The Medical Interoperability Miracle You Are Waiting On Will Never Happen

My new LinkedIn friend, Anne Zieger Posted a new article this morning on her site EMR and HIPAA entitled "Are We Waiting For An Interoperability Miracle?"  It is well written and insightful, but for all that misses the entire point.  Anne alludes to the fact that thousands of companies, tens or hundreds of thousands of people, or more, are working on this problem and simply can't come up with a workable solution.  They can't solve the problem because the problem they are solving isn't the problem they think they are solving.

Smart guys, programmers, doctors, marketing people, et al., are simply barking up the wrong tree and eventually will get to the end game that Anne pointed out

"The cold reality is that eventually, the data sharing system we have — such as it is — will fall apart of its own weight, as organizations simply stop paying for their part of it. So while we might not need a miracle as such, being granted one wouldn’t hurt. If this effort fails us, who knows when we’ll have the time and money to try again."

Precisely.

Here is where they are getting it wrong: It isn't about interoperability.  It is about a central data store that everyone reads from and writes to.  You can have all the interoperability in the world, but if nobody knows who you home healthcare provider is, who the custodian of your medical records is, you, or your emergency room doctor or anyone else outside that system, will not be able to find and access your medical records. 

The problem is a little like looking for your keys.  You had them at one time.  You know they have to be somewhere, because you got where ever you are, but good luck tracking them down.  The analogy breaks down when you realize that we are probably going to be looking for a web service, with no graphical user interface, so not only is the entire internet the room your keys are in, but the room is sealed, has no lights, and you have to hire someone (a programmer) to design and construct you a power source, a switch and a bulb to even be able to look for them.

As stated above, the only solution to sharing medical data is to have a central repository.  There are two viable alternatives to who designs, builds and maintains this repository: The government and health insurance companies.  We all know (and had proven to us with Obamacare) that the government can't understand, or even manage people who do understand, the technology.  How late was healthcare.gov and how many times did it crash in the first few weeks?  That leaves insurance companies.  Even if a health insurance company was savvy enough to actually build a working Electronic Medical Records (EMR) system, you still have the fragmentation of not knowing which insurance company to ask for your records.  ...and it is a security nightmare.

Which brings up the point that apparently nobody can build an EMR, much less those hotbeds of technology, insurance.  Pardon my sarcasm.  There are two viable enterprise EMRs in the land, Cerner and Epic.  Cerner is built on an amalgamation of software technologies, like nearly any big company will do in order to get productivity out of programmers they've hired and have no idea what they do.  No one person has an over view of the architecture used for their offerings and it just keeps growing.  Epic's offering is written in an archaic programming language called MUMPS designed in the 60s.  MUMPS was pretty slick then, but that was 50 years ago.  Both of these packages require weeks or months of training, are difficult to use, slow and cause great gnashing of teeth at hospitals all over the country.

If you follow along with our blog, you know that we have only once identified a problem and not offered some kind of solution.   We, at Sentia Health, have designed and developed a solution that not only gives us the central repository we discussed above, but automates the entire insurance process.  That means that the doctor in Switzerland who is attempting to fix the leg you broke on your skiing trip, has instant access to your medical records.  Even better, the cost of your health insurance will go down by about 1/3 because we don't have any big buildings, no people adjudicating claims, give the doctors the EMR, free, and pay in real time based on the procedures they perform and document.  That means they don't have to pay for an EMR, a medical coder, or a billing department.  The savings is in the automation.  that means saving to the consumer.  The consumer him- or herself gets the 20%+ the insurance company wastes (as mandated by the ACA, and why the think they can't make money) replaced with a simple $10/month subscription fee.  If your insurance is $450/month, like mine is that means you immediately save $80 (.2*450 -10). your doctor doesn't have to raise prices for years because he gets to keep the $32,000 per year he currently spends on EMR, the $40,000 he spends on compliance reporting and eliminates the coding and billing departments completely.  Ad the $80 to your part of the $72,000 in savings and you get about 1/3 of the cost of healthcare just going away.  The wasteful part.  The business part.  The part that all the Harvard MBAs waste or put in their own pockets at your current insurance company.  That means that everyone will be doing things this way because it is both better and cheaper and it will organically give you your central data repository.  Go look at SentiaHealth.com and tell us what you think.  follow us on Facebook, LinkedIn and Twitter.  Call the neighbors and wake the kids: real change is coming. 

If you really want interoperability, this is the way to have it.  We are testing this design all over the world today.  We have beta testing going on in India, the Caribbean and soon in South America.  Hang on America, we are coming.  We will fix this.

The Automation Revolution is Coming, Are You Ready?

I was checking my LinkedIn yesterday and found an article by Vivek Wadhwa titled These 6 new technology rules will govern our future, where he discusses the natural destination given the direction our technology and society is heading.

I have been evangelizing for years the eventual arrival of the Star Trek universe as imagined by Gene Roddenberry where we weren't in competition for scarce resources, eliminating the need for war and conflict and where machines do most of the work, freeing us up to think and innovate and to be smart, instead of sweeping floors and typing into spreadsheets.  Mr. Wadhwa said it better than I could and codified a few particulars that will make us 'free to think and innovate.' he says (with my commentary):

1. Anything that can be digitized will be.
   We are digitizing our social lives ourselves.  Doctors have reduced our very genome to a set of data.  With a little help from an algorithm, we can already predict the likelihood of some diseases from this genome.
2. Your job has a significant chance of being eliminated.As a developer, the main thought in my day is to make my own job easier.  I write tools that help me write software.  Some of these tools write software for me.  Today, I can generate about 80% of any application I am tasked to write, with the bulk of the remaining 20% being aesthetics, or making the user interface visually pleasing and easy to use.  If I can automate what I do, I can automate what you do.  Like in this example, the only thing that can't be automated is creativity and judgment.  There will always be marketing people.  there will always be musicians and artists.  There will always be entrepreneurs.   
3. Life will be so affordable that survival won't necessitate having a JOB.Mr. Wadhwa's example was cell phone minutes.  They want from incredibly expensive to virtually free in a couple of decades.  This is the 'freeing us from sweeping floors' that I have been talking about for years.  My company, Sentia Health, has automated the entire insurance process and distilled it down to data management.  We eliminated the need for a medical coder, billing department, third party Electronic Medical Records (EMR) (we provide the EMR free of charge to practitioners) and the whole health insurance infrastructure, plus patient and population reporting for a $10 per month subscription fee plus the real cost of the actualized financial risk of providing health insurance.  All of that automation should cut about 45% out of the cost of healthcare.  EMR and compliance reporting alone cost the average doctor over $70,000 per year.  With the most important (paid) part of the equation, the practitioner, living for less as well, we can reduce costs even further.  This is the 'think and innovate' part that follows the 'freeing us from typing into spreadsheets.'  It is only a matter of time before we (or someone else) automate(s) every other industry on the globe. 
4. Your fate will be in your own hands as never before.With all this automation, you will have the time to pursue your dreams, just like in Gene Roddenberry's vision.  You can solve interesting problems, if that is your bent.  you cant paint, you can dance, you can do whatever your little heart desires.  We advocate going forth and being fruitful to solve problems.  Your particular problem might be the perfect cupcake, or the fastest paradiddle, or the grand unified field theory, who knows?
5. Abundance will become a far bigger problem than poverty.
   We are already seeing this.  With the proliferation of the dollar menu, et al., we see a rise in obesity, cardiovascular problems associated with obesity, and diabetes.  Efficiency goes up, costs go down, we can all have more, and sometimes too much.  So much for the industrial revolution, robotics, and existing automation putting us all out of work and causing us to starve.  As we have been saying, the impact is just the opposite.  Things get so much cheaper that the net is we can afford more.
6. Distinction between man and machine will become increasingly unclear.With the exception of the extreme right, we can already enhance our minds and bodies with helpful hardware.  We already have pacemakers.  How long is it before your fitbit is internal instead of around your wrist?  How much longer after that will I have to wait to have a connection to my phone and therefore the internet, hardwired into my head, and a retinal implant (that I need anyway, to combat extreme myopia) to get results back from that connection that I can read without any external device?  You can draw your own conclusions about prosthetics going forward but I have read reports about mind controlled prosthetic arms in development.

So with Mr. Wadhwa's points 1-4 you can see where I was attempting to go with my Star Trek universe example: We won't need to work, we will be freed from the drudgery of sweeping floors and entering data into spreadsheets to go forth and solve interesting problems.  I just wish I had said it as eloquently as he has.  I am going to add a number 7, however:

7. Education will become increasingly important.Precisely as in the Star Trek universe, we have to know not only what problems to solve, but how to solve them.  I'm going to go out on a limb here and advocate a liberal education as it teaches you how to think and to consider opinions outside your own.  While seemingly contradictory, I am also going to advocate a STEM (Science, Technology, Engineering and Mathematics) education.  Once you've identified a problem, you still have to have the skills to envision and enact a solution.  As evidence I present both the current and future administration's lack of ability to solve the problems in healthcare that we have.  Literally none of them have both the vision and the technical skills to see the big picture and to put a solution in place to solve the problem they've identified, that is, healthcare that is too expensive.   

So there is my vision of a Gene Roddenberry future: a life of doing things we want to do with no strife caused by competition for scarce resources.  I would caution you all to look closely at number seven because you don't want to be a 'red shirt' (The Original Series (TOS), in The Next Generation (TNG) the command crew wears red and generally gets picked off early in the episode).  You want to be educated and solve problems, be an officer, not a part of the people who can't identify and solve interesting problems.  Without everyone being well educated, I suspect we will devolve back into the feudal system where the educated produce educated children and the uneducated produce more and worse educated children.  That will result in (and may already have resulted in) divine right of Kings.  By that, I mean the haves make all the decisions and everyone else just obeys.  Looking at the last election, I am unwilling to take that analogy further, lest we end up in 1776, 1789 or maybe 2016.

We can already fully automate financial institutions.  A health insurance company is nothing more than a bank that only lets you spend the cash you've saved on healthcare.  That means we can automate banks.  We can automate the trading floor, but we should not.  If your company builds a product, you are nothing more than a financial company that manufactures something.  Ford, Toyota, and others, already automate the manufacturing of their product and we can automate the financial services.  That pretty much automates everything, if not now then eventually.

So yes, there are the predictions, along with the potential pitfalls.  I suspect that a lot of us will sit on the sofa all day, eat bon-bons and watch 'Real Housewives of Proxima Centauri b.'  Those people will have to go get a job because the automated system will see the damage they are doing to themselves and the eventual resources they will consume to combat the outcomes of these choices and hike up their insurance costs until they have to get a job.  Problem solved.  For the rest of us who decide not to be red shirts, we can expect a long and fulfilling life of doing interesting things that make us happy and of helping our fellow human being do the same.