Over the past twelve months the temperature of healthcare IT has moved from a relaxing blood warming bath, to a searing hot therapeutic spa, complete with eddies and whirlpools of absurd valuations. It’s been a wild ride that has obvious connections with the dot com bubble — a time I recall from first hand experience. Back then the contrast was stark.  One day streets were filled with bustling enthusiastic technologists, and then suddenly, abruptly empty, as the money dried up and businesses closed, their decorative fountains softly babbling until someone finally remembered to cancel the utilities.

The signs are all here. The absurd valuations for companies that have a better blood test. The high fives and declarations of “awesome” at conferences as delegates speak in their unique healthcare IT patois of “engaged patients”, “APIs”, and “new operating systems for healthcare”.

It’s a kind of blind optimism that my taste for healthy cynicism reminds me must surely pass in the near term. Yet, while many of these ideas will pass into obscurity, the conceptual changes will become part of the fabric of our time, from which will emerge mature products.

You won’t need a crystal ball to see the outcome of this shakeup because reflecting on the past provides all the clues we need. In ten years we will see a few titans of healthcare IT standing strong, swallowing innovations wholesale as they emerge from small startups. They will own the market through financial and contractual dominance, presenting a single face for healthcare systems to work with, instead of an endless sequence of pilots leading to unscalable failures. This is the challenge of our time; to be a titan, or to sell early ideas to titans for a so-called easy exit.

As a self-confessed creative, my role in the future will be to generate inventive concepts, build them, and sell them to people who have the skills to transfer them into a global market. It’s a complex task that requires a deep understanding of healthcare, as well as the desire to continue learning in a massive field that will always tower above you like an intellectual Everest.

It’s important to remember that simple ideas can be powerful; more technology doesn’t equate to a better experience or outcome for a patient, and improving the patient’s situation is the name of the game. Patients with complex conditions need medical treatment from real doctors, not some AI that has a sexy name, but no clinical validation.

We must also remember that if you’ve seen one healthcare system, you’ve seen one healthcare system. What works at Partners probably won’t translate to Kaiser’s environment, and assuming that the pilot you’re working on will just “slot in” is extremely naive. These are large, complex, individualized systems that have evolved over extended periods of time, that are resistant to change, and are under continuous pressure to balance patient outcomes with staying in business.

Ah ha, you say, surely APIs will fix this? That piece of unmitigated nonsense continues to swirl around the news, and regardless of whether you believe FHIR or some other RESTful JSON variant of a “new healthcare operating system” will save the world, I contend that this is a distraction from the problem at hand. Protocols in healthcare have existed for some time, and they continue to focus on transport and data representation, rather than workflow’s across the enterprise. They are a necessary, but not sufficient condition, for moving to a higher state of interoperability.

As the bubble continues to inflate, it’s edges thin into a transparency that allows us to gaze through a pink tinted view to the hot air within. The patient’s temperature is rising, and as the fever climbs, insane oscillations and seizure-like behaviors precede imminent death. Yet even with all this uncertainty, one thing remains clear.

There will be winners, and they will win big.

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