Planning for change in healthcare: Help IT help you
Change happens. Sometimes very quickly.
The U.S. Healthcare industry spent $17.9 billion on cloud-based technologies in 2022 and is expected to increase that spending to $29.15 billion by 2026. And spending on technology is only going up. By 2025, roughly 26.5% of the population of the U.S. is expected to use remote patient monitoring at some point.
Progress toward common Electronic Medical Records (EMR) is happening faster thanks to Artificial Intelligence, and the digital transformation of the financial side of healthcare is a fait accompli. It’s hard to imagine an aspect of healthcare that digital transformation won’t touch. A lot of change will happen quickly in an industry not predisposed to rapid-fire disruptions.
Everyone has change anxiety
Doing change well isn’t going to happen without planning for change. In Europe at Charité Medical Center they have done an outstanding job of preparing for change. Dr. Carsten Javcobsen embarked on a mission to reinvent their electronic medical records, related processes, and procedures.
At the HIMSS conference in Chicago this year, Dr. Jacobsen, the Chief Operating Officer of Charité Universitaetsmedizin Berlin, discussed server-side and client-side modernization as a pre-requisite to getting the IT team willingly engaged. He also gave strong emphasis on how preparing for change was crucial to their success - recognizing change angst and preparing stakeholders in the hospital (including his IT department) for change was one of the best and most critically important tasks that he undertook to accomplish medical record modernization, get all the stakeholders supportive of the change, and so far, making the change stick.
Where does change anxiety come from?
Getting IT to embrace change requires that you understand at least some of where the change-angst in your IT department comes from. No small amount of IT change angst comes from the risk associated with adding new features, new users and permissions, and network access for hundreds or even thousands of new stakeholders to a large system that is responsible for critical line-of-business institutional operations that can’t afford to go down. (It does sound frightening when you put it that way, doesn’t it.)
First do no harm. Hippocratic oath? Well, maybe. But in this case, it’s from the IT bible. If IT adds an outpatient monitoring feature to the institutional server stack, only to have the institution’s admission and billing systems grind to a halt at random times during the day, IT will get heaps of criticism. For IT to feel more comfortable adding significant new features and capabilities, they must be given the resources to do so without compromising critical existing services or security.
Invest in reducing IT change anxiety
Adding and scaling new services is easier thanks to the services available on cloud servers like Amazon’s AWS and Microsoft’s Azure, but even those services can be expensive and risky if deployed to the standards of the last decade. The pace of modern change makes large server-side code bases that support and integrate multiple functions rather unwieldy, more expensive to scale, and very challenging to maintain. It may be time to help IT modernize architecture for change to remediate this challenge.
Server-side preparation for change
Until we have a chance to talk about what you’re running, I’m going to have to make some blanket recommendations, but the following is a pretty good place to start.
When I consider architectures for institutions that require agility and the ability to support mission-critical lines of business services, I will typically recommend small blocks of code that only need to support one service that can run independently from other small blocks of code supporting their own services. These are called micro-services and can run in their own containers so that if something bad happens to one, it doesn’t affect everything else. (Micro-services can also run on their own isolated virtual machine outside a container, which can rack up cloud costs quickly).
If you need to scale something up, the micro-service/container model lets you add more containers, each container running the particularly popular block of code and the supporting structures you need to scale. This arrangement lends itself very well to keeping systems operating, programmatically scaling services, and recovering failed containers. Adding a new service means adding a new container running that service. If it comes crashing down, it only takes down its container and leaves everything else well enough alone.
Are there drawbacks to Microservices on Containers? Yes. This architecture does add one more layer of management, and while there are outstanding tools like Google Kubernetes and Amazon Elastic Container Service to relieve much of this burden, they must be configured and updated as your business requirements change.
In general, however, the benefits of containerized micro-services are significantly worth the extra layer they impose.
Client-side preparation for change
On the front-end, writing new user interfaces to support new services or to support existing services on new devices becomes much easier when you aren’t using Web 1.0 best practices. Think about email apps. Google’s Gmail became very popular very quickly in part because it looked and felt more like a native application instead of a web-based email client.
If you ever find yourself frustrated because you must keep hitting “Refresh” to get the latest update from a server, you’re struggling with old technology. Modern UI development has solved this problem and others while making it easier and faster for a broader range of developers to be immediately productive when developing for you.
IT modernization: Like seeing the dentist
Helping IT modernize isn’t free, but it is a prerequisite to getting IT to support change more enthusiastically moving forward. It’s like visiting the dentist. Investing a bit of time and money (okay, and some discomfort) before you have problems can prevent a lot of future pain. Investing in modernizing IT now will make the change brought by digital transformation less painful for everyone.