In my other post about BIDMC’s webOMR acquisition by Athenahealth, I found this old post from John Halamka about the best of breed healthcare IT application approach and the all in one integrated EHR approach. In that post, I was really struck by the way John Halamka describes the challenge of balancing innovation and integration:
Epic eases the burden of demand management. Every day, clinicians ask me for innovations because they know our self-built, cloud hosted, mobile friendly core clinical systems are limited only by our imagination. Further, they know that we integrate department specific niche applications very well, so best of breed or best of suite is still a possibility. Demand for automation is infinite but supply is always limited. My governance committees balance requests with scope, time, and resources. It takes a great deal of effort and political capital. With Epic, demand is more easily managed by noting that desired features and functions depend on Epic’s release schedule. It’s not under IT control.
Most significantly, the industry pendulum has swung from best of breed/deep clinical functionality to the need for integration. Certainly Epic has many features and overall is a good product. It has few competitors, although Meditech and Cerner may provide a lower total cost of ownership which can be a deciding factor for some customers. There are niche products that provide superior features for a department or specific workflow. However, many hospital senior managers see that Accountable Care/global capitated risk depends upon maintaining continuous wellness not treating episodic illness, so a fully integrated record for all aspects of a patient care at all sites seems desirable. In my experience, hospitals are now willing to give up functionality so that they can achieve the integration they believe is needed for care management and population health.
These comments also say something significant about IT governance as well. It’s a challenging balance. Although, it also illustrates why a well done EHR API is so powerful. It allows a large organization to have deep integration into an EHR while not having to sacrifice the ability to innovate. Too bad APIs are Hard and so many EHR vendors haven’t executed on them. We’ll see if FHIR can get us at least part of the way there.
How do you approach innovation and integration in your hospital? What’s the right balance?