As I prepare for my new role at Amazon Pharmacy, I’ve been diving deep into pharmacy and healthcare workflows via The Internets. As part of that research, I’ve looked at dozens of healthcare workflows, like this one:
As I reviewed the workflow diagrams of many healthcare organizations, it became apparent to me that there were a number of issues with existing workflow representations:
Lack of Efficiency. Many steps involve a human manually copy-and-pasting and transferring information (typically via email) in a non-creative way.
Lack of Standardization. There is no consistent ontology around workflows, leading to ambiguity and potential disagreement.
Lack of Legibility. Workflows are often not written down and are transmitted through cultural and training mechanisms instead.
Lack of Discoverability: A standard healthcare organization has hundreds, if not thousands of these processes. Right now, there is no way for someone (say an operational exec) who wanted to see the entire picture to be able to find them all in a single place.
Lack of Data: As an operations manager, how do you know if the workflows are carried out with sufficient quality, or even being carried out at all?
In light of these problems, one technology trend I am excited about is the No-Code Movement. No-code is a philosophy that aims to create tools which enable non-programmers to directly solve problems within their organization using graphical software (you can think of it as Excel with superpowers, although Excel Never Dies). This is a powerful concept because frontline workers often understand their organization’s problems most acutely, yet lack the ability to solve them because existing technologies are too difficult to learn or use. Companies that are trying to lower this barrier in low-risk commercial settings include Webflow, Retool, and Airtable.
So, here’s my Request for Startups: Someone please make a HIPAA-compliant No-Code tool for healthcare. No-Code tools can make a big impact in healthcare operations by empowering individuals to automate and standardize workflows, resulting in greater efficiency, consistency, and ultimately quality of care.
Right now, workflows in healthcare organizations either (1) default to the lowest common denominator like email or (2) use out-of-the-box workflows from health IT vendors like Epic, Cerner, etc. However, I believe there is a sweet spot in the middle where operating individuals within organizations should be able to customize their workflows in a way that adapts to the latest state of knowledge, and works for their specific reality.
I think Retool has put together an especially easy-to-learn and powerful platform that can be used to represent workflows as code (caveat that Retool is more “low-code” than “no-code”, but a step in the right direction). Check out this video for a quick demo:
As an example of the potential power of No-Code platforms in healthcare operations, a lot of hospitals are buying third-party solutions that allow them to automatically follow up with patients via phone/SMS/email after discharge to try to reduce preventable readmissions.
The existing third-party software tools are certainly less expensive than staffing nurses to do manual phone calls/emails, but are ultimately limited by their adaptability and being “on the outside” from an IT perspective. With something like “Retool for Healthcare Operations”, one could imagine Nurse Informaticists within a hospital setting up an internal workflow that automatically sends a hospital-branded SMS or email survey to each patient that gets discharged from a unit (based off HL7 A03 messages), with full flexibility to customize to their changing needs and avoid lock-in.
A few other potential wins off the top of my mind:
Discharge Nurses setting up a dashboard and alert system that integrates with their remote patient monitoring devices that have been deployed to discharged patients.
Nurse Managers creating survey tools for staff to collect non-clinical information during rounding.
Clinical Operations creating Zapier-esque Connectors to link the Clinical EHR system to other systems-of-record like Facilities or Dietary for real-time updates (say a physician records in the EHR that a patient needs a specific type of diet and would like Dietary to be informed).
Unfortunately, none of the current leading No-Code platforms are HIPAA-compliant that I’m aware of :tears:, BUT I think there’s an opportunity for one of them (or a startup!) to be a first mover in healthcare.
There are certainly questions that would have to be worked out in practice. First, there would need to be stronger governance and version control tools for managing changes prior to production release (compared to lower-risk organizations where it is more acceptable to “move fast and break things”). Second, there would need to be a huge cultural/mental shift where it is acceptable and encouraged for individuals within a healthcare organization to think about representing workflows and operations in software, as opposed to using less persistent/legible tools like culture or training (although those should always be present)! Finally, there will inevitably be edge cases (as in any human endeavor) where the software fails to achieve a proper outcome, and tools/training must be created for auditing and correcting those issues manually.
Nevertheless, I believe that when frontline individuals are empowered with easy-to-use tools to make positive changes in their domains of work, society is more likely to flourish. I think this should apply to healthcare as well.
In the 21st century, one of those key tools is the ability to control software, and No-Code has allowed programming to climb the Ladder of Abstraction to the point where I can start to dream about user-driven applications in healthcare. We are beginning to see the rise of No-Code tools supporting the Creator Economy and startups with lower-risk operational needs, but it has yet to hit more complex regulated industries like education and healthcare. Yet I think it’s only a matter of time, and I hope to see this RFP come to fruition in the next decade or so.
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Cheers,
Alex
(Note: This is an early draft of my thinking, so please let me know where I am missing things/potentially wrong! )
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Hi Alex, this is a great article and I wish you the best of luck in your new role! Your request for a HIPAA-compliant No-Code tool for healthcare was met with Microsoft's release of SharePoint 2013, in addition that platform could cover all the scenarios/use cases/user stories that you referred to in your article! Unfortunately Microsoft disbanded its SharePoint product and development team shortly thereafter to focus on its Azure cloud platform and Office365 SaaS products, so far I have not seen this functionality reappear in the Microsoft stack, but in bits and pieces across AWS, Azure and GCP.