There is an evolutionary character to marketplace dynamics that closely mirrors natural selection. Business ideas emerge within the marketplace like mutations. Most die, a few stick, and just a handful wind up transforming industries entirely.
Much like the meteor strike that changed the earth’s climate and killed off the dinosaurs, technologies are often the external event that triggers new evolutionary stages.
Healthcare may be mere months away from its own Big Bang equivalent.
The deadline for the Center for Medicare and Medicaid Services’ (CMS) Interoperability and Patient Access Final Rule is rapidly approaching, the Trusted Exchange Framework and Common Agreement (TEFCA) initiative is building a health information exchange that will act as a universal floor for interoperability, and the agentic technologies necessary to independently turn that all of that interoperable data into action are already here.
The autonomous healthcare system is about to take shape, and health systems must prepare to evolve alongside it.
This is an industry that can no longer pretend its technology stack is exempt from disruption. Rigid, legacy infrastructure and bloated collections of point solutions cost entirely too much, fail far too often, and overwhelm caregivers and consumers with every interaction. The U.S. healthcare system will approach $6 trillion in annual spend by 2026, with 15% to 25% of that expenditure accounting for administrative expenses largely driven by fragmentation. When it comes to technology and efficiency, health systems are still in the Stone Age.
We have reached a point, however, where they can no longer forestall the macroeconomic and market forces demanding transformation. “Market selection” will soon weed out those still relying on digital architecture of antiquity.
Think of unified, interoperable data as the genome (or “datanome”) of an autonomous health system, the foundational code that encrypts what a health system knows, can see, and can do. Like genes, AI models and applications express suggestions for new actions or capabilities. They switch on, adapt, and specialize in response to clinical and operational context. Over time, the system learns the way living systems learn: through selection pressure, adaptation, and iteration.
The wing of a bird did not evolve one feather at a time. Nature exposes variation, the environment applies pressure, and the organism survives or disappears. The autonomous healthcare system will work the same way. Just as natural selection reconfigures genetic expression to produce traits like webbed toes or opposable thumbs, the autonomous healthcare system will use continuous data feedback loops to evolve its own intelligence.
It’s a massive departure from the way healthcare’s digital transformation has occurred thus far. Electronic Health Records (EHR) are digital filing cabinets that act as snapshots in time, lacking the ability to evolve or respond to new information. Documentation is the EHR’s center of gravity, despite the fact care unfolds over time, across episodes, between visits and in response to clinical decisions. Today, physicians spend nearly two hours on documentation and administrative tasks for every hour of direct patient care. This is a symptom of a system that can record work, but cannot autonomously complete it.
Even cutting-edge AI innovators design for this static system. It doesn’t work. They must adapt their intelligence platforms to this new evolutionary framework to retain market relevance. The autonomous healthcare system – a unified stack of data, algorithms, and applications – will soon subsume the thousands of fragmented point solutions that create friction and waste.
For the health systems and innovators that survive, the result will be a shift from managing chaos to cultivating an intelligent system that becomes smarter, more capable, and more resilient over time. It will “act” on its own with exceptionally high confidence on an increasingly complex set of tasks.
But markets hate a void, and market fitness is unforgiving. That’s why health system leaders must start transitioning now from the world they are in to the world that is coming. Those smart enough to read the tea leaves and agile enough to take quick, decisive action are investing in digital infrastructure today that will enhance value creation in tomorrow’s autonomous healthcare system.
The industry has finally reached a point where health systems must build better healthcare or be reshaped by those who are willing to do it first. And the clock is ticking. Healthcare’s meteor is visible in the sky; the technologies are here, the interoperability agenda is clear, and the market has already begun the process of selecting winners and losers.
Forward-thinking leaders will abandon playing defense with static, legacy architecture, and start playing offense by building the genome of an autonomous health system. Those that fail to evolve will be acquired by the strong or cease to exist altogether.
Photo: bluebay2014, Getty Images
David W. Johnson is the CEO of 4sight Health, a thought leadership and advisory company working at the intersection of strategy, economics, innovation and capital formation. Dave wakes up every morning trying to fix America’s broken healthcare system.
Prior to founding 4sight Health in 2014, Dave had a long and successful career in healthcare investment banking. He is a graduate of Colgate University and earned a Masters in Public Policy from Harvard Kennedy School. Prior to graduate school, Dave served as a Language Arts Peace Corps Volunteer in Liberia, where he survived a coup and coached a championship soccer team. Dave’s knowledge and experience encompass health policy, economics, statistics, behavioral finance, disruptive innovation, dual transformation, organizational change and complexity theory. Dave writes and speaks often on pro-market healthcare reform. His weekly “Roundup” podcast with Julie Murchinson and David Burda is required listening for thousands of healthcare leaders across all industry sectors.
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