The lack of interoperability in healthcare continues to be a vexing challenge for Health IT companies, IT departments and patients. Redox is a company taking a unique approach to solving this problem. They have built a platform of reusable data connections between healthcare providers and the innovative cloud-based companies that have products those providers want to use.
Redox recently held their second annual Interoperability Summit at the new CatalystHTI facility in Denver Colorado. Over three hundred people attended the event. The diverse audience included: startups, hospitals, large HealthIT vendors, payors and government health agencies. The sessions at the Summit reflected the diversity of the audience and ranged from topics like “Hacking the Health System Sales Cycle” to “FHIR: Be the Right Amount of Excited”.
During the Summit, I sat down with Redox CEO, Luke Bonney, to talk about the state of interoperability, the willingness of the industry to share data and what advice he has for the dozens of startups that approach Redox each month.
Below is a transcript of our conversation.
What is the state of healthcare interoperability today?
I think we are in a good state right now, but more importantly I think we are on an accelerated trajectory to something better.
An accelerated trajectory?
Yes, but in order to explain why I’m saying that, we have to take a step back.
In my opinion healthcare interoperability is inextricably tied to the adoption and migration to the cloud. We will never have true data liquidity, which is the state that everyone wants – physicians, clinicians, administrators, patients, providers, payers, etc – until healthcare fully embraces cloud architectures and cloud thinking.
Healthcare is still predominantly an “on-premise” world. It’s not wrong. It’s just how the industry has grown up. We installed servers behind our own firewalls. As we added systems we bought more servers and of course we added them to the other servers behind the firewall. Eventually we built connections between these systems so that they could talk to each other. But because everything was behind the firewall and because we were really just sharing data within the same organization, we didn’t give much thought to sharing that data in a standard way. As long as we were behind the firewall we could safely exchange data.
When you approach things from a cloud perspective, the thinking is completely different. When you build cloud applications you HAVE TO think about data portability and security. You HAVE TO work out ways to connect systems together across the Internet without a single big firewall acting as your shield.
So as people move more and more to this way of thinking we will see more movement towards frictionless data exchange.
So is healthcare moving more to the cloud?
Working at EPIC and now at Redox, I’ve had a front-row seat to this change in attitude towards the cloud by healthcare providers. Prior to 2015 healthcare IT leaders were still asking “What is the cloud?” and “Why should I bother with it?”. But today leaders are starting to ask “How can I better leverage the cloud for my organization?” It’s great to see so many proactively looking for ways to adopt cloud-based applications.
I also think that the consumer tech giants are helping propel healthcare forward. Companies like Amazon and Google have always been cloud-based. As they push into healthcare they are going to have a huge advantage versus on-premise legacy companies. As they gain traction so too will the cloud.
I can see how embracing the cloud will help healthcare achieve secure connectivity and certainly scalability, but even if we move completely to the cloud won’t we still need to exchange data in a standard way in order to achieve true interoperability?
Having a data standard would certainly be helpful.
Is that going to be HL7 v2? v3? FHIR? Smart-on-FHIR? Or something that Commonwell Alliance puts out?
(Laughing). We do seem to have a lot of standards don’t we.
Actually this is what is driving Redox. There really isn’t a ton of incentive to tear out the investments already made in HL7 v2 or v3. It works for the use cases where it has been deployed. The same applies to FHIR and Commonwell. All these approaches work wonderfully for specific use cases, but I really doubt any one of these approaches is going to be the single solution for all of our interoperability challenges.
Think about it. If I’m a CIO at a hospital and I have a working HL7 v2 integration working between two systems, why would I waste precious resources to move to a different integration standard if there is really nothing to be gained from it? It’d be a waste of time and resources.
The one good thing about all these standards and interoperability initiatives is that we are building an audience that is asking the right questions and pushing healthcare in the right direction. APIs are the right thing to do. FHIR is the right thing to do…and so on. All are relevant and needed.
So if not a universal data standard, what do we need?
The way I see things we might not need a single data standard if someone can build a common platform through which data can be shared. That’s what we’re doing here at Redox. We’re taking a pragmatic approach. Whatever data standard you are using internal is fine with us. We’ll work with you to find a way to share your data through our platform. And once you share it with us once, you don’t have to rebuild that connection over and over again each time a different company wants to connect. We handle that.
Is that the problem Redox set out to solve?
Actually when we started Redox we really just wanted to make it easier for cloud-based healthcare companies to scale and grow. What we realized is that one of the biggest impediments to growth was integrating legacy on-prem systems with cloud-based applications. Even if these companies could convince hospital IT teams to put their integration on the priority list, it would take a long time to actually get it done.
So we built the Redox engine to make this easier. Our goal wasn’t to solve interoperability per say, we just wanted to bring innovative web developers closer to healthcare providers so that they can solve problems together.
But because we were cloud from Day 1, we wanted to build everything in a reusable way, so that once we built a connection to one hospital, we wouldn’t have to build it again when the next company wanted to connect with that same hospital. This network effect wasn’t something we originally set out to build, but now it’s central to our success. It’s why we can talk about being a platform that enables data sharing vs being a tool that helps systems share data.
Solving interoperability is only partly a technology challenge. There is also the challenge of getting the healthcare ecosystem to actually share their data. Because Redox works with so many players in the ecosystem, have you noticed any change in attitude around sharing data?
Let me start by saying that I think everyone WANTS the data. There’s incredible value in health data. Medical records are a gold mine for researchers, public health authorities, pharma companies, payors, etc. Everyone would love nothing more than to build a comprehensive health record for their own purposes. The challenge of course is that it’s not easy to do that today. As you said, this is partly because of technology and partly because no one really wants to share their data altruistically.
I think there is one party that truly wants data to be shared and that’s patients. Patients are way more interested in sharing data than anyone else in the ecosystem. As a patient, data should follow me wherever I go. I never want to wonder if my doctor has all my medical information. I want people to have the data because I want the best outcome possible and my data can help make that happen.
I think companies and organizations in the healthcare ecosystem are slowly waking up to the fact that sharing data helps support their customers – whether those customers are providers, payors, members, patients, clinicians or government agencies. Sharing data makes things better. And as financial pressures in healthcare mount, everyone is looking for ways to do more, better, faster and with more accuracy. Sharing data is necessary for that to happen.
Redox works with a lot with startups and small/medium sized HealthIT companies. What advice would you give to those that are considering working with Redox? What should they have considered?
There are two key questions that I think every HealthIT company should ask themselves. Frist, what is the value your product or service provides? Second, Who is the buyer? Success in healthcare is less about whether your technology and more about aligning three things:
- An actual problem that needs to be solved
- A solution to that problem
- A buyer who can make a buying decision in a healthcare organization
I see a lot of companies that don’t really consider this last question. You can create an amazing product that solves a problem in healthcare but if the target audience for your product cannot make the buying decision then you have a difficult road ahead of you.
Beyond these questions, I would advise companies to really consider how their products integrate into the clinical or administrative workflow. Many startups begin with an application that isn’t integrated with existing hospital systems, like the EHR. But after they gain a little bit of traction they realize they need to become more integrated. But building in real-time data exchange into an application isn’t easy. You need to really think through how your product will handle this.
Lastly I would caution healthcare entrepreneurs about building their applications on the assumption that FHIR will be universally adopted. It isn’t and it will likely take years before it gains real-world traction. There is a lot of excitement around FHIR, but it isn’t the best solution for all situations.
One thing I am encouraged by is the number of people and companies from outside of healthcare that are coming into this space. I think they bring an energy and perspective that will help us all get better. Granted, many of them have stars in their eyes and don’t realize how tough healthcare can be…but, the fact that they aren’t burdened with any legacy thinking is exciting. Healthcare needs more outside thinking.