Getting Out of the Box

Do you know the feeling when you’ve worn a cast for an injured leg or arm? At first, it's so restrictive you wonder how long you can stand it. Then, you gradually adjust. The initial discomfort and confinement fade over time, creating a new reality with a feeling that “it’s not so bad.” But once the cast is removed, you genuinely sense relief and an appreciation for newfound freedom.

We can all get into a mental box the same way when stuck with something we cannot change. We gradually adjust, become de-sensitized to the constraints, and lose sight of being stuck. We accept this version of reality for what it is until something happens that helps us recognize the self-imposed constraints.

This mental box is a phenomenon common to healthcare when HIT vendors develop innovative solutions that use EHR data to make it easier to get work done better and faster. Invariably, they are hit with severe constraints to the EHR data they can get in real-time. As a consequence, their solutions are dummied down from using data to actually do work for customers to just displaying data where customers only know what work needs to be done. This is a common scenario, and it’s at the heart of many failed HIT vendor solutions.   

I recently spoke with a colleague who is an executive of a well-known healthcare data analytics company. Like many others, his company offers dashboards that describe what happened. His customers are continually aware of problems that need to be solved for things like care utilization, quality, and risk management. While his “real-time” dashboards use HL7 v2 messages, Vendor APIs, and FHIR API(s) to access snippets of EHR data, for the most part, they rely on nightly data batches to deliver a rearview picture of how things have been working.

My colleague has deep knowledge and experience using metrics to understand how things are working in healthcare. I wondered why he wasn’t putting that knowledge to better use by using EHR data to simplify or automate work, instead of just pointing to problems. I mentioned it’s now easy to get any EHR data in real-time, and he could supercharge dashboards. His response: “I already get the data I need in real-time.”

The mental box strikes again! He meant, without recognizing it, that he had adjusted to making compromises in what his solutions could do because of the constraints of the data he could get. His thinking and his product were constrained without him knowing it. He needs his “cast” removed.

Healthcare systems have been settling for looking in the rearview for decades. The mental box gets in the way of seeing solutions that get them everything they need. But, once healthcare systems are liberated, they act with their newfound freedom to scale strategic advantages and deliver patient experience.