Knowing the health expenditure worldwide, close to 10% of the GDP, and the expenditure of an innovation powerhouse like the U.S. (more then 17%) one can wonder why the Healthcare and IT combo is not more advanced than it is today. This underachievement of the healthcare industry is fertile ground for startups seeing many deficiencies in the system. While the expectations are high for these startups, they must be careful not to fall into the same traps as most of their predecessors who helped to shape the landscape we know today.
The Digital Health Archipelago
There are more than a handful of reasons why healthcare is lagging behind in terms of digitization. One of the main reasons is not a secret for most people in the HealthIT world: the lack of interoperability. Data is still mostly siloed away in proprietary systems (the EHRs, EMRs, PHRs and upcoming mHealth apps) which are often vendor-specific or home-grown by hospitals and providers. For those systems interoperability has not been the biggest concern. Big vendors have even been accused of deliberately practicinginformation blocking. Many of the established systems make sure the interoperability price tag to be paid by the healthcare providers is quite lucrative. Charging high additional fees for every extra data field to be exchanged is a quite common practice.
These short-sighted practices are slowing down progress in Digital Health tremendously however. The real value of Digital Health can only be realized when there is a consistent and complete picture of the patient across thecontinuum of care. Having limited interoperability between the many systems, mHealth apps, hospitals, regions, states and countries where your health data resides reduces this picture to a bucket of pixels with little to no coherence.
Raise Your Standards
Many organizations have already been working for decades on establishing clear standards for healthcare. The adoption of those standards hasn’t been very successful so far however. Vendors use their own dialect of a standard and some countries come up with their own standards for no valid reason. Furthermore some standards have as well been too complex (e.g. HL7 v3) to implement. These are all elements which didn’t help in constructing the complete view on the patient. More than 30 years of attempts on standardization have definitely led to some results but certainly not to the results we expect in 2016.
Change is sparkling in the air however. Healthcare standards are shiftingtowards APIs like most of the other more digitized industries already did. These APIs are the perfect playground for digital health startups. In contrast to their complex predecessors these APIs allow a lean development approach and are comprehensible in a short amount of time. The perfect ingredient for start-ups to cook a recipe for firing up interoperability.
What’s striking is that some of the Digital Health start-ups are taking advantage of the closedness of the legacy systems. They connect the dots between all the islands of existing healthcare systems. They pull data out of such systems, bring the data together and visualize it for the providers. Quite ironically, this new piece of software created by these start-ups is most of the time as closed as the systems they connect.
While it’s definitely valuable that they harmonize data this won’t help us in advancing healthcare, Digital Health startups should do more, much more. They should tap into data from different sources and provide insights based on this data. Through the aforementioned APIs they should as well expose the data and insights to other systems in order to bring real value into healthcare, all the way from the provider to the patient across the continuum of care. This will lead us to an ecosystem of healthcare systems ranging from EHRs over HIEs to mHealth apps. None of them owning the complete patient picture but all of them with the ability to access the complete patient picture when being granted the authority to do so.
Start a Fire
So where should these startups start? Well, start by igniting a fire. Or rather,FHIR. FHIR (pronounced fire) is the specification Digital Health startups should be looking at to create standardized APIs. FHIR is currently still a draft standard for trial use but is expected to be a full standard in 2017. It is very open and extensible by nature, which turns it into a great API for start-ups that inherently need this flexibility. Providing and consuming such an API facilitates data exchange and reduces the customer effort and money to be spent on interoperability. It saves time for both the start-up and the provider, valuable time that can be spent on the real core business, or rather health values.
Fortunately FHIR is getting more and more support from the big players in the HealthIT world as well so startups should undoubtedly help and lead in breaking this barrier of closed systems. Effortless plug-and-play interoperability can not be expected tomorrow but taking the steps in the direction to achieve this is something every company serious about Digital Health should do right away.
So Digital Health startups, be brave and jump in the FHIR.