Electronic health record system vendors are "entrenched" in a legacy mindset that hampers innovation, preferring to propagate the myth that EHRs require specialized IT systems in order to protect their prices and block new entrants into the industry, according to an article published this week in the New England Journal of Medicine. EHRs can and should be redesigned and adopt modern technologies wherever possible, says Kenneth Mandl (pictured), associate professor at Harvard Medical School and Boston Children's Hospital Informatics Program, one of the two authors of the article.
"A monolithic system with all-in-one functionality in the EHR system is perceived as an advantageous business model. It currently works for vendors but not for health care," Mandl tells FierceEMR in an exclusive interview.
Mandl suggests that EHRs would be better if standard technology were incorporated with, or alongside, EHR systems. Read on to learn some of his concerns and his thoughts on how to improve health IT.
FierceEMR: What's wrong with the current EHR systems being sold today? How should they be designed?
Kenneth Mandl: Clinicians are stuck in EHR systems with none of the features used in word processing systems or what their kids use, like iPhones and Facebook, that are dominant on the consumer side. EHRs should look like iPhones and run modular apps that compete with each other and could be deleted and replaced.
It's cheaper. A lot of these apps could cost 99 cents. In an app store approach, we can use many apps over many platforms. We really need to use approaches that rely on a standard data base format and standard apps and use technologies that are common in other industries.
FEMR: How did the health IT market end up behind other industries, with siloed, proprietary products?
Mandl: It's an odd market. Vendors have had a lot of success with these fully featured monolithic products and purchasers continue to purchase them.
FEMR: Is now the right time to make these changes? Or are hospital executives already too far down the road with their current projects?
Mandl: There's a real opportunity to begin to go forward in this area. The technology in the past three to four years is so ubiquitous. There's been enough experience with EMRs now that this sentiment will resonate with current users and potential purchasers. They're willing to move to more of a tapestry of software. Each year the graduates from medical school are younger and they're used to advanced technology.
FEMR: What's the current state of innovation?
Mandl: Some of the 700 EHR vendors that have taken up the gauntlet are moving to an app approach. It's not up to scale yet.
FEMR: Do you expect push back from vendors from the article?
Mandl: I hope so!
This interview has been edited and condensed for clarity.