Rhapsody

Life and Death and Taxes: The Conundrum of Cooperation

by Sean Zitello (Co-Creation Lab Director)
Oct 9, 2019
Life and Death and Taxes: The Conundrum of Cooperation

It’s easy to fix the healthcare interoperability problem. Everyone knows how to do it. We just give everyone their own node in the cloud. All data to and from goes through those nodes, and all data is in a perfectly interchangeable format.

Somebody — like the people running our electric grids — accepts and distributes that power. And when we turn on our televisions, it is as if by magic that images and sounds are present in a language we understand. Or if we don’t understand them, we turn on closed-captioning and select a language we do understand. 

The problem is theoretically solved. It is only our instincts that keep it from being made reality. And so inertia becomes the enemy of the patient — and the central problem to be solved. There are less-complimentary terms used to describe those who hold back this propulsion into the future, where all information flows like water from warm showers on cold mornings. I won’t use those terms here because I know better than to assume any of that is true (though some of it may very well be in different places).

My son often tells me how easy it is to solve every problem because he simply doesn’t find the issues of institutional malaise, regulatory incentives, or venture capital attraction sufficiently quantifiable to get in his way. The solution works when the players accept that it works and when the problem is significant enough that the mere fact of a viable solution is the most important consideration in the equation.

Kudos to him. “Don’t stop believing,” as the song goes.

It’s good to have sons who believe. It’s good to have actors who believe in their characters, who understand their role as the everyman in this great play of life. 

And what is healthcare if not that? Life and Death and Taxes. And why don’t we exchange everything everywhere, always and forever?

A few years back, while I was working for a large IDN, a decree came down from above. “There will be no more integration. We will route. We will filter. We shall give and we shall receive, but we will change nothing in between.” 

And then all was good in that world. Integrators would be released from the tedium of their labor. There would be only the standard, and the standard was deaf, dumb, and blind. Pay homage. We are free.

Except that for consumers and producers, not so much. We shifted the burden outside the center core and onto the edges, where it was to become less visible, where resources were provisioned differently — otherwise and elsewhere. They would hopefully refrain from complaint and accept the data as delivered, adequate, or perhaps less than. This would reduce cost. And cutting costs is a generally agreeable goal that is quite often achievable.

And so the Integration Apocalypse is a natural precursor to the Interoperability Blossoming we all acknowledge to be the inescapable drift of history. Everything standard. One transmission protocol (HTTPS). One data format (JSON). One Network (ModestlyObscuredWeb). One central scrutinizer (OAuth3000). 

“A fantasy. Science fiction,” you say. Don’t you bet your good cholesterol against it. It’s right around the corner.

The point of this is not to poke fun at anybody or everybody, but to stop and take note that things are often as they are for reasonable reasons. But we might re-evaluate whether some of those reasons can go by the wayside. In their place come new possibilities, new standards, new formats, new approaches, new paradigms, and new solutions to this age-old conundrum of cooperation. How do competitors agree on anything in a system that values innovation? How do private entities share that which is so closely held? 

In truth most vendors, including Rhapsody, would love if it were so easy to make secure connections, to have reliable semantically accurate exchanges. When we look at our product and listen to how our customers and partners want things to work, we strive to be that magic wand, that joy-bringer. We don’t like someone else coming in selling utopia-in-a-box dreamscapes, wooing our customers away with promises of dancing lilies and endless summers. And not because we believe they aren’t real or honest, but because we do share those ideals, and we know getting there is something we can only do together. 

Collaborate. Cooperate. Innovate. Save the Date.

The revolution will not be delivered, my friends. It will be negotiated at millions of tiny tables.

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