Monday, January 30, 2017

App, Snap, what are we doing with all this crap: Why buy-in may be the missing part of the HealthIt equation

I rarely associate the term "layoffs" with the healthcare IT sector. In fact, it could be argued that jobs in the HIT sector are plentiful, with many companies reporting a shortage of workforce. I'm not sure if others share my reaction to layoffs in the healthcare sector but when I read that Fitbit, a company I really respect, was laying off ten percent of its workforce due to lapsing revenues, I felt a twinge of responsibility. 
In an average week, I typically meet or meet with over a hundred healthIT experts or thought leaders. Add to this my on-line engagement and project collaborations and what you have is a lot of brain power and a lot of possible solutions to complex problems. So, when I read of the issues with Fitbit, I posed the question to the healthIT community; are we partly to blame?
Not all healthIT leaders consider themselves disruptors but I believe we all consider ourselves problem solvers. We like to question what's right and wrong in healthcare delivery. We like to offer possible solutions. But more importantly, we like to make others aware that there are solutions and that care doesn't have to hurt. And yet, with all the content we publish, the conferences we attend, and the consulting we do, as a collective sector, we have not been able to create sustained buy-in from either patient populations or physician communities. Buy-in, being the one ingredient needed for sustained growth has eluded even the most heavily funded of healthcare organizations. Consumers aren't flocking to portals, millennials are losing interest in the limited abilities of wearables, and physicians have abandoned hope of finding the patient-focused EHR and have instead opted for minimum met standards of compliance.  And here we sit; the disruptors, designers, the dreamers, all with the talent and savvy to get things done but doing nothing substantive. Why can't we create buy-in?


I've heard a lot of people and organizations refer to themselves as a disruptor or disruptive. While this may look good in a prospectus or on social media, very few meet the historic meaning of the word. For the sake of argument maybe we can agree; in the healthcare sector, disruption is the use of healthIT innovation to create better ways to deliver care, improve outcomes, and engage with patients, at a cost-savings. In my opinion, if a solution fails any one of the aforementioned tests, it's not disruptive.  
Patients are becoming more empowered than ever in our history. They are more resilient to changing care delivery methods and they know, more than practice leaders, how consumerism is affecting the care they receive. They're driving change. To that end. healthcare organizations have to innovate in a way that listens to patients as consumers of healthcare services.  Listening to patients does not signify a loss of control for practice managers; it's a signal that leaders are including patients in care decisions. This small action creates a vested interest for patients, creating buy-in.


LaRusso, Spurrier, and Farrugia (2015) wrote that healthcare delivery is better left to non-disruptive solutions. They concluded, "Tearing down everything and starting over is not an option in health care." While I respect the opinion of these Mayo researchers, I question their approach to the design question. In my opinion, it is not always necessary to destroy current systems in order to improve a design. Furthermore, in the healthcare sector, systems design is still in infancy. Many organizations are still moving from paper application and other outdated forms into innovative solutions, giving designers ample time to design from a foundation of interoperability and patient-centered approaches. Design can meet disruption when it is approached with the user and consumers or patients in mind. Designers need to stop designing for regulators and the c-suite, as their interests are flawed. Even CIOs are losing focus, content to chase revenues instead of changing outcomes. Regulatory compliance is a by-product or bonus of design, not the primary focus. Designing innovative healthcare solutions that are focused on the physician as the deliverer of care and the patient as the consumer of that same care creates buy-in.


And what of the dreamers? Dreamers are those empowered patients, curious clinicians, and other stakeholders who remain the silent majority while others make decisions about innovation used to deliver care and care-associated products and services. Often the most useful solutions come from a hundred crazy ideas from stakeholders. Patients should discuss with brands like Fitbit what makes a product attractive, what features are important, and what healthcare information is vital to keep their care personal.  Healthcare providers should also lend their expertise to product design and publish content designers would find useful when creating solutions. Stakeholders should ensure their voices are heard through social media platforms, focus groups, and direct contact. What can it hurt? Remaining silent about products or services designed around your health definitely hurts. Including the patient, provider, and stakeholder voice in design creates buy-in.


Finally, data is a peculiar thing. We all think we know how to use it until we don't. Data needs to be used as a learning tool. Using patient data as a segmentation tool or to tailor innovation to certain populations makes far better sense than using it to meet quality markers. That is to say, use data to measure what matters to patients and consumers. Meeting quality markers will be the result of that focus. Knowing what matters most creates buy-in.
We all want to believe the right solution will solve all the woes we face in healthcare. We'd like to believe interoperability will save the wearables industry. We'd like to believe the answer to the perfect EHR lies in getting the Dr's head out of the EHR and onto the patient. But at the end of the day, no matter where you fit into the healthcare landscape, disruptor, designer, or dreamer, buy-in is created when health becomes personal. The ultimate solution is not some shiny thing; it's a collaborative approach. How will this approach optimize my health or the health of someone I love? Perhaps failing to ask this question is why we owe soon-to-be former Fitbit employees an huge apology.