Digital Disruption … Is Healthcare Next?

The following article was recently published in Healthcare Information Management & Communications Canada, the journal for COACH members:

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As many industries have discovered, often painfully, digital technologies can be disruptive.  Just ask Blockbuster, Kodak, or Postmedia.   Is healthcare next?

In a presentation at the 2015 Marketing Transformation Forum, Ronald Velten, Marketing Director, Global Technology Services Europe at IBM Europe, identified three waves of digital disruption.  In the first wave, starting in 1995, the shift from analog to digital content had a profound impact on music, photography, and video rental.  The second wave, which started around 2010, has pushed many traditional media companies (print, radio, and television) to the brink of extinction.

More recently, in a third wave of digital disruption, new entrants, unencumbered by existing business models and legacy systems, are taking advantage of the constantly evolving digital landscape to enter markets previously considered immune from digital disruption. These new entrants are using digital technologies, not as tools to incrementally improve existing processes, but as weapons to disrupt the status quo.

Two examples of industries with perceived barriers to entry that once impeded digital disruption are taxis and financial services.  Like healthcare, these sectors are subject to regulatory compliance and are dominated by well-established players.

That both these sectors are threatened by digital disruption is a warning sign that the health sector should heed. How each of these industries is dealing with the threat offers lessons that the health sector should consider.

Taxis

As recently as five years ago a taxi license was considered a good investment.  Today, the price of these same licenses is in freefall in many cities.  New competitors such as Uber are siphoning customers who once had few alternatives if they needed on-demand transportation services.

Taxis have, for decades, operated in a little-changed regulated environment. A GrowthHackers examination of Uber’s phenomenal and rapid growth notes:

“All told, very few people viewed finding and using taxi service as something enjoyable—it was simply something that they dealt with due to the lack of an alternative. Before Uber you were beholden to an entrenched, monopolistic entity, whose sloppy execution and lack of regard for the customer experience was evident at every touch point.”

A less colourful but equally stark comparison between the taxi incumbents and new entrants such as Uber can be found in a recent survey by Ipsos Reid (conducted for the City of Toronto as part of the city’s review of the taxi industry). The survey revealed that less than one-third (29%) of respondents were satisfied with taxi service while nearly two-thirds (65%) reported that they were satisfied with new market entrant, Uber.

How has the taxi industry and the cities that regulate them reacted to Uber’s entry into the market?  The cities are tinkering with the regulations while the drivers protest.

According to a report by the Mowat Centre as part of the City of Ottawa’s review of taxi and limousine regulations, “Canadian jurisdictions initially adopted a reactive approach to ride-sharing firms, with cities such as Toronto, Ottawa, Montreal and Vancouver cracking down on drivers for by-law infractions or otherwise imposing barriers to operation.”

Even when overwhelming consumer demand forced many cities to reconsider their position and introduce regulatory reform, the taxi industry has continued to fight changes to the status quo.

Financial Services

Even the banks are getting nervous about the disruptive power of digital technologies.  According to McKinsey & Company, banks could lose up to 60 per cent of their retail profits to financial technology startups (often referred to as FinTechs).

Toronto-based FundThrough, which operates a business-to-business online lending platform, is one of many emerging Canadian FinTechs. In a Globe and Mail article examining disruption in the financial services sector, Steve Uster, FundThrough’s co-founder and CEO, observes:

“We believe that we are only at the beginning of this trend of startups popping up and filling a hole in financial services by using technology.”

A PwC report examining how Canadian banks are responding to new FinTech market entrants notes that  “Canadian banks will employ parallel strategies that comprise collaborating with and leveraging some FinTechs while innovating to compete with others.”

Why partner with the FinTechs?  Analysts at National Bank Financial asked the same question in a recent report. “Why, we asked ourselves, is the boring but profitable Canadian oligopoly inviting third parties into their most valuable, profitable business line?” to which they responded, “Simply put, we think they are worried … worried that innovators will nip away at, and ultimately fleece, their Golden Geese.”

How will the banks compete? Victor Dodig, chief executive officer at Canadian Imperial Bank of Commerce, proclaimed in a June 2015 speech that” we are responding with nothing less than a top-to-bottom reinvention of ourselves, and the traditional banking model.”

Summary

The third wave of digital disruption will sweep over healthcare just as it is sweeping over the taxi and financial services industries.  Will existing healthcare organizations ride the wave or be sent crashing into the rocks?

In their report entitled The Fight for the Customer: McKinsey Global Banking Annual Review 2015, McKinsey & Company offers a warning I think also applies to the heath sector:

 “Those that do not seek to transform may well become somewhat digitized, but will likely be stuck in the middle – outwardly modern, inwardly struggling, and moving slowly toward extinction.”

What are your thoughts on the digital disruption of healthcare?  Please share your thoughts with me at michael.martineau@avenant.ca or on my blog at ehealthmusings.ca

Ottawa Digital Health Networking Event

On May 18, 2016 from 5:30 pm to 7:30 pm, HIMSS Ontario is hosting a special networking eventing in Ottawa.  My good friend and digital health commentator, William (Bill) Pascal, will open the evening with a presentation on the state of digital health maturity in Canada. After the presentation you will have the opportunity to explore craft beer, wine and food pairings.  Don’t miss this rare opportunity.

Bill is the former Chief Strategic Advisor, Canadian Medical Association and now Principle, Richard Warren & Associates.  He teamed with Roger Girard, former CIO, Manitoba eHealth (and one of my digital health mentors), to prepare the in-depth assessment of digital health maturity in Canada on which his presentation is based.  Roger will be delivering the same presentation at similar networking event hosted by HIMSS Ontario in Toronto on the same evening.

HIMSS members: Free.

Non-members: $45 (includes HIMSS ON membership).

Location: Mill St. Brew Pub, 555 Wellington St. Ottawa (site of the former Mill restaurant).

Registration & cocktails 5:15-5:45

Speaker 5:45-6:45

Beer/wine/food pairings 6:45-7:30

Sponsored by HEALTHTECH

 

Digital Health: What’s Next?

My most recent “Last Words” article published in Health Information Management & Communications Canada magazine:

A good friend and former work colleague often remarks that once you have worked as a market analyst, you will always think like a market analyst. This observation rings particularly true around New Year’s when I feel the irresistible urge to offer my prognostications on what’s next for digital health.

This year, rather than offer specific predictions, I offer an overview of three major drivers that I believe will influence digital health priorities and direction in the near future.

Meaningful Use

In what might turn out to be one of the most significant announcements of 2016, Andy Slavitt, Acting Administrator of the U.S. Centers for Medicare and Medicaid Services (CMS), declared:

“The Meaningful Use program as it has existed, will now be effectively over and replaced with something better.”

According to healthIT.gov (a web site operated by the U.S., Office of the National Coordinator for Health Information Technology), Meaningful Use is defined as “using certified electronic health record (EHR) technology to:

  • Improve quality, safety, efficiency, and reduce health disparities
  • Engage patients and family
  • Improve care coordination, and population and public health
  • Maintain privacy and security of patient health information

Speaking at the J.P. Morgan Annual Health Care Conference on January 11, 2016, Mr. Slavitt identified what he referred to as the four “themes guiding our implementation” of a Meaningful Use replacement:

  • Reward healthcare providers for the outcomes they achieve using digital health technologies rather than simply for use of these technologies.
  • Customized goals that allow solutions to be tailored to practice needs. Slavitt stated that “technology must be user-centered and support physicians, not distract them.”
  • Levelling the playing field for start-ups and new entrants. This objective will be achieved by requiring open APIs in order to “move away from the lock that early EHR decisions placed on physician organizations” and thereby “allow apps, analytic tools, and connected technologies to get data in and out of an EHR securely.”
  • Mr. Slavitt proclaimed “we are deadly serious about interoperability” and put technology companies that attempt to “practice ‘data blocking’ in opposition to new regulations” on notice when he stated that such practices “won’t be tolerated.”

Each of these themes reflects issues and challenges that have hampered the effective use of digital health technologies by both healthcare providers and the general public.

While the Meaningful Use program does not apply to Canadian healthcare organizations, it did have and its eventual replacement will have a significant influence on the digital health landscape in Canada.

Digital Health Investment

In their year end review for 2015, Rock Health, a venture fund dedicated to digital health, stated that venture funding for digital health companies in 2015 raised $4.5B.  This level of funding was an increase over the record breaking level of digital health investments in 2014 and, according to Rock Health, represents a compound annual growth (CAGR) from 2011-2015 of 32%.

Rock Health noted in their year end review that while “overall venture funding showed a slight dip in 2015, digital health continues to hold a healthy 7% of total venture funding.”  They also remarked that investors continue to show their interest in digital health companies and observed that there is a “growing tail of investors who participated in at least one deal.”

This steady level of funding and growing investor interest leads Rock to declare that “digital health is no longer a novelty.”

Rock Health identified three particular digital health categories that exhibited noticeable growth in funding in 2015: personal health tools and tracking, care coordination, and life sciences technologies.  They commented that “as the industry faces growing pressure to cut costs, digital health will play a key role in enabling engagement with the end-user and improving communication and coordination.

Digital Everywhere

Computing technology, once the nearly exclusive realm of geeks and hobbyists, is now an integral part of everyday life for most people.

According to comScore, a global media measurement and analytics company, an average of 29.4 million Canadians per month accessed some form of on-line service during the fourth quarter of 2014.  Based on Statistics Canada figures, this on-line community represents just over 80% of the Canadian population.

Not only are a majority of Canadians engaging in some form of online activity, comScore notes that they are increasingly doing so across multiple devices including desktops, laptops, tablets, and smartphones. The number of Canadian mobile subscribers grew 5% from December 2013 to December 2014, with just over 80% of these subscribers owning a smartphone capable of accessing a variety of online services.

The pervasiveness of digital technology is changing how digital health solutions are perceived by end users.  Neither patients nor health providers need to be enticed to use digital technology; they do so in most other aspect of their lives. They need only be offered digital health solutions that are both useful and usable.

Summary

By clearly communicating its priorities and future direction, CMS is providing investors with insights that will shape their investment decisions.  This investment, if focused more on addressing user needs and less on certifying compliance with meaningful use guidelines, will likely produce digital solutions that end users will embrace and use.

What are your thoughts on digital health trends and drivers?  Please share your thoughts with me at michael.martineau@avenant.ca or on my blog at ehealthmusings.ca

2015 in review

The WordPress.com stats helper monkeys prepared a 2015 annual report for this blog.

Here’s an excerpt:

A New York City subway train holds 1,200 people. This blog was viewed about 4,700 times in 2015. If it were a NYC subway train, it would take about 4 trips to carry that many people.

Click here to see the complete report.

In My Mother’s Memory: The Usability of Digital Health Solutions

She died on a Tuesday. While my mother’s passing this summer was expected given her illness, I was still unprepared for the range of emotions that I have experienced.  Tuesday will never be the same.

As the oldest child and the family member most comfortable speaking in front of a crowd, I was asked to prepare and deliver my mother’s eulogy.  I found the main theme for this tribute in the words of Maria Shriver, a former First Lady of California and an American journalist:

Our mothers give us so many gifts. They give us the precious gift of life, of course, but they also leave treasured lessons that can guide us along our journeys even when they are no longer with us.”

My mother left me with many treasured lessons.  Her observations on nursing and the use of digital health solutions have shaped my views and influenced my digital health advocacy work.

My mother was a dedicated and caring nurse for whom nursing was as much a calling as it was a career.   She always referred to the people to whom she provided care as “her” patients.  Whenever we spoke about digital health solutions, she reminded me, often in subtle ways, to consider the needs of the people who use these solutions.

Although my mother was, at best, a computer novice, she saw the value in digitizing healthcare.  She bemoaned, however, what she referred to as the “well meaning” attempts to digitize the world in which she worked.  She often remarked that it was as if the people developing these systems “never walked the floor.”

Even though my mother retired nearly a decade ago, recent feedback from healthcare professionals regarding digital health solutions echoes my mother’s sentiments.

Earlier this year I worked with AmericanEHR Partners to analyze data from the annual AmericanEHR Survey on Physician Use of EHR Systems.  Among the various topics explored in this survey were respondents’ views regarding the ease of use of their EHR systems.

When asked whether they were satisfied with the ease of use of their EHR system, just over half (53%) of the survey respondents reported that their EHR system was difficult or very difficult to use.  Slightly more than one-third (35%) reported that their EHR system was easy or very easy to use.

One of the more striking variations in the survey data became apparent when respondents were grouped based on whether they were satisfied with their EHR system.

A significant majority (89%) of those who indicated that they were satisfied or very satisfied with their EHR system also reported that they found their EHR system was easy or very easy to use.

Conversely, for those respondents who indicated that they were dissatisfied with their EHR system, a significant majority (90%) also reported that they found their EHR system was difficult or very difficult to use.

In a New York Times commentary, Robert M. Watcher, author of “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age”, writes:

“Our iPhones and their digital brethren have made computerization look easy, which makes our experience with health care technology doubly disappointing.”

Why do digital solutions like the iPhone or Google’s Gmail have higher user satisfaction ratings than most digital health solutions?  Many experts suggest that an intense focus on usability and user experience is one reason for this difference.

Bennett Lauber, Chief Experience officer for The Usability People, LLC, and an active member of the U.S. Office of the National Coordinator for Health IT (ONC) Policy Committee’s Implementation, Usability, and Safety Workgroup, observes:

“Usability in healthcare can be difficult to achieve … A useable healthcare system must be designed to match the mental models and workflow of its users.  A usable EHR needs to work (effective), work well (efficient), and not cause any unnecessary frustration (satisfying).”

The ONC appears to agree with the need for a greater focus on usability and the use of tools that contribute to it. Their 2014 certification criteria for electronic health record solutions includes a requirement that vendors attest to using user centered design processes as well as report on the results of their usability testing.

Unfortunately, according to a report from the National Center for Human Factors in Healthcare, many of the 50 electronic health record (EHR) solution vendors serving the highest number of healthcare providers did not meet the ONC’s usability requirements.

Using data submitted by the vendors to the ONC as part of the certification process, researchers at the National Center for Human Factors in Healthcare found that 34% of these vendors had not met the ONC certification requirement of stating their user-centered design process.

Perhaps more concerning, 63% of these same vendors used less than the standard of 15 participants during the usability tests of their EHRs while only only 22% used at least 15 participants with clinical backgrounds.  Nearly one in five (17%) vendors used no physician participants and 5% used their own employees when conducting usability testing.

Researchers commented in the report that “the lack of adherence to usability testing may be a major factor contributing to the poor usability experienced by clinicians.”

So, what happens when digital health solutions are as usable and as useful as other digital solutions? When asked by Robert Watcher what the equivalent of the “Jeopardy!” victory would be in healthcare, Eric Brown, lead engineer of the Watson Health team at IBM replied: “It’ll be when we have a technology that physicians suddenly can’t live without.”

How do you rate the usability of the digital health solutions that you use?  Are there solutions that you or your user community can’t live without?  Please share your thoughts by commenting on this blog post.

Mike

 

Apple Watch: 5 Second Rule

For the better part of the last two years, I have written and spoken about the Apple Watch and the related HealthKit ecosystem. A little over a month ago, in what might be best described as an overwhelming desire to “walk the talk” (or, perhaps, to put my money where my mouth is), I purchased an Apple Watch. While it is still, in many ways, an expensive tech gadget that suffers from the limitations inherent in any first-generation device, the Apple Watch offers a compelling glimpse of a future in which computers are worn as well as carried.

Check out the remainder of this article here.

Mike

Apple Watch: Transformative Technology or Passing Fad?

The following article recently appeared in Healthcare Information Management & Communications Canada, the journal of COACH, the association for Canadian health informatics professionals:

Earlier this spring (though it was to tell from the snow still on the ground) I had dinner with several stakeholders from a project on which I am currently working. One of my dining companions, it turns out, reads my columns and blog posts.

“So, what new gadget are you planning to buy next?”, he asked between the appetizers and the main course.

“The Apple Watch,” I replied without hesitation.

My dining companions did not share my enthusiasm for Apple’s latest product. Indeed, I am, at least among my friends and family, the only person with any interest in the Apple Watch.

The results of my informal poll are consistent with the results of a recent Reuters/Ipsos survey that found only 6% of U.S. adults plan to buy an Apple Watch. This same survey revealed that an additional 18% of respondents were “very” or “somewhat” interested in buying an Apple Watch while just over three quarters (76%) expressed no interest at all.

In the Reuters article in which the survey results were published, Van Baker, an analyst with information technology research and advisory firm Gartner, notes that “many potential buyers will end up holding off until the second version of the watch, likely to appear next year.”

Among my circle of friends and professional acquaintances, price and questionable value proposition were cited as major reasons for not considering purchase of an Apple Watch.

Steve Ranger, the UK editor-in-chief of ZDNet and TechRepublic, notes in a recent ZDnet article that many of these same people who see little value in the Apple Watch also stated five years ago that “they would never buy a smartphone” for similar reasons. They are, he sarcastically quips, “the spiritual descendants of the people who thought the world would only ever need five computers.”

Mr. Ranger suggests that “just as the smartphone created new needs and fulfilled them, so will smartwatches.” They are not, he contends “just a smartphone shrunk down and strapped to your wrist” but “something new and different.”

So, what is the Apple Watch’s raison d’être? According to a Wired article entitled “iPhone Killer: The secret history of the Apple Watch”, smartphone users “are subject to the tyranny of the buzz – the constant checking, the long list of nagging notifications.” Kevin Lynch, Apple’s Vice-President of Technology, states in this article that the Apple Watch is intended to provide this level of engagement in “a way that’s a little more human, a little more in the moment when you’re with somebody.”

Technology columnist Farhood Manjoo offers a similar perspective in a New York Times article in which he reviews his recently acquired Apple Watch. “By notifying me of digital events as soon as they happened, and letting me act on them instantly, without having to fumble for my phone, the Watch became something like a natural extension of my body – a direct link, in a way that I’ve never felt before, from the digital world to my brain.”

After using the Apple Watch for a week, Mr. Manjoo notes that it has the potential to “address some of the social angst wrought by smartphones.” He predicts that the Apple Watch “could usher in the transformation of social norms just as profound as those we saw with its brother, the smartphone, except, amazingly, in reverse.”

A key ingredient in the transformative potential of the Apple Watch is the manner in which Apple’s Watch interacts with the wearer. While most computers to date, including smartphones, rely primarily on two senses – sight and sound – to convey information, Apple created what it calls a “taptic engine” for the Apple Watch to deliver physical sensations to the wearer’s wrist.

Haptics, the underlying technology on which Apple’s taptic engine is based, have seen limited use in consumer devices, mainly video game controllers. Brian Hall, a writer specializing in technology and culture, offers a succinct summary of haptic technology in a recent Macworld article:

Haptic technology—haptics—uses force upon the skin to deliver real-time tactile feedback. These physical sensations are created by tiny motors called actuators. Done right, haptics can mimic the feeling of a pin prick by a wearable that tracks your blood sugar, simulate the plucking of virtual guitar strings on a tablet screen, or re-create the physical recoil of a phaser from your favorite game controller.

In this same article, Mr. Hall suggests that haptics “may prove most useful, possibly revolutionary”. He contends that Apple, “with surprisingly little fanfare” has “embraced a new user interface” based on touch.

Not everyone is enthusiastic about the potential of haptics, particularly as a notification technology. Fellow Canadian blogger Tim Wilson states in a recent blog post that “the Apple Watch sounds more like invasive nag” than a useful tool and seriously questions whether it is the “game-changer” that many people contend it will be.

Technology columnist Farhood Manjoo suggests that the Apple Watch, unlike the iPod or the iPhone, is not “suited for tech novices.” Instead, he suggests that “it is designed for people who are inundated with notifications coming in through their phones, and for those who care to think about, and want to try to manage, the way the digital world intrudes on their lives.”

Will I buy an Apple Watch? Yes, I have the same feeling about the Apple Watch as I did about the iPad when it was first announced. I think the Apple Watch is one of those devices that once you use it and integrate it into your daily activities, you will wonder how you did without it.

Are you considering purchase of an Apple Watch? Do you think that the Apple Watch is a transformative technology or a passing fad? Please share your thoughts by posting a comment

Mike