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

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!

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.