I recently came across an interesting op-ed piece by Sean Parker, the entrepreneur who became a billionaire by investing in Silicon Valley start-ups (see: Sean Parker: Philanthropy for Hackers). In the article, he defines the hacker culture in the following way:
Hackers share certain values: an antiestablishment bias, a belief in radical transparency, a nose for sniffing out vulnerabilities in systems, a desire to “hack” complex problems using elegant technological and social solutions, and an almost religious belief in the power of data to aid in solving those problems. Hackers are popularly considered to be troublemakers, but they are also dedicated problem solvers, as interested in discovering holes in systems as they are in exploiting them for personal gain. By identifying weaknesses in long-established systems, they have successfully disrupted countless industries, from retail and music to transportation and publishing.
I have documented in Lab Soft News the failures of Microsoft in the past (Health Vault) to enter the healthcare market (see: Microsoft Purchases Healthcare Search Engine; Microsoft Renames and "Integrates" Its Healthcare Software Line; Implications of the Kaiser-Microsoft PHR Deal; Amalga Makes Inroads in the EMR World; Microsoft's Amalga/HealthVault Strategy Becomes Obvious). I will assume here that the Microsoft culture represents hacker values or at least did so in the past. The company, although still profitable, has been eclipsed from a technical and strategic perspective by by Apple and Google (see: Mobile: It Changes Everything).
I have been toying with the question of why "hackers," represented in part by Microsoft or other IT companies, have had difficulty "disrupting" the healthcare industry using hacker values such as transparency, a nose for system vulnerabilities, and a belief in using data to solve problems (Software to Healthcare: Israeli innovation disrupts medicine). I have come up with the two following possible theories:
- Hospitals are organized with a "top layer" consisting of executives who mainly manage revenue. Most of them are not physicians and have little detailed knowledge about how physicians and nurses care for patients. The management style of hospital executives is conservative, partly because of the regulated nature of the industry. Regarding IT, they have recently deployed EHRs that I think often inhibits the efficiency of physicians and nurses (see:Ten Reasons Why the Current Hospital EHR Model Is Unsustainable; Veteran Clinician Critiques the Current EHR -- Both Good and Bad). Their interest in big data and analytics has only recently been stimulated but is largely confined to tools to manage revenue.
- The "bottom layer" of hospitals is occupied by physicians and nurses who deliver care to patients although all major financial and product buying decisions are made by the executives. EHRs that are designed mainly to optimize hospital billing rather than clinical efficiency have been imposed on them by hospital executives.
In my view, our healthcare system will not be easily changed by "hackers" with disruptive technology. I base my conclusion, in part, on past failures by companies like Microsoft and Google to offer products that appeal to healthcare consumers. Such companies often lack an understanding of the culture and organization of hospitals and other healthcare organizations. However, I also think that we are on the cusp of radical health solutions involving smart phones linked to devices attached to the wrist. They will be used to monitor physical activities and also have, or will have, sensors to monitor pulse and blood pressure and even perform lab testing such as blood glucose levels.
Such mobile-generated data can be reported to physicians but will not necessarily be integrated with the medical records that are maintained in physician offices, clinics, and hospitals. Moreover, there is little enthusiasm at the hospital executive level, nor at the EHR vendor level, to integrate patient-generated data with hospital and physicians office data. Such integration can also be technically daunting because most hospital system are based on aging technology. In short, much of the formal healthcare delivery system is insulated from "hacker" ideology and consumers have little power to change the system.