High-tech, high-touch companies like Apple, Amazon, Google and Uber are not just knocking on healthcare's front door—they are poised to kick it down. The industry's glacial-like approach of adapting to new trends has never been more challenged. For chief information officers, that means embracing the shift to consumerism and fostering an environment where healthcare closely resembles how consumers interact with practically every other sector of the economy and their private lives. Modern Healthcare reporter Rachel Z. Arndt sat down with CIOs from a cross section of hospitals—health system, rural and academic—during the Healthcare Information and Management Systems Society's annual meeting in Las Vegas earlier this month to talk about how consumerism is reshaping healthcare.
Modern Healthcare: How do you define consumerism?
Dr. Brian Patty: Consumerism is trying to provide a good experience for your patients/consumers. It's about providing an exceptional experience so people are attracted to your organization. Beyond quality and cost, it's the other thing that's going to keep people sticking to your organization.
Randy McCleese: For consumers, it's about learning what it's like to do at least some management of their healthcare and know who they're working with. They become consumers then. As they start into that process, their demands are going to increase.
Cletis Earle: Consumerism to me is the philosophy that you take care of people who use your services. A consumer is a provider, it's an employee or a registrar or an individual from environmental services. Consumerism goes across the continuum. As we continue to develop as an organization and an industry, consumerism is going to allow us to adapt to all different philosophies. It's about morphing into more of a digital footprint.
We're going to be no different than the Amazons of the world. As the industry changes, we're going to have to change with the industry.
Patty: When I go back to the quadruple aim, it starts with patient experience, and then you have quality and cost, and it ends with care team experience. Those experiences are critical to keep people sticking to your organization, because they have choices.
Earle: Rounding is a perfect example. The same thing our providers are doing to be effective in managing our patient populations in the care settings with multidisciplinary teams—we have to round as well. If we're not doing everything as if they're our consumers, we're doing them a disservice.
McCleese: It's about customer service. Regardless of who you are, you're a customer.
Patty: And we have to understand it's not one-size-fits-all. You have to recognize who your consumers are and serve each of them how they want to be served. Healthcare is more and more becoming a service industry.
Earle: We have to deal with consumers and meet them where they are. For different generations, we're going to have to design for that particular demographic. It's going to continue to fragment. We're going to continue to do it all with the same strategic overlay, but understanding it's not a one-size-fits-all approach, as was just mentioned. We're going to have to become really good marketers, and that's something that IT people don't do that well.
Patty: Our marketing today is really about quality and cost. It's not about experience. And we're going to have to start paying attention to experience in order to deliver a product our consumers want.
MH: How does the entrance of Apple and Amazon and other consumer companies into healthcare affect what you are doing?
McCleese: We've got to make changes in healthcare
that are of that magnitude.
Earle: We're not even talking about people in the healthcare industry, but people in Silicon Valley, because we're going to have to be able to fail fast, too.
You can put models and practices in place that you can try to be able to adjust, so long as you're not putting your patients' lives at risk. Our consumers are expecting that, because they want to have these different solutions and thought processes. Some people may want to use their mobile devices to be more efficient in how they manage their own care, and some people of the same age may choose not to.
McCleese: People are expecting us to provide the same level of service they can get from Amazon or any others like that. They're pushing us to do that.
Patty: Virtual care, whether it's through telemedicine or chat or whatever, is going to become a key part of how we deliver care, because people are going to expect to be able to connect with the physician on their lunch break and not have to go into a clinic. It's just like going to shop on Amazon during your lunch break.
Earle: Our adoption nationally to patient portals has been dismal. Some organizations do it really well, and they've learned the secret sauce. But what we're forgetting is we've made it very complicated for our patients.
We've unfortunately been put in a position as healthcare providers of having to do it because we're checking the (regulatory) box, but that's created such a bad experience for our customers. It's, like, "Why the heck would I use it?" So adoption is down. It's about collaboration, because at the end of the day we all have to take care of patients.
It's no longer my record. It's not the doctor's record or the hospital's record—it's the patient's record. That opens up a collaboration between competing systems. I need to take care of my patient regardless of where they are. So if you're a competing system and my patient goes to your emergency department, I need to know about that, and we need to share information in real time so we can take care of that patient together.
Once we get over ourselves when it comes to that and we put the patient first, then we can collaborate on a model or infrastructure where maybe you don't need 10 different types of a patient portal; maybe you need one federated model. My chief medical information officer asked one of the medical residents how many electronic health records they have in their rotation, and they said five. Five different EHRs. That's a problem. How do you expect somebody to be efficient when they're coming out of medical school or residency and they have to learn five different EHR systems because they're doing rotations? We really have to talk about what we can do to work together—IT people, technologists—that is cooperative and collaborative and is putting the patient first.
MH: What are the limitations of these technologies?
McCleese: We couldn't even deploy mobile technology for our home health operations because they couldn't get a signal to take care of those patients before. So the limitations, when it comes to broadband, are that we couldn't deploy it where we really needed to deploy it, because we wanted real-time communication between that patient's home and the provider.
Patty: The traditional way we've set up our systems doesn't support this consumerism approach. If I'm putting the patient at the center, we need those technologies set up in our system. We have to have videoconferencing capability, we have to have that bandwidth. We have to be able to provide that experience. As we design exam rooms going forward, it's about video-enabled exam rooms to make sure that if the patient is there and we have to have a consult or bring somebody else into that room, we have the video capability to do that. And we should have the capability to do the same thing at the patient's home.
Earle: We're at a point where people are just used to picking up the darn phone and doing FaceTime. They can't understand that you need to buy a $60,000 telemedicine device. That price point is crazy.
You can't keep coming to market with high-priced units. We're not further along when it comes to telemedicine because we're still stymied about putting a half-million-dollar infrastructure in place in order to get results, and then we still potentially won't have a good amount of success.
Our customers get frustrated with us because they're doing it in their day-to-day lives, and we aren't. I think we could, but we're getting in our own way. We make it overly complicated. It doesn't have to be when you have a small device.
MH: How should the Apples of the world be working with healthcare companies?
Patty: We just worked with Apple on barcode medication administration, because the cameras on the iPhone are good enough now, and so now our nurses have iPhones and we're able to do barcode medication administration without the additional cost.
Earle: It's come to a point where you just need to invest a couple of more dollars and you can have a robust smartphone and are able to do 20 times more. You just have to integrate it into the software and make sure it works, and that's why we need our partners like Apple.
Patty: Companies are willing to partner. We just have to ask.
McCleese: That gets back to what we have to do from a technical standpoint: Do we have our infrastructure robust enough to handle all of this other traffic? If we're going to be putting iPhone-type devices in the hands of all our caregivers, we're going to be loading that network tremendously.
Earle: We're at a point where we either partner with them, or they're going to do it ahead of us. Now, you're also talking about some challenges with security. The software has to be robust enough that stuff is not sitting on that particular device. There's a whole litany of different problems. Every organization is going to have to look at their workflows a little differently.
McCleese: From the IT standpoint, we are not pushing these types of devices hard enough to be used by our caregivers; they can do 10 things with these other than enter the data in the EHR.
Patty: We issued iPhones to all of our nurses, and we issued iPads to all of our residents, so we're enabling our workforce to be mobile. There are some things you have to go back to the traditional desktop to do, but they can do 80% of their work with the mobile device.
Earle: We really need our vendor partners to step up, because, believe it or not, you have some that just stop developing and they refuse to offer support unless you upgrade. That's shortsighted.
McCleese: How quickly can our EHR vendors keep up with what we're seeing as the demand from the consumer to use these things? How quickly can they adapt to the newer technologies? And then the cost—some things to upgrade or change software is more than we can afford.
MH: Can you share some closing thoughts?
Earle: Consumerism is about collaboration. I want to really emphasize that. No matter how bad you think you may have it, you may have it much better than others. And everybody needs help. If you really start talking about collaborating, you can really go far—find out what you're doing well and what even somebody else is doing well and how you can adopt it. None of us like to reinvent the wheel. This is a new world, because the Googles and Apples of the world are investing billions of dollars, and we don't have those dollars. We should learn from each other and become better at delivering consumer-style products.
McCleese: Those of us leading this charge need to realize we are the consumers. We need to think about what it takes to satisfy us.
Patty: It's really about how we create that "wow" experience. For years, it was OK to say, "You can get an appointment in two weeks, and when you get there on time, you're going to wait for an hour." We have to be able to say, "Yes, we can get you in this afternoon or the doctor will come to your house via video."
It's really flipping to being a service-oriented organization and putting that patient experience as your No. 1 priority. That's actually going to improve care, because now you've got an engaged patient. If a patient is engaged in their care, their outcomes are going to be better.
Earle: It's convenience. That kind of waiting—that's unacceptable. With the upcoming generations, it's a different thought process. If you click on a webpage and it takes over X amount of seconds, that person is going to leave. They're going to go away. We cannot inconvenience people. Our moonshot should be making sure every patient is treated with the utmost care, no matter what socio-economic level, that every patient is treated as the most important asset we have.
