How to create an interoperable app ecosystem.
In the decade since the passing of the Health Information Technology for Economic and Clinical Health Act (HITECH) that introduced incentives to meaningfully use electronic health records (EHRs), hospitals and medical groups have installed computers in nearly every care setting across the country. While much of their focus has been on implementing these systems, they are starting to understand that their EHRs need to do more to enrich the patient and provider experience.
As the industry continues to consumerize, providers are navigating this changing landscape by embracing software in the cloud. While traditionally slow adopters of technology, the healthcare industry is further along in cloud adoption than some industries, according to some indicators. Movement away from on-premise solutions to the cloud has enabled an environment where providers can rapidly adopt innovative healthcare applications to meet their unique needs, improve the patient experience, and improve outcomes.
Healthcare apps are ushering in a new era of care delivery—with more than 318,000 health apps now available and more than 200 health apps added each day. However, the marketplace for these apps is fragmented as the industry continues to be plagued by three fundamental issues:
These underlying issues have led EHR vendors to create their own third-party app experiences and marketplaces to aid in discovery and distribution. But because there are many EHR vendors, each with their own separate app program and varying pricing structures, software developers struggle to decide who to integrate with and if it is worth the time and effort.
To attain a thriving healthcare app marketplace, the healthcare industry first needs to overcome the following core issues and create an interoperable app ecosystem. When this happens, the business model of the healthcare app marketplace will shift to a one-stop shop where an app can connect to any provider with any EHR, simplify how data is exchanged, and, in turn, accelerate the development and deployment of new technology.
The IT department has become accustomed to managing its on-premise systems, such as EHRs. Because they have all the control, they end up becoming the de facto decision-maker on what software to adopt based on certain technical requirements. However, as the industry continues to accelerate to the cloud, this will become less of an issue as IT won’t necessarily need to manage adoption of technologies.
IT’s role should evolve to one of oversight on data governance, privacy, and security. That is where a cloud-based integration strategy comes into play. In the future, IT departments should set guidelines for tech adoption to meet certain requirements outlined in their integration strategy framework. IT can start to democratize the technology purchasing decision, enabling other departments, care teams, providers, or individual employees to purchase and use whatever app they would like. This requires IT to understand how applications integrate with underlying data and to relinquish control if interoperability and security requirements are met, eventually enabling a bring-your-own-app ecosystem.
In a perfectly competitive market, the buyer is well informed of the benefits a product should provide. However, in health care, at best we have a compelling PowerPoint sales pitch. Provider organizations are forced to test new software and learn its benefits for themselves, rather than learn from those who went before them through an information-sharing mechanism.
This information gap is one reason the healthcare industry is plagued by 18- to 24-month sales cycles to get an app in the hands of users. Providers must thoroughly and meticulously vet solutions, which postpones the buying decision. In turn, vendors increase prices to compensate for the aggregate costs of these time delays. Increased prices only extend the amount of provider vetting. This chain of events contributes to slow adoption of new technology and is why archaic technologies like clipboards, pagers, and fax machines are still being used (see “Closing the Information Gap”).
Although interoperability is the right thing to strive for, it is hard to find appropriate business cases to achieve it. Provider groups often compete with each other for the same patient population, so they lack proper economic incentives to share data. However, given a useful application, they will share their data.
The problem is, most EHRs were never designed to interoperate, much less communicate with modern cloud-based applications. They have inconsistent data models as they are heavily customized to meet an organization’s unique needs. Furthermore, cloud-based software vendors lack the unique skillset to exchange data with EHR systems, and IT teams don’t know how to work with software vendors in the cloud.
How can cloud apps get access to your organization’s underlying data? Your organization needs to create a cloud-based integration strategy. Over the years, three distinct strategies have emerged:
As the healthcare industry evolves, it will overcome the core challenges of IT departments as decision-makers, long-drawn-out sales cycles, and lack of data access. We’ll see a new healthcare app marketplace emerge where open APIs are the norm. Operating as a one-stop shop for apps, the marketplace will feature apps that can be written once and used by any provider and reused on any EHR.
As more apps join this marketplace, integration projects will get up and running fast, enabling healthcare organizations and medical groups to be increasingly agile in adopting new technology. This marketplace will push the healthcare industry to a point where integration is in harmony with the provider’s workflow and supports care transitions. Ultimately, health care’s interoperability problems will be solved.
Niko Skievaski is president of Redox, a full-service healthcare integration platform that accelerates the development and distribution of digital health solutions.
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