It has been a month since my last post. I normally don’t take so long, but sometimes life takes over and you don’t always have the free time to get your thoughts down on virtual paper. Although my writing has been lax, I have been reading quite a bit lately. Now it’s time to write again.
Around this time of year, we see the obligatory bests and worst lists of the ending year. Like most people, when I read these lists I often think of what is missing that makes these lists incomplete or rankings that seem irrational or unjust. There were several examples of these I saw regarding healthcare IT that examined the past year and what is coming in 2016.
Instead of discussing a list, I would like to point out a single completed objective that all of us should reflect on as we evaluate 2015 and look toward the future adoption of new technology in healthcare. During late 2015, we converted from the ICD9 to ICD10 diagnosis code set. This was over 90 days ago and the expected major disruptions associated with this change have never materialized. Like Y2K and Obamacare, we have once again proven that healthcare is an industry that can absorb change and adapt to new procedures. We have demonstrated again that we normally overestimate the negative impact of change and our ability to cope.
When I look back at 2015, I remember all the time, money and energy that was spent by the AMA, congress and related parties to delay the implementation of ICD10 because the changes associated with the new code set would plunge the industry into chaos, provider revenue would evaporate, and patient care would diminish due to the unmanageable burden placed on physicians to improve the detail of their documentation.
As we now know, these problems appear to be manageable and their impact is minimal compared to these negative expectations. Like our military, American healthcare is the best in the world when you look at the level of our science and technology at our disposal. We are leaders in developing new treatments, medications and data analytics processes, but we struggle with adopting these new technologies when they mean that we need to take a couple steps backward in order to move forward.
In the military, we still develop weapons and train our soldiers for conventional warfare even as new enemies emerge that have no uniforms, borders or front lines. We still spend billions developing new tanks and fighter planes at the same time as drones and related technology replace these tools for strategic strike capability and reconnaissance. In education, we hang on to failing policies and curriculum for years as new ones that demonstrate promise are developed and ignored.
The thing that education, national defense and healthcare have in common is that they all support social agendas that provide benefits that are considered extremely valuable, but are difficult to quantify through a price. What is the value to each of us for our wisdom, freedom and health? These common values all have political components as well as financial ones. It is this political component that stunts the growth of these industries and their ability to adapt and take risks in the interest of growth and efficiency that is common with markets not subject to our level of regulation and subjective goals.
Industries like banking, telecommunications, entertainment, travel, information systems and transportation seem to rebuild themselves nearly from scratch over and over again to adapt to new technology. The ICD10 code set was completed in 1992. That same year, the web browser was invented. In 1993, email was introduced and the ability to create a PDF. In 1995, Windows 95 was introduced, the longest lasting version of the Microsoft operating system, which is now extinct. In 1997, broadband cable began replacing phone lines for the delivery of internet services. In 1998, Google first appeared as search engine changing the way we access information. In 1999, WI-FI made internet access wireless and accessible to mobile devices. In 2007, Facebook began connecting us socially through virtual connections.
These advancements in technologies all reinvented existing industries and created new ones during the same time period that it took for healthcare to adopt this single change in the documentation and description of diagnoses.
Most of these changes in technology affected me directly as a software developer and as the leader of a healthcare IT company for the last thirty years. I was around for all of them and I don’t remember many people complaining about how switching to Windows 95 was going to disrupt their revenue or how email was going to cripple existing communication while we all learned how to use it. There were no lobbyists out there being paid to delay the implementation of WiFi in order to preserve dollars for the telephone industry.
When change exists outside of healthcare, it seems to be accepted and viewed as an opportunity. Within healthcare, education and the military, it is viewed as a threat. I don’t have the answer for fixing this, but as long as this condition exists, our willingness to adapt and improve our ability to secure our country, educate our children, and improve the quality of our healthcare will always lag well behind our potential.
In healthcare, we have the ability to analyze payments, charges and adjustments to model the cost of future services and payment methods, but still 50% of all health plans send remittances to providers that are printed on paper. All healthcare providers must submit claims to Medicare electronically, but other health plans can still require paper forms. Each plan has their own processes for checking eligibility and claim status so that even though electronic standards exist, they cannot be universally implemented.
Medicare uses mainframe computer technology developed in the early 1980’s to process claims into the common working file, adjudicate payments and for mandatory data entry for many different types of healthcare financial transactions. The ability to share medical records across different providers systems is still a pipe dream. Even within a single provider network, combining data from different clinical and financial systems is a daunting task too difficult or expensive for most of them to attempt. I am sure similar issues exist in education and defense where the technology being used is so archaic that it seems embarrassing when you describe it to individuals working in the “private” sector.
These are all non-clinical examples that I am familiar with. I am sure there are many more examples of failures to adopt advancements in clinical technology that would directly benefit patient health. One example was a site I saw called “CrowdMed” that allows patients with undiagnosed illnesses to use the collaboration capabilities of social media to link physicians from many specialties together to address specific cases that do not fit into the mold of a specific specialty. The benefits seem obvious, but this technology would replace the “one-on-one” relationship between a patient and physician that our current system is built on and the assumption of authority and expertise given by the patient to their current physician and specialist.
When I look back at 2015 and into the future, I have decided that what I have learned is that I need to modify my own expectations of the ability of the healthcare industry to move forward to adopt new technology to replace existing technology. Back in 2007, I believed the success of social media would inevitably influence the delivery of healthcare. Soon, I believed, patients would be privately chatting with their doctor through text and video. Hours in the waiting room to discuss your blood sugar would be replaced by convenient time-shifted exchanges of test results and advice not linked to a specific visit or mutual availability. I spent nearly two years developing a secure communications system that would provide these tools for the industry. The product failed miserably. My only consolation is that it was not the execution of the idea, but the idea itself that was a failure. Ten years later, virtual communication between a patient and a physician still I largely non-existent and not reimbursed by most health plans.
On a related note, I also made mistakes assuming that systems based on outdated technology were on their last legs and would soon be replaced by more modern systems. This assumption caused me to pass on opportunities to leverage these systems and improve on them because I did not want to build on processes destined to be replaced. The struggles that were associated with the adoption of ICD10 over the last twenty years have taught me that maybe these systems will be around longer than I originally expected. I am rethinking the risk of leveraging them for new services that would depend on their continued existence.
In business, opportunities are often identified by taking some process already developed for another purpose, tweaking it, and providing another purpose for the process or some additional utility. My role is to find the opportunities that offer our company the best chance to capitalize on weaknesses in these processes and workflows that can be improved and provide enough benefit to our users that they are willing to pay for the tools used to make these improvements.
If I was responsible for “inventing” ICD10 back in 1993 and depended on generating revenue from this achievement, I would have gone out of business long ago waiting for this code set to be adopted. My point is that successfully creating new products for healthcare IT is not simply identifying new technology that could be leveraged for the industry, but correctly assessing the willingness of the industry to adopt these changes and let go of outdated tools. If you do not take this into consideration, you can end up with a product that sounds great in a demonstration, but turns out to have no potential customers.
By: Kalon Mitchell, President MEDTranDirect