Introduction

I’ve spent the better part of eight years building software for various healthcare technology companies. Each role came with its own set of challenges, as well as the opportunity to work with a different part (or parts) of the US healthcare system.

Lately, I’ve been reflecting on my time in healthtech – how it’s shaped my career, influenced my approach to building software, and broadened my perspective on the roles and responsibilities of those who both envision and deliver the solutions in this field. This post attempts to explore some of that.

How Did I Get Here? Why Do I Stay?

Without getting into my whole life story, how I ended up here is kind of funny. As a senior in college, I got a call to interview for a job that I didn’t even remember applying for. I was stoked because my goal was to land something before graduation and then chill for the rest of senior year. I ended up getting the job, and that’s pretty much how it all started. At the time, I had zero idea what I was actually getting myself into.

US healthcare is, to say the least, kind of insane. Those of us in healthtech get to look at it from a bunch of different angles as we try to build coherent solutions for what often feel like incoherent problem spaces. It can be wildly frustrating, but at least it’s never boring!

Anyways, for better or worse, I’ve stuck around.

Over the years, there have been opportunities to explore other industries – fintech, real estate, you name it. But nothing ever felt compelling enough to make the jump (even though some of the offers – looking at you, fintech companies – were very tempting).

Ultimately, I think it boils down to three things keeping me around:

  1. I want to build things that can positively impact people’s lives. Working in healthtech provides me with tons of opportunities to make contributions that can help improve patient health outcomes.

  2. There is no shortage of unique problems that are interesting, meaningful, and lucky for me, solvable with software. This makes it pretty easy to find things to stay engaged.

  3. There are lots of existing solutions that could be improved, to put it nicely. This leaves a ton of room to launch competing products that do things better. Bonus points if it ever involves unseating bigger players ;)

To be clear, while I find the work exciting and rewarding (and endlessly frustrating), I’m not here to defend the healthcare industry. Many of the problems we are now tasked with solving stem from the inefficiencies and overcomplications created by the industry itself. That’s a topic for another day.

Some Thoughts / Opinions

While thinking about what to write for this, one of the hardest parts was trying to figure out what was worth including. A bunch of stuff got tossed out, but in the end I still ended up settling on five things.

The first three try to convey the ways in which I believe us technologists fit into healthcare and what our responsibilities are beyond just shipping code. The last two attempt to discuss some examples of the more frustrating things you can run into.

Be Disruptive, But Minimize Disruption

I couldn’t help it with the corny section title, sorry.

Tech people love to “disrupt” and “revolutionize” things – at least that’s what a lot of places claim to be doing most of the time. But in healthcare, “moving fast and breaking things” runs the risk of causing bigger problems than users just being mildly inconvenienced by our iterations.

Breaking scheduling for a surgeon isn’t the same as breaking a feature in a social media app. Iterating rapidly on your UX might be fine for an e-commerce site, but it’s far from ideal when a nurse is trying to update patient information and the application keeps changing on them.

For physicians, software issues – whether a bug, bad UI, or poor performance – make an already difficult job even harder. Slow or inefficient software can delay them during patient visits, in turn affecting every other patient they need to see that day.

Of course, no one is going to build perfect software – that’s not the goal. Instead, I am arguing that as solution builders, we have a duty to minimize our potential to harm our users’ ability to perform their roles in healthcare.

Respect Patient Information Like It’s Your Own

Working on healthcare tech solutions usually means dealing with patient data at some point. My approach to dealing with it is simple: treat patient data like it’s your own. Don’t do anything with it that you wouldn’t want someone to do with your own data, even if it might technically be fine under HIPAA.

This mindset is not only respectful to patients but also reduces the likelihood of HIPAA violations. Ask yourself (HIPAA aside):

  • Do I want my name and address in someone’s slideshow?
  • Would I want my social security number in a screenshot on some Trello card?
  • How would I feel if my personal information was hardcoded into a unit test and pushed to GitHub?
  • Would I be okay with screenshots of my medical history being shared in random threads?

There is also the risk that all this information ends up in a data breach. The danger is always there, but sprinkling PHI around needlessly and / or not properly storing it increases the odds that something ends up going wrong. A data breach would obviously be catastrophic for your business, but it’s usually the patients that end up with the shortest end of the stick.

Imagine you’re a patient, and some tech company you’ve never heard of experiences a data breach including names, addresses, social security numbers, and more. One of your providers happens to be a customer of theirs. Suddenly, you’re facing identity theft, scam calls, and other fallout – all while you could also be trying to deal with your health issues. Feels bad.

Not Everything Needs Tech

Tech people are always gonna try and tech, I know. However, not every challenge needs a line of code to solve it. This probably applies to most industries, but it is especially true in healthcare, where many of the hardest problems are inherently human. Similarly, trying to remove people from the equation (e.g., automation) isn’t always the best solution, and it could even end up leaving you worse off.

One example that stands out to me is the growing number of solutions focused on minimizing, if not eliminating, face-to-face interactions between providers and patients. I’m not saying telehealth is bad – it’s not. There are tons of things you used to have to visit a doctor’s office for that can now be handled over the phone. That’s awesome! My concern is with solutions that aim to replace all in-person interactions between patients and providers.

As it turns out, many of these places are missing the mark due to something pretty obvious: patients generally prefer direct interactions with their provider when it comes to something as important as their health. Providers, likewise, value the opportunity to work directly with their patients.

My current company has remained cognizant of this for our physical therapy business, and it’s proven successful. We’re fortunate to receive a lot of positive feedback from both patients and physical therapists, a good amount of which has nothing to do with the software solutions we’ve built.

PTs enjoy working with patients 1:1 for an entire session instead of juggling multiple patients as they often do in a clinic setting. Similarly, patients appreciate having a provider dedicated to them for the full session rather than being handed a list of exercises and left on their own.

Our success lies in how we use technology to facilitate and improve the in-person physical therapy experience, not replace it. By focusing on enabling meaningful interactions rather than removing them, we’ve built a model that works to the benefit of both providers and patients.

Healthcare Runs on Faxes

It’s 2024, and you’d think we’d be done with the laborious paper-pushing fax workflows of the past. In many industries, that’s true … but not in healthcare! Even organizations using tech solutions daily still rely on fax.

The obvious question is why? We know modern tech solutions can replace paper and fax workflows in theory, so why hasn’t it happened everywhere? The answer is complicated.

Let’s say you’ve convinced part of a healthcare organization to adopt your shiny new software product that beautifully captures their key workflows. Everything looks great until someone points out that the old process also involved sending faxes to various internal and external recipients – billing, insurance, others – depending on the circumstances. Your software didn’t account for this, and apparently, there is no other option. Faxing is non-negotiable.

So, what do you do? You scream into the void, then discover that to both your horror and relief, there are services that provide APIs for faxing. You can even set up a number to receive faxes and have them sent directly to your application. Begrudgingly, you add functionality to your app for sending and receiving faxes, helping at least one team move their fax machine “to the cloud”.

The takeaway here is that healthcare professionals aren’t stuck sending faxes because they enjoy it. The problem is that, no matter how great your solution is for some individual organization, they still need to exchange information with countless others who might literally only use their fax machine as their main form of sending and receiving information. Whether it’s due to leadership not prioritizing tech adoption or straight-up reluctance – “this works fine for me, I don’t need your fancy application!” – fax machines remain the lowest common denominator.

Pay to Play

Healthcare tech is unfortunately one of those industries where if you really want to jump in the game, you have to have the money to do it. It’s a real shame because as I have mentioned before, there are tons of problems that are meaningful, interesting, and solvable with software. There are also a ton of opportunities to disrupt large industry players that have grown complacent and are now contributing to more of the inefficiencies and waste that plague our healthcare system. Sadly, though, there are just too many things making the barrier to entry way too high for a lot of potential newcomers.

Why is it so expensive? Some argue it’s the regulations, others might argue it’s price gouging. It’s probably a bit of both. The regulations do require you to do certain things which ultimately cost money. At the same time, the price points for some third parties can be outrageous, oftentimes for no clear reason. A general rule of thumb is to add one or two more zeroes to what a reasonable person would expect to pay.

On the other hand, there are also a handful of industry giants that gatekeep things you might want or even need access to in order for your business to function. They tend to charge you for them too because, well, they can.

For example: there are organizations out there that legitimately will not even consider buying into a software solution if it doesn’t have a plugin for whatever big name EHR system they use (I’m trying not to name drop because I don’t want to get myself in trouble). From their perspective it makes sense: keeping everything unified under a single system allows the organization to standardize and focus on becoming efficient within that system. Introducing another system just causes friction. You can do what they are asking, but first you have to pay the toll: Big EHR wants wants their cut for the privilege of working your product into their system. So … how bad do you want the customer?

Big EHR loves this arrangement – they get more money, you build and maintain things that are pretty much additional service offerings for their own system, and oh they get a cut of your revenue if you ever end up charging money for your app within their marketplace.

There are a ton of other things, but I’m sure you get the point. It’s a sad state of things, but who knows? Anything can happen!

What Now?

I don’t really ever write anything, but hopefully there were at least some interesting things up in there. Maybe at some point I’ll go into some of the crazy stuff, we’ll see.

I am likely to remain in healthtech for the foreseeable future, regardless of how frustrating it gets. As some of my friends and I like to joke: once you’re in here, you’re never getting out. At the end of the day, it’s fun to work on things that will hopefully end up making some aspects of this crazy system a little better.