John Gage, Sun Microsystem’s fifth employee and its former chief researcher, famously said “the network is the computer.” The majority of us experience this every day through interactions with a wide variety of highly-intelligent, super-connected networks including Facebook, which remembers our friends’ birthdays better than we do; ATM networks, which know instantly if we have the cash that matches our request; and the complex, yet seemingly simple interweaving of phone networks, which allows us to communicate smartphone-to-smartphone regardless of carrier. Sadly, healthcare struggles to grasp this important concept.
Earlier this month, I flew to Utah for a conference hosted by KLAS, a major healthcare research outfit, about interoperability. Interoperability is a clunky word that’s talked about endlessly in healthcare, but at its root is an important notion: health care information needs to flow freely. Interoperability means that important information isn’t stuck in proprietary enterprise software that a hospital spent millions of dollars buying years ago. Having this information in the right place at the right time equates to reduced risk of medical errors and makes the delivery of health services more efficient and less costly. I’m convinced more than ever the only way to free information from the silos where it’s currently stranded is for the industry to embrace connectedness by switching to cloud-based, open networks.
The goal is clear. Yet healthcare IT executives and those buying their products remain stuck in the old ways of thinking. In their minds, software is still the computer, and sunk costs keep it so. As such, health information is largely trapped on technology islands that are maintained at great expense onsite at hospitals across our country versus flowing across the care continuum via a universally available information network. Just how bad is the data jam? An Epocrates’ survey earlier this year of nearly 3,000 physicians found that only 14 percent of physicians can access usable electronic health information across all care delivery sites and six out of 10 doctors, even when in the same organization, aren’t effectively sharing information.
I was in Utah with key executives from the country’s leading health information technology providers – including Cerner, Epic, GE Healthcare, Meditech and others – to talk about how to improve interoperability and how to measure it. Yet the conversation among my colleagues and competitors quickly foundered. We’d gathered to talk about interoperability, yet no one believed that we could measure it because we all run different systems. Instead, the consensus was, we’d have to make do with a subjective survey of hospital chief information officers.
To me, this is the ultimate irony, and represents a complete failure to move into the modern era. I felt as if I were sitting in a room of record executives pushing back against the inevitability of the switch to digital music. I wanted to shout at all of us to wake up, and see how the old ways of doing business are being disrupted. Information will move online in healthcare, just as it has in other industries, including financial services, which has similar privacy concerns, whether health care providers and vendors like it or not.
There has been talk in Washington about requiring a certain level of information sharing among electronic health records companies. I believe, however, that a better solution will come from the market. One way to spur change is to try and gauge, quantitatively, how well information is flowing and make known the positive things happening as a result; rather than backing away from doing so because the effort is too hard or, perhaps, too embarrassing.
That’s why I decided that athenahealth would voluntarily report both our total automation rate (that is, the amount of information we are able to process electronically versus manually because of the web of connections we’ve built from our network to interact with the rest of care continuum), as well as the number of actual connections our network offers to those on it. Today, with more than 95,000 network connections with the likes of pharmacies, labs, hospitals, health information exchanges, other vendors, we are able to automate approximately 59 percent of our work. We believe that by disclosing these numbers – the only company to do so, that I know of – we can pressure others to do the same. And I believe strongly that, over time, as healthcare information moves online, those numbers can only go up and will become a competitive differentiator.
To be fair, things aren’t as bad as they were a few years ago. Some of the more egregious data-blocking practices, like the practice of charging exorbitant fees, are going by the wayside. Meanwhile, traditional software players are teaming up to create connected islands of information from which data can flow freely. athenahealth, is, in fact, building stronger connections to historically closed systems. Yet these moves to build information channels are akin to putting a Band-Aid on a broken arm: The entire enterprise software system in healthcare is broken.
With the cloud, the network really is the computer. We see this on athenaNet, which has 67,000 providers, serving nearly 70 million patients. Not only does everyone on the network benefit from access to the same information channels, but the connections also allow lessons to be learned and solved universally. For example, if a doctor in Minnesota gets a claim denied because of some medical coding requirement that she didn’t know about or because of a new insurer rule, that knowledge can be learned network-wide so that when those circumstances are recreated that denial won’t happen again.
What can be done? Committing to advancing connectedness is the first right step, but health care requires a paradigm shift related to the technology it uses and invests in. Health care executives must learn from other industries that the free flow of information is more than just some ethereal ideal. It must become a reality and we must measure it. Interoperability means that health information is unshackled so that it can go where it’s needed, securely and reliably, just as information does in other areas of our lives. Only then will we be able to say that we’re living up to the words that John Gage so presciently said so many years ago. “The network is the computer:” it’s time that health care meet the network.
Jonathan Bush is the CEO of athenahealth.