Electronic Health Reporter

Guest post by Edgar Wilson.

T-Mobile recently became the first cell phone carrier to offer free inflight Wi-Fi (in support of Wi-Fi texting, as cellular signals are still not yet allowed) to all its customers. Admittedly, this was technically on the strength of partnering with a third-party platform, Go-Go, but the carrier gets the glory of being first among its big four peers to take even this step.

In-flight Wi-Fi, Wi-Fi calling, and similar services aren’t necessarily new technology, but having support for limited internet browsing and texting, all delivered through one of the top carriers in the nation, makes for a reasonably good elevator pitch—especially if you happen to be a T-Mobile customer. But the importance of the development isn’t just the novelty of the technology or the value of the service on offer; it is planting a shining pink flag in the market and staking that claim of being “first.”

Early Adoption, Arrested Development

Being first hasn’t lost its luster yet, even in a time when consumer expectations are sometimes a generation or two ahead of current technology. Hospitals and their leadership recognize this, and so, despite uncertainty on everything from insurance market regulations to the future of EHR integration, many are taking strides to do as T-Mobile has done — and find a way to get there first on a variety of issues important to consumers. And like T-Mobile, being first doesn’t have to mean getting into the weeds of proprietary innovation and product development—although plenty of larger chains and clinics do take that route; for many hospitals, being first can be accomplished through strategic partnerships with tech-centric companies.

If there is one lesson out of Silicon Valley that has entered the American zeitgeist, it is that being the first out with something can give a company, product or even team of creatives a lot of leeway in terms of going on to iterate, improve, and generally tinker. But on the healthcare front, we see how the drive to be first—or even keep pace with the rest of the industry—can create a “hurry up and wait” situation where meaningful progress sometimes lags fanfare or technology.

That is why the top tech trends in healthcare don’t change much year to year; end users, hospital administrators, and tech developers are all still trying to figure out what works, what works best, and how to integrate new tools into the clinical workflow, the patient experience, and the regulatory environment governing it all.

That is the story of EHRs is a nutshell: a good idea, a rush to adoption (both willing and coerced), and then a lengthy period of reiteration as all stakeholders struggle to recreate or wholistically reconsider the context in which this new system can, and should, operate. But the rush to adopt first and configure later isn’t limited to high-technology in the healthcare sector; it pretty well describes the legal environment surrounding health insurance.

Industry Leadership: Being First or Being Best?

From how it affects patients to what it is still trying to influence in the provider space, the conversation about care and coverage is still shepherded primarily by fear, secondarily by outrage, and in most other respects by confusion. So it looks like we’ll be shopping the exchanges for a while longer, even under President Trump’s watch.

After gazing into the abyss that was Trumpcare, the still-evolving status quo that is Obamacare is more popular than ever. Here again, the power of being first seems to provide some residual sticking power to a law frequently and publicly dragged through the mud by people and organizations with at least as much visibility and influence as one like T-Mobile.

Despite the recent booster shot to Obamacare’s approval ratings, however, evidence remains thin that people have an appreciably better understanding of the law. Whether shopping for personal coverage or trying to understand how employer-sponsored plans fit into their options, shopping for insurance is still difficult for people who, by and large, have neither health literacy nor financial literacy. The ACA got onto the law books first, and even its loudest advocates can hardly claim it is the best way forward.

The promise of EHRs to make care more efficient and providers more informed is shockingly similar to the bill of goods insurers have been sold with respect to machine learning and artificial intelligence: basically, that the processing power and scale of digital records technology, coupled with some focused analytics, will end up saving time and money while improving the whole works.

Health Analytics: Waiting for Godot

As William Shatner sadly reflected, it hasn’t happened yet.

Amazingly, the insurance companies, beholden as ever to the twin powers that are shareholders and the actuarial tables, have not been much faster than the caregiving stakeholders themselves when it comes to turning modern analytics technology into actionable data, wisdom, and outcomes. In some respects, this is due to the same challenges the clinical sector is dealing with: workflow obstacles, user interface design, interoperability limitations, and too much continuous change and uncertainty to keep up with.

At this point, the potential of EHRs, along with all their wearable cousins and analytics siblings, is understood better than their actual interfaces. In the business, travel, entertainment, and just about every other industry, being first is the start of a legacy of improvement that can attract, then help retain, clients and customers. In healthcare, transitioning from implementation of modern digital solutions and systems, to optimization, is proving a struggle.

The power of the first isn’t just competitive advantage or even the opportunity to lead. Its most important legacy is shining a light into the murk of the future, and showing everyone where they must go. Whether it is tech companies with a new smartphone or service providers with a new perk, hospitals with creative partnerships or innovators with crazy ideas, the people and systems who give us the first iteration of something new are telling the rest of us how “normal” is about to change.

That is the important thing to keep in mind as we try to tune away the static of EHRs, healthcare analytics, and contemporary clinical workflows: we aren’t struggling without purpose. We are doing the hard work so that future generations of stakeholders and users on all sides can function in a better normal.