sviokla.com blog

Many years ago, there were a few influential academic articles that predicted that the coming web of information technology would cause more activities to be performed in a market, not within the walls of the firm. My friend and colleague Chunka Mui, wrote about this is his book Unleashing the Killer App, which noted that information technology was changing transaction costs, which in turn changes the boundaries of the firm. Almost every day the business press contains some reference to this trend — either directly or indirectly. In the Thursday July 13, 2006 Wall Street Journal, there are two articles — one on how car buying continues to change, not only due to the information sources like www.edmunds.com (check out my old Harvard Business School case on Edmunds for the back-story), as well as the influence of social networks like LinkedIn, on job finding. Both phenomena are “market” solutions for activities previously handled within firms. Markets are social networks, with some specialized rules, and we will continue to see the enhancement of markets for everything including cars, jobs, and the like.

What I find fascinating, and was first pointed out to me by my friend John Henderson, is that the “market” for healthcare — on a local level — has yet to be created — and in this I am not talking about the Heathcare Savings Accounts/High Deductible Health Plans (although these will figure into it); I am talking about the coordination of doctors, care givers, the hospital or clinic, and family members — just to name a few. Despite the importance of this process, and the vast use of the internet, there is yet no “market” or social network site, that helps to coordinate such activities. Imagine if WebMD, interoperated with LinkedIn, with open interfaces to content sites like the American Cancer Society’s cancer support group, and open links (with appropriate security of course) to care giving organizations like Kaiser Permanente. This would allow for what my friends who study social networking call “self synchronization” of all the relevant parties to meet the care needs of the sick or elderly person.

You need at least two things for self synchronization: first, situational awareness for all the relevant parties and second, a reallocation of decision rights. For example, my Dad recently had arterial surgery, and my two brothers and I (and our families) coordinated about who would take him to the hospital, visit him, and take care of him when he recovered back at home. There are millions of people who are undergoing this exact process of care, each in their own way. Everyone knows that the most basic communication about status on diagnoses, care, oversight, and companionship takes phone calls, emails, and a host of visits. What I wanted, and I think millions need, is an easy way to share situational awareness across everyone involved: the family, the doctors, the physical therapists, etc. In short, we need a “MySpace” for my Dad’s health, and for anyone who is sick. (Of course, in the near future, this information environment will also contain telemetric data such as his blood sugar, movement, blood pressure, etc., to the extent he will allow himself to be “instrumented” — and should be part of the space too.)

This MyHealthspace needs also to have clear sign-in rights, and some notion of who can do what — not unlike what is implemented in instant message systems. Imagine a space where someone, like my dad, could list a need for a physical therapist in Marshfield, who is accustom to working with Octogenarians, who have just recovered from surgery. The market for local talent who could fill that need will arise around the demand. Furthermore, if there are emergent reputation networks — as LinkedIn and others support, it would help me, or my brother or my dad choose whom to trust. Perhaps my brother, who is a doctor, could go ahead and schedule a visit by the therapist, and get access to his or her notes on my dad. Situational awareness, and allocation of decision rights can unleash the power of community as it regards medical care. Today, there are too many barriers to that self synchronization, which is not only inefficient, but often causes undue stress on the patient and the family.

I believe the only way that the USA will put a dent in generating a sufficient supply of potentially humane health care will be to help to create the markets that enable the ends of the network to self organize. In a certain way, MyHealthspace would be a new fangled coordination tool to help dispersed, over-busy families, take care of their families in a manner similar to how they did two hundred years ago before the industrialization of the economy scattered us, and professionalized the care of the elderly and infirm.