SynapticHealth Blog

There are a number of Information Technology trends, strategies and ideas that SynapticHealth has studied or been involved with over the past several years that are ripe for healthcare, healthcare information technology (HCIT), and healthcare information exchange (HIE).

1) Webs of Pages vs. Webs of Services

Simply put, the web, networks, information exchanges, and collaboration platforms have moved well beyond content, the limitations of html, and the desire to present information, and towards web services, software as a service (SaaS), even cloud computing.

We talk about "webs" not "The Web" for two reasons:

• In healthcare, we are not always talking about the Internet. But HCIT and HIE still need to leverage network technology that is scalable, etc.
• In healthcare, we are always talking about multiple networks.  For example, a hospital has their substantial internal networks and information exchange requirements to deal with, as well as their external trading partners that may consist of numerous networks. Even a service provider with a single web solution has to be prepared to deal with numerous publishing and consuming systems and networks. 

Regardless of the technical debates about what will win or stick, suffice to say that HCIT and HIE need to incorporate a "web(s) of services" strategy into their approach.

2) Web 2.0

We'll grossly over-simplify the somewhat silly debate of the silly migration from Web 1.0 to Web 2.0. SynapticHealth's take on all of this:  

If Web 1.0 was about email, web pages and content, search (searching for reference material, not everything search could be), and e-commerce, Web 2.0 has added to the mix a few key things: networking (social networking like Facebook and professional networking like LinkedIn and Plaxo), publishing (things like blogging and syndication), and web services (the ability to move apps and solutions from the enterprise to the network.  Here's the key point: Web 2.0 has helped the movement from a web of pages to a web of services (trend 1) via tools, an ability to enable collaboration whether end-users are commenting, subscribing, engaging, subscribing, etc., or (perhaps more importantly) developers are able to collaborate around information services.  Web 2.0 principles include the ability for anyone to easily get in the game.

3) Viral Expansion Loops

A key component of Web 2.0 tools and the ease with which one can get into the Web 2.0 realm of social and professional networking is the concept of end-users expanding the user base themselves, inviting other network participants and nodes onto a network, sponsoring certified or accredited members of network, etc.  The ability for networks and information services to go viral has been greatly expanded – and HCIT & HIE vendors, networks, sponsors and developers would do well to consider how the network’s own customers and end-users can expand the membership and even depth of use of the network.

4) Information Services Exchanges and Registries

The place to find the Web 2.0 tools, apps, solutions, web services, Software as a Service (SaaS), etc. are registries, information services exchanges, and web services directories.  Think Apple’s iPhone App Store, Salesforce.com’s Appexchange, Widgetbox, even Windows Vista and Apple Macintosh desk-tops where one can consume apps out of a directory.

There are numerous apps of this type, displaying the weather or stock quotes on web sites and desk-tops, or for use playing games on cell phones.  But healthcare, HCIT, and HIE need to consider listing apps on two dimensions:

1. Technically, apps need to cover the underlying technologies of current infrastructure as well as future networking services and even cloud computing or grid computing. 
2. The HCIT value chain is a good guide to consider the specific elements that healthcare, HICT and HIE information services need to address: integration and connectivity, then transaction processing and data governance, and on to value-added services like data quality management.  Eventually decision support, business intelligence, and data processing performance can be addressed.

5) Mass Collaboration

A key concept that is pushing various fronts in information technology in general is mass collaboration.  “Opening up” technical platforms like the iPhone via the App Store, APIs, and SDKs, has proved a strategic bonanza for Apple.  Numerous other apps, solutions and platforms like Google Health, Microsoft Healthvault, and others have made available to developers some tools to enable mass collaboration.   HCIT & HIE vendors will do well to follow this strategy.

6) Mash Ups and Bundles

Healthcare is a distributed network of disparate systems and as such, almost all apps, solutions, transactions, etc. have to “live” in numerous networks or on numerous grids of services, usually in combination with several other services.  Healthcare, HCIT and HIE should consider:

1. Technically, can your service  be mashed up or bundled – is it already – and is it adequate, scalable, replicable, etc.?  Otherwise, why not and what can we do about it?
2. Strategically, where can you lead the way in terms of being a mash-up or bundle “leader” or “sponsor” and where does it make sense to participate in other ways?

7) From Integration as a Service (IaaS) to Solutions as a Service (SaaS) to Platform as a Service (PaaS)

Adoption of updated technology for everything from integration to software distribution to development platforms is likely to include web services and service oriented architecture (SOA).  At the very least, consideration of updated ways to commoditize integration and information exchange in favor of several of these other trends (collaboration, better information services, better tools, mash-ups, viral loops, etc.) will require scalable technology, replicable code, markets and exchanges for these commoditized information services, and the establishment of company-, HIE-, solution-, and network-specific information services exchange capabilities (like SynapticHealth and the SynapticGrid).

8) From Grids to Smart Grids to Synaptic Grids

In other industries like power/energy, there is talk of moving from a grid to a smart – meaning, the integration of management applications (whether enterprise solutions or Software as a Service), so that nodes on the network or players on the grid can then engage in much “smarter” information or commodity exchange.   Consider that healthcare is a grid of grids – many disparate networks – in search of increasing the intelligence of the information exchange.  But it’s not just a matter of applications being certified as interoperable (able to connect to a particular grid) – it’s a matter of enabling a wide range of information services that are compatible with the many-to-many networks common in healthcare.  In order to have your application thrive in the eco-system of systems that is healthcare, you have to do more than just get certified as able to produce a HIPAA-compliant transaction, for example.  And again, where do you want to participate and where do you want to lead the effort of taking a particular grid from “smart” to “Synaptic”?

9) From HCIT to HIE to Synaptic Information Exchange

HCIT has significant challenges with HIE.  HIEs have issues dealing with all of the HCIT.  But SynapticHealth and the SynapticGrid are a means to start to address these challenges, specifically, enabling HCIT and HIE consumers, vendors, and developers to now discuss, list, publish, consume, mash-up, and distribute information services of several key tops (infrastructure, solutions, platforms).

SynapticHealth and SynapticGrid address all of these trends directly.

Get Synaptic.

Analogies help translate the SynapticGrid and what it can do for healthcare, but these analogies are only part of the story:  

·         Apple’s iPhone has it’s AppStore.  (notice RIM/Blackberry playing catch-up with the development of apps and a distribution channel).  The App Store is not just a portal that distributes cool gadgets, widgets, and apps for a particular piece of hard-ware; it is also a development platform complete with APIs and SDKs.  The strategic importance of the App Store is that it opened up the iPhone to mass collaboration, to the global development community, not just Apple developers and VARs.

·          Salesforce.com’s AppExchange.  Similar to Apple’s App Store, the AppExchange is an example of a registry of apps that greatly enhance the performance of Salesforce.com – for example, integration-as-a-service apps that let Salesforce exchange data with other applications, or web services bolt-ons that optimize Salesforce for use in specific environments (e.g. law firms).  Salesforce also has force.com, an entire platform devoted to the development community, putting them into the game of developing for Salesforce,com and beyond.

Both Apple’s App Store and Salesforce’s AppExchange have realized several key benefits that healthcare, healthcare information technology (HCIT) and healthcare information exchange (HIE): opening their platform to enable mass collaboration has been wildly successful, spawning new uses for their apps, new distribution channels, and new sales opportunities that neither company could have ever imagined.

Every single HCIT and HIE vendor, every solution, device, information service, etc. should either have it’s own app store (registry of information services), or be distributable via a registry like the app store.  The SynapticGrid can enable this.  Or if you develop your own app store or appexchange capability, make sure that the SynapticGrid can re-distribute these apps.

Remember, Apple’s App Store and Salesforce’s AppExchange are examples of one-to-many registries of information services: one device or one application to many end-users and developers.  If you develop your own capabilities in this regard, keep in mind that healthcare is almost always “many-to-many” – meaning that your app will almost certainly have to live in many types of ecosystems (or networks, or HIEs) and co-exist with many other apps.

You need to enable your apps to be mashed up or bundled into other information services exchanges, registries, grids, networks, etc.  The SynapticGrid is a place to start.

You need an app store for your apps, solutions, widgets, interfaces.  The SynapticGrid is a mall of these stores providing a single place for many-to-many collaboration.  Build your app store.  Put a virtual representation of it (a second location, if you will), in the SynapticGrid.  Go find other malls.  Distribute your apps far and wide.

Get Synaptic.

SynapticHealth is the Healthcare Information Services Exchange – a shopping mall of information services stores specific to healthcare, complete with all the tools required to discuss, list, publish, consume, sponsor, mash up and collaborate on healthcare information services.

A healthcare information exchange (HIE) is a source of healthcare information services – a sponsor and/or publisher of information services.   Many Regional Health Information Organizations (RHIOs) are this kind of HIE.

HIEs should have a presence at SynapticHealth – an information services store in the mall, so to speak – or – they should develop the same capabilities and have SynapticHealth link to these facilities (more on this later).

Challenges HIEs face that SynapticHealth can help address include:

·         Scalability: HIEs are not equipped to plug their services in.  Oftentimes, a pilot level HIE tries to connect a couple of hospital systems with a couple physician systems to exchange 2-3 data sets (transactions) and the pilot itself is $1MM in healthcare systems integration.  Preposterous.  Un-scalable.  An HIE will never develop enough adapters, interfaces, data exchange protocols, etc. etc. to be meaningful – so at best, the strategy has to be to develop a platform that the HIE’s entire community can develop to.  Why not develop approaches that:

o    Leverage updated integration technology and information exchange capabilities

o    Let the external development community install and integrate information services

·         Replicability: An HIE develops 5 information services, say data exchange of 5 transaction formats (continuity of care record, medication history, e-prescribing data, etc. – this would be awesome).  At great expense, they pilot these services between 3 hospitals and 3 physician groups, all of whom are on disparate systems – so you effectively have dozens and dozens of services by the time you account for the discreet data set, the publishing system and the consuming system, the transaction format, and more – BUT – you can rest assured that numerous other HIEs want to exchange the same data between the same systems.  Why can’t one HIE leverage what another has built?    System A publishes an outbound CCR consumed by System B – why build this at $175/hour 400 times across the country? 

·         Collaboration: Establish a presence in the SynapticHealth Forums to have common ground for discussing your information services.  Use the Directory to list downloads, links to other services, reference guides, specific information services including interfaces and adapters, etc., etc.   Promote collaboration.  Give the external development community the tools and the reasons to want to incorporate your information services and solutions into their efforts.  Perhaps give them a profit motive.

·         Promote Mash Ups: Move down the path towards adapters and APIs that invite the broader community to develop your information service exchange capabilities for you.  Consider where letting the external development community consume your apps into their apps might be valuable and develop to that end-game.

·         Reseller Distribution Channel and Revenue Model: List your information services  ‘assets’ in the SynapticHealth directory and share them, sell them, resell them, etc. on the SynapticGrid.  Get the market incented to re-distribute your apps.  Build novel distribution channels via SynapticHealth.

·         Relevance and “Meaningful Use”:  A presence in SynapticHealth and the promotion of scalability, replicability, mass collaboration, mash-ups, and alternative distribution channels all start to amp up the relevance of your HIE and this must certainly improve your ability to demonstrate meaningful use. 

With SynapticHealth, any HIE becomes a platform that leverages the Healthcare Information Services Exchange and the SynapticGrid in specific ways:

·         Listing of Information Services such as adapters, integration-as-a-service, hosted applications, protocols, etc.

·         Platform-as-a-Service

·         HIE-certified Services, Apps, Widgets, etc

·         Scalable HIE Services developed by the broader community.  Infrastructure, glue, etc. that can expand organically across the broader community, leverage a wider audience, leverage what other HIEs are doing, etc.

·         APIs and SDKs that bring the broader developer community into the game.

:Let’s talk about how SynapticHealth can help HIEs. 

Get Synaptic.

First, the SynapticHealth summary of the  meaningful use debate:

“Meaningful” = “Certified” vs. “Meaningful” = “Synaptic” 

“Certified” solutions that meet specific requirements for things like interoperability, efficacy, and compliance.  It’s understandable that when it comes to grants to cover solutions and professional services, the hope is that the funds cover quality products and services.  But:

1)     Issues:

a.     Who gets to decide what is meaningful;

b.    Who gets to be in the club of certified vendors;

c.     Is innovation stymied of the certification requirements are prohibitive for firms not already in the club?   

2)     SynapticHealth’s two cents:

a.     $0.01 = What if current certification bodies have really lame requirements for “interoperability” and “efficacy”?  Since when do all of the incumbents in a market, most of whom have had a dozen years to build great applications and have failed to do so (at least in the interoperability part, if not both the interoperability and efficacy parts) get to build constructs to keep out threats to their sales?  This is weak.  Yes, we want to avoid $40,000 investments in Uncle Vinnie’s software package.  But if a medical group or clinic is willing to select Uncle Vinnie’s software, we’ve got bigger problems than certification seeks to address.  But we’ll let that group go invest in a 12-yr old bit of bloat-ware that never worked well and certainly doesn’t engender the kind of upgrade in the healthcare system that we are all looking for (not that all solutions do this – but some of the certified apps are crap and we all know it).  And so we are going to argue that we will stymie innovation and small firms’ efforts to get in the game (un-American) in favor of maintaining the status quo.  Wow.  (That, unfortunately, sounds quite American lately, especially as it relates to the national debate on healthcare reform).

b.    $0.02 = More importantly, let’s all fix healthcare, HCIT and HIE rationally.  We would argue that SynapticHealth demonstrates more meaningful use than current certification processes because:

                                          i.    Interoperability: a HCIT or HIE solution vendor that has a) a Forum for discussing how to make the app interoperable, post faqs, etc,, b) a Directory that lists adapters, APIs, SDKs, routing protocols, data publishing and consuming directions, developers that have built add-ons, etc. c) a strategy for developing apps, widgets, web services, integration as a service, software as a service, etc. that can be widely distributed into various HCIT and HIE networks, and d) a desire to scale their app into the various bundles and onto the many “rails” that will be required to actually improve healthcare, HCIT and HIE processes – is already more interoperable than the current certification bodies’ requirements (as I understand them).

                                         ii.    Quality and efficacy:  a solution vendor that can demonstrate a) how their app changes the process of information exchange, b) how their app thrives in an ecosystem of apps, c) how they enable mass collaboration around the use of their app, and d) how their app can begin to commoditize connectivity and information exchange in favor of value added solutions is probably better than a lot of their competition.

Putting yourself, your applications, widgets, apps and applets in the SynapticHealth sandbox or shopping mall is a significant step towards demonstrating material use.  Adopting the SynapticHealth approach to interoperability is truly meaningful and game changing.

Some simple steps to do this:

·         Presence in SynapticHealth: SynapticHealth is a multi-step program designed to promote collaboration around information exchange, interoperability, product enhancements, etc. – especially as it relates to the requirements of material use.  Things you can do now:

o    Establish a Company- and/or Solution-specific presence in the SynapticHealth Forums

o    List your information services in the SynapticHealth Directory

o    Or – develop your own forums and directories and list a link on our site to your own sandbox or shopping mall.  One way or another, develop this discipline and then distribute information on your efforts widely.  Don’t make it hard for a Google search to find your gear.

·         Transparency and Openness:

o    Begin the process of developing adapters and information exchange services that are scalable and replicable (e.g. for publishing or consuming data or information services from external sources or other applications)

o    Develop APIs and other means to ‘open up’ your application to the external development community – the development teams from all those clients and outside parties that will develop for your solutions and applications in ways that you can’t imagine (mass collaboration)

·         Product Development Strategy:

o    Articulate a clear path towards interoperability via APIs and adapters

o    Describe existing information services that you will enable via web services / SOA or move into the realm of more scalable and replicable technologies

o    Articulate new information services (interfaces, adapters, transactions, entire applications or solutions) that you know your clients want, where you can leverage the external development community to build and distribute (perhaps with revenue share opportunities)

o    Describe “mash ups” with your application(s) that you are part of or would like to be part of (and are willing to enable)

o    Develop pilots and demonstration cases for these scalable apps, “mash ups”, bundled apps, etc.

And do it all at SynapticHealth – a common area for the community at large to expand on your ability to become more meaningful and useful.  Leverage the whole market. 

Get Synaptic.

What does it mean to get Synaptic?

1) Thrive in the healthcare ecosystem, the distributed network of disparate healthcare information technology (HCIT) systems by enabling healthcare information exchange (HIE).  Get truly interoperable.

2) Offer solutions to HIE problems that are: a) scalable: reconsider what tools you are using to get interoperable.  Open up to the larger developer community so that they have reasons to consume your applications, namely that they can improve them for uses you can’t imagine, b) replicable: when one solution provider or institution enables data exchange from A to B, we know that there are 500 other end-users that need to do practically the same thing.  How do we leverage this work over and over again, even provide a distribution channel for it?  c) "mash-able
" or "mash-up-able" - what’s the word there?  You get the idea – able to be combined with other services.  d) Game-changers: solutions that commoditize connectivity and data exchange in favor of value-added information exchange services like governance, straight-through processing rates, and reporting/analytics.  e) transparent: by this we mean that applications, services, apps, widgets etc are not just “interoperable” because some company or certification body says so.  They are interoperable because they are open to improvement, data exchange, etc. – one way or another, consumers, developers, etc. can see how many services, APIs, etc. that one solution has that make it synaptic.

Synapses are sparks between two connection points – data, information, ideas, memories, creativity, etc.  The more connection points using a similar service, the higher the need for scalability.  The more open and transparent the service, the more likely other developers can map to it, consume data from it, etc – or, the more likely it is to be “mashed up” into other services.

For HCIT and HIE vendors – or HCIT vendors in need of more HIE – these are the specific things SynapticHealth can help you answer:

Where is your API, adapter, information service, etc.?: This is really a two-part question and answer.

First, the assumes that you can show the world how you publish and or consume data.  Most applications cannot do this reasonably well.  SynapticHealth can clear a path for you through the usual healthcare systems integration applications towards updated, scalable, interoperability solutions.  Who knows – it might go well beyond your ability to live in the distributed network of disparate systems that is healthcare – it may transform your outlook on your entire application suite – not just your HIE capabilities.

Secondly, once you have a strategy for publishing and consuming data – getting interoperable – or Synaptic – how do you tell the world about it and distribute these information services.  The SynapticHealth Information Services Exchange, of course.  You need a store in our mall.  Shoppers for your information services need to know where to go to find these information services.  More important, in a “many-to-many” environment of stores in the mall – the Information Services Exchange – developers can improve upon your developers’ work.  Contact us for more clarification on this.

Is Your App Synaptic?  Does your healthcare solution thrive in the healthcare/HCIT/HIE ecosystem?  SynapticHealth can chart a course to more evolved HIE as well as improving your entire application suite.

Get Synaptic.