The connectivity problem

July 19, 2016
Luke Bonney Co-Founder & CEO

The healthcare industry is a complicated beast. Undeniably, it helps people lead better, healthier lives and breaks new ground every year in what medicine can achieve. At the same time, it’s also plagued by issues that keep it from advancing at the rate it should.

There’s no one specific thing that complicates the healthcare industry—there are actually many factors at play that were meant to help regulate healthcare, but actually hinder industry-wide improvement. Standards that were meant to unify the language used in healthcare haven’t been widely adopted. Meaningful Use has resulted in industry-wide overhauls that are still being adjusted to years later. And electronic health records, while modern and efficient, are leading to physician burnout and fatigue.

But beyond these issues, the healthcare industry is severely adverse to adopting change, no matter how beneficial or innovative. It is slow to adopt technology because it means shifting or redoing how everything within an organization is performed. This would be a challenge to a small clinic with a veteran staff, let alone a massive health system with multiple branches and facilities. The problem hindering healthcare today is the fact that it is highly regulated, bureaucratic, and inherently risk-averse—not exactly an easy place for innovation and new ideas to quickly gain traction.

At Redox, we view this problem through the lens of technology adoption. From our inception, we’ve been working to knock down the biggest healthcare barriers that prevent great tools from getting into the hands of users. Some of these barriers are manageable; others are chronic and structural issues. We decided to tackle the hardest one: interoperability.

Most of what you hear when people start yelling, screaming, and waving their hands about interoperability is frustration about standards—HL7 is so variable! What’s this CCD, CCDA, CCDA-32 thing? The Blue Button, doesn’t that solve all my problems? FHIR, what the heck is FHIR? Complicating things beyond the standards themselves is the inconsistent implementation of those standards by both vendors and health systems. It’s just the tip of the iceberg, but for most people, the standards question is enough to make your head hurt (and If you’re interested in going down that rabbit hole, you should read this post by our brilliant HL7 Whisperer, Nick Hatt).

The silent issue that no one really talks about is what I refer to as the “Connectivity Problem”. This is a problem that we spend hours every week explaining to people, so I decided to provide some in-depth explanation as to why it’s so critical.

If standards are the language we use in healthcare, then the industry is missing the telephone lines connecting everyone speaking it. Though so advanced in so many other ways, communication in healthcare currently lives in the land of telegraphs and the pony express. Why is this?

Meaningful Use, a key part of the Affordable Care Plan, produced many positive outcomes, the biggest being forcing a slow-moving industry to shift from paper to electronic health records by setting a hard deadline to adopt electronic health records. However, when it went into effect, it forced technology in its then-current state to be implemented across the country. For healthcare, that meant the leading EHRs were bought and turned on rapidly.

The unfortunate thing is that rapidly turning on EHRs at health systems meant installing separate and distinct instances of each EHR at every new location, meaning that healthcare today is run on separate servers behind firewalls at every single healthcare institution. Because of this setup, our patient data lives in literally thousands of separate, isolated databases.

What does this mean? Well, unfortunately, it means there is no single instance of Cerner, Allscripts, Greenway, Epic or eCW; there are thousands of instances of each EHR installed at health systems across the country. It is not a collective of sites acting as one—it is a fragmented network without functional links. Integrating with data that lives at each site means setting up and managing a secure connection at each location, making understanding healthcare’s standards only one part of the integration problem.

In the past, if you wanted to grow your business and interact with healthcare data, you had to build a multi-lingual translator and manage a massive network of secure point to point connections with each health system. At scale, this gives rise to a massive amount of redundant infrastructure connecting vendors and health systems.

This is why interoperability isn’t a one-solution problem. There is no quick fix.

When we think about solving the interoperability problem at Redox, we’re talking about figuring out the Connectivity Problem first by translating all the different languages that health systems speak. Beyond that, there are other issues we’ll need to tackle in order for healthcare to rapidly and continually improve as the technology we use continues to advance.

Setting up the telephone lines so we can actually hear what each other has to say is how it begins.

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