The Asteroid Manifesto
April 5, 2017
Remember the game Asteroids? At the risk of dating myself, I do. Asteroids came out in 1979 and was a great shoot ‘em up video game in which you blasted asteroids that flew relentlessly into your path. Being asteroids, they were unforgiving, destroying every ship they touched. If you somehow made it to the next stage, the asteroids came at you in more volume and speed. You had to be quite the twitch athlete to keep up and not get end-of-lifed. It would have been nice if there was a secret code that froze the asteroids mid-flight and provided an extra laser gun to assuage the attack, shifting the power paradigm and play a little offense. Alas, it was a perpetual game of “D”.
“Asteroids” in Behavioral Health
It reminds me of what I observe in healthcare and in particular, behavioral health. The volume of “asteroids” coming at behavioral health in the form of change is a few levels higher than any human “pilot” could possibly maneuver alone. ICD-10, Meaningful Use, Medicaid, and the uncertainty of what’s to come with the new administration in our country comprise an unabating tsunami coming at behavioral health while clinicians strain to provide the highest quality of care to clients, resulting in a gap of strategic vision and forced tactical operation.
The leadership, vision, hearts and minds in this industry are impressive, to say the least. There is enormous vision, IQ, intellectual property, and genuine empathy for those in need. But there is enormous challenge to shift from the defensive to the offensive and move from the tactical to the strategic because of constant reaction to change all with a brittle technology infrastructure with which to react. You’re in the middle of a hailstorm of asteroids, your steering system intermittently sticks, and your guns are jammed. It’s virtually impossible for you to level up.
Old EHRs: Circuits are Jammed!
Technology companies, EHR’s, have under-served and disappointed this market for some time now. It’s not because EHR companies don’t care or are egregiously trying to make things difficult for this market. The culprit is the age of EHR technology. Bottom line is that it’s old. The laser guns this market uses to break asteroids is on average 15 years old.
You don’t need to be a technology expert to know what 15-year-old technology and modern technology can do. Just look at the phones we carry in our hands. Who uses the same phone they had 15 years ago? It raises the question: why don’t EHR companies offer new technology? Why have other industries transformed and behavioral health has, yet again, been left behind?
A reason EHR companies don’t start over with new technology is due to the concepts best illustrated by the Innovator’s Dilemma. It’s hard for companies to pivot away from the very paradigm that produces revenue/cash. Blockbuster is a great illustration of the Innovator’s Dilemma; Blockbuster should have become Netflix.
This paradigm of old technology in a rapidly changing environment has created a fundamental misalignment in vision, strategy, and tactical execution for agencies. The old technology forces this market into a state of constant defense, reaction, and tactics. Ultimately, agencies get stuck in a permanent state of lag instead of at pace or ahead of what needs to be done and are challenged to focus on moving toward the future, proactively operating towards vision and strategic objectives. Some EHR’s have made valiant attempts to improve the technology via bolt-ons and modules. Those are indicators of building technology on top of old technology. It masks, not solves, the problems. The technology is a massive hurdle instead of a catapulting facilitator that is aligned with vision and strategy.
Valant became interested in supporting the needs of community behavioral health as it aligned with our mission of using great technology to make high quality care available to all who need it. But we had a decision to make: do we leverage our private practice product, building on top of it to extend it to meet the complex requirements of this market, or create a different type of EHR based on new technology and capabilities?
We didn’t have to sit on this question for very long as, at that point, our private practice product was about 7 years old, and we knew we wouldn’t contribute anything different. We would in fact be contributing to the problem pervasive in this market–that of “brand new” solutions built on top of older technology. And, ultimately, someone else would come along and disrupt us. So we decided to start over.
Adopting New Technology to Help You Level Up
Due to the profitable nature of our private practice product, success, and experience, we had a unique opportunity to pause and ask ourselves, “What if we could start from scratch and bring to market all new modern technology like we experience on our iPhones and in our personal lives?” We knew this was the way to go.
But we didn’t reinvent the wheel. Companies like Amazon, Facebook, Microsoft, Apple, Uber, etc., have all raised the bar for what is now the gold standard for enterprise grade software and they have all built on core tenets of performance, data, usability, and change management. These core tenets are what make current technology so smart and user-friendly, and they’re exactly the building blocks to use for community behavioral health, too.
My guess is if Steve Jobs, Jeff Bezos, Mark Zuckerberg, and Elon Musk built an EHR, we would be interested in taking a look. And the reason is because we trust their approach to technology. Maybe their first iteration didn’t have some feature or functionality, much like the iPhone didn’t support Microsoft Exchange when it came out, but we would be interested in starting the journey with them.
In evaluating new technology, there are always moments of discomfort, fear, uncertainty, and doubt that stem from the pain of being burned by technology in the past. Another frustration that is perhaps unforeseen is the natural tendency to judge new technology on old models of evaluation.
Once we let go of the pain of the past, the trap will be to apply the same models of evaluation of old technology to new technology. Imagine evaluating a VCR and Netflix with the same process. Netflix would invariably fail every test: “Where do I put the tape in? How do you protect the film from getting eaten? How long does it take to rewind?“ As the technology changes, the questions must change with it.
If we didn’t have to worry about technology hindering us, what would the market look like? What if technology were off of the agenda like it is in so many other industries? What if it worked and was at pace or ahead of where we needed to be relative to strategic objectives? What if we loved the technology as much as we love our iPhones?
We might just live in a world with that secret code which froze the asteroids and provided an extra laser gun! We might be able to get to things we hadn’t been able to get to in years. Our employees may be happier, patient outcomes improved, costs lower, and able to win new contracts and grow services and reach. If technology were out of the way because it just worked, these would all be attainable realities.
Changing the Game–and Winning
We are challenging this market to demand better from technology providers to achieve strategic objectives and to stop dodging asteroids. We are challenging this market to pause the defensive firing and absorb some short term adjustments for long term gain for this market, your agencies, your employees, and clients. The cycle has to be broken… Get the technology right and deliver on the mission this market deserves.
It’s time to ask yourself: where’s your “secret code” that helps your agency actively manage (and even plan for) continuous complications that come with community behavioral health? It’s time to utilize current technology to finally get proactive with regulations, destroying those asteroids and leveling up with ease. It’s time for an EHR based on game-changing technology.