Readers Write: Lessons on How to Survive in Healthcare

Lessons on How to Survive in Healthcare
By Nick van Terheyden, MD

From Samsung to Google to salesforce.com, the flurry of tech companies making a healthcare play over the past few months has left me both excited and dismayed. Excited because these companies have, in their own ways, revolutionized the way people interact with technology. Dismayed because of the steep hill they must climb and their battle to truly make their mark in the healthcare space.

We’ve seen it before. Tech companies dipping their toe in the water and then jumping back when they start sinking ankle-deep and losing their footing. From my 25+ years sitting at the intersection of medicine, technology, and policy, here’s my advice to these tech giants looking to make their mark in healthcare.

• Get out of your comfort zone and consider the clinician. One of the biggest misses for these tech companies entering into healthcare is they’re expecting the patients to drive the revolution. That’s where they’re comfortable – with consumers. But so much happens on the clinical data side that needs to be factored in. Data needs to flow both ways. Even more importantly, doctors and nurses are drowning in a morass of technology and data that in many ways is hindering their ability to do their jobs effectively and with the passion they had when they entered the field. Add on the fact that working with and interpreting information gathered by a clinician about patients is not a pure art or science. That makes it hard to create consistency in working with it. While a patient app, sensor, or portal is nice, any company entering into healthcare needs to pay as much attention to the clinician as to the patient.
• Build trust. We’re not making widgets. Google can’t mine healthcare data the way it mines ads and shopping data. It’s one of the major reasons they’re feeling the pain — it doesn’t fit into their core business. Healthcare data comes with all sorts of security and regulatory challenges, but even more important is that the healthcare consumer is a different kind of consumer and implicitly trusts their healthcare professional. They are already wary of ads targeted to their own needs – layer in data about their prostate exam and it becomes even more personal and they’re on the defensive. People interacting with the healthcare systems are typically vulnerable, stressed, and sometime scared. They need to trust their sources. Companies like Apple and industries like banking have built enormous trust with consumers, but replicating that in healthcare requires a different approach.
• Stop looking for standards and release data from hostage. For these companies to be successful, they need to learn to operate outside of the world of data standards. Google was wildly successful moving into email, successfully because the iMac and Simple Mail Transfer Protocol (SMTP) made it easy. There’s no such advantage in healthcare. There are so many variations of standards – from Health Language 7 (HL7) to Clinical Document Architecture (CDA) to the Continuity of Care Record (CCR) and Digital Imaging and Communications in Medicine (DICOM) – that even when they do exist, they’re insufficient for sharing. But there may be an opportunity for Google or another company to actually create a new standard and have it take off. While Google is good at navigating and working with large amounts of data (i.e. Google Maps is constantly updating itself to have the most accurate information), the truth is that patients are ultimately going to own their healthcare data. For anything to change and for progress to be made, it all needs to be easily shared. How companies can turn a profit from shared data remains to be seen.

The more innovation in healthcare, the better for all of us. We need it more than ever. But any new entrant into the space needs a little Healthcare 101 to be successful and to make a difference in the lives of patients, clinicians, and their caregivers. 

Nick van Terheyden, MD is chief medical information officer of Nuance Communications of Burlington, MA.