Yesterday, I used the term “Open Systems” when trying to understand Haque’s four pillars, but I didn’t really explore why I find open systems so interesting.  The topic, and whole purpose, of this blog is to figure out how to hack the modern healthcare system so that creative users can find ways to improve healthcare for themselves and for everyone.  Open Systems are one way to achieve this goal by making the system hackable.

When we make a system hackable, uses emerge that the designers and administrators never intended.  Sometimes those uses exploit the system (think email spam), and we must actively manage against them.  However, these novel emergent uses often add considerable value.  My hope is that open healthcare can save more lives at lower cost because it can recruit and deploy so many more participants than a closed, top-down system would even consider.

There is a lot of effort going into standardizing healthcare in every way from electronic medical records to treatment protocols.  What these standards have in common though is top-down specification and increasingly complex implementations.  Not only do these forces generally inhibit mass creativity, they actively discourage it.  Mass creativity is a threat to traditional hierarchies.

Healthcare is the epitome of complexity.  Not only is it a very hard problem requiring extreme amounts of talent to carry out even the most basic functions, there is so much money involved that the politics and red tape put every action under the microscope, thus regimenting the whole practice.  There is not an open system in sight.

The problem, though, is that bureaucracy doesn’t scale and it doesn’t adapt.  Past a certain point, it takes more effort to maintain the bureaucracy than it does to do the actual job.  To make matters worse, the bureaucracy is too slow to adapt to change.  It can’t evolve and improvise.  But how do we ensure quality of care while at the same time harnessing mass creativity?  The answer is in a little slight of hand.  What we really want is complex behavior, not complex systems.

Dee Hock, founder of Visa observed that:

Simple, clear purpose and principles give rise to complex and intelligent behavior. Complex rules and regulations give rise to simple and stupid behavior.

~ Dee Hock Quotes

The problem is in finding the right set of simple rules.

Coming from the technology world, I have a lot of faith in the lessons that the web has taught us.  In this realm, simple, open architectures and a philosophy of information sharing have lead to a vast ecosystem that simply didn’t exist 20 years ago.  While I have no illusions about silver bullets and quick fixes, applying some of the lessons of the web should get us a long way towards the goal of a fair and effective healthcare system.

There are two important lessons from the web that I want to address in the near future: Open Source and Standards Based APIs (call it Open Data?).  Individually and taken together, these areas of the web have made contributions on the same scale as many multi-billion dollar companies.  And they’ve done it on a shoestring.  Of course, I doubt that such a thing as an open source surgeon will ever exist, but adding billions of dollars of value (without billions in costs) on top of the existing healthcare infrastructure would be simply revolutionary.