaps to look a bit harder to find the innovators b/c they are out there, in droves.

    Thanks,
    Glenn Laffel, MD, PhD
    Sr. VP Clinical Affairs
    Practice Fusion
    http://www.practicefusion.com
    Free, Web-based EHR

    1. Thanks, Glenn, for the comment. I'm glad you're voicing your disagreement as my title was designed to be a little provocative to start a discussion. You guys are indeed doing some good work by offering a free product using a different business model that was first seen in the late 90's and crushed by the dot com failures.

      I do agree that the telemedicine 2.0, Health 2.0, and mHealth movements (which weren't really on display at HIMSS at all) are making some great strides. I go to the other conferences (like the recent mHealth one in DC) and see lots of excellent innovations there but I just didn't see those kinds of companies at HIMSS. That's not the fault of vendors or HIMSS, it's just that HIMSS is much bigger and therefore more expensive to go to so the small startups that doing most of the innovation can't afford it.

  5. Pingback: HIMSS Commentary: Is HITECH Promoting Innovation? | e-CareManagement

  6. Isn’t this the problem with any kind of mass government intervention? The market becomes obsessed with wait and see, and there is such a fear of non-compliance, that organizations stop looking at the big picture (the reason why they are doing something) and simply follow the instructions of the government without question.

    While there are some exceptions out there, I believe that most physicians (especially small practices) are looking at EHR as something they have to do rather then a way to transform the way they practice medicine. And they are looking at the ARRA funding as simply a reason to act now rather then later.

    The worst reason for a practice to implement EHR is because they want the $44K. That really needs to be the icing on the cake because otherwise they are going to miss the point. They are going to miss the true ROI which can only come from a total transformation of how they treat their patients and how they run their business. Therefore, they are going to force the application to adapt to their way of business rather then re-engineer their business to improve patient care. Without more physician buy in, my fear is that a few years down the road, they are going to look back on this experience as yet another way the government has slimmed their margins and slowed them down, and we’re going to lose them.

    Now this post is probably more pessimistic then I typically am because I do see there some good coming out of all this as long as there is more talk about the true value of EHR and not just checking off all the boxes contained in MU.

    1. Great comment, Sara. I'm a very optimistic person by nature and I love this industry because it has the opportunity to do real and lasting good for patients. But, like you, I'm feeling a little disappointed right now due to lack of quick progress caused by the government's freeze of innovation.

    2. These are some some great comments. I would like to add to Sara's comment.

      I am the lead software developer for our regional oncology office in North Carolina (Ankhos.com) and in all of our meetings, the MU guidelines have come up explicitly in maybe 5% of the decisions we have made. I am grateful that the lead physician understands exactly what Sara is saying; that the MU guidelines should be icing on the cake.

      As a good programmer, I have kept these guidelines in mind but a good EMR is going to be well on its way to meaningful use, anyway. What EMR would not by default have ePrescribing or ways to transfer information? Guidelines or not, that EMR would just not be successful or competitive.

      I do see the MU guidelines as helpful, though. They will help a developer have some sort of expectations of how his program might interact with some unknown application in the future. A more productive guideline would be about interoperability protocols.

      The detrimental part to making good software is the deadline. Trash software is created when you rush it out the door, and that's what MU is telling vendors to do.

      1. I appreciate the feedback. It's great to hear that only 5% of your decisions were affected by the MU decisions; when certifications come up I suspect that number will go up :-). I loved this point of yours — “What EMR would not by default have ePrescribing or ways to transfer information? Guidelines or not, that EMR would just not be successful or competitive.” That's precisely my concern — if you had to tell an EMR vendor this MU stuff why not also put things like “make sure your database has referential integrity” and “be sure to test your software.” Yeah, now I'm being silly.

  7. Shahid,

    I think you are correct in your observation of the current market, but I'll offer a more optimistic view of likelihood of future innovation.

    You need to look at the Phasing of the MU objectives.

    Phase I is designed primarily to 1) disaggregate the potential modules of existing EMR 1.0 offerings and vendors, and 2) begin to build specs to create a plug and play platform on which to build future apps. I think you're correct in observing that most of the functionality demanded in Phase I MU objectives is provided by existing vendors — there's not much need to innovate here.

    My take is that the lack of innovationbeing demanded in Phase I is an unintended consequence of the Phasing process.

    Phases II, III and following is where innovation can occur. These phases will focus on care coordination, improved outcomes, population health, etc.

    This is where we'll see development of many new apps that can be built on the modular platform created in Phase I. This is where remote monitoring, mobile, PHRs, data analytics and countless apps that we've never dreamed of will emerge.

    1. Vince, thank you for sharing and I agree with your sentiments which is why “hopefully temporarily” is at the end of my post's title 🙂 What's most interesting is your last statement: “This is where remote monitoring, mobile, PHRs, data analytics and countless apps that we've never dreamed of will emerge.” What I worry about is that MU and certification isn't a pre-requisite to any of those things, only a usable system, a good business model, and appropriate compensation (reimbursements and direct payments) are necessary. With this diversion of attention to MU and certification we won't get attention on the big stuff for years, unfortunately.

  8. Shahid —

    Cycles of innovation and regulation are a constant in any regulated industry.

    The feds are trying to speed up the adoption of innovation that's already out there, and we can differ about whether this is the best way to spend $19B, but as you say – what's done is done. The meaningful use targets (even the phase 2 & 3 targets, which may yet be fleshed out in a more ambitious manner) seem to be a ceiling for some vendors and health care providers, and a floor for others …

    I believe there is still tremendous opportunity for innovation in patient-focused tools, which were not as much in evidence at HIMSS (at least from my vantage point, as a virtual observer). Tools that can empower patients, truly reduce costs and free up health care personnel – given shortages of staff and funds – will not be constrained by meaningful use, and may even tie back into it in the future, as Vince suggests. (I'm thinking of everything from home monitoring tools that upload data to tethered and untethered PHRs to improve management of care without the need for as many office visits, to patient-managed appointment systems – e.g. at Group Health – that cut no-shows, and beyond.)

    1. David, as usual, you're quite right. I added “hopefully temporarily” to my post title with that in mind — I really do hope that Phase 2 and Phase 3 might create some innovation. I completely agree with as well on the patient-focused tools; that area has a good deal of promise but the business models don't match the government incentives and insurance reimbursements so they're slow to pick up. Thanks for sharing.

  9. I too was underwhelmed by the lack of innovative products on the floor this year. Am I disappointed? Not in the least.

    We've seen decades of vendors trying to “innovate” in the health IT space and while some strides have been made, it's clearly exacerbated fragmentation and made interoperability a low priority.

    Innovating is bad business when customers don't need it. No one buys innovation, they buy solutions, and the problems currently faced by healthcare providers do not require innovation; they require collaboration. I'm stoked to see vendors not innovating simply for the sake of it. Instead, they're focused on solving the problems their customers care about most – meeting a min-bar of community-driven best practices and getting systems to talk with one another.

    IMO, innovation in healthcare is certainly not dead. It's been rightly deprioritized so we can focus on the most important task at hand – implementing an efficient and interoperabile HIT system.

    Does make for a boring exhibit hall though…

    1. Good points, Justin. The problem is that the tools and technologies we've needed for interoperable systems have existed for decades. What hasn't existed were the incentives (answer to the question “what's in it for me to share?”). The MU and certification criteria still doesn't fix anything there — a vendor that controls the HIS in a hospital will be no more willing to share data next year than it was last year. The reason banks share information is not because the government makes them, but because we (consumers) make them do it. Until we can get the incentives aligned we'll continue to have issues.

      1. I hear you Shahid. If there's no financial incentive for interoperability, it won't happen in a way that creates long-term benefits.

        To be fair though, I wonder if the bank analogy appropriate. It's one thing for a person to change banks; it's another for a cash strapped hospital to change EMRs.

        I wonder, just like we've seen many physicians who are initially resistant to EMRs ultimately become staunch advocates, if MU will bring us to a tipping point where providers get a taste of interoperability and never look back. Once docs get used to being able to see patient records from other facilities, will they demand it going forward?

        Sure there's a risk that won't happen, but clearly years of unsubsidized “innovation” haven't helped solve this most important problem.

        1. You're quite right, Justin — the old model didn't necessarily work, either, so something had to be done and like most have agreed to in this (really wonderful) discussion is that hopefully this is a stepping stone to bigger and better things. Ultimately all physicians will end up using EMRs but that shouldn't be our goal: the goal is to lower costs and increase quality — my worry is that nobody has calculated the cost of each MU item and what it will take to achieve. We can certainly spend more and get everyone computerized but what's a big question in my mind is how much it will cost to get there and whether we can afford it.

          For a beautiful “back of the napkin” calculation of MU costs, take a look at this excellent blog posting over at healthSystemCIO:

          EMRs, Lab Results & Cost of Complying w/MU

  10. Hi Shahid,

    Great post! While I agree that currently a lot of energy and resources in HIT are being focused on the Meaningful Use checklist, however, I believe that this is laying a (much needed) foundation for future innovations. Consider for example, the richness of health data elements that will be available (problem lists, labs), uniformly across EHR systems will lead to better, sexier and useful apps. So I tend to be optimistic and waiting for the good part after we get done with our to-dos/checklists.

    Chintan
    Co-Founder
    http://TrialX.com

  11. Great post. When the gang of four in China decided to eradicate rats in the villages they offered a bounty to be paid at rat collection stations. What did the villagers do? They started raising rats!

    I would never underestimate the ingenuity of entrepreneurs to exploit the law of unintended consequences. Meaningful use will commoditize meaningful use opening disruptive opportunities.

  12. I see the Care Card being inserted into the top of a “I Pad” type device.
    Please take the time to read the Health Care Reform Initiative at: http://www.TheAmericanCareCard.com Everyone is looking for the Melody that makes all of us dance. This is it. You'll recognize the immense potential for the Company that helps to develop this effort. It will save hundreds of Millions of lives and be solidly implanted, (A daily thought) in the minds of Billions of people all the world over. Sounds exagerated. Just read please. Thanks

  13. The GOOOH People have gotten firmly behind my effort. They love it. It is Health Care Reform that is truly innovative. They are willing to get all 535 of their Representatives who are running for the Seats of Incumbents in this cycle to talk about “The American Care Card”. We want Microsoft to team with the leaders in Insurance, Banking, and Hospital and Physicians Associations to contribute to their campaigns. Everyone will be talking about “The American Care Card” during this election cycle. It's imparitive that Microsoft recognize the opportunity that lies here for cornering the entire Health Care and Entitlement Technologies Market.

  14. Shahid,
    Consider the exhibitors at HIMSS. They are all vendors with deep pockets.

    In any industry, established, deep pocket vendors, are not going to innovate. They have too much to loose by making drastic changes.
    For example, a local office manager is buying IBM X-series server to run a leading Practice management system. The software is written in COBOL and runs on AIX. Do you think the vendor is going to re-write this without a lot of expense and headache?

    This is the innovators dilemma. You are not going to see innovation at HIMSS. Innovation is occuring at small companies, and they are less likely to have a presence at HIMSS.

    CCHIT and Government carry a small portion of blame, most of the blame lies elsewhere.
    Lets stop complaining about CCHIT, ONC and MU. Focus on delivering the physicians want.

    1. Abhi, excellent comments, thanks for sharing. I think in general you are right that innovation is happening in small firms; however, having frequently visited HIMSS over the past decade I always spent a lot of time at the smaller booths in the edges away from the deep pocket vendors where the startups live. This year, I did the same and left generally disappointed (with some exceptions).

  15. I have kept these guidelines in mind but a good EMR is going to be well on its way to meaningful use, anyway. What EMR would not by default have ePrescribing or ways to transfer information? Guidelines or not, that EMR would just not be successful or competitive.

  16. Pingback: Harvard Business Review wonders whether the U.S. health technology sector has run out of gas

    1. Azmat.

      These applications are impressive. Would you and Apple consider a partnership with the Care Card Coalition? We would love to have you on-board. Let's sit together and discuss our way forward to insuring Apple and these applications have the first state and federal contracts for the new medical records applications that will be accessible throught the Care Card system. There is potential for applications that link all Care Card providers, even those outside of health care, to their Care Card customers. Each provider will need to have 'Control Panels' that give them the ability to manipulate procedure, service, and product pricing. We would also like to discuss development of the template that will be used by all Care Card participants to 'shop' providers through the online exchanges.

      Steven L Wolf

  17. Hi Shahid,

    I am a current nurse working towards my BSN and have an increased interest in the health IT and EMR development that has been increasing of late. While my facility has put forth the effort to change over to EMRs, the pace has come to a screaching hault due to the economic times we have all been put under. According to the HITECH plan that President Obama had put forth in February 2009, what is overall hope and prediction that can be said for hospitals and doctors offices alike with actually be able to initiate an EMR by the year 2011 as projected by the HITECH plan?

    1. Great question, Tracie. I think the chances of large-scale movement to EMRs is impossible by 2011. However, if your hospital was already down the path and has a sophisticated IT department and an executive team that has implemented technology previously they should be able to get started by then. It will be tough, but possible based on good management and implementation teams.

  18. ” When the gang of four in China decided to eradicate rats in the villages they offered a bounty to be paid at rat collection stations. What did the villagers do? They started raising rats”

    Bang On! Adapt improvise and overcome

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