My oldest is now driving, which means that she and I are sometimes sharing a car.

It has generally been a good process, as long as I don’t think too much about her leaving for college soon.  When I crawl into the car, there is always evidence she has left behind.  The seat and mirrors need to be adjusted.  I have found earrings in the cup holder.  Her chemistry book has been left on the floorboard more than once and I am starting to wonder if that one is on purpose.

One thing that makes me smile is knowing that I will always find a CD of some unknown indie band playing.  She loves music and I like getting a little of ‘her sound’ before I punch it out and flip over to the news. 

It reminds me of what my dad must have experienced when his Nat King Cole or Waylon Jennings 8-track tapes had been replaced by Bachman Turner Overdrive.

Ba-ba-baby, you ain’t seen nothing yet.

Which is fitting counsel for our industry right now as the EHR land rush continues to heat up.  It is fair to say that the entire HIT industry, and the providers to which they sell, are hyperventilating right now.  I guess that is what happens when $20-30 billion of money is thrown your way.

Last week I was on the ONC website where the first of the newly certified EHR products were listed.  Vendors are snapping photos of their now certified products like proud parents of fresh-faced graduates holding crisp new diplomas. 

Everyone is excited, and everyone should be.

There will be more excitement when the stimulus checks come in the mail, but that is for another post.

Amid the press releases and flying emails announcing the news that many have now made it officially across the first line, BTO echoes in the background.

Ba-ba-baby, you just ain’t seen nothing yet.

We’ve written generally about the impact technology adoption is going to have on our industry (see here and here for a couple of examples), but as I have been noodling this 70s rock band message for the past couple of weeks, I think it is time to start unpacking this more specifically.

The EHR craze is just the first in a big three stage industry evolution.  Wide-spread EHR implementation, in physician offices and hospitals alike, is the necessary first step.  We have to digitize the data before anything else can happen.

Yet, we have learned from the early EHR pioneers that ‘within the walls’ software implementations only slightly unfreeze the information locked in the paper charts. Is it good that information can more quickly flow from the front desk to the exam room?  Sure.  Is it good that a physician on call can login to see the chart of a patient who is in the ER?  Sure.  Does that change the game?  Not so much.

As a lever of systemic industry change, EHRs alone are pretty limited.  Archimedes, the Greek math dude that postulated he could move the world if only he had a lever long enough, would not be impressed.  With only EHRs, our data is still mostly frozen.

Which gets me to my favorite new buzzword.

‘Data Liquidity’

Now, I feel far cooler dropping ‘data liquidity’ into my conversations about all of this IT stuff.  The data, the information, is frozen, but we have to let it flow.  It has to be liquid.  So, the EHR implementation phase is the necessary first stage.  It can’t flow until it is digital, so digitize it. 

Great, we’re doing that and a lot of money is changing hands and a lot of hard work is underway and tons of physicians and their staffs are learning how to use their systems.

Phase Two, underway simultaneously, is less sexy because it is fundamentally about plumbing.  Movie producers love films about doctors and nurses; plumbers, not so much. 

Plumbing, however, is a key if liquidity is the goal.  No plumbing and the liquid doesn’t move to where it needs to go.

The HIE (health information exchange) game is in full swing and the plumbers are working hard to connect the pipes.  They are having esoteric (and mind-numbingly dull, to the rest of us) conversations about data exchange standards and transfer protocols and a million other things that I will never understand.  But getting the plumbing right is critical.

On the technical side, the HIE issues are really complex and probably a lot harder than making the initial EHR software work.  It is one thing to master a program where you control all of the parts.  It is another to make all of the disparate systems with all of this really complex data talk to one another.  We’re talking about information that directly drives how we care for a patient flowing from this system to that, through this exchange or that, and ending up in the right field with the right value at the right time.

It is heady stuff.

The technical side of the HIE world is probably easier than are the political issues and business model questions. I’ll bet on the gadget-heads to get their part right before the suits figure out theirs.

But, in spite of fits and starts and failures along the way, we’ll get it done.  Other industries have climbed the same mountain and enough brain power thrown against the problem will solve it.  Then all of these EHRs that we are furiously installing will all begin to plug in to the plumbing that hides underground.

Ubiquitous data interchange, if you want to sound technical.

Data liquidity, if you want to sound hip.

Then we get to the third stage, the really fun part of this whole journey.  That is when we start creating new business models and coming up with new ways to add value.  There will be winners and losers, and some big surprises on who ends up in which of those two columns.

This is not linear, because some of these Third Stage experiments have already begun.  They are early ideas, proof of concept things that have not yet scaled enough to really upset the industry.  But they offer a glimpse into where we are heading.  It feels a lot like 1995 in the Internet world.

But this stage, the stage that really matters, is enabled only by data liquidity.

So much of what we do and how we do it is tied to ‘where’ our data lives.  The data are physical (paper), so our business models and value chains and processes are constrained as well.

Once the data are digital and liquid, the ‘where’ does not matter.

And once the ‘where’ does not matter, we can rethink ‘who’ does the work.

And when we are free to think about ‘anywhere’ and an entirely different set of ‘who’ options, we will come up with new ‘what’ and ‘how’ alternatives.

And that is when the proverbial industry transformation occurs.

Here is a quick case in point.

Blockbuster, a darling of the 90s, is now in bankruptcy because their product got digitized and the Internet is a cheap plumbing system.  The process of schlepping to the store for a movie is now just too much of a hassle.  On Demand and movies on your smart phone or PC are so much better.  Today, you can buy about 50 shares of Blockbuster stock for the price of that $3.00 movie rental.  Ouch.

This is a theme to which we will return in future posts.  We think this is the conversation that matters.  We’ll see what lessons we can learn from industries that have gone before us in ‘liquefying their data.’  We’ll look at some of the early experiments with new healthcare business models as we try to divine the future opportunities. 

But here is the big point.

Right now, the software makers and the associated implementation pros are getting all of the attention because they are a gateway to about $44,000.  The plumbers, the real deep technical nerds, are working to make the HIE vision a reality.  All of that is good.  But the business people better get engaged.  This is not a software or plumbing issue.  This is a strategic business matter, an opportunity or a threat, to redefine what we do and how we do it.

Because we ain’t seen nothing yet.