It's easy for most of us to remember those cataclysmic societal events after which it is universally intoned that "things will never be the same again." It may be a little more rare to remember those events which slide under the radar of most folks, but which have profound consequences nonetheless.
One of those landmarks in the technology industry was IBM's announcement in 2000 that it was throwing its corporate weight behind the open source Linux operating system. Up to that point, open source software had been viewed as the product of a plucky but overall irrelevant cadre of cranks, crackpots, and cheapskates. It may have been fine for a network of gamers who never left their geek caves, but "mission-critical" enterprise platforms? Please.
But, Big Blue has never wavered in its support of open source since. It has been a key player in the drive to expand the use of the Open Document Format for top-layer productivity technology, and has doubled down on its Linux support; as recently as 2013, it announced it was investing $1 billion in Linux and other open source technology. However, more than any concrete technological element, IBM's support of Linux has continuously signaled to the entire tech world that some things could be commoditized to everyone's benefit and that creatively differentiating more valuable concepts could be good for developers and customers both. To tweak open source pioneer Eric Raymond's phrase, the cathedral and the bazaar can co-exist, and each can be better for it.
So, when IBM announced during HIMSS week that it was going to go all-in in leveraging its Watson cognitive computing technology into a new Watson Health business unit, dedicating 2,000 people to it, forming partnerships with fellow sector giants Apple, Johnson & Johnson, and Medtronic, and acquiring analytics developer Explorys and population health management vendor Phytel, it brought to mind an obvious comparison to its Linux investment could it signal that it was time to start thinking about a more collaborative ethos in sharing healthcare data?
Well, maybe, according to John Patrick, who was in the trenches at IBM when the epochal shifts not only of Linux but also the rise of the Internet hit the industry. In fact, Patrick, a founding member of the World Wide Web Consortium, was IBM's point man on the Internet and was also one of the executives whom then-CEO Lou Gertsner went to for advice when mulling the Linux move. After he retired, the Ridgefield, Conn., resident ended up on the board of directors of nearby Danbury Hospital, and became so intrigued by what was happening in healthcare he went back to school for a doctorate in health administration in 2014, and has just published a book, Health Attitude, highlighting his thought on unraveling the obstacles facing the industry.
"Up until roughly, now, pretty much everything is anecdotal," Patrick said. "The doctor says to you, 'You need to take this pill' because it's been their experience for their patients that it seems to work most of the time. That's not a very precise analytical statement."
Patrick did his doctoral dissertation on congestive heart failure patients, and uses CHF as an example of how aggregating vast swatchs of data can improve care on a population basis.
"If we can gather data on all these millions of patients when they go in to the hospital, how long they're there, what meds they're taking before, during, and after their stay, blood type, weight, cholesterol numbers when you look at that data based on the experience of one local doctor, it doesn't mean much, but when you look at millions, data doesn't lie. So I'm quite confident we'll develop a much deeper understanding, and that's where Watson comes in. Watson looks for meaning between the variables and consumes millions of journals and relates that to one patient. This is going to change medicine from an anecdotal basis to a personalized data-driven form."
But, as Patrick posits in his book's title, he says attitudes are going to have to change in order to fully realize this potential. In almost every way, he says, healthcare IT is about where the Internet was in 1992 old-fashioned formats, old-fashioned ways of doing things (think of physicians tapping away at a laptop screen), and perhaps most daunting, old-fashioned walled gardens akin to the Prodigys, and Compuserves and America Onlines that dominated packet-based communications in the first wave of online communities.
The looming question is how to create that overall gestalt of openness in healthcare, of "competition" similar to the attitude that has led financial institutions to create standards by which customers can transfer their funds from one to another in a matter of seconds. Right now, as Patrick says, in order for population health to work, "you have to have the data and the data is in the EHRs."
On an episode of Charlie Rose that aired right after IBM announced Watson Health, CEO Ginni Rometty said Watson Health was the company's "moonshot" for this era, the big and inspiring roll of the dice that compares with IBM's role in helping the space missions of the 1960s. Rometty said that, over the course of an individual's lifetime, what's in an EHR might account for 10 percent of that person's pertinent health data; genomics, another 20 percent. But other data, what Rometty termed "exogenous" to formal clinical numbers, will account for 70 percent.
At the moment, with so much pessimism around health IT, with interoperability efforts going in fits and starts, with data breaches occurring far too often, with docs complaining that EHRs haven't been worth the trouble and patients discovering too often their portals are doors to nowhere, maybe Rometty's "moon shot" will also turn out to be her triumphant moment. Just as Lou Gerstner demonstrated that the tech world was ready for a more open ethos, maybe Watson Health will be Rometty's legacy in doing well by doing good.
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