Halamka's Cautionary Tale for Healthcare

John D. Halamka, M.D.During my CIO career, I’ve worked on a few Harvard Business School case studies and I’ve had the “joy” of presenting my failures to Harvard Business school students for over a decade. I enjoy telling stories and inevitably the cases I teach are about turning lemons into lemonade.

In this post, I’d like to tell a story about a recent experience with Marvin Windows and lessons learned that apply to healthcare. I know that sounds odd, but hear me out. At Unity Farm and Sanctuary I’m the proud owner of about 100 Marvin windows from the 1990’s. All are still functional but incorporate nylon parts that eventually dissolve in sunlight. I needed to replace the nylon pins that hold the screens in place.

I did what anyone would do. I searched the internet for Marvin Top Rail Screen Pin, expecting to find the parts available on Amazon or a Marvin website. No such luck. Plenty of “plunger pins” but no top rail pins. I did find an unindexed PDF of a Marvin catalog . On page 43, I found "Top Rail Screen Pin M120 11867852”. I had a part number so ordering it should be easy, right?

I went to the Marvin website looking for a part lookup function, an ordering function, or a customer service app. No such luck. I did find a corporate 1-800 number on the Contact Us page. After calling that number I was redirected to  the web page of a distributor, since Marvin Windows will not sell anything to anyone directly.

Two days after emailing the distributor, I received an email back from a very kind and helpful person explaining that I had checked the wrong box on the distributor’s webpage - the part number I was asking about is from the Marvin product line and I had checked the Marvin Integrity product line. I explained the part number is the part number and I have no idea what product lines Marvin offers.

She noted that the part was available but the distributor sells nothing to no one directly.  I will have to find a local retailer and begin the entire process again. She was incredibly service oriented and when I asked, she agreed to find a retailer for me and tell them what part number to order.

Two days later, I received an email from a retailer 50 miles away noting that they could order the parts for me. I asked the cost and they said .25 each. Given that the process of getting a window part from Marvin is highly convoluted, I ordered 50 - a lifetime supply for the grand sum $12.50. I asked when the parts would arrive. The answer is unknowable since the retailer contacts the distributor who contacts the manufacturer and none of the above have customer accessible supply chain tracking or logistics information systems.

Two weeks later I emailed again and was told the parts would arrive 50 miles away in another week.

A week passed and I received a call from an incredibly service oriented person at the retailer who told me my parts had arrived (they weigh one ounce and fit in a standard letter sized envelope). I asked if she could mail them to me and she responded that Marvin retailers cannot mail anything to anyone. They tried it once a few years ago and since they don’t know how much postage it costs to mail a one ounce letter, the package would likely be returned undeliverable after a few weeks. Best not to risk using shipping services and instead, drive 1.5 hours to pick them up, sometime 8a-5p Monday through Friday.

Of course, I have a day job so that would mean taking time off work. I arranged to do conference calls during the 1.5 hour drive. I received my one ounce of parts for $12.50 one month after my search began. They fit my window screens perfectly. Victory!

One the same day I picked up the screen parts, I needed a very obscure electrical wall plate to cover an old electrical box with a deactivated switch. I needed half decora/half blank. I could not imagine such a part was ever made. 30 seconds after searching Amazon, I found it, clicked once and 12 hours later found it on my doorstep without lifting a finger (or paying shipping).

The purpose of telling you this story is that Marvin Windows senior leadership (and the Board) must be using Cobol-based mainframes to manage the company when they're not taking calls on their flip phones. It’s clear they’ve been asleep since 1985. When it comes time to replace the windows in my buildings, I would never consider Marvin Windows products, since it clear they care more about preserving an ancient business model and less about their customers modern expectations and experiences. Such companies will wither and be replaced by an “Uber equivalent” for windows.

But wait, I’m living in the glass house of healthcare and throwing stones. Just how easy is it to make an appointment with your doctor, seek real time telemedicine/telehealth advice, or get access to a “care traffic control” logistics application that shows your progress against a care plan?  In 2017, healthcare is still largely following the Marvin Windows approach of phone, fax, email, smoke signals and morse code.

The lesson learned is that in the near future, healthcare organizations that offer an Amazon approach will displace this which do not. That’s why BIDMC has focused on 5 pillars to guide IT projects in 2016 and 2017 - social networking communication tools, mobile enablement, care management analytics and cloud services. Every month we’re launching new functionality that gets us closer to the Amazon experience with such apps as BIDMC@Home (internet of things/telemedicine), OpenNotes, and Alexa ambient listening services. In two weeks, our entire dataset will be moved to the Amazon data lake with appropriate privacy agreements and security protections so we can take advantage of cloud hosted machine learning and image recognition services. By 2018, we’ll be much less Marvin Windows and much more Amazon.

I do not know the window business and maybe there is something about it that supports old business models while the rest of the world  innovates. However, I do know healthcare, and we need to embrace the same kind of consumer echnology focus as every other industry. If we don’t, our bricks and mortar buildings will go the way of Sears, JC Penney, and Macy’s  .