I lied to you. I read that more people will read your blog if you title it with ‘best’, ‘most important’, or ‘Top Five Something or Another.’ Sue me.

[Sidebar: A hospital executive and her family are at TGIF for dinner. While waiting for her order, the hospital executive grabs a purple crayon (it’s purple because I like purple), and starts killing time by reading the brainteasers printed on her placemat to her family.

“A plane crashes on the border of the US and Canada. In which country are the survivors buried?” Her son says, “I thought Canada is a state”.

“Question 2: ‘Point to the nearest patient in the room.’” She scans the room. She observes that none of these people are wearing a hospital gown. She is stumped. “Where are my nachos?” She asked]

Writing is the ultimate way for me talk to myself, and it calms the nascent voices vying for my attention. That is because when I talk to myself I know I am talking to an intelligent person. Maybe I should not require people with whom I am meeting with to play the music from ‘Goldfinger’ or ‘Ride of the Valkyries’ before I enter a room.

(I know some of you want to send me to a re-education camp to atone for my sins.)

The military has an expression I like; the diversion you are ignoring is actually the main attack. Sometimes things exist that, although they seem unconnected, are actually part of a larger plan. Not your plan, to be sure, but a plan nonetheless.

We’ve all been in planning meetings to suss out what we should be doing. There is innuendo and double-talk, evasive phrasing and arcane code words. You leave the meeting believing your task is to report back on what consumers really want, when what they really wanted you to do is find out what the hospital cafeteria’s soup of the day will be next Tuesday.

To most of us, the concept of e-commerce means nothing more than buying something over the Internet. It doesn’t work with healthcare, but it should. “Click here for our two-for-one holiday deal on knee replacements.”

E-commerce begat mobile commerce; shopping using a device other than a PC or laptop. However, mobile commerce is nothing more than reproducing desktop commerce, which is e-commerce.

Under either solution, consumers are forced to fill out forms to verify their identity, search inventory, and add items to their shopping carts. And in many instances, to close the sale, the consumer has to leave whatever app they are using and pay for whatever they purchased from a different app—eBay and PayPal.

Conversational commerce could also be called inference commerce. It should use the capabilities of artificial intelligence through machine learning. Pushed even further, you arrive at cognitive learning and hence, cognitive healthcare. It creates personalized virtual assistants, like Nordstrom’s personal shopper, only without having to pay for the person.

I like to think of it as an Assistant-As-App (AAA), although today many of those apps are nothing more than an online IVR tricked out to connect you to a real person—online chat. A real Assistant-As-App does not require a person behind the digital wall to help you complete your task (online scheduling versus finding a doctor—one is helpful, the other is just a digital Yellow Pages.)

Take this for example. During any given day I’ll chat with colleagues online, use Messenger with friends, use LinkedIn to stay in touch about work, and text my wife and children. Conversations. Conversations using my phone and without speaking to anyone. What is missing from all of these conversations is commerce. Messaging is how people communicate, but it is not how people access and engage with a firm.

But what if it was? Why not create an AAA that was a digital interface that enabled users to accomplish complex tasks through a natural dialogue with an assistant? I deliberately left a word out of the preceding sentence. The preceding sentence is the digital IVR solution. The missing word in that sentence is the 2^nd digital. The sentence should be, creating a digital interface designed to enable users to accomplish complex tasks through a natural dialogue with a digital assistant. This is the Super Smart App, the SSA.

Let’s try something on for size. Sally and her family moved to Philadelphia in August. She received an email from the Hospital of the University of Pennsylvania (HUP). HUP found Sally by mining data about people who moved to Philadelphia. The email told Sally that she could do everything she needed to do to manage her health by downloading HUP’s SSA, MyHealth.

So, Sally downloads MyHealth—not a trademark infringement of MyChart since MyHealth actually does things, and also works for non-patients. (Ten seconds of opining. Patient portals work—for patients. They do not work for family members, caregivers, and prospective patients (customers)).

Sally speaks to the app (like using Amazon’s Echo). “My name is Sally Smith. We are insured by Cigna. Does HUP accept Cigna?” “We do,” it replies.

“I want to register my family with HUP.”

MyHealth recognizes Sally from the email it sent her. “Sally, we have your address and phone number. Other than yourself, whose health do you want us to help you manage?”

Sally provides the profile information of her husband and children. MyHealth replies, “Everyone is registered. Your account is secure because we use voice recognition to identify you. Your husband may also want to add a voice signature to the account. If you want, you can tell me the name and contact information of your PCP, your husband’s and your children’s pediatrician, and I will contact them and get their Electronic Medical Records.”

Wow! Exclaimed Sally. MyHealth chuckled digitally, but Sally couldn’t hear virtual chucking. “I see you have two children, one in high school, and one in middle school. Pennsylvania requires all new students to have a physical before school starts. We have three pediatric Primary Care Practices within five miles of your home, one of which will come to your home to do the annual physical. Would you like to schedule an appointment?”

“Does it cost more to have the doctor come to our home?”

“It does, but because you are with Cigna, and new to the area, we can discount the cost by twenty-five percent, and your total cost will be three dollars.”

Sally scheduled the appointment. MyHealth replied, “If you tell me the name and contact information of your pharmacy, I can have all of your family member’s prescriptions transferred to the CVS Pharmacy two miles away from your house. Or, I can have them set up on automatic renewal through their mail-order pharmacy. For doing that, CVS will give you a twenty-dollar coupon.”

Sally tells MyHealth the prescriptions her family members are using. MyHealth replies, “If you switch to our mail-order pharmacy automatic renewal program we can save you forty percent.”

When we think of things like patient access, experience, and engagement, patients have one notion of how they should work, and providers have another.

So, that is how healthcare works in my mind. All of these capabilities can be designed today. The only thing missing is the leadership to do it.