Issue link: https://beckershealthcare.uberflip.com/i/961245
172 THOUGHT LEADERSHIP CMIO musings: Why are Apple and Google easier than EHRs? By Maulik P. Purohit, MD, MPH, Senior Vice President and CMIO at University Health System I t's Tuesday night, and you're on a flight back from a quick, three-day business trip. The plane just landed but your trip isn't over yet. You still need to get home. As you walk off the plane, you grab your phone, log in with your thumb without missing a step and open the Uber app. A driver picks you up in minutes and seam- lessly drops you at your doorstep. "Technol- ogy makes life so much more convenient," you say to yourself as you lie down on your couch and stream the latest House of Cards episode on your iPad. However, you can't help but think: If a tech- nology can make transportation so easy, why not healthcare? That would have saved you a headache Monday when you made an out-of-network urgent care visit while you were out of town, and the physician couldn't access your electronic health data. In fact, healthcare is one of the few industries that is made more complicated by technology advancements. The long and the short of it: Healthcare needs to take a page out of tech's playbook. Let's look at the Uber example a little more closely. While the IT build may be complex, the operations side is much easier. Uber doesn't have to train drivers how to drive or exude basic etiquette. There aren't many moving parts — of course, not in the liter- al sense. If your Uber driver didn't move, you'd be quite upset. While the transportation industry faces fewer regulations than healthcare, these ba- sic "Uber principles" can be applied to the tech transformation of healthcare. It's important to first lay out the main dif- ferences between healthcare and other sec- tors of the economy. Healthcare requires many moving parts, specific technical skilled labor, specific duties per individual and synchronization. First the human part — techs, registration staff, scheduling staff, triage, billing and coding specialists, nurses and physicians. Furthermore, not only are nurses and physicians subdivided by spe- cialty, there are subspecialties within those specialties — and they may be geographi- cally split across the hospital. On top of this complex arrangement of people is the third-party payer system, which consists of multiple organizations and hundreds of dif- ferent plans combined with intricate gov- ernment policies and regulations that differ state to state — and sometimes city to city. Uber has a passenger, a driver, a vehicle and a location. Somehow driving a car during peak rush hour in Los Angeles is much sim- pler. On a higher level, patient care requires healthcare's major players — providers and payers — to collaborate across an incredibly complex environment. When the two enti- ties collaborate with each other — and with tech — they often have to abide by each others' rules. Since healthcare is heavily regulated for patient safety reasons, there's often little to no room for flexibility with IT. A chasm emerges between tech companies and health organizations. Primarily, these partnerships involve risk and liability. What happens if a technology solution is implemented in a hospital, but something goes awry? Who is responsible: the vendor or the hospital? In other indus- tries, there aren't as many rules to adhere to. For example, Uber doesn't have to abide by HIPAA, or a HIPAA-equivalent, to shut- tle riders back and forth. What's more, the profit margins are much smaller in healthcare. Apple, Google and others are able to sell millions of their prod- ucts because they don't have a third party limiting them — only the free market with a growing demand for smartphones. Hospi- tals, on the other hand, are tied to restrict- ing forces, like payers, who will only reim- burse so much. Additionally, hospitals have expertise in healthcare, not IT. In fact, if you have IT talent, you likely work for a private com- pany, not a hospital. Hospitals use IT but do not design it. Many IT products, at least until recently, were designed by IT vendors that didn't truly understand healthcare and didn't prioritize the end-user experience. How can tech improve healthcare? Some big tech companies are starting to make an impression on the healthcare in- dustry from a patient perspective. Consider Apple's Health kit, which serves as an ex- ample of how tech can make a meaningful impact on the industry. Apple takes discrete data and organizes it into an easy-to-man- age format. With Apple's Health kit, pa- tients hold their own health information in their palms and transport from place to place. By giving the power to the patient, healthcare organizations are eased of vari- ous burdens, including IT development. However, Apple — and other tech giants — haven't done much yet to ease physician workloads. Below are two ideas on how we can accelerate innovation for healthcare providers. 1. CMS incentives. CMS, which already incentivizes physicians and healthcare or- ganizations for increasing IT use, could try to convince big tech to break into health- care by offering them monetary awards. HHS has historically fielded insight from tech companies to integrate it into health- care delivery. For example, it hosts a num- ber of summits and conferences each year such as the 107 Technical Interoperability Forum, inviting tech to offer up solutions. ONC also proposes a number of challeng- es for tech companies, such as the patient matching algorithm challenge, which asked teams to develop a better way of identify- ing and matching patients to their data. However, tech industry leaders — like Ap- ple and Uber — aren't quick to sign up for these programs. Better incentives, however, could lead to more actors getting involved and, ultimately, more diverse innovation. 2. Funding through the National In- stitutes of Health. What if the NIH got into the tech game? Instead of focusing only on basic science and standard clinical stud- ies, the NIH should more forcefully drive improved care delivery using IT. Through creative partnerships or funding oppor- tunities, the NIH could partner with tech giants to leverage and integrate their busi- ness models into health IT to improve care delivery — which may actually have more impact than the traditional methods of re- search. 3. The IT talent is in the tech indus- try. Let's revisit the Uber example. The transportation industry didn't do the IT research to create Uber. Instead, a couple of people got together and made the app. It's easy to forget, but Uber is a tech company, not a transportation business. Just like in transportation and elsewhere, the tech sector has a real chance to disrupt healthcare in a positive way. n