Innovating Healthcare by First-Principle Approach

What are the grand challenges being faced in healthcare and how should they be approached for effective solutions? There are plenty of grand challenges in our healthcare system which primarily stem from system/organization silos, providers/payers fragmentation and lack of true patient-centered- ness in communities. Those challenges create a number of gaps in terms of care delivery when a patient goes through different care settings. That’s an issue within a hospital itself. And then you extend it to a number of other set- tings: prehospital, rural hospital, emergency department, referring hospital/clinic, and then transport. Then secondary hospital and there may be a tertiary center too, and post-discharge varied care centers. When it comes to health- care, no two regions or communities are alike, even in the U.S. There is a disconnect in communication.

There is a disconnect in coordination. There is a disconnect in collaboration. These are seem- ingly very simple, but not many people are paying attention to what I call C3. The com- munication, coordination, and the collaboration that is within the facility or between the facilities along the patient journey. The fourth element is comprehensive which provides frictionless access to every patient and is robust enough to withstand any shocks. Meaning, these things should happen, but also need to happen more comprehensively so that nothing important is left out at the foundational level. Say you build a house, if the foundation is not comprehensive and robust, however well-communicated, well- coordinated or well-collaborated, then anything that you build on top of it is only short lived. It’s not going to serve the purpose that you intended it to serve in the long run. As in physics, to solve a complex problem we have to go down to first-principle (ie like atoms in Physics) and build out from there; a complex healthcare system having several rigid problems/needs requires us to adopt such first-principle approach to not only solve the problem effectively but also helps overall healthcare system work smoothly, efficiently and long lasting.

What does the overall landscape look like right now in terms of providing the right infrastructure and device

architecture for clinicians and other end-users in healthcare? When it comes to the technology, what we need is a fluidity, not rigidity, just like water. Water is a fluid; it flows through wherever there is a gap or there is a hole. So, that is where the “first-principle” approach comes in. Once you adopt a first-principle approach and the foundation is laid out, it goes like a fluid, so it connects things and goes through the gaps, and it establishes interoperability as a technology architecture. Then at the same time, it collects the data seamlessly. You’re not actually collecting on purpose; it collects seamlessly so that it becomes a data-driven architecture at the point of care. If you don’t have point of care alignment, you lose sight of your overarching goal. Technology architec- ture should not be thought of as “just for sake of technology,” it has to serve the overarch- ing challenges in the first-principle approach, meaning that it has to be aligned for the point of care which is patient centered and provider friendly. When it comes to the technology, what we need is to go to the fundamentals of communication, transparency, and empow- erment in decentralized environment, and unleash the potential of modern healthcare by utilizing innovative mobile solutions that are as fluid as water in bridging the healthcare gaps and withstands any shocks.

What are the biggest challenges in creating that architecture—technological, people, process, operational? How can those be addressed? It is actually all of the above, but more import- antly orchestration. There are so many tech- nologies, people, issues, and processes. It is not only what the challenges are for now, but what challenges might come in the future. People are living organisms and all these pro- cesses and technologies are also, in a way. The keys to orchestration are already out there, but you need to orchestrate together. Orchestration is also about keeping the busi- ness first principles in mind, not just tech- nology in mind. A lot of orchestration that people are rolling out, like architecture and technologies, involves only technical people and it should be more business savvy with engineering principles applied.

Harry Reddy Chief Executive Officer ALLM in Cambridge, MA

How can healthcare leaders engage in strategic planning to provide the precisely correct sets of technological tools that clinicians and other end-users most need? Making sure that these grand challenges are addressed, but not addressed in a silo. It is imperative when you are addressing these challenges you are not creating another silo. We also need to apply the first-principle

approach of starting at the foundational level by thinking afresh and using systems-thinking way where everything is interconnected with positive reinforcement and feedback loops built-in, as COVID-19 exacerbated these needs. We have a once in life time opportunity of pivot- ing for a transformative change with equitable access. At the same time, you have to also think about your neighborhood and your town. It’s not about just your home, because you’re not living in silo. You are living in a community. It’s about how you interact with your neighbor- hood, how you interact with your community, and how you exist as a social-being. This is a generational opportunity of mak- ing healthcare work by embracing 16th century decentralized person-centered approach with first-principle approach of digital transforma- tion in systems-thinking way; the keys to realize such successful healthcare is to provide at point of need the effective access, communication, transparency, and empowerment. COVID-19 has proven us again that the same keys are more effective than any other forces!

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