The Coming Health Care Singularity

According to Wikipedia, the Technological Singularity is the hypothetical future emergence of greater-than-human superintelligence through technological means. The Healthcare singularity could be the time when patients have access to better information and make better decisions than their physicians. The drive to this near future is fueled by the open and globaIized energy of patients as compared to physicians handicapped by closed and parochial health IT.

Physicians have skills. Institutions have capital. Patients have freedom, and that is what tips the information balance in their favor. When it comes to health IT, physicians and institutions are still busy installing closed, proprietary, single-vendor systems that erect strategic barriers to communications every chance they get. The protection of professional licensure and institutional consolidation gives both parties a sense of security even as the patient and policymaker barbarians are massing on the Web.

The Institute of Medicine just released Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Aside from reaffirming the $765 billion of “Excess Costs”, the study highlights the following:

The committee also believes that opportunities exist for attacking these problems— opportunities that did not exist even a decade ago.

    • Vast computational power (with associated sophistication of information technology) has become affordable and widely available. This capability makes it possible to harvest useful information from actual patient care (as opposed to one-time studies), something that previously was impossible.
    • Connectivity allows that power to be accessed in real time virtually anywhere by professionals and patients, permitting unprecedented diffusion of information cheaply, quickly, and on demand.
    • Progress in human and organizational capabilities and management science can improve the reliability and efficiency of care, permitting more scientific deployment of human and technical resources to match the complexity of systems and institutions.
    • Increasing empowerment of patients unleashes the potential for their participation, in concert with clinicians, in the prevention and treatment of disease—tasks that increasingly depend on personal behavior change.

Among many other conclusions, they say:

Conclusion: Advances in computing, information science, and connectivity can improve patient-clinician communication, point-of-care guidance, the capture of experience, population surveillance, planning and evaluation, and the generation of real-time knowledge—features of a continuously learning health care system.

The closed, proprietary EHR paves the way for the Healthcare Singularity. Meaningful Use Stage 2 is the bus that’s taking us there. In a world where empowered patients can compute, connect and organize freely and at negligible cost, closed EHRs become a source of data to be mined and exploited elsewhere – including apps, mobile devices, social networks, wikis and medical tourism.

Meaningful Use Stage 2 includes key provisions for patient engagement and access to data held by physicians and institutions. Labs will soon be required to report results directly to patients. Patient-run health CO-OPs like the Minuteman Health Initiative in MA have incentives to install a new breed of IT. OSEHRA is mobilizing significant VA / DoD investment in open source EHR technology. Meanwhile, although patients would be eager to engage their physicians, the inflexibility of the current EHR technology, security and business model makes this seem impractical and uncertain.

Healthcare singularity is now on the horizon and will happen rapidly as patients and physicians begin to interact outside the institutional EHR context. It will first become evident in situations where empowered patients have access to experienced advocates and significant social networks. It will be attended by physicians who choose open source and cloud information technology that, by design, is equally accessible to all the members of the care team. Where will you spot it first?

Adrian Gropper, MD is a founder of MedCommons and consulting on health services strategy at HealthURL.com. He is driven by the vision of doctors and patients collaborating around shared health records on the Web.

7 replies »

  1. Brian Ahier highlights up another reason why separating patient management from EHR could be a good thing. https://plus.google.com/u/0/+BrianAhier/posts/1bwNLTwn6D6

    In an environment where patients and unaffiliated providers are collaborating in health management, clinical documentation must be focused on clinical issues and reimbursement should be secondary to avoid conflicts of interest. Since patient management crosses multiple EHRs, patient management should be done separately from any of the EHRs used by the various clinicians.

  2. Great post, and I hope you are right… You’ve definitely nailed one of the biggest problems with our roll-out of EHRs, but my experience is that closed systems with deep pockets are surprisingly sticky. Can someone say, Microsoft.

    A perfect example is the emergence of private health information exchanges (a la Medicity). While they facilitate cross-compatibility, it is usually within a single health system which uses EHR compatibility to increase its own stickiness and thus make the system even more closed. For example, how many times have you heard a major health system promote that all of their facilities can share your health records. Of course, the subtext is that you will be in a world of administrative and technological pain if you want to share your records outside of the system.

    While I am not a favor of additional regulations, it seems we would be well served by stronger incentives to move toward open standards.

  3. It’s very expensive to put data into a typical EHR. Meanwhile, every single day people experience Web software designed to make it incredibly easy to put data into it. This difference means that systems that take data from EHRs will have more and better data.

  4. When I began advocating four years ago I would not have predicted the progress that has taken place already! The denial and defensiveness that was so evident is breaking down as providers acknowledge the system weakness and the moral bankruptcy it takes to sustain the illusion of control. Progress is coming from all directions and the impact will be confounding at first, but will mature into a healthcare model that is more functional, caring and cost-effective to the benefit of all.

  5. In somewhat violent support of your notions, the issue isn’t this EHR v that EHR, anymore than its Outlook vs Mail (i.e. PC platform v Mac platform). Interoperability holds the key to transparency of health data, and ultimately, improvement of patient health. When EHR1 begins to share meaningful data with EHR2, this communication in itself is a conversation we can tap into, to help populate the PHR. I’m guilty of suggesting that PHR progress is within 5 years. But, I’ve said that 5 times now. Dare I suggest that we’re within striking distance of that goal …finally?

  6. I’ve long said that I felt, as a patient trying to actively participate in my health and health care, like a peasant in an old movie, part of the rabble storming the castle with pitchforks and torches.

    The castle in this movie is the proprietary HIT system, and the patient torch is the smartphone. The healthcare systems that recognize this “singularity” (love that metaphor) will be left standing. Those that hew to old school inside-the-silo thinking will be dust.