I was lucky enough to sit down with Appian’s healthcare industry lead, Fritz Haimberger. Fritz is someone who practices what he preaches — outside of his day job, he still spare-times as a medic and a firefighter in his hometown of Franklin, Tennessee (just outside Nashville). I’ve been lucky enough to work with various healthcare clients over the years, from hospitals to pharmaceutical firms and equipment manufacturers; I’ve also been involved in GigaOm’s low code tools and automation platforms reports. So, I was interested in getting his take on how this space has evolved since I last had my sleeves rolled up back in 2016.
While we talked about a wide range of areas, what really caught my attention was the recognized, still huge, challenge being faced by healthcare organizations across the globe. “If you look at healthcare over 15 years, starting with electronic medical record systems — for so long, we’ve had a continued expectation that those implementations might cost 500 million dollars and might be implemented in 14-16 months. Reality has never been like that: repeatedly, it’s been three years down the road, a billion dollars plus in expense, sometimes with no end in sight,” said Fritz. “The notion of implementation time to value was blown away, and organizations resigned themselves to think that it’s just not possible to deliver in a timely manner.”
In part, this comes from legacy tech, but equally, it is down to underestimating the scale of the challenge. When I was working on clinical pathways for Deep Vein Thrombosis (DVT), what started as a simple series of steps inevitably grew in complexity — what about if the patient was already being treated on other drugs? What if blood tests returned certain, conflicting information? So many of these questions rely on information stored in the heads of clinicians, doctors, nurses, pharmacists, and so on.
The resulting impact is not only on data models and systems functionality but also the way in which information needs to be gathered. Keeping in mind that healthcare scenarios must, by their nature, be risk averse, it’s not possible to build a prototype via “fail fast” or “test and learn” — real patient lives may be involved. So, how can healthcare organizations square the circle between addressing unachievable expectations without having the “do it quick and cheap” option?
Enter low code app development, integration, process, and other forms of automation development platforms. Let’s work back from the clichéd trick in the tale and agree that it won’t be a magic digital transformation bullet. You only have to look at a technical architecture map of the NHS to realize that you’d need an entire squadron of magic rockets to even dent the surface. But several elements of the low code process automation platform approach (okay, a bit of a mouthful, so I’ll stick with automation platforms from here) map onto the challenges faced by healthcare organizations in a way that might actually make a difference.
First off, the low code development platforms are not looking to either directly replace or just integrate between existing systems. Rather, and given their heritage, they are aimed at accessing existing data to respond to new or changing needs. There’s an industry term – “land and expand” – which is largely about marketing but also helps from a technical perspective: unlike historical enterprise applications, which required organizations to adopt and adapt their processes (at vast cost), the automation platform approach is more about solving specific challenges first, then broadening use — without imposing external constraints on related development processes.
Second, the nature of software development with automation platforms plays specifically to the healthcare context. Whilst the environment is absolutely safety critical, it’s also very complex, with a lot of knowledge in the heads of health care professionals… This plays to a collaborative approach, one way or another — clinicians need to be consulted at the beginning of a project but also along the way as clinical needs emerge. “The tribal knowledge breakdown is huge,” said Fritz. “With platforms such as Appian, professional developers, clinicians, and business owners can better collaborate on custom applications, so it’s bespoke to what they’re trying to achieve, in a quick iterative process.” Not only does this cut initial time to value down considerably – Fritz suggested 12-14 weeks – but also, it’s along the process that complexity emerges, and hence can be treated.
Automation platforms align with the way it is possible to do things, but at the same time, they are, inherently platforms. This brings to a third pillar that they can bake in the capabilities healthcare organizations need without having to be bespoke — security hardening, mobile deployment, healthcare compliance, API-based integration, and so on. From experience, I know how complex these elements can be if either relying on other parts of the healthcare architecture or having to build bespoke or buy separately — the goal is to reduce the complexity of custom apps and dependencies rather than creating them.
Perhaps automation platforms can, at the very least, unlock and unblock opportunities to make technology work for key healthcare stakeholders, from upper management to nursing staff and everyone in between. Of course, they can’t work miracles; you will also need to keep on top of your application governance — thinking generally, automation platforms aren’t always the best at version controls, configuration and test management, and other ancillary activity.
Above all, when the platforms do what they do best, they are solving problems for people by creating new interfaces onto existing data and delivering new processes. “Honestly— if I’m looking at the individual, whether it’s a patient in clinical treatment, a life sciences trial participant or an insured member – if we’re improving their health outcomes, and easing the unnecessary burden on clinicians, scientists and others, that’s what makes it worthwhile putting two feet on the floor in the morning and coming to work for Appian!”
Yes, platforms can help, but most of all, this is about recognizing that solving for business users is the answer: with this mindset, perhaps healthcare organizations really can start moving towards dealing with their legacy technical challenges to the benefit of all.
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