SynapticHealth Blog

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.

There are a couple key challenges with healthcare information exchange (HIE) or interoperability:

• Healthcare is a distributed network of disparate systems - so healthcare information technology (HCIT) apps need to co-exist in the ecosystem of other HCIT apps.  HCIT is as good as it's ability to engage in HIE (usually).
• The building blocks of HIE - healthcare systems integration and connectivity, transaction processing, and data governance - need to be commoditized in favor of value-added services like data quality management and data processing, bundles and mash-ups, robust networks and 'rails' (like online banking), and more.

One way to demonstrate how your healthcare application, information service, or widget performs is to determine how Synaptic it is - that is, with how many other applications can it exchange data?  Does your application make a network of applications smarter?  Is your app a key component of any healthcare information exchange?  Would an HIE sponosored by a RHIO, a hospital, a health plan, a web portal or another HCIT vendor recommend your solutions or apps as 'compatible' in an ecosystem that they sponsor? 

Can you benefit from mass collaboration?  Do you have developers well beyond your own shop developing information exchange capabilities in/out of your solutions/apps?  Shouldn't you?

From a December 2000 BusinessWeek article: "Google pioneered a now-popular technique that counts the number of links pointing to a site as a gauge of its importance. According to the theory, every link to a site is a vote of confidence that the content matter there is useful." http://www.businessweek.com/bwdaily/dnflash/dec2000/nf2000127_947.htm

In HCIT and HIE, every system with which your system can easily exchange data should be a "vote of confidence" that you are interoperable.   Better still would be actual systems interfaces, adapters, transaction protocols, etc.  As apps and solutions evolve to web services, software as a service (SaaS), integration-as a serivce (IaaS), or other reasonable and scalable healthcare information services that can be bundled or mashed-up into various HCIT and HIE ecosystems of systems, vendors and developers can publish, consume and sponsor apps and bundles in the SynapticGrid - or at least list and discuss them in the SynapticHealth Directory and Registry.

This, in turn, helps determine how Synaptic your healthcare app really is.

Perhaps we should have an actual rating system - a score.  We will have awards for the most Synaptic - quantitatively Synaptic and qualitatively Synaptic.  Or better yet - for the highest SynapticQuotient.

Thoughts or ideas on this topic?

healthcare ecosystem
Healthcare is a distributed network of disparate systems (the "healthcare ecosystem"). As publishers, consumers and sponsors of information services, Healthcare Information Technology (HCIT) andHealthcare Information Exchange (HIE) vendors, users and developerscan improve healthcare by getting Synaptic - by thriving in this sort of ecosystem and leading the development of smarter, stronger and more profitable information services.

 collaboration
Healthcare relies on information and collaboration, meaning, the HCITandHIE, and the "glue" and other information services that make collaboration possible. Numerous interoperability, replicability, and efficiency challenges abound.

service registries
Every single healthcare organization, vendor, solution, device, etc. needs to articulate it's HIE capabilities - interfaces, transaction formats, APIs, data governance requirements, etc. "This is how my organization or application publishes and/or consumes data." A registry of these information services is more than a directory - it's a place to list, publish, consume, test, sponsor, mash-up, etc. various types of information services.

an exchange of services registries
A registry like the SynapticGrid is a one-to-many place to publish your information services. The SynapticGrid is a place where mash-ups and other "glue" between apps and solutions can more rapidly move the market to "many-to-many" solutions - a necessary next stage of the evolution of the healthcare ecosystem.

commoditization vs. value-added services
Certain parts of the healthcare value chain need to be commoditized: integration and transaction processing, primarily. Value-added services and especially mash-ups need laboratories, incubators, and profit motives - places where developers can collaborate and have a reason to share and sell information services.

transparency
Consumers of applications need a real means to determine which solutions thrive in the healthcare ecosystem. "Certification" and "meningful use" need to be demonstrated via APIs, interfaces, connection points, mash-ups, etc. - vendors need to list these services - and consumers need to be able to easily compare which apps are the most "synaptic."