So I’ve been uninvolved in the day-to-day operations of Synapp.io since February, mainly doing custom development for folks (some call it “fractional startup CTO” but I’m not actually really sure what that means). While this pays the bills, I’ve been looking for what’s next for me, and I’ve been exploring healthcare IT.

This space is interesting to me for a number of reasons, but it really boils down to these two facts: a) I inhabit a body and b) many of my friends and people I care about also inhabit bodies. So things that make those bodies work better, longer, etc. are interesting to me, and if I can somehow marry that with a business, so much the better.

The problem with healthcare IT is that it’s an incredibly broad market, with way too much to explore in a reasonable period of time. So I’ve been trying to narrow things down. One avenue I’ve been exploring a little is bringing some of the retail analytics technology and science I learned while working at Predictix to healthcare providers, particularly in helping them optimize their inventory of consumables and replenishment strategy to drive costs down. While there’s been _some_ interest in this, I’m not sure I feel the authentic demand that everybody at Flashpoint talks about.

Last week, in seeking to learn more about the market, I attended Health Connect South. It was an incredibly educational experience, and I got a chance to meet a number of people that I’m certain I never would have run across outside that context. One thing that I noticed during the conference is that nobody was talking about the costs of delivering healthcare, or inventory, or stuff like that, at all. That could be simply due to the prevalence of practitioners in attendance (Doctors don’t generally get into medicine to become business managers), but it made me reconsider supply chain as a focus.

What people *did* talk about a bit, particularly in the “Big Data and Healthcare” panel, were issues that were all related to electronic health records (EHRs):

– While an EHR may have all the data a doctor needs to deliver care, it’s not particularly well-organized or accessible at the point of care. (My doctor may not find my Grandmother’s breast cancer relevant to my strep throat infection, for instance.) Bringing the most relevant information to the front seemed to be something missing from existing solutions.
– Consumers on their own, and sometimes patients at the directions of their doctors, are starting to collect a _lot_ of data using wearable devices. Often, this is not even present in the EHR, and when it is, it can get lost in a jumble of unstructured data. (If my Fitbit has continuous heart rate monitoring on me for the last 6 weeks, why on earth is the nurse taking my pulse at the beginning of my annual physical?)
– *Precision medicine,* customizing treatment to the individual and their own genetics and biochemistry, is becoming more and more of a hot topic. Any kind of precision medicine, however, relies on actually having a place to store the data on the patient as a first step.
– Clinical trials are perpetually in search of participants who meet certain criteria, and filtering and screening applicants is currently a time-consuming process that really _should_ be easy to do (IMO) with an appropriate EHR solution.
– A fragmented EHR market means that patient intake is a much more painful process than it needs to be. When I start seeing a new specialist, they may go through a number of tests and questionnaires that collect unnecessary, redundant information that *already exists in another EHR*.

Now a good bit of work is being done to prod healthcare providers and EHR vendors to make their systems work better together. In particular, the CMS Meaningful Use standards (https://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives) are connected to financial incentives. HL7 and FHIR are making some strides in defining common APIs and data formats, but it’s still a fragmented market, with the technology over-promising and under-delivering.

Immediately my mind went to the idea of One EHR to Rule Them All, a portable record that went with the patient from provider to provider. But of course the problem with an idea like that is that every EHR is trying to be the One EHR. (“The best thing about standards is that there are so many to choose from.”) So assuming I can’t do that, what else could solve the problem?

One idea would be to provide an EHR to EHR connector service. Think of it as ETL for healthcare, or Zapier for healthcare. There are certainly lots of barriers in place to a business like that (one of the largest EHR providers charges tens of thousands of dollars per site for export functionality to be enabled). So I did a little googling and found out that there are already businesses – mostly consultants – who will build your interoperability for you. Now a good business (IMO) that could be built here would be one that develops such integrations and interoperability as a service, but does it in such a way as to collect a library of IP that makes each new project just a little bit easier.

All that being said, I’d love to make that pivot in my own “fractional CTO” work, so if you know of anyone who’s doing any EHR integration or interoperability work, I’d love to talk to them to see if I might be of service. I’d also love to hear any opinions on whether building the EHR-EHR connector service solves a real problem for healthcare providers, or if I’m just imagining that it would.