A cardinal rule of success is that vision should guide strategy and tactics. Put simply, you must know where you want to end up before planning how to get there.
Keeping that end goal in mind also helps with the inevitable course corrections that must occur along the way.
When it comes to improving interoperability in health IT, a clear vision of what we hope to accomplish has been lost in all the strategic and tactical discussions about technical and business issues. Fortunately, the smartphone app store provides an intuitive and powerful guiding vision for building a modern healthcare IT ecosystem enabled by true interoperability.
Creating a health IT ecosystem
The goal and animating vision of interoperability should be the creation of a vibrant, effective and efficient health IT ecosystem. In this vision, interoperability provides the basis for a collection of devices and applications that are easily connected, communicate in real time and collaborate to deliver outstanding results.
We know this vision is not a hallucination: it reflects the digital world we live in today with the creation of app stores. App store models harness market demand and competition to deliver variety, choice and optimization of quality and cost. Market forces weed out bad ideas and approaches and reward good ones.
App stores can also create a multiplier effect. Apps can be viewed as building blocks that are stacked and linked to provide new capabilities. In effect, different apps can leverage each other’s strengths to deliver greater value. For example, the messaging and camera apps on your smartphone work together to capture and deliver images via SMS.
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We can see the results of this approach at scale when looking at other successful IT platforms. Salesforce has built a hugely powerful platform that other developers can leverage to deliver new features and entirely new applications. In this model of enterprise B2B software integration, the end user can use Salesforce-provided modules or competing ones that plug in seamlessly.
Likewise, Microsoft undertook a remarkable change in direction when they launched Microsoft 365, and it has succeeded beyond expectations by providing powerful integrations with competing plug-ins.
Now imagine a similar health IT ecosystem where a clinical decision support app can partner with a unified communications app to deliver critical information to the right person in real time. Or a population health management platform that can leverage a separate predictive algorithm app to risk-stratify a population and design specific interventions. Don’t like the "out of the box" documentation module your EHR vendor supplies? Swap in a different one. These possibilities hinge on a broad, interactive view of interoperability and the positioning of today’s siloed EHRs as true innovation platforms.
Enabling the vision
App stores achieve interoperability between applications by using application programming interfaces (APIs). This proven approach powers a large portion of the digital economy and is emerging as a key enabler of health IT too. The key here is competition and choice (just like the apps in the app store).
The best path forward is to establish conditions that harness market forces to drive innovation of APIs that is closely attuned to the actual needs of digital health companies and healthcare providers. And the best EHR app stores are EHR-agnostic, encouraging developers to invest more in their applications knowing they will be available to a larger customer base.
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This combination is far more likely to result in near-term success than relying on legacy technology or a single vendor-sponsored app store. It also provides a path for balancing the utility and value of standards-based approaches to API development like FHIR with the need to innovate quickly and be more responsive to market signals. This FHIR+ or “both/and” approach can maximize the impact as innovators race ahead to the bleeding edge while standards developers reach consensus and codify the best solutions into even more efficient models.
Now, that’s a vision we can all get behind.
Dave Levin, M.D., is the chief medical officer for Sansoro Health. He is a nationally recognized speaker, author and the former CMIO for the Cleveland Clinic. You can follow him @DaveLevinMD or email [email protected]