By KIM BELLARD

Matthew Holt is going to tell me I’ve been thinking about infrastructure too much lately (e.g., cybersecurity of them, backup plans for them), but if you don’t have infrastructure right, you don’t have anything right.

And healthcare most definitely does not have its infrastructure right.

We’re spending between 15-30% of our healthcare dollar on administration, and no one views our healthcare system as efficient or even particularly effective. We have numerous intermediaries like PBMs, billing services, revenue cycle management vendors, and all sorts of digital health solutions. There are layers upon layers upon layers, each adding its costs and complications.

In some ways, healthcare’s infrastructure has changed remarkably in the last two to three decades. Most transactions – e.g., claims or eligibility – are sent, and often processed, electronically. Most physicians, hospitals, and other health care clinicians/organizations have electronic health records. You can find out the expected cost for prescription drugs at point-of-sale. You can do a virtual visit with your doctor. There are vast amounts of health information available online. AI is coming to health care, and, in some cases, is already here.

But: we’re still sending faxes. We’re still filling out paper forms, repeatedly. We still make innumerable phone calls, usually spending long waits in queue. Everyone hates provider directories, which are never up-to-date and often inaccurate. Talk of interoperability notwithstanding, there are far too many data silos, leading to at best us lugging around disks with our downloaded records to at worst physicians acting with incomplete information for us. Healthcare has had far too many data breaches, and cyberattacks have held patient data hostage (e.g., Ascension) or put a halt to those electronic transaction (e.g., Change Healthcare). And we’re not at all sure how to govern AI.

The amount of medical literature has been growing exponentially for decades, and the volume of health care data is growing much, much faster. Physicians once guarded health information like the guild they are, but the Internet has democratized health information – while doing the same for misinformation. If anything, we have too much information; we just can’t use it as effectively as we should (e.g., it can take 17 years for evidence to change physician practice).

This is not an infrastructure that is not coping well with the 21^st century.