Today at Harvard Medical School, Zak Kohane and Ken Mandl assembled 100 folks to discuss "Substitutability" - the notion that EHRs of the future will be more modular and more iPhone app-like, possibly with common Application Programming Interfaces.
Some of the speakers at the conference were Mitch Kapor (Lotus founder), Sean Nolan (Microsoft), David McCallie (Cerner), Alfred Spector (Google), Rob Kolodner (formerly of ONC), David Liss (New York Presbyterian), Charles Friedman (currently at ONC), Mark Frisse (Vanderbilt), Clay Christensen (HBS), David Kibbe (Senior Advisor to AAFP), Aneesh Chopra (US CTO), Todd Park (HHS CTO), and Regina Herzlinger (HBS)
I served on the opening panel called Open or Closed Platforms? One or More Platforms.
Here are a few of the key points.
I suggested that standards can be required at different levels of specificity depending on the transaction. e-Prescribing transactions should be highly specified to ensure the right drug, right dose, right form, right patient are transmitted securely with data integrity from provider to pharmacy. Sharing an office note might be done with less specificity - a secure transport layer plus a human readable payload that might be XML such as a CCD document, PDF, or a scanned TIF image. Quality measures are very precise and require a high degree of specificity to ensure comparability among clinicians and institutions. Even though these examples have different levels of specificity required for interoperability, the architecture is left open to innovation - these transactions could be done in comprehensive EHRs, iPhone apps, or PHRs with point to point data exchange or via a healthcare information exchange.
Several of the panelists thought a common API in front of various EHR vendor products was unlikely. Exchange at the data layer was viewed by all as very possible and most thought the meaningful use plan for 2011,2013, and 2015 data exchanges made sense.
All agreed that common data transport with appropriate security is important.
The general theme of the panel was openness. Microsoft offers a standards-based way to enter and retrieve data from healthvault. Cerner is supporting XDR, XDM and XDS as well as Cerner proprietary APIs which enable custom plugin applications to work with their products. OpenMRS is an open source platform for electronic health record development, embraced widely in developing countries.
The move toward more openness - regardless of architecture, platform, or open source/proprietary product type - was refreshing. To me, being able to extract data out of an EHR (even via a proprietary API) combined with common data transport standards and translation into structured vocabularies gives us a path forward for health information exchange in the near term.
The industry is changing, motivated by meaningful use, a business case for data sharing, and patients expecting coordination of care. Add to that healthcare reform which requires quality measures and H1N1 surveillance which requires public health data exchange, and the pace will accelerate.
It's clear the we'll have many product choices in the future - some integrated, some interfaced, some modular, and some platform-based. My take home message from the conference is that innovation and data standardization can co-exist.
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