Craigslist and the Specialization of the Health IT Market

One Big Solution to Health IT?One of the main stories of the 20th century marketplace was consolidation - while various processes and products were refined, they began to fall under one major umbrella. In many cases, multiple stores and specialties were now located under one roof at first in the form of the mall, with its many boutiques and types of stores next to each other. Then, as the century wound down, it was all brought under literally one roof in one megastore - WallMart, Target, all offer products in completely unrelated and increasingly diverse departments. This evolution makes sense as accessibility became more prized - the ease of getting all errands done as soon as possible - while brand awareness and loyalty encouraged patrons that they were receiving the same great deals/products in each of the departments. However, while the megastore remains prominent in US culture, there has been a small movement of specialty stores cropping up in the shadows of these behemoths. Customers go to them when they need help with a specific problem and need to know they are dealing with experts in the subject matter and not someone that can work in the deli one week and home electronics the next.

But what does this all have to do with health information technology? How does the rise of the consolidated megastore tie in to the current health IT landscape? The answer lies in EHR adoption and capabilities with an eye looking to the future of healthcare.

In order to provide a better return on investment to facilities while satisfying government criteria in order to meet the definition of EHRs, health IT companies expanded their scope to encompass many various departments, applications and workflows in their EHRs. This lent the attractive appearance of uniformity - all accessible underneath the same "roof" of one system, made more attractive by decades where software applications had difficulty interfacing with each other. Furthermore, instead of having multiple bills/vendors to pay, there was just one check to cut and facilities were promised that everything they needed would be provided with this one acquisition (the fallacy of the silver bullet).

In many respects, EHRs handle a great deal of transactions very well; by including many departments the possibility exists of sharing data more efficiently between physicians and improving care for the patient. Possibility, however, is rarely the same as actuality. The fact of the matter is that adopting a universal system for an entire hospital has great promise - but that hospital is comprised of very different workflows and specialties. When I say someone is a "physician" - what do you think of? If we polled a thousand people, we'd probably get a wide ranging definition as well, dependent on specialty (surgery, pathology, radiology) and sub-specialties (clinical pathologist, orthopedic surgeon, etc.). Each of those comes with its own requirements, workflows, and needs for documentation. The problem with the all-in-one solution is that it forces awkward processes into situations where they may not fit or capture anything of importance.

Another way of thinking about this specialized vs. universal solution approach to EHRs has been brought up recently by multiple blogs (at least 4 found here, here, here, and here). In those posts, the question isn't posed in terms of consolidation or a megastore, but instead looked at from the perspective of 'unbundling' and using Craigslist as the example. The posts discuss how Craiglist was once a catch-all that offered up services that allowed visitors to purchase anything on there - from tickets, to furniture, to services, etc. It was revolutionary by bringing these services onto the internet and connecting audiences while facilitating business. However, as time went on, specificity was needed to attend to each of those outlets providing more granulity for the users. Thus rose up websites and apps that specifically dealt with buying tickets (StubHub), or rating services (Angie's List) or a variety of other avenues. By focusing on just one aspect, businesses could offer a better experience that spoke directly to the needs and concerns of the users as opposed to a catch all that had to include "No Pets Allowed" even when buying concert tickets.

Unbundling of EMR leads to rise of specificity

Similarly, these posts conclude that is the direction EHRs are moving in. This first generation showed the ability to unify these workflows and send captured data into one location, available for multiple physicians to access to provide better treatment. But, as time passes, there is a rising tide of applications that deal with only one specialty, or only one aspect of a workflow. They focus not on solving pre-screening documentation for every department, but just capturing the most pertinent information for one specialty. Meanwhile, standards are solidifying for transferring data using HL7/CDA, which means that as long as those applications can send that data back into the main system, it can be used appropriately by other physicians. Instead of physicians going through templates that are included just to make the EHR sale more appealing, but not actually usable or pertinent to their work, they can utilize forms and applications that incorporate exactly what they need in exactly the way they need it.

Seeing this rise of focus on a particular workflow in healthcare has been a slight vindication around mTuitive. We've prided ourselves on being THE synoptic reporting company - we focus on making synoptic reports for healthcare and little else. We know we must play nice with Laboratory Information Systems (LIS), EHRs, and other health systems - but we don't try to replicate what they already do. We work closely with domain experts to adopt professional/national standards in reporting to match their everyday workflows - which is why our solution for surgeons is different than the one for pathologists or what we offer emergency department trauma physicians. By trying to do everything at once, companies offer up bland solutions that force users to shoehorn their needs into a pre-existing template. There's no sense of deep knowledge about the particular solution, it's just bundled in to be more attractive in sales. In other words, the fresh bread is just two aisles away from the lugnuts - and the staff knows equally about both (which is to say, very little).

By unbundling these apps, allowing developers and domain experts to focus on the unique elements of each workflow, companies are making sure that each department and user will have a good experience tailor made for them. Right now, most experiences with EHRs involve a lot of training that include the phrase "but that doesn't pertain to you." And, perhaps not coincidentally, most experiences with EHRs have been viewed negatively. When physicians feel their specific needs are being met and they are being handled by specialists with keen insight into their workflows, then they will be more receptive to using these applications, which will lead to an increase in data capture and thus greater possibilities for improved care. "When the only tool you have is a hammer/everything looks like a nail," the song goes. We live in sophisticated enough times that we should demand our physicians are better equipped with more tools at their disposal.