When do Physicians Behave Like Consumers?

Robert-Rowley_avatar-100x100There Are Some General Rules-of-Thumb

Robert Rowley, MD
Twitter: @RRowleyMD

We are seeing a flood of health IT tools come in to the market, some simple and some highly complex. The way that physicians approach the adoption of these tools has major implications for vendors.

Electronic Health Records (EHR) systems have been the centerpiece of health IT for a number of years, and now a majority of U.S. physicians and hospitals have adopted EHRs into their practice. Getting these systems to talk to each other, and create cross-institutional views of consolidated health data about patients, is the next stage of health IT development. We are also seeing multiple web and mobile products that can be used as stand-alones, or have some ability to connect with larger EHR systems, and the degree to which physicians (and patients) adopt these new tools depends on a number of factors.

Sometimes, physicians acquire health IT tools like consumers, and sometimes they behave more like institutions. It is important, especially for vendors, to understand the differences here.

Acting like institutions
Classically, the adoption of EHRs has followed an institutional pattern. The selection of products is done through a committee process. Requests for proposals (RFPs) go out to vendors, sales reps from those vendors make presentations, a short list is created, and a decision is eventually made. Sales cycles are long. Vendors use their sales departments to “make the sale.”

After selection, then comes the implementation process, often with vendor-furnished staff or consultants. Training takes place, and workflow optimization follows. Often, depending on how usable the product is, workflows take some time to return to pre-implementation levels. Maintenance and product upgrades are part of the future.

Large systems, particularly hospital-based EHRs, are deployed this way. Many other kinds of products assume this process as well – there will be a need to “sell” the product to a committee, and implementation (if it is chosen) may take a long time to play out. Integration with systems already in place can be tedious and individualized to a particular location’s needs.

Acting like consumers
The consumer Internet is based on completely different dynamics. Individual consumers can make the decision to use an app themselves, and can do so quickly, in a snap. Consider how most of us add mobile apps to our smartphones. The barriers to adoption are very low (the apps are often free), and the key here is to grow and sustain usership over time. What percent of your users open up your app and use it every day – that is a metric that is important in the consumer Internet. The spread of such products is done more through marketing, rather than sales.

Now, granted that health IT is more business-to-business (B2B) oriented, rather business-to-consumer (B2C), certain lessons from the consumer Internet still apply – even when the target audience is healthcare professionals.

A good example of consumer-patterned EHR deployment can be found in looking at the experience of Practice Fusion, a company I helped start and helped grow until I left in 2012. The approach here was actually quite revolutionary – not so much because it was web-based (and therefore relieved the local practice of the burden of servers, networks, security, backup and upgrades), and not so much because it was free (subsidized by in-product advertising, revenue sharing with business partners, and use of anonymized de-identified data). Its more revolutionary aspect was that it approached physicians as a consumer Internet company, rather than an institutional sales-cycle company.

Rather than participate in “pitching” to hospital systems, physician groups, and Regional Extension Centers (RECs) in a traditional way, Practice Fusion simply made it possible for physicians to decide themselves to adopt the product, and sign up directly online, in a snap. Training and workflow optimization was done mostly remotely, though an array of on-site consultants were also engaged for those who wanted them. Its distribution pattern, like consumer Internet companies, was mostly through a robust marketing team, rather than sales (sales was mostly focused on securing advertising and other revenue sources).

Not surprisingly, the experience of Practice Fusion is that it has been adopted by physicians who have the most “consumer-like” characteristics – they can decide themselves on what products to use, and can do so in a snap. Such physicians are in smaller, independent practices. They are not reliant on hospital or large-group decision-making committees to make EHR acquisition choices.

If anything, health IT that follows a “consumer-like” adoption pattern, like Practice Fusion, has struggled gaining inroads into “institution-like” settings. As an aside, one of the dilemmas for such vendors is that physicians are increasingly aligning themselves with hospitals or large groups – something like 50% of U.S. physicians work in practices owned by, or closely affiliated with, hospital or large-group systems. ACOs will increase that trend. If such companies want to remain successful in this environment, there needs to be a more institution-like product – something like a Practice Fusion Enterprise Edition, which can be deployed for a fee, comes without ads, and has open API access to all a practice’s data so that auxiliary companies or consultants can create the kinds of reports and dashboards that a large group will need. It is unlikely that a vendor can anticipate what kinds of reports will be needed by each local install, and it is more likely that the institutions themselves will be in a better position to custom-define and create the kinds of tools they locally need.

When do physicians act like consumers?
We have seen that, while large health IT systems deployed in groups and hospitals follow a traditional “institution” pattern, “consumer-Internet” approaches can be done, and can be successful.

So for vendors that are creating products in this space, it is important to be cognizant of the ways in which physicians behave like consumers, and where they behave like institutions.

There are some general rules-of-thumb that can be extracted from experience: if a health IT product can be adopted by individual physicians directly, without having to go through a committee process, then the “consumer-like” pattern applies. The focus in this case is around lowering the barriers to adoption, building the product in ways that encourage lateral spread among colleagues (“viral hooks”), and creating sufficient value where daily usage can be sustained.

If, on the other hand, a product requires an installation and integration process, and is reliant on linkage to existing systems (e.g. a hospital’s EHR), then the “institution-like” pattern is a better approach. The focus is on adding value to existing health IT, and leveraging the institution to help promote its use.

In the coming years, many new products will enter the market. Some will help locally-installed EHR systems provide better value. Some will be more focused on mobile deployment, and will be able to bridge the silos of health data between institutions. As vendors build these products, it is important for them to understand ways in which adoption follows “consumer-like” or “institution-like” patterns. The success or failure of vendors will be related to an understanding of these dynamics – when physicians behave like institutions, and when they behave like consumers.

This article was original published on Dr. Rowley’s blog. It is republished here with permission.