Building a Product Engineering Culture in health care

In the last decades, Technology has eaten the world. It has disrupted and is disrupting every single industry, from automobile, aerospace, manufacturing, telecommunication, entertainment, banking, to e-commerce. The common denominator in all these industries is that technology has enabled a group of talented teams to design and launch new products, experiences, tools, and modern infrastructure at lower costs, disrupting incumbents and offering novel experiences and better services to their users and communities. Those innovations often offer a far better experience, and are accessible, competitive, and scalable at an order of magnitude higher than traditional incumbents.

These differentiators — experience, access, and scale — are all aligned with the vision that my colleagues and I believe is what better Health Care should be about. However, the experience of health care delivery systems with technology has had abysmal results. Technology has amplified health care system dysfunctions and raised dissatisfaction from health care professionals and patients alike. This should not come as a surprise. Although we invested heavily on digitizing the clinic, the medical records, and a lot of our administrative tasks through the deployment of EHRs, the experience of care and the culture of technology in Medicine did not improve dramatically. It focuses too much on billing, reimbursement, processes, and enterprise reporting and monitoring. We are today operating health care with inadequate technology infrastructure and more importantly, inappropriate technology culture.

One of the key observations I realized after 10 years as a Clinical Informatician and more recently as Chief Technology Officer of Inception Health — an Innovation group at Froedtert and the Medical College of Wisconsin — is that the majority of Health Care systems do still consider technology as a supportive function to their clinical operations. However, learning from other industries, the true value of technology is when it becomes an integral part of the ecosystem it is trying to redefine; or in other words when technology becomes the business.

I believe that what we need today is a different way to think about technology in Health Care and for Health Care. As Health Care systems, we need to become technology-first. If we aim to deliver better patient experience, we know that it requires the combined synergy of medical knowledge, clinical expertise, quality care services, and the technology foundation to deliver it at scale. That means that as Health Care systems we have to operate across all the components including technology. Surprisingly, one may consider that health care has abundance of technology — MRI scanners, monoclonal antibodies, and customized cellular therapies just to name a few. And that is true. Medicine and life science are the most advanced sciences with a plethora of innovation and research. On the opposite side, health care systems — the service industry delivering those same innovations and technologies — are not. Can you think of a Health Care system that is considered in top technology innovators of the year? When was the last time you came across an open-source initiative that was launched by a health care system and used by thousands of startups and companies around the globe, such as Airflow open-sourced by Airbnb or React open-sourced by Facebook? Today, health care systems are still the largest user of fax machines as their interoperability platform. Anyone who has interacted with a health care system knows that the treatments and doctors are amazing, but the hoops one jumps through to get the care they need are anything but innovative, intuitive, or customer-centric.

Health Care systems must transform. We must be better. We must be digital; not defined by our bricks and mortar, but by our ability to be there when patients need support in the middle of the night. Be there to support when people are making health choices for their lives and the lives of their family. Be there when people have a care need but can't take time off from work. Be there to bring the best services to support patient journeys, from primary care and prevention to supporting complex cancer-fighting regimens. We must be wherever they are. We must remain human-focused, and harness technology.

At Froedtert & the Medical College of Wisconsin, we decided in the last few years to build Inception Health Engineering. It has been a bold vision and a true statement that Health Care systems must combine the culture, people, and technology to build and deliver a better care experience for patients. The lesson learned is that building technology within a health care system is an uncharted territory with so many opportunities and unknowns. We had to discover our own paths and technology stack, hire the talent, learn the agility, and build the capabilities to innovate fast and drive our own clinical experiences. Conway famously coined that the system is designed to mimic the cultural and the communication pathways of the organization building the system. And hence, we believe that our engineering and product-driven approach is necessary for our evolution.

Technology can make us better people and can help us transcend the boundaries of our capabilities to help others in a meaningful way. With that in mind, it is a no-brainer that technology and medicine are meant to synergize.

Not long ago, health care organizations used to build their own electronic health records. Brad Crotty and I both came from an organization that used and deployed its own electronic systems. The system, which is the predecessor of the current Electronic Health Records, was built in the 1980s by clinicians such as Warner Slack, Howard Bleich, and Charles Safran to improve safety and availability of information in the clinical setting. It is increasingly important that we don't outsource everything — technology and our experiences are just as important as the entrances to our buildings and services we provide inside. Conversely, the journey of building a culture of engineering in Health Care has its own challenges. Nonetheless, it is the most rewarding path to build what Marty Cagan from SVPG coined as Empowered Product Team who can solve hard problems in ways their customers love, yet work for their business.