Epic and other EHR vendors caught in dilemmas by APIs (Part 2 of 2)

The first section of this article reported some news about Epic’s Orchard, a new attempt to provide an “app store” for health care. In this section we look over the role of APIs as seen by EHR vendors such as Epic.

The Roles of EHRs

Dr. Travis Good, with whom I spoke for this article, pointed out that EHRs glom together two distinct functions: a canonical, trusted store for patient data and an interface that becomes a key part of the clinician workflow. They are being challenged in both these areas, for different reasons.

As a data store, EHRs satisfied user needs for many years. The records organized the data for billing, treatment, and compliance with regulations. If there were problems with the data, they stemmed not from the EHRs but from how they were used. We should not blame the EHR if the doctor upcoded clinical information in order to charge more, or if coding was too primitive to represent the complexity of patient illness. But clinicians and regulators are now demanding functions that EHRs are fumbling at fulfillling:

  • More and more regulatory requirements, which intelligent software would calculate on its own from data already in the record, but which most EHRs require the physician to fill out manually

  • Patient-generated data, which may be entered by the patient manually or taken from devices

  • Data in streamlined formats for large-scale data analysis, for which institutions are licensing new forms of databases

Therefore, while the EHR still stores critical data, it is not the sole source of truth and is having to leave its borders porous in order to work with other data sources.

The EHR’s second function, as an interface that becomes part of the clinicians’ hourly workflow, has never been fulfilled well. EHRs are the most hated software among their users. And that’s why users are calling on them to provide APIs that permit third-party developers to compete at the interface level.

So if I were to write a section titled “The Future of Current EHRs” it could conceivably be followed by a blank page. But EHRs do move forward, albeit slowly. They must learn to be open systems.

With this perspective, Orchard looks like doubling down on an obsolete strategy. The limitations and terms of service give the impression that Epic wants to remain a one-stop shopping service for customers. But if Epic adopted the SMART approach, with more tolerance for failure and options for customers, it would start to reap the benefits promised by FHIR and foster health care innovation.

About the author

Andy Oram

Andy Oram

Andy Oram writes and edits documents about many aspects of computing, ranging in size from blog postings to full-length books. Topics cover a wide range of computer technologies: data science and machine learning, programming languages, Web performance, Internet of Things, databases, free and open source software, and more. My editorial output at O'Reilly Media included the first books ever published commercially in the United States on Linux, the 2001 title Peer-to-Peer (frequently cited in connection with those technologies), and the 2007 title Beautiful Code. He is a regular correspondent on health IT and health policy for HealthcareScene.com. He also contributes to other publications about policy issues related to the Internet and about trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business.