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Maybe it’s because I spent my early career as a “cowboy surgeon” in Colorado, but I’ve always been a bit of a maverick when it comes to using technology to improve health care delivery and outcomes. I was chief of surgery at the Veterans Administration when I founded and chaired the Health IT Innovation Development program under the White House Office of Science and Technology Policy to develop radical, interoperable information systems in the federal health care space─ an idea a bit out of the mainstream at the time. Today, in my role as Deloitte’s chief medical interoperability officer (CMIO), I am engaging across the government and public health sectors to help improve health care quality and safety by advancing. clinical, technical, interoperability, and informatics initiatives– again working over and around the usual boundaries of the traditional ecosystem players.
In the old west, “maverick” was a term used to describe a calf born outside the barbed-wire boundaries of a ranch. Without a brand, the maverick calf didn’t belong to any particular rancher and roamed free on the open range between ranches without the traditional constraints of the fenced-in properties of the cowboys.
This got me thinking: What would the future state of health care information look like, if the underlying health care data that drives the business of today was no longer constrained behind the “barbed wire fences” of any particular health system? And instead, set free at the direction of the real owners of that data ─ the patients and consumers?
What would a truly radical, future-state health care information system look like?
Today, providers, payers, and their vendors own and control patients’ health data and the information systems on which it resides. In a future where patients own and control their health data, which resides in standards-based information systems in the cloud, patients can potentially look forward to providers and payers integrating with them rather than the other way around Helping those patients and consumers more effectively navigate the open range of the health care ecosystem.
This is a radical paradigm shift from our current provider- and payer-centric health care ecosystem to a patient-centered one driven by radically interoperable data, with open platforms and artificial intelligence connecting individual, population, and environmental datasets in real time and allowing all stakeholders to leverage previously untapped or unknown data and insights. This is a world in which we move clinical informatics into mainstream practice and empower patients to have and to take much more control over their own health care experience.
Time to get radical
It is time to get radical about information systems interoperability because it is the technology engine that will likely drive future-state, patient-centered health care. Right now, we have a fee-for-service (FFS) payment model in America—the more health care providers do the more they get paid. However, most patient’s want (and should receive) the most appropriate, highest-quality care at the lowest cost—that’s the value-based-care future state. To reach this ideal state, providers and payers need to be able to measure quality, outcomes and cost, and to differentiate cost from price.
But that’s only part of the equation. Getting to the point where a patient can shop for the highest-quality care at the lowest cost requires patient-centered technology that provides the data they need to make informed decisions. Interoperability is a determiner for this possibility: It takes varying types of structured and unstructured data–genomic, environmental, biological, population health, publicly available, and more—and uses artificial intelligence (AI), natural language processing, machine learning and massive computing power to mash it up, compute across many datasets, and discern valuable information about health care quality and costs.
Importantly, in a world of radically interoperable data and platforms, the patient (and/or their caregivers) stores and controls their health data in a personal cloud- and standards-based information system rather than ceding ownership to the provider’s electronic health record (EHR) – which, technically, is a system of record for legal purposes, quality indexing/evaluation, and billing. The patient-owned data is the source of truth: when a health care provider puts in an order for care, it’s done centrally through that patient’s ecosystem, not the payer’s or provider’s.
Elements of radical interoperability
With the exception of the patient-centered technology described above, many of the elements of radical interoperability are not new. What is new is harnessing these and other innovations in a patient’s own platform, serviced by data stewards of their choice, that will radically change health care delivery. Among platform basics are:
If we want to see a future state in which computational and scientific advances can help us predict and deliver the most personalized, highest-quality and cost-efficient health care, we need information systems interoperability to help us break through current constraints.
It is time to start taking down the “barbed wire fences” and allowing patients to roam the open range of the health care ecosystem with their own data in hand, engaging when, where and how they want, unconstrained and in fact empowered by radically interoperable data. It’s time to be a maverick.