The aggregation theme evolved quickly and was the title of one of the morning’s panels.  From my perspective, the notion of aggregation falls into three big buckets:  aggregation of content, aggregation of patients and aggregations of physicians/provider.  The aggregation of content play is lead by HealthCentral and WebMD, and in both cases, the eyeballs on the content drive the ad dollars.  The aggregation of patients is a bit more intriguing. It is led by Google Health, but as Microsoft HealthVault’s General Manager made clear in the consumer aggregation panel, they are a platform and not an aggregator.  If that is the case, then, in my humble opinion, why is it called a Vault!?  The last spot in the aggregation game is providers, which in some cases is for communities and in others, for delivery of online service, like American Well.

So, the idea of interoperability first laid down by HealthVault was expanded significantly in a Health 2.0 Tools panel that started with MediKeeper and change:healthcare, migrated to interactions of records and EHRs with Sage and Kryptiq and moved to the very real issue of drug interaction issues with Polka and PharmaSURVEYOR.

From a CLOUD perspective, this idea of aggregation and interoperability seem to be in tension, both conceptually and in the business models.  And, if the aggregation remains at the website level, the cost of interoperability will simply be too high.  My worry is that the wonderful innovations I saw today and yesterday won’t be fully maximized unless I can put the best of them together for my purposes.  The race for Web real estate has been tried before, and it failed back in the dot com bust in the early days of Web 1.0.

The only place in which aggregation and interoperability truly meet in an unrestricted way is at ME, the individual, the consumer, the patient.  Rather than putting fancy front-ends on a systemic problem, the Internet must be reinvented from the inside out.  Nowhere is this more clear than healthcare, and in the case of the health system and its users, it really is a matter of life and death.

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Much like HL7 and CDISC have only 15% adoption due to privacy concerns, these topics, payments especially, appear to be the elephants in the room at Health 2.0.

There is lots of innovation at various points in the system from American Well to Practice Fusion to YourNurseIsOn, but all of these exist in the current plane of competition (Innovator’s Prescription, Clayton Christiansen). Without reorienting the system from the user, ME, out, we’ll be putting fancy Internet and Web interfaces on top of the problem but not fix it. A CLOUD-enabled world means to change that plane of competition, so all these innovators have a new standard to work with that actually solves the problem.

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