One of the first things you learn as a doctor are the ABCs. In medicine, the ABCs are

Airway

Breathing

Circulation

You can’t do anything in medicine, until you first assess and are reliably assured about the ABCs. No matter whether it is a trauma patient coming in on the ambulance with the sirens blaring or a regular scheduled annual visit at the primary care clinic, the ABCs are the first thing on a doctor’s mind. Once the ABCs are locked down, the next steps can be started.

In health information technology, there also a few things that need to be reliably assured about before you can start doing anything else. I’ve been searching for a similar mnemonic, the best I have come up with is the three S’s.

Safety and security

Seamless Integration

Scalability

The first S: Safety and Security

You can’t start talking about a health tech solution unless you can without a doubt, assure that patients personal health information is protected - and the clinician is not leaving herself liable. The US standard, HIPAA and HITECH, even with all its flaws, is the most well known and accepted. Unless you can be HIPAA compliant or the equivalent where you are working, then there is no point in starting.

Being HIPAA compliant is now a lot easier and there are startups who are helping to do just that like TrueVault and Aptible. The founders are all great guys and worth reaching out to if you need to be covered.

The second S: Seamless Integration

Whatever you are building MUST work with the existing legacy systems in use at hospital and clinic. There is a lot of talk, especially in tech communities, about disrupting systems. But in healthcare, you must work the incumbents - at least at first even if your goal is ultimately to replace them.

Hospital EMRs are the classic example. The hospital is so invested in them that they often, without any consideration, block any attempt at using third party solutions. It can be frustrating but I like to think about it from their perspective.

It’s like the hospital has paid a huge amount of money to hire a professional chef to prepare an elaborate meal. And now, one of the dinner guests wants to bring in their own snack to the table. The chef was sold as being able to cater to everyone but, as with large enterprise systems, it doesn’t fit the dietary needs of all the people at the table. So your cheap and ready to use snack maybe perfect for this one dinner guest, but its taken as a slap in the face and a huge waste of money on the guys who hired the chef.

I include seamless, not only because I couldn’t think of a synonym for integration that started with an “S”, but it shouldn’t be a costly process to make your innovation play nice in the sandbox. Most EMRs, as an example, won’t return the favour and won’t play nice back.

Finally: Scalability

Scaling up is something most startups have on their mind but so does the hospital. Health systems are full of innovative clinicians who have hacked together a local innovation to a problem they face. Some have even been able to formalize them into their clinics and departments. But they usually stop there and end up as islands of innovation that do 2 things:

1. Cannot spread beyond the first place it was started

2. End up blocking network wide systems that administrators want to put in place.

Your innovation cannot be a just another pilot, it has to from the start, have a plan on how it can scale up to the entire institution and beyond.

As a doctor within the first few moments of any clinical encounter, reviews and secures the ABCs. The same applies for planning, discussing, or doing anything with a health IT project. If these three S’s are establish, then the rest of challenge can start.





