Blog - Medical Informatics Corp

CTO Craig Rusin at TEDxHouston

Craig Rusin Introduces Real-Time Clinical Decision Support

From the TEDxHouston event on November 3, 2012:


Craig has been waving a flag of innovation and opportunity throughout the Houston Medical Center. He has been an advocate for a new way of thinking about the valuable biological information that medical technology is able to generate. The complex interplay of medical diagnosis, computer assisted decision making, patient confidentiality and the big data movement will be explored by this local entrepreneur.

In the spirit of ideas worth spreading, TEDx is a program of local, self-organized events that bring people together to share a TED-like experience. At a TEDx event, TEDTalks video and live speakers combine to spark deep discussion and connection in a small group. These local, self-organized events are branded TEDx, where x = independently organized TED event. The TED Conference provides general guidance for the TEDx program, but individual TEDx events are self-organized.




Actively Listening to Your Customer

After reading the article “Listen to Users” by Travis Good, we looked into our own communication practices to make sure we are doing the best we can to listen and understand to our users.

Providing healthcare solutions is not about addressing one particular group’s needs, but is about designing a solution that meets the needs of stakeholders across an institution. As the CEO of a healthcare software company, I believe it is absolutely critical to actively listen and respond proactively to your customer’s needs.

In this industry there is no lack of ideas on how to improve patient care. Clinical professionals are acutely aware of the problems that surround them on a daily basis. The challenge they face is that many of these problems require solutions that are outside their area of control and expertise. Listening to multiple stakeholders within an organization allows you to gain perspective on the problems they face and the feasibility of implementing a practical solution that integrates into their workflow.

I make it a point to talk to different institutional stakeholders at a minimum of one time per week, if not more. It is not just important to listen to these stakeholders, but to understand their needs and communicate their needs back to them. I highly recommend this practice to other vendor company leaders. Interactions should not be limited to one group; one should actively engage physicians, nurses, technicians, administrators, information system and biomed representatives across the healthcare institution. 

You will discover very different stories and needs across an institution that are related to your product. In a broad sense you will find:

System users want solutions that fit into their workflow, help improve patient outcomes, and solve critical problems that are currently not being addressed.

Administrators want products that ultimately add value to their institution and help meet strategic goals.

Technology managers want systems that are easy to maintain, safe, secure, and do not disrupt other internal systems and networks.

Being empathetic to your customer reminds you to re-focus what you do on a daily basis, to what is important to your customer.

Do you have any other tips or ways you focus on being a better listener with your users?





Barriers to Rapid Improvement in Healthcare IT

There is a lot of talk in the healthcare IT industry about bringing successful product development strategies from B2C companies such as the Agile software development and Lean Startup methodology. Agile focuses on rapid development of software based on iterative and incremental improvements, while Lean Startup implements a fast to fail mentality.

Innovation in Healthcare IT can have its own unique challenges. A high regulatory burden forces companies to implement quality systems and put software though standardized validation and verification processes. And while few would argue that software that could be used to treat patients should be well tested and documented, it introduces a significant barrier for rapid innovation.

Both Agile and Lean Startup emphasize being flexible and learning quickly from your customers. However, institutional customers are naturally risk-adverse and not prone to test new products. This makes testing the market and validation with customer feedback challenging to say the least. Combine this with the increased regulatory costs, a long sales cycle of 6+ months, a U.S. market that is less than 6000 registered hospitals; it can be cost prohibitive for smaller companies to develop and test new products in the marketplace. Vendors face an uphill battle to deliver new or improved products to their customers.

To see rapid improvement in the quality of healthcare IT, two changes in behavior and communication are needed from healthcare institutions and healthcare IT vendors.

  • Healthcare Institutions must change their behavior in adoption of new and improved technology. They should consider working with smaller, more agile vendors and be open to collaboration with these vendors. It takes two to make any relationship work and both parties have to be willing to put the time and resources into building relationships and openly discussing how to improve products.
  • Institutions can provide incentives to work and support those vendors that go above and beyond in the areas of service and product development. This can include providing access to information, clinical expertise, and specialized facilities such as simulation labs to test improved products. In order to see products rapidly evolve to fit the needs of an institution, it is absolutely critical to build partnerships with vendors and collaborate on win-win contracts that build long-term relationships.
  • Vendors must also change their behavior in working with healthcare institutions and in the way they develop their products internally. Vendors need to actively listen to their customers on multiple levels across the organization and integrate feedback mechanisms into their product development processes.
  • Vendors can improve software development turnaround time by adapting Agile processes for their software development teams and automating quality system reporting requirements. In addition, building stronger internal communication between product management, sales, and software development groups can help re-focus product priorities to customer needs.

Methodologies like Agile and Lean Startup can provide insight into how to improve healthcare software companies. Agile promotes active planning, the use of cross-functional teams, and encourages rapid and flexible response to change. Lean Startup teaches us to accelerate the feedback loop with our customers: learning faster, coding faster, and measuring faster. These practices, to be effective in healthcare must be adapted to fit the unique challenges of a highly regulated, slow to change industry.


Finding Good Data, Not Just Lots of Data

Have you read Doing Something With All That Data by Fred N. Pelzman, MD, MedPage Today Staff Writer?
In that article, Dr. Pelzman struggles with the same issue that we hear from so many clinicians. Recovering patient information from an EMR or any hospital IT system is about finding “good data, not just lots of data.”
The standard EMR dashboards are rules-based systems where you take a large data set, apply an obvious rule or filter, and see data results that are manageable, but there’s room for improvement. The next step is to use algorithms and intelligent filters to give clinicians better information. Instead of manageable sets of data, it’s about meaningful data that can be used for patient treatment.
What meaningful data would you like to see used for patient treatment?

Predictions and Trends in Healthcare IT. Here’s what’s happening in 2014…

After reading Frost & Sullivan: The Three Big Predictions for the Global Healthcare Market and Digital Health Trends of 2014 by Travis Good, I put together my own thoughts on this year’s trends and predictions for IT healthcare.


I prefer to focus my predictions on things that are either in my control or can be considered a science. When we talk about clinical decision support there is a lot of opportunity for improvement across the Healthcare IT space, everything from mobile apps that help monitor patient health to centralized applications that address day to day decisions that clinicians make.


1) The applications that will have the greatest impact over the next year are the ones that not only provide flashy solutions, but also help the user and the organization create a pathway to the solution they are looking for. In healthcare success comes from good execution of idea and its integration into the users workflow.

2) The emergence of more players in the clinical decision support arena, especially in regards to big data analytics. This means for customers/buyers, expect more noise. Different technical solutions were made to fit specific problems and this means a solution that worked in one area might not be optimized for another. Make sure you understand your needs and can communicate those to others.

3) An increase in healthcare organization adoption of technologies and solutions from non-traditional players. Consumers in general are more accustom to user-friendly mobile apps and technologies. It is clear that those demands and expectations are transferring to healthcare IT solutions. In general large companies, or the traditional player are often slow to react and less agile to adapt to these customer demands.


When it comes to trends, I completely agree with Travis Good (@travisjgood) on the hazards of predicting the future of mobile medicine.

In fact, one of my favorite excerpts describes the accuracy of forecasting:

“The fragility of our attempts to foresee the future is well captured by William A. Sherden. In The Fortune Sellers (1998) he casts a cold eye over a wide range of contemporary forecasting including economic prediction, weather forecasting, population forecasting, technology assessment, business planning, financial services, futurology and fortune telling. He concludes that:

‘‘Of these 16 types of forecast, only two – one-day-ahead weather forecasts and the aging of the population – can be counted on, the rest are about as reliable as the 50–50 odds in flipping a coin. And only one of the 16 – short-term weather forecasts – has any scientific foundation. The rest are typically based on conjecture, unproved theory, and the mere extrapolation of past trends – something no more sophisticated than what a child could do with a ruler (or perhaps a protractor).’’”

Horner, D.S. (2005) Anticipating ethical challenges: Is there a coming era of nanotechnology? Ethics and Information Technology, 7, pp 127-138.

Do you see any other IT healthcare predictions/trends that will bring a big impact to the marketplace in 2014?