Senator John D. (Jay) Rockefeller IV today introduced legislation that will facilitate nationwide adoption of electronic health records and will build upon the successful use of “open source” electronic health records by the Department of Veterans Affairs as well as the “open source exchange model,” which was recently expanded among federal agencies through the Nationwide Health Information Network-Connect initiative.

Read the news release.

The fundamental problem is that every commercial clinical systems product on the market today relies on a single, physical data repository, generally with HL7 interfaces, and is based on relational data base architectural models that are now close to 20 years old. Outside of healthcare, the IT world has embraced Services Architectural models and is now moving into semantic data models as well. But the cost of a major architecture change is simply prohibitive for commercial healthcare IT vendors. For all the talk about interoperability challenges, not being able to incorporate new data models into our clinical systems environments down the road may be a much larger constraint on improving our nation’s health.

M.D. Anderson

Good post, Matthew. And Jeff's term "clinical groupware" is terrific. That's the transition you're describing in a nutshell, from stand-alone client-server EMR software application from a single vendor, to "clinical groupware" (web-based) capable of assembling relevant patient data, sometimes from multiple sources, and communicating between and among care providers, patients, and appropriate others. The outputs are coordination and continuity.
What we're seeing in the "EMR space" was predicted by Clay Christensen according to his "law of the conservation of modularity." Namely, that EMR components or modules would emerge as the products improved, creating options for medical practices to purchase these parts at much lower prices and to mix and match, plug and play. E-prescribing and web portals are prime examples of this trend. And, overall, it's good for the physicians and good for their patients. Less risk, more and better defined benefits, and generally increasing use of health IT for more affordable care.

Posted By: DCK

At the current cost of most EMRs there is scant return on investment for most physicians in small practices, where the marjority of them work, especially for over-worked and underpaid primary care docs. Most big EMR companies, like Allscripts, NextGen,etc. usually require client-server setups, which is last century technology and requires individual software installs at each site and big investments in hardware. Even after going live, most offices can’t share records with another physician if he/she uses a different EMR. Good luck trying to access lab data from various labs in one place. We need to make a low-cost/free web-based EMR which runs on open source software available to all physicians and make lab/radiology data available via the web. Data needs to be patient centered. So long as “big-iron” EMR companies with proprietary software and data, which they won’t share, are advising national policy, I expect something similar to a bailout of the Big 3 so they can make more gas hog SUVs. Let’s not just pave over the cow path here.

Comment by CT IPA Doc - January 27, 2009 at 6:24 am