Switching Out EMRs For Broad-Based HIT Platforms

I’ve always enjoyed reading HISTalk, and today was no exception. This time, I came across a piece by a vendor-affiliated physician arguing that it’s time for providers to shift from isolated EMRs to broader, componentized health IT platforms. The piece, by Excelicare chief medical officer Toby Samo, MD, clearly serves his employer’s interests, but I still found the points he made to be worth discussing.

In his column, he notes that broad technical platforms, like those managed by Uber and Airbnb, have played a unique role in the industries they serve. And he contends that healthcare players would benefit from this approach. He envisions a kind of exchange allowing the use of multiple components by varied healthcare organizations, which could bring new relationships and possibilities.

“A platform is not just a technology,” he writes, “but also ‘a new business model that uses technology to connect people, organizations and resources in an interactive ecosystem.’”

He offers a long list of characteristics such a platform might have, including that it:

* Relies on apps and modules which can be reused to support varied projects and workflows
* Allows users to access workflows on smartphones and tablets as well as traditional PCs
* Presents the results of big data analytics processes in an accessible manner
* Includes an engine which allows clients to change workflows easily
* Lets users with proper security authorization to change templates and workflows on the fly
* Helps users identify, prioritize and address tasks
* Offers access to high-end clinical decision support tools, including artificial intelligence
* Provides a clean, easy-to-use interface validated by user experience experts

Now, the idea of shared, component-friendly platforms is not new. One example comes from the Healthcare Services Platform Consortium, which as of last August was working on a services-oriented architecture platform which will support a marketplace for interoperable healthcare applications. The HSPC offering will allow multiple providers to deliver different parts of a solution set rather than each having to develop their own complete solution. This is just one of what seem like scores of similar initiatives.

Excelicare, for its part, offers a cloud-based platform housing a clinical data repository. The company says its platform lets providers construct a patient-specific longitudinal health record on the fly by mining existing EHRs claims repositories and other data. This certainly seems like an interesting idea.

In all candor, my instinct is that these platforms need to be created by a neutral third party – such as travel information network SABRE – rather than connecting providers via a proprietary platform created by companies like Excelicare. Admittedly, I don’t have a deep understanding of Excelicare’s technology works, or how open its platform is, but I doubt it would be viable financially if it didn’t attempt to lock providers into its proprietary technology.

On the other hand, with no one interoperability approach having gained an unbeatable lead, one never knows what’s possible. Kudos to Samo and his colleagues for making an effort to advance the conversation around data sharing and collaboration.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Broad-based HIT platforms can provide a vital infrastructure component for personalized medicine. Health data that is freed from existing proprietary platforms and silos will allow providers, researchers, payers and therapy vendors to see a more complete picture relative to healthcare outcomes. Such an environment requires a more robust identification, authentication, privacy and security solution set than currently employed by heath data controllers.

  • Fact of the matter is legacy systems must be replaced. Cerner, Epic, Allscripts etc. have reduced productivity, delayed patient care, driven up costs and chronic disease has escalated with over 50% of Americans inflicted accounting for 86% of all care dollars.


    Health Catalyst, just integrated 18 hospitals and over 3600 doctors and their patients in less than 90 days at a fraction of the cost Cerner was charging IU Health that I think was ongoing for over 18 months. My company who works with an advanced Complete Practice Resource platform along with our services makes written guarantees none of the legacy systems can match. 90% of the problems in healthcare are all about inadequate technology and services needed to optimize earnings and care. A simple evaluation of any private practice or hospital clinic can show major productivity gains, reduced costs and better care out comes given doctors have more time for chronic care cases. Doctors make much more money and go home within minutes after their last patient vs. paper work or updating inadequate EHRS. All one has to do is search for new systems and do due diligence and ask for a written guarantee with damages for late installs, insufficient training or any other issues that could causes damage to patient care. Integration with Catalyst and our system is extremely easy and inexpensive as now even a solo doctor can have major gains form using an all inclusive system with data analytics, cloud security , patient engagement, data analytics and pop health management for optimizing VBC or any reimbursements for that matter. To me it is not brain surgery it is a willingness to make a change and accept the fact out dated technology needs replaced and the sooner the better!

  • John,
    Do legacy systems have to be replaced? I think they have some real staying power in most organizations.

    I think Health Catalyst is doing some great things, but they are using the data from the EHR. They aren’t really a replacement to the EHR. I don’t ever see them growing into a replacement either.

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