The problem in healthcare is not the lack of innovation.

The problem in healthcare is the ineptitude of healthcare leaders and digital health vendors to create a meaningful, sustainable adoption of innovative services and solutions. The problem is their failure to effectively manage change, especially by engaging and enrolling the clinicians in the use of innovative solutions.


Born, raised, and educated as an engineer in Germany, I epitomize the proverbial German penchant for “efficient effectiveness”, also known as quality. After a decade in software engineering to optimize service delivery in a couple of industries including banking, I fell into healthcare at the Mayo Clinic in Rochester, Minnesota in the fall of 2000.

My first assignment was to aid Mayo’s software development teams to improve the way they developed Mayo’s multitude of IT solutions. From project management and requirements engineering to user experience design and automatic software testing our team was tasked with ensuring the quality of the solutions developed at Mayo.

Being new to healthcare, it took a few months to learn about the existence of a unique healthcare application called the “electronic medical record” or EMR. Once I saw the application being “used”, I was shocked and appalled. Though I did not know much about healthcare and clinical notes at the time, the cumbersome user interface and the sheer number of steps and screens that clinicians had to go through to get their job done was appalling. This solution was clearly not designed with any user input, and not optimized to facilitate the clinician/clinician interaction – something I could relate to from my experience in other service industries.

So as the years progressed I stumbled across “a set of technologies to deliver care at a distance” (a.k.a., telehealth) and vowed that “not under my watch” will technology be used “against” the clinician/patient relationship.

Ever since then, I’ve stated that “I’m doing penance for the sins committed by the software engineering profession through the abomination called the EMR.”

The Usability of Telehealth

When I turned my attention to telehealth, especially on video visits, I quickly realized that given any decent video chat/video conferencing system, a great user experience can easily be achieved for clinicians and patients alike.

The straight-forward Happy Day Scenario from the physician’s perspective — click a link, let the patient in from the waiting room, talk to the patient, disconnect — can easily be achieved by numerous video conferencing solutions.

So I began to turn my attention to the other critical elements of “optimized service delivery” that I had learned before joining healthcare — namely the design of the workflows leading up to and following the visit; the training and support required to make the change easier and lasting.

As I had learned, without proper workflow design, without appropriate training and adequate support, even with an easy-to-use solution, telehealth would never be as easy as the well-established in-person visit.

The problem in telehealth 15 years ago as well as today does not lie in the lack of innovative telehealth solutions — which is why I never had the desire to develop my own platform. No, the problem lies in not getting clinicians to confidently embrace telehealth as an alternative, supplemental care delivery modality. And that’s due to incomplete standardization of workflows, inadequate training, and insufficient support to ensure a smooth experience every time.

And without it, telehealth is very “unusable”, and therefore lacks adopters. But we need telehealth!

Shift Happens

The last three decades have given birth to an incredible amount of technologically-enabled innovation. The internet. The Smart Phone. And now AI.

The patient of the 1900s evolved into the Modern Healthcare Consumer of the 2000s. What started in banking and finance with online banking and online trading quickly swept over to online commerce first with Amazon, followed by BestBuy, JCPenney etc. Expanding into travel and transportation Uber, Lyft, Expedia, Kayak, and AirBnb set new expectations for convenience.

In the late 2010s instant communication through social media tools became ubiquitous, accelerated by the advent of the smartphone making these internet based tools instantaneously available everywhere.

When you live in this world of instant access and near-instant gratification, imagine what it feels like to go back to healthcare. Arkane and antiquated are almost too nice to describe the change of pace when interacting with verbally scheduled appointments, arduous efforts to get yourself to a clinic, and wasteful waiting time in waiting wards. Add to that the explosion of medical information available to everyone, “Dr. Google” only exacerbated the disconnect between the expectations of the “Modern Healthcare Consumer” and what healthcare was (and is) able to handle.

So it’s no surprise, as I learned at a conference recently, that rural patients of an FQHC rather use the slick telehealth service of the tertiary care center that is 80 miles away, rather than the cumbersome “you call this telehealth” experience (if the clinicians are even willing to do telehealth). And that “competition” is in addition to the health insurance supported virtual only services or the self-insured companies’ health plan’s telehealth offerings.

So what are leaders to do?

The key to successful innovation adoption in healthcare (including telehealth) lies in winning the hearts and minds of the clinicians. Just take a look at the last 12 articles I wrote about engaging clinicians to achieve telehealth success.

To succeed, everyone — executives, operations, finance, IT, etc. — must follow proven change management approaches, such as the ADKAR® model. Executive and senior leaders must paint a clear vision for change that creates awareness and desire.

Next, the innovative solution or service must be integrated in such a way that it enables the clinicians to practice on top of their license — permitting them to do only the things that only they can do. This requires a proper and well thought through workflow design with the clinicians and workflow implementation (which is actually the rocket science part of all of this).

As indicated above, this is complemented by proper training of all, including clinicians, on the new direction, the new workflows, new policies, new technologies, etc. E.g., here’s a straightforward telehealth training regimen for clinicians.

Most importantly, post implementation executive leaders must request and continually monitor key performance indicators as to the actual performance of the innovative solution or service. This critical step is the one that is most often overlooked as leaders move on to the next project, “hoping” that whatever was deployed will take hold. But as we know, “hope is not a strategy”.

Doom or Boom?

I am deeply concerned that the next 3-5 years are a “doom or boom” moment for healthcare. If healthcare leaders — especially the leaders of smaller organizations and those serving rural populations or urban populations with lower socioeconomic status — do not learn how to quickly and effectively adopt innovation to sustain and grow their services and their revenue, much of the US healthcare system could falter and implode or will need to be “bailed out”.

Given the complexity of the network of thousands of ineffective healthcare organizations, however, as much as 80% of any bailout funding will be wasted and not directly create the intended effect.

So how can we educate and inform and incentivize those leaders now?

For more information on this crucial topic see my collection of articles on “Innovation in Healthcare”.

To receive articles like these in your Inbox every week, you can subscribe to Christian’s Telehealth Tuesday Newsletter.

Subscribe to Telehealth Tuesday

Christian Milaster and his team optimize Telehealth Services for health systems and physician practices. Christian is the Founder and President of Ingenium Digital Health Advisors where he and his expert consortium partner with healthcare leaders to enable the delivery of extraordinary care.

Contact Christian by phone or text at 657-464-3648, via email, or video chat.