An Open Letter to Those Who Might Change the World by Fixing Healthcare

Since 2011, over $13 billion in venture funding has flooded into digital health. 2015 alone saw well over 200 digital health companies raise more than $2 million each. From personal DNA tests to on-demand doctor’s visits, startups are taking a page from technology giants (Google, Apple, Amazon) and digital unicorns (Uber, Slack) to bring healthcare into the internet age. Adding fuel to the flame, the widespread adoption of internet and mobile tech has evolved patients from passive recipients of care into active managers of care. Healthcare’s consumerization has created a perfect breeding ground--not only for new models of care delivery to take root--but for entrepreneurs to introduce new tools and apps for the patient and provider alike. 

As my company, athenahealth, expands beyond the ambulatory care space and builds out its cloud-based services for hospitals and health systems, we’ve quickly realized that this entrepreneurial spirit is badly needed in the inpatient market, too. 

If we’re going to disrupt the status quo and truly wow the hospital market with a new way of doing things, we need that innovator’s passion, and we need it now.

Inpatient facilities – from tiny critical access hospitals to leading academic medical centers – are starved for innovation when it comes to IT. They’re running on clunky, monolithic systems that were never built for the internet. Many of them weren’t even designed for a clinical setting. Rather, they were built as general ledgers, tracking financials long before they were tracking diagnoses.

The entrepreneurs that are tackling the inpatient space already are, for the most part, operating on its fringes. I don’t blame them. The pain of selling into a large health system can take years off your life. Hospital workflows are complex, inconsistent, and puzzling even to their own doctors. 

Below are just a handful of the big, hairy problems we’ve observed in the inpatient space. Let this serve as an open call to entrepreneurs (from healthcare, or not!) to step up to the challenge of solving them.

1. Core hospital modalities lacking cloud-based solutions.

Blood Banking. Blood is essential to the day-to-day operations of any hospital, yet few modern solutions exist to help facilities collect donations, purchase blood products, screen for blood type and disease, store supplies, track distribution, and manage safe transfusions.

Labor & Delivery. While labor/fetal charting and fetal monitoring (i.e., baby telemetry) are the core functionalities of any Labor & Delivery system, they often fall short when it comes to coordination, device integration, clinical decision support, and remote monitoring/telemedicine.

Pharmacy. Most legacy hospital information systems have a pharmacy module embedded in their offering. As such, few cloud-based, best-of-breed solutions exist to support core pharmacy workflows, including order entry, dispensing, and inventory and purchasing management.

There are a seemingly endless number of “jobs to be done” in these (and other) core clinical workflows, and the reality is you don’t need to be a robust core clinical system of record to succeed in addressing them. Rather, innovators have the potential to fill a multitude of gaps simply by finding ways to surface the right info, at the right time, to the right people. How might we use the power and nimbleness of the cloud to do so?

2. Virtualization of ancillary services.

Put yourself in the shoes of a critical access hospital. Found in some of the most difficult-to-reach corners of the country, these facilities are located at least 35 miles away from any other hospital. I once took three flights and drove for another four hours just to visit one of them. They’re tiny operations, typically with no more than 25 inpatient beds. Given their relative isolation, these hospitals are often limited in their resources, lacking the ancillary services (e.g., radiology, pharmacy, and clinical laboratory) considered standard at large academic medical centers. How might we leverage advances in communication technology and telemedicine to give these rural facilities much-needed access to the services of their larger, better-resourced counterparts?

3. Discharge planning.

Discharge planning is a painstakingly slow process, one that often leaves patients and their families waiting for hours longer than anticipated. From physician sign-off, to follow-up appointment scheduling, to patient education and care plan delivery, a succession of interlaced tasks trickles down from that initial discharge order, and rarely are they efficiently executed. How might we empower both patients and providers with the tools they need to guarantee an efficient, painless discharge process?

4. Care transitions and handoffs.

As sleep-deprived doctors and nurses wrap up their hospital shifts, their care transitions and handoffs are often messy and disorganized. Notes are scribbled on post-its, unsecure text messages are sent, and incoming clinicians are frequently left calling their off-shift colleagues for information when problems arise. This lies in stark contrast to other industries. Take air traffic control as an example.

Like hospital care teams, air traffic controllers have high-risk jobs where people’s lives are dependent on their accuracy, details, and effective communication. As such, handoffs are driven by stringent processes. Debriefings are done at the end of every shift, with checklists and acronyms used to make sure nothing is missed. The final section of each controller’s day is dedicated to watching his or her replacement, making sure all of the relevant conditions are fully understood. This entire handoff process also has a strict no-interruptions policy. How might we leverage mobile technology to encourage similarly effective handoffs in the hospital setting?

5. Medication tracking.

Patients are constantly being prescribed new medications (and having others cancelled or dosages altered) while in the hospital. Yet, when a patient goes in for surgery, his or her list of current medications is often riddled with errors – a potentially life-threatening situation. To make matters worse, the medication kits stocked by the hospital pharmacy and used throughout the facility are rarely 100% accurate, resulting in errors in medication administration, use of expired drugs, and poor inventory management. How might we improve medication tracking to ensure a safer patient experience?

If athenahealth is going to extend the health information backbone across the continuum of care, we need help. Feeling inspired? Think you’ve got what it takes to challenge the status quo in hospital IT? Then join the More Disruption Please Hackathon, and help us unbreak healthcare.