In my previous posts (see this link for the first post in this series), I discussed the nature of a disruptive innovation, as well as my joy — and grief — with the ONC’s Direct Project and (S&I) Framework programs. On the one hand, I’ve been pleased and encouraged by increased government transparency and (at least verbal) support of true health IT (HIT) innovation. On the other hand, I've been disheartened by troubling issues involving decision-making, ballooning complexity, closed social networks, and restraint of trade attempts, as well as frustrated by efforts to dismiss disruptive innovation.
I presented an example of one such troubling issue, which I experienced firsthand, in my previous post. It relates to the Direct Project’s rules and regulations (called “specifications and standards”) that enable groups of vendor HISPs (health internet service providers) to knowingly engage in practices that are anti-competitive (restraint of trade), innovation inhibiting, and undermine the purpose of the Direct Project whose goal is to enable everyone to use simple and secure HIT that’s better than using a FAX machine (see this link). Although the HISPs' business strategy runs counter to the Direct Project’s goal, their tactics are being condoned by government officials. The reason: The HISPs are not breaking the rules, even though those same HISPs helped create those rules! So, instead of fixing broken rules, our leaders turn a blind eye and say that what they’re doing is OK. Well, it’s NOT OK!
Note that my views are from the vantage point of a small business whose efforts to gain acceptance for a disruptive technology has been repeatedly frustrated despite the fact that (a) literally everyone who sees our HIT in action is amazed by our capabilities and ingenuity, and (b) no one disputes our claim that we offer a viable solution to many daunting challenges facing meaningful healthcare reform.
When we became involved with ONC--volunteering our time and knowledge--we hoped that our gov’t would be delighted with our novel HIT because it is what they said they wanted, i.e., simple, secure, inexpensive, efficient, and convenient solutions for sharing patient information. We soon began to realize, however, that powerful influences in the private sector, which include corporations with gov’t ties, had different ideas. In an attempt to control the marketplace, they appear to deploy a strategy aimed at establishing HIT specifications and standards that (a) foster complexity and inefficiency resulting in costly, difficult to build products and (b) allow business agreements that block competition.
For example, we have faced resistance from HISPs since our novel peer-to-peer messaging architecture is the only Direct Project implementation that: (a) securely exchanges e-mail and attachments having end-to-end encryption (i.e., data are protected in transit and where stored) and (b) enables individuals to share individuals (not just organizations), thereby ensuring that everyone involved in healthcare, including patients, are all using compliant software…[that sends messages addressed to] the individual-for-no-other-eyes [as per this link and being discussed at this link].
In addition, Direct Project standards fail to duly consider disruptive HIT. For example, we are the only vendor (to my knowledge) using desktop tools (MS Outlook and Excel) that provide certain capabilities the standards assume HISPs would provide via web-based services in the cloud. From our vantage point, these standards do nothing but add incredible complexity to our straightforward approach (examples of this added complexity is doing DNS certificate lookup instead of LDAP only and doing XD* transformations). Since we are forced to comply with those standards, we had to team up with a new type of HISP that allows us to continue using our elegant approach and avoid much of the imposed technical complexity we don't want nor need.
In retrospect, we’re not surprised that the Direct Project has been resistant to our disruptive technology and unaccommodating to our needs. After all, that’s what to expect when disruptive innovations are introduced to mainstream markets. This conclusion is supported by Keith W. Boone in a recent post to his blog; Keith is a self-described “standards geek” for GE Healthcare and a long-time participant in gov’t initiatives, including the ones mentioned above. Here’s what he wrote:
A healthy IT marketplace would favor disruptive innovations (simple products and services that initially serve the bottom of a market and then move up to displace established competitors) for improving patient engagement, communication, and care coordination. Improved population health obtained at a lower cost would result … When disruptive innovators attempt to commercialize their innovations within the established value network in the industry — essential trying to cram it in the back plane of the competition … — that system will either reject it ... or co-opt the potential disruption, forcing it to conform to the existing value network in order to survive. The idea that disruptive innovations can fit into the current healthcare value network … ignores this key point … The real challenge is not providing disruptive technology in Health IT, but rather, in providing a new value network in health care that will enable disruptive innovation. When that happens, the new value networks will have the necessary technology to support it, and indeed, the current EHR industry will either adapt, or die.So, can disruptive innovations be integrated into the value network of the current healthcare market? Well, if our country had created a rational healthcare value network, then good disruptive technologies would be welcomed with open arms.
But with our current healthcare system, this is obviously not the case. Instead, disruptive innovations must create new, more sensible value networks and markets that focus on transforming the system in ways that benefit the patient, reward the provider for delivering high-value care, reduce complexity, increase security, and save money. And that's what we are focused on doing.
In my next post, I’ll present my mind-boggling experience with the ONC Query Health initiative.