Gary L. Thompson, Co-founder and CEO, CLOUD, Inc. (aka @CLOUDHealth)
“The basic fact that order often hides more than it reveals has sometimes itself been hidden with the art and science of organizing our world.”
David Weinberger, “Everything is Miscellaneous”
Which came first, the chicken or the egg? This is an age old question, and in the evolving world of technology and social media, it can be updated and modified so as to be relevant to the topic of this post at HL7 Standards: Is Health IT Trapped in the Physical Geography of Healthcare? Before reframing the chicken and egg question, though, let me lay the groundwork for @CLOUDHealth’s series of guest posts…
Over the past several months, I have enjoyed the weekly #hitsm chats moderated by the team that brings us HL7Standards.com. During those tweet chats, it became clear that 2 or 3 extended posts might be a valuable addition to the occasional 140 character burst of wisdom that I hope to have contributed on behalf of @CLOUDHealth at #hitsm. It is hard to pack the entire CLOUD vision into one post, so we decided to break it up. This week we’ll look at the idea of a physical geography of healthcare, a meme that was first captured by David Weinberger in his book, “Everything is Miscellaneous” from which I quote above. Next week, I’ll take a look at another critical question, are privacy and transparency on a collision course or simply two sides of the same coin? Finally, I’ll pull all of this together and look at how linking people and not just data is vital to the 21st Century healthcare revolution we are all seeking and working to build.
So back to the chicken and the egg and an updated version of the question: “Which came first, the individual or the institution?” In the midst of massive investments in electronic health records (EHRs) and the unfolding rules and regulations of government-mandated health care reform, this is a critical question to understanding a different approach to health IT and the resulting impact on changing the physical geography of healthcare. Efforts like Google Health did not fail because it was too early to market. It failed because it made two faulty assumptions. First, it assumed that the Internet is an electronic courier service for documents, and second, it assumed that the current physical geography of healthcare is static.
Although VISTA (Veterans Health Information Systems and Technology Architecture) has won much-deserved accolades, the Department of Veterans Affairs is an excellent example of how reframing the interaction between individual and institution can change the physical geography of healthcare. CLOUD’s Chief Strategy Officer, Paul Wilkinson, and I recently co-wrote an article for the Texas Review of Law and Politics titled, “Set the Default to Open: Plessy’s Meaning in the Twenty-First Century and How Technology Puts the Individual Back at the Center of Life, Liberty and Government.” Beyond some of the legal concepts, we also explored in a practical way how advances in technology could change delivery methods for government services. The VA was one of two specific examples.
As we said in the article, “As the health care debate unfolds, the VA duplicates functions performed elsewhere in the public and private sectors that could be improved by the more elegant use of technology as an aggregator of services.” Quite simply, in order to deliver health services to veterans (a noble, appropriate and much deserved use of taxpayer funds), the VA completely replicates an entire health system of staff, hospitals and services. Think about that for a minute. The VA completely replicates an entire health infrastructure to deliver health care services to a specific set of individuals. Since the VA started at the institution level and not the individual, it didn’t even consider another path. It has instead rebuilt an entire physical geography of healthcare to achieve its goals. Paul and I explore this example in more depth in the article, as well as looking at the Departments of Education, Commerce and Labor through the lens of the individual, rather than the respective agencies.
So, you might be asking, “those are interesting examples but what does they have to do with health IT or Google Health?” Well, from the perspective of the veteran, every hospital could be a VA hospital if the doctors, nurses and other resources in a specific facility meet the requirements for that individual’s care. However, since the VA starts with the infrastructure and not the individual patient, the tools to know the answer to that question don’t start until the veteran walks through the door of the VA hospital. The Department of Veterans Affairs actually makes this explicit on the VISTA monograph page, “VISTA is built on a client-server architecture, which ties together workstations and personal computers with graphical user interfaces at Veterans Health Administration (VHA) facilities.”
What would happen, though, if we liberated the EHR from the physical geography of healthcare? What would happen if we re-conceived the EHR (and the PHR) as presentation layers to health data, rather than the electronic equivalent of health documents and manila folders in digital filing cabinets? This distinction is the ultimate cause of Google Health’s demise. In a CLOUD-enabled Internet, the distinction between a PHR and the EHR evaporates, however, for Google, the physical geography of healthcare loomed large. Since the EHR currently exists inside the infrastructure of the healthcare system, they only had one choice to build a patient-centric solution, the PHR. But isn’t the only real difference between a PHR and EHR the ownership and authenticity of the data? If our health data could be cross-tagged by both patient and the appropriate health professional, then the context of the data will determine the strength and utility of the information, not whether it is a PHR or EHR. Technology now allows us to pull information, rather than just push it, and right now, the paper-based paradigm of the EHR and the physical geography of healthcare have trapped health IT in a world of push.
As you digest this first post and prepare for the next two, I call your attention to some CLOUD resources that will help in understanding how an Internet that starts with people and not webpages is at the foundation of this paradigm shift for not only healthcare but all of our data. The first is my TEDx talk at TEDxAustin on 2.19.11 on “Reweaving the Fabric of the Internet.” The second is a sequence of four short YouTube videos on the CLOUD homepage: CLOUD and the Internet, CLOUD and ME 1.0, CLOUD and the Power of WHO, Connecting WHO and WHAT in the CLOUD. Until next week, keep following us on twitter @CLOUDHealth for more updates on the “Power of People. Connected.”
Gary Thompson is Co-Founder and CEO of CLOUD, Inc. (www.cloudinc.org), a non-profit technology standard consortia founded in March 2009 and based in Austin, Texas.
Prior to CLOUD, Gary has been involved with numerous startups, all of which push the leading-edge of their industries, including his most recent role as founding VP of Sales and Marketing of Kimbia, Inc., a Web 2.0 online fundraising company for Giving Power™. Gary also served in several sales management capacities at Apple, Inc. over two decades during the John Sculley and Steve Jobs’ eras. His responsibilities covered corporate accounts, education and Apple’s reseller channels from the first color Macintosh to the iPhone.
Former Governor Bush appointed Gary to the eGovernment Task Force for the State of Texas in 1999 and was reappointed by Governor Perry to the Texas Online Authority until 2004. Gary’s education includes a BA from Northwestern University, an MBA from the Kellogg School of Management and a JD, University of Texas School of Law. Gary is deeply involved in the Austin community, having participated in the Leadership Austin Essential Class of 2004-2005 and currently serving as Board President for the local chapter of the Leukemia and Lymphoma Society.
Gary has been blessed by 21 years of marriage to Maureen, his wife, and is father to Taylor (12), Kyla (9.5) and Katelyn (7). They live west of Austin, TX.
Latest posts by Guest Author (see all)
- A Day in the Life: A Doctor’s Visit (Before and After CLOUD) - May 3, 2012
- Are ACOs Like Chasing Unicorns? 32 Health Systems Don’t Believe So - January 17, 2012
- IT’s Role in Measuring Social Media ROI For Health Care Organizations - November 8, 2011