Why are we building a Product Engineering team in Healthcare?

In the last decades, Technology has eaten the world. It has disrupted and is disrupting every single industry, from automobile, aerospace, manufacturing, telecommunication, entertainment, banking, to e-commerce. The common denominator in all these industries is that technology has enabled a group of talented teams to design and launch new products, experiences, tools, and modern infrastructure at lower costs, disrupting incumbents and offering novel experiences and better services to their users and communities. Those innovations often offer a far better experience, and are accessible, competitive, and scalable at an order of magnitude higher than traditional incumbents.

These differentiators — experience, access, and scale — are all aligned with our vision of what better Healthcare should be about. However, the experience of healthcare delivery systems with technology has had abysmal results. Technology has amplified healthcare system dysfunctions and raised dissatisfaction from healthcare professionals and patients alike. This should not come as a surprise. Although we invested heavily on digitizing the clinic, the medical records, and a lot of our administrative tasks through the deployment of EHRs, the experience of care and the culture of technology in Medicine did not improve dramatically. It focuses too much on billing, reimbursement, processes, and enterprise reporting and monitoring. We are today operating healthcare with inadequate technology infrastructure and more importantly, inappropriate technology culture.

One of the key observations I realized after 10 years as a Clinical Informatician and more recently as Chief Technology Officer of Inception Health — an Innovation group at Froedtert and the Medical College of Wisconsin — is that the majority of Healthcare systems do still consider technology as a supportive function to their clinical operations. However, learning from other industries, the true value of technology is when it becomes an integral part of the ecosystem it is trying to redefine; or in other words when technology becomes the business.

In Healthcare, technology is the business.

So we believe that what we need today is a different way to think about technology in Healthcare and for Healthcare. More importantly, as Healthcare systems we need to become technology-first. If we aim to deliver better patient experience, we know that it requires the combined synergy of medical knowledge, clinical expertise, quality care services, and the technology foundation to build it. That means that as Healthcare systems we have to operate across all the components including technology. Surprisingly, one may consider that healthcare has lots of technology — MRI scanners, monoclonal antibodies, and customized cellular therapies just to name a few. And that is true. Medicine and life science are the most advanced sciences with a plethora of innovation and research. On the opposite side, healthcare systems — the service industry delivering those same innovations and technologies — are not. Can you think of a Healthcare system that is considered in top technology innovators of the year? When was the last time you came across an open-source initiative that was launched by a healthcare system and used by thousands of startups and companies around the globe, such as Airflow open-sourced by Airbnb or React Native open-sourced by Facebook? Today, healthcare systems are still the largest user of fax machines (now upgraded to e-fax servers) as their interoperability platform. Anyone who has interacted with a healthcare system knows that the treatments and doctors are amazing, but the hoops one jumps through to get there are anything but innovative, intuitive, or customer-centric.

Healthcare systems must transform. We must be better. We must be digital; not defined by our bricks and mortar, but by our ability to be there when patients need support in the middle of the night. Be there to support when people are making health choices for their lives and the lives of their family. Be there when people develop a care need but can’t take time off from work. Be there to bring the best services to support patient journeys, from primary care and prevention to supporting complex cancer-fighting regimens. We must be wherever they are. We must remain human-focused, and harness technology.

At Froedtert & the Medical College of Wisconsin, we decided to build Inception Health Engineering. It is a bold vision and a true statement that Healthcare systems must combine the culture, people, and technology to build and deliver a better care experience for patients. By relying on vendors and solutions, we can only get so far. Because this is uncharted territory with so many opportunities and unknowns, we must discover our own paths and technology stack and have the talent, agility, and capabilities to innovate fast and drive our own clinical experiences. Conway famously coined that the system is designed to mimic the cultural and the communication pathways of the organization building the system. And hence, we believe that our engineering and product-driven approach is necessary for our evolution.

Culture + People + Technology = Experience = Healthcare

At Inception Health, our engineering mission is simple: we strive to build the organizational design and the culture that empower our people to leverage technology to build new healthcare infrastructure driven by the same philosophy, approach, and scale that has enabled other players in other industries to become successful and build better care to our patients and communities.

Technology can make us better people and can help us transcend the boundaries of our capabilities to help others in a meaningful way. With that in mind, it is a no-brainer that technology and medicine are meant to synergize.

We are building our product culture, as we explained in a recent blog post, around a few tenants:

• We value Autonomy. Teams, we call them squads, are fully operational and can independently ship products and make decisions that are autonomous through our CI/CD, reaching the patient.
• Our engineering team is a clinical team. Rather than writing a prescription, our team writes code. We have demonstrated in our recent research that delivering a digital experience can have an impact on a patient’s care journey and cost of care. We also demonstrated that including more sophisticated tools such as AI and Chatbots can help patients make more informed decisions.
• We have invested and continue to invest heavily in automation of our CI/CD, safety, quality and security of our infrastructure on Amazon Web Services (AWS) to make it safer and more rigorous for developers in each squad to build digital care experiences.
• We are a small team but we believe that many others will join us and we welcome collaboration with like-minded groups to collaborate and learn together.
• We focus on care delivery as a Product rather than a project. We do that by measuring the problem and delegating to squads to build their solutions. We are implementing an approach based on Objectives and Key Results (OKRs) to define our goals and the key metrics we want to achieve as an organization through our teams.
• We focus on Experimentation and Data as a Product. And we are in the process of building our Data Mesh architecture to make data a first-class citizen in the product lifecycle and in the measurement of success. We have invested in our Observability (o11y) and our Experimentation Platform, split.io, to build better products.
• We are carefully crafting our clinical engineering culture. I have personally shifted from focusing on engineering, architecture, and design to work on team culture, product vision, technology platform, compliance, security foundations, and managing 1:1 with my tech leads. Our team has so much evolved from our initial premise that we published a few years ago in Health Affairs about Adopting Agile Principles in Healthcare.

Not long ago, healthcare organizations used to build their own electronic health records. Brad Crotty and I both came from an organization that used and deployed its own electronic systems. The system, which is the predecessor of the current Electronic Health Records, was built in the 1980s by clinicians such as Warner Slack, Howard Bleich, and Charles Safran to improve safety and availability of information in the clinical setting. It is increasingly important that we don’t outsource everything — technology and our experiences are just as important as the entrances to our buildings and services we provide inside. Conversely, the journey of building a culture of engineering in Healthcare has its own challenges. Nonetheless, it is the most rewarding path to build what Marty Cagan from SVPG coined as Empowered Product Team who can solve hard problems in ways their customers love, yet work for their business.