Future Now
The IFTF Blog
Engineering Health Care—HC2020 Perspective
Accelerating the Process of Change
As this HC2020 perspective noted, “medical care is moving
from its model as a healing art provided to isolated individuals by independent practitioners to one in which care is delivered by coordinated groups of providers … responsible for optimizing the health of defined populations of patients.”
In fact, this evolution is well underway. March 22, 2011, marked the first anniversary of the landmark Affordable Care Act that includes multiple initiatives to promote systemic change. But the existing health care system (or, more accurately, fragmented non-system) has tremendous inertia. The continuing controversy over the ACA, which includes strident efforts to repeal it, is a clear indication that bringing about a fundamental transformation of health care will be a slow and often painful process.
But there are signs of hope. Consider, for example, the story of the Nationwide Health Information Network (NHIN) and The Direct Project.
The NHIN is an ambitious effort by the Department of Health and Human Services (HHS) to create a comprehensive electronic network that will provide patients and providers with instant access to important health information wherever and whenever it is needed. The development of NHIN began in 2005, and has proceeded slowly as developers grapple with thorny issues like picking the most appropriate technical standards, ensuring that stringent privacy protections are maintained and convincing practitioners to share their patients’ data with others.
In late 2009, in order to move forward more quickly, HHS decided to try a dramatically different approach: rather than following its normal practices, it agreed to try using a “lightweight” organic development process whose goal was to come up with a simple way for two parties to electronically exchange health information securely and privately. Instead of developing a set of detailed technical specifications and then hiring a contractor to fulfill them, The Direct Project started by inviting all interested parties to participate in an open development
process based around a public wiki, an open code repository and a blog. Initially, perhaps a dozen organizations were expected to join the effort, but more than 60 groups showed up and participated actively in the process – all on a volunteer basis.
In less than 12 months, The Direct Project has moved from initial discussion of goals to the development of a model to the creation of a set of prototypes to the launch of the first pilot implementations. The involvement of so many external parties not only helped ensure that the standard that was chosen would be widely acceptable, but these same groups are now disposed to actually use the standard because of their investment in its development. The capabilities provided by The Direct Project are not a substitute for the NHIN, but they now seem likely to be a simple first step that can provide an inviting on-ramp to the larger network.
The striking success of The Direct Project suggests that by finding innovative ways to accelerate the pace of change, we may actually reach the goal of creating a more effective, more affordable, more accountable health care system in our lifetimes.
The HCC2020 Forecast Perspective on Re-Engingeering Health Care can be found here.
And a more detailed account of The Direct Project can be found here.