The
Children’s Health Informatics Program in Boston published a working paper
last week that outlined the "ten principles for fostering development of
an ‘iPhone-like’ platform for health care information
technology." This paper is the byproduct of a perspective piece featured
in the March edition of the New England Journal of Medicine. Bloggers went wild, chattering with glee about the new role of the iPhone as a framework for EHRs nationwide. One
blogger noted that “a better strategy may indeed be the building of an
Open, iPhone-like platform with open SDK, open APIs, etc., heck, even throw in
an AppStore (with an app review feature) and let the development community have
at it… Are you listening Washington?”
The iPhone-like platform that docs and healthcare gurus are raving about is a sexy product put out by Apple—well done of course. But a better comparison to creating an EHR application market alluded to by the
NEJM authors and their fans is software-as-a-service (SaaS). Popularized by Salesfore.com, SaaS
has proven itself a successful business model.
In the case of Salesforce.com,
it created a web-based platform for managing large amounts of customer data. SaaS lets clients manage large data sets securely
off-site and tailor databases to meet their application needs by choosing them à la carte. The ones they select are then integrated into one functioning piece of web-based software. The client saves on equipment and licenses and instead pays a monthly fee for the
hosting a secure transactional site.
Salesforce.com maintains the privacy of millions of client customers while smartly providing a tailored user experience for its clients. Additionally, the applications that lie on top of the basic SaaS platform may be from competing vendors that want to sell a specific software function to the user.
Now, imagine this in the world of
EHRs! As highlighted by the authors of the NEJM piece, there would
be great value in tailoring an EHR based on individual needs. After all, why pay for stuff you don’t
need? A software-as-service EHR platform would foster a competitive marketplace too, potentially lowering prices while raising quality.
While the analogy to the iPhone is hip, it is inaccurate. The iPhone
is a great toy—don’t me wrong, I love mine—but iPhone mainly traffic in the realm of music, movies, email, games, and oh yeah, being a phone. With respect to ushering in a new era of eletronic health records
that can be handled via an "app store" or SaaS approach, there is still a very long road ahead. Why?
Adoption. Let us not forget
how few hospitals and docs currently use EHRs (less than 10 percent)
Incentives. While incentives
are ripe for EHR purchasing thanks to ARRA, there is little incentive for
vendors to alter their behavior and move them to a more ‘open’ mode
of software development;
Development. Drawing developers
to an apps marketplace for a EHR/SaaS platform is not that easy. In the Apple
world, anyone can build an application and many do it more for fun than profit. Additionally, Apple's well-known brand is a beacon for developers who know that
millions may use their apps. A similar marketplace just does not exist yet in the EHR space.
In fact, an open source platform for EHR tools already exists. Despite being a lower cost alternative to
commercial products, it hasn't taken off. Vista,
the nation’s open source EHR, continues to sit, awaiting mass download. Hmmm. Let’s keep our excitement in check.
Also Interesting:
[+] FISMA—a roadblock for EHRs?
[+] GE offers no-interest loans to promote EHR software
[+] Community Health Centers: An EHR helping hand, please?
[+] States take bigger role in promoting EHR adoption
[+] Doctors aided by emerging offshoot of EHR software
[+] EHR standards committee meets and prepares to sprint
[+] New study cites poor uptake of electronic health records
[+] Patients cheer on EHR technology, not afraid of privacy risks