Photographs by Alistair Guthrie
Orion Health is taking an industrial design infusion to give Barack Obama a hand reforming US healthcare. Andy Kenworthy peeks at Orion’s master plan
Ian McCrae is a former Ernst & Young man and senior business analyst for the London Stock Exchange. He’s probably used to being a few clicks ahead of the rest of us. In the 16 years since he founded Orion Health, the firm has gone from a five-person startup to New Zealand’s largest software exporter.
When McCrae started Orion Health in 1993 there were around 200 World Wide Web servers in the entire Internet, most in university campuses or government agencies. While the rest of us were playing computer games that now look like they were drawn with blunted crayons, Orion Health was busy working out how New Zealand’s National Health Index could pass everybody’s details around every health centre in the country. Orion then acquired the first commercial Internet link in New Zealand and harnessed its blistering nine kilobits per second to become the first Kiwi company to use international Internet marketing to sell its products.
Orion does the opposite of killer apps. Its specialist healthcare programs might one day save your life, or the life of a loved one. They may already have done so. Your doctor almost certainly uses Orion products, as does your local hospital every time a new patient arrives. Orion’s Concerto Portal has helped sweep away centuries of staggering down hospital corridors clutching dog-eared paper files. It allows medical staff access to a single view of their patients’ computerised admissions records, blood test, X-ray results and more.
Orion’s cWorkflow Modules are a set of software tools and applications that help manage and support things like disease management, clinical notes, discharge summaries and e-prescribing. Symphonia Messaging & Mapping Tools allow IT professionals to convince a host of previously incompatible healthcare computer systems to finally talk to one another. And the Rhapsody Integration Engine brings all of this together, with the aim of making it all as easy to use as anything on your desktop.
“The way to get good products is really good design up front. Once you do a good design people will copy it. You have to be putting out good design twice as fast as everybody else to stay ahead”
Being this useful should bring success. And it has. McCrae claims his firm is now the market leader in several areas of its sector, particular when it comes to integration engines. “Last year we lost one sale in that area,” he says. “But we won all the rest.”
The firm now has turnover of around $60 million and 330 staff, with offices in the US, UK, Spain and Australia. This helps to explain the air of affluent creativity in the stripped-down, stylish interior of the company’s Auckland HQ, and McCrae’s quietly spoken confidence when Idealog meets him there. “We reckon we will open another couple of offices by the end of the year and our turnover should hit $100 million,” he says, matter of factly.
I don’t doubt him. Orion posted 40 percent year-on-year growth from 2002 to 2007—and that was before Barack Obama decided to pump another US$10 billion annually over the next five years into this sector in the US. During his campaign for the US presidency, Obama pledged to invest on an electronic health records programme to streamline the work of hospitals, clinics and physician offices. He has since said that he wants a full digital health records system in place for the whole country by 2014.
It’s not easy to appreciate from New Zealand just how difficult Obama’s task is. Like most countries, the health system in the US is riven with bureaucratic and commercial rivalries, professional mistrust, entrenched commercial interests and incompatible systems, philosophies and legal requirements. Integration will be as politically challenging as it is technically difficult—but McCrae is happy to help. “That’s a big pie,” he says of Obama’s billions. “All we need is one percent of that.”
To get it, McCrae must complete Orion’s transformation from precocious startup to world player. Design and usability, he reckons, is the key. “This company started out working in small groups of people and was pretty informal, and we have relied on the talent of those small groups of people. But as we grow we have had to be more systematic about things. We reached a scale where we had to get out of the startup mentality, so we went looking around the world to people like Apple to work out how they do it.
“When it comes to software manufacture, industrial design doesn’t come into it as much as it already does in hardware. Looking at ergonomics, look and feel, that has been relatively unusual in software design. Apple gets the idea, whereas Microsoft is a late convert. Microsoft is very technically led, they do the technology first and then put a skin on it. When Steve Jobs took over Apple he wanted design to be in everything. When was the last time you saw an Apple manual or a guide book for an iPhone?”
That’s the model—that Orion software will be so easy and instinctive for healthcare people to use, they won’t need instructions and won’t need to learn anything new.
“We wanted to train our people, so we focused on user-centred design,” says McCrae. “We sent them to San Francisco where they trained with Alan Cooper, who helped create Visual Basic and has now set himself up as a design guru.”
In mid-2008 Orion created an eight-person design team, with the help of funding from Better By Design. McCrae now considers their role crucial to the future of the company. “Companies with the best products have a far better chance of prevailing,” he says. “The way to get good products is to have really good design up front. We need to be able to do good design and do it well, because once you do a good design people will copy it. You have to be putting out good design twice as fast as everybody else to stay ahead.
“Santa Monica, Sydney, Boston, Edmonton and Palma de Mallorca—Orion uses pleasant locations as a staff retention programme. Their people get to do their O.E. and still work for the company”
“The companies that will win this business will be those with the most elegant, user-friendly products out of the box. Most of the software organisations don’t have the commitment to design. We know this because when we recruit their staff, we ask them.”
As well as poaching the odd bit of US talent, Orion has established offices in Santa Monica and Boston to add to its other outposts. The office locations read like a travel brochure on their website. This is not accidental. Orion uses pleasant locales as a staff retention programme. That way their people get to do their OE, and still work for the company.
Orion sells all over the globe, with about 85 percent of the company’s revenue coming from international sales. But the US is the single biggest healthcare IT market in the world, and Orion has worked hard to break into it.
“It’s all about having a presence, getting the reference sites,” says McCrae. “The smaller hospitals are excited to see us because vendors don’t usually go there. But now we have UCLA, which is two and a half times the size of Auckland hospital.”
The roster of big US clients also includes John Hopkins Hospital, in Maryland, Baltimore, which has topped US News & World Report’s annual rankings of American hospitals 18 times in a row, the New York State Department of Health and Greene Memorial Hospital, Ohio. Shared Health, one of the largest public/private health information exchanges in the US, now uses Orion technology to connect medical information for entire geographical areas.
McCrae explains the importance of each new conquest. A single hospital may be running up to 800 separate computer applications, roughly equivalent to one for every bed in the place. This makes for a lot of complexity for Orion to step in and simplify.
Adam Sawyer, Orion’s general manager of products and clinical design, talks me through their approach. In the initial research phase, Orion sends a qualified clinician to establish in detail how people are working at the target site. “We don’t take them over to a coffee shop to interview them,” says Sawyer. “We send someone who knows what they are doing and watches the way that people work.”
Orion also tries to get to know a bit about the personalities behind their clients. Staff create example ‘personas’ and attempt to design the software to match them. For example, the end user may be a married nurse who finds technology intimidating, or a young surgeon who is comfortable handling complex information on screen. The trick is to design software that’s friendly for a variety of users.
The design team brings this all together. To avoid the dangerous urge of jumping to conclusions, they use the Balsamiq Mockups sketch design visualisation software. This creates a virtual ‘doodle’ of how your new software will look in operation, and some of its properties. What Balsamiq doesn’t do is pixelated perfection; it works like an architectural walkthrough, getting the user interface right before you start pouring the digital concrete.
This deliberate simplicity prevents the designers’ recurring nightmare. You don’t want to introduce a concept design to your customer, and have them say something really useful like: “Can I get the icon in cornflower blue?” Or worse: “I just don’t like it.” The aim is to keep the client in the process, working with you.
Which is the core of Orion’s challenge. How can it stay ahead of the design curve now that every company is out there surfing it?
“People’s expectations are so high now. They see this stuff on their phones,” says McCrae. “People are used to using Google, Gmail, that’s becoming the norm. But things like health and accounting programmes can still be hard to use. That is not the future.”