Giving a patient medications in the ER, having them pop positive on a test, and then withholding further medications because…
Time Capsule: WWJD: What Would (Steve) Jobs Do If He Worked in Healthcare IT Instead of Apple?
I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).
I wrote this piece in June 2009.
WWJD: What Would (Steve) Jobs Do If He Worked in Healthcare IT Instead of Apple?
By Mr. HIStalk
I’m having an identity crisis. After working exclusively with Windows PCs for decades, I bought a Mac for a family member.
The MacBook is easy to use, sleek, and full of eye candy. Its lit-up Apple logo exudes barely contained and self-aware hipness. I’m not fully convinced that it’s not just “different” instead of “way better” than the usual PC clones running Windoze, but I admire Apple for using its advantage as a proprietary hardware/software vendor to package cool design, thoughtful engineering, and a boffo user experience into a machine that ends up doing pretty much the same stuff you can do on a PC, only making you feel smug while doing it.
All the Mac people I’ve known were artsy types. I figured them to be right-brainers who were too preoccupied with social protests and making vegan brownies to handle manly computer tasks like using Regedit or spending a pleasant afternoon reinstalling WinXP after running out of options to fix one corruption or another. And, Steve Jobs in his jeans and turtleneck was one beret short of being a full-on artiste, while Microsoft gave us the hyper-annoying loudmouth Steve Ballmer as the cartoonish, kill-our-enemies capitalist pig who was ideally cast for the political climate of that time.
I’m convinced there’s a fortune to be made for someone to create the healthcare IT equivalent of Apple.
The industry is a lot more like Windows than Mac. Systems were clearly designed with user experience and brilliant design way down on the list, which is pathetic given that busy doctors and nurses are supposed to use them happily and constantly while not killing patients. Instead of Apple-like control over the entire ecosystem, customers just buy whatever systems they want, throw them in the same data center, and then fuss when the end result isn’t exactly seamless.
Systems break a lot, they disappoint their owners, and they are a long way from being cool. Fanatic loyalty to a product or company is unheard of, not too surprising considering that vendors titrate their effort (and quarterly expense) to a customer satisfaction level that’s only very slightly above the “let’s kick these guys out and start over” level.
Epic is kind of Apple-like. They have a quirky CEO who has an unwavering agenda, a funky campus, products that carry a premium price and never get de-installed, and tight control over their ecosystem. They hire easily influenced kids instead of other vendor’s retreads. Their customer list is relatively small but cult-like, jostling for space at the annual Verona gathering like Apple-heads annually migrating to California.
Epic does shun one of Apple’s core competencies, however: slick marketing that intentionally creates a world-against-us mystique. People still talk today about that shocking and downright arrogant 1984 Super Bowl commercial that declared war between an Macintosh-empowered creative class and oppressive Big Brother mainframers portrayed as storm troopers (which was really more of a minor skirmish since Apple wasn’t exactly a force to be reckoned with back then).
On the physician EMR side, you’ve got companies that have some Apple characteristics as brash giant-killers: eClinicalWorks, athenahealth, e-MDs, and a few others. Big companies have bought some of the potential Apples, although it’s hard to simultaneously bring them into the corporate fold while not screwing up what made them interesting in the first place. (What would you get if GE bought Apple? GE.)
So here’s my business advice (understandably highly valued and sought after since I’m a wage slave in a non-profit hospital who knows nothing about business): now’s the time to start up a physician systems company using Apple as the model. The market is fragmented, some of the major players and their technologies are stuck in the 1980s, Uncle Sam is throwing money around like only someone with a currency printing press can, and the number of doctors doing “none of the above” on an electronic system is 80 percent. Getting even 5 percent of that market would be a fantastic business.
And here’s my highly secret strategy that nobody would think of: hire a few people from Apple to show you how to do it. The reason HIT products and companies look alike is because the same people were involved, floating from one job to another and bringing their same preconceived notions along for the ride.
You’ll know when you’ve succeeded: users will clamor to have your lit-up logo on their laptops to show everyone how cool they are.
This is frankly one of the things I needed on a Friday. Funny as heck and too the point. Never made the connection between Apple and EPIC…brilliant. The truth is there in front of us. Keep hiring the same guys wearing different Jerseys and the playbook will have the same results. Bring in different industries to Healthcare too! The fact is the loyalty to EPIC seems to fade after someone notes the cost was not 30% above budget… but 300% once you look at the support model. But like much else in HC, this change is very slow.
You on the other hand are fast and to the point. I hope to see more of your humor and insight again (maybe on a Friday again). Thank you.
Oi vei. Stick to your day job puleeeze.
Epic is no Apple. Epic runs on mumps. There is NO innovation from Epic.
What sets Epic apart is Judy herself. Not her products. And the lack of competent executives at her competitors. She knows (and I do as well) the dirty little secret in sales/business.
I admire Epic because I know how Judy does business. Not their products.
Your premise of a new EMR product “based on Apple” is proof you don’t get it either.
Steve Jobs is rolling in his grave.
Stay away from the movies will ya.
Vendors like AthenaHealth, PracticeFusion and even the iPad only DrChrono are examples of companies that have made inlets to a more sleek and modern Web-based/Tablet-based experience for physician end users. Even so, these systems are designed in .NET, Flash and xCode and the useability still lacks. The market is yet to see a true game changing product emerge. When are we going to see an open standards based EHR that uses HTML5, CSS3, JavaScript designed front end? When are we going to see a Big Data like solution using something like Hadoop the drive the backend data structures of these systems? The modern IT solutions and products that exist in the mainstream Web 2.0 type companies like Google, Facebook, LinkedIn, Netflix and others still seem a long way off in the world of Healthcare IT.
If I had read this back in 2009, I would have agreed with the analog between Apple and EPIC. Both were the darlings of their respective industries. I’m convinced however that though both remain dominant in their market niche, that their “wonder” years are on the wane. The reality is not everyone is going to switch to an iMac, a MacBook, an iPad or an iPhone thought their market share remains daunting. Likewise, not everyone is going to buy or switch to Epic as their EMR. In fact, I just read in a KLAS blog that the torrential flood of users leaving their EMR for Epic has reduced dramatically and even those buying Epic over Cerner, the two biggest players has reduced to 2 to 1 (from 5 to 1) a few years prior. Further, without Jobs at the helm, I am increasingly forecasting that Apple’s best days may be behind them not necessarily in market share but in being the defacto techno visionary company of choice. Both Samsung and Google seem to be on the rise at the expense of Apple’s share price and I don’t consider either of those companies the longer term alternate to a Jobs-led Apple either. I think what relying on a celebrity CEO like Steve @ Apple, Bill @ Microsoft, or Judy @ Epic does over time is sets up their company for a slow steady decline after their influence is gone. I think the industry is saying we need to rely on a more balanced approached to who we put all our faith in. Though we want a single company or individual to rescue our healthcare industry, I choose to rely on the well informed individual patient and their families about the blessings as well as the limitations of medicine as the key to healthcare’s future.
yeah, something like this…..http://healthsystemcio.com/2011/02/08/what-if-facebook-and-amazon-built-an-emr/
Thought provoking. The health care industry in general has gained a lot of benefits from the influence of other industries, such as the aviation industry. I remain open-minded about other industries tiptoeing into the health care setting … as long as one remembers that patient health is not predictable nor uniform and never a finished product. That lean staffing potentiate risks such as disrupting workflows for those that provide direct care, medication errors, and increased risk of falls/lack of supervision. That one is cautious and realizes that there is such a thing as bad engineers and engineering and that health care leaves no margins for error without consequence.
Where is the Apple of healthcare? I have been preoccupied with this question for the last few years. It always nags at my subconscious especially after meeting with a vendor on a sales call. After a massive vendor conference, the thought barely leaves me for several weeks. I am always disappointed coming away from these type of events hoping to find a true innovator and while I have uncovered a few, they are usually struggling against the entrenched players. I recently read a good article about Tesla and the “Rent Seekers”
http://steveblank.com/2013/06/24/tesla-versus-rent-seekers
Rent seekers are determined to keep everyone at the status qou, accepting ill designed software and below par service using Fear, Uncertainly, and Doubt tactics to steer healthcare providers away from scary upstarts and collect their dues.
http://en.wikipedia.org/wiki/Fear,_uncertainty_and_doubt
There are converging technologies that I think can bring about a true change, things like natural speech recognition, converged and massively parallell computing and storage architecture for the masses, machine learning , and ground-breaking personal computing form factors. These things if put together in the right combination with technologically relevant software structures, could truly revolutionize the healthcare market. Who will do it though, certainly not the rent seekers, I think your article from 2009 is spot on that it needs to come from developers outside of healthcare, if not the apple folks themselves but from a group of people where there are no preconceived limitations with great funding and time to develop.
I have personally discussed this very issue with some friends who design software for companies like twitter and yahoo who referred me back to Atul Gawande’s book “The Check List Manifesto” and said if they were to design something it would be more about using machines to supplement and aid healthcare rather than trying to mimic a paper chart. In the end it would be great to see a fully baked product come out of silicon valley, ready for mass consumption, a delight to use, and easy to maintain at a reasonable price. In fact wouldn’t it be great it was released as open source by people who aren’t trying to buy their own island, but who are trying to fix one of our nation’s biggest problems?
Great question…and funny…
and here’s what Steve WANTED to do. I resurected an old promo video from 1998 when Apple was just getting involved in the HIT world. It was their vision for 2008. I think they got the image /video and communications pieces done…but missed by a mile the real medical component. (sorry for the minor skip on the video…technical old VCR tape problem!)
Enjoy..
http://kelzongroup.com/applevideo.html
Wow, having recently seen the informed consent screens for physicians in Epic I gotta question your eye for user experience. The only thing Epic and Apple have in common in dominating their industry and a closed system strategy. Epic didn’t innovate, they really didn’t do anything differently, and they didn’t do it cost effectively. This company you call innovative had a backup plan of PAPER at Sutter Health. Third parties aren’t writing hundreds of thousands of apps on Epic’s platform – because they can’t. You can’t even Google a screenshot of their amazing software because they won’t let their clients share it. Apple would have proudly put it in a TV ad because they knew few people could replicate it. Innovating in healthcare would be something that impacts outcomes of human lives (like the way Apple changed the way we use our phones) instead of simply fattening the wallets of HIT execs, consuming all the oxygen in the vendor space for years, all the while robbing the taxpayers. The analogy is just way off. While we’re at it, Apple couldn’t even change healthcare unless they negotiated directly with the insurance companies to subsidize your care plan, owned every hospital in their “network” down to the perfectly pantone-painted gowns/blankets, and gave you 10 options for chief complaint. Apple isn’t even running the desktops in hospitals. As a technologist in healthcare, I think some people in our industry just forget how damn dysfunctional healthcare is living in their respective hospital bubbles. We vendors get to see the big picture across the country – from 100 bed community hospitals to the big, multi-facility IDNs. Apple wouldn’t touch this industry because it is a quagmire trying to treat patients that don’t want to change their lifestyle.
Comparing Epic & Apple….For those of you mentioning “open-source”, please STOP right there! Apple is all about closed system. If Apple were to enter healthcare, not only would they recreate the EMR/HIE/Analytic software as we know it, but they would developed hardware to specifically support this software.
IMO- McKesson has a better opportunity to mimic Apple than Epic. It is about total control over all products and tying them together (“interfaces” don’t exist in Apple’s world).
Chris…”Apple wouldn’t touch this industry because it is a quagmire trying to treat patients that don’t want to change their lifestyle”
Good comment, as the video I posted shows, Apple did ‘touch’ health care, got burned and got out (along w MSoft, Google, and 50 other Fortune companies over 30 years). So you may have some very valid points.
I’m pretty sure Steve Jobs would not have developed such an exclusionary system as Epic.
Cj Carver – Apple not exclusionary? Then how come I can’t change the battery in my IPad, Iphone, etc?
And I have read on this web site in several recent posts where Epic is far from ‘exclusionary’. Within the last week I read where they give the source code to their clients so they can link to it and better understand the design, see Reliant Health piece:
http://histalk2.com/2013/09/04/histalk-interviews-larry-garber-md-medical-director-for-informatics-reliant-medical-group/
Anybody have a copy of the Apple source code?
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