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Healthcare's Big Problem With Little Data

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Every year, the analyst firm Gartner publishes between 90 and 100 "Hype Cycles" with insight on about 1,900 different technologies. The Hype Cycle above is the one for Emerging Technologies for 2012 (published in August) and shows "Big Data" heading toward the "Peak of Inflated Expectations."

According to Gartner, Big Data has about 2-5 years before reaching it's "Plateau of Productivity." That's the enviable point at which a technology finally delivers predictable value. The promise of Big Data, of course, is a treasure trove of high value across many industries  – including healthcare. Everything from predictive and prescriptive analytics to population health, disease management, drug discovery and personalized medicine (delivered with much greater precision and higher efficacy) to name but a few.

Like many emerging technologies, the future here is brilliant and chock-full of headlines highlighting all the rich rewards ahead. In the meantime, however, "little data" in healthcare continues to give us all peptic ulcers.

While it lacks any formal definition, one way to think of little data is anything that operates at the unit level. One account, one patient, one customer, one transaction or one record. Healthcare billing data has evolved sufficiently that much of it has been standardized and automated – but clinical data is still years behind. Clinical data at the unit level is chaotic and dysfunctional because it's not easily transferable or usable outside of the system that first created it. In a world of competing financial interests and an increasingly mobile population – every patient encounter represents an opportunity for technology vendors to lock-in providers.

Word Processing had an equally chaotic start as well. You could export/import between competing word-processing applications, but the steps weren't easy – or seamless. That's the same dilemma facing the entire Electronic Health Record (EHR) software industry. Simply adding the word "cloud" to the marketing material (and pricing scheme) doesn't change the underlying dysfunction. In fact, it's often just a way to capture the allure of a new technology to sell antiquated ideas around the profitability of data that's effectively held at ransom.

It's a classic innovator's dilemma. On the one-hand, in order to support early (and often significant) development costs, commercial solutions need to be proprietary and protectable  The challenge in healthcare is that the proverbial other hand is data that literally and figuratively represents our lives as patients inside our ossified healthcare system. Historically, the crutch that many software vendors have relied on is the format of the data itself. The sales process is designed to glamorize the feature and functionality – while obscuring the fact that the data format is 100% proprietary. Through the years, this cycle of customer acquisition and lock-in has now been repeated hundreds of times.

By at least one estimate (here) there are now about 500 independent EHR vendors.  Out of that large group is a subset of about 400 with at least one customer that has applied for Federal stimulus dollars through the labyrinthine process of meaningful use attestation. That would suggest a "first-cut" of about 100 vendors who made some commitment around certification – but have no reported customers (at least to date). That's a staggering number of single-purpose software vendors for any industry to support – even bloated healthcare. The simple fact is it can't. While there have been a few high-profile cases of EHR vendors shutting down, this last week was the first high-profile example of a vendor that was effectively decertified by the Feds for both their "ambulatory" and their "inpatient" EHR products. From the HHS.gov website last Thursday:

“We and our certification bodies take complaints and our follow-up seriously. By revoking the certification of these EHR products, we are making sure that certified electronic health record products meet the requirements to protect patients and providers,” said Dr. Mostashari. “Because EHRMagic was unable to show that their EHR products met ONC’s certification requirements, their EHRs will no longer be certified under the ONC HIT Certification Program.”

One vendor out of 400 isn't a trend, but it does suggest that as the rigors of meaningful use and certification increase, more and more vendors will likely not survive. With almost 400 EHR vendors and the certification process still in its infancy, we can expect a lot more chaos in this ecosystem of competing interests. There may come a point when a provider sees more value in advertising their EHR affiliation than ER wait times.

Big Data is clearly where all the excitement and headlines are, but it's the little data that is likely to have the most effect on our individual healthcare. That is at least until Big Data gets well beyond its "peak of inflated expectations" and closer to its "plateau of productivity." The question then is – which vendors are likely to be around in 2-to-5 years?