Slack for Healthcare: What Enterprise Collaboration and Messaging can do for the Future of Healthcare
As a product designer in the healthcare space and father to a 13 month old who’s constantly sick, I’ve been thinking about the future of healthcare experiences, messaging platforms, mobile UI trends, and a holistic, patient-centric digital health experience. This is a post I wrote imagining a future of direct messaging and service integrations in healthcare. Thanks for reading.
Slack, the enterprise collaboration and messaging app, is on fire, and you’re living under a rock if you didn’t notice. In just two short years, it has skyrocketed to a $2.8 billion valuation, is adding $1 million in contracts a week, and rapidly devouring market share from established competitors like HipChat and Yammer. Even considered against the backdrop of our current times, with crazy VC investing and unicorns, it stands alone as a singular phenomenon. What can the rapid rise of a messaging and collaboration app tell us about the future of healthcare?
To the casual observer, Slack may not appear to be much more than yet another messaging app with great service integrations, but there’s a lot more there than meets the eye. By leveraging consumer behavior via adoption of messaging platforms, interoperability of enterprise APIs, and the mobile card UI paradigm, Slack delivers an experience that reduces noise, reduces reliance on email, makes sharing and sending files super easy, and makes collaboration delightful and productive. It makes direct communication easier, and it puts everything your team needs to be successful, all in one place.
In tandem with these trends driving Slack’s growth and UX, I think we’re at a tipping point of consumer stickiness with messaging apps, interoperability of traditionally closed and troublesome healthcare data standards, and EHR penetration, such that a holistic Slack-like experience from a major healthcare technology company or system is not that far away in the future. Without further ado, let’s get into the details — what could a Slack-like experience for healthcare enable for patients?
Direct communication with your healthcare team.
With my wife out of town, the responsibility of dropping our 13 month old off at daycare falls on me. On one particular day two months ago, after we (read: the boy and I) ate our breakfast and got dressed, we arrived at daycare only to hear those dreaded words that every working parent fears — “You’ll have to come pick up your kid, he’s sick.”
This time I happened to get the call just as I had stepped out, so I was able to come right back in and pick him up — that wasn’t the hard part. Here’s what had to happen next, all whilst juggling a feverish baby in hand, right outside a car:
- Fished my phone out of my pocket.
- Found my son’s Kaiser card in my wallet.
- Found the advice nurse line on the back side of the card.
- Waited ~20 minutes to get on the line with an advice nurse.
- Relay the symptoms to the advice nurse and decide whether or not I should make an appointment ASAP, or head home and call it in.
- Finally get confirmation that 102 is the threshold, and that I should head home.
This all occurred on the side of the road by my son’s day care center, as he wailed in the back seat while I tried to figure out what to do next. What if instead of this experience, I could send one message to an advice nurse on my mobile device, and head straight home so my boy can start napping his illness away? What would that look like?
First of all, you’d be able send a message, akin to SMS, directly to your healthcare provider. Notice I didn’t mention doctor, or nurse, or what have you. This channel can be white-labeled on an institution-wide basis, however say, Kaiser, or OneMedical, or whoever the customer is, wants to label it. Here, I’d recommend calling it “Advice Nurse” or something generic. You’d also be able to upload a photo into the channel, pull in reports from a third party app like FitBit or MyFitnessPal, request appointments, and request lab reports and summaries.
I’ve used a generic stock photo to stand in for the advice nurse here, but the idea is the same. Here, we’ve already established that my son has a 101.1 fever, that it’s not a huge deal unless it persists for a while, but that we should still bring him in for a closer look. When I respond with my availability for the appointment, the care provider can see which Kaiser office I frequent, and whether or not there are available appointments. If there are available appointments, she can choose the slots available, and send them to me in a card that I can use to accept the appointment and add it to my calendar, with two taps (1 to indicate the selection, and one to confirm). Rescheduling, or scheduling on alternate days, can be handled the way we handle it now — with our words. And texting. Simple.
Of course this approach will be difficult to scale, but we’ll examine that below. For now, let’s assume this experience beats getting on the phone.
All of your health records, shared files, and protected health information in one place, secured, forever.
Before I had Kaiser, I was self-employed and had Blue Cross Blue Shield. In those 5 years of being self-employed, I saw a doctor twice, a specialist once, and had one hospitalization for a bout of sepsis. The sepsis bout disrupted my digestion, and I’ve had lingering symptoms related to FODMAPs ever since. I had a mole looked at, documented, but not excised by the specialist. The doctor put me on klonopin for a short period to help with sleep. The problem?
None of these care providers spoke to each other, none of them were part of the same system, one of them still had paper records (still!), and each did not realize the others’ existence. What if these treatments intersected in a meaningful way?
When it came time for me to relay the past 5 years of my health status to my Kaiser physician, I had to recite it from memory. I’m only 30 years old so it wasn’t that big of a deal, but I’m sure there are plenty of patients in other age and health status cohorts who aren’t as privileged.
What if, when I shared a piece of health data with my physician, it lived on in one secure place in the cloud, and on my mobile device, authenticated via Touch ID?
Piggybacking off of Apple’s Touch ID, we could establish your identity, assign security and access permissions, and have these permissions follow you throughout the system no matter where you go. You could be a Kaiser patient now, but when you leave the system, Slack for Healthcare can turn off Kaiser permissions, and turn on permissions for your new provider. You could view and delete any past communication with any provider, and access all previous provider data via an archive. You could view all lab results and past touchpoints and records in the system, all in one place.
With Slack for Healthcare, you are the data store, and you turn on the fountain for your providers at your leisure — you’re not the one who has to chase down the trickle of information through the massive flood of data.
So how do we make Slack for healthcare a reality?
While an experience such as the one above looks appealing and potentially solves major pain points in the healthcare experience, we’re still far away from an infrastructure that can support the levels of sharing, permissions, security, and market penetration implied in the above mockups, and far away from legal constraints that would enable the creation of a service such as this one.
The biggest hurdle remaining to be overcome by far is interoperability and open data standards. The current state of the healthcare IT ecosystem is fractured at best. The HL7 standard has been adopted by the major EHR platforms, but these systems are all closed, and the standard is unwieldy and doesn’t play nice across data formats. Patient data does not flow through the system as seamlessly as the patient’s journey does, at least not yet. Gliimpse, Validic, and to a lesser extent, Practice Fusion and EPIC, are all pursuing solutions to this problem from different angles, but ultimately, the major players in the space will have to decide on an interoperability standard and then play nice with each other. That standard looks like it’s going to be Fast Healthcare Interoperability Resources (FHIR), but it is now roughly 5 years since FHIR has been on the scene. Adoption is slow, I’m not holding my breath, and neither should you.
The second biggest hurdle will probably be human capital. Kaiser Permanente serves 9.1 million people nationwide, with a workforce of 174,000, of which 48,000 are nurses. If we run with the current workflow of advice nurses, and assume that every person is active on the service and is sending ~2.5 messages per day, that’s 22 million messages per day that need to be triaged and responded to, but that’s at the higher end, and probably an exaggeration. Fortunately, we’re currently at a tipping point of machine intelligence and natural language processing that I think will, in the near future, offer great value to a messaging service such as this one. Companies such as Luminoso have been using natural language processing with great success in social media channels in order to give companies behavioral data to act upon to manage brand risk and customer support. It’s only a matter of time until this technology is powerful enough to provide the security and efficacy demanded of a healthcare communication.
Lark and Luka are two services that have sprung up in the last few years around giving advice in a consumer context (screenshots below). They can accept free text entry, but they shine the most when they offer users structured text inputs and then offer a set of options afterward that map to what they’re asking for.
How far of a leap is it to think that in the next 5–10 years, a similar NLP engine can process a set of structured inputs and determine whether you need to call an advice nurse or not?
The last major hurdle, amongst the dozens I’m ignoring, is probably distribution and consumer adoption. Would every ACO and healthcare provider have their own skinned version? Is this one company that owns all of the data and manages the entire experience from end to end for every customer? Where does the data live? How is it secured? What happens when a patient switches providers? Is there a universal Slack medical record number that all providers the country over adopt and use? These are wicked problems with no clear answer, demanding the attention of entire businesses in other verticals in and of themselves, and they all stand in the way of providing a better experience for patients.
At the end of the day, the healthcare service experience and the value it delivers is all about and for patients. The current system that we’re working to reform appears insanely confusing, but upon closer inspection, it makes all the sense in the world. It was never patient-centric — it focused on solving business needs first, then practitioners needs, while still addressing patient needs just enough to remain legally compliant and fiscally solvent. Whenever a hard call had to be made, it came at the expense of the patient experience.
Switching providers? Good luck migrating your health record, we use EPIC and they use Practice Fusion.
Changed your insurance? Better make sure your provider is still covered, not our problem.
Need a novel procedure covered? Here’s what Medicare owes, here’s what the hospital owes, you’ll get yours in the mail in 3 months and you better pay up, buddy.
If we tackle data interoperability and security first, meet consumers where they are (mobile messaging), and build a system around how patients should access healthcare, we can design a new experience that unlocks entirely new value propositions for patients, while capturing more of that newly created value. It will take a team of world class data engineers, data scientists, business developers, and UX and product professionals, but it can be done. Electronic health records and interoperability should be table stakes. Commodities. Let’s build a better future together by focusing on the consumers and service providers of healthcare, and decommoditize this space with great, user-centric design.