In my brief foray into Healthcare Information Technology (IT), it took only a couple of weeks to discover that the challenges they faced were harshly reminiscent of what we’re facing in Ag Information Technology.
Yet from a business perspective, the business-to-business arm of Healthcare IT has been lucrative for at least a decade, as evidenced by the fact that there are about a dozen publicly-held Healthcare IT companies. So what’s the problem in Ag IT? Why aren’t pure Ag IT companies scaling like their counterparts in Healthcare IT? What’s holding Ag IT back?
Before I start, let me clarify some terminology. Healthcare IT is served by hardware and software companies whose mission is to improve patient safety, health care quality, efficiency, data collection and potentially help restrain rising costs. Ag IT is similar in that it is served by a combination of hardware and software companies. While I don’t discount the role of hardware in Ag IT, my analysis has been skewed towards software companies providing software across a range of areas. Table 1 shows some examples of different types of software products within each industry.
You might be thinking, where’s telematics? Telematics is akin to how a medical device communicates with the Internet to move its data — it is infrastructure. You can think about telematics as infrastructure right along with local and wide-area networks (LAN/WAN), cellular systems, Wi-Fi, networking, security appliances and other Internet backbone technologies and protocols. One of the biggest reasons that Healthcare IT has been able to scale as an industry — to the tune of $24 billion by 2015 — far earlier than Ag IT is that core Healthcare IT relies on an exceedingly mature LAN/WAN infrastructure. In Ag IT, the infrastructure that we need to achieve breakout growth is still being built and installed, all the way out to the machine.
Just a couple of years ago, there were large areas of the U.S. that weren’t covered with cellular signals. Today, even in lesser developed international markets, access to signal has reached a tipping point. In Ag IT, we will continue to rely on companies’ investments in infrastructure for several years. Those companies will continue to be incentivized with a disproportionate amount of the available profit while this is underway, with the longer term shift toward companies servicing the end consumer more directly.
Fits And Starts
Now, let’s shift gears and move away from hardware and infrastructure toward the pure software aspects of Ag IT (see Table 1). Where Healthcare IT and Ag IT maintain striking similarities is in the area of interoperability between software systems — more specifically, the lack thereof. With the passage of the Federal HITECH Act in February 2009, new rules were created demanding interoperability within Healthcare IT. Out of the $25 billion dedicated to driving the adoption of Healthcare IT, roughly $600 million was targeted at the states to build out state-level Health Information Exchanges. Because of the sophisticated nature of the Health Information Exchanges grant program, actual data on implementation of Health Information Exchanges is very difficult to interpret. But the overwhelming sentiment in Healthcare IT is that the money has not been effective in driving Health Information Exchange development and adoption because many states basically licensed a commercially available product and “checked the boxes.”
As a result of this tokenism, interoperability goals in Healthcare IT are still far from being met. Furthermore, the federal dollars will dry up without the emergence of a compelling and sustainable industry business model. Consequently, businesses — especially actual healthcare facilities — have been very reluctant to make investments in Health Information Exchanges because it will ultimately end up being reflected as a cost increase to the patient.
Because of all this, as recently as March of this year, I maintained some serious doubts that Healthcare IT was on the right track in the area of interoperability. However, a recent announcement made by a newly formed organization called the CommonWell Health Alliance has many in the industry suddenly bullish on the future of interoperability in Healthcare IT. The organization was formed by several of the country’s top Healthcare IT software companies, most of them publicly held. This alliance has been formed with the following mission:
- The CommonWell Health Alliance aims to define and promote the following core services and standards while enabling care integration and data liquidity.
- Patient Linking and Matching: Provide a way for vendors to identify patients as they move from setting to setting, in a robust and seamless industry-wide data environment.
- Patient Access and Consent Management: Foster a HIPAA-compliant, patient-controlled means to simplify the management of consents and authorizations for data sharing.
- Record Locator Service and Directed Query: Enable providers to match the locations of a patient’s previous health care encounters, no matter where the encounter occurred, and gain access to that data in an industry standard way.
Speaking at the press conference announcing CommonWell’s launch, Cerner CEO Neal Patterson said, “It’s time for vendors, even as they continue to compete in the marketplace, to break down their data silos.” He added that progress on the data liquidity front would have to come from the private sector. “Our government is not going to deal with this problem.”
Interestingly, Farzad Mostashari, the National Coordinator for Health Information Technology for the United States, has taken issue with this commercial alliance. “The question to ask is, will it work, will it help move us forward? Many efforts have tried to be ‘the’ network, but it can’t come at the price of inhibiting other good activities,” he said.
I’m having a difficult time believing Mostashari’s contention that the CommonWell Health Alliance isn’t going to move things forward, considering that the history of interoperability in Healthcare IT has seen tens of thousands of peer-to-peer integrations between systems. An entire sub-industry was created within Healthcare IT just to support the old model with untold billions going toward consulting and product development. Most of these costs were ultimately paid by the provider and passed along to the patient. A new study from the West Health Institute says that $35 billion of an estimated $750 billion in healthcare waste per year could be eliminated from the system by solving the problem of interoperability.
Regardless of how Health Information Exchanges ultimately take their final shape, the HITECH Act has definitely driven adoption of Electronic Health Record/Electronic Medical Record technologies as intended, so there is some positive news for Healthcare IT. However, there are numerous qualitative aspects of the new adoption that are cause for concern today. Moreover, one of the unforeseen consequences of all the changes in Healthcare IT caused by the government has been a complete paralysis of innovation. Virtually every software company in Healthcare IT has been forced to shift resources from R&D to becoming certified in the new environment. These certifications, called the Stages of the Meaningful Use within the HITECH Act, are scheduled to extend into 2016, leaving little hope of things improving any time soon.
Key Takeaways For Ag
For Ag IT, the lessons to be learned from Healthcare IT are abundant — and none are as clear as how to go about achieving interoperability and the need to proactively take matters into our own hands. Commercial entities must come together in order to prevent waste from being a necessary step in the process. I’m happy to report that there’s a lot of great news, because there are already many great efforts taking place in Ag IT. Many of those efforts are focused on solving engineering challenges related to equipment interoperability. For the pure software aspects of Ag IT there’s already an organization that stands out as the candidate capable of making a seismically positive impact on Ag IT. It is the AgGateway organization, and while the organization is structured and operated as a not for profit, it is constituted almost entirely of commercial entities with common interest in collaboration across organizational boundaries.
The mission of AgGateway is very similar to that of the CommonWell Health Alliance in that its focus is on interoperability. The big difference is that AgGateway has been around for almost a decade and is highly organized and managed. For the past four years, AgGateway has consistently achieved more than a 35% growth rate in its membership and today is made up of about 180 companies including all of the names you’re probably thinking of right now. The key issue being addressed in AgGateway is data standards, and that’s no easy thing to tackle. It’s well understood in both Healthcare IT and Ag IT that the lack of data standards is the central issue behind the majority of information systems challenges.
By now you might be exhausted just thinking about reading another article on standards, so we’ll exit the topic on a high note. Progress can and is being made. With the continued support from agribusinesses like the members of AgGateway and other groups, the opportunity to avoid the calamities that have occurred in Healthcare IT is within reach. It’s my sincere hope that agribusinesses not only keep investing in these collaboration efforts by being generous with resources, but also make your company’s position well known so your employees and customers can also contribute and participate.
Clearly, this critical component in the future of agribusiness will continue to evolve in the coming days, particularly in the area of software development. Stay tuned for updates as significant advances occur.