Creating a digital front door

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In recent years, more than a few tech industry giants have set out to fix what appeared to be comparatively straightforward challenges in health care, only to quietly retreat with their tails between their legs as much smaller health care IT firms feigned surprise. To outsiders, their failures made no sense at all.

Weren’t these the same innovators that redefined how business is done? And weren’t they the same companies that in just a few years advanced health care light years ahead with compute power, limitless storage and networking sophistication now taken for granted – even as they introduced innovations in data science that revolutionized patient care?

The answer of course is yes, but the bigger question that is not asked often enough is how a different outcome was ever expected—not because the preeminent technology leaders are lacking, but because health care is unlike any other industry. No other arena requires so much technical acumen to solve its technology challenges. But that is just the tip of the iceberg.

The digital front door—which provides patients with an intuitive, personalized experience for care navigation—puts this reality in perspective. Digital front doors are crucial for facilitating interactions between patients, providers and payers on everything from appointment scheduling to prior authorization and payment.

Digital front doors are not overwhelmingly daunting from a technical perspective. Yes, they encompass a number of technologies, such as electronic health records, patient portals, payers’ core systems, call centers, chatbots, mobile devices and many others. But such platforms should be fairly straightforward for the world’s best technology companies to build and deploy.

Why then do so many tech companies struggle to create effective digital front doors in health care? And more broadly, why do so many health care IT projects undertaken by tech juggernauts fail when their success in other industries is without parallel?

Domain expertise is often hyped, but in health care the hype is real.

In the more than three decades since Internet companies first emerged and began looking for ways to apply their skills in health care, domain expertise has proven to be a key factor of success, for five reasons.All are broadly applicable and can be attributed to failures not only in the design, development and implementation of digital front doors, but other health care systems as well.

1. Consumers and patients are different: Although patients are consumers and consumers are patients, they are very different. Yes, like all consumers, patients want a frictionless experience. They want to be able to quickly schedule appointments online, track pre-authorizations and access prescriptions. But unlike other consumers, who can simply move on if a function fails, every process covered by a digital front door impacts the clinical experience in some way. Lives are at stake, a reality that negates the typical bug-fix approach to development. IT projects rightfully slow under those circumstances.
2. Workflows are complex and numerous: Health care workflows are overtly complex – requiring a deep and detailed understanding not only of what patients need and how providers and payers work, but also deep insights into how innumerable subunits function. This includes everything from radiology and oncology departments to payers’ prior authorizations, assessments for value-based care, and tracking social determinants of health. Even at a small clinic, the sheer volume of workflows an IT organization must learn and address dwarf those encountered in even the largest deployments in other industries.
3. Health care standards are stringent: IT solutions and services providers also must comply with a litany of demanding standards, from well-known requirements like the Health Insurance Portability and Accountability Act, to requirements like those stipulating that application programming interfaces must meet interoperability standards like HL7 and FHIR. Beyond the digital front door, things only get more complex with requirements that govern every piece of integrated software and hardware, from infusion pumps to patient monitoring systems. The complexities involved present most technology companies with far too much to learn.
4. Data is unstructured and disparate: Health care data that must be processed in care navigation platforms like the digital front door is often incomplete, duplicative, or formatted to work only with existing legacy systems. In other cases, it is not even available digitally. For example, a recent study found that 61% of physicians record patients’ social needs in clinical notes rather than using a structured taxonomy in the EHR.
5. Health care is always changing: Even basic health care systems must address rapidly emerging needs and innovations. The rise of personalized medicine and genomics, higher precision diagnostics – such as three-dimensional imaging that results in files 20 times larger than their predecessors – and remote patient monitoring mobile devices and wearables, demand IT systems able to address an ever-increasing deluge of highly fragmented data. The scale of this challenge will only increase. Data volumes are growing exponentially, so that by 2025 it’s expected the compound annual growth rate of data for health care will reach 36%.

For providers and payers that want to transform their operations with a digital front door and other mission-critical systems, these factors are not a reason to remain static. Instead, they are a reminder to proceed with a two-pronged approach that combines best-in-class technology providers with partners that have a long track record of not only designing and implementing successful health care systems, but who can also speak to the risks and potential points of failure involved – points we know are capable of stopping the most successful technology companies when working alone.

John Squeo is senior vice president of provider and health care services at CitiusTech.