Clinical Groupware: It's time for modular EHR technology
Friday, August 21, 2009
| David C. Kibbe, MD, MBA
About the Author - David C. Kibbe, MD, MBA is Senior Advisor, American Academy of Family Physicians; Chair, ASTM International E31Technical Committee on Healthcare Informatics; and Principal of The Kibbe Group
What’s happening in the EHR technology industry today is analogous to the move from mainframe computers to PCs. The vertically integrated, top tier companies – GE Centricity, NextGen, Allscripts – would like to continue to sell their comprehensive EHRs to their best customers, who will pay their highest prices, and at the maximum profit margins. But they are struggling to add value fast enough and at a price point that individual medical practices can afford. The proof of this can be found in many small practices across the country, as they try to get these vertically integrated vendors to respond quickly to needs for new functionality -- such as population registries, connectivity with local hospitals, and patient web portals -- but find the workarounds and awkward installations maddeningly frustrating. They’re screaming for the features they need, but getting a lot they don’t need, at prices that seem like extortion.
In brief, we doctors have arrived at a next stage of value definition for EHR technology, one at which faster response times, greater agility, convenience, and lower pricing have become as more important than a very long list of features and functions that are no longer as useful or desirable as they once were perceived to be.
Clinical Groupware is the term that I have used for the development and deployment of health IT platforms and applications, the characteristics of which include: use of the Internet and the Web as a platform; explicit design for health data exchange and online communication among providers and patients/consumers; a modular or component architecture upon which applications can be aggregated to meet specific clinical and workflow tasks; all while allowing interface standards and protocols for data exchange to emerge in a market-driven manner. Clinical Groupware applications can be distributed as software-as-as-service, and are intended to support today's mobile health care environment by supplying the right information, at the right time and the right place.
In brief, the metaphor for Clinical Groupware is the iPhone and its many thousands of apps, rather than a database for medical records.
And it is no coincidence that ONC and its new HHS Certification process, which will determine how physicians may receive HITECH incentive payments for "meaningful use of certified EHR technology," are supportive of a modular and highly interoperable approach to EHR technology. Even CCHIT has announced a certification program for components of EHRs that they hope to put into place in 2010, allowing modules such as ePrescribing, patient scheduling apps, disease registries, and outcomes reporting apps that plug-and-play to receive its seal of approval.
References:
Kibbe DC. Why clinical groupware may be the next big thing in health IT. TheHealthCareBlog. Feb 13, 2009.
Mandl KD, Kohane IS. No small change for the health information economy. N Engl J Med. Mar 26 2009;360(13):1278-1281.
Kibbe DC. Clincal Groupware: when not-as-good is actually better. TheHealthCareBlog. June 15, 2009.
Crounse W. Is it time for "clinical groupware?" Healthblog. June 24, 2009.
Dolan B Kibbe: successful EMRs will be like the iPhone platform. MobileHealthNews. June 24, 2009.