The Future in Present Tense: One Industry Luminary’s Take on the Current Landscape of Healthcare

Yes, I think they do. Well, looking at the older cohort—my mother still practices, and my father is now retired—some of them just want to get out now. But there is a whole group who kind of get the message and are grudgingly accepting that they have to use EMRs, and grudgingly accepting the whole patient engagement thing. And I think in a way, this is just a transitional issue, because generationally, the younger doctors are all on Facebook, and they don’t even understand what the issue is. What’s scary to them is that they’re so used to having technology immediately available in their hands that they don’t fully appreciate the PHI security issue, that your iPhone app may not be secure enough!

Do CIOs as a group understand where things are headed, in your perspective?

Yes, I think that CIOs have some of the most thankless jobs today, even though they’re fascinating jobs, but on the other hand, they are the ones who are out in front with a lot of risk. You’ve got the tension that a CIO feels over ICD-10 and 5010, but you also need to satisfy the docs and satisfy the BYOD demand, and the docs need single sign-on for everything, and by the way, if we have a single breach, you are in deep, deep trouble, and by the way, we’re cutting your budget and this needs to get done in the next year. And by the way, we’re competing for qualified IT people with Epic [the Verona, Wis.-based Epic Systems Corporation], and we’re only able to pay about three-quarters of what Epic pays. I think CIOs get it; it’s more the constraints and the priority issues.

Many people in healthcare have been expressing concern about the growing dominance of Epic in the industry, as a potential policy problem, while others believe the concerns are overblown. What are your thoughts?

I think it’s a legitimate concern whenever any single vendor becomes dominant, per monopoly and pricing power issues; there’s certainly something to that concern, and I’d think there’s probably a concern for Epic as well. And I think that most companies agree that competition makes them better. That said, one of the issues we’ve had in healthcare that makes it somewhat different from other industries, is that we have had extreme fragmentation both on the supply and demand sides. Look at what happened in retailing when Wal-Mart and Target started standardizing, or in the airline industry when American Airlines got Sabre; or in banking, with NICE, and such. So in some ways, there’s a certain amount of standardization that needs to happen in this industry, and even consolidation, and we need some of that.

The fact that I can send an Outlook Invite to someone in India, and they can receive that Invite and respond to it, is kind of amazing, right? So there’s power in that. And part of why Epic has done well is that that they’ve standardized implementation somewhat as a craft; and it reflects some of the frustration that a lot of organizations have had with this interoperability mire. And that kind of thing has happened in some other industries.

That’s what banking did, of course. But some people are feeling some ambivalence around this situation in healthcare IT.

Yes, and ambivalence is healthy; there are some good and bad aspects involved. And with CommonWell, there is some genuinely good intent, knowing some of the people involved. But there is also the reactive side of it which is, Epic is eating our lunch, and the rest of us had better get together so that we collectively can survive, so that’s a part of that reaction as well. So in some ways the market is kind of addressing that. But one of the interesting things of this to me is, if you look at other industries like airlines, banking, and retail, who was it that did the consolidation? Either the suppliers or the demanders/consumers. In this case, it was the vendors. The providers are so fragmented that they can’t consolidate; the same thing with the consumers. So it’s the vendors. And that’s kind of odd in a way, right? In the airline industry, it was American Airlines. And in the banking industry, it was the banks who told the vendors they wanted this thing. But here, the vendors decided they would  get together and standardize.