As we focus this month on the promise and potential of digital transformation across healthcare, it's encouraging enough to take stock of the huge advances that have already been made in the past decade of the post-EHR era.

But as we all know, there's a still plenty of room for innovation and improvement as patients and providers look to take advantage of the rich profusion of data that already exists and is growing near-exponentially.

A major impediment, of course, is interoperability. But progress is being made, and momentum seems to be picking up speed – particularly as CMS and ONC prepare to finalize some era-defining rules they say will finally compel some of healthcare's most foot-dragging entrenched interest to embrace data exchange and empower consumers.

And if those don't quite do the trick, there are plenty of hungry companies champing at the bit to help force some big changes of their own.

For the Amazons, Apples, Googles and Salesforces, healthcare is an "untapped market for them; the margins are much better than retail, and there they're making significant moves," said David Biel, U.S. healthcare consulting leader at Deloitte.

"No one is happy with the system the way it is today," he said. "And there are a ton of non-traditional players who are highly motivated to get into this business and disrupt it."

Those facts – along with the inexorable forward march of technological transformation, clinical innovation and consumer expectations – are pointing to a future that looks very different than today, said Biel.

In Deloitte's recent "Future of Health" report, researchers looked far into the future, nearly to mid-century. Health in the year 2040, according to the report, will thrive on the lifeblood of "radically interoperable data," flowing freely open and secure platforms, helping provide insights for better decision-making on the part of consumers and health systems alike – whether enabling better care delivery or offering insights for day-to-day wellness.

We reported on the study when it was first published in January, but found its premise worth revisiting as we explore the various ways digital transformation is taking shape today – and how it will continue to play out in the future.

The term "radically interoperable data" is exciting, after all – especially from this vantage point, where basic sending and receiving is still a big challenge for many hospitals. But Biel says it will be a reality within the next 20 years or so.

"It really means access to and curation of a very large number and wide ranging set of data that includes individual health data, environmental data, social trade, financial data, institutional data," he explained. "The radical part is that it can be accessed in real-time and analyzed for patterns that impact someone's health and wellness. It can bring insights and serve them essentially up to the consumer where they are, real-time and always available."

By 2040, as Deloitte sees it, empowered consumers will be able to "essentially cross index and intermingle different types of data that today are probably in vastly different places that are not accessible to each other and not standardized in any way," said Biel.

"Imagine a future state where you wake up in the morning and your in-home device basically tells you that it has noticed that the pollen count has risen you know outside, and that the forecast is showing that the pollen count is going to be high for the next few hours and then essentially it's going to burn off by noon," he said.

"The interoperable insight engine knows that you're an asthma patient, and also that you have a jog scheduled at 7:30 in the morning, and essentially recommends to you that you don't  go out and take that jog – that you wait until after the pollen count has dropped, has rescheduled your afternoon meetings for the morning when you were going to take your jog, so now there's open period on your calendar where you can do that.

"And, by the way," he added, "it's noticed that you're almost out of connected inhalers so automatically reorder them for you, and a drone dropped them at your doorstep overnight."

7-year cycles of innovation

Biel concedes that right now, despite all the hard work from very smart and forward thinking stakeholders on the vendor, policymaker and provider sides, healthcare is still "far, far, far, from radically interoperable – we're probably barely even sitting upright so we can start crawling."

That said, "we're at the front end of a 20 to 30 year industry transformation," he said. "The industry forces and the disruption that's upon us are true indicators that we're going to be going through a cycle of innovation – and multiple waves of innovation."

Indeed, Deloitte's choice of the year 2040 isn't arbitrary. It's 21 years from now for a reason.

"We've determined that innovation happens in seven-year waves, essentially, and that big industry transformation typically takes around three innovation cycles," Biel explained. "Right now, we're sort of at the front end of the first wave."

From a technology point of view, there's a "surplus of innovative digital point solutions, but all not really connected and all very difficult to implement," he said. "There's also an unprecedented pace of clinical innovation. Think about the fact that 10 or 15 years ago it took over a billion dollars to do the first DNA sequencing and thousands and thousands of man hours. And now, you can you can essentially do it over the Internet for $150 – and it'll be probably under a hundred dollars soon."

But if technology and medicine are both making big strides, there are still some major current impediments to the future we all want.

For one thing, consumers are "disenfranchised and unsatisfied in a very significant way," said Biel. For another, "we have an unsustainable economic outlook. We're looking at healthcare spending coming up over 20 percent of GDP in the next few years. Longevity is increasing. Medicare will run out of money when people start living to 150 years old."

Those factors and others – driven largely by the "non-entrenched outside players who are coming into the market," unencumbered by healthcare's traditional incentive structures – are going to help "accelerate the kind of interoperability that we think is going to ultimately take hold and drive a whole new health ecosystem and help the economy," he said.

But more traditional entities – the federal government, say – have an important place at the table too, said Biel – who's encouraged by CMS' and ONC's proposed interoperability rules.

"We've finally gotten to a place where the government is really trying to push things along more aggressively," he said. "Seema Verma and some of the others that are sitting up on Capitol Hill are incredibly enlightened, and are trying to move the government in the right direction. So I think those things are very helpful and sends a clear signal to all the players that we have to consider and think about these things more seriously.

And those rules – aimed at established health systems and longtime health IT vendors – are meant to send the message to them that the old ways are over, and it's time to adopt more of a "2040" mindset.

"I think there is deep interest by all players," said Biel. "I think the entrenched players are deeply interested in the technology and the insights that they can derive through data. But I think they are less incentivized to actually try to break the business models that are funding them today.

But I do see, within those organizations you see a lot of organizations developing pretty sophisticated data and analytic strategies: Putting in place chief digital officers and chief health information officers; developing interoperability centers of excellence. They're starting to really take a look at what they need to do to share data."

But the public and private sectors will need to work in tandem to truly enable this two-decade progress toward radical interoperability, said Biel.

"We're starting to see, which is also encouraging, the non-traditional and traditional players spending time together and pairing up and looking at partnerships and ways that they can bring their different skills and capabilities together to create something innovative and new," he said.

"So those all give me hope that this is going to happen. And I do think that over time at the end of the day the consumer, ultimately, and the lack of sustainability of the healthcare economy are going to ultimately drive us to this place. You sort of have nowhere else to go but to innovate in a way that breaks the mold."
 

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Healthcare IT News is a publication of HIMSS Media.