The Mathematical Imperative for Platforms in Healthcare

Network mathematics explains the imperative for platforms in healthcare.

There are only two ways to make connections in a network — i.e., ways to connect the diverse nodes in a network. The first is through point-to-point connections. A simple diagram (below) provides an example of the math. Here there are six different participants in a healthcare network. If you rely on point-to-point interfaces – such as email, fax, phone, in-person contacts – there are 15 possible connection points to make.

The connections between the nodes can represent potential communications, actions, or data transfers. You can also think of the connections as potential failure points in a network — where communications, actions, or data transfers should happen but don’t.

In a point-to-point network, as the number of nodes in a network increases linearly, the number of possible connection points increases exponentially.

The other way to connect nodes – or people – in a network is through a network hub — a platform. The math here is much simpler — the number of potential interfaces is simply the sum of the number of people in the network because all of the interactions occur through the centralized platform. In our case of 6 participants in a healthcare network, a platform requires 6 interfaces.

Consider the example of a complex diabetic patient, in this case, one who has 14 nodes in their care network. Let’s count them: the patient, a primary care physician, a pharmacist, an ophthalmologist, a diabetic educator, a podiatrist, an optometrist, a nutritionist, a hospital, an endocrinologist, a social worker, a mHealth smartphone app, a glucometer, and a health plan coordinator. The diagram below illustrates this scenario.

The care network of this complex diabetic patient sums up to 91 potential point-to-point connections! The only practical way to care for complex chronic care patients’ ongoing needs is through a platform.

Consider a few other examples of complex networks in healthcare. A study in the Annals of Internal Medicine documented that the typical primary care physician has a referral network of 229 coordinating physicians. The math here works out to over 26,000 potential point-to-point connection points.

Another study looked at the number of staff members with whom a hospital patient might interact. During a typical 3- to 4-day stay in a large hospital, a patient may interact with 50-60 employees. If you do the math here, that’s between 1,225 and 1,770 potential point-to-point interfaces among staff members and the patient.

Yogi Berra is attributed with saying “In theory, there is no difference between theory and reality. In reality, there is.” Thus, in theory, a complex diabetic patient COULD be treated effectively in a point-to-point network.

In reality, this is virtually impossible to achieve. Necessary data about the patient’s progress is unlikely to be consistently transmitted throughout the network. Critical workflow handoffs will be missed. How can ONE CARE PLAN possibly be created and continually updated? The quality of care and outcomes inevitably will suffer.

The takeaway: many of healthcare’s complex, inter-organizational challenges CAN NOT be solved by point-to-point solutions! There are just too many failure points – where data isn’t shared, when a task in a common workflow gets missed. Platforms are a must-have, not just a nice-to-have.