We have the innovation and technology to do it, but are we ready to act?
By Stuart Hanson
Anyone who says innovation in healthcare doesn’t exist hasn’t been paying attention for the past 18 months. From the way providers large and small pivoted to telehealth to keep patients safe, to the way scientists from around the world came together to develop vaccines and treatment protocols, to the way public health agencies worked to provide mass distribution of the vaccinations—innovation and cooperation abounded. Was it all perfect? No. But it does show that we are capable of innovating urgently.
One area where innovation is clearly lacking, and has been for a very long time, is interoperability. It’s an issue that numerous companies, consortiums, agencies, and others have been trying to solve for decades. Regardless, the issue remains.
In the midst of the pandemic, I needed an emergency eye procedure. I was lucky that my provider was able to quickly verify my coverage with my insurance company and I was able to get the treatment I needed. During my follow-up exam, I met another patient who also needed an emergency eye procedure. If he didn’t get it, he risked retinal detachment, a condition that could lead to blindness if not treated in time. While we were in the waiting room, the man told me that he had already been to the office twice before to have the procedure, but was sent home because the provider hadn’t been able to connect with the man’s insurance company to verify coverage. I don’t know what happened to the man, whether he got the surgery in time to avoid retinal detachment or whether his condition deteriorated.
This same scenario is played out all too often across our country. In a time when can share news in near real time with family and friends on Instagram, it can still take weeks or months to share critical administrative and clinical healthcare data between two entities whose actions—or inactions—can be the difference between life or death. Why?
The issue isn’t that we lack innovation to fix the problem. The issue is that we’re focused on fixing the wrong problem. We have entrepreneurs and tech giants entering the healthcare market every day, bringing with them new apps or solutions that promise to “transform” healthcare. But most of those solutions sit on top of the technical infrastructure, whereas the real problem is the infrastructure itself. A great telehealth app may streamline workflows or improve patient-provider connectivity, but new apps can be virtually impossible to bolt together with the provider’s billing system, clinical record system, or privacy and security controls. Although it may be great, innovative, timely technology that we desperately need, it’s yet another layer added on top of previous layers that sit atop an outdated, ineffective infrastructure—an infrastructure built primarily to support batch-based, one-way communications like EDI. It’s like building a yacht on top of a rowboat.
If we want to create real transformation in healthcare, we need a new infrastructure blueprint—one that doesn’t add additional features on top of a fractured system. We need an infrastructure that starts from the bottom up. It exists, thanks to truly innovative companies that recognized the problem and realized that a viable solution is already available. In 2019, IBM, PNC Bank, Elevance (formerly Anthem), CVS Aetna, Cleveland Clinic, Sentara Healthcare, and Health Care Services Corporation came together to discuss how we could use new, innovative technologies to solve the systemic problems that have plagued our industry for too long: data sharing, data integrity, and trust. Together, they formed Avaneer Health.
The focus of Avaneer Health is leveraging innovative technologies to create a neutral network through which healthcare organizations, patients, and other key stakeholders can access accurate, timely information in real time—an Internet for healthcare.
First, payers and providers commit data to the cloud and allow it to be discoverable based on permissions that are set by each party. Users can connect to the network via the cloud, where the ID keychain and master index locates the information requested and matches it to the data available, then delivers it to the requestor. The intermediary—Avaneer Health—provides certification, end-point validation, an immutable audit trail, cybersecurity, and compliance. Use cases include eligibility verification, prior authorization, and real-time access to accurate, complete medical records.
The network also connects with rich solution providers like revenue cycle management companies, telehealth platforms and others that are involved in care coordination or the business of healthcare. This eliminates the need for payers and providers to build and maintain connections with multiple systems. Fewer touchpoints mean fewer opportunities for security issues, not to mention reduced IT costs and resources needed to manage those gateways.
If the U.S. healthcare system were its own country, it would rank forth in GDP, right behind China but ahead of countries like Germany, India, and the UK. We spend between 25% and 30% more per person on healthcare than any other country. This might be okay if our outcomes were better, but they aren’t. I keep thinking of the man I met in the waiting room and wondering how much longer he had to wait or if he ever got the surgery at all.
We know the problem and we have the technology, innovation, and ability to solve it. The question is whether we’re going to act or if we’re going to continue to build layers on top of layers on top of layers. Our patients are waiting on us to make the call.
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