Trusted Networks Key to Moving Forward

As the healthcare industry swings toward digitalization, there are signs of progress as well as the need to address thornier problems such as data sharing and privacy across networks and organizations. Healthcare is perhaps unique in that it collects, and has the capacity to share, a massive amount of extremely personal data about individuals, while having to maintain unmatched levels of privacy and patient disclosure on that information.

Recently, healthcare institutions have also been expected to establish pricing consistency and transparency, an equally gargantuan task in light of the industry’s complexity and one with which only 14% of hospitals are in compliance.

While the ecosystem poses seemingly insurmountable challenges, here is a way the issues can be addressed both with existing and emerging technology.

Recent regulations, such as the 21st Century Patient Cures Act and the Price Transparency ruling, have provided a foundation and standards for the exchange of data between healthcare institutions. A number of data assets and data-based products – for example, publicly available datasets such as social determinants of health, digital twin data, AI models for risk stratification, and so on – are available in formats that allow for fast and secure data exchange.

Modern tech stacks for emerging healthcare products are based on a modular framework, with microservices and application programming interfaces (APIs) allowing for rapid compatibility with platforms. Agencies responsible for managed care, such as the Centers for Medicare & Medicaid Services (CMS), have also pushed the need for efficiency and cost savings in healthcare service delivery. Technology is a core capability to achieve this. Consumers are asking for more technology-enabled care journeys that are personalized to their unique life circumstances and health conditions. And we now have access to scalable and relatively inexpensive services such as blockchain, which are capable of creating fast and robust trust networks.

These regulatory, market, technology, and consumer forces are the key sources for complementarities in the ecosystem. So why have solutions been so slow in coming?

A major problem in healthcare is the slow adoption of new technologies. Partly because of regulatory pressures, data privacy and security concerns, the issue is compounded by the lack of an open architecture (by design) of incumbent systems such as electronic health records (EHRs). Finally, there’s a general aversion to adopting any technology that could upset the business-as-usual functioning of a health system, provider office, or health plan.

Healthcare Needs Platforms Built for Trust

One approach that would allow for controlled trials of emerging technology and faster adoption would be for the healthcare industry at large to develop a platform-based ecosystem consisting of a developer platform and trust framework for permissions-based access to data and objects. Blockchain comes to mind as an available technology that could handle the necessary complexity and data privacy to achieve this.

The bottlenecks to actualizing this approach, sadly, are multiple. First, a critical mass of healthcare institutions would need to sign up for such a platform. Many existing, legacy systems internal to these institutions would need to be retooled in order to interface with said platform. As a long-term project with multiple spurs of installation, trial, and training to make it work, the return on investment (ROI) for this work system cannot be realized in a short period of time.

A critical mass of IT developers would need to work across the industry to either rewrite the legacy programs or develop interfaces that are compatible with the platform. Access to more healthcare institutions as a potential market would attract more of these developers, and would create a low-friction path to adoption. To scale this network effect, a large upfront investment in building the platform would likely be needed. Simultaneously, leadership at healthcare institutions would have to be brought on board and exhibit active willingness to overturn legacy methods of technology adoption.

As developers contribute the highest value in this ecosystem, the initial table stakes will likely need to be free or even compensated for the initial mass of popular products. These developers will need to perform due diligence on the technology and match capabilities to customer needs in a detailed and swift manner.

Healthcare institutions will have to redesign their operations to include "innovation labs" that are serious about inviting emerging technology into their previously closed systems, albeit in a controlled fashion. A slowdown in product purchase and adoption could result in developers losing interest in continuing to build for the platform; this can be countered by change managers continuing to challenge orthodoxy across the organization, especially where the value chain can be broken into finite elements and addressed by technology. One example of this might be using an optical character recognition (OCR) application to read complex unstructured contracts and feed them into an intelligent database.

While it may seem like a stretch to many of today’s industry leaders, I believe this type of high-functioning, trust-based ecosystem could go a long way toward solving many of the deep-seated problems in the U.S. healthcare system.

Bhrugu Pange is managing director who leads the Digital & Technology Practice at AArete, a global management and technology consulting firm.