Why Healthcare Needs Amazon (or Anyone) to Shake Things Up

As healthcare in the United States embarks on what PwC describes as its most radical shift in 80 years, most health IT incumbents just aren't cutting it.

It's tough to make generalizations about an industry as tumultuous as technology, but there are arguably two certainties: Technology changes rapidly and innovation rarely comes from expected places.

Largely, that is, but not entirely true. The healthcare industry offers evidence to the contrary. Technology doesn't change rapidly — systems that use MUMPS, a programming language developed in the 1960s, still process many of today's electronic health records — and innovation rarely comes at all.

Some blame the risk-averse nature of an industry built on the oath "first do no harm." Some point to the murky nature of healthcare data, which is largely unstructured and therefore hard to standardize, let alone analyze and send to a smartphone. Some say the strength of healthcare's fee-for-service model gives cash-strapped hospitals and clinics little incentive to try anything new when treating sickness remains more profitable than promoting wellness.

[Related: Fixing Healthcare Requires Netflix-Like Disruption]

Whatever the case, it's almost universally accepted that healthcare needs to innovate — and recent research suggests that healthcare's IT incumbents aren't up to the task.

'New Health Economy' Biggest Shift Since Employer-subsidized Care

"The ground is shifting rapidly," PwC's Health Research Institute writes, "giving way to what we call the 'New Health Economy.'"

Fed up with not getting their money's worth from a healthcare system valued at $2.8 trillion in 2013, PwC says patients will use technology to better consume services that keep them well, instead of just treating them when they're sick. Healthcare providers have little choice but to cut the fat, stop making errors, better manage chronic conditions and treat patients where they work, play and live.

[Related: Feds Aim to Regulate Healthcare IT While Doing No Harm to Innovation ]

Simply put, PwC says, "the New Health Economy represents the most significant re-engineering of our health system since employers began covering workers in the 1930s." Change will hit everyone, too: Hospitals, insurers, pharmaceutical companies, employers, retailers, patients and IT vendors of all stripes.

When the dust settles, those able to adapt to what analyst firm IDC calls technology's third platform — social media, big data, cloud computing and mobility — will stand tall. Everyone else will fall.

Reluctance to change drove athenahealth from the EHR Association, an industry group that the cloud healthcare IT vendor sees as stuck in the past. EHR vendors such as Epic Systems say customers don't buy into the healthcare IT cloud. athenahealth disagrees — and does IDC, PwC and, it's safe to say, most of the rest of the economy.

[ Analysis: Why the EHR Market Is Poised for Disruption ]

Reluctance to change also explains why EHR systems don't work for accountable care organizations, according to KLAS Research. ACOs have complex technical needs, and most major EHRs don't handle care management, quality reporting and information sharing very well.

The accountable care organization, it's worth pointing out, is espoused by the Affordable Care Act as the care model that will give patients better, more efficient, more coordinated and more proactive care. Oh, and if it succeeds, it will kick to the curb the fee-for-service model that got the U.S. into its healthcare mess in the first place. Vendors that ignore it do so at their own peril.

Healthcare IT Must Adopt Social Media Principles

Last week, Dr. John Halamka, CIO of Boston's Beth Israel Deaconess Medical Center, spoke at MIT's Information and Communication Technologies Conference. Halamka gave the audience, which included the leaders of close to 20 startups, a veritable laundry list of the technology that healthcare needs.

  • For ICD-10 coding, Halakma says, "We are desperate for [natural language processing] solutions to take unstructured data that doctors capture in the course of their work. It needs to be turned into structured, analyzable data."
  • Cloud-based analytics platforms that gather data from all facilities a patient visits, as well as from any medical devices a patient may use, and present that data in "innovative interfaces."
  • Biometric login solutions for electronic prescriptions of controlled substances, since federal law deems username and password insufficient.
  • Better security, especially for mobile devices. "We need tools and technologies that give us control over devices we don't own," Halamka says.
  • Improvements to the electronic medication administration record (eMAR) that "close the loop" from the time a drug is ordered to the time a patient takes it, ensuring that it's the right patient, the right drug and the right dose. Medication reconciliation that pulls data from a patient's pharmacy will help, too.
  • An ecosystem of applications that actually lets patients view, download and transmit their electronic personal health information. Meaningful use requires healthcare organizations to make ePHI available to patients, but there's no place to put it.
  • Cloud-based secure information sharing across institutions, especially in states where health information exchange hasn't quite caught on.
  • Cloud-hosted stores of anonymized data that patients volunteer for research purposes.
  • A nationally curated registry of best practices, drawing on decades of research from all leading institutions, which any physician or hospital could query at any time.

[ Feature: Big Data Analytics Use Cases for Healthcare IT ]

If there's a takeaway from this list, it's that "healthcare could use a lot of Facebook- and Amazon-like apps," as Halamka puts it — applications that use social media principles to make it easy to gather, analyze and share patient information. EHR systems written in Visual Basic 5 (nee 1997) aren't going to cut it, Halamka suggests.

If Amazon Can Make Recommendations, Why Can't Hospitals?

Blogger Paul Roemer asks, What if Amazon ran population health management? Amazon collects lots of data on shoppers' purchasing behavior and makes recommendations for future purchases. Healthcare organizations collect lots of data on patients' (un)healthy behaviors — but they sit on it.

[Related: What's Hindering Healthcare IT Innovation (And How That Can Change)]

How much better would healthcare be, Roemer asks, if hospitals made recommendations based on the terabytes of data they've collected about their patients? How many hospital readmissions would be avoided? How many chronic patients would get better? How many accidental deaths would be prevented?

To borrow an analogy, healthcare faces a Blockbuster Video moment. It can stand by the status quo, watching tumbleweeds blow through its aisles of VHS tapes, or it can forge partnerships with anyone and everyone who understands the New Health Economy and keep those customers happy, healthy and engaged.

Brian Eastwood is a senior editor for CIO.com. He primarily covers healthcare IT. You can reach him on Twitter @Brian_Eastwood or via email. Follow everything from CIO.com on Twitter @CIOonline, Facebook, Google + and LinkedIn.

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