The new company follows Civica RX model ofcooperative stewardship
By JULIE MINDA
SSM Health, Intermountain Healthcare and Presbyterian Healthcare Services are teaming to create a "health care utility." The startup nonprofit company, called Graphite Health, will tackle digital interoperability challenges that slow innovation uptake in health care. It will do this by establishing a common-language platform that the company's members can use for operationalizing digital innovations.
Dredge
Graphite expects to attract Catholic, other nonprofit and for-profit health care systems and philanthropic organizations as members. All members will provide expertise and capital for developing the data platform and a marketplace of technology applications that members can use. As a condition of membership, all who join will subscribe to the IT equivalent of a Hippocratic oath that obligates them to protect patients and their data.
The Graphite marketplace will establish a single location for innovators to distribute digital tools to health systems across the country.
Graphite is modeled after Civica RX, a nonprofit generic pharmaceutical company established three years ago to source or manufacture essential generic drugs. More than 50 U.S. health systems representing 1,350 hospitals, and major philanthropic organizations are part of the Civica RX collective.
Carter Dredge, a board member of Civica RX and Graphite Health, has been deeply involved in the start-up of both companies. The senior vice president and lead futurist for SSM Health talked to Catholic Health World about Graphite Health.
What learnings from the Civica RX start-up are applicable to Graphite Health?
We have learned from our work on Civica that things can build fast. When we first launched Civica we thought it would take four to five years to get traction. But when you have a really compelling and noble mission and an environment hungering for a solution and the structure to benefit everyone and bring mindshare and financial capital together, you can make real progress fast. It's been three years since we launched Civica and we have 50 products available.
Four of Civica's seven original founding health systems are Catholic. (In addition to SSM Health, they are Providence St. Joseph Health, Trinity Health and Catholic Health Initiatives, part of CommonSpirit Health.) We expect Graphite to have high representation from Catholic health care as well, and that is essential.
This is a great opportunity for Catholic health care, because we are deeply committed to engaging in digital innovation in a way that benefits the common good. If organizations are just in digital innovation for themselves and by themselves, they're probably spending too much or going too slow.
Graphite will need collective scale to make this approach work. If we are going to do digital innovation, we need to do it as a collective. And this will enable local providers to engage in national-scale cutting-edge innovation.
Which types of technologies will Graphite enable first?
Graphite is an interoperable data platform that can be used to create a marketplace made up of numerous outside applications. I'm not able to say exactly which applications we'd start with, but I can say we do not plan to start at the highest end of clinical complexity.
When we have enough functionality, we will then continue to build out applications with aligned partners that have higher and higher direct clinical impact.
Who at the member health systems will be doing the work?
Graphite is an operating company. It's a business with a management team and dedicated staff. Additionally, because it's a member-generated business, we members can tap into a variety of teams in our organizations and use the collective wisdom of our systems in real time.
The gap between the people building out the platform and the end users at the member organizations that will be using the platform actually will be quite small — the end users will be on the teams that are helping develop this. We'll have a structure to engage departments such as IT and finance and the clinical areas. We will have a substantial operating core.
What are the main problems that Graphite hopes to address?
Speed to adoption of innovation is a problem. Health care is extremely complicated — with regulatory, financial, technological and data privacy complexities, to name a few. When we do something new, there are a lot of nuances in how we connect new technologies into the existing platform. For instance, if two organizations work together and try to connect, even if they both have an electronic medical record system from the same vendor, those systems may be used in different ways. So, there may be local differences, differences by clinical application. It is not uncommon to take 12, 18 or even 24 months to implement a new technology. It's a steep hill to climb.
Another key problem Graphite will be solving is that health care organizations and the vendors that work with them need a common digital language to conduct business. We want that language to be ubiquitously available so developers can create and scale technologies and create value with them.
What is the main differentiator that will make Graphite's efforts more successful than past efforts in this area?
The main differentiator is that Graphite is a health care utility; it is a nonprofit entity. Since it is a collective, no one organization owns it. The members' goal is to accomplish a common good. And as Graphite gets larger, it's not just going to reduce costs and spread that benefit among members, it can also reduce the price of health care for patients. That is because no one owns this, so no one is trying to pull margin off of the business. We're trying to streamline everything.
How will Graphite avoid the pitfalls in pursuit of interoperability?
It's the complexity of health care that is a main barrier when developing new solutions. In many sectors of the economy, innovation happens in an iterative way. It is hard to do something iteratively when there is the possibility of patient death or other harm.
It takes a long time to get the right safeguards in place and make sure the data is secure. And so, the cost to switch technologies is so high. Innovation is time- and cost-prohibitive in health care, much more so than it is in other industries. Also, there is a lot of expertise needed when implementing new technologies in health care. External groups that try to come in to innovate underestimate the time and complexity and the important nuances of innovating.
We need disruptive innovations in health care, but innovating is complicated when it comes to human health. There are such high stakes. So, the concept with Graphite is that we all can work as a collective to figure this out together.
How will Graphite protect patient data?
We know that to accomplish what we want to accomplish with Graphite, numerous organizations and people will have to work together. The health care data these organizations work with requires a high degree of privacy — a rock-solid foundation of trust. Graphite is not in the data selling business. Instead, it's in the business of enabling health care data to work towards a more virtuous innovation cycle, whereby when you solve one problem, it allows solving another problem even quicker and more sustainably. Too much innovation in health care still happens in silos because the data is siloed.
Our digital Hippocratic oath is about enabling scalable innovation with data, while still doing no harm to the patient. Especially as more organizations become involved with Graphite, it will be essential that we all agree to that oath because this all must be done in an environment of trust and with the patients' best interest as the top priority.
The value of this common platform is not about making money off of data assets. Patients are not products. They're our beloved community and family members.