We’ve been through several waves of health IT adoption, and are witnessing a new phase of growth (temporarily interrupted by the rise in interest rates) with exciting new ventures. All these digital health companies bring in expert doctors, nurses, or other clinical staff to help them design products and interact with potential customers. These highly experienced people, with one foot firmly in the world of medicine and the other in IT, form bridges between technologists and the clinicians still out in the field.
For this four-part series, I interviewed more than a dozen clinicians who work in IT now, asking them in online meetings or over email to offer advice to their peers in clinical settings. They described how the IT world is different from clinical settings, and—more practically—what criteria their potential clients should use when evaluating IT products and services.
Working at a Digital IT Company is Different
It’s a big learning experience for a doctor or nurse to move from a clinical setting to a digital computing environment where programmers are developing apps, services, or devices for use in health care.
Dr. Omar Manejwala, chief medical officer at DarioHealth, describes the main job of the clinician at a digital IT company as bringing together two cultures. “There’s one culture of arrogance in technology and a different culture of arrogance in medicine,” he says. “The CMO’s role is in part to bridge those two groups so solutions are most likely to be efficient, effective, and ultimately adopted.”
Many of my interviewees felt compelled to explain why they left clinical settings for the world of IT development. A bit of guilt might underlie these justifications, because staff shortages in clinical health care are notorious and growing. Is it fair to your patients to close up your clinical practice and go to a vendor?
The explanation offered by all these clinicians was the same: They wanted to have a broader impact than they could have in their previous hospital or clinic. In the old settings, they could treat one person at a time, or fix a workflow for one department. In an IT company, they hope to contribute to a product or service that improves health care for thousands of people. Dr. Mark Stephan, chief medical officer of Equality Health, used the metaphor of “doing at scale” what he had done as a clinician (a phrase that might make more sense to computer technologists than clinicians).
Another reason for moving, as explained by Cindy Gaines, chief clinical transformation officer at Lumeon, is to stretch one’s skills. Having felt that she had accomplished so much in healthcare delivery, she wanted to try out something new. She said that she had long been the expert in the clinical area, and felt like a novice when taking the job at a software company. That was challenging!
Differences Between Clinical and IT settings
In general, respondents said that digital IT companies are fast-moving, whereas clinical sites must be cautious because system failures can do immeasurable harm. Furthermore, digital companies focus on delivering a particular product or service, whereas clinical sites have many functions run by multiple disciplines.
Aaron Neinstein, chief medical officer at Notable, points out that clinicians might be carrying on treatment, research, and education at the same time. A digital company such as Notable can focus on their core mission.
Manejwala says that digital companies tinker and adjust products rapidly, whereas in medicine you have to test results at each stage. Digital vendors want doctors to be willing to move faster and iterate over evolving solutions in digital technology.
Lisbeth Votruba, MSN, RN, chief clinical officer at AvaSure, pointed out that clinical environments are very complex, which is the reason behind their many rules and administrative tasks. She says that outsiders often underestimate the inherent complexity of clinical settings: compliance with regulations, aspects of hardware, end of life issues, integration with outside software, and so forth.
Digital companies attempt to take on this complexity in order to simplify tasks for the end-users. On top of the complexity they unload from the clinical environment, their design, development, and testing make their task complex.
Neinstein says that successful digital vendors eliminate the complexity by listening to clinical experts while creating their products and services. Neinstein defines the job of digital companies as solving the problems that the clinicians hold in common. Dr. John Showalter, chief product officer of Linus Health, estimates that clinics are 80-90% similar.
Neinstein discusses the fast pace of a start-up company. Managers put a premium on results and execution. Coping with a small team and fewer resources than at a large company, the start-up fosters more collaboration among staff. When a product release or customer deployment is coming up, everybody works together to pull it off.
Dr. Kate Behan, chief medical officer at Arcadia, writes, “As a clinician, I didn’t appreciate the time and effort involved in critical components of digital technology, such as ensuring data quality and validation, writing code, pushing it into production, and the sheer complexity of data management.”
Know Your Needs
When I asked my interviewees to offer managers in clinical settings advice in deciding what technology to adopt, the answer was universally the same: Before anything else, decide what problem you need to solve. Various respondents phrased this requirement as “How will this help my patients get better care?”
This precept might seem so elementary as to be not worth saying, but the interviewees indicated that the task can be hard. IT salespeople are prodigious at demonstrating wonderful technologies and demonstrating that they solve problems—but are those your problems?
Every site has multiple pressures and difficulties to solve, of course. If you’re managing a clinical site, your primary task is to settle on your chief need and define it clearly and accurately.
Behan writes, “I’ve seen tools adopted because they were new and exciting, but actually didn’t address an unmet need. Consequently, the end-users of that technology struggled to find value and meaning in its application. Similarly, if remote patient monitoring didn’t solve an unmet medical need, the organization had difficulty engaging patients and ultimately, the technology wasn’t meaningfully adopted.”
Dr. Khaliq Siddiq, chief medical officer at Clever Care Health Plan, wrote in email that if the organization’s true shortcomings are on the operational and workflow side, a new technology may be only a temporary solution and could even lead to additional challenges.
Showalter says that doctors and nurses can explain what’s not working for them in their current environments, but find it hard to articulate what the solutions might look like. He recalled Henry Ford’s famous quote about asking for a faster horse instead of an automobile.
Furthermore, describing processes is difficult, and clinicians tend to leave out steps that they have performed often and find to be intuitive. They also tend to think of recent patients they’ve seen when describing their needs, rather than surveying their entire patient base to see what’s most common. Active questioning can help uncover the truly important situations.
Linus Health addresses these kinds of unconscious bias through a design team that puts mockups and prototypes into doctors’ hands and gets feedback—a process that’s common in design but that Showalter finds to be rare in health IT.
Stephan says that technology can be key to transitioning from a fee-for-service environment (where providers are paid for each unique service they perform) to value-based care (health care that is designed to focus on quality of care, provider performance, and the patient experience). Equality Health works mostly in the Medicaid space and offers its technology platform free to primary care providers. He says, “The company uses an activity-based financial model tied to health plans’ quality initiatives to optimize provider workflows and improve outcomes in value-based care.”
The next article in this series offers practical advice for choosing a digital app or service.
