Liquid data and the health information economy: Is !011 finally .

Leonard,

I enjoyed your article very much.I guess you offer a really good overview of about of the many challenges of making health information liquid.As often as I hold with your opinion that 2011 should see health information become truly liquid, I sadly feel that we are still years away.

As you are no doubt aware, freedom of health information has almost nil to do with technology.

ike so many other things in our lives, limitations are determined by particular interest groups, politics, and ultimately money.

Some things are definitely changing for the better:as you pointed out, many key system vendors (both inpatient and outpatient focused) are first to keep open-platforms. this after years of tenaciously locking that information down to ascertain market-share, and create barriers to new entrants (and innovation).I definitely believe this open-platform trend is being driven by larger forces, typically associated with healthcare reform (and HITECH dollars).

Other things stay the same:consumers (i.e. patients) demand more efficiency, more transparency, better access, you call it. while simultaneously demanding tighter security.While greater liquidity with tighter controls should be everyone's goal, in practicality, it is difficult.In fact, the sharpening of HIPAA and HITECH privacy/security teeth is likely the single greatest inhibitor of data flow.But let's not stay there.

I remember a prevalent assumption by consumers (and IT folk as well) is that physicians welcome access to more information.After all, with more information, clinicians can get better, more-informed decisions, right?This is true if you completely remove reality from the picture.Physicians are already overwhelmed with the data they do have.Furthermore, anyone who has seen a physician in the final 20 years knows that anything in surplus of 5 minutes of face-time is unusual.There are ever-more time commitments, as easily as financial implications that drive physicians to spend fewer and fewer minutes with their patients.Requiring a doctor to track-down more information, and then assimilate it is perhaps too often to ask or expect.Throw liability into the mix and it's a non-starter."Dr. X, if you had interpreted the sentence to question your health information exchange (HIE) portal, you would make known that Dr. Y prescribed such and such treatment.Your failure to do due diligence has caused irrevocable pain and woe to my client."In the current climate, I would regain it really hard to break a doctor for such "negligent oversight."

From a technical perspective, HIEs and NHIN help provide necessary middleware to have more use of data stored in disparate databases.Current use-cases require clinicians to pull this information (e.g. make calls through the architecture to various end-points that might house relevant information).In price of usability, we want to run from a pull-based answer to a push-based one - where clinical providers automatically receive data on their patients whenever new information becomes available, any time, anywhere.

Nevertheless, the larger issue - in my humble opinion - is to proceed to translate the role consumers (patients) play in the healthcare ecosystem.First and foremost, this involves making patients more directly responsible for the price of their healthcare (I intended to introduce a connection to the only released study of healthcare costs by the California Healthcare Foundation - CHCF; alas, their site is low at the moment).This is happening. and likely has a lot to do with various favorable trends occurring throughout healthcare.

Smarter, more-fiscally conscious consumers make smarter decisions.They search out providers who make the clock to reexamine their information fully before a visit . and they pay more for higher quality.Smarter consumers also reward organizations that place in technology, infrastructure, progressiveness, and ultimately better clinical outcomes.They get a lot more rationale when it comes to things like data security.For instance, if I want companies to learn all my data and run data-mining algorithms to call my risks for various illnesses, maybe I want to find a way to compile and share my information.

At the end of the day, the thing that's going to do this all chance is a liquid, consumer-driven market.Consumers who demand excellence and invention from their suppliers (providers and technology vendors alike), and are willing to support it up with money get what they want.Instead, we get a marketplace where consumers are uncompromising in their need of everything.They typically have a sensation of entitlement inversely proportional to their part to overall costs (and directly proportional to their use of healthcare resources).They assume responsibility for nothing.They are willing to pay for nothing (generally speaking of course), because they have entrusted private payers and the authorities with their buying power.The administration has no clue how to do this responsibility, and private payers care far less around the perceptions of their customers than their profit margin.

I apologise if I sound too cynical.The accuracy is, I am not.I really think that we are on the sceptre of a complete transformation.Bankrupt Medicare and Medicaid systems, skyrocketing health insurance premiums, and the iPhone are all turning the tide.As consumers get larger healthcare bills, they're leaving to increasingly ask the correct questions:how can Netflix give me so much for so little?why is the iPhone just the coolest thing ever. and now the iPad?!These companies didn't just happen.Genius, or not, they play the pick of the crop.For every one of them, there are thousands that didn't survive.And who decided?We did.We made Netflix and we made the iPhone.Isn't it time we directed our care to something a little more significant than Angry Birds?