Health IT from the CIO’s Chair 11/4/15

The views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers.

Left or Right?

I recently participated in a panel discussion on the topic of collaboration tools in healthcare. While I was probably invited to extol some wisdom as a so-called expert, I found myself instead being educated by others on the panel and the audience.

I was reminded that as EMRs get little love in a crowd of doctors, CIOs equally get little love in a mixed crowd of venture capitalists, digital health CEOs, and the usual big vendors in the “helping healthcare move from fee-for-service to value” game.

The lack of love actually extended beyond just the CIO — it was aimed at the whole IT enterprise. The words “disruption” and “innovation” were thrown around in a context that implied the establishment (enterprise IT led by a luddite CIO) just needs to get out of the way.

My first reaction was of course to minimize the feedback and chock it up to folks that don’t understand the nuance and complexities of healthcare delivery. But as the panelists spoke and the audience reacted, it was not so easy. The trouble was, these folks were making great points.

I often get asked what I do as a CIO. My well-rehearsed answer is that I manage teams that help translate workflows and build engagement to advance our organization’s use of enabling technologies. My old answer was I fix computers, so the new one is better, right?

Anyway, when I break down the work our teams do and really think about how much time we spend on change management and building engagement, I’d say that easily more than half of the time is spent around some form of convincing people to adopt technology. Contrast that with users choosing to use new technologies on their own. You start to wonder: can corporate users as consumers bring their own adoption to work alongside their BYODs?

I heard someone say a while back that we love new technologies at home and hate them at work. My fellow panelists made this same point. When technologies emerge that make your life easier, corporate users — who are consumers at home — will choose them and use them across their digital lives. I always try to remember that I used Dropbox before it was allowed by corporate policy.

Below is a chart that shows the most-blacklisted and deployed apps in the workplace. While not a perfect lineup, it is not a coincidence that the ones on the blacklist (left) are consumer driven and the ones most deployed (right) are enterprise sponsored. Again, not perfect alignment by each company listed, but I bet in a straight up poll the blacklisted would win the popularity context by a wide margin.

I’d offer up a few observations. The first is that productivity tools are different from rich-functioning workflow applications. The list includes primarily collaboration tools — you don’t see vertical applications, line of business transaction systems, or customer-facing business apps.

The second is that “land and expand” works. If you give people what they want, they will use it, and once a tipping point is achieved, the solution morphs into an enterprise one. Let’s give Aaron Levie, CEO at Box, a ton of credit for building a really credible enterprise business from early roots of “land and expand.” I bet if you asked him, he would tell you how hard it was and how many nuanced features had to be built that not a single consumer would appreciate.

Translating this to the landscape of digital health, I think it means that enterprise IT needs to better recognize emerging tools that consumers are driving into the company and find ways to adopt them – faster! I also think it means that vendors with a “land and expand” approach need to think about how they will transition from the left side of the chart to the right. While consumers seek instant usefulness from point features, healthcare organizations — like all corporations — need a lot of integration and complete feature sets.

My advice to left-side digital health companies is to find an enterprise partner, a healthcare organization that loves the idea of your product and wants to help you learn the nuance and complexities. But most importantly, one that will help you understand how to architect for a complete feature set. It may take a while, but the hard work and the longer road taken will pay off. The overnight success healthcare software vendors I meet all tell me they became an overnight success after years of hard work building the product.

Darren Dworkin is chief information officer at Cedars-Sinai Health System in Los Angeles, CA. You can reach Darren on Linkedin or Follow him on Twitter.