March 14, 2017

Opinion: Too Big to Succeed

I got into Orlando late the Saturday evening before HIMSS17 just in time to attend the CHIME CIO Forum on Sunday. This year’s HIMSS attendance was advertised at over 40,000 people, all looking for innovation and solutions in a very technical collision of business, IT, internet-fueled instrumentation, and healthcare. I started to think about the size of that attendance. According to the AHA, there are 5.564 registered hospitals in the USA. Now I realize that healthcare in general is much vaster than what is represented by hospitals, but still, the appeal of the simple math, around 7.3 people per hospital, gave me some pause.

The dark thought wandering at the edge of my consciousness on that midnight drive to the hotel was “are we the problem?”. You must admit, 40,000 people searching for solutions to unsolved problems suggests that there is a lot of room for improvement. This year those innovations come with tag lines such as “unbreak healthcare”, “healthcare data matters”, and “the new EHR”. Some would defend the chaos, claiming it’s an environment that bolsters innovation, and perhaps so, but in my opinion, we live in an age when people are more in love with the “idea of innovation” than the actual hard work and persistent failure and retry cycle that goes with it. Similarly, the reality hits me that healthcare entrepreneurs who come and go from year to year at HIMSS may not be back in 2018 but experience their lifelong passion being acquired by a much larger entity, or feel the pain of having the idea expire on the cutting room floor. Wary CIOs know that buying into early adoption can carry extra risk. Such is healthcare.

Allow me to backtrack a little. I was lucky enough to catch the last Delta non-stop from Boston to Orlando. I was lucky enough to get upgraded because of the unhealthy amount of flying I do. And then, I had the unique pleasure of sitting next to a physician who works for a large hospital network. I’ll call her “Dr. Alexis” to protect her identity. They recently replaced their formerly-famous LMR with a new HCIS that is a four-letter word that doesn’t rhyme with anything. We exchanged the normal pleasantries and put our trips in context for each other. Dr. Alexis was about my age, she wasn’t going to HIMSS, but when she heard I was, I instantly became the representative of “them” – the evil global IT industry hell-bent at making physicians miserable. Juxtapose that with millennials who won’t adopt unless they can push a button to get it. I’m confused.

She matched my Coke Zero with an adult beverage and I learned a lot. She loves working with patients. She is intelligent, healthy, and energetic, and committed to her vocation. The new EHR/EMR is costing her 2 extra hours a day in documentation (to which her productivity pay is linked). The system doesn’t match her workflows. She and many others with her tenure are considering early retirement or a career/venue change: “this isn’t why I became a physician.” It’s too hard to order things – and then the killer question: “Well jeesh, Jim, you work in technology, why doesn’t Apple or Google or somebody just put my patient demographics, problem list, drugs, and allergies all on one screen of a tablet or an iPad?” After a sharp intake of breath, I simply told her that it already existed, and was called MEDITECH 6.16. I decided against explaining that Google and Apple mainly made software tools that made it easy to write other software; or explaining all the innate barriers of entry that protect the longstanding IP investments of the major players in the industry.

I don’t mean to make light of Dr. Alexis, in fact, just the opposite. The conversation haunted me all week long. I have lived most of my professional life on the infrastructure side of the environment. Most of our customers have bought their last array and built their last data center. Now the IT equipment part is in a pristine Tier 4 data center facility and part of “the cloud”. The best we can do at CloudWave to improve the physician or patient experience is to beat down the goblins of network, storage, and virtualization latency, the security-destroying zombies of the darknet, the foibles of daily IT operations, and the ever-lurking demon of unplanned downtime.

Allow me to do a cinematic “pull-back” shot. We are no longer on the surface of the planet Healthcare IT, we are looking at it from space. None of the planetary systems communicate with each other for mutual defense. The operators have to do too much to make their equipment work. Outrageous markups on drugs, bandages, and software are helping healthcare break the back of the largest and most promising economy on the planet. Productivity drains from well-intended but poorly implemented regulation are rampant. The tools that the inhabitants of Planet Healthcare IT expected to be their salvation have become the very instruments of their demise,

I don’t think this can be overstated. Healthcare IT shouldn’t need 40,000 people who have the opportunity to attend a national conference (not to mention the 95% who weren’t there) to represent or evaluate the vast variety of technology solutions available. It is a sign there is room for improvement. The laws of economics suggest that a free, fair, and open market will veer towards efficiency, however, healthcare is a political hot potato, and as such, the government has acted to ensure that the market is not free, fair, or open. No one wants to be blamed for breaking it, and few are willing to take the risks to fix it. Regardless of your political perspective, few would argue that even more tax money is going to be invested in healthcare, or for that matter Healthcare IT. MU 2 and ACA may have been the historical peak. Multi-trillion dollar budget deficits may just produce some bipartisan pragmatism. The tough choices may well be pushed back to consumers who will vote with their wallets and their noses for quality. The efficient market will be allowed to operate to some extent, and likely consolidate a bit. Perhaps in a few years, HIMSS will be somewhat smaller, a measure saner, and perhaps even more productive.

Some of you may have read this and concluded that I have a gift for the obvious. Some of you may think I am completely nuts. Both groups are probably correct. That said, having had the privilege of working with a lot of great people in this space for a long time, I care what happens. My advice – drive the change so that it doesn’t plow you under, and stick with our friends at MEDITECH as they retool for the value era. I’m pretty sure they called it right.

Jim Fitzgerald is EVP and Chief Strategy Officer at CloudWave. He values the role of community hospitals in healthcare and tries to help create solutions and services that allow them to flourish and retain their independence.