Why Docframe is building a no-code platform for Health IT

Why Docframe is building a no-code platform for Health IT

Peter Morrow

Last weekend my significant other had to work late because her clinical lab’s software provider was installing an update that required over 12 hours of downtime. She is a clinical lab scientist (CLS) for a large lab in SoCal. This downtime forced her team to work with old-school pen and paper for a whole day! All because their software provider couldn’t deploy an online update.

I’m writing this in 2022. Not 1999. But unfortunately, this experience is pretty typical. Many hospitals, clinics, and labs work with clunky, unreliable, and antiquated software tools to manage patient data. While the rest of us have adopted modern cloud tools with nearly 100% uptime, much of the medical world has been left behind.

Software companies avoid industries with sensitive data

How we ended up here is a complicated story, but the simplest place to start is patient privacy. In the early days of the internet, Congress passed the Health Insurance Portability and Accountability Act (HIPAA), which was signed into law by President Clinton in 1996. The same year, Congress passed the Communications Decency Act (CDA).

Four years later, Scott McNealy, CEO of Sun Microsystems, said “You have zero privacy. Get over it.” This was a reflection of the attitude in Silicon Valley in 2000. Maintaining Privacy conflicted with many internet companies' business models and was technically difficult to execute. This would set the tone for the next 20 years of the internet.

So, the simplest reason why doctors and scientists have inadequate software is that Healthcare’s privacy requirements were much harder to work with than the looser requirements in Sales, Marketing, and Social Media. Talented software engineers and well-capitalized investors ignored software opportunities in healthcare and instead focus on areas with less sensitive data.

Medicine has lots of specialties

There's a wide variety of specialties in medicine. These specialists each have slightly different software needs, which makes the Health IT system disjointed. These gaps are magnified by the wide variety of medical devices and tests systems they need to interface with.

The first wave of Health IT tried bridging the gap with custom on-premise systems. An individual health provider’s IT team would manage every component of their system, from server hardware and software to each laptop, tablet, and desktop machine. This approach has the benefits of higher control and flexibility, so the Health IT team can connect each medical device and customize their software’s functionality to each clinic’s needs.

This approach works pretty well for some, very large, health systems that can afford to recruit top IT talent, but for most health providers this extra control often creates extra work and more room for security mistakes to be made. Eventually, the on-premise approach would prove to be too counterproductive, even for the larger health providers.

These problems with on-premise software are not unique to healthcare. The problems with home-grown, on-premise software systems would usher in the next chapter for enterprise software, “the cloud.”

From on-premise to the cloud

When most people hear “the cloud,” they think of popular consumer storage products, like iCloud, Dropbox, or Google Drive. But, when IT folks hear “the cloud,” they think of platforms like AWS or Hubspot. Both are correct. Cloud-based software is any software that is accessed over the internet, where data is stored in a server somewhere that the user cannot directly access. The cloud software provider directly manages the server infrastructure for the customer and develops a secure application layer to access data.

The benefit of using the cloud, instead of a traditional on-premise system, is that many of the tedious and time-consuming tasks that come along with managing your servers go away. This frees up more time to focus on things that directly affect users. Cloud-based tools are also much easier to secure because most of the cybersecurity work is offloaded to the cloud provider. But, these benefits come at the cost of sacrificing substantial control. With an on-premise system, IT had full control over their systems, for better or for worse. But with a cloud-based system, the degree of control the IT team has is dependent on what customizations their cloud-based software provider allows.

Healthcare’s painful transition to the cloud

Health care providers have been disappointed by the first generation of cloud providers.

When [Dr. Sadoughi] got word of the new system, she was optimistic. Not any longer. She feels that it has made things worse for her and her patients. Before, Sadoughi almost never had to bring tasks home to finish. Now she routinely spends an hour or more on the computer after her children have gone to bed.
Why Doctors Hate their Computers - New Yorker - 2018

Most cloud tools in the Health IT space, like Epic, Meditech, and LabWare, provide very few customizations compared to what was possible in the on-premise days. The Health IT cloud companies aggressively push customers to adopt their way of doing things claiming that they follow “best practices.”

This aggressive push leads to politically driven implementation cycles, where physicians have little say about how their software works, as the cloud provider pushes for a system-wide standard that doesn’t work well for anyone. One clinic’s director will push for adding a question to the patient intake form, while another clinic manager may push for a slightly different question that can be redundant for the patient.

While this might seem counterintuitive, standardization is not always a good thing. Imposing software standards where they are unnecessary can create frustrating user experiences for physicians and patients. Standards in EHR, LIS, or other areas in Health IT try to be as comprehensive as possible. But, there are so many different sub-specialties in medicine and too many styles of patient care to accommodate for. Eventually, the software standard becomes a bloated master of none.

Health IT cloud products’ infatuation with standards also creates problems for specialists in new, developing fields, like genomics, where the science is changing more quickly than the cloud product’s standard can keep up with. This means that the doctors and scientists who are working on the most important problems in medicine, like cancer research, have to rely on home-grown solutions that integrate poorly with their existing EHR. In many ways, the status-quo, where cloud products impose a rigid monoculture of standards on the medical field, is stifling innovation.

This is why larger health institutions are passing on the latest generation of Health IT cloud tools. Many are migrating their on-premise systems to cloud infrastructure providers like AWS and Azure, so they can maintain control over their internal standards. But, this is oftentimes an overly ambitious task to tackle internally, even for the most talented Health IT teams. As a result, the clunky, home-grown, on-premise legacy systems, that can go down for 12+ hours, continue to prevail.

What if cloud products were modular and composable

As the problems with on-premise systems, the problems that doctors have with the first generation of cloud tools are not exclusive to Healthcare. IT professionals in many industries have become frustrated with the rigidity and overly-complex standards they have to work within the modern cloud.

At the root of this problem is that many of these cloud platforms were not built with customizability in mind. Baked into their application architecture is the assumption that all customers will use the software in pretty much the same way. The first generation of cloud products, especially in Health IT, were not built to be resilient to change.

To solve this problem, a new generation of cloud companies is taking a fundamentally different approach. We are taking complex software systems and breaking them down into composable building blocks. This idea is taking an old idea, that has historically been used to build word processors, the Composite Pattern, and applying it to how we architect enterprise Software as a Service (saas) products.

The composite pattern underpins the next wave of disruptive change coming to the enterprise software industry: no-code.

No-code is coming to disrupt the cloud

Designing software as composable building blocks is a powerful framework for customization. It allows makers to hook custom blocks into the system, as long as it is compatible with the composition’s inputs and outputs. Imagine building software with the flexibility that Lego bricks afford, combined with the security and scale of the cloud. That is the no-code vision.

Products like Notion and ClickUp are flipping the saas script. The script for the first generation of saas has been something like, “Here’s how our saas product works. It follows best practices. You’ll need to change how your team works to use it.” For no-code, the script is “These are the building blocks our saas product provides. You can combine them in any way. Here are examples of some of the ways other companies have used our product. Make what you think is best for your team.“ In other words, no-code is a “choose your best practice” approach.

No-code abandons the attempt to standardize how industries operate and focuses on strengthening how their building blocks work. No-code embraces the cloud without abandoning flexibility.

Finally! Health IT can make software that health care providers will love, with no-code

Most health care providers aren’t software engineers. So, we shouldn’t expect them to manage their servers and software stack. But, and this is the big “but,” most software engineers don’t practice medicine.

Why should software companies be providing a standard for doctors, if they know nothing about medicine?

The status quo answer is that the software company can hire product people who used to practice medicine or know a lot about medicine, that guide the software’s standards.

No-code says, the best practice might be dependent on the customer’s geography or specialty and may change more quickly than we can keep up.

Let’s let doctors lead the design of their software standards and allow them to share with other doctors and health care providers as their needs change. Provide them with a composable platform for managing patient care, that is built to be resilient to change and agnostic to how data is managed.

Why no-code has failed in healthcare so far

The no-code space is in its infancy of saas disruption. We are only starting to see a few products with substantial traction, but there are lots of new products launching every week. But, none have focused solely on healthcare, until now.

Docframe is building a new no-code platform from the ground up for the next generation of Health IT applications. Docframe’s product introduces a new kind of no-code building block called a “Doctype.” Doctypes can represent any kind of health data. From a Patient to a Sample or even an NGS testing pipeline. Doctypes come with strict security baked-in. Access to each data point can be fine-tuned with a simple, privacy-conscious, no-code interface.

Right now, we’re focusing on use cases in the health startup world, like lab data management tools for biopharmaceutical or NGS testing companies. We’ve also met with no-coders (aka visual developers) who want to make healthcare apps to improve the user experience for patients and physicians.

The most important lesson we learned from our launch is that there is an enormous appetite for change in the Health IT space and there are many makers with revolutionary new ideas for improving patient care looking for a platform to build with. Some are surgeons or doctors, and many are Health IT professionals that are fed up with the status quo.