Digital Transformation in Health Care Can Be Fixed

  • In 2010, the President’s Council of Advisors on Science and Technology said, “Americans [will] soon enjoy the benefits of electronic health records.” Harvard Business Review predicted, “Innovations in telemedicine will accelerate in poor countries where access and cost are critical issues. Such innovations can transform health delivery in rich countries.”
  • Ten years later, very little of that promise has come to fruition. Millions of Americans have a half-dozen unused health management apps on their smartphones and a fitness wearable collecting dust in a drawer.
  • Meanwhile, they still call their doctor’s offices for appointments, fill out paper questionnaires, fax records, write checks.
    Back in 2006, Harvard Business Review first asked, “[W]hy is innovation so unsuccessful in health care?” Now one can reasonably ask, Why hasn’t anything changed?
  • Digital startups are highly valued by investors, and Silicon Valley has produced a glut of health care unicorns.
    (Oscar Health is valued at $3.2 billion,
    Babylon Health at $2 billion,
    One Medical, $2 billion,
    Devoted Health, $1.8 billion, and
    Phreesia, $970 million.)
  • Eager to support their members and patients, payers and providers alike have partnered with an array of vendors to create a ragged collection of solutions, but these have mainly served to scatter badly needed functionality across health systems and platforms.
    The fragmentation frustrates consumers and undermines investments.
    Patients must log in to one app to manage their weight, another to track their chronic condition, another to pay their bills, and yet another to book an appointment for a child.
    The more individual products they need in order to take control of their health care, the less likely they are to utilize any of them.
    Why would they, when they can still pick up the phone, call the doctor’s office, and have all that work done for them?


1.Most digital initiatives do not focus on consumer needs.

  • Consumers want convenient, high-quality, and affordable care-goals that digital solutions such as online booking and telemedicine support.
  • They also want solutions that analog health care cannot deliver, including tools that they can use wherever they are, that help them care for themselves or their loved ones at home, and that help them deal with the health care system.
  • Human-centered design is agile and iterative, seeking consumer feedback early in the design and development process and returning for more insight throughout the product’s growth cycle.
  • Following this strategy ensures a friendlier product that is better equipped to meet true consumer needs.
  • It also translates into cost savings: patients are given a chance to react to a series of prototypes, and the concept and execution can be tweaked before an expensive software development effort brings the product to life.

2.The value of digital solutions is difficult to measure.

  • Do patients rate providers more highly after a telehealth or an in-person visit?
  • How many people begin booking an appointment online but don’t follow through?
  • In the future, these capabilities can be mined and expanded to answer even more complex questions, such as whether high engagement with the product correlates with better long-term health outcomes.

3.Clinicians (and patients) are skeptical of solutions that affect their workflow.

  • Clinical workers may be asked to enter data into a new system, or even into two systems rather than one.
  • Doctors-already threatened by burnout before the pandemic-are loath to learn how to use another piece of software that could take away face time with patients and cause yet more administrative work to pile up.
  • In one instance, apps that allow online booking require clinics to standardize their appointment types and data entry, forcing clinicians-including busy specialists-to relinquish control over at least some portion of their schedule.
  • Doctors are often rightly concerned that even the best tools will not be fully compliant with the Health Insurance Portability and Accountability Act and protect patient data as well as their existing systems do.
  • Payers worry that technologies will evolve too quickly and they won’t be able to communicate the cost-saving benefits of the product to their customers.
  • Even patients sometimes resist changes to the medical system workflow. After logging into several different applications using separate user names and passwords in order to transmit information to a doctor’s office, filling out a form on a clipboard might not seem so bad after all.

4.Most health care IT and electronic record systems are antiquated, making integration challenging.

  • Although private and governmental initiatives are driving incremental change, developing a product that works across hospital systems-or even within a single one-can feel impossible when the average system utilizes multiple electronic medical records in its central and affiliated practices.
  • Retrieving data from these systems via their rigid, often proprietary, APIs in order to make decisions about patient care, personalize an experience, or just show someone a test result can be extremely complex.
  • Cloud solutions can be just as secure as on-premise infrastructure, but they do require different security measures.
  • Modernization of infrastructure takes time and requires resources.
  • Despite the demonstrable value, it tends to be delayed in favor of other initiatives with clearer short-term advantages and fewer perceived risks.
  • The health care system we worked with understood immediately that a good team of vendors could help manage-or at least avoid amplifying-the chaos of multiple health record and API data sources. It recruited two primary types of vendors for the project.
  • Point solution vendors provided plug-and-play tools, such as an external triage tool, to enhance the user experience of the product.
  • Integration vendors brought their experience to bear on navigating the firehose of available data.
  • The health system required that any candidate vendor feel comfortable working within the existing technology framework to provide a seamless, integrated user experience, and that all vendor contributions to the final product were contained under a unified umbrella of user identity management and security.

5.The slow pace of health care innovation is at odds with tech sector ideology.

The Promise of Consumer Digital Health Care, Fulfilled



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Joaquim Cardoso @ BCG

Joaquim Cardoso @ BCG


Senior Advisor for Health Care Strategy to BCG — Boston Consulting Group