The views/comments/contents posted on this blog are based upon my own interpretation or opinion on a given topic and are not necessarily the view of any other party or employer of mine either currently or historically.

The blog is intended to stimulate discussion and gain opinion on trends in the sector I enjoy working in.

Thursday, 30 October 2014

EPR vs Content Repository and Apps - Is it a losing battle?

EPR's are massive undertakings to procure, implement and maintain.  They are also hugely expensive and demanding on valuable clinical front line staff to implement.  These statements are well evidenced in many publications and research over the years, yet still we see hospitals, regions or even countries chasing EPR solutions, usually from a single vendor to get over interoperability fears.

But, I see a shift in thinking starting to emerge and I for one think its both exciting and beneficial to all of the stakeholders.  The move is towards a structured repository of content which would typically include patients historical and future notes, medications, alerts and care plans etc.  Standards such as IHE XDS will facilitate development, procurement and implementation of best of breed departmental systems that can function in isolation but publish or access beneficial content such as results to/from the XDS Registry and Repository if necessary.  This is not so new now, but what is interesting is the rapid pace in which industry and clinical users are embracing mobile device based "apps" to access or record new content in real time.  This can include patient vital sign observations through to personal monitoring devices that populate an app managed by the patient in the community setting and uploads data to the central repository.

Whats really exciting about this is that clinicians and industry from start-up innovators through to more seasoned apps houses can now participate in contributing to the Health IT sector with a realistic chance of being able to sell and implement the solution, having being able to focus efforts towards addressing a specific demand in an agile and affordable manner.  The nature of the app means that implementing it, maintaining it and ultimately replacing it in the long term is a lot less disruptive to an organisation and the end to end costs are likely to be much less than having to add or modify modules to an EPR and testing/validating all of the interdependencies.  Adoption of the app is also more likely given its focus on a task or function and the familiarity that most health practitioners and patients have with this technology today.  The training and change management costs are also likely to be much less than inclusion of similar functionality in a much larger traditional EPR type solution.

If companies/developers and health providers can abide by some of the logical demands as defined by the NHS ISB for example regarding consistent location and format of content such as patient banner and also nail down consistent use of descriptive terms and nomenclature then there are few reasons why the use of apps in mainstream healthcare won't continue to flourish and start to threaten the big EPR players in the market.  Clearly this is something that Apple™ have recognised with the release of the Healthkit and enhanced capabilities of their OS.

Its great to see the innovation, and larger vendors must be mindful that customers want to see innovation and solutions that can be developed and implemented in an affordable, agile manner. Standards based exchange of content via Web API interfaces is the future and its great to see some of the companies starting to embrace this reality.

Its my belief that use of Apps that fulfill a specific requirement for a target audience will become mainstream, underpinned by standards based interoperability and a repository(s) of structured content facilitating the various apps based access points to that content.   The idea of a monolithic EPR solution seems out dated already and I think its days are numbered as is the appetite for them; financially, technically and operationally.

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