Getting Agile in a Healthcare Setting, by Raj Amin, Co-Founder and Exec Chairman
August 10, 2016
Value-based care is upending “the way things were” in healthcare organizations across the country, requiring new paths to treat patients and more efficiency across the healthcare system. Physicians aren’t happy with the technology they have been given, and in fact a recent paper in the Journal of the American Medical Association a Stanford Professor stated “de-implementing the EHR could actively enhance care in many clinical scenarios.” The good news is we all want this to change. CIO’s, CMIO’s and various innovation teams are being inundated with new innovative technologies, and in my experience they seem to be excited about their potential impacts. At the same time, however, they are hampered by the internal difficulties that come with trying to pass things “through the queue” within the IT organization to give it priority. For example, the typical cost of a new integration can be between $200,000 and more than $500,000 if you take into account all of the resources that come from within the IT team to support it. If each potential service needed to support that size of investment, it would have to be a critical product that was fully proven prior to making that level of investment.
There’s the issue. You can’t be agile if you must fully prove out your opportunity before taking some initial steps. Let’s say that a cardiologist intuitively understands that she can treat patients faster if she has a few key data points and sequences their care according to specific plans that she uses. She wants to see that data in a dashboard, select care plans, and use a simple app to get specific data points from patients under her care during a 90-day period following their surgery. Creating a first version of this type of application, otherwise known as a minimum viable product (or MVP), could be a fairly efficient investment to make on its own for an IT department using an in-house or external development team. However, getting the data into the application and hosting that data in a HIPAA-compliant service is where things begin to slow down and cost begins to spiral out of control.
Important questions come up in accessing data that can slow the process to a stand still:
• What EHR are they using and how is data mapped?
• What output formats are easily available?
• How will the data be merged from the new service with the EHR data to see one patient view?
• Is there a pre-integration data set for testing?
• How will security be handled post-launch?
Technical infrastructure not designed for this purpose introduces barriers that stop the process from moving into agile development toward an “MVP” or first phase deployment. Traditional EHR’s that contain the data needed were not structured for this purpose, so it’s hard to retrofit them for this need.
What’s needed are more flexible systems designed for “test and learn” processes and more robust data output if we are to allow innovation to flourish in healthcare. Interoperable systems that have well formed API’s will make this process much more agile as we create and test new approaches to care delivery. Having data and systems that move quickly from test to deployment is also critical. Ultimately, being agile means getting to the first phase of a workable product that can test the hypothesis of your idea, then move it into an iterative development cycle without doing the heavy lifting of deep integrations each time you want to try something new.
This approach has worked very well in the broader technical community as “API’s eat the world” and cloud-based platforms continue to make it more cost effective to scale complex solutions. Companies like Twilio are proving this to be true. Mana Health has designed its ManaCloud Platform API to allow for agile development against clinical data, as a central, scalable platform for launching new digital services. Other companies like Tableau focus on more agile paths for data visualization and others on machine learning and rapid mobile app creation. By bringing more agile-friendly technology partners together with health organizations wishing to embrace innovation, we will truly impact the quality and cost of healthcare through better use of technology. And it’s not a choice anymore it’s a necessity.
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