Catalyzing the app store for EHRs

Recently, Steve posted about the idea, floated by Ken Mandl and Zak Kohane, that EHRs (or health IT more broadly) could move to a model of competitive, substitutable applications running off a platform that would provide secure medical record storage.  In other words, the iPhone app model, but, for example, you could have an e-prescribing app that runs over an EHR instead of the Yelp restaurant review app on your iPhone.  We’re thinking about the provider side of the market here, as Google Health and Microsoft HealthVault are already doing this on the consumer side.

It’s nice to ponder these “what ifs,” but we’re a bit more action-oriented here and we’ve turned our attention to asking what it would take to make this happen.  It seems that there are two things that are needed. First, we need the platform.  Some of the most notable platforms started out as proprietary that were then opened up.  The IBM PC comes to mind as an example. Some were designed from the beginning to be open platforms with limited functionality until the market started developing applications.  A recent example is the development of iGoogle and the tons of applications that are available for free.  Finally, there was the purely public domain development from the beginning to end that we’ve seen in the Linux world.  Or perhaps we don’t need a common platform and maybe what is needed is to stimulate the market for health IT products that have open application programming interfaces (APIs) that allow for third-party application development?  Several ideas come to mind.

A venture fund for platform providers.

Perhaps the key is to put more money behind companies that offer EHRs that allow 3rd party app development.  Will seeding a fund convince other investors to get in?  Are there startup ventures out there that could take advantage of the fund?

A venture fund for app developers.  Apple and Kleiner Perkins did this – they set up a $100 million fund to invest in companies that would develop applications for the iPhone.  Makes some sense, but there are some differences.  Apple already had the platform and a developer community was emerging.

A prizeBob Hughes has posted before on Pioneering Ideas about prize philanthropy, which is an intriguing approach to stimulating desired breakthroughs.Could a prize that awards a pot of money for development and ultimately use of a platform/app approach to health IT catalyze a competition among vendors?  Prizes tend to work well when companies believe that winning the prize will give them a leg up (through the innovations they developed to win the prize or the reputational capital earned by the publicity) on a new market.  The cash doesn’t hurt either, but it’s often not enough.  Would that be the case here?  What accomplishment should a prize reward in this case?  Apple made some headlines by announcing that a billion iPhone apps had been downloaded.  Could the prize target be a certain number of app downloads?  The intriguing idea is that a group of vendors could collaborate to share the prize by developing a common API (see OpenSocial as a model).  Would the publicity alone (assuming there was lots) stir up demand for this approach?

Other ideas.  We’d love to hear them. As you can see, we don’t have the answers here and need a lot of input.So if you have some thoughts on this, post a comment or contact us.  And if you know others that might care, please pass this on.

John Lumpkin, MD, serves as director of the Robert Wood Johnson Foundation’s Health Group, where he is responsible for planning and program management. Prior to joining RWJ, Dr. Lumpkin led the Illinois Department of Public Health for 12 years. As  assistant vice president, Steve Downs plays a leading role on the RWJ Foundation’s Pioneer Portfolio team. During his tenure at the Foundation he has created, developed,  or overseen the  Foundation’s investments  in such key initiatives as Project HealthDesign, InformationLinks, the Health e-Technologies Initiative, the Public Health Informatics Institute, Connecting for Health, and Common GroundHis writings may be found at Pioneering Ideas, where this post first appeared.

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4 replies »

  1. The Clinical Groupware Collaborative (CGC) is a formative stage group addressing the opportunities and challenges described in Steve and John’s excellent essay.
    On behalf of Acting Chairman – David C. Kibbe MD, MBA — and Acting President – Steve Adams — here’s some additional information:
    Principles and Objectives
    You can also read more about the CGC in recent blog postings by Bill Crounse of Microsoft and yours truly:
    We expect that you’ll be hearing a lot from us shortly. Based on word-of-mouth, over 50 platform and/or application companies have expressed interest in the CGC.

  2. Steve and John are right on. The reason that the Apple App Store works is that while Apple serves as a gatekeeper in terms of usability and standards to maintain the user experience and sometimes its own position as a business, fundamentally it opens its platform to anyone willing to play along with its rules. The result speaks for itself, over 2 billion downloads and 10’s of thousands of applications to choose from, including for healthcare.
    A fund to encourage healthcare applications around a common “relatively” open (understanding the requirements for privacy, security, and common identification of a given patient) , yet which is a user friendly platform, is worthy but would suffer from issues of scale and thus interest at a few dollars per app when compared to the Apple app store.
    I see funding a web based platform providing at its core the ability to easily capture patient data, store, retrieve historical and other relevant information in context of patient encounters, share and report (ARRA). It would be highly flexible to specialties and work moments. As other posters above have said it must be a controlled highly reliable platform as patients lives are at stake. A bit like Apple’s approach and degree of control if one thinks about it…
    It would be provider friendly and highly modular Service Oriented Architecture. This core would be low cost or even no cost, an EHR lite. Any provider would be comfortable using it as an entry to an electronic record. The platform would use voice data input and command and control in innovative ways as overwhelmingly this has been a provider preference, although one which does not capture usable data.
    The “apps” would be subscriptions to services essential to providing care, increasing provider productivity and quality and let’s not forget.. managing the revenue cycle. The incumbents in the vendor community could provide apps, the community of providers could develop their own for sale or for sharing gratis, other stakeholders such as payers and foundations could provide modules which are mutually beneficial, a seed fund could provide funding for innovative new approaches . The API’s would accesible and easy to work with within the constraints of providing a seamless user experience, adherence to standards, and high integrity of the data.

  3. Jonathan said, “…the problem with the current system is that these EMR systems are effectively isolating themselves from the competition.”
    I don’t believe it was 100% conscious isolationism on the part of EMR system vendors. More likely, that was a side-effect of the old paradigm, when applications were designed to be all-inclusive, in supporting certain business processes or workflows, often with a specific client in mind. Sharing data, especially outside of the enterprise, was considered a remote possibility. In a way, that was due to little interest in health IT in general, and other providers’ data in particular. Actually, without the ARRA money, I am afraid, we wouldn’t have seen this level of activity on the EHR systems market.

  4. Right now the problem with the current system is that these EMR systems are effectively isolating themselves from the competition. This is good for them, but leads to lack of innovation from everyone else. This is the current state of the market, which forces young startups (especially Health 2.0 companies) to think differently in order to get into this market.
    In order to become familiar with the current market I have had extensive contact with physicians who are using the Epic system. Many of these physicians, especially the younger ones, think in an Apple mindset. What Apple did with consumer products has had a ripple effect which is being felt in healthcare. Many physicians are saying why cant our IT systems be like my iPhone?
    From what I know about the current EMR vendors a platform approach is far from their business model (think IBM before Microsoft or Microsoft before Google). History shows that these disruptive innovations will not come from these companies but from new companies with different approaches to the problem. The market is the best incentive for any new company, therefore if you want to stimulate change help the small companies grow and innovate.