Children's Hospital Boston conference explores innovative ways to transform the national Health IT system

Harvard meeting explores how health information technology can be modeled on "iPhone-like" platform to spur innovation and reduce costs

As government, industry and academic leaders work to transform the nation's health information system, there is increasing interest in the notion of a national health information network in which consumers can actively engage, and which can provide the foundation for an "iPhone-like" ecosystem of applications to compete on price and value. In such an ecosystem, purchasers of applications -- whether physicians and hospitals buying electronic health records, or patients and consumers buying technology to support wellness and disease management -- would be able to easily substitute any application for any other.

Assembled at a conference hosted by Children's Hospital Boston and Harvard Medical School, more than 100 thought leaders, including representatives from the Executive Office of the President, the Department of Health and Human Services, Google, Microsoft, IBM, and a diverse array of companies, universities, and organizations, explored innovative ways to transform the national Health IT system.

Kenneth Mandl, a physician and researcher at Children's Hospital Boston and associate professor at Harvard Medical School, explains: "If health information technology evolves to provide platforms that permit physician practices, hospitals, or patients to pick and choose from a 'store' of applications that are entirely substitutable, a competitive environment will emerge that allows for better pricing, more customized applications and innovations that cannot be anticipated at the moment. Value should be high, and switching costs low."

Mitch Kapor, founder of the Lotus Corporation and now Senior Advisor on Health Information Technology at the Center for American Progress, opened the meeting suggesting that a new "Health Internet" could arise through processes that parallel those in the personal computer and Internet revolutions. He highlighted the catalytic role that government played in defining common protocols for the Internet which enabled the Internet to be created from open source and proprietary software. He also called out the critical role of consumer applications in driving growth of the PC and the Internet, throwing into greater relief the requirements for success of a "Health Internet."

Isaac Kohane, director of the Children's Hospital Informatics Program and professor at Harvard Medical School elaborates: "The model has proven successful for personally controlled health record platforms such as the Indivo system developed at Children's Hospital Boston, Microsoft's HealthVault, and the GoogleHealth system. These consumer-driven platforms have attracted development of an ecosystem of third party applications that add value. Substitutability of healthcare applications gives doctors and patients choice in what best fits their needs."

Clayton Christensen, professor at Harvard Business School and author of The Innovator's Prescription: A Disruptive Solution for Health Care, strongly encouraged promotion of disruptive innovation in health information technology. He spoke about the need to move from current-stage complex monolithic health information systems toward platforms that distribute innovation and that engage the consumer. He emphasized that such disruption is a normal part of product life cycles across many industries and warned against policies that would stifle it.

Harvard Business School's Professor Regina Herzlinger, author of Who Killed Health Care?: America's $2 Trillion Medical Problem -- and the Consumer-Driven Cure, argued that the success of health reform is entirely predicated on giving the consumer a central role in managing health care finance and also the health information management tools to promote information transparency and shared decision-making.

Aneesh Chopra, US Federal Chief Technology Officer, and Todd Park, Chief Technology Officer of the US Department of Health and Human Services, floated for feedback the idea of an effort to extend the Nationwide Health Information Network (NHIN) to include consumer health information platforms, and engage consumers, privacy experts, and other interested parties in pursuing this idea. Park described the NHIN as a "Health Internet," which had been from its founding intended to involve consumers, providers, government organizations, and others in its fabric. On behalf of the Office of the National Coordinator for Health IT (ONC) and multiple supportive government organizations, including the Department of Veterans Affairs, the Department of Defense, and the Centers for Medicare and Medicaid Services, Park and Chopra asked the attendees if there was interest in supporting and participating in an effort to assess current NHIN protocols, adapt them for use by consumer health information platforms, and address the integration of consumer health platforms and consumers into the NHIN. Meeting attendees responded with tremendous enthusiasm. Park and Chopra committed to bring these expressions of interest back to D.C. and work with ONC on how such an effort could be mobilized.

In contrast to a platform model with distributed innovation, the health care system has less than a dozen major vendors whose systems take months to years to implement, cost thousands to millions -- or tens of millions -- of dollars, depending on the size of the installation. Most of these systems are monolithic and difficult to integrate with emerging innovative software.