I am very excited about the Blue Button Plus. For a background on Blue Button, I have written about it here. Blue Button Plus takes over where Blue Button leaves off – its provides a blue print for how patient data is structured and how it is securely transmitted.
My new digital health startup is incorporating the Blue Button in the product that I we are working on, so I spent a few hours this week attending Blue Button Plus Webinar and watching videos from the Direct Connect Connect-a-thon. I applaud all the work that is being put in the transfer of patient health data but I could not help but notice that the way it is being handled eerily sounds familiar to another time when a new concept for securely transferring data were being developed. Being on the Webinar this week reminded me of my time in the late 90s/early 2000s in sessions in Redmond listening to the architecture of Web Services. It took me back to the time when of UUDI registries, WSDLs, WS-*, WSDL2* generators and all the other alphabet soup. I listened to the presenter talk about the Trust Communities (groups of organizations that trust each other to exchange data) – a sort of “walled garden” and one could see right away that this has the potential to be messy. It is no surprise that even at this early stage, issues of how to get Trust Communities to talk to each other are already cropping up i.e. protocols for getting two “walled gardens” to communicate. It reminds me of the time when we were trying to figure out how to push our White, Yellow and Green pages simultaneously to the Microsoft and IBM UDDI registries because we needed to be in both registries and the issues of the need for federated UUDI registries that came up just as they are now with Trust Communities
While I am concerned about the architecture of what is taking place today because it sounds like Web Services all over again, I am most concerned that these complex solutions have the potential to suppress innovation around patient records because I think they are going to keep innovative startups from participating. Here why I am concerned: How does a small startup get to be part of a trust community? On the Webinar its was mentioned that organizations need to be accredited to participate – by whom and how much will that cost? Will accreditation be at a cost that small companies can afford? I think most who have gone through accreditation processes will agree that prepping for accreditation is a extremely costly in terms of time, resources and money – all of which are at a premium in a startup. There is a lot of hope for a coming technology-driven revolution in health care; however, if some of these issues are not addressed to help smaller startups (that are willing to take on risks to innovate) to play, there will not be much innovation in the patient record space.
Going back to my web services analogy; we all know how the web services story played out - more inclusive approaches to solve data exchange problems, REST and oAuth, were a catalyst for for the innovation and opportunities in the tech industry today while Web Services as they were originally conceived do not play much of a prominent role outside of the enterprise. However, its not all doom and gloom because as soon as I started to think that “there has got to be a better way”, I received an alert on Thursday morning that Humetrix (a San Diego-based digital health startup) had created a new way to share patient records that simply involves the generation and scanning of QR codes. In my opinion, simpler, inclusive and yet secure ways to exchange data are the way the catalyst for a technology-driven revolution in patient health records.