With every news cycle promoting the “next big thing” that could revolutionize healthcare, the cart is invariably put before the horse.
The thrilling “this will change everything” widget unfailingly depends on a series of major benchmarks before it can be viable, much less transformational, in its own right. The intransigent challenges of interoperability, and some significant cultural and operational shake-ups across the country are the pillars of change upon which all other exciting opportunities for improvement depend.
What we learn again and again, with each new generation of technology and each round of hype, conferences, and speculation, is that the solutions we so desperately need are already out there. They work, with conditions, and in many cases they are getting deployed experimentally.
What is lacking, and what keeps those solutions from solving problems, is the cultural paradox in healthcare. Namely, that the wisdom of every other industry or human endeavor for some reason cannot apply in healthcare: failing forward is unacceptable, and perfection is a precondition for adoption.
Consider the blockchain.
Blockchain embodies the hype-hope paradox
There are a bevy of reasons enthusiasts will site to heed the lessons the world has learned from Bitcoin (both its rise and its imminent fall) to adopt the underlying technology of the blockchain in healthcare.
It can serve as the access/security/authentication protocol for health record exchanges. It anonymizes the chain of data exchange. The very nature of the blockchain decentralizes the ownership of the EHR, as well as obfuscating access behind hashes/certificates. The patient would be able to set standards for access to enable various providers to view the EHR, and it would not be down to jealous MDs to fax or otherwise share their “proprietary” record.
With built-in, non-proprietary systems focused on the growing challenge of information security, a critical shortcoming could become a manageable tension. By extension, this would offload liability to an extent and altogether reduce justification for administrative growth. The scales might actually tip back in favor of clinicians, rather than admins. One of the major impediments to effective deployment and evolution in clinical environments is the overburdening of clinicians and the swelling of the administrative class relative to actual care providers.
Even the spreading plague of ransomware would be abated by virtue of blockchain’s architecture: when records are distributed, a single node cannot be hijacked to disrupt the entire chain and control access to the data.
So, are blockchain’s potential applications in healthcare overhyped? That depends on how comfortable you are presuming that the antecedent challenges of large-scale interinstitutional cooperation, standardization, and interoperability frameworks are all but over and done with. Because without crossing all these thresholds, blockchain’s applications all remain in the foggy world of “potential.”
I, for one, am a blockchain optimist. The laundry list of possible applications and benefits has me paying attention, if not cheerleading. But I don’t think it is a panacea; I think it is just promising enough that it provides yet another good reason to navigate through the more pressing roadblocks, and see what other potential solutions we can enable along the way.
We must embrace failing forward
Failing forward is the modus operandi of every success, be it personal, institutional, organizational, technological, whatever. The life or death reality of healthcare seems to have indoctrinated many to treat failure as an absolute, rather than a context for progress. Our healthcare leaders, caregivers, institutions are afraid of failing forward because the stakes seem so high. Well, they are—but that’s why it is important not to get hung up on the fact that failure is a part of change.
We do this with medical development, pharmacology, procedures, but not with institutional growth and development.
When medical researchers talk about their latest discovery in the treatment of a particular disease, they get enthusiastic right when they go from what they have learned, to what it could mean. Essentially, it isn’t the discovery itself, but the potential it unlocks, that keeps these researchers going back to the lab day after day. Whenever a patient decides they want to pursue a treatment – whether it is cutting edge or time tested – they are preoccupied with the potential to improve.
Digital records, metadata, and all the cascading benefits of digitization in healthcare remain firmly in the realm of potential, because Meaningful Use was basically a federally mandated fail forward initiative. Unfortunately, stakeholders have gotten so preoccupied with the “fail” of the program that “forward” progress is inhibited.
Don’t believe the hype? Don’t believe the critics
We live in an era of microcriticism fueled by social media and impatience. Heroic innovators of the past didn’t have to contend with the scrutiny and commentary that consumes modern pioneers. But in the case of healthcare, we can dispense with all the buzzwords of “innovation” and “disruption” because changes are necessary, imminent, and unavoidable.
We are all casualties of the current era of change: doctors, nurses, administrators, patients–no one has a monopoly on the frustration and discomfort being caused by the disorganization, even the chaos intrinsic to healthcare’s current crossroads. But we do all have a stake in seeing the chaos tamed, the progress managed, and the imperfect systems developed further.
It isn’t about believing the hype, it is just a matter of tolerating short-term failures in the interest of long-term improvement.
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