By John Halamka, MD
Twitter: @jhalamka
One of our Mayo Clinic Platform team, Emily Wampfler, recently forwarded me an overview of MIT’s Platform conference.
Read the Barclay’s piece. It notes that 55,000 people changed focus from product support to a platform service line orientation, remarkably enhancing business opportunities.
Few organizations in healthcare have created a Platform which connects data producers and consumers, standardizing security, enhancing reliability and accelerating agility. What is the urgency to embrace a Platform approach to healthcare?
I believe a Platform strategy is the best way to reduce barriers to innovation. What specific barriers? I have my own opinions but also asked colleagues like Dr. Craig Monsen, CMIO of Atrius. Our examples are not related to any single institution we’ve worked at (Atrius, BIDMC or Mayo) but are drawn from multiple decades of experience in healthcare.
Operational
- Innovation efforts compete with staff time required for day to day activities
- Innovation efforts may disrupt efforts to standardize work in an organization
- Innovation efforts may not be aligned with the immediate goals and priorities of leadership
Technical
- Innovation efforts may require data standards that are emerging or not yet implemented
- Innovation efforts may require clarification of data use rights
- Innovation efforts may require novel IT infrastructure
Business
- Innovation efforts may require significant time investment from IT, Information Security, Compliance and Legal
- Innovation efforts may require new policymaking about intellectual property ownership
- Innovation efforts may require clarity about unrelated business income for a 501c(3) public charity
- Innovation efforts may require finalization of slowly evolving regulations (ONC information blocking rule, CMS interoperability rule)
Legal
- Innovation efforts may require re-evaluating security, privacy, conflict of interest and consent policy
- Innovation efforts may require clarification about what projects are operations(as in HIPAA Treatment, Payment, Operations) versus research
What can a platform do to mitigate/eliminate these barriers?
If senior management (Executives, Board) broadly communicates that a Platform effort will require short term additional work but the resulting standardization of technology, process, and people will simplify future work, then the organization will tolerate the extra effort and disruption. I think of it like building a house. Anyone who has ever done a major construction project knows about the dust, delays, and inconvenience of building. However, when the project is done, there are decades of enjoyment to follow.
Although data standards constantly evolve, a Platform creates a single place to get/put data using whatever technologies exist today while permitting transition to what’s next when it’s available. Although EHR data extraction today may require third party tools or proprietary work arounds, once the data is flowing to a Platform then collaborators can access data via a single point of authorization and authentication without any dependency on the EHR itself. I’ve used this technique to make data available to innovators using FHIR long before FHIR was part of EHRs. The Platform can embrace emerging standards like FHIR R4 long before such standards are native to the EHR.
Data Use rights are a key issue and require a consensus of internal/external stakeholders. I will detail some of the issues about Ethical Uses of data in my next post. A Platform which serves as a single point of data input/output enables the consistent enforcement of data use policy.
I recently worked on a project that required a novel business relationship between a 501c(3) Public Charity and an existing EHR vendor. The business people agreed it would be unrelated business income and would be taxed. Once a template was developed for unrelated business income arrangements, it was no longer a barrier. Similarly, intellectual property rights covering developments made using data from a Platform require a standardized policy. For example, is de-identified data made available for innovation at low cost with the notion that derivative intellectual property creates an ongoing revenue stream OR is the data cost initally high with the notion that derivative intellectual property is unencumbered? A platform enables easy monitoring and execution of such arrangements
In sum, a Platform can be an organizing framework for operational, technical, business, and legal stakeholders to create a set of standardized, templated use case variants without having to re-negotiate every new innovation project or collaboration. In my experience, without a single enterprise approach (call it a single front door) to connecting data producers and consumers, there is unlikely to be innovation agility in healthcare.
In the first 100 days at Mayo, many stakeholders will weigh in on these issues. I’ll report on lessons learned along the way.
John D. Halamka, MD, MS, is President of the Mayo Clinic Platform, where he leads a portfolio of new digital platform businesses focused on transforming health by leveraging artificial intelligence, the internet of things, and an ecosystem of partners for Mayo Clinic. This article was originally published in his blog Dispatch from the Digital Health Frontier and is reprinted here with permission.