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Health IT from the CIO’s Chair 9/10/14

September 10, 2014 Darren Dworkin 6 Comments

Fine print: the views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers.

EMRs – Application or Platform?

It is hard to go very far these days with out someone looking to dismiss EMRs as “just the transactional system.” It seems every new IT innovation or idea is the next big thing that will do us the favor of connecting with our installed systems, but do so much more. Population health, analytics, mobility, and patient engagement are all the new platforms to focus on.

Wait. EMRs are depended on every minute of every day to enable care delivery through zillions of transactions and are the result of years of hard work and untold dollars. They aren’t a platform? Really?

I want to believe that our enterprise EMRs are really agile platforms on which care delivery can be transformed. They are just works in progress. Oracle, SAP, Facebook, and Salesforce.com all started as applications and grew into platforms. Some better than others, but it was a journey.

In my mind, our industry’s EMRs are on this same path. I think that the EMRs brought to us by Epic, Cerner, and Meditech (which I will refer to as the Gang of Three) all have a shot to truly be called a platform.

If the Gang of Three want to be seen as a platform and not just an application, they will need to evolve as did their big brothers in the ERP world.

Demonstrate market share dominance through rapid growth, consolidation, and the other vendors pivoting their business models in other directions as not to compete head to head. A goal here is to establish enough customer mass that effective and brilliant “group think” could take place. The market moves buyers to want enterprise all-in-one solutions instead of best-of-breed department ones.

I’m going to give the Gang of Three a grade of A on this one.

Demonstrate innovation of function, design, and features. Basically, they should be darned good — maybe even outright awesome — at transactions. Expect to see massive investments in R&D and lots of co-innovation with customers.

I’m going to give the Gang of Three” an A on this one, too.

Be regarded as having deep industry capabilities, clear and comprehensive road maps, and embedded best practices. Other software vendors from other industries would view the vertical as too complex to enter based on the learning curve.

The Gang of Three earns a split grade on this one. Deep healthcare knowledge, A. Comprehensive roadmaps, B. Embedded best practices, C.

Provide analytics. This would be translated as performance suites with end user-centric dashboards, complex and robust data integration suites, comprehensive data quality tools, and the real belief that they are enabling massive amounts of information to be transformed to competitive knowledge.

The Gang of Three gets a B+ for focus and initial efforts, but a C for execution.

Support mobility. This would be demonstrated by enabling wireless workflows across the organization. Optimized work can be done from anywhere, at any time, and on any device. Costs and tools matter in this space, so device management and security are key parts of all offered solutions.

The Gang of Three earns a C. Good progress on vision and good early applications, but with lots of work ahead.

Demonstrate reliability, flawless uptime and performance, and sub-second response times. Terabytes of data managed and delivered at the speed of thought. The paradigm of all information available in real time would be realized and would drive the enablement of new workflows never imaged before the system was installed. With the reliable availability of information, new business models to share and move data around the ecosystem would emerge.

I’m going to give the Gang of Three a B+.

Platforms are not just about function, but equally about cost. They would need to enable the shift within the IT organization of today that typically has 80 percent of costs on tactical IT delivery and 20 percent on strategic initiatives to at least a 50/50 split. IT operational costs consuming the majority of resources are lowered through hosting, cloud, and other leveraged services to allow for greater spending on innovation. Support costs are predictable and fall over time. Costs act as a consolidation driver as much or more than workflow.

This earns a B for the Gang of Three.

The toughest and probably the most important area for our gang to distinguish themselves as a platform is to create choice by building a leveraged open ecosystem. Choice would be fully realized by creating open APIs to access data models and workflows. Customers and third-party vendors would look to solve problems by building solutions within the system and innovation would be an open challenge to solve for everyone.

The Gang of Three gets a D-. This alone isn’t the definition of a platform, but it is crucial to the mix. This is the biggest area in which our gang needs to improve.

So, Gang of Three, it is time to get everyone involved to help us solve problems. Talk to your customers and third-party developers, court them, and encourage them to build their applications in such a way that they have a technology dependency on you. Risk some value you may create on your own, but balance it by figuring out how to extract value from your new workforce – your third-party developers.

It is time to enable choice!

1-29-2014 12-54-46 PM

Darren Dworkin is chief information officer at Cedars-Sinai Health System in Los Angeles, CA. You can reach Darren on LinkedIn or follow him on Twitter.

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Currently there are "6 comments" on this Article:

  1. SAP and the ERP vendors struggled for 20 years to deliver BI and in many ways still do. I don’t see analytics becoming a core competency of EMR vendors anytime soon if ever. Organization would be better off with a comprehensive information strategy that leverages those large invests in EMRs with best of breed analytics.

  2. They are wait-a-bases where information slowly decays.

    There are 4 distinct types of data – and they are not created equal.

    Constant Data – doesn’t change ever
    Parameter Data – changes infrequently
    Delta (dynamic) Data – changes all the time
    u-data – analog data about the human (feelings, emotion, fear, etc)

    EMR’s are records of what happened and we live in a world that is always happening. Boom!

  3. While I like the overall thesis, the reality is far from what is portrayed. The gang of three do not rate nearly as well as you give them credit for, eg your analytics score is way-off!

    Like ERP, there will be best of breed bolt-ons to EHRs to add value/needed functionality. How well the EHR vendors open up to allow such bolt-ons remains to be seen. A lot of talk, very little action.

  4. On the reliability scale, I’m sorry to say you are way off.
    It is only a matter of time before we see some very impactfull system outages.
    No difference between the major players. They all use lowest common denominator clustering and snapshot lag backups.
    They should be deployed on fully mirrored systems running on non-stop or ultra high reliability hardware like Stratus or others.
    Instead they go of the lowest cost Wintel or AIX platforms.
    Not to mention how many hospital data centers are Tier 2 at best.
    Sad state.

  5. Platforms don’t make money in the license software driven business models of the ‘today’, however, the smart play is to have an open architecture (truly open) so that everyone would want to build applications on it. Look at Sales Force. Highly functional transaction with a great adaptable platform. As the $$ moves to risk and scalability and away from license agreements, in the traditional sense, the all important transactional platform must change. Hopefully to a highly optimized and secure platform that allows for creative people to solve problems. Or we will all be ripping these EMR systems out in a few years to replace them with a solution from BezosLand.

  6. Absolutely Health IT is the framework that enables the management of health information across multiple electronic systems and devices, such as wireless medical devices, hospital information systems, communications infrastructure, and electronic health record (EHR) systems. Three federal agencies, the FDA, ONC and the Federal Communications Commission (FCC) each have unique responsibilities in the health IT arena.
    I believe that our organization is in right way and of course it is in top in Health IT , I hope that we can have strategy plan in “TELEMEDICINE “area in near future to.

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