Mr. Skievaski goes to Washington (to advocate for meaningful interoperability)

Getting into the Department of Health and Human Services was a bit of an adventure. Security was tight, to say the least. But I made it through and was escorted up to the “PH” level of the building where the Washington Monument could be seen peeking through the blinds. The tables were arranged in a U shape as they always seem to be in collaborative government settings. I looked around the room and was happy to see some familiar faces: a few Redox partners already settled into their respective spots adorned with a tented name card in Times New Roman, a fine line around the border. Some serious business afoot. 

We were convening to provide feedback to the Deputy Secretary of the Department of Health and Human Services and his team. They wanted commentary on the topic of ‘Liberating Healthcare Data’. If you haven’t been following the saga, HHS (via CMS and ONC) has been driving to open up EHRs and stop ‘Information Blocking.’ I was up second, after our friends at Apervita and before our friends at Flatiron. Here’s what I said:

Hi, I’m Niko co-founder and president of a data interoperability company called Redox. We have 110 employees and our platform primarily connects cloud-based applications to the EHRs used at healthcare delivery organizations. Our install footprint includes more than 450 HCOs exchanging data, bidirectionally, with the software solutions they choose to use to drive efficiency, patient experience, provider experience, and population health—really the entire spectrum of digital health solutions. It’s good to look around this room and see many partners represented here today.

We have a saying at Redox that “we are all patients.” We’re a company that’s a few steps removed from patient care so this saying reminds us of the impact that interoperability can have, and why it’s so important to get this right. We depend on our healthcare system in our most vulnerable moments. We see loved ones confused about their options. We ruin our credit over the insurmountable costs. We’re not engaged in our care, we’re apathetic at best and fearful at worst. Every time we come in contact with healthcare we see numerous ways that technology should improve this experience and feel helpless in making it better. No stakeholder has the information or authority to help us. It’s too big. The hairball is too complex.

The thing is, patients, don’t want their data. They don’t have direct demand for this. Rather, it’s derived demand. Derived from that fact that what patients demand is their health and the health of their loved ones. Data can only make this impact if it’s turned into information. And the application layer is what does this. Applications turn data into information. They bring actionable insights and inform us how to behave differently. At Redox, we see an average of 7M patients every day. But we don’t serve patients directly. We serve them through the applications working to turn these data into information. 

So developers are vital here. That’s the point I want to get across. Yes, there are many stakeholders in the interop problem, but software developers—entrepreneurs more accurately—are the ones who will come up with the solutions that will actually make a difference. We cannot forget that as we serve the powerful incumbents in the space who have numerous incentives to not let this happen. EHR vendors see a future where they’re relegated to the backend while point solutions replace the user experience. Health systems see informed and empowered patients shopping, finding the care that aligns with great outcomes for lower costs. They call it leakage. We can all pay lip service to the mission to liberate these data, but when the rubber meets the road, the status quo will prove difficult to overcome. 

At Redox, we bet on developers from the beginning. This is what has worked for us. We’ve created a network that exchanges data through a single API endpoint, a single data model that actually meets the needs of the market today. This is where efficiency gains in the market come from. They don’t come from proprietary APIs at each care delivery organization. They don’t come from various points of connectivity that developers will need to manage and standardize. Developers need a network to connect to. Connect once, connect all. Without it, the benefits that the cloud and multi-tenant architecture have brought to nearly every other industry will still fall short in healthcare. The dream of scaling software will stay a dream. 

Software developers are the ones with the right incentives to make this happen. I’ve personally talked to hundreds and hundreds of health tech entrepreneurs who saw some injustice in our system and formed their company to attack it. They want to serve patients, but they need to build value propositions for those who can pay: hospitals, providers, payers, those who take risk, etc. For every inefficiency out there, I believe there’s an entrepreneur trying to get their product to market to solve this problem. We do not have an innovation problem in healthcare, we have a technology adoption problem. We don’t need to spur innovation, we need to create the environment where technology can be adopted without the struggles of dealing with incumbent vendors and the IT teams who are the gatekeepers, disincentivized to let new technology through at the expense of their provider’s happiness. 

Developers are currently confused by the promise of a more ideal world, utilizing a truly standardized exchange specification (FHIR). Yet in reality, they don’t find this in the wild. They find the optionality built into the standard to be comparable to what we saw in HL7v2 or v3. They need something now that can work with what we have today. 

That’s what Redox has been able to provide: some relief—often to the point of excitement—that no matter what the EHR, what standard is supported, what customizations have been applied, and what authentication mechanism is in action, they’ll get something consistent out of the other end. That’s what Redox provides, regardless. It’s for developers so they can bring an application to market and actually make a difference. We are all patients; let’s create the environment where an application layer can turn data into the information required to engage us in our healthcare. Thank you.

I closed out my trip to the hill with a trip to Founding Farmers. After a short wait, I was able to snag a bar seat and reflect on the day. I am encouraged by the dialogue happening and hopeful that the voices in the room resonated. Solving healthcare's interoperability problem and "liberating healthcare data" is a worthwhile mission. Let's work together to make sure we get it right.