All of us are smarter than any of us: Welcome to the community

By Glen Tullman
04:06 PM

The recent release of the final rule on "meaningful use" will have a profound impact on healthcare providers across the country.  Those who already have an electronic health record in place are well positioned to capture a share of the $30 billion in Federal funding based upon meeting increasingly challenging standards of use.  Many of those who don't have an electronic health record are starting to search for one.

The final rule is good news for providers, who'll be reimbursed as early as next May for technology that has been proven to reduce errors, improve quality and help improve their business. And it's good news for patients, who'll benefit from the resulting improvements. 

But as we look forward to the transformation that the stimulus will accelerate, it's worth thinking through where this change may lead us. The real question is, how will the widespread use of electronic health records change healthcare in America?

For years, we at Allscripts have argued that the answer to that question is that use of electronic health records will 'connect healthcare.'  If you want to improve care across a health system, information must be freed from the silos that restrict its flow.  Physicians in the clinic need to be able to access information from the hospital; those in hospitals need to understand how their patients were treated outside; and post-acute providers need to have access to both physician and hospital information.  Connectivity is  key to the free flow of information and physicians with more information, contained and easily accessible in their electronic health records, would deliver better care.

As it turns out, we were only partly right.  Connectivity and the access to information is only the beginning.  The real payoff is tied to a much more old-fashioned word: community. 

To better understand, think about the following question:  What do the following five things have in common? 

  • Who Wants To Be A Millionaire
  • The Symbiotic Intelligence Project
  • Wikipedia
  • The Harlem Children's Zone Project
  • Sharp HealthCare in San Diego

Stumped?  The answer is that each of these organizations has, in its own way, proven a single concept that is central to the future of healthcare in America – that all of us are smarter than any of us.

"Who Wants To Be A Millionaire" is one of the most successful TV game shows in history.  But as James Surowiecki, author of The Wisdom of Crowds, pointed out, Millionaire is also one of the great examples of the power of group intelligence.  Contestants win by correctly answering a series of increasingly difficult trivia questions.  When stumped, they have three options: eliminate half the possible answers, call a friend or expert for help or poll the audience for their opinion. 

Which is the most effective?  Surprisingly, it turns out that the poll is the most effective choice by far.  While the most intelligent friend or expert the contestant could find  gave the right answer only 65 percent of the time, the show's audience of strangers delivered the right answer over 90 percent of the time. The data from Millionaire suggest that the best way to get a reliable answer – to a trivia question, at least – is simply to ask a group of people who are wrestling with the same question.  But does the same approach work with other kinds of problems? 

It seems so.  Surowiecki points to a series of experiments conducted by physicist Norman L. Johnson at the Los Alamos National Laboratory. Johnson is the founder of the Symbiotic Intelligence Project, which investigates how information systems such as the Internet can help groups find solutions that individuals don't find on their own.  As New York Times healthcare journalist Steve Lohr wrote recently, "few concepts in business have been as popular and appealing in recent years" as the discipline that visionaries like Johnson have (as a group) contributed to founding.  Known by a number of names -- open innovation, crowdsourcing or collective intelligence -- "the overarching notion is that the Internet opens the door to a new world of democratic idea generation and collaborative production" writes Lohr.

Wikipedia is one example of the power of collective intelligence and community innovation.  Eight years ago, when Microsoft, a company with over 88,000 employees, launched its Encarta digital encyclopedia, who would have bet that a start-up with 35 employees would win the global quest to produce the best digital encyclopedia? 

Yet, when Microsoft decided to discontinue Encarta last year, Wikipedia was receiving 97 percent of the visits that U.S. Web surfers made to online encyclopedias. 

Why?  In the end, Microsoft -- a great company and a great partner of ours -- chose not to compete with Wikipedia's community -- the millions of online volunteer contributors.  

Look around and you'll find the same story repeated everywhere.  Whether it's Google for information, YouTube for videos, Facebook or Twitter for socializing or Flickr for photo sharing, the power of the connectivity to improve upon old business models is undeniable. 

Each of these businesses, and innumerable others that leverage the power of collective intelligence, rests not on the fact that they are Internet applications or even that they are connected, but rather on three basic concepts:

  1. They are all communities
  2. We all contribute 
  3. We all benefit, in many cases, disproportionately to our contributions

Which brings me back to healthcare. Assuming the Stimulus and other efforts in the market succeed in making the electronic health record ubiquitous, and we believe that it will and will do so quickly, how will this connectivity change the way we provide care? The answer, I believe, lies in community. 

But what, exactly, is a community? According to Wikipedia, community has traditionally been defined as "a group of interacting people living in a common location."  While the Internet is changing that definition by expanding the reach of individuals and breaking down geographical barriers, it's important to remember that all healthcare is local.  The vast majority of care is provided within an hour's drive of the patient's home.

Which means it's ultimately up to local groups of healthcare providers to manifest the future of community-building using technology. So, here's the real point. As we talk about the future of healthcare and about two of the newest concepts -- the Accountable Care Organization and the Medical Home -- what we're really doing is using technology to go back to the future.  We're making it easy for teams to collaborate to deliver better care. In the end, it's a group of people in a connected system of health that will manage both our health and our care. That's the real innovation being enabled here.  It's just like the old days, only better. 

Communities across the country in places like Hartford, CT, Worcester, MA, and San Diego, CA have already seen the writing on the wall.

  • In Hartford, CT, Hartford Healthcare Corporation is one of the leading examples of a health system that has leveraged technology to build a broad community of care.  Under the visionary leadership of Steve O'Neill, Hartford's Vice President of Information Services, the health system has integrated many of the best-in-breed IT solutions – including Eclipsys in the hospital and Allscripts in the physician practices and homecare agencies – deployed across its network of hospitals, physician groups, long-term care providers and home health providers.  And Hartford was one of the founders of a statewide health information exchange, a groundbreaking effort to develop the "physician office of the future" by sharing patient information electronically across multiple healthcare organizations and stakeholders. Steve doesn't talk about technology; he talks about improving patient care by using the power of the network.
  • UMass Memorial Healthcare, Central Massachusetts largest not-for-profit health care delivery system, is another great story. Under the leadership of CIO George Brenckle, UMass has developed a unique connected healthcare strategy that enables information sharing and collaboration among all the members of a patient's care team, inside or outside the health system.  The Allscripts Electronic Health Record used by their 400 employed physicians, for example, is being connected not only to the health system's flagship hospital, UMass Memorial Medical Center, who uses a competitive system, but also to many of the system's 2,000 affiliated physicians who choose to participate.  This sharing of information reduces potential errors but also cuts duplicate tests and moves patients through the system more quickly. And, despite using multiple systems, UMass has "one source of truth" about the patient.
  • In San Diego, Sharp HealthCare, recipient of the 2007 Malcolm Baldrige National Quality Award, is implementing the Allscripts Community Solution to enable physicians, hospitals and other health care providers across Sharp and its affiliated practices to connect and collaborate for a team approach to patient care, regardless of where they are located or which clinical technologies they use. Under the leadership of Bill Spooner (HIMSS/CHIME CIO of the Year in 2009), Sharp is giving clinicians shared access to a single, unified patient record, bridging gaps that often exist between hospital-based and office-based care.

Each of these organizations is well positioned to achieve "Meaningful Use" based on the efforts they have already made.  More important, though, they are poised to achieve the longer-term goal, something we at Allscripts call "Meaningful Value."  Simply stated, "meaningful value" comes from harnessing the electronic health record to drive value for you, your practice and your patients and that extends beyond simply benefitting from the Stimulus dollars. It's truly about equipping our physicians, nurses and other caregivers with the information they need to deliver the care we want and deserve.

Thanks to the Stimulus, we have an injection of funding to leverage technology work towards meaningful value and to build virtual communities of care across the country, connecting providers and patients to all the information they need, when they need it, to produce the best health outcomes.

The industry is undergoing many changes -- consolidation, mergers, acquisitions and strategic partnerships -- all aiming toward creating the foundation that will join the disconnected silos of healthcare to create connected communities with new care models that better serve both providers and patients.  At Allscripts, we believe we're leading the way, not just through our merger with Eclipsys (see for more information) or through our size and ability to connect 180,000 physicians, 1,500 hospitals, and 10,000 post-acute organizations, but more important, through our willingness to connect all healthcare stakeholders to create something entirely new.

Imagine a physician who's able to tap into the collective wisdom of hundreds of thousands of their peers to solve a particularly thorny problem. If 50 people who had nothing better to do on a weekday afternoon than to sit in a game show audience were right 91 percent of the time, imagine the intelligence of a network of the world's best clinicians.  And imagine a team of connected caregivers in your own community all without paper but with real-time information access.

With a community like that at your fingertips, what problems couldn't you solve?

An Inspiring Example

Many have said that healthcare is fundamentally different from other industries and that getting past the inherent problems that plague our system is impossible.  The same criticism has long been leveled against our nation's education system.  That's why I find the story of Geoffrey Canada so inspiring, and so relevant to this discussion.

Born to a working class family in the Bronx, Canada worked his way through college, earned an MA in education at Harvard, and then returned to New York City in the 1990s determined to help improve the city's school system. Canada tried a new approach to solving the educational problems that have plagued Harlem for decades.  Rather than try to solve the problem of a particular "silo" -- the school -- Canada decided to focus on fixing the community as a whole. 

The result, the Harlem Children's Zone Project (HCZ), has been called "one of the most ambitious social-service experiments of our time," by The New York Times. While HCZ provides free and world-class education for Harlem's kids from infancy through high school, the 'tipping point' was creating a neighbourhood that surrounded the children with an enriching environment of college-oriented peers and supportive adults.

After starting with just one block in 1997, today HCZ has grown to nearly 100 blocks and provides services to 17,000 children.  It’s been such a great success that President Obama instituted a Promise Neighborhoods Initiative intended to replicate the HCZ in 20 cities across the country.  The program received $10 million from Congress in 2010,  and the administration has requested another $210 million to move from planning to implementation.

Geoffrey Canada's genius was in realizing that fixing a school wouldn't have a lasting impact.  To really change the educational system, he decided, you need to create a community. 

What we think is overwhelming today, creating connected communities using technology, has already been done in virtually every industry.  Now it's our turn and the HiTECH Act and Meaningful Use are important stops along the way towards getting to a connected system of health to make us all proud.

Glen Tullman is Chief Executive Officer of Allscripts (