I used to love rollercoasters, especially the wooden ones. You know, the one where the chain link would drag your car up slowly as you hear the clink, clink, clink. The anticipation of the first fall would make your heart race. Then it would start, accelerating you through the curves.
I’ve sat through countless presentations: Deloitte, Oliver Wyman, Accenture, and many others. At one point, I realized that as they described healthcare’s trajectory, I was getting the same feeling in the pit of my stomach — the feeling I got when I was on the rollercoaster.
Then it dawned on me: the feeling wasn’t the feeling of anticipation that one feels before you reach the top. Instead, it was the excitement of the increasing speed and the jarring turns. The ride was well underway.
While part of the fun of a roller coaster is in not knowing what’s coming next, I don’t find the same to be true when leading IT in a complex healthcare organization. Here is a simple model that takes a look at where we’ve been, and where we may be going, across several areas of focus.
I would like to highlight a couple of things and present a few ideas.
The Pace is Quickening
We had a decade to get the EHR right. We had five years to get our care coordination platforms for pop health in place. We probably need to have our digital core in place soon for consumer efforts. And we should also be in planning — and soon pilot — for AI/Machine learning for the personalized care models which are right around the corner.
Technology doesn’t lead strategy, but the strategy will require technology. The role of the CIO is to anticipate the platforms that will be required to deliver on the strategy. The CIO is expected to stay ahead of the curve.
The EHR was the first big drop on this ride. We are now taking that momentum into the curves.
Technology will be at the center of every major advancement in healthcare in the coming decades. Our health system won’t be looking to us to invent everything. However, they will be looking to us to be able to participate in those advancements. This is where platform thinking comes into play.
I would like to suggest that the Digital Core is the platform where we will build experiences for the foreseeable future. This isn’t new, but it’s relatively new to healthcare.
The idea behind a platform is to organize the elements (data, services, security, workflow) and automate the process for creating new experiences. It’s also a place to collect and measure results.
The following block diagram shows where a digital core exists in healthcare.
To understand how this plays out in healthcare, I want to take a look at how most innovation is done in this field.
First, a new application is found that does something important. You sign a contract with the vendor. The vendor will need data from the EHR in most cases, and must begin meetings with that team to gain access. They will get a feed and integrate their application to the EHR data. Then the vendor does their pilot and, hopefully, they can scale the solution.
This is an oversimplification of the process, of course. These sentences represent months of work and countless hours in meetings just to get started.
Let’s take a look at how a platform really works.
A physician has an idea and a development team that he’s hired. He would like to build the application that will greatly enhance the experience of his patients and benefit many others as well. You direct him to the platform portal, where they submit a request to build. This triggers an email workflow to the appropriate parties — click, access approved.
The vendor digitally signs the BAA. They are then issued a security token and access to the sandbox to begin development. The API documentation shows them what data they have access to, and the design standards give them direction on how the system wants their brand to be displayed in the market. They develop the app in a sandbox and demo to the appropriate parties.
In the first scenario, there are several manual- and labor-intensive processes. We tend to reinvent the wheel with every new application. In digitally disrupted industries, such as retail, financial services, and entertainment, they’ve already realized that they need to reduce or eliminate the friction associated with innovation and change. A Platform is a strong first step.
Consumer strategy is the next drop in the ride with a whole new set of twists and turns.
New Skills Required
There are two things that jumped off the page as I look at this chart. First is that we will need to develop external consumer capabilities. Second, that the role of the CIO is smack dab in the middle of the strategic roadmap for any healthcare organization.
Consumer capabilities are not new to healthcare IT, but external consumer capabilities are going to be new for many. How do you engage this population, design your services to meet their needs, and gain feedback on a consistent basis?
There is a new set of capabilities being introduced to healthcare. We are seeing experience maps, customer journeys, digital agencies, a plethora of new applications, and almost every health system has an investment arm.
You can’t afford to hire all these skills… and you wouldn’t want to. Instead, you have to create the right conditions, where partners want to be a part of solving your health systems challenges. Cedars-Sinai is using TechStars to get smart, young entrepreneurs to solve the challenges facing their system. We partnered with colleges and universities to conduct studies on our data and provide insights.
You can create the conditions regardless of the size of your organization. Talk to some entrepreneurs at the next conference and ask them this question: “Outside of cash, what do you value most in a partnership with a health system?” I think you will find that your system can provide much of what they are seeking.
Whether you agree or disagree with the chart above, the role of the CIO is to consider the major movements in the industry and the business, as well as map out the corresponding technology strategy. Technology strategy doesn’t lead, but if it doesn’t anticipate the change, the platforms may not be in place to make the next business strategy work.