Healthcare Reform & Prioritizing The User

I was really interested to read the other day that the president of Comchart Medical Software (an EMR vendor) just announced in a blog post that his product is no longer going to be certified for Meaningful Use. For those readers that don’t work in healthcare and don't know what I'm talking about, Meaningful Use is a really important qualification program happening right now in healthcare.

Some background. As part of healthcare reform, the government wants healthcare providers to use software (as opposed to paper) when providing care. Specifically, they want providers to invest in and use an Electronic Medical Record (EMR) system. The hope is that the use of these EMRs will enable interoperability between providers; improve care quality, safety, and efficiency; engage patients in their care; and improve overall population health.

With that in mind, the government has laid out a five year plan and three stages of Meaningful Use implementation and compliance that EMRs must meet. Just like the name suggests, the government wants providers to use their EMRs “meaningfully." In each stage of the implementation, the usage requirements of electronic healthcare become more and more significant.

The government is pretty serious about this effort. In the short term, they’re providing financial incentives (specifically, higher Medicare reimbursements) to providers that meet Meaningful Use requirements.  In the longer term, those incentives will turn into penalties.

As you can imagine, this change in the law has led to massive technology investments on the part of healthcare providers. They’re all scrambling as fast as possible to implement their EMRs -- and vendors that make software for healthcare have seen their sales skyrocket. On a side note, this is a large part of the reason that you’re seeing more and more independent doctors becoming employed by large hospitals and health systems. They can’t bear the cost of installing an EMR on their own.

But now that EMRs have gotten some traction with providers (Stage 2 goes into effect in 2014), things are starting to get interesting. As providers are further along in their meaningful use certification, they’re finding that they actually use (and need) these products to run their businesses. Like most users, they want the software to be user friendly and to align with what's important to them and their patients.

And of course, the good EMR vendors -- like most good software companies -- are learning, iterating and releasing changes and improvements to delight these providers.

But, wait a second, not so fast. Maybe they're not.

Remember, the priority and goal of the EMR vendors isn’t necessarily to serve their customers (the providers) and, by extension, patients. The priority and goal of the EMR vendors is to help their customers reach a specific list of objectives as laid out by the government 4 years ago. The EMR vendor's goal isn't to make a product that helps providers and patients, their goal is to make a product that complies with a series of strict government mandates and timelines.

Anybody that knows anything about product development, especially software development, knows that the the product you set out to build in the beginning is always wrong. You have to launch and iterate and iterate and iterate to get it right. You can't know in the beginning what is right so you must change and release, change and release.

But given that the government is likely the least agile organization you'll ever find, they can't change their product requirements to meet provider needs. Or at least they can't do it quickly. So it was just a matter of time before Meaningful Use requirements and what's good for providers and patients began to diverge.

And that’s what we’re seeing with Comchart’s decision to halt their product’s Meaningful Use certification. Take a look at this excerpt from their President's blog post:

While the individual people involved in promulgating these EMR mandates (mostly) have the best of intentions, they clearly do not understand what transpires in the exam room, as many of the mandated features confer little or no benefit to either the patient or the healthcare provider.

And this:

As a result of the mountain of mandates, ComChart EMR  and the other small EMR companies will have to choose to implement the mandates or use their resources to add “innovative” features to their EMR. 

So, in short, a software vendor has decided to prioritize its users over government mandates.

Now of course I don’t know enough about the clinical value of Meaningful Use requirements to understand how off base they actually are, but I’m confident that we’re going to see more of this in the months to come. You just have to assume that, despite their good intentions, the government missed the mark with these mandates. And because big government mandates aren’t at all agile – like software development needs to be – you just know that Meaningful Use mandates are getting further and further away from what’s best for providers and patients (they just didn’t know what they didn’t know whenthe requirements were written).

Related to this, I’ve written a quite a bit about how bad enterprise software is when compared to consumer software. For the simple fact that, traditionally, big enterprise software companies could get away with it – they just needed good salespeople that could sell an individual or a small group of individuals on their product and those individuals would force their employees to use the product. Enterprise software companies can survive (and thrive) with a weak product.

But what's happening here is even worse. The government, who’s even further removed from the needs and wants of the end user, is mandating what the software must do with virtually no ability to iterate on it as priorities change and new discoveries are made.

Despite everyone's best intentions, this is a recipe for a terrible product. It is so far removed from what's good for the end user.

In the long term, I think we'll see more and more of these small, user-driven EMRs abandon Meaningful Use certification. And this will result in two types of products, or two different somewhat radical product directions: one that meets Meaningful Use requirements but is painful to use, and one that doesn't meet those requirements but is a delight to use.

In my view, in the long, long term, as Meaningful Use requirements are scaled back or phased out completely, the lighter-weight, user-driven EMRs will be the vendors that win. They'll have such a strong and inherent product advantage over those that were forced to rely on the government to design and dictate their product roadmap.

That said, I recognize the challenges for EMR companies that go their own course. This is going to create a major client management problem in the short term. And I recognize that it's likely going to take years for these vendors to win back clients. But physicians are no different than any other consumer; they want great products that are beautiful and intuitive and easy and seamless. Eventually they'll demand it. And eventually they'll get it.

As I wrote about in my post about the business to employee to business sales strategy, this is the same course that companies like Yammer and DropBox and Xobni are taking. They've prioritized the user and built a sales and product strategy that relies on user satisfaction and product quality to succeed. These companies are winning because they're bypassing the bureaucracy and misplaced priorities that lead to large, lumpy sales and mediocre product offerings.

They've prioritized the user. And the EMR vendors that do the same will be the ones that win.

This is going to be fascinating to watch.