Time Capsule: A Harvard Vision of One-Stop Shopping: Why Someday You Might Buy a Michael Jackson Ringtone, a “Pull My Finger” Game, and CPOE from the Same Vendor

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in July 2009.

A Harvard Vision of One-Stop Shopping: Why Someday You Might Buy a Michael Jackson Ringtone, a “Pull My Finger” Game, and CPOE from the Same Vendor
By Mr. HIStalk

The software my hospital uses is the same as everybody else’s – old. We still have musty mainframes running character-based applications. We use oddball servers running systems whose vendors have changed hands several times or closed up shop completely. Some of our systems, like the gray-haired employees who support them, haven’t changed their look since Reagan was in office.

So here’s my thought. The only significant, computing-related change I’ve seen in my hospital in several years came about because of infrastructure, not applications. The expensive and painfully implemented software applications had only modest impact on creating information and even less on its consumption.

Those ground-breaking technologies at my place were:

• Wireless connectivity that made systems portable and therefore clinician-friendly.
• PACS and related imaging technologies that changed the entire paradigm and workflow of managing and using patient images.
• Physician portals that took information we already had (mostly in the largely ignored clinical data repository) and made it universally available and easier to use.

(I’ll eliminate the Crackberry since peon employees aren’t allowed to have them, but executives are fixated with them to the point I’m thinking about trademarking the name VPacifier).

You could argue that these weren’t new technologies at all. Years before we put them in, our employees had already been screwing around with WiFi, digital photography, and Internet pages at home. They didn’t have to be prodded to use their equivalent at work.

So, as my previous hospital employer’s chief medical officer always said after rambling pointlessly, where am I going with this?

The most promising innovation in physician systems won’t come from for-profit software vendors like Cerner and Epic, who aren’t thrilled at the prospect of rewriting their cash cows. Instead, it will come from the iPhone, and I’m not just talking about mobile applications, I’m talking about software architecture.

A couple of geeky Harvard professors are pushing the concept of “an iPhone-like platform for healthcare information technology.” They’ve written a journal article and are convening a tiny, invitation-only conference of non-vendor people to flesh out the concept later this year. If they can overcome the back-scratching CIO-vendor-consultant troika that keeps the status quo in place, their idea could be big.

What they’re saying isn’t new: monolithic, scripted applications sold by soup-to-nuts vendors don’t work well (can I get an amen?) A better architecture model for healthcare involves tightly focused, substitutable, turnkey, plug-and-play applications that run on the same basic platform. The customer can use whatever combination of mini-apps that works best for them, with one flip of the switch bringing one of them online (or offline in the case of buyer’s remorse — gee, I wonder why vendors would have a problem with that?)

Like the iPhone, in other words, with its ridiculously well-designed user interface, its App Store, and its portable form factor. People get the iPhone without going to class, studying a stack of manuals, or hiring a consultant to explain what they just bought. They also aren’t held hostage to the single vendor to which they’ve sold their souls.

It does not take a Harvard person to tell you who would love this (customers) and who would hate it (the troika, although CIOs might surprise me and embrace the idea). Those who love it have additional ammunition: the cheap consumer gadget known as the iPhone will be rearranging healthcare IT priorities even if the Harvard guys flop, most likely soon taking the #4 spot on my list.

So can the Harvard guys succeed? Beats me. They have a fun idea that needs a ton of fleshing out to even be discussed publicly. Lots of ivory tower stuff fails. And, nobody’s paying much attention since the HITECH gold rush has them hypnotized.

Still, I’m cheering for them since it’s about the only radical platform change out there that could shake the HIT applications business back to life. Open source has elicited nothing but yawns. Vendors are consolidating without new entrants to threaten them. Hospitals haven’t shown any interest in manhandling their vendors into updating their last-millennium wares. Same old, same old.

I think it’s darned interesting, although being an industry pessimist, I’ll root for the Harvard guys while betting against them.