Yauheni Solad MD, MBA | Physcian| Entrepreneur | Innovator

Health IT inefficiencies as the market driving force. A change catalyst or a problem?

 Powered by the COVID19 pandemic, anything related to healthcare and technology skyrocket in value. A record-breaking $14.8 billion across 637 deals were pulled into digital health by PE and VC investors [1]. Changing healthcare landscape due to a potential transition to a virtual first care model, bundled with fear of missing out so prevalent all across the tech market, drove digital health company valuation to a new height. In this post, I want to take a step back and talk about the fundamental value those companies bring. After all, we already invested billions of dollars into Electronic Medical Records systems, patients’ portals, and patients-facing digital front doors. Isn’t it enough to fully launch a widespread wave of consumer-focused digital transformation around healthcare?

Unfortunately, No.

Let’s take an example of an appointment scheduling company that raised more than 100$ million to expand COVID19 vaccination scheduling efforts. This company produces a tangible value by helping struggling healthcare systems and local governments schedule COVID19 vaccine appointments. It raised yet another round of funding and increased its overall valuation. What’s wrong with that?

Technically nothing, there is a clear market opportunity and genuine pain point that the company solves. The real question is deeper. Why do we have this pain point?  

Overall, when an inefficient market creates a business opportunity for a disruption and pushes the current market participant to innovate, it is a good thing. Plus, customer improvement around the healthcare scheduling experience is fantastic as long as it focuses on the facilitation of care options discovery by better and smarter tools like conversational agents or even virtual (or real) care selection companions. But, when the main focus is on bridging the glaring gap in the technology left by the multibillion dollars Electronic Medical Record implementation, then, as a healthcare technologist, I don’t find it very appealing.

For the last year, We are living in a world of a global pandemic. From day 1 of the lockdown, we all knew that eventually, we will need to coordinate vaccinations and develop comprehensive scheduling logic to define eligibility on a federal and state level.

What did we do on a federal and state level for the scheduling unification?

Did we push EMR vendors to start supporting at-scale FHIR based appointment scheduling or ensure we can search, route, and schedule patients across institutions and states?

 No, we didn’t.                 

Most EMR vendors didn’t simplify or frankly even improve their appointment scheduling modules, especially for the patients without Patient Portal access.

We forget that in 2021 good user experience in digital tools is not an option but a requirement! We continue to operate in a world where users have to fight inefficient technological solutions to solve their problems. Aftercall healthcare is one of the few areas where customers can be “really invested “ in solving the riddle of the poor digital front door.

Appointment scheduling is not the only or, frankly, the main problem, and I’m glad that market forces bring to market solutions making user expense better. Still, all of this is a symptom of a bigger problem. How can we save money in healthcare if almost all innovative companies that can do anything at scale are getting a unicorn status and billion-dollar valuations?

True, healthcare is a huge market, but when are we planning to introduce technology-driven efficiencies that will drive the cost down?

For how long can we continue to splice the pie of healthcare administrative waste and leave only breadcrumbs as a saving passed to our patients?

We are operating in a world where a commercial enterprise’s main goal is to exploit and monetize our current market inefficiencies, not to solve an underlying problem. The are many problems with that approach, but one of the main ones is an eminent desire of a market leader to protect its core business. Again, from a business perspective, there is nothing wrong with that, but I have a huge conceptual problem from the healthcare customer perspective.

Inefficiencies in healthcare are solvable, but because we like to invest base on “narrative” and “momentum,” ignoring underlying value and strategy, we can create a powerful force that will fight against innovation.

If we follow our appointment scheduling example, what incentive will you have as a vendor to reform our current siloed appointment system? Would you support or lobby against any federal regulation that will push EMR vendors to a unified scheduling API with federally sponsored open-sourced and ready-to-use tools? Maybe I am wrong, but if discussion about tax code simplification thought as anything, is that market value wins over simplicity and user-friendliness.

This can bring us to the world of dozen small monopolies created around glaring inefficiencies of our current technologies. This is far away from the interoperable world we envisioned.

Inefficiencies are solvable, but because we like to invest base on “narrative” and “momentum,” ignoring underlying value and strategy, we can create a powerful force that will fight against innovation.

We urgently need to rethink our approach to digital health tools. Knowing first-hand about many federal projects and non-commercial projects, I see that we are doing a lot, but we can do even more.

We need broader public/private collaborations that empower the development and implementation of reusable solutions, not creating local, feature-specific monopolies.

We need to start looking beyond simple data exchange and talk about unified user experience across multiple platforms enabled by either EMR vendors or openly available SMART of FHIR tools.

In a perfect world, commercial scheduling applications will help you to make your decision about finding a clinician that uniquely fits you as a patient based on your unique characteristics and preferences, not just create a connection layer on top of a fragmented scheduling infrastructure to make basic cross scheduling possible.

Yes, my health IT colleagues, we can do better.