It’s December again—time to reflect on lessons learned and begin the new year a little wiser. In 2014, I saw countless examples of disconnectedness in healthcare. There was the first known Ebola victim in the U.S., Thomas Eric Duncan, whose recent travel to West Africa was overlooked in his hospital’s electronic health record system. There was the revelation that tens of thousands of veterans were waiting months or longer for care at the VA. And we’re just getting news that, beginning in 2015, nearly 260,000 doctors will face Medicare reimbursement penalties for their failure to go digital.
Healthcare is failing to connect care teams to timely clinical information; failing to connect and engage patients in their own care; and failing to connect healthcare providers to innovation and financial results.
In our otherwise connected economy, a wealth of information about each of us can be easily surfaced and made available. But in this regard players in the healthcare system, like many hospitals and the VA, have what we might call a learning disability. Their huge IT systems exist as information islands, disconnected from the world beyond their walls.
Even as inpatient admissions are on the decline, hospitals continue to pour millions, even billions, of dollars into software systems to support care delivery and coordination. These systems take years to deploy and armies of staff to manage. But they simply don’t know that much about most of us. Think about yourself. Chances are, you have aches and pains, go on and off different diets, and take medications for one thing or another. And how much of that does your hospital know? Do you even “have” a hospital? Most of us, thankfully, go for years or decades without visiting one. As a result, some of us have Twitter followers with more insight into our relevant health story than a hospital. And so do many companies outside the cloistered healthcare economy. United Airlines, for example, knew where Thomas Eric Duncan had been; Facebook probably did too.
Many hospitals are trying to fill their information gaps by forging data links with trusted doctors and suppliers through an emerging Electronic Health Record (EHR) monoculture. There are countless attempts across the industry to get all care providers onto a single IT system, so hospitals can create an information ecosystem with themselves at the center. Control the patient’s data, and you control the patient. It makes perfect business sense—for 1990. I call it “captured care.” In this bizarre dystopia, it is all too easy for hospitals and health systems to build captive customers instead of loyal customers.
The model with one health entity of any kind at the center no longer makes sense for two reasons. First, it’s based on geography, with each hospital or system dominating a region. But the reality is that patients move around more than ever, and information has the potential to move even faster. The best specialist for diagnosing and treating a rare carcinoma might be 3,000 miles away. With an Internet connection and air travel, geography doesn’t have to be a barrier to getting the right care. But in closed information environments care can only be sourced from providers within the system.
Second, we’re generating mountains of health data ourselves, yet lack meaningful ways to integrate it with our official records. With wearable devices and mobile apps at our fingertips, we’re able to chart exercise patterns, pulse records, diet, and sleep. In a system under lock-down, there’s no way to integrate this rich trove of life data with all those expensive images and test results that are in a pre-Internet proprietary system at the hospital. It doesn’t make any sense.
Kicking off the year knowing that nearly 260,000 doctors will make less money because they didn’t embrace a more connected future is disheartening, to say the least. In my vision for 2015, captured care gives way to connected care. Healthcare, just like every other industry, can operate better and more effectively if backed by the Internet. Our health records should belong to each of us, just as our health does—it should be ours to do with as we please. Often this will mean connecting. It might be to consult with three specialists in different parts of the country, or to post lung x-rays on a social networking community for patients with respiratory disease. It will certainly mean tapping into a health information economy with patients’ universal online charts at the center. That way care can be secure, but as accessible and shopable as the goods we buy on Amazon. That way, innovation becomes not something doctors are penalized for skirting, but something they are eager and capable of embracing. For a world of connected health data, we need modern, open systems, like those in virtually every other industry. Is it too much to ask in 2015?
Jonathan Bush is Chief Executive Officer, President, and Chairman of the Board of Directors at athenahealth, Inc., which connects care and drives meaningful, measurable results for more than 59,000 health care providers in medical practices and health systems nationwide.