HIE, mobility, open platforms start to knock down 'walled gardens' of proprietary EMRs

On the cover of its September issue, Wired magazine declared the web "dead" but also proclaimed, "Long live the Internet." Instead of searching through a browser, people are increasingly turning to specific online applications to find the information they need or the online experience they seek.

As usual, healthcare is a bit further behind the rest of the world, according to consultant Vince Kuraitis, and is only beginning to move away from the "walled garden" approach that early Internet leaders Prodigy, CompuServe and AOL found success with, only to be overtaken by the open web once broadband took hold.

Kuraitis, author of the e-Care Management blog noted this Wednesday at the Mobile Health Expo in Las Vegas while attempting to assess whether the HITECH section of the American Recovery and Reinvestment Act was working. "Health IT has been a series of walled gardens, locking docs into a particular [EMR] company, but is moving toward open platforms," Boise, Idaho-based Kuraitis said.

"It's way too early in the game to call [HITECH] successful or not," Kuraitis said, but he contended that HHS "got it right on the three major policy decisions" too far. Meaningful use, according to Kuraitis, emphasizes the "meaningful" part rather than the "use" part. The decision to have the Office of the National Coordinator for Health Information Technology oversee the certification process created a level playing field for vendors, taking away the advantage of what Kuraitis called the "oligopoly" of large, established vendors that created the Certification Commission for Health Information Technology. And CMS opted for "lightweight, open standards" in its final rule for Stage 1 of meaningful use, Kuraitis noted.

This being a conference on mobile healthcare, Kuraitis made the point that with health information exchange, health IT is moving toward open platforms the way mobile technology did. Before the iPhone application programming interface and the Apple App Store came along in 2007, apps for PDAs and later smartphones weren't built on any consistent platform.

Now, the app field is wide open, though there's a battle between the walled garden of Apple--which takes 30 percent of developer revenues from the App Store and can veto apps it deems unsuitable--and the open-source approach of Google's Android operating system, which allows the developer to keep more of the money but doesn't give Google much control over the brand.

The movement toward open EMR platforms to facilitate health information exchange is "nothing short of miraculous" to Kuraitis. In the context of mobility, this presents wonderful opportunities for innovation and connectivity. "This opens the door for remote monitoring companies, PHRs and app developers to connect with the walled gardens," Kuraitis said.

Stage 1 of meaningful use provides what Kuraitis called the "plumbing" by getting technology into physician offices and hospitals. Future stages will give patients their own health data in electronic form, with the help of the types of middleware vendors Kuraitis referenced.

So is HITECH working? "It's working as well as it could be working to this point," he said.

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