Healthcare’s Black Swan?

April 17, 2015 in Medical Technology

Is there a Black Swan gliding unseen through the corridors of healthcare? Could a sudden information revolution trigger rapid evolution and change – even a collapse among some of the massive health systems dominating today’s landscape?

The ‘Black Swan’ concept articulated by author Nassim Taleb in his 2007 book of the same name is an unforeseen event – one with profound impact and, in retrospect, recognized as inevitable. World War I, the PC age, and even the phenomenon of Harry Potter are examples. An information revolution in healthcare has been predicted for decades, and so would at first blush seem an unlikely Black Swan. So let me put a slight variation into Taleb’s model: the coming healthcare information revolution is a Black Swan not because it is unexpected, but because it is unexpected by those who will be most impacted – providers who have deliberately blinded themselves to its approach by refusing to join the information age.

The health IT industry talks endlessly about “interoperability,” an unwieldy word virtually stripped of meaning by repetition. We all say we’re trying, but the needle barely moves. Consider an Epocrates survey of nearly 3,000 physicians: only 44 percent share patient data across their own organization. That’s pitiful; especially given that 94 percent are comfortable allowing other providers to view relevant patient information.  

The reluctance to connect in healthcare is morally crass. It keeps care fragmented, frustrates patients and providers, increases the risk of medical error, and holds revenue associated with value-based and coordinated care hostage. It has led the government to the brink of mandating rudimentary information fluidity, rather than allowing those who are actually good at exchanging health information to rise, build unique care services, and defeat the idle.

A bill circulating on Capitol Hill would explicitly prohibit “information blocking” by imposing sanctions on vendors and providers that fail to enable seamless information sharing or take affirmative steps to impede it. That is fine insofar as it goes, and Congressional action might dislodge some portion of the ecosystem from its stubborn stasis. But ultimately a tipping point of consumer demand, not an edict from D.C., will be our Black Swan.

In imagining the new reality, it is helpful to reattach interoperability to a meaningful definition in three tiers:

1). Information sharing within the walls and departments of a single organization that might be more accurately labeled “intra-operability.”

2). Basic information sharing across unaffiliated organizations using disparate IT; this is the nut that needs cracking, a problem solved for many industries years ago – remember when your PC couldn’t communicate with your sister’s Mac?

3). Universal access to information via open platforms.

That final tier strikes many as hopelessly pie-in-the-sky, but the open platform couldn’t be simpler. We experience it every day in our non-healthcare lives: consider where we can see information from thousands of retailers, or, where we shop every major airline. How long until consumers start demanding the same in healthcare? 

The majority might not see a dark bird on the horizon, but its silhouette is clear to those who look. The future is telehealth, proactive population engagement, remote monitoring and improved patient access. Technologically, we’re fully capable of those today if not for a lack of national connective tissue to allow caregivers ubiquitous access to patient information.

Providers and vendors who do not advance connectivity will die out. Very soon, interoperation will be requisite to profiting and thriving, just as it is in telecommunications, financial services, and countless other segments of the modern economy.

Because I can see the Black Swan on the horizon, and it’s beautiful.

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