A couple of Sundays ago, I was sitting at church. Every so often, our choir at All Saint's Episcopal Church in Austin, Texas goes "all out," and this was one of those Sundays. It had been ten years since our choir had performed the Choral Mass in C from Mozart.  It was worth the wait!

As I sat in my pew, I was mesmerized by all of the instruments from the voices of the altos to the tenors, as well as the violins, cellos, french horns and other assembled pieces of a small orchestra. We're not a big church, so we had to tuck our performing guests in to the nooks and crannies. The impact of this assemblage on our worship was magnificent. It also got me to thinking...

The last time I was lifted up by music was in Amsterdam, where I had just spoken at the Sibos conference. Sibos is a global financial conference hosted by SWIFT. At almost 10,000 attendees, it seemed big but pales by comparison to the upcoming HIMSS conference in Las Vegas. At almost 40,000 attendees, I am impressed by the complexity and scale of the effort of this health conference and am in eager anticipation on my flight. I was equally impressed by the opera at the Concert Begouw in Amsterdam in October 2010, where I wrote this piece about the instruments of finance, a blog later turned into an article for SWIFT's quarterly magazine, Dialogue. 

As you can tell, I like music.  So, you may be asking... what does music have to do with healthcare? To answer that question, we have to start with the sheet music from which the musicians in Amsterdam and All Saint's Episcopal Church worked.  In the case of the choral mass in C from Mozart, this piece was written and first performed in Salzburg in 1779. As I was listening to it bounce from the ceilings of our sanctuary, I couldn't help but think, "how many times and in how many places has this piece been played?" since 1779, and for that matter, "how many different places around the world was this same piece being played at the same moment?"  

Of course, the challenge with this question is the same one facing our social media and our data in healthcare and beyond. We can't connect them, because in the case of our orchestra, the notes to be played are trapped in a 2-dimensional space known as sheet music. However, what if this sheet music was capable of being multiple-dimensional? What would happen if the notes to be played were connected across space and time? Suddenly, the celloist (like my son) could be fused together with every celloist playing this same piece around the world. But for the problem of the space-time fabric, he could also be connected to the celloist playing the choral mass for the first time in Salzburg in 1779.

And, isn't this same the same problem with our EHRs? As I have written previously, our approach to EHRs and PHRs is also trapped in the limited dimensions of the sheet music of healthcare.  The evolving HIE landscape faces a similar musical challenge. The HIE is trapped in a physical geography of healthcare, much like an orchestra playing this same sheet music in a pit.  We've assumed that the only players that can play music together are the ones that are in the same physical space, but with the Internet, that isn't true. Many musicians have experimented with cyber orchestras, and I believe it is time for us to evolve the HIE and ACO in the same way. 

Just because a specific set of musicians (healthcare providers) have come together in the same orchestra does not mean that they are the only combination of players that can perform the music of health. I, as the listener (patient), should be able to dynamically bring together my own personal orchestra. However, the notes in my sheet music (EHR) are two-dimensional. I need to be able to tag these notes, so that I know who else can play them. I need to break down the physical geography of the orchestra, so that the pit in my concert hall can span the world, not just my narrow region, state or other HIE container. 

The Internet gives us the opportunity to reframe our sheet music. However, it is us, not the Internet, that is constraining the multi-dimensional capacity of this connective fabric. Our current web pages and digital EHRs are in many ways simply digital versions of our 2-dimensional sheet music. CLOUD envisions a multi-dimensional Internet that allows us to rebuild our healthcare orchestra, so that the uplifting power of the Choral Mass in C (or any music) can bring its healing power not only to the ears of its listeners but to every organ that makes us human and whole.