Time Capsule: Sun Was Right: The Promise of Healthcare Applications Requires a Grid, Not a Data Center Full of Servers

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in February 2008.

Sun Was Right: The Promise of Healthcare Applications Requires a Grid, Not a Data Center Full of Servers
By Mr. HIStalk

Sun Microsystems has been saying for years that “the network is the computer.” I hooted when I first heard that because it seemed so transparently self-serving, but I actually think the company was right all along. Sometime, maybe sooner than later, your data center won’t need servers. In fact, you probably won’t need a data center or IT staff at all (so in an ironic twist, you can use that space to store paper medical records).

I came to this conclusion after realizing that those Sun thin client blowhards were right, too. All the software that’s important or cool these days runs over the Web, not on a desktop PC. I’ve traded Office bloatware and piggish e-mail clients for free, stripped down versions that run on the ubiquitous information grid known as the Internet. Tastes great, less filling. I can get my job done, derive and create greater value, and let somebody else worry about what’s under the hood.

In other words, I don’t need a loaded PC any more than I need a gas generator, a TV antenna, or an outhouse. The grid is better, cheaper, and more reliable to meet those needs. All I need is a connected appliance. But more importantly, the network adds tremendous value. You contribute a little by joining, but you get a lot in return (well, hopefully not in the outhouse part of my labored analogy, but you know what I mean).

That’s how physician billing vendor athenahealth works. It applies the collective knowledge of thousands of customers to instantly update reimbursement rules for all the practices on its grid. Doctors’ offices don’t need a roomful of souped-up computers or an expert on arcane billing practices. They just need a connection to the grid.

Back in the hospital, we’re still using the same old (literally) applications, monolithic piles of esoteric and proprietary hardware that require skilled care and feeding, connected by a fragile spider web of interfaces and middleware that often causes problems with response time, downtime, and botched upgrades. Even when they’re up and running, those systems have plenty of functionality but zero intelligence, obediently regurgitating stored data in a format that’s little different than how it was entered.

The Holy Grail is to pull data back out in a way that lets hospitals learn something actionable, like which antibiotics work best or which lab values correlate with genomic profiles. Few hospitals have the capability to even get that kind of information from their own locally stored data. Fewer still can tap into the collective knowledge of their fellow IDN members. And nearly none can focus the accumulated intelligence of hundreds of peers when making important clinical and business decisions.

New technologies such as Software as a Service will allow hospitals to move to the next level of collaboration – actually pooling their collective expertise with that of their fellow grid users. The applications themselves could be expertly managed by experts and paid for as a service instead of buying racks of servers and installing patches.

Organizations centralized IT in the first place to gain leverage, reduce costs, and reduce risk. Hosted applications are the next step up the food (and value) chain. Capital requirements should be less, space and people requirements minimized, and they’d get the best IT talent money can buy, not just the best that’s willing to move to International Falls, Minnesota.

Hospitals are uniquely positioned to share knowledge compared to nearly every other industry. Most of them are non-profits, those more than 50 miles a way aren’t competitors, and few disagree that healthcare costs are sucking the wind out of our economic sails. For that reason, it will soon make good sense to shut down the endlessly duplicated silos of locally maintained hospital IT and get on the grid instead.