Healthcare technology - specifically information technology - is key to the progression of the healthcare industry. It is key to cutting costs, boosting efficiency, and improving quality of care. This is undeniable to the tune of $19B (and about $40B total), dedicated to healthcare technology and EHR adoption, according to the federal government as part of the American Recovery and Reinvestment Act in 2009.
All this holds true, yet adoption and introduction of healthcare IT systems is a slow, arduous process, and the costs of healthcare are rising much faster than innovations are being introduced and leveraged for their cost-saving potential. In fact, it is not just in the US that healthcare IT systems (primarily EHR) are cited as the top priority, but a worldwide sentiment that the hurdles to healthcare tech adoption must be solved. After all, 75% of EMR implementations fail on their first go around. This statistic doesn’t paint a rosy roadmap for healthcare IT adoption. This post discusses some of the hurdles relating to the adoption of innovative healthcare IT including lack of domain expertise, misaligned decision-making structure, false perceptions, the fragmented healthcare landscape, and challenges developing with a consideration for end-user adoption.
The failure rate and the resulting apprehension and difficulty surrounding the introduction of innovative IT in healthcare is a product of many factors that combine to create hurdles. A primary hurdle for space is the lack of qualified clinicians, or providers, who are prepared to or qualified to make a purchase. Often, the informatics knowledge needed to make a purchase or consult on an implementation is missing from healthcare organizations. Instead, unqualified individuals are advising system developers, who in turn don’t have domain expertise in healthcare informatics.
The lack of necessary informatics talent and expertise creates an environment ab with problems when introducing healthcare IT innovations. As a result, problems accumulate and a negative perception grows around technology changes within the provider ecosystem. IT becomes an additional cost and time spend for clinicians when in fact it should be a tool to achieve better efficiency and allow greater attention to care delivery.
These misperceptions and lack of informatics knowledge within healthcare organizations create an uncertain environment for healthcare innovators. In addition, healthcare providers are perpetuating their side of the problem by neglecting the formation of organizations that are built to create buy-in and education on the benefits of healthcare IT to all stakeholders. The first step in the right direction of change is to introduce the necessary informatics personnel within organizations to mediate the adoption of innovations for all stakeholders - including the end-users of technology.
As of now, many organizations have key decision makers who make purchases with very little proximity to the end-users (and patients) of the technology or the IT systems themselves. The sales process within healthcare is known to be long and disjointed as decision makers are spread sometimes illogically throughout organizations. Selling it can require selling multiple stakeholders and appealing to their high-level interests even when a product may actually be intended for day-to-day use by specific clinicians. Chances for successful implementation are lowered when the decision maker operates from this disconnected position. In this arrangement, the perceptions of IT within an organization can be reinforced as an unnecessary cost center and wasteful time spend.
One step back from the healthcare organization and one step towards the innovator, (or vendor) additional challenges exist when introducing new IT innovation. The innovator must carefully align the product from day one of concept development with the parties that will be involved. Depending on the nature of the product this could include interfacing with everyone from the insurance agencies who may end up seeing cost changes from your product to the administration at the hospital/provider who will be purchasing the technology. Unfortunately, these focuses sometimes cloud product development so much that innovators build and spec their product without fully consulting the end users of their systems. Implementations ultimately fail based on adoption by actual end-users.
Keep in mind that these challenges are not insurmountable, and in the next article of this series, there will be detailed success stories of innovators who are finding traction. But before we touch on the stories and paths through this difficult maze, there are a couple other challenges worth mentioning. One is the lack of proof or cases around the economic feasibility and benefits of healthcare IT. To this point, it is often unclear which stakeholders actually benefit directly from the innovation. So there is not a clear monetary story for adoption, and there is a cloudy picture of the benefactors of the technology. In this scenario, the fragmented nature of healthcare doesn’t help because it is unclear which party/stakeholder should pay the bill for new innovation in IT.
The fragmented structure of healthcare in the US adds to the barriers of healthcare innovation adoption even further when vendors must spread their resources across thousands of individual providers. A lack of standardization and/or regulation of healthcare IT specifically EHR/EMR means that the interoperability of these systems between thousands of health providers and systems is minimal. So even as adoption is moving forward with regards to EHR at most providers, the stage is being set for additional barriers to innovation as fragmented providers create a network of sometimes incompatible IT systems.
To conclude, the opportunity for innovation within healthcare IT is massive by the numbers, but the barriers are big enough to derail ambitious projects. There are success stories though, and our next post will highlight some lessons learned from vendors and products who have unlocked some of the challenges discussed in the past two posts.