SaaS Is Dead. Welcome to PaaS.
SOFTWARE
Reuven Lirov
Cloud-based software for private practice owners is a dying technology thanks to huge companies such as Oracle and Amazon. The truth is that it’s been a long time coming. In technology terms, you generally see tech go in and out of fashion faster than clothing. New gadgets replace old ones and continue to improve our quality of life. As we venture into the end of the second decade of the new millennium, we’re seeing the death of yet another technology—software as a service (SaaS), or the cloud-based model. By this I mean, a model where a single company, with no leadership representing your direct interests (not just your specialty), offers you software based on their interpretation of your needs.
The Client Server Age
The electronic health record (EHR) first hit the market decades ago, and it helped chiropractors standardize much of their practices, making it easier to fight those who would smear this noble profession. Just think about this: chiropractic is a $14.7 billion industry according to IBIS WORLD reports, and it is growing annually at around 1.7%. This may not sound like a lot, but 1.7% of $14.7 billion is a whole lot
of new growth. When EHR hit the scene, it was all about meeting compliance standards, but it quickly became clear that these systems were costing doctors time and money. It was just too time consuming to care for both the patient and a computer. The next generation took advantage of this and created the first local software that focused on speed.
Local systems took the industry by storm. They wildly outpaced their predecessors and allowed cli-
nicians of all specialties to begin to truly standardize care while minimizing the cost for the patient. Growth in practice numbers alone was impressive, with most practices popping up in the Northeast and in California and Texas. The problem with local systems, though, is their inability to keep up with industry shifts as practices experience them. They relied solely on their own ability to keep up and manually update clients with memos and e-mails (see 1950s for memos). It was around this time that it became clear that there was yet another area of concern for practices—integration.
It isn’t enough to be able to simply document compliant notes, and to do so quickly. You also need to schedule and track patient financials, as well as create, check, submit, and follow up on claims. It turns out that of all of the actions taken in practices today, the most complex is billing. This has almost nothing to do with how complex it should be, but instead with how complex the major players have made it. It’s important to recall that insurance companies have deep pockets and manipulate all facets of regulation, including state licensure boards in many states. This means that whether or not you are a cash-only or insurance-based practice, you are often subject to their whims. It sounds scary, and it is, but thanks to the advent of integrated systems, practice owners could schedule, document, and bill from the same system, which saves time, energy, and overhead. Unfortunately, this still didn’t solve the problem of keeping up with industry shifts.
Cloud-Based SaaS (Software as a Service)
This started to change around 15 years ago. Companies such as POI created cloud-based technology, such as Vericle, that began aggregating data across practices instead of isolating practices. Think of it like a shared immune system. As your colleagues experience sudden shifts imposed by big corporations, interests, insurance companies, and more, these systems look at the data and decide whether it’s relevant to you and
apply safeguards to help prevent similar issues from harming your practice. This new ability revolutionized practice efficiency because it meant that, like antibodies, your technology wasn’t just some dead thing that animated when you turned it on to manage your practice. It was a living, intelligent artificial intelligence (AI) that was constantly thinking about your best interest and how to keep you safe. Well, just like each technology before it, the past 10 years has seen a dramatic shift to a new type of technology called platform as a service (PaaS).
The problem was that these technologies never actually approached and worked with practice owners as peers, no matter how many technical and compliance issues were solved by them. Instead, they were a conversation between programmers and practice owners, often resulting in frustration. Thankfully, the world of technology is filled with incredibly intelligent individuals dedicated to the success of our industry. The result was engines that allowed existing organizations to create custom online solutions that gave practice owners not only the benefits they could experience on the technical level, but also on the coaching and process level. For example, LCS is an application recently built for chiropractors working with Elizabeth Thomas’s LifeTime ChiroSolutions organization that took weeks to create, but only hours to implement for her clients. This gave Elizabeth the power to have an engine that would cost her tens of millions to reproduce, and leave out the incredible wealth of knowledge the engine has attained. These engines allow coaches and chiropractic leaders to customize their own product, geared toward their own clients, that focuses on implementing solutions for their needs and not some blanket software that may or may not cover all of the client’s needs.
PaaS (Platform as a Service)
PaaS is the newest revolution in practice management because it allows for custom software built on reliable engines, much like Oracle and Amazon have done with their stores such
as Fashion, Audible, and others, to give practice owners the solutions they need without the distractions of features they don’t. The power here is both in its ability to provide the scalable solutions in technology and service that the cloud provides but without the generality that it usually requires. In the standard cloud model, you have a segmented population on many different platforms because they focus on this specialty or way of practicing. PaaS means that all practices can share the same engine while receiving a fully customized and unique front-end user experience.
The true power of the PaaS approach is in what we’ve dubbed “the network effect.” It’s the ability of an engine to draw on its many solutions to learn and grow in order to help its members. It’s kind of like having a shared immune system so that if one member gets the “flu” and develops “antibodies,” then all members share in the new antibodies and are immune to the “flu.” The PaaS approach provides this advantage for areas such as medical billing where engines can identify and learn when a single practice experiences a new denial just invented by an insurance company and immediately apply such a rule before new claims ai e submitted across millions of practices, thus instantly saving them from experiencing payment delays. This allows for renewed focus on the human side of discovering new rules ahead of denials, thus creating the incredible results that PaaS solutions offer.
Reuven Lirov, MA, is one of the pioneers of PaaS and cloud computing. (' I Remen founded POIwith a vision to create a real-time enterprise level d practice management solution to replace traditional software technology. ^ He is the author of “Treat or Be Treated” and is regularly a featured speaker at events around the country. He can be reached at (727) 266-2225.
