Electronic Health Reporter

By David A. Watson, chief executive officer of Akiri, and former CTO, Kaiser Permanente.

The American Medical Association (AMA) identifies one of the biggest challenges in healthcare today as the secure sharing and use of trusted health data in real time across the complex U.S. healthcare ecosystem. To hijack a Winston Churchill quote — data liquidity is a riddle wrapped in a mystery inside an enigma. The key to solving this puzzle is not more technology; we’ve had good integration technology for 30 years. What we need is a fundamentally different approach that addresses the adoption issues that have so far prevented success.

Do we face challenges caused by the inability to accurately identify different fragments of patient data coming from different systems producing incompatible data that is exacerbated by incomplete or inadequate data standards? Absolutely. And they are being addressed – albeit slowly – by the technology community. The more intractable problem is adoption. That challenge can be boiled down to three overlapping issues which hinder productive health outcomes:

1. Trust – there is insufficient trust among the healthcare data trading partners (e.g., healthcare organizations fear that shared data could result in some sort of business disadvantage).

2. Economic Incentive – there is no direct economic incentive for those who possess the data (and bear the cost of creating/communicating it) to share it with those who need it (and who benefit from it).

3. Control – organizations that share their data want to have a sense of control regarding what is being shared with whom.

Achieving data liquidity in the sprawling systems that make up the U.S. healthcare economy requires a combination of rethinking the applied technology to make it easier and less expensive, while closing the adoption gap by giving the participants in data exchange solid business reasons to do so. Without addressing the economic issues and retaining a strong privacy compliance footprint, no amount of technology will overcome the market entropy noted above.

Data, data everywhere

Healthcare data currently resides in multiple heterogeneous systems, such as electronic health record systems (EHRs), various administrative systems (e.g. claims administration), health information exchanges (HIEs), clearinghouses, and in a variety of clinical systems, repositories, and formats. While many complain about the proliferation of data, the benefit of the EHR adoption push has been to convert uncomputable paper into computable data. Our challenge is to address the current disorganization of healthcare data. In the meantime, the ability to glean actionable insights and create value from this tsunami of data in a timely fashion, while navigating the sprawling and complex regulatory environment, is dependent on a new approach that focuses on specific use cases and value drivers.

Deadly data jams along the information highway

Physicians have reported using half their time on electronic health records (EHRs), costing more than $1 billion per day on an annual basis. Current health data sharing methods are both insufficient and inefficient, resulting in information gaps for patients and healthcare providers. Physicians need good data to develop appropriate treatment strategies and achieve timely financial events, such as prior authorization. Yet while attempting to liberate this data, the healthcare industry must also confront the fact that it suffers more data breaches than any other industry. The market needs a new approach to exchange data seamlessly and securely as healthcare continues its inexorable march towards full digitalization.

We can solve healthcare’s data liquidity challenges

Healthcare in the U.S. is a service delivered by a multitude of disconnected entities struggling in a dysfunctional marketplace with significant information inequities to deliver timely, affordable, and value-based healthcare. It is no wonder that the U.S. spends approximately twice as much as other developed countries on medical care, despite similar utilization rates. Digitization of healthcare requires payers, physicians, HIT vendors and regulators to work together to establish the necessary legal, economic and clinical environments to deliver a vibrant healthcare economy with superior outcomes for patients while reducing the debilitating burden on U.S. GDP.

An expanding, unbroken circle of trust

The time is now to develop a practical, comprehensive solution to the health data liquidity issue. A new way to address these challenges is by establishing secure, private peer-to-peer networks (vs. VPN) with requisite data services to connect and securely exchange health data with trusted partners. As physicians, health systems, payers, and pharma/life science companies subscribe to and participate in such networks, the circle of trust strengthens and expands, and the value of the data increases exponentially through opportunities to apply the data to improve patient outcomes.

Enabling “smart contract” functionality allows data trading partners to determine what data they will exchange with whom in an environment that supports high value exchanges. Finally, providing a mechanism that supports the exchange of economic value among the data trading partners is currently the missing link.

This isn’t the stuff of dreams; these are capabilities fully within our reach today. Isn’t it about time we moved health data sharing into the 21^st century?