The mobile health revolution is occurring in the midst of a much broader shift in business models around computing and software. For decades, IT suppliers sold proprietary hardware by locking customers in and upselling them for decades with add-ons and upgrades. The concept of switching costs became a tool for building barriers –barriers for customers to choose new suppliers and barriers for entry for new businesses.
One of the first visionaries to buck this trend in IT was Bill Gates. His choice to focus on the desktop operating system in a world where IBM was making huge profits selling hardware must have seemed foolish to many. He saw the potential for that desktop to be both the basis for a profitable business and a platform for innovation. Legend has it, he drew the analogy that “each desktop computer is a razor and our software products are the blades,” alluding to the business model made famous by Gillette.
As IT strategies have evolved, it’s common to ask new entrants, “Are you a product company or a platform company?” The idea is that a business can succeed if they develop a bit of roadway or plumbing that others find it advantageous to ride on (or through). The fun part of watching platform companies execute is how they decide what to keep proprietary and what they open for innovators to ride on. Google guards its core Page Rank algorithm sacredly, but exposes many other services including its maps API, Google docs and, of course, the now powerful Android operating system. Long ago, Google decided it was going to make money by aggregating large numbers of people on the web, initially through search and increasingly through other means, such as its mobile operating system.
I suppose all of this thinking originated even further back, when toll gates were introduced as a way to make money through controlling a transportation route. Software platforms are like this. You innovate on top of the platform and someone (you or an advertiser) pays a toll for access.
So what does that have to do with connected health?
About 10 years ago, we started in earnest to focus on the problem of home monitoring for chronic illness management and prevention. At the time, the sensors we used were ‘dumb’ and extracting the data required tethering them to a central hub, which in turn connected through the patient’s phone line to a server computer somewhere. The early visionaries who offered home monitoring systems provided end-to-end solutions. By putting together the sensors (scales, blood pressure cuffs, oximeters, etc.), the home communication hubs, the connectivity to the server and the various software components, these companies were able to develop vertically integrated, high margin services. And we were grateful because we could not manage all of that integration on our own. We focused instead on showing the clinical efficacy of home monitoring.
As we moved from monitoring congestive heart failure (CHF) to hypertension and diabetes, we couldn’t make the numbers work for these vendor proprietary systems. Their integration and resulting profit margins were too expensive to justify for these lighter touch applications.
The sensors were still dumb, so these monitoring programs ended up with its own cobbled together solution from the sensor to the hub to the software and analytics. I credit my old friend Doug McClure for bringing this cacophony to my attention and suggesting we build a platform to centralize the data flows and allow us to source components individually on the front end. Doug was visionary in this regard and architected a system that we are still using today, seven to eight years later. Its core is a database structure that enables us to securely bring in data from home monitoring devices via several channels. Over time, we moved from vertically integrated vendors to customized packages that are patient and condition specific. We now use a number of different sensors (now with integrated wireless radios – no more cables) and at least two home hub devices, which feed their data into our technology platform. From there we can display those data for both patients and clinicians.
In fact, as we saw better and better outcomes from these home-monitoring programs, and anticipating a move to pay-for-value reimbursement models, we made the case to IT leadership at Partners HealthCare that these data should be integrated in our core clinical systems. That journey was completed a few months ago and we are now able to securely bring home monitored data into our electronic medical record (EMR) system. This data is displayed for clinicians in the Partners EMR and for patients in the Patient Portal via a common infrastructure pathway.
We created a platform and achieved Doug’s original vision. And, it didn’t take long for us to start to reap the benefits of this strategy. As clinicians move their focus from acute illness to prevention, we are increasingly becoming interested in activity monitoring as a clinical measurement and tool for patient engagement. Via this technology platform, we are able to easily integrate a number of commercial activity monitors into our system.
In fact we are just now completing our own ‘input service’ or ‘API’ so parties that want an onramp to our highway will be able to develop the software to do so.
One of the most exciting opportunities to come our way in recent months involved a bit of serendipity, but illustrates the power of platform technology. As we look to the future, we envision many more patient data streams coming into the system as we extend care beyond our four walls and make it a continuous function in the lives of our patients. Among the most important data types to fill out this vision are Patient Reported Outcomes.
As luck would have it, the team at Partners implementing the strategy to measure patient reported outcomes was looking for a way to integrate these data into our electronic record and patient portal. We started collaborating about eight months ago and the result culminated in a funded project to link patient reported outcomes into our EMR and Patient Portal using our core platform. It’s a win/win. The institution gets to reuse the platform and leverage that investment, and the Center gets to be a leader in the gathering and analysis of both subjective and objective patient-derived data.
It’s a nice chapter in a long story that illustrates the power of platforms for innovation.