Exchanges - Health Information, Energy Information, Internet

An exchange is a central distribution and routing entity or infrastructure whose primary value to a system is that it provides a standard central infrastructure for translating and routing data between entity players. A Securities Exchange provides such a framework for financial transactions, an Internet Exchange does the same for network data and as we develop energy exchanges and health information exchanges, those models must provide the requisite guideline for the infrastructure we build.

Energy Exchanges : As energy generation become increasingly diversified, i.e. some of the energy of the grid originate from consumer (industrial, commercial, residential) premises the need for robust framework for inter-scource transfer become apparent. Current work on grid standards (IEEE P2030,  NIST IR 7628 etc) while not referencing an energy exchange provide an intrinsic roadmap for such an exchange. The expectation that energy could be generated by a diverse collection of entities from traditional utilities (state owned, community owned or privately owned) to a broader group that could include private residential and commercials. While energy produced by the later groups are expected to be largely consumed by the owners, there are no limitations from re-selling the energy back into the grid. Indeed, it is more likely that energy will be generated in this new energy "plants" to help create a federated grid of sources. The role of exchanges in such a federation will be critical to their success.

A view of exchanges can be garnered from the internet. Internet data transfer is hardly efficient in the absence of exchanges. Consider a case of multiple internet service providers. The absence of local interconnects , local exchanges or peering services will imply that data traffic may not always follow the true "shortest" path, but a tortuous pathway of fiduciary arrangements. In many African countries, internet routing continue to follow such staid paths, resulting in higher connectivity costs and lower service quality. In practice, most data content is local, yet in in practice in many African nations, most data traffic is international. Local Internet Exchanges reduce traffic costs, limit latency and could aid quality. Energy Exchanges could have a similar  effect.

Health Exchanges: Health Information Exchanges are the most important form of health exchanges today as they are designed to provide a robust framework for health care data interchange between a disparate set of providers helping to drive data standardization and the widespread adoption of electronic medical records in health care practices.  A Health Information Exchange (HIX) is intended as a data interconnect-point and could also serve as data repository (local, regional, national or even global) of live health care data and thus a cross point for all types of health care entities from care givers to researchers to insurance providers and regulatory entities. Indeed on a national level, there will be a heirachy of  HIX from the local to the regional to the national. Conglomerate Providers will serve multiple roles as both a peer-ing service (similar to data peering services provided by large network service providers) for external entities as well as service point for their individual service members. For example, a Health care Insurance company with services in 6 states could also act as a health-data-peering service for other insurance companies in the various states where it operates, as well as to the various hospitals and practitioner offices in those states. 

HIX are at a critical junction in the United States as their framework and parameters are being developed but often by professionals with little knowledge of successful exchange models. Indeed some conversations about HIX presumes HIX providers could also be considered customer (patients) facing entities. But the reality is that that is not only an inefficient proposition, it could also stifle innovation and drive down adoption of HIT. As in Internet Exchanges, the end users need not be intimately informed about the details of HIX - these are for providers and aggregators to worry about. Consumer services (including access to health care data) should be left to competent consumer focused entities. Indeed, a provider could as a matter of practical preference and strategic imperative include HIX services in its repertoire, but that service should not be conflated with its other services such as ensuring that patients have access to their own data - if requested, and that patients have a reasonable mechanism for recourse.

I have seen some cases where the issue has been raised, but it is apparent that desire to guarantee patient access protection could be best served by ensuring that the data sources are clearly defined and determined and that a patient record includes the originating source(s) of the records and that providers (not HIX) provide a mechanism for patients (or their representatives) to effectively access and review their data.

ENergy exchanges (EnergeX) will need similar consumer protection. Indeed, while HIXs have no real patient interfaces, EnergeX of the future are expected to have those. Energy will have a bi-direction flow from consumers to the grid and this arrangement will help communities keep a handle on its energy infrastructure and also maintain a reasonable cost lid on energy.

The future of data transfer on the internet, health network (increasingly on the internet) and energy grid (internet and power line) is an exciting and challenging one and exchanges will play a great role - in many cases akin to those in the financial exchanges across the globe.