We’re living in an age of experience, extreme consumerization, and very rapid change. Just keeping up is a major challenge for companies. What is good today may not be relevant tomorrow, and a new service or product line today could be cannibalized by something much better depending on what comes next. But brands must do more than just keep up. They must rethink how they operate to better anticipate consumer needs. As a result, companies need to rethink the relationship between operations, people and technology.

Historically, a company could consider sudden market shifts as “black swan” events, but today such events (think natural disasters, pandemics, etc.) seem to happen more frequently. Businesses must adapt as quickly as markets change, and intuitively deliver experiences based on new-age product lines and services. To achieve this, they must cut across old silos. And they must build frictionless, seemingly invisible work processes that reflect the new need for greater operational agility and fluidity.

Enterprises have invested heavily in technology but little attention has been given to the processes sitting on top, which tend to be choppy. Many of these processes are, at best, inconsistent. And they often are completely broken. Leaders need to think about processes as the end-product of their technology work, the end outcome that serves customers and the market.

But even in a highly-automated age, processes will still be driven by people. So, thinking about how you motivate, train, and develop them will be the best path to better serving customers. Several key approaches will help guide your strategy. First, think of the outcomes you want to achieve. Second, consider that those outcomes will best be driven by having the right kind of people in place. Finally, take advantage of the new ways technology enables you to turn any businessperson into a programmer, or put more \\simply – engage in “citizen coding.”

Optimizing operations with outcome-oriented thinking

We need to rethink the relationship between business operations and technology.  Many leaders think their companies have been digital for the better part of a decade. However, the pandemic exposed critical gaps in between how digital they thought they were and how far they still have to go. Now they aspire to a state where “everything is digital,” but it’s unclear what that means and what companies should do to get there.

To paraphrase author Stephen Covey, start with the end in mind. Digital transformation must begin with a clear sense of the brand’s purpose in the market, which then should lead to reconfiguring work processes to achieve your purpose. First, identify the problem you are trying to solve and the value you are trying to deliver. From there, consider the kind of customer experience you want to create, the one that best reflects the values of your brand.  Only then can you decide how best to render work in a digital manner that brings modern workplace efficiencies and differentiated convenience to customers.

Getting there requires a radical rethinking of the relationship between IT and business functions.  In fact, the lines begin to blur, and that’s good. Technology needs to be considered in the context of what you are trying to deliver to the market. When we talk about process transformation, or even enterprise digital transformation, technology should not be the first thing we think about.

The Threat of Digital Sameness

As nearly every company in recent years has found itself both inspired and intimidated by Amazon’s astonishing capabilities and the often-cited “Uberization of everything,” a dispiriting haze has afflicted the digital experience of brand after brand. Many pundits call this “digital sameness,” a too-formulaic customer experience that fails to convey the unique feeling and value of a specific brand. This sameness can be avoided by taking a resolutely customer-centric approach to work processes. It means knowing your customers and what they value about your products or services, and ensuring that their digital experience with you uniquely reflects that.

To avoid the cookie-cutter approach, it’s critical to create a new empowerment in two ways—among employees and across your entire corporate ecosystem. Allow and encourage employees to focus on customers in all they do, and reward them for creatively doing so. And find every possible way to coordinate the supply chain, too, to concentrate all its efforts on customers. Brands that work fluidly with their employees, suppliers, vendors, and partners will better be able to give customers a differentiated and memorable experience.  

“Intelligent automation” is what we call the collection of technologies that combine to transform your processes to create exceptional experiences for customers. It is a lever to create fluid and adaptive business processes that are critical to building and delivering innovative products and services.

Take, for example, an international agricultural company that sought to streamline its largely manual and fragmented order fulfillment, financial reporting and customer care processes. We worked with the client to take an end-to-end approach using intelligent automation. This allowed them to improve how they served customers while reducing unit cost and cycle time, from procurement to final delivery.

Automation unlocked 52,000 hours per month, allowing associates to take on higher value work. The client’s citizen coders manage 80% of the automation development process. To date, they have created a variety of bots from a strong pipeline of automation processes. Automating the order entry and fulfillment processes improved average handling time by 75% and saved $20 million so far, generating a 4X ROI.

The softer side of digital business

During the pandemic, company after company declared they were responding aggressively with digital. The harsh reality, though, was that they realized how reliant they were on human beings.

Technology is evolving at lightning speed, and valuable capabilities are emerging that will make a big difference in every company. However, we have over-indexed on a workplace future that prioritizes machines over people. The implicit assumption is that as business becomes more digital, employees must adapt and fit in.  Instead, we need a better understanding of the digital worker ecosystem. Imagining a less “human-centric” future is misleading. The truth is, human-digital collaboration will be a key driver for how work will get done.

To drive the scale of ongoing business transformation, the key will be to unlock the talent base that already sits within an enterprise. The goal should not be only to think how to replace them, but rather how to get them to embrace a culture of digital thinking.

Many business leaders have a mindset that can be characterized as “Hey, let me skill my workforce. Let me make them a little more technically trained, and so on and so forth.”

But if you think about it as a “skilling” exercise, all you’re going to do is give people better tools to use with existing systems, and make those a little more efficient. This approach can calcify existing operations and make it harder to evolve modern ways of working. To be a fully digitally-enabled enterprise, you need to ask: What type of employees do I need within that ecosystem? Will they be cubicle workers? Repetitive workers? Or experts who can sit alongside digital workers, or “bots,” including those created by Robotic Process Automation, to focus on the needs of customers? For the enlightened enterprise, the answer will be the latter.

Bringing on more bots doesn’t mean you can get rid of humans. Technology is still far from advanced enough for that. People have the ability to think deeply, which computer algorithms don’t possess. So you need to ask: “What kind of workflow do I need? Do I have that skill profile today?” Your people must be partners to help constantly evolve your digital capabilities. Yes, they will acquire new skills, but more importantly, they will partake in a new operational mindset.

Citizen coding

When I talk to operations teams inside companies, I’m often surprised by their lack of appreciation for technology. I don’t expect them to be coders – to be proficient in writing programs or even understanding how that is done at any level of depth. But they must appreciate what technology can do, what pathways it can create.

For those leaders trying to drive positive change inside companies, a fantastic way to drive digital transformation at the grassroots level has emerged. It’s the low-code/no-code movement. People who have no training in programming and don’t think of themselves as technologists can now begin to engineer software. I call it “citizen coding.”

Citizen coding will only increase the utility and relevance of software since the people doing the coding are more likely to be ordinary business people. Over time, citizen coding will progress across many dimensions. Consider this: – one day, citizen coders could invoke voice-enabled commands to guide the entire software engineering process.

Low-code/no-code programming tools can help drive corporate transformation at the grassroots level, and empower less technical employees to move forward without fear that technology might cannibalize their jobs. They’re the ones writing the code, and they know how to improve their work and their company. And ultimately, such an approach can take companies to significantly higher-value business models.  

Some IT purists possibly resist low-code/no-code since they don’t always appreciate the value and talent that can be unlocked by empowering business teams to use such tools. Having come from the IT side, I too was skeptical of this movement. End-user software built by amateurs? That’s almost like a shadow IT organization! But I’ve gone from a skeptic to a convert. IT leaders should consider such tools, if properly selected, governed and used, can accelerate the software development lifecycle — when combined with traditional programming approaches.

In fact, I’ve been pleasantly surprised by the enthusiasm with which teams take to such tools once we orient and train them. And the way the low code/no code platforms are evolving increasingly includes governance and orchestration structures that ensure the resulting systems are safe and integrated well with existing enterprise technologies. Other new tools emerging alongside this movement, such as “process discovery and intelligence” software, help continually monitor processes and automatically generate suggestions for improvements, which further helps accelerate the pace and scale of transformation.

Clinical trials, a crucial phase of drug development, continue to evolve as new technologies allow researchers to manage them without participants coming to a physical location. Historically, they had to go somewhere to get medications and report results. Now reporting is done online and drugs are delivered by mail, in what are called decentralized trials (DCTs). The trend began before the Covid-19 pandemic, but it has significantly increased drug companies’ need to use this approach.

The very first DCT was done by Pfizer in 2011. It was known as the REMOTE (Research on Electronic Monitoring of Overactive Bladder Treatment Experience) trial, part of a so-called Investigational New Drug Application with the FDA.

“The scientists managing the study recruited participants on the Internet, relied on online questionnaires and electronic diaries, and delivered the drug under investigation directly to participants’ homes,” says Rob Goodwin, vice president and head of operations for global product development at Pfizer. Recruiting participants was a challenge. “It wasn’t easy to bring patients in through the Web,” continues Goodwin. “Not having a central study site presented a logistical challenge. But we learned a lot. It was a springboard for several other trials, and it set us up well for the pandemic.”

A few years later the FDA officially called for “new strategies to modernize clinical trials to advance precision medicine, patient protections, and more efficient product development.” In a 2019 statement, then-FDA chairman Scott Gottlieb said that critical medical innovations could be delayed or completely lost because the cost of testing had gotten so high. He said the U.S. needed  “a more agile clinical research enterprise capable of testing more therapies or combinations of therapies against an expanding array of targets more efficiently and at a lower total cost..”

Traditionally, drug trials have been performed by clinicians or researchers affiliated with an academic medical center or hospital. Participants come to the facility, where drugs are dispensed, vital signs measured, and tests carried out. Such trials remain the gold standard, says Yosef Khan, principal for clinical trials and real-world evidence at Premier, a healthcare improvement company, and remain necessary for products such as surgical and medical devices. But in many cases they drain sponsor resources and impose a burden on participants, many of whom might not live nearby and/or face transportation and time challenges.

Three factors, says Khan, have led DCTs to evolve during the past 20 years. The first is frustration on the part of clinical researchers about the length of trials and the resulting attrition among participants. Then there is the rapid growth of technologies that allow researchers to conduct remote trials or access clinical registries, which are vast databases containing real-world data about medical conditions and how doctors are treating them. Finally, the government has given a push. The federal 21st Century Cures Act was passed in 2016 to accelerate the “discovery, development and delivery” of medical therapies. It encouraged biomedical research investment and facilitated more rapid innovation in review and approval processes, among other things. Khan says additional regulation remains necessary to ensure that the data collected in DCTs going forward is accurate and reliable.

Decentralized trials offer a range of benefits, including reducing the needed size of research teams and lowering costs for drug companies. More participants may be attracted to trials that eliminate worries about travel and time demands. And perhaps most importantly, because physical boundaries disappear online, researchers can broaden their participant pool to more accurately include people of diverse ethnicities, genders, and ages.

This addresses real problems with how medical science has proceeded until now. “Studies show persistent minority underrepresentation in clinical trials, even for conditions that affect them disproportionately,” reports the Journal of the American Medical Association. “Black people accounted for only four percent of 300,000 participants in trials of cardiovascular and diabetes medications approved by the FDA from 2008 to 2017, and Hispanic individuals accounted for 11 percent.” (Black Americans represent about 12.8% of the population, and Latinos 18%.) Recruiting minority participants for Covid-19 vaccine efforts in the past two years has been a challenge, according to some researchers. Improving the diversity of trials is critical, says Khan: “If I have only white men in the trial, can I really say the drug will work for all demographics?”

“There is great hope that DCTs will increase diversity, bring in unmet populations, and increase retention,” says Pfizer’s Goodwin. “I would say it’s too early to determine whether these efforts are panning out…You’re trying to create the best experience for the patient, but some populations have concerns and simply won’t join a trial. The challenges aren’t simply related to technology. We must continually focus on making patients comfortable.”

Despite the clear benefits DCTs offer—including, says Khan, the ability for small biotech startups to more easily carry out clinical trials—they come with challenges. Sending drugs to individuals by mail can be complex and even pose a risk if shipments are lost or compromised. Wearable biometric devices, often required for modern trials, are still relatively finicky, and troubleshooting them remotely can be difficult. There are also privacy concerns about online reporting, though blockchain technology offers some ways to protect personal healthcare data.

“When the pandemic hit, we weren’t new to DCTs, which gave us the ability to move quickly,” says Goodwin. “To develop the coronavirus vaccine, we were able to take advantage of existing technology such as telemedicine, and work with local labs, so patients didn’t have to travel. We used e-diaries and a range of apps that people could download to their mobile devices, though some people chose to use physical diaries to record signs and symptoms. We taught people to swab themselves, and had the swabs picked up at their homes.”

Pfizer doesn’t rely on in-house technology for its DCTs—it partners with third-party companies that handle many aspects of remote trials. Medable, umotif, and snapIoT are among the companies operating in this industry.

Ultimately, says Goodwin, “a hybrid approach is the way of the future.” In such cases, participants might show up in person at the beginning of the study for necessary lab tests and paperwork, and return only if the study required it or if they experience an adverse event.

Despite hurdles, remote trials are likely to become standard practice. “Change is difficult,” says Khan. “But we have to continue accelerating the use of DCTs.”

The recent urgent climate discussions at COP26 in Glasgow reinforced our understanding that current climate pledges by countries do not go far enough. Even with the latest Nationally Determined Contributions (NDCs) from 192 territories, the world can expect a mean temperature increase of 2.7°C by 2100 and likely a 16% rise in global greenhouse gas emissions (GHGEs). Every tenth of a degree of warming makes a difference if we are to avoid catastrophic climate change. Governments and businesses must act urgently to accelerate the transition to a net-zero carbon economy.

While disruption is inevitable, this moment offers an opportunity for incredible innovation. Research increasingly indicates the path to continued profitability lies in pivoting to sustainable growth.

Getting the U.S. on the road to a carbon-free economy will require $2.5 trillion in spending over the next decade, one authoritative study concluded. But we’re already seeing the results of early investments: clean technologies created $1 trillion in value for investors in 2020, reports the World Economic Forum. New investments aside, efficiency improvements can improve sustainability indicators across existing value chains by optimizing performance and identifying areas to reduce waste and GHGEs. Technology offers the toolkit for both use cases, and crucially for industrial leaders mapping a course for a sustainable future.

This mission for industry has been my passion for most of my professional career. It’s been particularly prominent for the last decade at Schneider Electric, where I was EVP for industrial automation until last May when I took the role of CEO at AVEVA, whose industrial software helps leading multinationals save 15-30% in energy costs, reduce carbon dioxide emissions by 9-15%, and cut industrial downtime and waste by 25%. AVEVA’s experience working with over 20,000 industrial customers across more than 40 countries has given us extensive insights on the data-led innovation critical to driving performance, profitability and sustainability. Here are three ways industrial companies are doing so.

Leveraging data to optimize the entire value chain

Aker, a Norway-headquartered leader in sustainable energy solutions, created the first plant of its kind in transforming captured carbon dioxide into fertilizer. The result not only enables Aker to significantly reduce CO2 emissions from industrial flue gases, but it has turned those emissions into actual productive assets. The captured CO2 can also be transported via ship or pipelines for permanent storage elsewhere. Aker is now sharing that know-how as an offering for other companies.

This innovation could have only happened by embedding digitized data across the entire operations lifecycle, and then using it to optimize production, improve efficiencies, and design new processes. AVEVA worked closely with Aker on this carbon capture engineering technology, and we extended our partnership this year so that other companies can leverage it at a global scale.

These types of innovations are possible and practical at a time when 80% of instruments in plants are connected to the internet of things (IoT). This data is essential currency for industrial enterprises in mapping every step of the production process, allowing complex businesses to develop a meaningful digitization strategy and execute it on the ground. Platforming this data across the organization and applying predictive artificial intelligence (AI) is also helping industrial companies and manufacturers optimize operational performance and reduce downtime while tracking for sustainability goals.

Digital Twins help map sustainability metrics to industrial data

We already appreciate that data-led technologies can similarly be put to work in the battle against climate change. What is harder to do is to track and monitor greenhouse gases across the value chain, enabling industries to reduce carbon emissions with a systematic, comprehensive strategy designed to meet net-zero targets and incorporating sustainability into all facets of the business and drive meaningful innovation.

To help calculate risk/reward scenarios both for financial gain and for ESG benchmarks, we employ Digital Twin technologies, which create a virtual representation of physical assets so that companies can predict the outcome of various operational changes. Digital Twins are vital in enabling step-by-step strategies toward measurable improvement for long-term change. The results also give stakeholders across the organization a common goal.

A good example is Henkel, a manufacturer of household products such as washing liquid Persil. To support its customers and align with its sustainability commitments, Henkel built a digital backbone that connects its global operations in the cloud; that’s 3,500 sensors in each site providing 1.5 billion data points to meet fluctuating demand while reducing energy usage. To date, Henkel has reduced its environmental footprint by one-third, using less energy, less water and producing less waste.

Partnerships across the ecosystem to realize economies of scale

Technology cannot win the battle on its own. Alongside digitalization and innovation, cross-sector partnerships are fundamental in supporting organizations as they develop, invest and deploy technology to meet the world’s net-zero climate ambitions. Accelerating progress on sustainability requires breakthrough collaboration with suppliers and competitors to innovate at scale.

I’m particularly proud of AVEVA’s long-standing partnership with Microsoft to help customers facilitate sustainable business outcomes in industry by leveraging cloud technologies and big data analytics. The two companies, for example, support the energy transition vision of TechnipFMC, a leading technology provider to the energy industry. We work together on a range of sustainable implementations including green hydrogen, floating liquefied natural gas and other global projects. A joint solution deploying the AVEVA E3D software ran a dynamic flare header simulation that helped reduce the amount of steel used in the ultimate design by 34%. The exercise saved TechnipFMC €20 million, helped optimize the value chain and minimized the use of carbon-intensive resources.

These digital tools support collaboration across organizations and have proved their worth over the pandemic. Leveraging these solutions to partner organizations can help business leaders drive innovation, achieve systemic gains, and deliver enhanced value for stakeholders.

Make the choice to prioritize sustainability

Regulators and consumers are already pressing brands to embed sustainability across their operations. About 80% of major international companies now report on sustainability, and thousands of enterprises have committed to net-zero emissions by 2050 through initiatives such as the Race to Zero and Business Ambition for 1.5°C, including AVEVA. Now comes the hard part of achieving those objectives.

COP26 has made it clear that we must act now to protect the planet for ourselves and for our children.  UN General Assembly President Abdulla Shahid’s words from the opening of the conference still ring true: “We are entirely capable of turning this around, if we so choose.” We do. And we must.

I remember being 12, walking the streets of downtown Vancouver with my entrepreneurial uncle. He was pointing out prime retail spots, underused locations, overlooked gems. After two or three blocks, he stopped and quizzed me. “What businesses are missing, Shafin?” 

He was always looking for opportunities. As Ismaili refugees from Uganda, my father and his brothers had to make it on their own when they landed in Canada. Fast-forward to the present, and I work with entrepreneurs everyday as an investor and advisor, including many people in the expanding creator economy. What I’m struck by is how many parallels there are between the successful entrepreneurs I know today and the immigrants I grew up with. And the more I think about it, the more it comes down to one idea: necessity. 

They’ve been locked out

My family fled Uganda after dictator Idi Amin took control in 1971 and forced Ugandans of Asian descent out of the country.

Many of us eventually settled in Canada, with families to support and no time to waste. My father was a trained pharmacist, but didn’t have the certifications he needed to practice in Canada. While he worked on that, he and his brothers hustled at low-paying jobs and set up their own businesses in Vancouver. I don’t think they ever considered themselves to be entrepreneurs — they were just doing what they had to do.

Many of the most successful entrepreneurs I know today faced distinct but related hurdles. They turned to entrepreneurship, in large part, because they were locked out of opportunities elsewhere. They may have lacked financial resources, family connections or access to a fancy education. So they had to find their own way forward using the tools at hand. 

I don’t think it’s any coincidence the creator economy is swelling at the same time that middle class opportunities are shrinking. Older millennials graduated university with tremendous debt and found a depressed job market after the 2008 financial collapse. Gen Z carries a shocking amount of debt for the youngest generation of working age, and is facing a roller coaster job market amid the COVID-19 pandemic. For many of them, home ownership is a pipe dream. All these problems are magnified for young people of color. 

Against this backdrop, it’s no surprise to see this new way of working emerge — especially considering women and people of color constitute a significant and growing contingent of the creator economy, i.e. all the people creating content and building personal brands on platforms like Instagram, YouTube, Twitch, et al. As this industry takes shape, power is slowly being transferred from the platforms to the creators, giving them more options for monetization and fan interaction. This, in turn, is opening access to the industry for people all over the world.

They hustle like there is no Plan B

My father spent many 16-hour days going between work and school, while my mother worked to take care of three kids. My uncle put everything he had into his video store, and willed it into success. They all exemplified the so-called “immigrant mentality.” They acted like there was no Plan B — because there wasn’t.

Scratch the surface and you’ll find the same spirit underlies the creator economy. The best creators are tireless hustlers — because they have to be. 

Ask any successful YouTuber, Twitch streamer or OnlyFans creator — it’s a grind churning out content, building audiences and finding ways to monetize. Richard Tyler Blevins, better known as Ninja to his legions of fans on Fortnite, built his massive following by streaming himself playing video games at least 12 hours a day, every day. 

It’s also no coincidence the creator economy soared during the pandemic. Behind the surge in musicians using platforms like Twitch is the reality that COVID-19 decimated their entire industry. The same goes for journalists on Substack. Long hours sunk into honing their craft is a testament not only to their work ethic, but to the fact that for many of them, there is no backup plan right now.

They are ruthlessly ‘uncomplacent’ 

Underlying all the challenges my family faced was one constant: gratitude. I saw it in all the adults in my life — an understanding that they were the lucky ones. That manifested itself in a refusal to be complacent. They went from parking cars and cleaning hotels to owning their own businesses and putting their kids through university. They could have stopped at any point and admired how far they’d made it, but they always felt compelled to work harder.

I see that same spirit in so many successful creators today. Forget the cliche of the pampered primadonna. They know perfectly well how lucky they are to be making money doing what they love. They know how many competitors are breathing down their throat. They know they have to continually learn, improve and adapt … or vanish into obscurity. 

You see that kind of ruthless uncomplacency in one of the forefathers of the creator economy — Gary Vaynerchuk, a.k.a. GaryVee. A big name today, he started off doing reviews on YouTube of wines sold in his family’s liquor store. He grew a cult following, but didn’t stop there. He went on to start multiple successful ad agencies and even has launched an NFT line that has grossed $85 million in sales.

All of this isn’t to say that passion — even joy — isn’t a part of the formula for entrepreneurial success. But I think it’s an oversimplification to reduce the creator economy to “passion-preneurs.” Like the entrepreneurs from my childhood, so many are driven by necessity — the need to earn a living, support a family, and improve their lives — and by the inability to find this opportunity elsewhere in the current economy. There’s one last thing I see in the creator economy that reminds me of my family’s story: the optimism that things can change for the better.

Shafin Diamond Tejani is the founder and CEO of Victory Square Technologies, which supports technology startups through sustainable growth.

The healthcare industry is rapidly being recontoured by the forces of digital innovation, new industry regulations and growing consumer expectations for better healthcare experiences. From our observations, healthcare payers and providers increasingly have both the technology tools and the regulatory incentives to overcome the industry’s traditionally adversarial silos and barriers.

The goal: delivering consumer experiences that seamlessly unify payer and provider functions and physical and digital channels. Soon, care, payment, follow-up, referrals and ancillary services will all be blended into a single, frictionless process that makes traditional boundaries between payers and providers transparent to consumers.

Already, payer-provider convergence is accelerating as interoperability, price transparency and aggressive new entrants with deep pockets erode the industry’s traditional barriers and business models. We’re seeing health plans executing diversification strategies designed to increase alignment and collaboration with providers. Some payers, including United Health Group/Optum and Blue Shield of California, have even bought provider practices.

On the provider side, some — including UPMC and Intermountain Health — have stood up their own health plans, taking on both insurance risk and the financial risk of shifting to more value-based contracts based on improving health outcomes. The race is on to deliver a seamless healthcare experience, and long-term incumbent players and new entrants alike are placing their bets.

To succeed in the emerging healthcare landscape, senior healthcare leaders need to first understand the forces reshaping healthcare and the experiences payers and providers deliver, as well as the impact of these forces on core healthcare technology.

In this article, we’ll look at the drivers of change and what they entail for technology selections, and in an upcoming essay we’ll evaluate emerging core technology strategies and explain the capabilities healthcare organizations need from next-gen technology.

A radical industry makeover

New market forces are driving out longstanding healthcare complexities and costs that historically have stymied innovation by preventing efficient data sharing and market-driven economics. These new developments include:

• Consumer-empowering regulations. The federal data interoperability rule breaks open data silos and sets standards to enable data flows among entities both inside and outside of healthcare. Similarly, price transparency regulations that reveal contract data and negotiated rates are already influencing payer-provider negotiations. This is inching the industry closer to a market-driven model for pricing medical services.
  
  Together, these regulations are rendering legacy business models based on proprietary data ownership and opaque pricing strategies obsolete. Consumers stand to gain real control over their health information and the ability to easily comparison-shop on quality and value.
  
  
• Mass “API-ification” of core payer and provider functions. With new advancements in technology — combined with interoperability regulations mandating standards-based application programming interfaces (APIs) — an ecosystem-powered approach is emerging to drive value from platform and technology investments. Standards-based APIs will help providers and payers overcome process gaps and inefficiencies by enabling real-time automated transactions.
  
  For example, an API could enable a best-of-breed quality management system to exchange data with a core administrative system, resulting in the ability to streamline quality reports and identify care gaps more quickly. APIs also will democratize data and functionality, enabling innovation marketplaces for third-party apps and developers. Imagine an App Store or Play Store specific to healthcare. Apps could range from FDA-vetted clinical functions to medical appointment reminders.
  
  
• New value-based care and payment models. The adoption of new payment models is aligning payer and provider incentives and inspiring new business and care delivery models that are breaking down traditional adversarial silos. This is accelerating payer/provider convergence.

A new platform for a reshaped industry

These forces — and the new industry topology they are creating — are testing the limits of traditional health industry technology platforms and surrounding applications. Traditional technology infrastructures are ill-equipped to support new value propositions based on interoperable data flows, transparent pricing and open ecosystems. 

Consider the friction points that exist at the historically adversarial payer/provider boundary: authorizations, referrals management, claims adjudication, denials management, appeals and grievances, etc. Both sides are heavily invested in a parallel revenue cycle management (RCM) arms race plagued by redundancy, inefficiency and costs.

Converting these friction points into value for consumers and healthcare organizations will require open platforms and an ecosystem approach to technology and automation. These must be built on an intelligence layer that draws on data and insights from combined consumer, payer and provider data sets — and increasingly, from combined payer/provider business models.

An evolution ahead

To support new business models based on payer/provider collaboration and even co-ownership of health systems, the industry’s technology platforms and strategies need to evolve. Yet we see many organizations trying to drive these alignments with outdated platform strategies that are technologically incapable of supporting the data fluidity and consumer-centricity these new business models require. Today’s profound business and operating model shifts require fundamental changes in how business and enabling technologies are architected.

At the same time, healthcare organizations need to resist the market noise and focus on making sensible investments that build on, and drive value from, their existing platform investments and leverage their incumbent advantages. Organizations must take time to understand the next-generation technology capabilities they’ll need.

In Part 2, we’ll dissect emerging solutions for delivering frictionless end-to-end consumer experiences and the characteristics healthcare organizations need from next-gen tech to generate opportunities in a reshaped consumer-focused industry.

William “Bill” Shea is a Vice-President within Cognizant Consulting’s Healthcare Practice. Patricia (Trish) Birch is Senior Vice-President & Global Practice Leader, Healthcare Consulting, at Cognizant.

Will American democracy survive? It’s a sad question many of us are asking these days. It’s also the title of the opening session at our Health+Wealth of America conference on Thursday Dec. 16 in midtown Manhattan. Addressing it will be Don Guttenplan, recently-appointed editor of The Nation. We are duly excited that this will be our return to in-person conferences. Here’s our great program.

It’s not an optimistic time in our country. But we are determined to seek signs of progress and arguments for it. And our speakers are eloquent. Not to mention diverse. We are probing where our country and the world are going, and you have to look at that diamond from many angles. We hope it’s not really a lump of coal. The conference is co-hosted by Techonomy, our CDX digital transformation subsidiary, and Worth Magazine, our corporate cousin inside Clarim Holdings.

Worth has shifted towards a broader definition of “worthiness,” and is launching a new list called the Worthy 100—entrepreneurs changing the world for the better. Jacqueline Novogratz, founder and CEO of Acumen, is one of the world’s most visionary change-agents, and she is on the new list. She will also be on our stage as the closing speaker. Her view is that Americans take too narrow a view of who and where they are, and that needs to change, particularly in a world beset by climate change, global pandemic, and potentially uncontrollable immigration. Her session is entitled “Declaring American Interdependence.”

The morning ends with the very Anthony Scaramucci, on “Why Bitcoin Is Headed to Half a Million.” He’ll surely give us, too, his latest assessment of Trump. Then we’ll have breakouts, lunch, and return to hear activist, author, and politician Zephyr Teachout, who recently announced her candidacy for attorney general of New York State. She’ll be interviewed by brilliant Financial Times columnist Rana Foroohar, about, among other things, why we need to break up big tech.

Markets may be mostly up, but it’s often hard to see progress underway on the big systemic things that matter—equality, global warming, education, health care, and especially the pandemic. One of our speakers who can find that progress is Amanda Leland, the recently appointed executive director of the Environmental Defense Fund. She’ll talk about EDF’s war on methane, its upcoming satellite to find and monitor it, and why even as we fight determinedly against global warming, we must work to help those most vulnerable to it. Then two other top leaders of EDF, Heather McTeer Toney and Dr. Margot Brown, will (in a breakout) explain why EDF is so focused on environmental justice–ensuring disadvantaged communities get a voice in environmental policy and that climate action doesn’t only benefit the rich. Separately, two top leaders in impact investing, one from UBS and one from Toniic, will explain how the way we direct our money can be critical to tackling climate change and social problems generally.

Is the Democratic Party “sleepwalking to catastrophe” asked columnist Ezra Klein recently in a profile of the uncannily-accurate pollster and political analyst David Shor. This expert will tell us why he is deeply worried about the direction of the Democrats. We blend politics with economics, because it’s all connected.

Business leaders will also be there in force. Betterment CEO Sarah Kirshbaum Levy joins Kevin Pleiter, head of the capital markets group at global technology consulting firm Cognizant, to discuss the direction of fintech. How could the dizzying range of entrepreneurial financial innovations work better together?

It’s a time of health care crisis, confusion, and, too often, suffering. Veteran investor, author and pundit Esther Dyson has turned her life towards philanthropy with a big long-term project called Wellville. She’s working to help five less-affluent counties around the U.S. better build systems to keep people healthy, as she’ll tell us. Alberto Casellas, EVP and CEO of Synchrony Health and Wellness, describes how Americans can more affordably pay for health care. Top business strategist Rita McGrath joins healthcare communications veteran Ritesh Patel to examine how innovation is changing the pandemic-era patient experience. Jim McCann, founder and Chairman of 1-800-FLOWERS.com, delves into the emotional lives of Americans in this painful pandemic era, which his company uniquely engages with. He’ll be joined by PTSD expert and psychiatrist Dr. Charles Marmar of NYU Langone.

Health care is a crisis especially for mothers in many parts of America, so Simmone Taitt, CEO of Poppyseed Health, a company focused directly on maternal health, helps us understand how that has to change.

This diamond has multiple facets. Google’s Jesse Haines explains how the search giant is working to enhance job creation and entrepreneurship with its Grow With Google initiative. Valarie McCall, chief of staff for the mayor of Cleveland, joins three other women leaders to dissect why women still have so much difficulty breaking through in male-dominated industries like government, real estate, and insurance. Immediately afterwards, we’ll hear from Anoop Gupta, CEO of startup SeekOut, which a group of Microsoft executives recently started to bring more fairness to hiring and diversity to organizations, using algorithms and better software design.

New School Professor Natalia Petrzela, a historian of American culture, talks about both her upcoming book FIT NATION: How America Embraced Exercise As The Government Abandoned It, as well as her extremely-relevant previous one, entitled Classroom Wars: Language, Sex, and the Making of Modern Political Culture.

There is, of course, much more, especially on climate and innovation. Full list of speakers is here and the agenda is here. And the all-important registration page is here. Vaccinated only, of course. But while the in-person experience will be incredible, you can also join us for free online if necessary.

This may sound odd coming from someone like me who has long worked in healthcare technology, and especially as the literal co-founder of an EMR company, but in the same way that we saw paper patient records heading toward extinction decades back, the EMR as we know it is beginning to wobble. It’s like an aging boxer in round 13 taking on a younger, faster opponent.

The word EMR is a noun, a static thing. In truth, when we use the term, we far more often have an active idea in our minds, making it more like a verb. And in fact, many paragraphs and entire books are dedicated to describing and understanding what an EMR actually is. The U.S. Government has gotten in on the act, with a corpus of literature, revisions, artifacts, checklists, commentary, and guides – all to define this one thing. 

So I ask you: What is an EMR?

It’s easy to hearken back to the pre-digital era and remember the patient chart, stored in a filing cabinet in our doctor’s office. Its simplicity and the simplicity of that analog era may seem quaint, but it was easy then to define a medical record.  It was one individual doctor’s record of what had been seen and done with their own eyes and hands for a given patient.

The promise of the electronic era was romantic and ambitious – to break down the silos of a world before computers and build a composite, complete picture of the core clinical information about a patient. It would encompass the work of many hands and eyes of all the doctors who touch a patient – untethered from geographical boundaries.

But that’s not what’s happened.  Instead (and unsurprisingly) form has followed function.  EMRs became mechanical turks for the original myopic recordkeeping of the doctors of yesteryear.  Only this time, to pay for their added time and expense, they were way “more so.”  EMRs enabled documentation far more than a doctor’s hand would ever bother to capture (thus making the billing codes a little higher). Anything the hands and eyes of a doctor did to that original paper chart was fully captured in highly compliant and extremely legal bloat-script. And to do that, EMRs included lots of other things we somehow added to their original definition. Like a deranged and perhaps half-blind baker, we threw together a recipe – a pinch of front-end workflow, a dash of software processing, and of course a handful of storage capabilities. We mixed it together haphazardly, and then we required it universally.

I think of today’s EMR as a three-layer cake.  

Layer one: The Workflow. You know the drill: Check-in (“insurance card please”), intake (“Smoker?”, “How many packs?”, “Can you step onto this scale?”), exam (“Cough please”), orders (drugs, labs), check-out (“that’ll be $95 and please take a card to schedule your radiology from the stack in the sliding window”). These are the step-by-step tasks that the EMR software walks staff and providers through in order to produce a consistently-documented and compliant encounter, one that does not lend itself to lawsuits but is as billable as possible. 

Layer two: The Compute. The data captured through those workflows in the first layer is then used to gonkulate new info.  CPT codes are calculated and defended by ICD codes, interview data, and time logs. “Meaningful Use” metrics are calculated and attested to, for quality, of course, and of course also for other payments. Quality scores are gonkulated again as referral forms and automated “consult letters”. Tremendous amounts of compute are funneled single-mindedly to turn the clinical experience into financial outcomes, whether fee-for-service or “value-based” care.

Finally, layer three: The Storage.  Unfortunately, this is not the storage we might want, a longitudinal profile of the patient with relevant aspects updated frequently. Instead, it is the storage of all of the above metrics generated by the compute, geared simply to be ready for audits and questions.  Armed with this storage, providers hope desperately not to be embarrassed when patients come back expecting to be remembered. This has led to many EMR cartoons that feature blind men and elephants, as even the most wizened experts struggle to adequately identify what EMR they are looking at. 

All this has contributed to an enormous explosion of healthcare vertical monopolies (and related price increases) across the country. Many have rationalized that if an  EMR is only to be a “core sample” of the Workflow, Compute, and Storage of one physician’s experience, then the logical thing to do is to move all the physicians a patient sees under the same EMR roof. Such consolidation has created a mirage of “continuity of care”. 

As EMRs have matured and regulators have blanched at the silos created by their original mandates and incentive programs a decade ago, the ecosystem has slowly nudged itself towards sharing. Record sharing (originally mandated by HIPAA) is becoming a norm, with common sharing services like Commonwell yielding a 20% match rate for Epic record queries and a 70% match rate for Athenahealth (the company I founded). It’s increasingly common now, as a doctor looks at their patients, for them to find externally-generated data in a patient’s EMR. Such a record is not machine-readable, allows no alerts to fire on that data, and leads to few algorithmically derived insights.  But it’s a helluva lot more than nothing, even as it’s a helluva a lot less than we deserve.  

My summary is that EMRs are OK as they are today, but absolutely nothing compared to what they could, should, and maybe will be in the very near future.

So what should EMR mean? Let’s go back to those three aspects: Workflow, Compute, and Storage. 

First, we need to liberate that Workflow layer which today means a thousand things.  Most of the workflows are unrelated to moving people through old-school office visits. In old EMR speak, we called this concept “the encounter,” and it was tied tightly and rigidly to care delivered over an exam table or hospital bed. 

The new workflows are different. They are the always-on, often nearly free, constant contacts of the digital health age. Think of such workflows as the “edge computing of care”. K Health and Buoy Health will give you free bot-doctoring that is getting better and better. And a dozen more digital health players will give you weirdly-affordable super-fast online team-based care.

The new explosion of health communication means text threads, care plan alerts, and group messaging, which offer ongoing relationships and community with providers and with patients like you.  These workflows will be more important than office visit workflows going forward. The original workflow engines, so a long part of traditional EMRs, should also be able to write to our records. But so should thousands of additional applications and sources.

All of this demands a totally different workflow engine. What about passive monitoring of exercise, or steps, or glucose levels? There are whole companies yet to be built that are centered on new care modalities that have nothing to do with exam rooms. 

Now let’s relook at Compute.  Sure, we should be able to compute codes and bill them. Why, though, are we stuck with EMR’s Compute being entirely geared towards claims? New age providers are increasingly creating products that don’t fit neatly within the world of the CPT code. Many are asking for a monthly subscription fee from employers and payers.  Then those organizations purchase pieces of their care product that they don’t provide with their own staff, not unlike a general contractor with subcontractors.

New age providers will need to buy care as often as they bill for it. Where is the Compute to direct that spend? Where are the ledgers?  Back in the third party administrator days in California, there were a few rudimentary capitation management apps, but they are ancient and not connected to anything.  Firefly Health, the company where I serve as executive chairman, bills employers for its care but also pays specialists for jumping in on sticky cases, which eliminates the need for a full-on referral.

There is also a whole category of marvelous Compute that will come as we more routinely ingest social-determinants-of-health data, which is super important.  The dominant providers and their fee-for-service (FFS) agreements are technically interested in such things, but cannot make such things core to their systems and processes. There is not enough return to FFS-dependent providers to incentivize their radically reducing fees generated by patients. 

Other Compute could surveil populations for what’s working and what’s not, for the purposes of making real-time trade outs. Again that’s not a thing traditional FFS business models can afford to care about, but will be a major win for all new age, value-based players. As more and more healthcare players are born digitally native, there will be more and more APIs to call to calculate care coordination. For example, can you schedule across all the siloed electronic calendars in medicine today? Looking outside healthcare, Kayak has no problem interacting with all the calendars of airlines worldwide. Such discrepancies point to a dramatic misappropriation of where we currently spend our industry’s Compute.

Finally, Storage.  What should we store? Core samples? Blind man soundings? Of course not. The term EMR should refer to the record and only the record – a complete  operational data store for every American. Meanwhile, digital health companies today are intentionally narrow. Ria Health, for example, makes no bones doing anything other than alcohol treatment. They have no plans to do a middling job at X-rays and colonoscopies and all the other things traditional IDNs seek to cobble together. They plan to do alcohol treatment well and, to do so, they need to get a really complete, comprehensive and continuous view of their subjects.

We should all have an EMR, and it should operate like our LinkedIn profile – when we make a change to it, everyone following us should be able to know right away.  There can be no “Save as PDF” and re-sending to friends and prospects. This is what digital-native companies must have. Such companies have no interest in guarding their evidence of care on a patient. In fact, they know they do a much better job when their understanding of members is complete. In that way, they are natively sharers, for both selfish and inherently good reasons.

In my old EMR life, we talked about the scalability of technology. Today, “extensibility” is just as important. Can a tech-native provider build its own workflows and have them seamlessly co-exist with “rented” ones? Can they do the same with their compute? And of course, as with Spotify, can they dispense with keeping an out-of-date, memory-hogging copy of just their own songs alone and instead get a database of all the songs in the world? We know how to do this shit. In fact, in parts of our lives that we care about much less deeply, we do it all the time. 

Simply put, the EMR we have come to know does a very important thing. But god willing, we will need it less and less. EMRs grew up to do a certain job, at a certain time, in a certain place. They are not wrong or bad, but they are closely related to the rapidly-diminishing office-based, fee-for-service world. As digital health companies move from being cool parlor tricks and gadgetry to the mainstream, let’s hope that “place” moves into the rearview mirror.

With upstart EMR provider athenahealth, Jonathan Bush was one of the pioneers of the digital health movement enveloping healthcare today.  He is currently an active investor in numerous young healthcare companies, is CEO of Zus Health and Executive Chairman of Firefly Health.

THURSDAY, DECEMBER 16 | AN ALL DAY HYBRID EVENT

Techonomy, CDX and Worth host our first full-fledged, fully-vaccinated in-person event! We invite you to join us in midtown Manhattan (or virtually) for the latest installment in our Health+Wealth of America series, where we’ll bring together experts on our national mood and politics, the future of business, the pandemic, the state of tech and transformation, the push for equity, healthcare, education, climate responsibility, and more.

At this all-day event near Grand Central Station, we’ll bring together speakers like: EDF’s Amanda Leland, Anthony Scaramucci, health care activist Esther Dyson and Don Guttenplan of The Nation to discuss what is happening with the health and wealth of America, defined broadly.

We are really excited to return to face-to-face – our collective conversation has only grown greater during the past year and a half. We look forward to seeing you there.

“When you think about globalization, the question is how fast can fintechs address global needs and gaps. ”That’s how BMC’s Strategic CTO, Greg Bukowski began a discussion about disruption across the financial services industry. The conversation addressed how data, automation, and the hybrid cloud are driving customer experience innovation. Bukowski was joined by Morgan McKenney, the just-departed former COO of Global Consumer Banking at Citi and CDX Founder Drew Ianni at the recent CDX + FIN Accelerate FinTech Summit in New York City and online (speakers appeared in person at CDX’s offices). 

 “Financial disruption is accelerating as we speak,” said McKenney. “Most banks have realized they can’t do everything themselves and, even for large banks, partnering with fintechs – to improve capabilities with your customers – is a well-trodden path. [Disruption] has already happened on the consumer front, and soon it’s going to happen in a much deeper way at the institutional level, with new digital currencies and networks.”

Data is the New Digital Currency

BMC believes successful companies in the future will be “autonomous digital enterprises,” in which automation is not just used to streamline routine tasks and monitor and troubleshoot digital systems and networks. They will also be able to continually analyze and refine corporate and consumer data to make it more powerful. Bukowski said  “data is the new digital currency.” He added that BMC finds that all financial services firms, including disruptive fintechs, are looking to leverage value-added data and insights derived from automated processes that allow them to provide superior customer experiences and journeys.

McKenney agreed and talked about the challenges created historically because Citibankwas assembled over time as the result of dozens of acquisitions. Each of them had different databases and systems, so the challenge was integration, particularly in data processing and automation. She believes that to fully embrace automation and best take advantage of the cloud, companies “have to have an amazing data stack to be able to drive and automate continuous learning, while leveraging AI to help with things like personalization for consumer applications.”

Not Everything Has Moved to the Cloud

While there has been plenty of hype around public cloud providers and the innovations, solutions and cost savings they can deliver, most global financial services firms still continue to rely heavily on mainframe, on-premise computing to run their operations. 

Said McKenney: “As we think about cloud at a high level, Citi processes $4 trillion worth of payments a day, and holds $1.3 trillion of balances on behalf of our customers. And that means you need hyper-resilient, ultra-secure, always-on systems.” She noted that many financial services firms have moved some data and infrastructure to the cloud because of the added scalability and agility that allows, but that a significant amount of computing infrastructure, systems resiliency, and data storage remains on-premise, since security is so critically important.

 “We work with several large banks and the vast majority of their business still runs on mainframes,” added Bukowski. “In fact, we just released a mainframe survey where we interviewed 1600 customers, and 92% of them are growing workloads on their mainframe, on-premise systems.” He also acknowledged that the share of workload going to the cloud is increasing because it “provides superior scalability and the opportunity to efficiently create and deploy applications that impact the customer experience and journey.” Bukowski believes we will live in this “hybrid” IT world for some time, but as mission-critical business applications are redeveloped over time they can migrate to the cloud and be accessed as SaaS based applications and solutions.

Building For The Future – Mastering The Customer Experience

Looking ahead, Bukowski noted that larger financial services firms have a unique opportunity to “partner with the fintechs building out these platforms and services and migrate what would be mainframe workload into cloud-based SaaS services.” He currently sees this happening, for example, in the insurance industry which he describes as “a commoditized market taken over by fintechs – where the savvy players are reducing their mainframe footprint and using more SaaS-based (cloud) solutions.”

McKenney said the future is about “digitizing end-to-end,” adding “it’s not just about the glossy, customer-facing front-end. It’s everything in the middle and the back-office that ultimately delights the customer.” She believes that as far as customer experience goes, the bar is now being set as much by companies outside of financial services as both inside it. The customer expects to have great experiences regardless of what kind of company they are interacting with or where they are engaging that brand. McKenney also believes traditional financial service providers can more proactively involve their customers in product development: “I would love to see Citi’s customers giving the bank product ideas, where they become our product developers as well.”

Bukowski closed the session by suggesting that the autonomous digital enterprise will recognize that its computing and application development infrastructures must ultimately be architected and deployed to make internal teams more efficient and productive. Automation will play a big role and “as companies fundamentally transform their operational models, that will move workloads off the mainframe and into the cloud.” This will take time, of course, and enterprises of all sizes must continue to innovate and improve the customer experience by leveraging a hybrid I.T. stack.