NEJM: Don't be tied down by EHR vendors
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“[T]here’s a clear path toward better, safer, cheaper and nimbler tools for managing heatlhcare’s complex tasks,” wrote Kenneth D. Mandl, MD, MPH, and Isaac S. Kohane, MD, PhD, from the center for biomedical informatics, Harvard Medical School in Boston.
The authors stated that early health IT offerings were cutting-edge yet contemporary EHRs “distinctly lag behind systems used in other fields,” adding “most [contemporary] EHR vendors not only have failed to innovate but don’t even embrace existing modular architectures with interfaces that allow extension of product capabilities, innovative uses of data and interoperation with other software.”
They wrote that more than 700 vendors now produce approximately 1,750 distinct certified products yet fail to interoperate which has not helped patients or physicians. “Furthermore, despite this sprawl, a few companies controlling much of the market retain entrenched in ‘legacy’ approaches, threatening other vendors’ viability.” Mandl and Kohane argued a healthy IT market would favor disruptive innovations for improving communication and patient engagement.
They advocate a subset to be highly specific to healthcare:
- Secure private storage: “Local or cloud-based storage…is highly adaptable to healthcare if accompanied by strong, compliant privacy policies";
- Communication among providers or between providers and patient is not unique and can be addressed with products and protocols;
- Documentation tools: text processing and other software that supports task-oriented group processes in multiple industries “easily outperforms EHR systems”;
- Graphing, mapping and analyzing tools: “Some, like Google maps and R statistical package, are free and open-source. Others, such as ArcGIS and SAS, are proprietary but have public programming interfaces for integration into the workflow of heterogeneous users across disciplines. All these tools cost a fraction of 1 percent of the typical EHR system.”
“Programs should not be held hostage to EHRs that reduce their efficiency and strangle innovation,” the authors concluded. “New companies will offer bundled, best-of-breed, interoperable, substitutable technologies … that can be optimized for use in healthcare improvement. Properly nurtured, these products will rapidly reach the market, effectively addressing the goals of ‘meaningful use,’ signaling the post-EHR era, and returning to the innovative spirit of EHR pioneers.”