The Healthcare industry is definitely one of the oldest industries in the history of civilization. In most developed countries, this industry comprises about 10% of the GDP. Needless to say, it is a huge part of the world economy.
Today, healthcare has developed drastically. The systems use state-of-the-art tools, cutting edge apparatuses and instruments. But, they are yet to utilize the latest technology in this sector. They have implemented technology in some ways, but are still far behind on digitizing operations and automating their processes.
In this article, we are taking a deep look inside the Healthcare Industry by considering an example of Epic Systems, a healthcare software company established in 1979.
Epic System develops and sells an Electronic Medical Record (EMR) system called “Epic EMR”. They were one of the pioneers in this field. The first EMR system that came out was in 1971 and Epic started in 1979, but it only took off and started growing around the 2000s.
The CEO, Judy Faulkner invested 70,000$ to start this company in Wisconsin. And now, it employs about 10,000 people, holds the medical records of 54% of the patients in the US alone and 2.4% worldwide (as of 2015).
In 1996, HIPPA (Health Insurance Portability and Accountability Act) was passed by congress. It mandated industry-wide standards for healthcare billing and information storage through any electronic medium. It also was passed in order to reduce healthcare fraud and abuse. HIPPA-compliant cloud-based systems were being introduced more after this which has been a boon to the healthcare industry in more than one way.
Microsoft Azure and Amazon Web Service(AWS) are cloud-based platforms developed in the 2000s which are widely used for developing healthcare systems (among others) all over the world. Although cloud computing has transformed the old systems in aspects of cost, interoperability, data ownership and more, there are other challenges that still remain unsolved.
The challenges we come across while trying to digitize healthcare:
The main problem with EMRs- Users hate them.
Dr. Atul Gawande is a surgeon and writer for The New Yorker magazine. In one of his articles titled “Why doctors hate their computers”, he shares his experiences as a doctor training to use the new digitized EMR system. This is actually a very good example of gaining a user’s perspective on digital systems.
Dr. Atul recollects seeing the trainees visibly annoyed with the system and its UI/UX. He even points out that these systems tend to get in the way of the organic workflow of the doctors and nurses. They have to change the way in which things are being done which results in more time loss than increased productivity, as well as irritation.
Researchers at the University of Wisconsin even found out that physicians spent about 2 hours doing computer work for every hour spent face to face with a patient, no matter the software they used.
Old systems and old methods are hard to change.
It’s fair to say that the systems that we used in the past have not proved to be very efficient. This is mainly due to the old models of software development used during that age. Mostly, sequential models like the ‘Waterfall model’ were used in which there is basically no incremental cycle of trial and error.
Using these models is not the best way to make such a complicated system. This resulted in the systems not being user-centric. The main principle was, first to build the product, then train the users to use it. Make the people adapt to the software instead of the software adapting to them. The training cost was hence, inevitably high.
Obstruction in the workflow.
Another thing why users resist these systems is because they just want their jobs to be as easy as possible. Like, if a patient is in front of them and explaining their problems, it’s way quicker and easier to jot that down on a piece of paper. Going out of their way to open the desktop program and find the exact place to put that information, naturally seems like a harder way to do things.
The new era of Digital Healthcare has begun.
Technology has come a long long way since then. Before, these things could be done only on a desktop, which was a pain. But these days, there are much easier options like mobile phones and tabloids. The waterfall model is not used anywhere. New adaptive models are used in which the users themselves are kept as the main stakeholders for the project. It is definitely possible to make the programs adapt to the users, instead of the other way around.
Due to the progress in AI and Machine Learning, there can be ways in which the system won’t affect the workflow of the users. For example, using a tab and pen to note down things, and maybe convert that into data later. Or, using a speech to text translation software to do that. We know that these things have already developed tremendously.
So it is definitely possible to make a system that will blend seamlessly into the workstyle of the users. We can’t say that a system as advanced as that can be developed so fast in the near future. But it has already started happening in bits and pieces. Some startups are developing just the note-taking software for doctors using voice recognition, or handwriting recognition, etc.
So, even if a big, advanced software that checks each and every box of the users may be a bit far in the future, new things have already started happening. The new era of digitized medical records has already begun.
New technologies like cloud computing have already started taking over the healthcare world. Cloud computing has transformed the healthcare systems by lowering the costs, increasing the ease of interoperability, and giving control of the data to patients themselves. Although there are some obstacles in implementing this, we can expect that they will be tackled in the near future. Even cloud computing services like Azure and AWS will get better with the development of technology.
Epic Systems has already been working with Azure and AWS to provide really good cloud-based solutions. In an ideal world, there would be tons of medical data stored without much hardware, and is accessible to patients and medical professionals all over the world and has great interoperability. But there are a lot of HIPPA standards, rules and regulations surrounding that area which limit its powers.
Why will the healthtech industry strive?
It is not that easy to convince the doctors to use the new system all of a sudden. They will be reluctant if a new system tries to replace old ones because you have to go through the whole process of training and adapting again. The entire database will have to be migrated from the old system to new, which can be a lot of work.
But technology is improving constantly. These things will be easier in the future because of technology intersection. Moving data from one system to another will become less tedious or manual due to the interoperability of systems. There are organizations like Health Level Seven (HL7) that are dedicated to empowering global health data interoperability. The APIs are also developing at a faster pace than ever.
Moreover, the demographic of the users are bound to change gradually. The new generation of doctors and nurses will be the generation who grew up using technology. Inevitably, they will start rejecting the outdated systems that are hard to use. They will be more open to welcoming a more advanced form of healthcare. So a new system will have to be deployed to handle that rejection.
Right now the buyers of these digital products will, of course, be skeptical because the losses are known, whereas benefits are quite less. But eventually, there will come a time when the benefits will be much higher and the risks will be much less, compared to now.
User engagement can be made better than ever.
Engaging the user in the really early stages is important in the newer way of doing this. Even if the doctor and nurse consultants were employed to make the older products, that was not enough. At the end of the day, it’s not the doctors and nurses who are writing codes or designing or testing the quality of the product. It is going to be a computer programmer, designer, or a QA engineer who has never even experienced things from the doctor’s or nurse’s perspective. So, the actual users must be involved from the very beginning as a key stakeholder in the whole process.
In this way, a system can be developed which will not be a time sink to the users, but instead, multiply their productivity.
When we try to build a product and bring someone from that sector to come and help us with it, the general way is that we understand the problem and suggest solutions. But a more efficient way to do this is to find someone from that sector who has a deep understanding of the problem and is clever enough to devise a solution to that.
It may be hard to find such a guy who is a sort of a productivity junkie, but it’s not impossible. There will possibly be some people who have thought a lot about the problems and come up with a solution. So our job as a product manager or developer will be to understand the problem and the solution together, and then help them in making the solution a reality.
As technical people, we often tend to forget that we are not the practitioners ourselves. What we can do is find an efficient practitioner with a clever, makeshift solution. And, work with another group of practitioners to polish that solution into an ideal product.
So, we should be able to develop the system in such a way that it will not only multiply the productivity of the users but also make the users feel like it is definitely not a waste of time. Sometimes what happens is, due to bad UI or because the product hampers the organic workflow of the users, users will feel like they are doing the extra effort for the software. Hence, it is really important to make the users feel and experience their productivity grow after using the software.
Systems should be more customizable and adaptive.
The legacy systems are now outdated because they are not customizable. The system needs for a hospital with 20 beds will automatically be different than another one with say, 100 beds. So, the new systems that we build must be customizable for any hospital according to their size, the way they operate, their specializations, etc.
For a company like Epic who has most of the market share, it will be really hard to grow out of the old system now. Since it is a legacy system, it is much harder to change it now. However, that is not completely impossible. There are possibilities to modernize the legacy system.
As healthcare- the trillion-dollar industry in the U.S. continues to grow, it has to be ready to adapt to new technology and digital transformation. Relying on the legacy system will only add up to the cost of maintenance while degrading the operations at healthcare institutes.