[Openid-specs-heart] There is no business model for patient-directed or patient-mediated exchange

[Adrian Gropper]

Today's discussion was very timely. The issue centered around what
incentives a hospital or their EHR vendor would have to adopt FHIR as an
alternative or improvement to patient portal View, Download, Transmit. It's
hopeful to envision an economic win / win / win situation for
patient-directed or patient-mediated interoperability where the three
parties are: the provider institution / the provider's technology vendor /
the patient.

Unfortunately, this is NOT LIKELY for some very obvious reasons. Here are
some facts:

   1. Apple (the largest company on the planet) is giving away for the
   vendor intermediary component and doing a very good job of it. The software
   isn't just free, it's actually built into the mobile OS so you have it by
   default. It's like trying to charge for text editors if Microsoft builds
   Word into Windows. It's hopeless unless Apple screws up on privacy or
   security or user experience. I would not bet on that.
   2. The provider (the first win) can't charge the patient for API access
   and ONC and Don Rucker himself have made it clear that patient-directed or
   mediated access needs to be built into the cost of the medical service
   provided (the same way the hospital doesn't charge you for medical records
   or the the electricity used during your visit). Patient access via a portal
   and via a FHIR API is simply a cost of doing business built into whatever
   service is being billed. You can't decline it because it's a right of
   access.
   3. The benefit of patient-directed or mediated interoperability accrues
   to the patient (the third win) in their ability to get second opinions,
   shop for alternatives, and "leak" out of the provider's network. The
   patient might well be willing to pay for these benefits but because of 1.
   and 2., they will not be paying either the provider or the provider's EHR
   vendor.

As a result of these simple facts, HEART has failed to get any significant
participation from either the provider or the EHR vendor businesses.
Expanding the scope of HEART to take up patient ID, patient matching,
patient verification, app certification, and all sorts of other
provider-directed exchange topics would not change the reality of 1, 2, or
3 and will put us in competition with Argonaut and CARIN and other groups
that are already chartered to represent the interest of the provider and
EHR vendor stakeholders.

Adrian
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