Hospitals, and doctors specifically, need more tech tools, not fewer. The shift to platforms and networks-of-networks is essentially unstoppable, geographical pockets of interoperability might be what the industry actually needs, and there’s a new type of healthcare supply chain emerging. Well, that, and you’ll be able to download next-generation EHRs from Apple’s App Store.
That’s what I walked away from the inaugural HLTH (pronunciation for the uninitiated: health) conference this week in Las Vegas with. Of course, I went into the event with an eye on what it all means for hospital IT departments.
“I have said many times that I do think this internet thing will be a big deal in healthcare at some point,” joked Jonathan Bush, athenahealth CEO. “But I also think this physician thing will be a big deal, too.”
Both are so important, indeed, that Lumeris CEO Michael Long said a new type of supply chain is emerging in healthcare and it’s not about getting enough drugs or latex gloves just in time.
“We’re talking about a supply chain for the delivery of care,” Long said. “What powers this supply chain will be a re-imagined doctor-patient relationship.”
That’s a big break from the paternalistic care driven by resources immediately available to physicians — and data previously inaccessible to doctors will be the rocket fuel powering easy-to-use tools that change behavior for patients and caregivers alike to maximize the effectiveness of both prevention and treatments.
“The digital foundation we finally have in healthcare, coupled with high-performance computing capabilities and the surge of data, means we can do something with that information,” said Bryce Olson, Intel’s Global Director of Health and Life Sciences.
Plumbing: Platforms and networks
We’re not quite there yet, realistically, on a widespread basis. But innovators are building platforms, technological infrastructure and connective tissue to reach that point.
Redox, born of Epic employees with implementation, strategy and interoperability expertise, released on Tuesday what CEO Luke Bonney called a FHIR profile called R-FHIR. R-FHIR enables developers to use FHIR to exchange data across Redox’s network of some 250 hospitals.
“FHIR is a highly-extensible spec,” Bonney said. “We think this is the one developers will have the most confidence in over time.”
Redox’s overarching goal is to build connective tissue so web developers don’t have to — a novel idea neither entirely different from, nor mutually exclusive to, athenahealth’s ongoing effort to create microservices.
Athenahealth chief Bush said that the next version of its cloud-based EHR will be available in the Apple App Store. Called Epocrates Connect, the new app is slated for availability in September, and while the current version of Epocrates is already in the App Store, Epocrates Connect is a piece of what Bush described as transitioning to a platform that ultimately enables developers, both internal and non-athena innovators, to build on its underlying infrastructure.
“Developers on the athena platform won’t need patient database, log-in, security, capacity, hosting, production systems,” Bush explained. “All that will be provided, they won’t have to manage the data — all they have to do is manage their own product.”
EHR rivals Epic, Cerner, Allscripts and Meditech, among others, are also taking a platform approach to foster an ecosystem of innovation among developers.
To date, the biggest problem is that doctors lack interoperability and many of the tools make them work more slowly and simultaneously know less.
Athenahealth’s is taking a layered approach beginning with infrastructure, on top of which resides compute, then data, applications and the services that clinicians interact with.
“The idea that we should have fewer tools is such a bad idea. There is not some finite number of tools you can download just so the data will work together,” Bush said. “This is not a new problem, it's been solved a hundred times. Why not here yet?”
Up next: Three-way intersections
One could be forgiven for buying into the bold vision that so much data and infrastructure constitutes a nationwide if not a global capacity for any doctor, given appropriate permissions, to view, download and transmit the health data of any patient in front of them.
Perhaps that shouldn’t be the prize and what the healthcare system needs, instead, is more regional areas of interoperability that enable such data sharing in the places patients are most likely to present than, say, a New Yorker suddenly needing care in San Diego.
Either way, there’s little disputing that health information interoperability is a thorny and longstanding problem and even the move to value-based care and risk-based contracting won’t make the situation much better because hospitals still want to keep their patients.
What is needed most right now is people with experience and understanding in healthcare, technology and user experience, said Krishna Yeshwant, MD, General Partner of GV, formerly known as Google Ventures.
“We need the people who can translate those different worlds. Two is really hard, but three, I don’t think we’ve seen that in healthcare,” Yeshwant said. “The most interesting things happen at intersections.”
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