Phishing in the Stream: Unlimited Bandwidth, Driverless Cars, and the Future of Health Data

Sept. 20, 2017
There is a widespread belief, misguided in my judgement, that owning your own copy of the data has intrinsic value and gives organizations competitive advantages. In contrast, APIs promote a single source of truth approach by making the data available on-demand.

Most Labor Day weekends, I head to Denver with a group of family and friends for an extended weekend of hiking, great food, great beer, and 3 nights of Phish (a most awesome jam band if you are into that kind of thing). It is always a good time and a chance for two generations to connect and share.

Driving to breakfast one morning, my brother Steve observed, “The next generation doesn’t own music the way we did. They don’t own CD’s or even download and store much anymore. They just stream what they want in real time.”  This echoed a similar thought that had crossed my mind the previous night while hanging out with one of my nephews.  Steve and I decided we would explore this further over breakfast with his boys, Matt and Dan, and Dan’s girlfriend Alex. They are all college grads in their mid-to-late twenties. After agreeing to buy them a great creole breakfast in exchange for tolerating our questions, we launched into an interesting and wide-ranging discussion.

The entire conversation was essentially about the commodification of bandwidth in different forms. It turns out that as the cost of bandwidth drops, it can dramatically change how we think and behave.

What we learned in our discussion is that while these young adults all have a strong interest in music, their attachment is to the music experience not the media. Growing up in a different age, my brother and I collected albums, studied the covers and “liner” notes and later graduated to collecting (or burning) CDs. To be attached to the music you also had to be attached to the media.

No more. These young people stream what they want in real time. As long as they can get what they want, when and where they want it, they will stream. When do they download? “When I am going to be on a plane,” said Alex, “or when I am going for a hike in the mountains and I know the cell coverage will be spotty or absent.”

In short, when the bandwidth is adequate and reliable, they see no need to possess a copy of the music.

The conversation then flowed from talking about music to a discussion about driverless cars and cars-on-demand (COD) like Uber or ZipCar.  Because it’s a great place to live and people have flocked to the region, Denver has developed a serious traffic problem, and it’s getting worse as the streets were designed for an earlier age.  Now, I’m no urban planner, but I’ve read some interesting things about how COD could have a significant positive impact on city traffic, parking and the like. You call for the car. It comes to pick you up, takes you to your destination, and either parks somewhere or goes to fetch the next rider. The concept is essentially the same whether it’s Uber or driverless.

I asked, “Well what about cars?”  There was a bit of back and forth on this topic, but eventually we learned that these millennials viewed cars the same way they viewed music.  Assuming they can get the car they want, when they want it and at a fair price, they would be fine with COD. There’s no great attachment to the object – the car. The attachment is to reliable transportation. As Matt pointed out, “Owning a car in the city is expensive and a pain.” ZipCar’s tag line, “Own the trip, not the car” captures this nicely. Much to my surprise, I am beginning to think American’s long-term love affair with cars will fade as the bandwidth of COD increases.

This is fascinating from an emotional and philosophical perspective. The relationship, value and emotional attachment is to the experience not the ownership or the object. In an effort to test this further my brother and I pushed for examples where physical ownership – having your own “copy” matters as much as the experience. It wasn’t a surprise when this group of active young people chose camping gear as an example. In this case it was not just about having the gear they want when they want it. There was an emotional attachment to the object as well. It was more personal. It held memories and experiences beyond the mere utility of the tent or sleeping bag. It turns out there are limits to unlimited bandwidth. There will always be gearheads, steam punks, and record album collectors.

Being an API evangelist, I couldn’t help but see a connection between our breakfast conversation and how we manage data in healthcare today. There is a widespread belief, misguided in my judgement, that owning your own copy of the data has intrinsic value and gives organizations competitive advantages. Even worse, traditional integration methods, like those based on HL7, inherently drive developers towards duplicate databases and all the problems this leads to when it comes to synchronization, security and portability.

In contrast, APIs promote a single source of truth approach by making the data available on-demand. I don’t need to have a copy of the data if I can get what I want, when I want it and the way I want it. Sound familiar?

Carried to its logical conclusion, this means Continuity of Care Documents (CCDs) and Health Information Exchanges (HIEs) and the like are “old school,” like owning a record album. Why do we need to consolidate copies of data in an HIE or exchange half-baked CCDs if we can exchange that data from point-to-point in real time? Maybe HIEs should evolve to be the keepers of the master pointers that help us locate and route the data rather than the repository of the data itself. CCDs are really “retro” and just need to go away entirely, and the sooner the better.

Making copies and hording data may confer advantage in the short-term – but only in the short term. The real and lasting value comes from competing on analytics by turning data into actionable information. This implies the ability to deliver on velocity, volume and variety when it comes to moving data, in other words, bandwidth. This theme of getting the data to flow also runs through this recent pair of essays in The New England Journal of Medicine on the state of healthcare IT and the impact of the HITECH Act.

Data must flow freely in order to be valuable. That’s what well designed APIs do: they can create huge increases in bandwidth. That’s one reason why the rest of the digital economy adopted them long ago. And as these young adults are showing us, that’s the way of the future.

Special thanks to Dr. Stephen Levin, Dan, Matt and Alex for their contributions to this post.

Dr. Dave Levin has been a physician executive and entrepreneur for more than 30 years. He is a former Chief Medical Information Officer for the Cleveland Clinic and serves in a variety of leadership and advisory roles for healthcare IT companies, health systems and investors. You can follow him @DaveLevinMD or email [email protected].

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