Four disruptive EHR trends to monitor over the next decade
If you pay close attention to discussions surrounding emerging technology, it is likely that you have heard some hot new technology or service described as ‘disruptive’. Like many other overused adjectives tossed about in popular discussions describing something as ‘disruptive’ has fallen victim to overuse and often misuse.
In the EHR space, analysts periodically claim some emerging technology will disrupt how health care offers services. Before discussing what could become a disruptive EHR trend in the next ten years, clearing up some definitional ambiguities is a logical place to start.
A disruptive technology does not just mean a breakthrough technology - according to The Clayton Christensen Institute, a technology think tank, disruptive products are “cheaper, lower performing technologies target non-consumers or low-end customer segments and grow upmarket to eventually kill larger competitors with less expensive, simpler products.” The personal computer is cited as an example of a disruptive technology in the computing industry, by providing consumers with a cheap alternative to expensive mainframe computers.
However, disruption is often confused with what the Clayton Christensen Institute labels as a “sustaining innovation” or a product or service that “targets demanding, high-end customers with better performing, more complex products” which ultimately do not lower prices as a disruptive product does, rather resulting in high performing and more expensive products and services.
When applying the textbook distinctions between disruption and innovation, a majority of the evolution of EHR products can be classified as a sustaining innovation rather than disruption, as EHR products have largely improved their functionality without offering consumers a genuinely inexpensive and functional alternative. Given the lack of true disruption in the EHR space where can consumers expect true disruption in EHR technology in the next ten years?
1. Mobile health
Mobile health represents an area that has been called ‘disruptive’ in the context of monitoring and clinical data collection as the necessary push for population health efforts to realize their potential. The main barrier to mobile health’s disruptive potential, however, rests in the technology’s inability to provide a cost effective solution to secure data sharing between an EHR and mobile components.
One precondition necessary for mobile health to become a disruptive EHR trend is discussed under number two below, through the development of open architecture or open source software facilitates data sharing between EHRs and other components.
2. Open API
Interoperability between EHRs, or between EHRS and other devices, has been hampered by a lack of connectivity or restated the systems are not able to communicate and share information between due to deliberate blocking between software systems. Open architecture or open APIs can rectify interoperability with little cost to consumers and also allow EHR systems to scale up without costly upgrades or add-ons.
3. A user and patient-centric EHR
Providers often bemoan the counterintuitive and workflow disrupting way EHRs operate from the user perspective. What is often ignored in this discussion is the fact that frustration from EHR users not only disrupts productivity it also can cause the patient experience to suffer. As such, a user and patient-centric EHR certainly could disrupt the EHR space.
4. Protocols to create a truly seamless interoperable EHR
Julia Adler-Milstein, an assistant professor of health management and policy at the University of Michigan, estimates that only between 20%and 30% of providers are using EHRs to communicate with physicians at other institutions. In testimony before the U.S. Senate Committee on Health, Education, Labor and Pensions she testified that the barriers to interoperability the barriers are “are largely not technical ones". Rather, lack of interoperability is due to "an agreed-upon set of standards, implemented in a consistent way”.
As such, disruption in the area of interoperability would not involve new technology, but rather the standards and regulations which dictate whether EHR data exchange is possible. With a uniform standard, a great deal of cost in research development could be avoided as an interoperable EHR would only need to comply with the uniform standard, rather than attempt to work around various blocks to data sharing placed by vendors attempting to their preserve market share.
Ultimately the question of where and when disruption in the EHR space will occur depends on both the posture of consumers and vendors who have shown a great deal of risk aversion. The likely disruption will come from a player outside the core of the health IT industry who may be willing to risk short term returns for long term and transformative success.
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