Open architectures for EHRs could spur innovation

EHRs would benefit if developers had the ability to create applications (app) for them. Several organizations are working to build the open architecture to allow it, according to the panelists of a Sept. 15 presentation at the 2012 Medicine 2.0 Congress.  

Health IT can be downright ugly and unbearable to end users’ eyes. It could be better. To make this point, Kenneth D. Mandl, MD, MPH, pointed to a graphic created by data journalist David McCandless for the December 2010 issue of Wired. McCandless transformed a drab health report into an appealing, easily navigated graphic that provides a hypothetical patient with accessible information and actionable instructions.

“We took a developer working with an application programming interface (API) and it took him eight days to bring that picture to life,” said Mandl, an associate professor at Harvard Medical School in Boston and director of the Intelligent Health Laboratory at Children’s Hospital Boston. The resulting app is now running on three platforms through the same API at Children’s Hospital.

“EHRs should look a lot more like iPhones than they do now,” Mandl continued. Developers build tools for smartphone users that aren’t provided by their device manufacturers and users can select the tools they want based on their needs. Consumers don’t turn to a single company for all of their IT needs, and providers shouldn’t have to either, according to Mandl. “The way EHRs are marketed, there’s an expectation that they’ll provide all functions doctors need.”

“The problem is that a lot of EHR applications tend to be siloed,” said David Haddad, MSc, a program manager for Open mHealth, a nonprofit dedicated to building open architecture for health IT. “It becomes difficult to integrate different types of data sources, to have tools and techniques to make sense of information, and to connect with EHRs.”

Programs like Open mHealth and the Office of the National Coordinator for Health IT’s SMART, which is currently developing an app-friendly EHR user interface, represent just two organizations working to build open architectures to allow developers, from those employed by corporate health IT vendors to those working in their parents’ basements, increased ability to deliver substitutable EHR apps.

Despite the lack of progress to date, health IT enthusiasts are optimistic. Toyota started building the Corona, an economical car intended to get passengers from point A to point B, long before it started building the Lexus, Mandl pointed out.