Health care big data will fail unless we remove the silos

A few days ago a colleague of mine was inching south through the mother of all traffic jams: 60 straight miles of construction work on I-95 just south Washington, DC. The three-lane highway was jammed. Route 1, which runs parallel to I-95 was also jammed. Cars were stalled in the middle of the highway having run out of gas from waiting so long.

He looked at the map on his phone and there seemed to be no escape, just miles and miles of thick, dark red lines symbolizing Google’s traffic data along the only two routes south. In roughly three and a half hours, he went roughly 50 miles. The jumbled, wasteful, clogged highway wasn’t altogether different from the state of America’s health care system.

Then, something sort of amazing happened. He’d exited the highway to Route 1 (for the second time), when Google Maps recalculated the route. If he continued straight, Google told him, it would take another 55 minutes to get through the traffic. But if he took the next left, it would be only 10 minutes.

Google wasn’t wrong. He weaved the car down a narrow Virginia country road, down a steep, wooded hill, then up a steep hill and through a homeowners association development, speed bumps and all, then around another corner to meet up with Route 1 again. He’d bypassed about 5 miles of road and about 45 minutes of traffic.

It’s too bad health care doesn’t work like this.

It’s not just the elegant merging of smart direction-finding software with satellite and crowd-sourced data on the roads and traffic that was impressive. It was that a single company, Google, could bring it all together, and then get it onto the user’s phone with  a native, user-friendly app.

Health care doesn’t just need this sort of innovation, it needs a company like Google or Apple to bring it all together. As Imran Qureshi recently wrote in Wired, getting “big data” into the hands of physicians isn’t enough. It’s not nearly enough. Qureshi wrote that tomorrow’s innovation will merge big data with usable workflows, the kind that are actually usable in the real world of practicing medicine.

What’s needed is the app that automatically and seamlessly helps you avoid 45 minutes of traffic in the palm of your hand.

It’s no secret that the use of information technology in health care is years behind, maybe even a decade behind what other industries have been able to do. One reason is silos.

In health care right now information is siloed almost beyond belief. First you have the EHRs. About the best they’ve managed to do is throw dozens or even hundreds of pages of data at doctors, little of it useful, much less integrated into meaningful workflows.

Hospitals silo their own data aside from the EHR. States also have their own data silos, in the form of health information exchanges. These you have to log in to separately on a case by case basis — again not a good workflow for patient care.

Another silo of huge troves of data is genomic, and the ability to quickly search, track genetic markers, and build risk profiles for people. Mastering genomics and integrating it into health care delivery opens up doors that are almost beyond comprehension.

Then you’ve got the consumer industry: the wearables, the gadgets, the fitbits, and the hundreds of startups that are cashing in on the power of mobile technology. These flashy toys collect their own proprietary data, which is rarely integrated or shared with the larger care delivery system.

Finally, you have the data that is already being carried around by nearly every smartphone user: geo-location data about where you go, how you get there, and other information that could be of great use to health care providers. Did you go to McDonald’s three times today? Did you go to the pharmacy to pick up your prescription? Do you walk to work every day? Your smartphone knows these things, but the data isn’t being meaningfully used in a way that truly helps people.

The other problem with information technology in health care, aside from silos, is the companies themselves. Either their proprietary systems are designed specifically not to be interoperable, or they are designed to be interoperable but the company is too small for that to matter.

There are a series of large incumbents which have dominated information technology in health care for a long time. These huge companies are almost universally reviled by health care providers for their lack of user friendliness, their lack of interoperability, and their general failure to provide health care providers with meaningful ways to actually improve care.

Meanwhile, many smaller startups actually are doing very smart thing with mobile technology and health care, but they are too small to be able to integrate with the larger systems.

Companies like Google and Apple could make a huge difference in bridging this divide. They know how to own the market, they know how to leverage useful partnerships with other large incumbents, and they know how to create software that actually works for people. Actually, it could be argued that only these two companies can bring together the unique characteristics needed to finally, once and for all transform the use of information technology in health care. (Ok, maybe we could add Microsoft to that very small list.)

This summer Apple announced it would be trying to do just that with its new Healthkit app (“Could it change health care?”). They’ve partnered with Epic Systems, the Mayo Clinic, and other health systems as part of its rollout. The app will come standard on the iPhone. Dan Diamond wrote in Forbes that this “could be transformative for mobile health strategy.”

Let’s hope so. Otherwise, no amount of big data will save health care from resembling the tangled, time-wasting, gas-burning, soul-destroying traffic jam that it does today.

Jason Giffi is an emergency physician who blogs at The Shift.

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  • James O’Brien, M.D.

    “This summer Apple announced it would be trying to do just that with its new Healthkit app (“Could it change health care?”). They’ve partnered with Epic Systems, the Mayo Clinic, and other health systems as part of its rollout. The app will come standard on the iPhone. Dan Diamond wrote in Forbes that this “could be transformative for mobile health strategy.”

    Epic is the vendor with big K Street presence largely responsible for these problems in EHR. So no I am not looking forward to their next bad product.

    This is not hard. Electronic health records should be on an encrypted thumb drive not a cloud.

    • DeceasedMD

      I have read a few of your comments on EHR’s and could not agree more. Well said. Apple and google think they will solve HC problems. How arrogant. They will only add to the problems, as the costs for things are over the top as u know.

      On the side, a funny story. The EHR company trainers are not so well trained- at least the ones I met on a vacation. Could not get away from them as 40 swarmed over the hotel. One was actually a truck driver who got on the band wagon and learned on his own the EHR. None of these people had computer type degrees that I met. It was rather frightening how much money was being spent on 40 of them at this 4 star hotel.

  • sleemd

    I don’t understand the distain against Obamacare. You can keep your doc if you want….just pay cash. Why is loss of employer sponsored insurance seen as such a bad thing? It’s what got is into this mess starting over 50 years ago….lulling people into believing they’re getting insurance and health care for “free.”

    At the end of the day….you get what you pay for….and there’s no free lunch. America’s been over-insured for decades. Get rid of insurance wherever possible and restore the doctor-patient relationship, and cost accountability immediately becomes relevant when patients are actually paying first-dollar themselves for services.

    Wouldn’t you rather know/choose what your paying for and getting in return, instead of having it all but mandated by your employer and insurer?

    • NewMexicoRam

      You’re describing exactly what most people are upset about–they feel lied to. Do you think the Dems could have passed what you describe? Never.

  • guest

    I am all for better integrated medical data but, quite honestly, I really don’t think I want my physician to know how many steps a day my Fitbit shows I am doing, or whether I have picked up my prescriptions quite yet, or whether I stopped at McDonald’s to have a cheeseburger for lunch instead of going home and having kale…

  • SteveCaley

    We are acting in completely opposite and contrary ways regarding electronic health information, and we are in a jam. The jam is a fundamental result of basic laws and rules; it cannot be finessed away by cleverness in application design.
    1) Health information is to be protected – there must be impervious walls up to prevent unwarranted poaching of private information.
    2) Health information is to exchange freely – there must be no silo walls that prevent necessary exchange of private information.
    Private health information is valuable; it is subject to theft, the same as credit card and financial information. If there is a value, there will be a poacher.
    We skip blithely along ignoring the fundamental disconnect between these opposing things, in the way that we ignore the “War on Drugs” over the last fifty years – there is a profit to certain things, therefore they will be attempted. We have billions of dollars invested into stopping the flow of drugs; but there is a market for their importation, which can be frustrated but not extinguished.

  • Margalit Gur-Arie

    “Health care big data will fail unless we remove the silos”

    In which case I hope it fails, and not just fails, but crashes and burns in a spectacular bonfire of techno-slavery vanities.

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