Let's Talk About ME 1.0 (and a New Way of Delivering Healthcare)

By Jennifer Dennard
12:03 PM
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I’ve been participating in the weekly #HITsm tweet chats for awhile now, and had the good fortune to meet many of my fellow healthcare IT tweeters in person at HIMSS a few months ago. It’s always nice to put a name with a face, or in this social media case, with an avatar. One icon that had intrigued me was that associated with @CLOUDHealth. As I knew from the chats, Gary Thompson was the man behind the diaphanous image associated with this particular Twitter account. The concept behind the account stemmed from CLOUD Inc., of which he is co-founder and CEO - also known as the Consortium for Local Ownership and Use of Data, Inc.

Though the organization uses imagery associated with wispy white puffs, there is a solid concept and purpose behind it, as its website states: “The Internet should start with us, not web pages. Our connections are bigger than the edges of a website, deeper than an individual social networking page and broader than any one of us can imagine. But, our connections are broken. Just like HTML unleashed the Web revolution; CLOUD's CTML will unleash the ME revolution.”

What does this have to do with healthcare? Well, according to the website, healthcare is just one of five ecosystems within CLOUD’s purview. “In the midst of the national debate over healthcare,” the website states, “we can not lose sight of the fact that health is about you. ME 1.0 can help both you and the healthcare system achieve that goal.”

But what does that really mean? Gary Thompson was kind enough to clarify a few things for me as he prepared for TEDMED 2012, which kicks off today in Washington, D.C., and from which he’ll be live blogging and tweeting.

Most of us have a basic understanding of what Web 2.0 means. What does ME 1.0 mean?
ME 1.0 is the CLOUD concept of focusing on the individual and their information, rather than the websites into which information is typically entered. Although we are pioneers in this space, we fully expect many others to contribute and advance this new paradigm. Advocating for ME 1.0 is not to say that CLOUD believes the Web paradigm will disappear, but as the many apps and other tools from smartphones and the post-PC era are already showing us, technology doesn’t stand still. ME 1.0 reflects a new design principle for not just the post-PC era, but a new information era.

Your website mentions that CLOUD is “dedicated to re-structuring the Internet to enhance privacy while facilitating connections between people and data.” It seems this statement is very reflective of much of what is going on in healthcare today – particularly healthcare IT as it relates to healthcare reform. How will a restructured Internet ultimately lead to better care?

Interestingly, industries beyond healthcare are attempting to resolve the same privacy, security, data portability and identity issues that are at the core of many healthcare IT issues.

These issues can’t be solved silo by silo. As global consumers, we’re not going to use one set of tools for health and then another set for finances and yet another for education. Having to manage privacy or data settings separately for my doctor, Facebook or Google rapidly becomes a scaling problem with the 100s of websites we each use in a year. When we start with the individual, the answers get easier, for both people and those attempting to access and use our information appropriately.

One example I like to use when discussing how a new Internet can impact health is with clinical trials. Scattered information about patients, as well as legitimate privacy concerns, mean that not only does an individual patient potentially miss out on a life-saving treatment, but that clinical trials for new drugs take longer than they should. By restructuring the Internet, information can unlocked from our digital filing cabinets by making it simultaneously private and transparent.

In the website’s description of the current limitations of the Internet as we know it today, entering the same information multiple times via different log ins for different sites is mentioned as a drawback. Providers often face this frustration with different log ins for different computer systems depending on what department of facility they’re working in. Will the new Cloud Internet advocate for some sort of single sign on?
Actually, CLOUD believes that the era of log-ins and sign ons will come to an end in the world of ME 1.0. These limitations aren’t an Internet issue as much as they are a consequence of a Web-based view. Even with great tools, like OpenID, we’re still logging in. That’s the problem, and a single sign-on simply puts a band-aid on it, rather than advancing the paradigm. Trying to resolve privacy, security, identity and data portability in the presentation layer is not only hard, but just not the most effective place to address the underlying problem.

CLOUD defines this new interface to information as a Digital Weaver™. Just like a web browser is to HTML, a Digital Weaver will be to CTML (context markup language). A Web browser, using both HTML and CTML, could be a Digital Weaver, just like you can view XBRL data (see below) via a web browser.

However, an iPhone or Android app, a blood pressure monitor or other piece of health equipment, could also be a Digital Weaver. Depending on the interface and the connections, the weaving of information may be narrow or broad, but the key is a greatly expanded view of how and when we access our information digitally. The Web or an EHR is just one way of seeing data.

It seems like the use of a new “open standard,” as you mention in one of your videos, would find great favor with the government, especially CTO Todd Park, who has a history of advocating for open source healthcare. Have you reached out to anyone at a state or federal level yet?
CLOUD’s founders and executive team have worked at both the state and federal levels during their careers. I served as an appointee for then Governor Bush in 1999 on the State of Texas eGovernment Task Force; and Paul Wilkinson, Chief Strategy Officer, worked in many different congressional roles, culminating in his role as Senior Advisor to the former chairman of the SEC, Chris Cox.

In Paul’s role at the SEC, he helped roll out a standard, known as XBRL (extensible business reporting language), now mandated by the SEC and many other global regulatory entities.

When discussing “open standards,” it is important to note two different ways in which they are adopted. In the case of HTML, no one thinks of mandating its use. The government, like any individual or company, simply uses this language, and the necessary tools, to create Web pages and deliver information. In the case of XBRL, its adoption was different. The standard developed in the private sector, and to spur its impact on public financial reporting, the SEC, like other countries’ agencies, chose to mandate it.

Since CLOUD will be a global standard, we are not working with any individual government or agency yet. Since the time horizon for CLOUD’s new language for the Internet is still 2-3 years away, it may be the case that we have elected an entirely new administration when it is ready. However, if Todd Park is still in his leadership role as CTO, we certainly hope, that like HTML or XBRL, he sees value in the new paradigm we are creating for the government’s work on behalf of the citizens of the USA.

In laying out the concept of the new Internet, it seems as if this new ME 1.0 world won’t need things like EMRs or HIEs – all the data will be out there, tagged and ready for accessing by different providers. How will CLOUD’s concept work “underneath” these IT solutions?
This is a powerful question and reflects exactly the paradigm shift that CLOUD envisions. Just like the iPhone and iPad changed what we expect in a mobile device, CLOUD wants our expectations to change with the Internet.

We’ve never needed EMRs, EHRs or PHRs. All we have ever needed is rapid, easy access to the right health information in the right context at the right time. The terms EMR, EHR and PHR define the containers into which we are putting health information. We will still need the right viewer or Digital Weaver™ for our health data, so we fully expect new tools to develop, and it is likely that current vendors will be amongst those developing the next generation of health access. With privacy and security in the heart of the Internet, though, there is no reason a Facebook could not become such a provider, too.

We’ll also still have HIEs, but we will create them virtually, the same way that information already flows freely on the Internet. However, we will no longer set up separate organizations to achieve the flow of private, secure information.  We can’t forget HIEs are a legislative creation, like ACOs and RECs. We can’t confuse organizational structures with the underlying goals that led to them.

Have you reached out to any healthcare vendors? To offer your new language as the engine that could power their product?
We’ve engaged in conversations with industry leaders and vendors, across not only healthcare but other industry leaders like Pearson, Northern Trust, SWIFT and technology vendors like Akamai. There are several healthcare leaders that we will be announcing soon as members of our Health Founding Circle, like LIVESTRONG. Other industries will follow. In respect to the confidentiality of these discussions, we’ll save the list for a future announcement.

At this point, we’re approaching the CLOUD paradigm from a business and strategy perspective but have in our long-term strategic a full technology liaison and evangelism effort.

What’s it going to take to truly get this off the ground? What sort of timeline have you set up?
CLOUD’s success will take time and money like any large-scale transformational project. Similar to the HITECH Act with its 2014 target, big efforts take time, and like ICD-10, sometimes those deadlines can even be moved.

CLOUD’s funding comes from Sustaining Circle and Founding Circle members ($50K and up), as well as individuals, through CLOUDCircles. LIVESTRONG is representative of our Founding Circle members, and we will soon be announcing several others, across industries. Although the effort is a significant one, by approaching the problem from a new perspective, the actual cost per year to fund the Consortium and our budget is not significant. In the spirit of transparency, we’ll be posting that budget to our website in the next several months.

Just like CLOUDCircles are designed to crowd-source the funding for CLOUD, like Wikipedia, we also expect to crowd-source use cases, scenarios, as well as testing. We are in discussions with industry leaders, like Spigit, regarding innovation platforms and community tools to support this new approach to agile standards development.

Jennifer Dennard is Social Marketing Director for Atlanta-based Billian's HealthDATA, Porter Research and HITR.com. Connect with her on Twitter @SmyrnaGirl.