The missing operating system in healthcare
At HIMSS 2017, IBM's chief Ginni Rometty reassured in a keynote that there will be "new collar jobs" because of advances in cloud computing, data, and AI.
We are bravely marching towards cognitive computing in healthcare. However, the world of healthcare technology is dotted with isolated islands that make this march a huge challenge.
Some of these islands store medical records. Some perform billing. Some host radiology information systems. Some patient activity. Some nurse calls. Some store lab tests and so on.
In fact, each of the 50 major specialties in medicine form distinct islands of their own, sometimes with little correlation. Different equipment, devices, software systems.
Not only that. Each of these islands house hundreds of thousands of legacy systems. For example, there are 2 million medical imaging systems worldwide.
Despite exploding advances in medical innovation, the healthcare industry is at the rudimentary level of interoperability. When a patient is in emergency, a doctor cannot access her past records quickly if it's she's not part of his hospital's network.
Hospitals aren't able to build bridges across their own islands without making economics spiral out of control. Multi-year rollouts of large electronic health record systems run into hundreds of millions of dollars. Some rollouts have resulted in layoffs and coincided with departures of CEOs.
Indeed, we are trying to apply advanced technology, such as cognitive computing, over primitive, complicated, and expensive architecture.
Isn't this icing on an over-baked cake?
Two key concepts that make operating systems what they are
Whether they run your computer (such as Mac OS or Windows) or your smartphones (such as Android), there are two concepts that operating systems (OS) take into account.
1) Abstraction: Concealing underlying complexity and unwanted details by providing higher level functions. As users, we aren't interested in figuring out how to make our phones talk to our Bluetooth speakers. We just want our music.
The OS abstracts the complexity making our life easy.
2) Arbitration: Managing and organizing available resources without requiring users to do so. Beyond a point, we aren't interested in deciding how our computer's resources must be allocated. We are more interested in playing YouTube with 20 tabs open and writing our document at the same time.
The OS arbitrates a computer's resources for us so that we don't have to.
A missing OS for healthcare's islands
OS-thinking is now pervasive in many industries.
- Tesla is an OS that updates itself even while its consumers are driving.
- Amazon Web Services manages the complexity of server management.
- Airbnb applies OS-thinking by connecting the dots with travelers and hosts, managing the entire underlying process from booking to payment. Uber does the same for transport.
- Domo is attempting to do the same for business intelligence software. Google sheets does that for XL spreadsheets.
You get the picture. The older model is complicated and restrictive. The newer model is simpler and flexible.
While OS-thinking exists in spurts, it's largely missing in healthcare. A plug-and-play like simplicity that wraps up underlying complexity. Through the use of abstraction and arbitration.
The industry is too big and frail. We can't simply upgrade it like we do with smartphones or computers. We need to simplify complexity within each island and build bridges at the same time.
We recently applied OS-thinking to one specialty of healthcare. Endoscopy systems that gastroenterologists use to examine our guts.
Old technology pervades the gastroenterology field. As with the rest of healthcare, software systems that plug into endoscopy machines are extremely expensive. With bells and whistles that most doctors don't ever use.
enki endoscopy writer, what we built, rests on top of a cloud-based electronic health record platform. We wrapped the complexity of compliance, data, reports, access, coding and billing, patient management to make things simpler for users.
In other words, enki abstracts and arbitrates endoscopy report writing for gastroenterologists.
Healthcare industry requires a wider application of OS-thinking. Far reaching interoperability standards (FHIR works in that direction) that makes the industry more open. Policies that compel medical organizations exchange data more easily.
More important, we need to do this without breaking the bank.
Then our isolated technological islands will come together.
Technology giants interested in healthcare must not only look for opportunities to push adoption of advanced technology. They must be willing to do the grunt work that will make such adoption meaningful.