When discussing software development with long term/post-acute care (LT/PAC) providers, one type of request often heard is a variation on the following: “Can you customize your software for us by doing X, Y, or Z?”
The answer, invariably, is, “You don’t want to work with a vendor who would say ‘yes’ to that.”
Here is why. Although it sounds attractive to be able to pay a vendor to do something specific for the customer, it is an absolute trap. No viable, long-term, professional technology company customizes its product in this way.
Look at Microsoft. Look at Apple. Look at Oracle. The reason they do not customize their software is because the professional software model only works if the technology company builds a product that is applicable to a wide customer base. The economics of professional software simply do not work if the product is different for every customer.
Facing an Illusion
Unsophisticated, first-time software buyers may feel like they’re in the driver’s seat by directing the development of a particular technology solution, but this, too, is an illusion because companies that agree to customize software give more power to customers than what is economically beneficial to both parties.
By allowing the provider with the biggest checkbook to control the product road map, the providers that have less money—the clear majority—are essentially rendered voiceless. This also leads to software that is built around incrementalism (adding features requested by various users) versus true innovation. And, when a vendor falls into the trap of allowing a big customer to pay for certain features to be added to its core product to create a version that is customized to the buyer, it is no longer a professional software company, it is a custom software development company—which entails an entirely different business model to be sustainable.
While it sounds like a great thing to do, it has proven to be the death of commercial software companies time and time again.
A More Sustainable Approach
True innovation is dependent on the rest of the technology ecosystem—an ecosystem that, today, is built on open application programming interfaces (APIs). Interoperability is literally the lifeblood of a commercial software company. Without the ability to connect to other systems, it will die.
Successful, professional software companies run on democratic processes—everyone pays their maintenance or subscription fees, and everyone benefits from the continued, fair evolution of the product. A smart vendor engages its customers and has focus groups and steering committees to help guide road map decisions.
While large customers may have a greater voice in this process, it’s usually because they operate more complex operations. However, their input is balanced by other users to ensure the product can ultimately serve the needs of the broader market.
This is particularly important for LT/PAC organizations that may acquire other facilities or need to partner with upstream and downstream providers. As referral networks continue to narrow, this means everyone.
Configurability, Interoperability
The best software companies understand the importance of, and demonstrate a commitment to, configurability. An example of this is a company that builds its software solution in response to a range of different workflows and configurations and then allows these various switches to be set to meet the unique workflows of an individual customer. It is the depth and breadth of that configurability that is the true hallmark of powerful, commercial-grade software—the kind of software that fuels innovation.
Instead of looking for a vendor that will customize its software for the customer, what should be sought out is a partner that is committed to interoperability. A custom solution is not likely to “play well with others,” and in value-based care, upstream and downstream providers will seek out partners who can easily exchange the necessary data.
An example of this is a company that integrates with more than 100 third-party systems and its analytics software allows the provider to monitor and analyze care data to pinpoint inefficiencies and drive out variances. Then, because the company’s system is also highly configurable, it can modify workflows to further lower costs, improve clinical quality, coordinate care, and maximize reimbursement.
Choosing Innovation Over Customization
Leading electronic health record (EHR) vendors have made progress with technology that represents a significant improvement over first-generation EHRs, which were little more than electronic filing cabinets.
“Human factors” engineering has been applied to user interfaces to improve their intuitiveness and efficiency and lower training requirements. Multidimensional analytics tools are used to identify variance in key process and outcome measures, as mentioned earlier.
Clinical decision support—driven by episodic discrete data and logical rules/expressions—is used to coach care decisions in line with the validated standard of care. Care coordination tools are employed to focus the full care team on the patient and progress against the care plan. Today, this combination of capabilities represents the state-of-the-art in deployed EHR technology.
By taking advantage of huge increases in the capability of top-tier cloud computing platforms to manage big data, coupled with the maturation of machine-learning toolsets, technology leaders are beginning to realize the incredible potential of EHRs to predict potential outcomes and recommend care solutions that can vastly improve the efficiency and quality of care.
Birth of the Intelligent EHR
This new, third-generation of capabilities is built upon full, longitudinal personal health records (PHRs) augmented with Internet of Things/personal device data and inclusive of social, environmental, financial, behavioral, and genetic factors.
On this person-centered foundation, leading innovators are leveraging the targeted application of deep machine learning to both structured and unstructured data in the comprehensive PHR to identify early indicators for changes in condition and opportunities for intervention.
Much as the Amazon online shopping experience learns about each shopper and makes shopper-specific recommendations to continuously improve both the shopper’s experience and Amazon’s financial and operational outcomes (such as average order size, revenue per shopper, and so on), “intelligent EHRs” learn about each person and make person-specific recommendations to improve both the person’s experience and the care provider/operator/payer’s clinical and financial outcomes performance.
As America continues the migration to value-based care and LT/PAC networks continue to narrow, outcomes performance will become the ultimate determinant of success or failure.
LT/PAC providers and operators will either suffer the same fate as the Main Street retailer who watched Amazon take its business by offering an ever-better, continuously refined experience with each successive engagement, or equip themselves with the necessary tools to drive continuously higher outcomes performance. n
Lee Kilmer is vice president of product management for MatrixCare. He can be reached at lee.kilmer@matrixcare.com.