For the majority of my career I have been obsessed with creating technologies to modernize our largely dysfunctional U.S. healthcare system. To me, it is very clear that the emergence of cloud computing has finally created the opportunity to truly address this daunting problem. Cloud-based solutions are the only viable option for effectively getting providers, patients and other key stakeholders online so that the necessary efficiencies find their way into the system.
To the rest of healthcare IT, however, it is not so clear, as witnessed by the lack of truly cloud-based companies in the marketplace.
Most of the large, established players in this industry continue to rely on the outdated client/server or older technologies, such as MUMPS. Some of these companies’ products trace their roots as far back as 1969. These companies and their software were built before the world wide web, before Facebook, the iPhone and iPad, salesforce.com — and even email, for God’s sake! There also exists a tremendous amount of confusion related to the morass of small, bootstrapped EMR companies, which number in the hundreds. People do not understand the difference between buying a monolithic single-purpose app to utilizing a robust, cloud-based platform approach.
This lack of understanding has made me realize that we need a better way to explain what the cloud has the power to do, and what true cloud-based technology even is. Easier said than done!
I was recently afforded a breakthrough, though unfortunately at the expense of an ancient treasure. Allow me to explain:
In January of this year, a 3,500-year old cypress tree in Central Florida named “The Senator” caught fire and burned down. As I read the article about it in the Miami Herald, I was blown away that a tree this old could even exist. I was curious, so I did a little research on the Internet only to find there were older trees, including the oldest of its kind: a tree called “Methuselah” located in California that is 4,842 years old. In looking at pictures of this tree, it doesn’t even look alive, as it suffers from age-induced deformities.
As I continued to look into this topic, I found there were even older trees existing in the form of clonal colonies. The oldest of these, a colony of quaking aspens in Utah, is estimated to be at least 80,000 years old.
This colony, called Pando (Latin for ‘I spread’), is considered to be the oldest and heaviest living organism on Earth. This is evidenced by identical genetic markers and a comprehensive, subterranean root system. Trees sprout from its roots, endure healthy lifespans and perish as others sprout, creating a sublime biological cycle that keeps the organism alive.
Continual replenishment keeps Pando young, healthy and vibrant — I was absolutely blown away by its beauty!
And that was my “eureka” moment.
Up to this point, healthcare IT companies have focused exclusively on “app” building. Some of these apps date as far back as 40+ years, an eternity in technological terms. These are the Methuselahs of the world: old, twisted and hollow at the center, although still alive.
All software creation efforts begin with a set of common tasks that include the creation of a security framework, data model, computing infrastructure and many, many others. Therefore, software developers spend much of their time taking care of these very basic functions before they get to work on their true innovation. This is the equivalent of planting a seed and watering every day in order to grow a tree.
A modern, cloud-based platform, however, solves this problem by affording the developer most of the basic building blocks and allowing them to focus their time and capital on true innovation. Built correctly, this platform also allows the developer to tap into a rich ecosystem for distribution of their product.
A true ecosystem for healthcare can only emerge if developers can build their apps on an existing cloud-based platform. My company, CareCloud, has built a system for the industry on which this is possible. Although today we are the builders of the apps, there will soon come a day where it is others who are building those apps on our platform.
In essence, developers will be leveraging the “root system” so that building “trees” or “apps” consists of only the part that happens above ground, not below. As new needs arise for healthcare reform or scientific breakthroughs, old apps die and others are born.
It’s now clear to me why people are confused about cloud-based innovations in healthcare IT; it is because early on in Pando’s life, the colony looked simply like a few trees, or apps in our case. However, the observer failed to realize the power of the underlying root system.
Healthcare needs to move away from systems that were built before the web. Systems that were built to be housed inside the hospital or doctors office, without an awareness of the outside environment. Systems that were built primarily to bill, collect and document the infrequent encounter between a doctor and a patient in a brick-and-mortar facility.
We are moving towards an instrumented reality where a continual stream of data is captured from a multitude of sensors and medical devices attached to a person’s body. This data will be correlated against a person’s genome, medical history and external data. Volumes of data will be analyzed in seconds, resulting in actionable information being sent to caregivers.
It is inconceivable to me that anyone could think that systems written to live in isolation using old technologies could morph to meet these modern requirements, or that companies could innovate around the periphery of these systems. Equally inconceivable is people thinking that the recent progress in electronic medical records adoption, stimulated by the HITECH Act, has closed the window for new entrants in healthcare IT. This is like saying that because everyone had a cell phone there was no opportunity for Apple or Google to enter the wireless market. In that scenario, both companies had 0% market share in 2007 and today enjoy over 77%. This was only made possible because the power of their respective solutions was not their cell phone capabilities but rather their iOS and Android platform capabilities.
Healthcare organizations that have implemented the old systems have chosen to risk their ability to compete in the marketplace. Some will perish, some will integrate a patchwork of technologies to make do, and the bold ones will rip out those systems and replace them with agile, cloud-based solutions.
Massive, technology-led disruption in healthcare delivery is needed to change healthcare for the better. The core of healthcare technology today is simplistic, old and rotten. Modern requirements mandate a new architecture, in the spirit of what is emerging through cloud-based innovations.
It’s an admittedly ambitious task. It took tens of thousands of years for Pando to reach its current state. Is it possible for any single software company, of any size, to solve all of healthcare’s problems? This is one of the problems I see with commercial software companies of both the client/server and web-based variety.
But It is my belief that the only way to create all of the daunting functionality that is needed to power healthcare is the democratization of the platform. In essence, letting the world at-large build on top of an elegant, powerful foundation.
Healthcare needs a Quaking Aspen!