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CloudView blog

Ideas and insights to help health care providers stay informed and profitable in today's challenging health care environment.

(Buyer) Beware The Status Quo

by David Fairbrothers, Co-founder and CEO, Dorsata

Imagine the following scenario. You are a physician specializing in spine care.  You've added an urgent consult to your medical office schedule. The patient, who lives 110 miles away, arrives after a two hour drive in early morning rush hour traffic in severe pain. She describes a two week history of nearly disabling, excruciating sciatica. She's already seen a surgeon and an interventionist, both of whom offered two very different opinions.  She is looking to you for a ‘tie-breaker.’ She was unable to obtain her medical records or copies of her recent spine MRI from the other physicians. Unfortunately, both outside physicians use different EMRs, neither of which communicates with yours.  While the patient waits 35 minutes in the exam room, your office staff hurries to call both outside offices to request their records be faxed.  The actual MRI images can't be faxed, so all you have is a report. To deliver the most definitive and conclusive opinion, you need to see the films. What now? 

         A) Ask the patient's family to make a 220 mile round trip to pick up and deliver the records and MRI.

        B) Order a clinically not-indicated and repeat MRI, adding $2,500 to the cost of the visit. 

        c) Provide a best-guess opinion based on inadequate information.

Of course, the correct answer is none of the above. Sadly, this is not a unique scenario. This happens everyday in our current healthcare system.  Real-time access to patient data across the entire healthcare ecosystem is the only way to truly “fix” the problems described by the story above. Yet despite years of regulatory and policy efforts, we are no closer today to true data interoperability than we were a decade ago.

Recently, along with a number of fellow More Disruption Please partner company CEOs, I was invited to visit Capitol Hill to discuss a number of important key policy issues affecting the success—and potential failure—of our businesses. As a startup, securing such wide access to key policymakers is next to impossible. athenahealth’s Hill Day is really the only way that we can have our voices heard by those that make legislative and regulatory decisions affecting our customers and our livelihoods.

Here are a few thoughts I shared that day:

C-CDA is not TRUE interoperability

Many vendors cite mechanisms that transmit patient data, such as the Consolidated Clinical Document Architecture (C-CDA), as evidence of “interoperability,” but this is a low bar. As a software developer, I have written true integrations to many Application Programming Interfaces (APIs) that provide well-defined endpoints to rapidly and securely access and set structured data.  For example, if I wanted to write an application that coordinated the arrival times for a group of friends for a dinner reservation, I could ask the group’s smartphones for GPS data to obtain each member’s location; ask Google Maps’ API for directions, traffic data, and travel time for each; and then process a proposed departure time for each. This would be doable in a weekend hackathon. The healthcare industry still sends faxes and formatted XML documents. Think about that.

Interoperability - previously a “check box” item, now an essential part of clinical practice

Previously, providers’ were required to purchase EMRs that checked the interoperability box in order to receive Meaningful Use incentives that offset the very cost of their implementation. In the latest MACRA policy guidance—a significant expansion of how Medicare providers will be paid—leveraging technology that requires true interoperability to function will be essential.

Dorsata’s core product is an example of such a technology. We do for EMR documentation what TurboTax does for your tax forms, on a tablet. We bring logic, workflow, and intelligence from clinical decision support to the assessments, documentation, diagnoses, and orders that are ultimately packaged, coded and sent back to your EMR. Solutions like ours require that patient data not only be available in real time in the exam room, but also that data can be pushed back in a structured way to a variety of systems.

Ultimately, solutions like ours require that policymakers and regulators rethink how they define “interoperability.” Simply choosing a single standard architecture or protocol is not enough. What will solve the problem is establishing qualitative guidance around what should be achieved through interoperability. This way, as cutting edge technology and protocols change, policy won’t have to struggle to keep up. The goals and objectives of true interoperability will not change, even as clinical use cases for interoperability evolve.

The bigger challenge is overcoming the other side of the market, which is made up of large, entrenched providers of monolithic, legacy systems that ardently oppose strengthening regulators’ qualitative definition of interoperability. It’s this bar that prevents startups from carving out modular niches in oft-maligned areas of EMR systems and delivering innovative, order-of-magnitude improvements. If true data interoperability were actually in practice, it would be simple for providers to drive a best-in-breed strategy for certain aspects of their workflow. 

Don’t be Siebel Systems

The cost of building and bringing high-quality, scalable solutions to market have never been lower, and the barrier to standing up a software application and iterating it with the direct input of your end users is almost non-existent.

Legacy vendors that believe they can prevent their customers from embracing a “best of breed” strategy that leverages innovative solutions to solve specific pain points have been shown time and time again to be wrong. Eventually, a major market shift that alters the customer landscape will force them to adapt or die. No example is more sobering (or classic) than that of Siebel Systems, killed by an over-reliance on large enterprise customers whose margins were squeezed following the tech crash of 2001. $100m contracts were the first to be slashed, and Siebel was neither prepared, nor equipped, to adapt rapidly.

Hospitals and large health systems aren’t immune to shifting market forces, either.   In their case, a one-size-fits all technology solution doesn’t just lead to mediocre product experience; it could also threaten their survival.  Healthcare organizations must learn from Seibel’s mistakes: As founding Siebel executive Bruce Cleveland opined himself, beware the status quo, and accept that diversity is your best shot at survival.  

Healthcare organizations must find commercially viable ways to work with innovators building disruptive solutions for providers and offering ROI-driven pricing structures. If they succeed, we will wonder why software ever cost hundreds of millions of dollars to buy, implement, and manage—and we’ll have much better technology, and stronger institutions, as a result.

Ultimately, it comes down to everyone in the healthcare ecosystem -- large, legacy vendors and startups alike -- making hard choices because they’re the right thing to do. At the end of the day, healthcare is about keeping patients healthy and caring for the sick. We owe it to ourselves to set a higher bar for the solutions we offer our caregivers.

David is the co-founder and CEO of Dorsata, a health tech company that gives providers a more efficient, intelligent, and enjoyable way of interacting with their EMR. He has been involved with or led product development in seven different companies in industries ranging from consumer internet to health IT. He is a full-stack developer on a variety of web and mobile platforms such as Ruby on Rails, AngularJS, Swift, and LAMP. David holds a BA from the University of Virginia and was an offensive lineman on the school’s football team.  He can be reached at david@dorsata.com.

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