Pros and Cons of Centralized and Decentralized Data Networks for Interoperability

Interoperability is one of the biggest and longest standing challenges in healthcare. Government policy makers and private sector companies of all shapes and sizes have been working on this problem for decades, offering all kinds of approaches to technical, syntactic, semantic and business-case constraints to make information more intuitive Exchange.

Stuart Hanson is the CEO of Avnir Health, an administrative healthcare collaborative data network that includes some of the biggest names in the industry including Cleveland Clinic, Centara, Optima Health, Aetna, CVS Health and Carelon.

Data exchange means different things to different people, he says, but one thing holds true: networks are key to unlocking what he calls true interoperability.

Healthcare IT News WebMD spoke with Hanson to talk about the meaning of “interoperability,” centralized versus decentralized networks, clinical versus administrative interoperability, and how the right network can transform the industry and improve patient care.

Q. You argue that interoperability can mean different things to different stakeholders in healthcare. How do you define it?

One. In a truly interoperable healthcare system, data would not need to be requested, collected, and validated every time it is needed. Instead, it will be constantly refreshed, always current and accessible in real time to those who are permitted to access it, allowing all healthcare stakeholders to work together to create a cohesive, high-quality experience for the patient is allowed to work.

This definition of interoperable will break free of existing data silos and system-based barriers to sharing and enable entirely new processes and workflows. This will be a giant step forward for better human experiences and lower costs, many of which we cannot even imagine today.

In addition to an improved patient experience and better outcomes, true interoperability will enable better collaboration between healthcare stakeholders, simplified transaction processes as well as more timely, effective deployment of solutions across markets.

Q. You work in the data networking space. Please talk about the pros and cons of centralized and decentralized networks and why you believe the latter is important for achieving interoperability in healthcare.

One. A centralized network is designed around a primary server that manages all information and activities on that network.

The advantages of a centralized network include:

• Data is aggregated so it requires less communication between participants to stay up to date and exchange data.
• The data is controlled by a single authority, which can make it easier to enforce rules or regulations.

The weaknesses of a centralized network include:

• Lack of transparency in how data is used by third parties.
• There is less chance that the data is immutable.
• It is more challenging to ensure that the data is not secreted.
• Reduced redundancy and vulnerability to attacks.

In a decentralized network, there may be multiple servers acting as primary servers. They manage information on their own while still connecting to each other.

The benefits of decentralized networks include:

• Data must be collected and validated every time it is used without compromising data integrity, immutability and traceability.
• By giving data originators complete control over their data and who has access, it reduces the need to manage multiple interfaces and standalone connections.

The weaknesses of decentralized networks include:

• Can be more complex as they require coordination and communication between many participants.
• More resources (for computing and storage) may be required as each participant must store their data locally to perform computation and processing.

We believe that a decentralized network is key to achieving true data liquidity as it eliminates many of the issues surrounding trust and friction by increasing transparency and data immutability.

A decentralized network supports greater collaboration and innovation by enabling stakeholders to more effectively communicate, transact, and simultaneously deploy new processes, unlimited use cases, and innovative solutions.

Q. You differentiate between clinical interoperability and administrative interoperability, and you focus on the administrative. Why is it like this?

One. We have built our network with the objective of creating value for the industry and our initial focus on administrative interoperability is aimed at helping the industry achieve a rapid and significant return on investment.

The annual cost of administrative inefficiencies in the US healthcare system is in the hundreds of billions of dollars, primarily due to inefficient processes in manual, billing, coding, physician administrative activities, and insurance administration. This significantly affects patient care, provider reimbursement, and costs.

And it’s money that could be better spent on direct patient care, investments in technology and innovation, and more value-based initiatives. We also believe administrative data is more ripe for a new network because a single use case – entitlement, for example – can create financial wins for payers, providers and patients at the same time with relatively limited effort to connect. Is.

When our founding members – Anthem (now Elevence), Cleveland Clinic, CVS Aetna, HCSC, IBM Watson Health (now Meritiv), PNC Bank, and Centara Healthcare – came together in 2017, they discussed what would facilitate the collaboration. How to build an ecosystem, real-time data sharing, distributed governance, and common processes running in a trusted, permissioned, and secure environment in which participants can transact with each other.

This connectivity will include common data model, latest technology standards and infrastructure capabilities, modern security and immutability which will solve the connectivity and interoperability issues of healthcare. That’s how the idea of ​​Avneer Health was born, and that’s why we’re focused on reinventing the back office – or the business – of healthcare.

Q. What do you believe healthcare provider organizations and health IT leaders should be doing today to solve the interoperability problem?

One. Health IT leaders already recognize the challenges of the current state of connectivity with business partners – heavily fraught with technology debt, dependent on custom point-to-point integrations, and dependent on data intermediaries who are responsible for critical administrative exchanges. To add cost and time.

And I encourage them to recognize that despite all their investments in legacy systems and platforms, many of them are still really struggling with a lack of interoperability. This is all, in my opinion, due to dated infrastructure and technology debt and a new network is needed to truly solve the issues.

Adding more bolt-on technologies is not the answer. The answer lies in re-imagining new ways of working together with other healthcare stakeholders.

Joining a decentralized network facilitates interoperability that is more complete in the following ways:

• Once connected to the decentralized network, providers are not required to make direct connections to any other network participant with whom they choose to cooperate or send transactions.
• Data remains decentralized and participants can control how and with whom they collaborate.
• Once a connection is established, data can be available in real time without being requested, allowing for real data fluidity and transparency.

Follow Bill’s HIT coverage on LinkedIn: Bill Siwicki
Email him at: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.