How we can consumerize health care

Note: this is co-posted on O'Reilly Radar

Recently I wrote about one my my key product principles that is particularly relevant for designing software for the enterprise. The principle is called the Zero Overhead Principle, and it states that no feature may add training costs to the user.

The essence of the Zero Overhead Principle is that consumer products have figured out how to turn the “how-to manual” into a relic. They’ve focused on creating a glide path for the user to quickly move from newbie to proficient in minimal time. Put another way, the products must teach the user how they should be used.

Just this weekend, I downloaded a new game for my son on the iPad, and he was a pro in a matter of minutes (or at least proficient enough to kick my butt). No manual required. In fact, he didn’t even read anything before starting to play. This highly optimized glide path is exactly what we need to focus on when we talk about the consumerization of the enterprise.

This week, the first Strata RX conference will focus on bringing data and health together. Just as in national security (the place where we came up with the Zero Overhead Principle to help combat the lack of tech adoption by overloaded security analysts), there is tremendous opportunity to apply lessons learned in the consumer space to the health care sector. We know the space needs disruption and it is a way to make constructive disruption with a rapid adoption cycle.

Take, for example, my sister who recently started her residency at one of the most well regarded medical institutions in the world. How did her training start? With a meet and greet so all the residents could get to know each other? An orientation on what they could expect from their training? Or perhaps, an inspiring speech about the choice they’ve made? No, none of the above. Her first day started with an eight-hour training on health IT systems! Only the day after did they finally have a meet and greet.

As another example, talking to a chief physician of a major health care division, this person told me about how they have worked to create programs where one physician can help another to increase proficiency on their state-of-the-art IT systems. When I pushed on why they would want to spend such critical time in this way, this person remarked about the amount of time physicians spend working in those systems (e.g., reviewing films, tests, etc). To me this is horrifying. Health care professionals (not just the physicians) go through tremendous training, already have brutal hours where they are literally making life and death decisions, and now we’re subjecting them to an absurd amount of overhead training due to the IT systems. Sure the systems are complex, but so are Google, Facebook, and LinkedIn. When was the last time you looked at a manual or took a training class for any of those products? We must not allow complexity to be used as an excuse to accept technology that requires anything short of the Zero Overhead Principle.

The time to consumerize health care is now. Just like entrepreneurs are doing with the enterprise, we need to apply consumer product principles to health care. Let’s build systems that create a dialogue with users. For example, when someone gives a dosage of 100 mg/liter instead of 10 mg/liter the technology presents a dialogue box that simply asks, “Did you mean 10 mg/liter?” instead of providing either an obtrusive error message, or worse, letting the mistake happen. Let’s focus on the design of our technology to be interactive so that it facilitates efficiency. For example, when a physician enters a diagnosis, they are also presented with a dialogue that says, “Some people who were diagnosed with X were also diagnosed with Y.” This functionality is the equivalent of the serendipity that Amazon provides when users are browsing or checking out of their site, and it can be totally relevant and helpful for health care systems.

The bottom line is there is no excuse for violating the Zero Overhead Principle even in areas as complex as health care. By leveraging the key lessons that are now standard in the consumer space, we can put the power back into the health care provider’s hands.

Here's the orginal post on the Zero Overhead Principle that was posted on TechCrunch

The enterprise is back. We’re seeing a resurgence of companies to help support everyday work tasks. Workday is replacing stodgy-feeling HR systems with intuitive software that users can easily navigate. Dropbox and Box are resolving the time-old challenge of file sharing and alleviating the frustration of using SharePoint. Even LinkedIn is providing novel recruiting and career management solutions for the general consumer and the enterprise customer. But while these successful companies are tackling different issues, their general product philosophy is much closer than many realize.

A central theme to this new wave of innovation is the application of core product tenets from the consumer space to the enterprise. In particular, a universal lesson that I keep sharing with all entrepreneurs building for the enterprise is the Zero Overhead Principle: no feature may add training costs to the user.

My team and I at the Department of Defense discovered this vital rule in the biggest enterprise of them all — the U.S. government. After 9/11, we were tasked with building new technologies to support counter-terrorism analysts, and we quickly learned a critical lesson in how the analysts interacted with technology. We observed that regardless of how powerful the new technology was that we deployed, our largest challenge was getting the analysts to adopt it.

The real challenge for analysts is that they are already overloaded and tend to ignore additional tools that require training (remember these guys have real time pressure).  So we had to adopt a different mindset. Our products had to work naturally with the analysts’ work styles. Period.  That’s the Zero Overhead Principle. Put another way, our products had to teach the user as they went along. In essence, we were really just building enterprise products with a consumer mindset.

Products that require training are a waste of time. Do you remember the last time you took a training class? You were probably in a room with poor lighting, alongside other people who really didn’t want to be there, half-listening to a monotoned instructor (sounds kind of like driver’s education, right?). Did you really pay attention? Of course not. You probably used the event as an opportunity to catch up on your social networks. After all, you’d been given the information in those handouts anyway. And when you actually had to use the system, the frustration set in immediately. Inevitably, you had to find someone in your organization who actually knew the answer or resort to reading the handouts to complete a one-minute task.

Why do we tolerate a lack of the Zero Overhead Principle?  Many people claim it’s because of the complexity of the technology. That’s silly. When was the last time you took a class on Google, Facebook, or LinkedIn? (Granted, there are those that are trying to make money by hosting these classes.) Need more evidence? My three-year-old kid kicks my butt in Angry Birds and Plants vs. Zombies (without being able to read a single word).  Even the iPhone and iPad don’t include a manual! These products are just as complex as enterprise products. The reason they have to subscribe to the Zero Overhead Principle is because if they don’t, user adoption will fail.

What are the traits that the best enterprise companies use in adopting lessons from the consumer experience? Here are the top three product principles:

1. Focus on building a “glide path.” Build the product in a way that funnels users into the experience so that they are becoming increasingly adept at understanding and using the product.

2. Use data to find friction. If you can’t measure it, you can’t fix it. Instrument the product to monitor user flows and be able to test new ideas in how to iteratively improve your product.

3.  Prioritize the design experience. Too often we’ve seen enterprise companies that leave design as the last step in an attempt to add some polish. Instead, put it up front and integrate it into the entire process. It’s a lesson that has served the consumer environment well and will continue to pay dividends in the enterprise environment.

Focusing on the underserved areas of enterprise is becoming a growing trend, as savvy enterprise customers want better software. If you are tackling the enterprise, give yourself a competitive advantage and make sure to implement the Zero Overhead Principle.

(Photo courtesy of: Keene Public Libary)