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Healthcare it should just work (Together)

August 11, 2013

In healthcare IT, it seems like everything is harder than it should be. Faced with regulatory pressures and appropriate safety concerns, as well as multiple key stake holders and competing priorities, many projects drag-on for an unreasonably long time.

Faced with these challenges, some would propose large, tightly integrated, single vendor solutions that do everything from capture clinic notes and research data to send patient billing data and manage bed count.

Large tightly integrated systems are appealing to centralized administration. They lower overhead of managing multiple systems and reduce or eliminate integration costs. In selecting these systems it is argued, perhaps rightly, that their ancillary features and functions are "good enough." I have watched this process. And when "Is it good enough?" turns into "Is it likely to cause harm?" you know an interesting point has been reached.

In a commercial environment, each vendor is motivated to improve their system and its components to increase sales. In a large system, if a feature is key to triggering the decision to implement the system, great effort is made to improve it. If another feature is less critical to the overall effort, it maybe judged by whether or not it will avoid causing harm. Hence, that component will be made adequate to surpass that lesser test.

Smaller systems which focus on one part of the system (one hospital, one department, one need) are motivated to solve that portion with excellence. If they do not, someone else will.

The "system" here is U.S. healthcare informatics. Do we have a strategy in which our healthcare system is served by multiple interconnecting systems? Alternatively, are the key decision-makers relying on one vendor "winning" and inter-connection being defined as using that system?

Mature industries see interconnection standards where vendors, large and small, must plug in.The history of rail, automotive, home entertainment, consumer electronics, and avionics all tell of the emergence of these standards.  Perhaps healthcare IT will acquire these standards from government pressure, via ONC HIT and other mandates. Or, perhaps the multi-vendor CommonWell Health Alliance™ is the turning point.

In the presence of standards; systems, sub-systems, and components can be selected on their own value proposition. The trade off between best-of-breed features and easy integration is removed.  The future is hard to read in the short term. In the long run, standards win.