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As the leader of a nonprofit employer coalition focused on health care and health care benefits, I’m often a desired audience for vendors touting innovation. With employers being the biggest purchasers of health care products and services, we make sense as a market access point for many organizations seeking to introduce their solutions to employer purchasers. It’s a part of the job I find fascinating and inspiring. With all that is broken with our health care system, there is no shortage of fresh takes and creative attempts at solutions.
A problem emerges, however, when we ignore first principles in health care. Consolidation seems to be the trend du jour across much of our health care provider and insurance markets, but we’re also seeing the idea manifest itself in our vendor options.
SaaS — Software as a Service — is a blanket term for any technology solution used on an ongoing basis, and it usually has an ongoing fee tagged along with it. Really, we can use the shorthand word “platform” to get at the idea. Tech-focused companies are increasingly entering the market with these platforms built to ease a specific problem set from the health care benefit world in an effort to create a burdenless sandbox in which a particular need is met more efficiently.
These platforms vary in size and scope, as well as in quality and effectiveness. I can pretty quickly determine if they are a tech company trying to play at health care or a health care company trying to play at technology – or that rare unicorn of actually marrying the two properly.
But one thing all these platforms have in common is they have ignored one of health care’s first principles: Language. Health care is one of the most prohibitive language vocabularies in the history of communication. Long after Hippocrates, throughout the illiterate middles ages and even through the invention of the Gutenberg Press and the starting embers of mass literacy, medical knowledge was communicated in Greek and Latin as a barrier to the masses. That precedent of convolution has never been corrected – in fact, it has been deepened and developed into a market force.
The result is we have thousands of platform solutions, all of which are not designed to work with their competitors. It’s true functional API development is a requirement of CMS’ Interoperability and Patient Access Rule, but the logistics of staying on top of such an inexhaustible list is not really viable.
This includes at the fundamental level of electronic medical records. While we see technology companies meeting the requirements of interoperability, it all falls apart in real-world application. Every piece of the health care system – the doctors, the nurses, the hospitals, the PCP offices, the private practices, the specialists – they all must know how each of these works with the other or else the whole system crumbles.
Realistically, it never solidified long enough to crumble.
What we have is the ruins of a Health Care Tower Babel – the height of hubris reduced to thousands of isolated vocabularies and data siloes. And all of these platforms are building their own smaller towers on the unstable rubble. They ultimately are not solutions, but temporary instances where the small portions of the problem are sorted. But, ultimately, they still don’t ladder up to a real resolution.
So, what does an actual solution look like? Well, we need to return to that vocabulary problem. How do we decode health care and make it so that everyone can communicate the information effectively?
The simplest answer is a standard. If we don’t establish a standard, competition will only create instability.
What does a standard mean? It means an official, agreed upon vocabulary, an information architecture with universal taxonomy, and an itemized and codified list of interoperability requirements for health care technology.
Mike Stancil is president and CEO of the Pittsburgh Business Group on Health.