Before the Blue Button Developer Conference on Monday, I stepped inside the U.S. Digital Service for something of a pre-party. USDS hosted this mix of people in full suits rubbing elbows with tattooed technologists wearing t-shirts.
In the packed room, USDS Deputy Administrator Edward Hartwig climbed onto a couch to deliver congratulations to the team that worked with the Centers for Medicare and Medicaid Services on the API-first Blue Button 2.0.
"We're on the cutting edge of what digital medicine is going to be in this country," Hartwig said.
Here's a look at what happened at USDS and the subsequent White House developer conference – and what it signals is coming from the federal government and a fistful of companies that dominate healthcare and technology.
"EHR vendors need to develop clearer terms of service than what exist today. Without those, many emerging companies will likely struggle to solidify business models."
Adam Culbertson, HIMSS Innovator-in-Residence
APIs, FHIR, cloud coming down the pike
A taste of what to expect digital medicine to blossom into: Open APIs, FHIR and cloud computing, coming together to eradicate, or at least ameliorate, barriers to interoperability.
Whereas Monday afternoon's White House hackathon focused on Blue Button 2.0 arming health insurance companies with an API to make claims data available to developers and researchers – a worthy pursuit indeed – something even bigger is brewing.
And six tech titans publicly pledged to use HL7's FHIR and Argonaut specifications to advance health information interoperability: Amazon, Google, IBM, Microsoft, Oracle and Salesforce.
The companies did not divulge exact details about how they will use FHIR, though Microsoft Corporate Vice President Peter Lee told me the software giant will support FHIR in many of its products, including Office 365.
It's not just those big IT guns, either. Electronic health record vendors including Epic, Cerner and Allscripts also have developer programs to enable third-parties to build software on their electronic health record platforms.
Interoperability is one obviously important piece of this. The less discussed angle at this point, though, is the innovation that making data, claims and otherwise, more broadly available will ultimately spark.
And if what some of the other speakers at the Blue Button event said proves to be true, coming changes will be even more impactful than meaningful use.
"We should see a massive system unleash. It will operate no differently from the consumer ecosystem. Doctors and clinicians are consumers, too."
Hemant Taneja, General Catalyst
Dataquake: Get used to the word
One Silicon Valley venture capitalist dropped a word one doesn't hear every day: dataquake.
"We're going to look back on 2018 and 2019 and say, 'Those were the years of the dataquake,'" said John Doerr, chairman of Kleiner, Perkins, Caufield and Byers. "Data was required to be interoperable, innovators came together to move us to an app economy."
Consider Apple's App store. That model essentially created a whole new economy some $50 billion strong, Doerr said, much of it earned by software developers.
General Catalyst Managing Partner Hemant Taneja said he expects something similar in healthcare as well.
"We should see a massive system unleash, bigger than any other vertical," Taneja said. "It will operate no differently from the consumer ecosystem. Doctors and clinicians are consumers, too."
It won't happen overnight. HIMSS Innovator-in-Residence Adam Culbertson, who was also at the event, explained that the startups that CMS, EHR vendors and others are looking toward to actually undertake app development based on the data and APIs need clearer terms of service than what exist today. Without those, many emerging companies will likely struggle to solidify business models.
Culbertson said the Blue Button API is a great starting point. Ideally, this will impact other develop programs such as EHR makers seeking third-party app developers.
"EHR vendors need to develop clearer terms of service than what exist today," he said. "Without those, many emerging companies will likely struggle to solidify business models.
"But I think the work coming out of CMS is helping set a standard of the art of the possible in this new emerging ecosystem of API driven health applications," he added. "The winners will be patients, more informed consumers and happier providers whom have a chance to see the market drive innovative new technologies."
An app economy is where health, like so many other verticals, is headed.
"It's hard to say where the first wave will break, whether it will be apps, consumers or providers. But the vision is long overdue."
John Doerr, Kleiner, Perkins, Caufield and Byers
Unleashing the power of consumerism
That pre-party at USDS struck an optimistic note that stretched out all day. Shafiq Rab, CIO of Rush University Medical Center, credited CMS Administrator Seema Verma with embracing the API-first open data strategy.
"Seema has made this personal," he said. "And when things get personal they go far."
Verma, for her part, said we are at the beginning of a digital health revolution. "We have the ability to take that data and unleash it," Verma said. "We're unleashing the most powerful force in our economy: the consumer."
We all know change is coming to healthcare but accuracy in future predictions, as always, tends to be elusive. But FHIR, open APIs and cloud are no longer predictions, they are healthcare's future.
"It's hard to say where the first wave will break, whether it will be apps, consumers or providers," said KPCB's Doerr. "But the vision is long overdue."
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