Avoid long contract lock-ins says Obamacare IT chief

In an exclusive HSJ interview, Bryan Sivak, chief technology officer at the US Department of Health and Human Services, said industry advances such as cloud computing meant potentially better, cheaper and more flexible solutions were increasingly available.

Mr Sivak, who is overseeing the technology programme of the US health reforms widely known as “Obamacare”, spent four days in the UK as a guest of NHS England.

The two administrations are keen to share learning on digital health developments and are also close to signing an agreement on common standards of certification to better enable health technology companies to mutually access both markets.

The former tech entrepreneur who co-founded two start-ups said the health IT market was on the brink of profound change.

He stressed it was critical that trusts ensured their data was “portable” and that they did not become “locked in” to any one system.

While existing systems, by companies such as Epic and Cerner, may be right for some trusts, other solutions were available, he indicated.

Mr Sivak described contracts for existing systems as potentially “difficult to get out of”.

“If you want to upgrade it costs lots of money and takes years to implement something by which point you need to do the next [upgrade],” he said.

He also commented on cloud computing, which involves resources being retrieved from the internet through web-based tools and applications, rather than a direct connection to a server.

“The cloud cuts down on the amount of customisation but it rapidly increases the ability to implement new features. It decreases the costs of any one given implementation because it makes them more ‘cookie cutter’,” he said.

He said such technology was a “perfect example” of Harvard Business School Professor Clayton Christensen’s “innovator’s dilemma”. This describes the process by which a technology or service initially takes root at the bottom of the market and moves up the chain until it eventually displaces established competitors.  

“You are going to have a number of very large, very embedded technologies that are going to have a very difficult time fundamentally shifting their business model to match this new style of doing business,” he said.

Mr Sivak said leading vendors were becoming more open to their products being interoperable with those of rivals because they realise “the system is changing and the people that change quickest are going to win”.