The healthcare space


It was just a matter of time before the enormous, sprawling American healthcare industry became “the healthcare space,” as it was referred to by more than one speaker at the Digital Health conference sponsored by the Hudson Valley Economic Development Corporation at Marist College last Thursday. At least since historian Frederick Jackson Turner’s influential argument that our unique national character was shaped by the nation’s restless westward expansion, the idea of occupying space has been a positive American theme.

And what a huge frontier this industry occupies! As estimated by the World Bank, 17.9 per cent of the nation’s gross domestic product (GDP) for the 2009-2013 period was spent on healthcare. According to the Kaiser Health News, federal actuaries at the Centers for Medicaid and Medicare Services are projecting that the healthcare proportion of the GDP will climb to 19.6 per cent by 2021. That’s close to double the healthcare share in most industrialized countries. The marketplace is broken.

If ever there was an economic sector going through cataclysmic changes in the way its services are provided, it is American healthcare. It seems that everybody’s seeing opportunity in the healthcare space.


Pharmacy companies provide a good recent illustration. Five of the biggest pharmacy chains have announced they will be giving their customers an easy way to download their individual health records. The five national companies says they will work together “towards standardizing patient prescription information to fuel the growth of private-sector applications and services that can add value to this basic health information,” according to a federal announcement. Patient assessment tools will allow nurse practitioners to recommend care and to “create full encounter notes that then can be sent electronically to primary-care physicians.”

That information flow is of course what your community pharmacy and your primary-care provider have been doing for decades. The difference is that a huge amount of patient information, from the reading of vital signs to prescription habits and from specialist input to family history, is now being assembled and utilized in real time. Individual health records, collected from various sources and transmitted on request, will very soon be readily available to health provider and consumer alike.

 Digital clearinghouse

Much, much more is coming. Apple’s forthcoming Healthbook app is described by one journalist as a digital clearinghouse, the company’s purported attempt “to dominate this space,” allowing consumers to utilize sensors to track health, fitness and activity. Other giant companies too are looking for “the killer app for the quantified self,” as a veteran computer scientist has described it. The increase in information flow in healthcare continues to accelerate exponentially.

One speaker at Marist likened the forthcoming changes in the healthcare space as similar to the adoption of ATMs by financial institutions. If convenience persuades you to entrust your money to a machine, can more systematic health records avoid a similar convergence?

The Marist conference, moderated by Axon Communications healthcare consultancy expert Mario Nacinovich, featured a potpourri of bureaucrats, researchers, entrepreneurs and marketing people who tried to cram their virtues into 20 allotted minutes of presentation fame. All ten speakers employed PowerPoint accessories. Each stood behind a lectern with a microphone on a raised stage. It took more than five grueling hours and cancellation of a scheduled morning break for them to get their points across. For those onlookers who survived that portion of the program, two hours of a networking luncheon and panel discussions among the speakers awaited.

 Information backbone

Information needs to be retained in systematic categories that make sense. To cope with information overload (stemming not from the filibuster by the speakers but from the amount and diversity of available health data), a certain amount of commonality, sometimes referred to colloquially as an information spine or information backbone, is necessary. But because healthcare is so diverse and so complex, a great degree of flexibility is also required.

The basic building block of digital health consists of the systematic collection of electronic health records (EHRs) in digital format capable of being shared across different healthcare settings. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.

The standard of “meaningful use” is defined by the federal government as digital records that improve health quality and efficiency, engage patients and family, improve care coordination, and maintain privacy and security of information. Persons with the skills and knowledge to manage medical information are in high demand.

The HVEDC Digital Health conference, which boasted an auditorium-full of 300 invited attendees, was publicized as an introduction to “the next big thing,” being added in HVEDC’s pantheon to the life science industry, the food-and-drink cluster and digital 3D printing. Digital health was a space in which the Hudson Valley could and would excel, the hosts proclaimed. But the sheer diversity and scope of digital health proved a formidable obstacle. The audience listened to a survey course taught by many instructors each of whom saw business opportunities. Each speaker described the piece of the proverbial elephant with which he or she was most familiar.

The experience was more interesting than enlightening. Perhaps the next big thing will be better focused.


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