EMR Platform

After I wrote my post about 50 EMR markets instead of 1 EMR market, I started to wonder what an EMR might look like that was just an EMR platform.

The basic idea would be that some vendor would create a platform where other vendors could build on top of their platform. They’d offer the core elements and foundation needed for an EMR and then companies could build applications on top of those core elements that focus on the 50 different EMR markets (or whatever the number actually is).

The easy part is seeing someone who builds some specialty specific applications like growth charts for pediatrics or a drawing application for dermatology. The hard part is to decide which elements of the EMR are “core elements” that can act as a foundation for every type of specialty, practice, location, etc.

I guess the question of core elements really comes down to whether we can define any part of the EMR to be something that EVERY doctor could use. I think of the iPhone as the example of a platform that people have taken and expanded with applications. The core elements are the phone, the GPS, the accelerometer, etc. Then, various companies have created applications using that platform that can cover a wide range of markets. Making the comparison of EMR features with iPhone features is not an easy one.

I honestly don’t think any EMR vendor has done something like this yet. Sure, some of them have some API’s where some customizations can be done. However, I’m not sure I’ve seen the full embrace of creating an EMR platform. The closest I’ve probably seen is some to the open source EMR software that’s out there. It seems like some of them have done a good job modularizing the software so that many different people can iterate on the software.

What do you think? Is an EMR platform possible and what would it look like?

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

19 Comments

  • I think it would look something like the Google Apps marketplace, or maybe it is the Google Apps marketplace. I keep asking the question, “Who’s the one to build it?” So far, I haven’t heard of anything, and Google’s app marketplace isn’t exactly taking off thus far, although there are some enterprise applications moving onto it.

  • I see an EMR platform happening by a Cloud Computing vendor wanting to differentiate. IMHO, it would behoove that vendor to use Amazon/Microsoft/Rackspace as the IaaS platform, then build a PaaS platform on top of it. Finally, the vendor could work with the client to build a SaaS solution (which your beloved certification organization could certify with a Site cert)…lol!

    Some food for thought. I was wondering today about the future of EHR records retention. Will HHS mandate retention requirements that will lead to the current email archiving vendors entering that market? From a PACS/Radiology standpoint, what storage and retention requirements are coming? Will we see entire SAN/NAS deployments for images with pointers to the EHR record? Is that the status quo (excuse my ignorance)?

  • Leonard,
    I can almost guarantee that Google Apps won’t be the EHR of the future. Possibly a Google Health integration.

  • Steve,
    I think something interesting could and will be done with the Amazon/other cloud companies. I’m still not 100% sure how that would work in EMR.

    There’s no doubt that there will be some major records retention questions. I haven’t seen any real indication of where it will land. Seems early on for any of this rule making I think. No doubt the email record retention companies are watching this closely. SAN’s are getting so cheap that there’s no doubt we’ll be seeing more and more of these in healthcare. Even in smaller healthcare settings.

  • The closest we can come to this is the HL7 standard. It would be impossible to have an EMR platform because all the parts have to be connected. IE, it is no use having drug interaction checking without having a medications list without a problem list without a recall option without a scheduling function without a lab function. Medicine is not a simple banking type business where every customer basically has a limited number of options. Medicine has almost as many variables as there are doctors and patients so the modularization of this complexity and basic useability would be much larger than its centralization. So there is no logical reason to modularize. Think of all the iphone apps having to interact with each other for each to function separtely.
    The iphone platform is simply a programming language like C or Basic. The iphone is the platform just as the PC is the platform for serious software.

  • I agree with MikeCEO that there are a lot of data elements in EMRs. There are only about a dozen high level ones but as usual the devil is in the details. Even for something simple like recording blood pressure there are many ways that EMR vendors have decided to do this. On the good side there has been a lot of work that has been done on an international scale to define more and more of the details. The problem is that the EMR vendors by and large seem to be largely unaware of those activities. As a result they keep producing idiosyncratic EMRs that lack the sophistication that is needed by the practicing physician.

  • Hi John,
    In the past few years a spirit of cooperation has developed between a number of the standards organizations that are working on EMR related standards. Some standards have started with one organization but the intent seems to be to migrate to have things finalized as ISO standards. Back about 25 years ago Richard Dick proposed that there should be a common reference medical record structure that could server as the intermediary format.

    Have a look at ISO 10781 EHR System Functional Model, ISO 13606 EHR Communication, ISO 18308 EHR Architecture Requirements, the ASTM CCR or Continuity of Care Record, HL7 CDA Clinical Document Architecture. Then there are nuts and bolts specs with LOINC and SNOMED. The CUI or Common User Interface specs developed jointly by the NHS and Microsoft.

    While most of these standards are still in development an EMR built around these specs would be really good.

  • Raymond,
    I’m not so familiar with the ISO standards, but there are a number of EMR vendors who claim to develop for the other standards you mention. Are there implementations just lacking or is is that the standards aren’t developed enough to really know the impact that those standards will have once adopted?

  • John,
    It can take years to get the ISO standards through to final ratification. The thinking that has gone into the standards during the development process is quite impressive and is far more rigorous that what is usually seen during the development of your average EMR. My feeling is that the EMR developers can gain a lot of insight into what is required by reviewing these various standards.

  • The situation here in Germany is about the same. Key to success for a vendor is to lock its customers into the product with no easy way out. You can buy your way out or get help from specialized companies but quite a bit of money will be involved.

    I believe Open Source will be the answer. There are only a handful that would serve as a good base. Many are established but have 10-20 year old codebase. The core/plugin model you propose is entertained by GNUmed already. This FOSS EMR by a handful of physicians is working on that model already. It tries to honour as many common software principles as possible. Without going into detail the advantage for a programmer is a clean speperation of database (backend), (medical) business logic and frontend (user interface). The (small) international team tries to keep health system related issues out of the core as much as possible. From the clinical point of view design decision are openly discussed with physicians. However I know that GNUmed did not look into the ISO standards. Coding is done in the open and there is no reason an interested party (physician or IT business) cannot participate.

    While this may sound like an advertisement it covers many points of what you propose. If you want to look at other FOSS EMR have a look at openEMR and OSCAR.

  • Sebastian,
    I’m a HUGE fan of open source. So, I’m glad to hear that GNUmed is doing well. Does it have much use in the US or has it mostly been international?

  • John,

    I am not aware of any installation in the US. We have always wondered what the reasons could be. We assume that EMR are mostly used for billing in the US rather then medical documentation. GNUmed does not offer a billing module. While this can easily be changed we have not been contacted by anyone from the US (doctors, programmers) who were interested in extending GNUmed for the US. This might be due to the fact that the German and the US market are heavily regulated and big players are doing an excellent job to make sure OpenSource will have a hard time getting certified.

  • Sebastian,
    Yes, billing would be a major reason why. In fact, many US doctors want an EMR for billing. Sad state of EMR huh?

    I actually think that Open Source will be fine getting certified if they want. The real question is, why would they want to get certified? EMR stimulus money is the only possible answer, but from a features and open source principle of developing based on the community needs EHR certification should be close to last on the list.

  • Sebastian,
    Yes, I was told that as well, although I believe they’re smartly waiting for the official HHS ARRA certification. It will be interesting to see what happens with their open source package going up for it.

  • I like the approach of OpenMRS which supports HL7 is completely modular, has an intuitively constructed UI, is web based, and whose underlying components are all themselves FOSS (java, mysql, etc…) what’s great about it is that it’s extensibility comes from it’s concept dictionary. regimen’s are all reusable

  • I am currently working with a company, Medical Coding USA (www.medicalcodingusa.com) that has a platform upon which he builds the EMR suited to each client. It is super-easy to use, and as his transcription service, I can attest to that first-hand. The providers and surgeons who are currently using it have commented on the ease of learning the system, making a transition to his platform fairly liquid.

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