It's that time of year again. You know, the weeks where we finalize our budgets and make predictions on what trends are going to impact healthcare in the coming future. Talk about a losing game, though, playing catch-up to next year's predictions.
Instead, let's consider a new idea. How do we ensure that you are really ready for 2019's predictions? Lets get ahead. I'm going to recommend one action based on two core beliefs (two among many).
I apologize in advance, as this is probably the most technical post I've ever done. Sometimes, in order to solve hard challenges, you have to dive a little deeper. Stick with me, though, as I think this will truly impact the coming year for you.
Here are the beliefs:
Belief #1: You can't out-innovate the market
If there is going to be $5 billion spent on healthcare innovation by startups, and my budget for innovation is $5 million or $50 million, it's wise to make it easy for them to solve my problems. Grow your unpaid staff and available set of solutions.
Let the market do its job and see how you can benefit from the growth happening around you.
Belief #2: The market will innovate on your behalf if you provide a platform
How do you tap into that $5 billion in healthcare startup spending? You make your health IT system a platform.
A platform provides secure access to your data assets through a simple and streamlined process. Developers can request access via the web in order to build applications on top of a set of documented APIs.
Oh, is that all? Yes, actually, and the options are growing by the day.
The most important move for every health system in 2018 will be to ensure that you have a platform.
Why build a platform if I have an EHR?
When half-truth is presented as whole truth, it becomes untruth. Well, the half-truth that has us on an endless path of workarounds is that "the EHR is a platform for health."
No. The EHR is an important piece of the healthcare IT architecture, but it should be considered no more than a large source system that supports many of the workflows within healthcare. Now, I'm not diminishing its importance or the need to invest in this system. I'm just saying that if we can stop pretending that the EHR is a platform, we will all be better off.
I'm not down on EHRs; they are incredible for what they do. Of course, I love relational databases as well, but I wouldn't build a search engine on top of one.
What the EHR lacks
There are a number of EHR deficiencies when it is used as a platform. First, it doesn't have all the information on the patient. So when I write an application on the EHR APIs, I may still be missing some information.
Second, we can defend caché as a data technology, but one size doesn't fit all use cases. A platform will be a mix of several database technologies to provide the best tool for the job.
Third, a platform is about sharing data in a secure way, to enable innovation to occur across a broad base. Well, EHRs compete on data. If you don't believe that, read your contract. Better yet, ask the EHR providers how they feel about taking data out of their EHR and dropping it directly into another EHR. I have asked – it is frowned upon and discouraged with legal action.
Finally, a platform is more than technology. A platform is supported by business processes, contracts, security frameworks, and a simple interface to streamline these workflows. You know you have a platform when a new vendor can request a token, be approved, and start developing in a sandbox environment the same day while maintaining your security and compliance posture.
Once you get here you can begin to leverage the market to solve the problems which face your health system.
What Does a Healthcare Platform Look Like?
A picture is worth a thousand words... which is good, because I limit these posts to 1,000 words. You can ignore the technologies; they are just there as an example.
When we started to build our platform in 2012, there were no options in the market for this kind of architecture. The good news is that there are several to choose from today.
What you need
There are seven elements of this model and the characteristics which define a platform:
- Source Data Layer - Ability to support multiple source data repositories, models, and frameworks
- Integration Layer - Support for standard exchange, integration, and vendor APIs
- Aggregation Layer - Ability to aggregate, process, and store multiple data stores for unique use opportunities
- Direct Integration - Direct integration either via published integration channels (HL7, ETL, etc.) or vendor APIs
- API Layer - Provide and publish APIs for a community of developers to leverage to build solutions
- Security - Provide strong access and authorization, as well as security controls
- Internal/External Development - Facilitate and support development from internal developers and/or external third-party developers
There are two types of solutions currently on the market: aggregators and integrators. Aggregators extract data from the source systems and have mechanisms for keeping records in sync. Integrators provide connections to source systems and broker those connections.
Both solutions will work. Aggregation models provide more options and better performance. However, integration solutions are generally less expensive.
Some of the key players in the space include the following aggregators: Datica, Minerva, Health Catalyst, Salesforce.com, Kinvey, InnovAccer, Hart, Knowledgent, and Infor. The following are the integrators: Redox, Informatica, Mulesoft, and Cloudmine.
What is the payoff?
I'll say it again: you simply can't out-innovate the market.
We implemented one of these platforms at our health system and the payoff was agility, flexibility, and cost. We built and placed into pilot a multi-EHR patient portal in three months. When an online check-in system for our clinics in Texas was deemed to be a security risk, we rebuilt it on the platform and launched it in 14 days.
How about launching a machine learning pilot on radiology images, or AI for predicting code blues based on bedside data? All enabled by a platform.
Side note: we heard about five blockbuster deals in the news this week. A system CIO with a platform opens up options that won't require wholesale replacement of the EHR to gain immediate benefits to the merger.
My recommendation for the next 12 months is to conduct an RFP to identify and implement one of these platforms. I believe this kind of solution has value for small and large health systems alike.