z3ugma · z3ugma · Dec 19, 2019
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+title: Big Outsiders Won't Revolutionize Healthcare IT
+layout: post
+date: 2019-12-19T22:22:04.299Z
+published: false
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+Brandon Hamilton  2 days ago What do folks make of this? I don’t think it’s been posted yet: https://www.youtube.com/watch?v=P3SYqcPXqNk
+YouTubeYouTube | Google
+Google Health - Tools to help healthcare providers deliver better care
+
+Jeff Wells  1 day ago I have a couple of initial thoughts. First, Google appears to be proposing to build a better interface on top of existing EMR’s, and bringing some of their technologies to bear in the process. On the surface this might seem attractive since existing EMR interfaces are seen as a significant pain point for clinical staff. My second thought is that this may be a very difficult sell at the healthcare system level. They’ve committed to a core EMR (e.g. Epic) and expect everything to revolve around that application. The amount of configuration and training for these large implementations is huge. To think that they’ll be willing to retrain staff on a Google interface is a stretch, not to mention the interface work, etc. 
+Just some initial impressions based on prior work with HC customers...I could be entirely underestimating this. 
+Also sent to the channel
+
+samuel:ambulance:  1 day ago Current EMR systems are varying shades of awful. Spend some time on @EPICparodyEMR’s twitter feed to get a sense of just how bad. So this does seem like an exciting development. Watching the video from a clinician’s perspective, I can see how much of an improvement Google’s interface is. As Jeff said, the amount of configuration and training around EMRs is enormous and the resistance to even small changes in that configuration is very high. Additionally, current EMR systems are built around the needs of healthcare administration finances and billing, not around improving workflows for clinicians or patient care. The actual users (physicians, other providers, nurses, case management, etc)  of EMR systems vocally hate EMRs. Electronic documentation has been connected (in everything from blog posts to peer reviewed journal articles) with physician burnout (and depression/suicide), worse patient outcomes, and even direct harm to patients. Given this and the uniform lack of other options in the EMR market, I feel that the market has must have strong incentives that do not align with the end user’s needs and that new entrants with a vastly different vision than the current run of EMRs is going to have significant challenges to overcome.
+
+Fred Turkington:flag-madison:  1 day ago This is true of basically any enterprise software product, and is more a function of centralization & standardization than it really is about bad software
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+Fred Turkington:flag-madison:  1 day ago The smartest approach I think I've seen is http://barnett.surge.sh/
+
+Fred Turkington:flag-madison:  1 day ago Disclaimer: I worked at Epic doing customer success engineering for 7 years and I've seen both sides of the story
+
+samuel:ambulance:  1 day ago Definitely the pattern with enterprise software. I think a huge part of the problem is that the people buying software aren’t the people using it. 
+
+Fred Turkington:flag-madison:  1 day ago But that's true of lots of enterprise processes
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+Fred Turkington:flag-madison:  1 day ago e.g. HR and benefits policies that trample individual situations around sick time, family leave, etc
+
+Fred Turkington:flag-madison:  1 day ago I'm sure you've heard of a large company unfairly screwing an employee by sticking to their policy
+
+Fred Turkington:flag-madison:  1 day ago The way around it is decentralizing within the enterprise - push down decision-making and monitor for outliers
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+Fred Turkington:flag-madison:  1 day ago That's essentially what BYOD is in IT
+
+Fred Turkington:flag-madison:  1 day ago Barnett is a good proposal for a BYO...Software
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+Fred Turkington:flag-madison:  1 day ago The incentives in the United States aren't there except for large ACOs and payer/provider orgs like Kaiser Permanente, the VA, the DoD/MHS
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+Fred Turkington:flag-madison:  1 day ago So I don't think Google will be the one to revolutionize this space, with their focus on centralization of their own tech. They'll be implementing pretty colors on top of the fundamental truths about enterprise software
+
+Fred Turkington:flag-madison:  1 day ago The revolution will come from people investing in decentralization of user interfaces and federation of data. See Redox (company), and FHIR/the Argonaut project (OSS) for the teams that I think are doing the hard work necessary to make it happen
+:100:
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+samuel:ambulance:  1 day ago Very astute analysis. Couldn’t agree more. I certainly hope things will align to deliver on this decentralization. 
+
+Brandon Hamilton  7 hours ago Great stuff
+
+Brandon Ballinger  2 hours ago I think Apple's work in health—letting patients import their medical record to their phone—is a really promising indirect approach to this same problem. Once patients have their records in their pocket, that becomes the natural "center of gravity." I think over 3-5 years, an app ecosystem will develop, and eventually somebody will build an app that succeeds in attracting a critical mass of both patients and doctors, bypassing Epic/Cerner and centralized hospital purchasing departments.
+
+Brandon Ballinger  2 hours ago I think that directly building EMR software and trying to sell it to hospitals, or even get hospitals to adopt it for free, will likely be a dead end for Google. Doctors have been complaining about EMRs for 10+ years, so the pain has always been there. It's just the purchasing / adoption incentives of hospital CIOs don't have much to do with either the patient or doctor experience.