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Viewpoint: Now isn't the time for the Uber for healthcare

Startups left and right say their goal is to be the Uber of their industry, providing the radicalized, consumer-centric, on-demand service that Uber did for transportation. But this term has become a catch-all for any sort of innovation, and it also unrealistic — at least for healthcare.

A large part of Uber's success stems from its premiere as the first true digital disruptor in an industry ripe for change — transportation. It met a need. Suddenly, people could summon a car to their location with a few taps on their touch-screen phones and no longer deal with hailing taxi cabs or worrying about payment at the end of a ride.

Now, Uberization in any other industry refers to an on-demand, convenient option that consumers want. Consumers seek a hassle-free exchange that places a premium on convenience — so convenient that you don't have to say anything to anyone if you don't want to.

But we're in an era where stakeholders are pushing to bring the human element back into healthcare. Many providers voice disdain with required technology, saying it detracts from their time and relationships with patients. Researchers from Northwestern University have found physicians using EHRs spend about a third of the patient visit looking at a screen, and just that time spent looking away causes patients' satisfaction to drop.

This is one of the key reasons an Uber for healthcare isn't feasible. Where Uber automates and simplifies a process that, aside from requiring a human driver, doesn't require much else, healthcare interactions are personal and can't be replaced with a screen and app.

A recent Tech Crunch article summed it up nicely: "Uber…[is] successful because [it] has streamlined the time it takes to get a job done….in a sense, the friction or pain necessary to complete a transaction is removed." It continues, "On-demand services like these work great for individual transactions. Therein lies the problem: Healthcare is not a transaction business; it is a relationship business."

Trying to Uberize healthcare — turn an industry dependent on human interaction into an automated one — is the antithesis of what medicine and healing require. Even Jonathan Bush, co-founder and CEO of health IT vendor athenahealth, laments how humanity has diminished from patient care. In a contributed piece for Forbes, Mr. Bush wrote, "Healthcare has been digitized, but it's come at the expense of being consumer-friendly. We need to unbreak this reality so we can be more connected to each other."

Automation and convenience do have some place in healthcare, like apps that allow users to schedule appointments or technology that moves health records between providers. Patients should be able to access care and information in this manner, seamlessly and with ease. But automation and the promise of convenience seem like a shortcut to or a distraction from doubling down on some of healthcare's long-term challenges, like access to care, affordability, comprehensive health plan coverage and the social determinants of health. There's no convenient fix for such deeply rooted, complex problems. What good is having an app that reminds a patient to take his medicine if he can't get to the pharmacy or afford the prescription in the first place?

Addressing these larger problems requires more than a quick and convenient fix, especially since problems affect patients differently. Uber's model addresses a want shared nationwide — on-demand, relatively cheap transportation. Everyone has essentially the same needs and expectations, and they're pretty simple demands. But healthcare is local and needs vary, so these broad strokes are unlikely to be as successful.

Although now Uber caters to a global consumer base with a clear, shared need, it didn't start as an on-demand service for every consumer. Uber began as a luxury service, only offering UberBlack cars marketed for people wanting private cars to get from point A to point B. Cars must be black, generally of a certain high-end model with leather interior (though specifications vary by city). UberBlack cars must also have livery designation.

Only after Uber reached a certain economy of scale could it introduce UberX and UberTaxi, the low-cost "economy" option and the option that partners with city taxi services, according to a report in The New York Times. "Uber shifted from a convenient alternative to luxury cars to an alternative to taxis to, now, a credible alternative to owning a car."

Healthcare innovators trying to emulate Uber are starting too big. Uber didn't reach its current capacity by simplifying a process for all people at all times, which is what many healthcare innovators are doing. This may partially account for why the majority of healthcare startups — at least half, according to an Accenture report — go under. 

Unlike other one-size-fits-all solutions, one innovation center in the Twin Cities is approaching innovation by focusing on hyper-local systemic healthcare issues. Upstream Health Innovations is affiliated with Hennepin County Medical Center in Minneapolis. The center's goal is to keep the county's residents out of the hospital, or coming "downstream" in the care continuum, according to Chip Truwit, MD, chief of radiology and chief innovation officer at HCMC.

While most other hospital-affiliated innovation centers focus on technological developments or commercializing products, Upstream Health Innovations can be thought of as service design, Susan Jepson, vice president of innovation at Upstream Health Innovation said in a previous interview with Becker's Hospital Review. Service design is about making the most of resources to improve the quality of service for end users.

Using a $2.5 million grant from United Health Foundation, Upstream Health Innovations conducted local ethnographic and observational research analyzing how the social determinants of health affect the way patients of Hennepin County interact with the HCMC. The center is building a resource engine to offer patients information and solutions to some of these social determinants and non-clinical barriers to care, such as employment, shelter and food. A note placed in the EHR identifying such obstacles can help community health and social workers provide proactive care and interventions to patients when needed.

"It's very important as we're moving forward to make sure we are looking at ways to address [how a patient interacts with our healthcare system] so our core competency is delivering care," Ms. Jepson said. "We want to do that, but have to remove some of these obstacles."

Healthcare innovation needs to first focus on removing those obstacles, much like what folks at Upstream Health Innovations are working on. You can't make care more convenient for somebody who doesn't even have access to care in the first place. And these issues related to care access run much deeper than a new app or technology can fix. 

Healthcare can't be generally disrupted like the transportation industry was. It's too personal, too local and too systemically flawed for overlay solutions to catalyze the scale and complexity of change innovators are trying to achieve.

Perhaps, as the NYT article suggests, Uber will remain the exception, not the norm. Or, healthcare's Uber may be on the horizon, but it is not what the industry needs quite yet. There are more pressing problems to solve first.

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