Sunday, September 13, 2009

Why healthcare needs to be more like Apple and less like Windows / Intel

There is a common perception in our country that more is better, particularly when it comes with choice. More choice means more competition and the ultimate beneficiary is the consumer. Is this actually true? Can there be too much choice?

Take consumer electronics, specifically, portable music players also known as MP3 players. Various hardware companies produced them with varying options and memory capabilities. Another companies had the music content that needed to be compatible with the variety of MP3 players. In addition, the MP3 players and the content providers needed to also be compatible with the large number of computer configurations offered by even more companies.

Although the enormous choice of MP3 players, content providers, and computer configurations allowed each separate category to be priced optimally due to competition, the irony was that very few consumers took the plunge of enjoying their music libraries on portable MP3 players. Too many problems occurred. Crashing the computer was probably the most common and frustrating. Many MP3 players had plenty of options, perhaps too many while others had too few. Music content providers worked like cable companies charging monthly fees which people frankly balked at because the content wasn't broad enough. In short, too many options caused confusion, the setup caused frustration, and consequently the promise of the digital revolution was just that, a promise.

Indeed when Apple introduced its iPod music player many years ago in 2001, Apple was a late entrant in the MP3 player market.

But it didn't matter. Millions have been sold. At Apple's recent conference, they noted that iPod's marketshare is at nearly 75 percent of the MP3 market and perhaps even more fascinating is that over 50 percent of purchasers have NEVER purchased an iPod before. In other words, iPod is entering households that normally wouldn't have a need for a MP3 player, let alone an Apple product.

Apple's success speaks volumes about what people really want. It isn't about choice, choice, choice, its about asking a simple question, what do people want? For Steve Jobs and his team, the question has been that simple, yet as complex. They determined that it was to have an intuitive MP3 player and seemless integration with content providers so that people could focus on the music experience and less on the technical aspects.

In many ways, this mirrors the original thinking with Macintosh computers, where the question was what do people want from their computers? It wasn't that they wished to type commands in DOS, but use intuitive interfaces and inputs like an icon based system and interacting with it using a mouse (and now touch screen with the iPhone and iPod touch).

The introduction of the iPod was a radical departure what people had previously experienced with MP3 players and other content providers. Both the interface on the iPod and iTunes, Apple's content provider of music, audiobooks, and then later video content which includes movies and television shows, were and still are elegant and simple to use. Both iPod and iTunes continue to have further improvements. Apple recently introduced iTunes version 9 and now offers iPods in a number of configurations including iPod Touch with WiFi capability and larger screen, the new iPod Nano, a much smaller device with a smaller screen as well as a built in video camera, and the iPod classic, which has a larger memory capacity, but looks like the original iPod.

So why was Apple so successful, when other companies presumably had an advantage by being first to market? Unlike the Windows / Intel configuration where different companies produce the software and others produce the hardware, Apple is a true vertically integrated consumer electronic company. Apple designs and produces BOTH the hardware and the software. Apple products work in a closed proprietary system. Apple's original iPod came in one color, white, and one configuration. The iPod essentially works with one system, iTunes. Fortunately, iPod and iTunes works with PC computers so the rest of the world can enjoy the benefits of thoughtful Apple engineering since only 5 percent of the PC market is currently held by Apple.

Apple won in the MP3 marketplace and is making significant headway in the smartphone market with its iPhone because the company continually asks an important question - what do people want?

So, in healthcare what do people really want?

Do they want choice, choice, choice? Do they want to have every test, every medication, every imaging test, every hospital, and every doctor available to them? Do they simply want the right test, the right medication, the right imaging test, the right hospital, and the right doctor available to help them get better?

Unfortunately, Americans believe in the former. Indeed, that is what economists would argue that more choices are better for everyone. Yet in the complex world of healthcare, can consumers get the correct combination of tests, medications, imaging tests, hospitals, and doctors to get the best outcome? It makes the simple task of hooking up a MP3 player to one's personal computer seem infinitely easier, yet history shows that until the introduction of Apple's iPod that acceptance was limited to those in the know, specifically technophiles.

Apple demonstrated with its iPod and iTunes that sometimes a simple streamlined system is far better than the chaos inherent in too many choices.

In healthcare, those in the know are doctors and patients who are fully engaged in being empowered, not because they want to, but because they have to, often because of a serious illness. Otherwise for the majority of us, we don't give much thought to our health until something happens. By then it is a hard learning experience of copays, deductibles, explanation of benefits, and network and out of network discussions. The vast majority don't want this responsibilty any more than they want to be technophiles in getting a simple MP3 player hooked up to their computers. There is nothing wrong with that belief. When people get ill they should be focused on simply getting better.

If we believe that this is what people really want, then what the American healthcare system needs instead of its fragmented configurations of multiple small medical groups, multiple hospitals, multiple radiology centers, surgery centers, and duplicity of medications, many of which are not better than existing therapies, and make itself more simple and user friendly. All patients would have a primary care doctor that they could rely on should something happen. This doctor would be one working in a large multispecialty group where primary care doctors and specialists work with specific hospitals with all of the imaging and operating rooms, and robust medication formularies with just the right number of therapies needed to do one thing - get the person they are treating better.

In other words, move from the world of Windows / Intel where more groups are available but do their own thing into the world of Apple where all of the players are aligned in the same direction. In healthcare, this means do what Apple does and use integration either true vertical or virtual integration to have the desired outcome.

Would the public stand for this or complain that their choices and their freedoms are being restricted?

Steve Jobs and his team at Apple know what people want in their world of consumer electronics. With his recent liver transplant, I wonder if he ever gives much thought on how to revolutionize the healthcare system?


Anonymous said...

Hmmm... Vertically integrated, controls hardware & software, closed, proprietary system, one configuration... Sounds kinda like an accountable healthcare organization like Kaiser Permanente, doesn't it? Are they the "Apple" of healthcare?

Anonymous said...

healthcare process is far more complicated than grasping a sound or a video thro the internet. Liu miss the point that everything is done thro the iTune platform, which there is not a single platform in healthcare. Not because of availability, but because of the inherent complexity and lack of communication standards in healthcare.
Unless and until there is a personalized electronic health record, where every provider use it for healthcare process platform, and where treatment protocols are built in, to facilitate a genuine patient-centered (not physician-centered/facility-centred) care.


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