December 10, 2015

EHRs as the “Operating Systems” of Healthcare?

As of March 2015, 779 health IT vendors supplied certified EHR products to 490,575 health care professionals participating in the CMS EHR Incentive Programs and/or ONC REC Program. 30 of them are big players, primary, and 749 supply secondary EHRs to participating health care professionals. Surprisingly, market share hasn’t changed much in 10 years – so what does that mean to the EHR systems? Are we at the tipping point of disruption?

EHR - doctor prescribing medication

Electronic health record (EHR) systems have evolved over time; moving away from their initial focus on collecting information for claims and billing to more patient-centered workflows involving individual patients.  Along the way, there has been some success with the integration of other technologies and systems, such as imaging, order entry, devices, information exchange, etc.  However, paper or electronic records of one provider’s encounters with a patient isn’t enough as we move into a future of value-based purchasing, population health, evidence-based practices and personalized medicine, not to mention the use of wearables. As Robert Rowley, MD defined it instead of being thought of as physician tools, they should be used as practice tools.

There are two streams related to EHR data that need remodeling:

  1. Data analytics and reporting – Those who will be paid for performance and outcomes need data that represents the records of each of a patient’s providers, all of their encounters, as well as, home monitoring and self-management activities. To make sense of all of this data, they will also need access to tools for data analysis, trending and reporting so that both providers and their patients can understand and take actions to improve their overall health. In order to do so, firstly, one must have access to all this data. Having a portable record that is patient-centered and that follows you throughout the whole care system, additionally having features such as data visualizations and reporting, demands a new approach no matter how well the specific EHR system is integrated within a network.
  2. Competitive efforts –  Too often, physicians, nurses administrators and other professionals are disappointed to find that the newly implemented EHR can’t fill some specific need. This brings us to the real question of whether EHR vendors will continue their competitive efforts, attempting to meet all of the needs of healthcare? Or will they finally open access to their proprietary infrastructure and bodies of knowledge built over decades, to assume a central and important role for providing the data to complementary applications and systems that will present information for a multitude of provider, researcher, payor, and patient needs. Is giving open access to internal data to new startups and other digital health companies that will be niche specific the answer? Athena Health seems to think so and this is exactly what interoperability legislation is aiming to do.

EHRs are evolving and filling functional gaps for hospitals, physicians and other provider needs as they shift to value-based reimbursement models and managing the health of patient populations, in addition to individuals. However, in order to remain competitive in the future, EHR vendors will have to collaborate with other vendors who can easily integrate with their system to provide enhanced access to useable information and services.  We definitely agree with the AMIA’s 5-point call to action for a better EHR in the future  – especially the section related to Fostering innovation. This section is focused on moving EHR vendors into using public standards-based application programming interfaces (APIs) and data standards. The taskforce believes moving to APIs and data standards will enable EHRs to become more open to innovators, researchers, and patients.

We can not help but wonder are EHRs becoming the “Operating Systems” of Healthcare? When EHR vendors move to open access to internal data (and APIs)  they will, just like an operating system, represent a platform for all those add-ons and new features (apps)  other satellite companies or startups could develop and specialize in.

So, which vendor(s) are currently well-positioned for collaboration with other technology vendors for a more holistic systems approach?  

Athena Health has been taking a proactive approach in waiting for stage 3 to commence. Athena has been, for quite a while, working on making its API available to their partners and others. Through a special program in 2014 together with Mashery they announced a partner program called  “More Disruption Please” where they invited other companies to pitch them with open API project ideas. Since then they have been making efforts in educating others about their Application Developer Marketplace and their EHR APIs.

Allscripts has also recognized the value of exposing their application program interface (API).  This specifies how the software components of other technology vendors should interact when programming for the use of data contained in the Allscripts EHR.  

Third-party digital health companies have already developed applications that meet the needs of healthcare providers, patients and payors on top of the Allscripts platform.  Each application fills some specific gap with relevant and useful information; leveraging the data already contained in the EHR system.  The 186 existing apps facilitate patient education, clinician search, decision support, care coordination and other important workflows and tasks.

It will be interesting to see which of the remaining EHR solutions will be next to follow the lead of Athena Health and Allscripts to remain relevant in the EHR marketplace. It is a brave new world we are entering!

Author: Digital Health Team
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