Will We Ever See HealthIT Interoperability, Costs, Outcomes and Value Revealed?

Every major industry on the planet uses Information Technology (IT) to improve the cost and quality of the products that industry delivers. Banking and finance have long used integrated and standardized IT to transfer funds, analyze risk according to millions of variables and improve the customers interactions with the company. Travel industries including agents, air and rail have long used IT to enhance efficiency and effectiveness of travel. The same can be said of all major retail chains, oil and gas manufactures and distributors and Automobile manufacturers. Even major league baseball has garnered the benefits of statistical analysis in fielding the best possible 9 man team to counter the opposing team. 

Indeed there's only one industry in America which has failed to implement IT in order to improve the quality and value of the products it manufactures and delivers to it's consumers, Health Care.

The greatest advance in the quality and cost of the four clinical outcomes (preventative, medical, surgical and palliative) manufactured and produced by physicians, hospitals and therapists with their patients will come not from a hand held Tricorder, silicon based diagnostic or fitness apps or from telemedicine. Outstanding improvements in health care will only come from the full interoperability of EMR/EHR and billing systems via standardization and integration utilizing shared API's with resulting tabulation and revelation of clinical outcomes according to all variables.

Interoperability, standardization and integration of EMR/EHR and billing systems will lead to the tabulation and revelation of clinical outcomes according to all contributing and non contributing variables. This will result in two "waves" of improved quality and costs in health care. These waves will come first at a macro level, and will be followed by a second 'micro' level wave of accelerated improvements in diagnostics and treatments and outcomes for patients working with physicians.

The first wave, or macro wave will be enabled by integrated interoperable EMR/EHR and billing systems giving doctors and patients for the first time in history, in near real-time the ability to discern what are the best diagnostics and treatments for which patients and which diseases. In addition, we'll find out exactly who are the best doctors and hospitals and therapists for which diseases and which patients. Most importantly we'll find out why they're the best (or worst). Ensuing QC will improve all under-performers. Epidemic and pandemic foci of diseases and bio-terrorism and fraud would be instantly revealed. Finally, capitalistic competition based on the quality and cost of the 4 revealed clinical outcomes will reward those who are truly the best doctors and hospitals.

The second wave of improved quality and costs of health care will be borne out of the reapplication of data gleaned in the first wave of revelation of outcomes. The second wave will build on the 4 clinical outcome revelations of the first wave. Health care providers and researchers and even patients around the world can parse the value data (outcomes/costs) and examine targeted molecular, societal and digital means to improve the diagnostics and treatments of any patients, patient groups, diagnostics and treatments for individual or population based disease variables revealed in the first wave of preventive, medical, surgical and palliative outcomes

The software and hardware for the first wave of tabulation and revelation of clinical outcomes according to all charted variables already exists. The insurance, EHR, pharmaceutical and pharmacy industries have been bartering, selling and analyzing this private personalized health outcome data on tens of millions of patients for decades, it's a billion dollar business. Actuaries don't like to guess. The credit card industry has been using fraud algorithms for decades. The hardware for interoperability already exists, we don't really need Watson-like processors to tabulate and reveal charted information. 

The most never asked question in the connected health or digital health or Health 2.0 world arises out of this stalled system; Why, despite the fact that all the pieces to solve the interoperability puzzle of EMR/EHR and billing systems have existed for decades, haven't we progressed in the last two decades to implement full interoperability in order to garner the clinically obvious and enormous benefits for patients and their doctors?

The answer to the question of why hasn't interoperability been implemented may be found in Harvard Professor Clayton Christensen's widely accepted thesis on disruptive innovation; "Disruptive innovation describes a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly move up market, eventually displacing established competitors." The answer to the question of why may be found by analyzing which health care market competitors will suffer the most displacement from interoperability of EMR/EHR and billing systems.

The competitors which would be displaced by integrated decentralized encoded EMR/EHR and billing systems due to the capitalistic competition based on clinical outcomes involve the 5 highest market cap ancillary industries of health care, and they're not willing to downsize or be disrupted. In essence, these industries have deemed themselves, "too big to fail". These 5 industries would be devastated due to the forced consolidation and downsizing from the outcome data revealed by integrated and interoperable EMR/EHR and billing systems. These industries remove the largest share of health care dollars from both patients and their physicians. In addition, these industries receive massive taxpayer subsidies or wavers from Federal Regulations. These industries represent the largest combined donors in America to our Congress people and the Administration. The industries which would be damaged by capitalistic competition based on clinical outcome revelation and are preventing the implementation of interoperability are;

• Insurance Industry                                                                             Few will argue that publicly subsidized and private health insurance companies make their profits for their shareholders, bondholders, executives, bureaucrats and patron politicians by financially or physically rationing access to preventive care, diagnostics, treatments, physicians, hospitals and hospice care. The results of that rationing will be revealed in different costs and clinical outcomes for patients on different insurance plans. How would it be for business if Humana patients were dying or more sick than age and disease matched United patients? Insurance companies do not want the clinical outcomes of their patients revealed. These insurance companies don't want to compete capitalistically based on the quality or the cost (value) of the clinical outcomes of their patients.
• Pharmaceutical industry                                                   Pharmaceutical companies and their middle-men PBM's do not want to compete capitalistically based on the quality or costs (value) of the drugs they produce. That is the main reason why physicians can't get their EHR's populated with drug formulary and prices according to insurance plan and suffer the scourge of prior authorization rationing. It would not be beneficial for pharmaceutical companies if their expensive name brand drug performed no better or even worse than a generic or competitors alternative. In addition, the companies would have to change their direct to consumer marketing from, "don't trust your doctors history and physical exam, instead ask your doctor if our drug is right for you" to " our drug is more expensive and works no better than the generic alternative or another companies drug, so ask your doctor is our drug is right for you". In addition, integrated EMR/EHR and billing systems would reveal regional and national disparity's of pricing and supply which demonstrate collusion against Americans or different population groups.
• Medical Malpractice Industry                                                                 In order to use the clinical outcome data to improve under-performing physicians and institutions, medical malpractice lawyers will need to be curbed. Health care remains the only profession in the world prevented from policing itself and performing quality control (QC). Instead of prospectively identifying under-performers and correcting them, we simply retrospectively sue their scrubs off creating a never ending cycle of errors and defensive medicine. The medical malpractice trial and insurance industry is huge and neither will want to be neutered in any way just to improve health care in America.
• Academe/Publishing                                                                        These two symbiotic industries exist based on the rights of refusal and ownership of patient, clinical trial and bench research data and associated IP. In addition, Academe, or your larger tertiary care University Based Medical Centers exist clinically based on the impression that their clinical outcomes are superior to those of the surrounding communities or regions. Indeed, the Cleveland Clinic and Mayo Clinic and others have opened a host of satellite facade Clinics around the nation staffed by local doctors. No Medical Center Director or Hospital Administrator would ever want their outcomes or costs (value) to reveal that they are second best in a community for any service they provide. Academe doesn't want to compete capitalistically based on the quality and cost (value) of it's outcomes. Academics ascend the hierarchy via publishing delayed peer reviewed clinical data which would now be available instantly via the world wide web either from the bench to the bedside. 30 years ago Academe teamed with the Tobacco industry to neuter the Senator Shelby Amendment which would have made all reproduced publicly financed research data available in real time on the web via the Freedom of information Act. More recently another Federal Law mandates the rapid online posting of reproduced government funded data which is being ignored by researchers and institutions who consider their clinical or bench research data to be 'theirs'. Interoperability, revealing vital scientific population health data would disturb the 200 year old Academic publishing bureaucracy in which publishing gets free data to support a billion dollar advertising and subscription gig and academics build their CV.
• EMR/EHR and Billing industry                                                             HIT, EMR/EHR and billing systems despite 20 years of products remain the only IT utilized by any industry which fails to improve the quality or price of the product manufactured or produced by the industry. Clinically, HIT has only proven to allow physicians and hospitals to up-code office visits utilizing the availability of default software. All EHR companies sell patients PHI and personal charted data to ancillary industries for profit without allowing patients and their doctors access to this data to improve outcomes. Simply stated, this industry consists of dozens if not hundreds of companies all claiming that their software is 'the best', charging physicians to input data which the EHR companies sell and charging and profiting off physicians and institutions for every work motion and secure communication they perform. Standardization and integration via common API's would greatly downsize this industry by demolishing and integrating proprietary API. This industry highly subsidized with government forced purchases by hospitals and physicians and with the sale of patient data does not want to compete capitalistically or be downsized due to standardization or integration.

Despite the fact that integrated, standardized and interoperable EMR/EHR and billing software would be extremely beneficial to patients and their doctors, we'll never see it happen in our lifetimes due to the 5 industries which have deemed themselves, "too big to fail". Coincidentally, our lifetimes will be shortened due to an inability to integrate and standardize EMR/EHR and billing systems to reveal the 4 clinical outcomes according to all variables.