One vendor does not rule them all
Every executive of a large healthcare system wants to innovate. They want to do more than less. They want to use tech so their staff can focus on more important tasks. While there are many things holding them back, there is one refrain that continuously comes up.
"We want to innovate, but we don't want to have to manage dozens of vendors."
Let’s unpack that statement, explaining the rationale and how large healthcare systems can innovate. I will be up front with you, dear reader, this is a tough problem to solve. However, it is a worthy problem to tackle.
Why Innovation = Working With Multiple Vendors
This is the most important graphic for the next decade of healthcare software. This graphic shows how a single platform, Craigslist, that did dozens of things, had it's features unbundled and improved by dozens of players. This is the future of EMRs. Each section will be unbundled by players who will focus entirely on one facet of the broader EMR. For example, by focusing on one facet, QueueDr can give that facet more attention and develop more features than a single EMR focusing on dozens of facets can. Look how Airbnb took the idea of listing apartments and made it the largest hotel chains in the world) (https://www.nytimes.com/2015/05/12/business/airbnb-grows-to-a-million-rooms-and-hotel-rivals-are-quiet-for-now.html?_r=0).
However, this graphic can be scary to CIOs and COOs. Many see the 20 different tools and see 20 different places where they could be hacked, 20 different invoices to pay, 20 different points of contact to have meetings with etc.
The question being asked is, is it worth it? Does the innovation provided by additional vendors outweigh the additional cost of managing those vendors?
One Vendor Can't Do It All
Doctors don't like their EMRs. Patients don't use their portals. Overall, the track record of IT in healthcare is poor. The idea that future innovation will come out of the same EMRs ignores history (and we know what the Greeks say about that). Some of the smartest EMR vendors realize that they can't build everything. It's why they have started partnership programs where companies can integrate into their EMR/PM systems. This is hopefully the future of all of healthcare and will become reality faster if CIOs/COOs/the US Government demand that their healthcare vendors create easy ways for any product to plug into their system.
How Healthcare Systems Can Innovate with Dozens of Vendors
While many healthcare system executives would agree with all of the above, their question is still valid, "how the hell do I manage all this?" We have some ideas and tips to make this much easier.
Our tips combine "outsourcing" with standardization. These tips involve large healthcare systems throwing their weight around without suffocating innovation. Too much process and you SQUASH innovation.
1) Pick an EMR/PM (referred to as an EMR for convenience sake) that allows for easy integration.
One of the fastest growing companies of the last 5 years is Slack, which is a group communication platform that teams use to stay connected. Slack was founded 4 years ago, it is now worth $9 billion. Slack is basically a better email. The main reason for it's growth was that Slack made it super easy for every tool a worker uses in the day to integrate into Slack. Slack has become a central place for not just communication, but also project management tools, CRMs, marketing automation, calendars etc. 4 years ago, a slack user would have had 5-10 tabs open, now a Slack user never has to leave Slack. It's a perfect example of how integration can make dozens of tools unite seamlessly.
By choosing a system that prioritizes easy integration, you will get access to hundreds of apps that you can plug-in quickly and easily.
2) Standardize Processes like Security Testing and Invoicing
Work with your EMR company on the security tests that they put their partner apps through. Make the security test very similar to the security test that you give vendors now. You don't have to do the testing anymore yourself!
Encourage the EMR to allow apps to be on your monthly invoice so that you only have to pay 1 bill.
Make sure the EMR API works regardless of your specific hosting environment.
All these steps will help you avoid unnecessarily duplicating work. Don't forget, the EMR companies work for you. You influence what they build and when.
3) Use middleware if your EMR does not allow for integration.
Certain EMRs do not allow for easy integration. Don't have your IT team do a bunch of one-off connections with a series of vendors. That's a nightmare encompassing with different hosting environments, VPNs, and security requirements to name a few of them. There is a better solution.
Middlewares are pieces of software the live between your EMR and vendors. Your team integrates once into the middleware, while vendor apps integrate into the same middleware. Evaluate those middlewares that already have robust APIs that your vendors can integrate into. Datica (datica.com) (formerly Catalyze.io) and Redox (redoxengine.com) are the two best ones out there because of their experience (remember, integration is hard). With middleware, your internal team does not to maintain an API or documentation.
Instead of a series of one-off integrations between your system and various vendors, you will have a one time integration into the middleware.
If you choose a non-open system, this is the most important step you can take. It will allow you to go live much faster and more securely then if you do it internally. You can finally pilot products in months instead of years.
4) Have the following documents standard for partners
a) NDA
b) BAA
c) Vendor Contract
d) Security questionnaire if you don't choose 1 or 2 above
e) Invoicing: use ACH instead of checks
Send these to the partner apps upfront. While this can be annoying for vendors, we'd rather use your documentation than not work with you at all.
5) Have a standard pilot process
Create a standard pilot process for all new products. Before beginning, outline the key metrics to watch. You can also put goals for those metrics, but don't be obsessed with them, you will be wrong. After going live, have bi-weekly (once every two weeks) check-in meetings with the vendor. Produce monthly data reports with metrics of success filled out. Make sure the documentation isn't overwhelming. Include the metrics of success, where they can improve, and how they've changed over time. Keep it to one page max.
6) Do not have a standard pitching process
Do not only allow certain people to bring in new products. Give anyone and encourage everyone to present products that they think can help solve a problem. You can have a board of people that approve every single pilot but give your employees organizational freedom to solve the problems that they think need solving. This will mean more work for that board of approvers (which should include clinicians, admins, billing, operations, and patient access reps), but you will benefit with better solutions that solve the most urgent problems.
If you've chosen an open EMR or a middleware, you can experiment with a completely decentralized way of piloting. That's where true innovation begins as solutions are forced to prove themselves immediately or be discarded.
7) Don't be afraid of mistakes
Slack wasn't always a group communication platform. The company was trying to make a computer game and failed. Along the way they build a communication platform to help them as they developed the game. After the game failed, they turned around and started selling the communication platform.
Make sure that your system and connection with vendors is secure. That part cannot have any mistakes. However, after that, it's ok to make mistakes on your way to innovation. It's far better than stasis. Communicate with your patients, they will understand. If the patients don't understand, feel free to send the feedback to the CEO of the vendors you are using to let off a little steam :).
Remember, innovation can be messy, but as long as it is done securely, progress is being made, even in mistakes.
Patrick Randolph
Patrick Randolph is the CEO and Founder of QueueDr, an automated patient access product used by thousands of providers to get their patients earlier appointments while ensuring providers have a full schedule.