Crossing the Healthcare Technology Chasm


Jan 14, 2016 TigerText

By: Itamar Kandel, President, TigerConnect

Have you ever wondered why healthcare seems stuck 15 years behind other industries when it comes to adopting new technologies? Anyone who sells to this industry will concur, some with a sigh, some with an eye-roll, and some with a rueful smile.

There are two salient explanations to this problem: Safety and workflow. The first I learned in 2004 during my tenure at VERITAS Software, when I worked on a partnership with Cerner Corporation
to embed the VERITAS File System (VxFS) and VERITAS Volume Manager (VxVM) into Cerner’s PACS product. The value proposition was crystal clear: our tools could help Cerner manage the vast array of spinning disks inside their PACS with (then) modern tools to increase the resiliency and performance of the system.

That contract took me 12 months to close. 12 months. And a similar one with GE Healthcare took me 18 months.

Over a drink at a local Kansas City bar with Cerner’s CTO Rod Coombs, I asked in earnest, why should such an obvious deal take so long. Why wouldn’t Cerner sign the contract, finish integration, train its sales force, and start selling the best PACS around at a fraction of the time. His answer had a ring of truth to it, and I remember it to this day. Rod said, “If your software fails and brings down a system in a bank, people may lose money. If the same happens in a hospital, people may die”. Healthcare is conservative, but it is conservative for a reason: lives literally depend on it. Every new piece of technology needs to be bulletproof.

The second explanation was made clear to me from my interactions with Dr. Robert Mittendorff, a practicing physician at Kaiser, a venture capitalist, and a classmate from business school. He explained to my team in painful detail the enormous workload clinicians face, the sliver of minutes they have to deliver care, and the rigid workflows that help them navigate the minefield that is their grueling workday. A deviation from an established workflow is risky and could be deadly, so the payoff needs to be significant. Any freshly-minted Y-Combinator grad could identify in 30 minutes 30 opportunities to dramatically improve the patient discharge process, the transfer protocol from the ED to the NICU, the shift change procedure from one attending doc to the other, or whatever. However, the more dramatic the change, the more resistance that grad will face trying to introduce a new technology to improve one of these inefficiencies. Breaking a workflow and forcing a change could take years.

You will not be successful introducing new technologies into the hospital workplace unless you take these two elements into consideration and adjust accordingly. To overcome these two hurdles, first, invest enormous effort in testing, testing, and testing again anything you plan to deploy in a hospital. Test it as if someone’s life depends on finding every bug. Most often, it does. Second, understand existing workflows, and find ways to easily bridge the old and the new, allow for an evolution rather than a revolution in how care is delivered.

At TigerText, we followed these two strategies and shown enormous time savings, cost reduction, and increased patient safety when clinicians coordinate and communicate using our HIPAA-compliant messaging system. But we have also realized that change can’t happen overnight, because established workflows with older tools exist for a reason. Two great examples of such old technologies are pagers and faxes. Everyone in Silicon Valley is dumbfounded when I mention how prevalent those archaic technologies are in the healthcare industry. I seriously doubt half the landed gentry from San Francisco down to San Jose know how to send a fax, let alone a page. But snickering aside, we cannot expect the clinicians to drop their existing tools and learn something new, just because the technophiles say it is “better”. Instead, we have built bridges from the technologies of the past to those of the future, allowing an easy and stress-free transition between one and the other. One such tool we call TigerPage, which follows the exact workflow of a regular page, but instead of carrying a pager, the clinician gets the message inside our app. Another tool is TigerFax, which similarly allows the clinician to get an inbound fax into the TigerText app. These tools enable clinicians to gradually transition from faxes and pagers at their own pace rather than forcing them to learn something new overnight, and eventually move to the modern messaging paradigm with minimal disruption.
These two approaches of (a) sacrifice time-to-market speediness in favor of highest quality possible, and (b) minimize disruption to existing workflows, should be adopted by all who hope to provide technologies to the healthcare market. If more vendors follow these two best practices, we might finally see this intransigent market start to pick up new technologies faster, resulting in improved care, reduction of costs, and easier lives for the caregivers. Not to mention more sales. Seems like that’s worth the hassle, eh?