IMHO – HIE’s Impact on Mobility

Nearly ten years ago, the industry was abuzz with mobile activity. Palm’s introduction of the Palm Pilot a few years earlier, in 1996, launched the personal digital assistant (PDA) revolution. Spurred on by the dot com mania and the rapid market penetration of PDAs, dozens of companies set their sights on healthcare where the opportunities for mobility were mind-numbing.

Most of the early hopefuls targeted either e-prescribing or charge capture – the two functional areas with the easiest to articulate value propositions. Several of these venture-backed companies raised millions of dollars. Yet, despite their undeniable value, nearly every one of these companies either went out of business, or were rolled from one company into the next until they eventually disappeared. Epocrates emerged during this period and had phenomenal success gaining clinical adoption, but suffered from a yet-to-be defined business model.

I started working with MercuryMD when its two founders were still in residency. The Company literally operated out of a loft apartment in the old tobacco district in Durham, North Carolina. MercuryMD began as many other high-flying VC-backed start-ups were crashing and burning. Our premise, unlike that of the solid-gold, “3 month ROI” VC darlings was simple and yet confounding – we would integrate into a hospital’s disparate HIS environment, capture only the pertinent information, reassemble the information in a patient-centric database, and then serve it to physician handheld devices according to their specific census. The premise was confounding because few understood why anyone would pay for just data.

Ultimately, the crux of MercuryMD’s data delivery solution was that everything starts with the information. Clinicians will not use a mobile device simply for the sake of using it. The device must first earn its way into their workflow, which requires having mission critical information. Once that information is in-hand, getting clinicians to adopt adjunct functionality, anything from charge capture to context-based clinical decision support, becomes relatively simple.

To deliver this solution, MercuryMD had to solve several key problems, including rapid low cost HIS integration, a reliable enterprise data conduit, and delivery to the end device.

Fast forward to today, and things look surprisingly similar – with one glaring exception. In 2000, devices were extremely limited in their capability. They were really only beginning to support WiFi, which didn’t matter that much because most hospitals didn’t have it (other than in isolated locations, like ED). You certainly couldn’t make a phone call with your PDA. Color screens were cool back then, but cool generally meant shorter battery life. Back then we used to care about how big an application was, and how many you had on your device. And, to be clear, the devices were purely consumer-oriented, meaning virtually no native enterprise capabilities.

Today, devices all but ship enterprise-ready. They are powerful, capable, and multi-functional. They support Bluetooth, WiFi, and cellular (GSM/CDMA), and they are pretty good at jumping between them. Memory is no longer an issue, nor is processing. Blackberry especially and iPhone increasingly are shipping in an enterprise mode for simple fleet deployment and management. Security, while still suspect, is getting better with each new OS upgrade. I would say that the vast majority of the challenge facing enterprise mobile solutions in 2000 no longer exists.

And yet, despite the capability of smartphones and their ubiquitous presence, most of the smartphone apps leave something to be desired. Yes, iPhone passed a billion downloads, but how many are like the iFart app that my daughter downloaded onto my phone this past weekend? Momentarily humorous and then forever discarded.

Looking back at the MercuryMD solution, it is clear that everything from the database to the data deployment to the end-devices has radically improved. The laggard? Data integration. And, actually, to be more specific it’s data availability – “integration” is an issue only because vendors make it one. Enterprise data is the missing element needed to create enterprise solutions.

While I have plenty of reservations about when and how healthcare information exchange (HIE) is going to happen, I believe it holds the key to breaking enterprise mobility wide-open. Imagine all of the developers and development shops who are sitting around trying to think of self-contained healthcare applications. There doesn’t seem to be a lot to work with. Don’t hold me to anything here. I’m not suggesting we’ve exhausted the limits of useful, standalone healthcare apps. I simply believe that if you want physicians, and clinicians more broadly, to use mobile devices in their daily workflow – and I’m sure they want to – you need to start with enterprise data.

MercuryMD, now part of Thomson Reuters, is more than capable of pulling out read-only data from enterprises… and there are dozens of others who can do the same. But it should not be a required competency to develop and create useful enterprise apps, and hospitals should not be paying for integration every time a new vendor shows up at the door.

HIE, provided it does not become yet another vendor-controlled platform, has the potential to turn-on the data spigot for hundreds of mobile development shops, all vying to create high-value solutions. Let’s hope that this is done correctly, and in our life time.

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