Health IT Innovation? Not Without Open Platforms

The word ‘innovation’ gets bandied about with such frequency in healthcare analyses these days, you’d think it had some kind of magic transformational power.

Look, I get that small companies can rapidly and significantly create healthcare improvements before larger companies and the government can even form a research team. I agree completely with the philosophy of innovation.

But is the government’s role simply to unleash innovative forces, or is there also a regulatory responsibility to consider? Is it one or the other, or a balance of both?

The issue here is closed platforms, which enable most EHR vendors to position themselves as the single source of innovation. They also create dependent customers and glacial progress in two parallel areas of innovation—evidence-based medicine and information technology.  No one company can keep up with the natural pace of advancement in either realm, let alone both.

As other industries did long ago, HIT needs open platforms to support innovation.

The Apple Store currently has about 800,000 iPhone apps and roughly 300,000 iPad apps. Google Play has something like 600,000 apps. Even Salesforce Exchange, a store based on a proprietary CRM system, offers in the neighborhood of 1,000 applications.

In these industries, innovators can develop against an established platform without having to be actual customers of the platform developer.

In health care IT, this is a safety risk, as Epic CEO Judy Faulkner described it in a recent interview with Forbes magazine.

Faulkner: Let’s talk about safety. Cars are not a mishmash of pieces from different manufacturers. For the safety of the passengers, the manufacturer has figured out that you can’t put random components together because if you do, you won’t produce a safe vehicle. It’s the same situation in our industry …

Forbes: What about allowing outside developers to build applications on your platform? …

Faulkner: Our customers already do that. Cleveland Clinic has really neat apps. They did that on their own. Developers have to work through a customer. We don’t let anyone write on top of our platform, come read our code and study our software. I worry about intellectual property at that point. With our customers, we make sure we have signed agreements. They know they have to respect our software …

True, cars are not a “mishmash of pieces from different manufacturers,” but neither are they coordinated components all created by one entity. Auto manufacturers rely on scores of sub-manufacturers for various parts, and yet the industry is still highly competitive and innovative. (And, on a related note, who thinks Apple lets app developers read the code and study the software?)

And automakers create safe products—increasingly so with each passing year. The mainstream auto market is open and competitive, to the benefit of consumers, with auto safety and fuel economy as the focus of innovation. HIT could learn a lot about open innovation from the auto industry.

While HIT speaks of open innovation” in rather non-specific terms, academics have made a concerted effort to define the phrase. In his 2005 book Open Innovation: The New Imperative for Creating and Profiting from Technology, UC Berkeley Professor Henry Chesbrough describes open innovation, with help from Wikipedia, as follows:

“Open Innovation is a paradigm that assumes that firms can and should use external ideas as well as internal ideas, and internal and external paths to market, as the firms look to advance their technology."[1] Alternatively, it is “innovating with partners by sharing risk and sharing reward.”[2] The boundaries between a firm and its environment have become more permeable; innovations can easily transfer inward and outward.

The central idea behind open innovation is that, in a world of widely distributed knowledge, companies cannot afford to rely entirely on their own research, but should instead buy or license processes or inventions (i.e., patents) from other companies.

To the hospital administrators who have chosen largely closed, proprietary EHR solutions, I would ask you these questions: Is your HIT provider sharing both risk and reward? Are you comfortable with all the innovation for your core HIT platform coming from one highly structured entity? Do you believe there must be a better way to manage health data?

Open platforms enable innovators to compete on value and quickly make the best solutions available to users. Plug-and-play applications must constantly compete without vendor lock and the ever-looming possibility of irrelevance and replacement.  The developer of open platforms creates a market where everyone wins, including the client and the application developer.

In healthcare, open platforms are not just more effective; they’re also imperative because they truly support evidence-based practice and continuous quality improvement.

Rapid innovation is the best way to drive continuous quality improvement and the only way to bring evidence-based medicine to the point of care in a timely fashion. A single vendor’s research and development can never attain a comparable level of innovation.

According to Mercom Capital, the first three months of 2013 were a record quarter for HIT venture funding, with some $493 million raised through twice as many deals as the previous quarter and nearly four times the number of early stage deals.

This is good news for the business of health IT but not necessarily healthcare. With closed platforms, these newly funded innovators will labor to get simple interfaced data. How quickly could healthcare potentially improve if all this investment were to develop systems on top of open platforms?

Apparently, only athenahealth gets it, particularly with the recent acquisition of Epocrates. Jonathan Bush and the athena team are going to produce an app store on top of the athenaNet platform based on the Epocrates brand–the premier physician HIT brand in the market.  Will that platform be open for innovation? I would bet on it.

The federal Open Source EHR Agent (OSEHRA) and its community are supporting the VA’s VistA system as an open platform, which promises innovations for VA medical centers, HIS facilities and an ever growing base of open source VistA users in the U.S. and abroad. The question is, when will provider organizations demand open platforms to unleash innovations for patients and providers?  Care to place a bet?

Edmund Billings, MD, is chief medical officer of Medsphere Systems Corporation, the developer of the OpenVista electronic health record.