EHR Is the Database of Healthcare

I’ve been regularly writing and thinking for the past few months about something I’ve branded as the “Smart EMR.” Basically, the EMR of the future won’t be a repository of documents and information like before. Instead, doctors will have an expectation that the EMR is smart and can do something valuable with all the health information that’s stored in the EMR. I love this subject. I should put together a presentation on it and start touring it around the country, but I digress.

While at HIMSS I had the pleasure of talking with Sean Benson, VP of Innovation at Wolters Kluwer Health. In our discussion, he said something that hit me like a ton of bricks. He suggested that EHR software is the database of healthcare. The implication being that EHR software is good at collecting healthcare data and storing that data. What they’re not good at doing is actually providing the smart layer that goes on top of that data.

I’m sure that many who know about Wolters Kluwer Health’s (WKH) software offerings might see Sean’s view as bias since WKH, as best I can tell, wants to be the smart layer that goes on top of EHR software. In fact, they showed me some really interesting technology they have for processing all the medical information out there into a really digestible format, but that’s a post for another day. Their interests and clinical decision support software aside, the idea of the EHR software being the database of healthcare seemed to resonate with me.

I’ve often described EHR software to date as a big billing engine. Some EHR are trying to break that mold, but that’s a hard mold to break since a big billing engine is what the market has asked them to create (for the most part). With that in mind, it’s certainly hard for an EHR software to develop a true Smart EHR platform.

I can see in my mind’s eye a product development team going into the EHR vendor executives office and pitching some amazingly smart and effective EHR software for improving patient care. The cynical me then sees the EHR vendor executive saying, “We can’t monetize that.” or a related “That won’t sell more EHR.” The sad thing is that the executive is probably right…at least today. The market hasn’t started demanding a Smart EHR and improved patient care. I’m hopeful that the new ACO model will help to shift that focus, but it’s still too early to tell if that will provide the impetus for change.

Another part of me hopes that a true entrepreneur will come along and build an EHR that provides such a stark contrast in how it provides patient care that doctors won’t be able to resist using it. Something impactful like the stethoscope, that if a doctor isn’t using it patients won’t go to that doctor. However, this line of thinking seems to push the concept of EHRs being the database of healthcare and not the All in One Smart EHR.

If I’m an entrepreneur with the vision of transforming patient care through smart use of EHR data, why would I want to build an EHR from the ground up when there are a number of very large EHR vendors that have APIs that allow me to build upon their data? If the data’s already been collected, then I’m likely to focus all of my energy creating innovative solutions with that data, not creating the mechanism to collect the data.

What’s a database? Tools to collect data, store data and then retrieve data. What’s an EHR today? Mechanisms to collect health data, store the data and then retrieve the data.

Ok, that’s a bit of an over simplification, but the analogy is there. You can see why so many EHR vendors are trying to become “the platform” of healthcare. Turns out that being the repository of data that everyone else builds cool stuff on top of is very valuable. However, building that platform requires a very different culture and focus than building Smart EHR solutions.

This is why I’m sure many EHR vendors will try to develop some Smart EHR solutions, but in the end EHR will be the Database of Healthcare that other Smart EHR applications connect into. I don’t think that’s a bad thing at all.

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.

22 Comments

  • I couldn’t agree more. But the interoperability problem needs to be solved first. Once that situation improves, healthcare will swing hard toward a best of breed model, like banking and airlines and most other industries. (Airlines don’t use the same software for ticketing and tracking flightpaths, after all). See montrue.com for one example of a new company taking this approach.

  • You might have to develop your own EMR because you can’t get full unfettered access to the data as this is not universally available and sometimes blocked…?

  • Dr Nick,
    Maybe, but I see that changing more and more over time. Many EHR are opening up the flood gates to their data.

  • I sense function creep.

    Classic to almost all software, we want more, yet what is there isn’t “there yet”.

    Has anyone yet agreed that we even have one single good EHR system yet?

    As Dr Nick alluded to, until there is a standard method of storage AND a universal way to access that data, doing much smart with the data will be a challenge for those that can’t access the data (3rd parties).

    As Google & Facebook and others know, the more data you have, the more power you have…so why would an EHR company give up that power?

  • Oracle had all the data stored in their database and gave up that data. Salesforce had all the data in their platform and opened it up to be much more successful than if they’d stayed it on their own.

    I think the EHR company that opens up and gets developers to build on their platform will change their company from a 100 million company to a billion company. It’s a big bet since it could go all wrong, but that’s what’s at stake and many will take that risk.

  • Could not agree more – opening up is the key to breakaway success imho
    It is changing but far too slowly in part because the traditional vendors fear being relegated to what is perceived as the minor data warehouse function. Is this not the foundation of the Health 2.0/3.0 and in particular the CGC http://collaborativehc.org/?

    And the move by customers to another solution will be very difficult – there is significant first mover advantage to existing solutions especially since the cost of changes (not just $) is so high

  • No kidding this is what makes sense…

    But who says these companies think this logically?

    It is just like an arms race, “I don’t want to be the first to reduce the number if ICBM’s, you go first…”

    Vendors are scare that if they open up their data, they will lose control.

  • The first thing is that every database is proprietary as well as EHRs. So the solution is as it as been mentioned once is to make the EHR and other applications accessible through the browser within a predifined export format for data exchanging.

  • Great conversation. Agree that the interoperability problem needs to be solved before true progress can be made. I also agree that while EHR companies will likely open up their data eventually, it’s slow in coming. Access to the reporting databases however, are more readily available, and if you can tap into, and marry that data with the vast amounts of unstructured data that exists and you’ve got the start of a system/solution that could truly begin to talk about predictive analytics and real insight into this critical data.

  • You state, “If I’m an entrepreneur with the vision of transforming patient care through smart use of EHR data, why would I want to build an EHR from the ground up when there are a number of very large EHR vendors that have APIs that allow me to build upon their data? If the data’s already been collected, then I’m likely to focus all of my energy creating innovative solutions with that data, not creating the mechanism to collect the data.”

    I agree, but I also feel that until we’re able to marry the disparate types of data (including the vast amounts of unstructured data), with the data housed in these reporting databases our insights are going to be constrained.

  • The EHR could be the Database of Healthcare, but until it’s able to incorporate more than just the data it produces, it’s never going to be effective as the Database of Healthcare. If 80-90% of all data is unstructured, and these EHR groups are only able to deal with the 10-20% do you really want it to be your core? I want my physician to have access to more than 10-20% of my data when making critical determinations about my and my families care.

  • Kimo,
    Good comment. I think there are a lot of people working on the issue you describe, but we definitely have quite a ways to go before we have access to all the data.

  • The smart layer is achievable today when you have a healthcare specific data warehouse that is doing the complex work of aggregating healthcare data from all of your source systems (i.e. clinical, financial, claims, emr, patient satisfaction, lab and pharmacy data among other sources) and presenting it in a digestible format using a tool like QlikView that allows care process teams to focus on the data specific to the care they provide. Then, they can see clinical process improvements that will increase quality and secondarily reduce waste. That sort of approach is going on today in systems across the country including at Allina, Texas Children’s, Stanford Hospitals & Clinics, North Memorial, MultiCare, Providence Health & Sciences and others.

  • I was trying to figure out where, ultimately, your EMR is stored? Is it on every individual system that you have been seen at? If you go to a new Doctor, how do they retrieve your EMR, and from where?

    Thank you

  • Hi Jay,
    Right now EMR data is very patient/organization centric as opposed to patient centric. So, all of a patients data could be stored across dozens of different doctors and hospitals separate EMR software. With rare exception, there’s very little data sharing between EMR software. Lots of people are trying to change it, but it’s not happening quickly. Most of the data sharing between organizations is still done by fax.

  • I see. So each time you go to a new Doctor they create another EMR of you? So one could have an electronic medical record of themselves on multiple systems and they do not contain info from anyone else? If so, then doesn’t that resemble the old model of each doctor has a folder full of paper on you?

  • Jay,
    That’s right. Although, most doctors still upload the faxed documents from your other providers into their EMR. So, I’d say it resembles the old model almost exactly. You have to remember that the paper chart didn’t always represent your full medical record either. Each of your doctors had their own paper chart. Sometimes that paper was shared between doctors and sometimes it wasn’t.

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