A few posts back, I described how the flexibility offered by content management systems made them superior to traditional methods for building websites. Content management systems such as WordPress (used for building this site) are designed in a way that allows new capabilities to be added to sites quickly and easily. The appearance of a WordPress-based site can be transformed simply by changing the theme, while new functionality can be added using self-contained modules referred to as plug-ins or widgets. Since plug-ins and widgets can be added on-the-fly, website builders can change and improve their sites as the need arises. Though I have chosen WordPress as an example, just about every content management system shares these features.
Thousands of plug-ins and widgets are available from hundreds of sources, providing extensibility, flexibility and a buttress against obsolescence for web developers. Much like Androids and iPhones, content management systems act as a sort of platform to which app-like modules may be added to attain the required functionality. Having worked with DNN, Joomla, and WordPress for the last few years, the thought recently occurred to me that they provide the perfect metaphor for designing the next generation of EHRs.
While content management systems are becoming more flexible and more extensible, EHR technology seems to be going in the opposite direction. Dominance in the inpatient EHR market seems to be shifting to a few vendors that sell closed systems for which they alone are permitted to provide functionality. Utilizing functionality from other vendors usually requires expensive interfaces, and data-level integration is rarely allowed. Ambulatory EHR products have similar restrictions.
Today’s EHR products are closed by design–not due to any limitations imposed by programming methods or hardware limitations. Closed architectures allow vendors to prevent clients from moving from one product to the other. Consider how great it would be if practices could mix and match functionality in their EHRs. I wonder if this approach to EHR design would increase EHR sales. If practices no longer had to worry about being locked into a specific product, or limited by the R&D capabilities of a single company, they might be less fearful of investing in an EHR. Imagine being able to buy a form template, a reporting engine plug-in, or a problem list widget from a variety of companies and know that each would integrate seamlessly into your system.
The software architectural features required to support an EHR as a platform are very different from those needed to create a typical client-server product. Therefore, getting any current EHR product to work in this manner would most likely require extensive programming or starting from scratch. Actually, starting from scratch might be just the impetus needed to spur real innovation in clinical information systems.
Innovation spurred by platform EHRs might lower ownership costs and increase functionality by bringing more companies and technical talent into the HIT market. Widget-based interfaces might make usability issues less troublesome by allowing for user-customizable systems. EHR implementation might become easier and more predictable because modular EHRs would allow practices to implement only the features they require — not an entire monolithic system as is currently the case.
This seems like a good idea for an open source project. However, the skeptic in me doubts that any major EHR vendor will see any merit in the idea. For some reason, market-leading technology companies rarely see the value of a new way of doing things until well after the market has shifted. The brief history of computing is littered with the remains of once powerful companies that were too tied to the status quo. When was the last time you heard someone mention Compaq, DEC, orSun Microsystems?
The iPhone was dismissed as a flop immediately after it was announced — even before anyone had seen one. The first platform EHR will likely receive a similarly derisive welcome. Fortunately, some ideas are simply too good to pass up. I certainly intend to give it a shot.