If this equation has some validity, then the complexity of the health cloud may be inferred from the number of potential exchange transactions. Here the HIE (exchange transactions) term, a surrogate measure, will be replaced by interoperability. The equation is reformulated as:
In terms of a complexity scale, the lowest score would be 1, e.g., the instance of a single patient being seen by a single provider. For any single provider in a practice setting the complexity score can never be less then the total number of patients in the practice, i.e., complexity score equals xHRs generated in the practice. The complexity score takes off by orders of magnitude with the addition of more entities and exchange transactions. The complexity for any cloud configuration may be bracketed, in terms of magnitude, where interoperability is complete (exchange transaction = 1) or where interoperability is none (exchange transactions = Entities × xHRs). To appreciate the overall magnitudes of the health cloud hypotheticals may be illustrative. To simply the math the hypotheticals are confined to the practice of Emergency Medicine in Emergency Departments in the Unites States.
USA Hypothetical
- US population = 306,000,000
- US hospitals = 5,700
- US physicians = 800,000
- ED annual utilization rate = 0.35
- All hospitals have an ED that sees at least 1 patient per year
- Complexity where the interoperability is complete = 8.6E+132
- Complexity where the interoperability is none = 7.0E+19
California Hypothetical
- California population = 37,000,000
- California hospitals = 350
- US physicians = 140,000
- ED annual utilization rate = 0.35
- All hospitals have an ED that sees at least 1 patient per year
- Complexity where the interoperability is complete = 1.8E+09
- Complexity where the interoperability is none = 2.6E+17
Single Provider Hypothetical
- 2,000 hours worked per year at 2 patients per hour
- California hospitals = 350
- Complexity where the interoperability is complete = 4.0E+03
- Complexity where the interoperability is none = 1.4E+06
Complexity and Interoperability (Complete/None)
Why is this exercise necessay? It is necessary to appreciate the enormity of healthcare’s movement from paper to digital exchange and storage. The present problem is not appreciated because it is literally hidden in paper. Paper, in terms of complexity, has an interoperability equal to none, which serves as the upper thresholds for the above hypotheticals. Not completely true, but true enough for the proposition being presented. Paper actually is syntactically interoperable, albeit by facsimile, but that’s for the next post…
Footnotes:
- Here “x” stands for undefined health record, e.g., EHR, EMR, PHR, etc.
- Scientific E Notation