Two John Halamka posts caught my attention this week: Making a Difference and A Time of Uncertainty. Both posts ponder where the next round of innovations will come from. Given the ever-changing regulatory landscape in healthcare and the creation of many new Alternative Payment Models (APM), I agree that incumbent vendors and provider organizations will have their hands full for years to come.  They’ll be focused on the goal lines set by the feds and payers and won’t have the freedom and bandwidth to focus on what’s coming next.  It’s kind of a weird, federally induced “Innovator’s Dilemma”.  That is, incumbent vendors are forced to put their emphasis on their customer’s current needs at the expense of thinking about their unstated or future needs.  That leaves it up to startups and other established companies that are currently operating (mostly) outside of the healthcare market (i.e. Google, Amazon, Microsoft, etc.).

Halamka goes on to offer a list of “top challenges” for these groups that includes:

  • A master patient identifier for the country
  • A provider directory for the country
  •  A consent registry/record locator service for the country
  • A customer relationship management platform that supports care management
  • A groupware communication tool for healthcare
  • A set of security solutions that makes two-factor authentication/endpoint encryption easier
  • A mobile platform for patient/family engagement that provides usability and high-value transactions to the consumer
  • A telehealth/telemedicine platform that supports documentation/billing in the cloud
  • An interoperability platform that leverages cloud technologies to seamlessly provide clinicians with the information they need when their need it
  • An analytics platform that notifies/alerts clinicians when something needs to be done – providing wisdom, not just a flood of data

Given our love for innovation and the thought that we need to make it happen in spite of the regulations, I had planned on breaking this down and building this week’s #hcbiz theme around it.  Then I read this comment from another reader at the bottom of the post and my mind immediately changed course.

“As someone who works for a large Healthcare IT company, we are losing sight of what really matters and that is delivering exceptional patient care. Regulations don’t matter – what matters is that as a healthcare consumer our needs are met. Cancer does not care about metrics, MU, etc. We need to bring the focus back on the patient.” – Reader comment on A Time of Uncertainty

Immediately I flashed back to a personal experience I had about a year ago.  An elderly gentlemen I know had taken a spill on some ice and cracked a few ribs.  He was being cared for in one of the largest hospitals in Buffalo. My wife and I went to pay him a visit and upon exiting the elevator on his floor I immediately noticed flashing lights on the ceiling that indicated a patient’s call button had been pressed. These lights would continue to flash for our entire 3-hour visit – we’ll soon see why.

We found our friends room with some help from a friendly nurse and went in to say hello. He was doing OK, but he was sore and waiting for the nurse to bring his pain meds (he was one of the folks who had pressed their call button).  About 30 minutes into our visit a nurse finally came in.  She was equipped with a giant cart with what looked like a full desktop computer on it.  When I say giant cart, I’m talking like the one AV team used to roll into your high school room with a 29” Zenith TV and VCR on it to watch JFK.  After navigating this behemoth through the room (I had to move the chairs for her), the nurse assured our friend that she had his pain pills and would be with him right after taking care of his roommate on the other side of the curtain.  The roommate didn’t seem to be completely with it and that interaction dragged on for quite a while – to her credit the nurse handled him gracefully. It was at least 15-20 minutes before we saw that giant cart rolling back our way.  Finally, some relief for this sore, old man.  All the nurse had to do was scan the pills, then scan his wristband. Once for each of the 4 pills she would be administering.  Unfortunately, her gargantuan computer cart would only fit at the end of the bed and she had a corded scanner.  Worse yet, the cord was about 12 inches too short!  So, in order to get scanned the patient, an 80-year old man with broken ribs just had to lean forward a foot or so… 4 times!

He winced and toughed it out. Scan… Error….  The nurse, now noticeably flustered quickly dismissed the error without reading it (as in, this happens a lot). Let’s try that again. Lean… Wince… Scan… Success!  You can now take pill number 1.  After about 10 more minutes of this cycle all 4 pills were administered. All boxes were checked and all processes were followed. I moved my chair again and the giant cart with the tiny scanner chord was whisked away to take care of other patients waiting for their call button to be answered.

This anecdote adds an important dimension to the innovation/regulation conversation.  Not only must we find ways to innovate in the face of heavy regulation, but we must not forget what we’re doing in the first place.  We’re taking care of people. And while I believe that improving patient experience is a noble goal on its own, I’m not calling for altruism here. This is just good business.  Your patients are increasingly demanding a better customer experience and now have the first-dollar out of pocket voting power that comes with getting the bill.  They’re not going to care that you bolt your computers to a giant cart to increase security as part of your HIPAA-compliance program (that’s the only explanation I can think of), but they’re certainly going to care that they wait an hour for their pain pills and then have to lean forward on broken ribs to get scanned by your bar-code scanner with the ridiculously short chord.  Further, that poor nurse who has to be the face of this madness all day probably goes home drained of all her energy because she knows this is crazy too.  I suspect that leads to morale issues, decreased output and ultimately turnover.

So I challenge you heavily regulated, over-burdened healthcare organizations.  When thinking about your innovation plans, take a second, catch your breath and get this poor nurse a longer chord.  Your business depends on it.

Discussion Details

On Wednesday, June 15, 2016 the Business of Healthcare community will discuss these ideas in #hcbiz 18.

12:00 PM EST — Tweet Chat

The tweetchat begins at 12:00 PM EST and will ask 3 questions in 30 minutes:

Q1: Forget innovation for a minute,  what are some small things that healthcare organizations can do right now with minimal resources to improve operations/workflow/patient or provider experience?

Q2: Who will drive innovation in healthcare for the next 5-10 years? Startups, non-hc orgs like Google/Amazon, provider organizations, someone else?  How?

Q3: Can incumbent HealthIT providers survive on satisfying regulatory needs alone? How long of a runway do they have sans innovation?

Follow the #hcbiz hashtag on Twitter or use an app like to join the conversation).

12:30 PM EST — Blab

Then at 12:30 PM EST, the #hcbiz Show will dive deeper with a live 1-hour panel. Subscribe here!