Saturday, March 13, 2010

The Dawning of the EMR as a Platform...allowing us to "get the health care that we build"

Joe Flower continues to be one of my favorite healthcare writers. In a recent article in HHN Online, he talks about the heroes in healthcare who are constantly trying to improve the system. I love the quote on which he ends his article:

As Aristotle famously shaped it, "We are what we repeatedly do. Excellence, then, is not an act, but a habit." We will not get the health care that we want. We will not get the health care that we deserve. We will get the health care that we settle for. We will get the health care that we build, where we are, with the tools that we have, with the courage and compassion and collaboration and hard insistence on excellence that lies within us.

At the recent HIMSS conference, I think we began to really see the first signs of an important paradigm shift in the EMR world which will help make this ability to build a better healthcare system more feasible. Specifically, we saw the rise of the "Ecosystem" or "Platform" - terms which will become the buzz word of the coming year as vendors are starting to "open" up their systems (e.g. via APIs, or other technical and business transparency).

Stepping back, the historical scenario for an EMR vendor is to sell you all three tiers (database level, application/functionality level, and user interface level) as a tightly integrated unit. The upside is they should all work well together, the downside is minimal ability to customize one layer without having to get involved with the other layer because they were so tightly linked. For example, if you wanted to display vital signs in a different way in your user interface - you would also have to change the underlying data model and application abilities. We can refer to this as the "Tyranny of the Three-Tier Architecture".

Unfortunately, what we have seen are quite bad user interfaces from the EMR vendors and minimal ability for real life users to improve upon them. The result has been poor adoption of EMR systems, as well as multiple instances of "unintended consequences" from poorly defined user interfaces. Fortunately, the EMR vendors must have realized this was the case (or they are getting spooked by the new crop of HIE vendors and system integrators who are trying to take their data and allow for more customized user interfaces).

So at HIMSS, I found that many EMR vendors are now allowing at least some ability for users or third parties to create new widgets and user interfaces to "put on top of" their EMRs. We are still pretty early in this phase, but eventually- the hope is that this will become analogous to Apple creating the "iPhone Platform": The EMR vendors will ideally compete to create the best platform which will then allow for some true innovation at both the application and presentation layers, or alternatively brand new vendors will come along to create platforms which take what is needed from legacy systems while allowing for others to build on top of them in a unified environment (e.g. GE's new Qualibria). Either way... the ideal result will be an Ecosystem where we can indeed Build the Healthcare System we need and deserve.

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