I’ve made the case in recent posts that Accountable Care is like installing a new OS. It changes the rules for how resources are allocated, shifting control away from the system itself and more toward the users — us. Should this new OS be open source, a collaborative endeavor, or proprietary?
The common misunderstanding of “openness” of all kinds (open source, open data, open innovation, etc.) is that it’s about the thing. It’s about the data, the code, the innovation, or whatever resource is being shared and developed.
But what makes open models successful is the community that emerges around the resource. The fact that the resource is open is just a prerequisite to working together in a wider community to create value. The free part is about the ability to have input from a wide variety of sources. The community, the resource and their work product must maintain a kind of sustainable symbiosis, and often that will come through innovation and the development of creation spaces.
Community + resource = (sustainable) product/ future resource
Open source and open data sources are one way to build a foundation that John Hagel calls creation spaces. John Hagel, co-chairman of the Silicon Valley-based Deloitte LLP Center for the Edge, writes about “creation spaces,” in the Power of Pull.
In referring to the maker movement of shared (open) workspaces, Hagel says, “the fortunate byproduct is a new physical platform for learning, discovery, and serendipitous encounters with diverse ideas and relevant expertise—all the characteristics we extol for creation spaces and scalable learning.” The key is how people learn together, and learn faster, by building together in a shared environment.
How long before we see real creation spaces in health care, and what’s required?
Lower Risk Means More Trust, More Collaboration
Developing the community takes shared resources, passion, communication, a set of agreed-upon rules, and the foundation of an architecture to pull it all together, but the real foundation of it all is trust.
That’s good news, because by aligning incentives of patients, providers and payers in value-based payment models, trust is increasing and appears to be driving demand for more open models in health care.
When there is less risk, the community becomes less loss averse and focuses more on the shared benefits, and the creation of still more shared benefits creates a virtuous cycle.
Communities and Creation Spaces
I wrote about risk-reducing architectures back in my Moneyball Medicine series. I made the case that community development and connecting problem solvers in a network or creation space leads to risk-reduction (and therefore even more trust) for those who join on multiple different levels:
people and services find each other, opportunities can connect with solutions
allowing for coordinated actions to be taken to solve problems
participants can share information, data and other resources, creating an exchange
participants can collaborate on new solutions and try new approaches, to learn from each other
collect data as a shared resource and with statistics on what works and what doesn’t (big data analytics) and
build a common body of knowledge, or praxis, that can be constantly refined (eventually I suspect, we’ll have a topo map of human health that defines how multiple health measures are connected)
Through network effects, each of these benefits become more valuable over time.
These are all highly valuable in a value-based care system where each participant is attempting to learn what works and what doesn’t in a completely new business model. We’ll need to learn fast to be successful.
Movement Toward Creation Spaces in Health Care
Large, traditional institutions are starting to get it. Just last week an announcement was made about an online partnership between the New England Journal of Medicine and the Harvard Business Review.
“The collaborative publishing project between the Journal and the Harvard Business Review comes at a turning point in American health care,” Dr. Gregory D. Curfman, NEJM Executive Editor, said in a statement. “Never before have the interests of the health care community and the business community been better aligned.”
Their idea to meet these needs is to join forces in an online forum. At least some of it will be based on an interactive online social creation space aimed at reducing costs and improving care.
In another example, Motley Fool recently asked if a platform like Doximity, a social network, could pull together the fragmented EHR market (hat tip to Dave Chase). Perhaps what they are really asking, is, “What might the world look like if EHRs had been built for communication and collaboration (social) rather than billing?” EHRs as communication tools are an afterthought, currently they’re mostly transaction systems. Still, times are changing, and the big EHR players are attempting to go into information-capture mode and platform mode.
A Proprietary Solution
Epic announced this week that they have an API. Sadly, it sounds like the API, rather than allowing developers to exchange information with EPIC systems, will only allow others to submit data to the system; say if you have a device that tracks movement, you can allow it to insert that data into the patient’s record, but not to receive anything in return.
Hopefully this is just evidence of a risk-averse organization dipping it’s collective toe into the water of developing creation spaces in health care. This early attempt does not sound like co-creation as much as data donation. These are the advantages of being a market leader and having leverage and the proprietary solutions leverage affords. Nonetheless, it is a step in the right direction.
New collaboration spaces sorely needed, the benefits are there.
A CommonWealth Fund study shows collaboration was the key to reducing 30-day readmissions. They found six core areas where that helped reduce readmissions:
partnering with community physicians or physician groups;
partnering with other local hospitals;
having nurses take responsibility for medication reconciliation;
arranging follow-up appointments prior to discharge;
having a process in place to send all discharge papers or electronic summaries directly to the patient’s primary physician; and
assigning staff to follow up on test results that return after the patient is discharged.
We see a kind of dose-response type of curve for the number of processes introduced.
Via twitter, a family doctor in Salt Lake City’s response was, “It’s about coordination. Shocking.”
Physician Luis Saldana has found, with physician engagement, social tools allow all stakeholder to learn from each other. This is scalable learning, and it will continue to thrive in a value-based health system.
And it sounds a lot like what Farzad Mostashari has said: the vision for the US Healthcare System is where “every encounter and every patient has access to all the world’s knowledge.”
The need for collaboration is happening much faster than we think, and the evidence is rising with some leading indicators. According to a report by Availty (hat tip @VinceKuraitis, @CORHIO), in 3 yrs, 52% of hospitals expect 25-50% of revenue to be value-based; 36% anticipate 51% or more revenue value based.
In other words, the business model of health care will be turned upside down in 3 years, and creation spaces and community architecture may well be the answer to learning how to cope with this new normal on short order.
That leaves us with the question I posed in the beginning: should this new architectures of learning and creation be be open source? What about the foundational elements, the data?
Fred Trotter recently made a compelling case that all (impersonal) health data should be open, as we can all benefit, and proprietary data sources inhibit our ability to build the best health care system as quickly as possible. As a foundation for new communities, like the community of “hacktivists” that have formed around DocGraph, data really can be a source of new innovation. Can we risk having it controlled by early land-grabbers?
We’ll hear a lot in the coming years about who owns the data and how this data can serve as the foundation for collaboration spaces. Access to the data may hold the keys to our success in delivering care under a new model, with over a trillion dollars, and thousands of lives, at stake.
Quick plug: VivaPhi has partnered with Health 2.0 to develop the Health 2.0 Code-a-thon: Power to the Patient in San Francisco Sept 28th and 29th. We will have challenges from ONC, Optum and more, including one to bridge the wellness/health care divide in mHealth. Register today to build the future of health care!