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Year of the Module?

January 20, 2010
by David Raths
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One aspect of the meaningful use interim final rule that caught my attention was the forward-looking focus on certifying EHR modules as well as complete EHR systems. On Page 41, the Office of the National Coordinator for Health IT states: “We believe that it will be common in the near future for Certified EHR Technology to be assembled from several replaceable and swappable EHR Modules.”

ONCHIT’s leaders go on to compare the health IT marketplace to the market for consumer electronics, “where, for the purpose of setting up a home theater, a television, DVD player, and stereo system can be purchased from three different manufacturers, from a single manufacturer, or as a complete system from one manufacturer.”

They say a subscription to an application service provider for electronic prescribing could be an EHR Module and used to help meet the definition of Certified EHR Technology provided that the electronic prescribing capability the ASP enables has been tested and certified.

Some well-established vendors of legacy EHR systems probably don’t like the idea of moving toward plug-and-play interoperability with the components of lots of small competitors who may do one thing well. But I bet it is music to the ears of people like David Kibbe, MD, a senior advisor to the American Academy of Family Physicians.

Dr. Kibbe has been arguing for — and promoting — a grass roots movement toward modular, Web-based, and less expensive software for managing clinical work and information in medical practices. He calls this movement “Clinical Groupware” and is helping to form a new trade association, the Clinical Groupware Collaborative, to promote collaboration among its members. Executives of companies such as 4Medica, RMD Networks and VisionTree are represented on its board.

Will individual modules, Web-based applications and software-as-a-service play an important role in widespread health IT adoption? Or are there too many interoperability obstacles in the way?

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Comments

YES, interchangeable modules are the way to go! But instead of simply being web-based and SaaS implementations, they should also be applicable to desktop (standalone) and local area network applications that are vital when high-speed Internet is unavailable, when Internet connectivity is intermittent/occasional, when the Internet is down or slowed by traffic volume, when remote servers are overwhelmed, and when people or organizations want to store sensitive health data securely in their own computers (behind their own firewalls) rather than in a remote database (e.g., in a public cloud).

In addition, these modules should focus on enhancing EMR/EHR functionality, especially in terms of improving decision making by implementing "patient-centered cognitive support" and supporting the patient-centered medical home (see http://bit.ly/8DPmJw)

And interoperability can be provided simply and inexpensively through node-to-node networks that exchange patient data fluidly between disparate systems by providing data translation and transformation functions, as well as end-to-end encryption.

That kind of interoperability presupposes an adequate virtual EMR model and one or several servicable controller models, to hand-off or receive messages or documents in a controlled way.

These aren't new ideas or even new business attempts. I think we are ripe for progress in this space. Based on the purchasing behaviors of most moderate to large health systems, there seems to be a shared conclusion that they do need to assemble parts of the community EHR from multiple vendors.

I do, however, acknowledge your premise ... there are no obvious clear exemplars, despite some fabulous apps, patterns, and innovative uses of services like some of the twitter API uses.

Sounds like CCOW on steroids would do the trick!

David Raths

Contributing Editor

David Raths

@DavidRaths

www.linkedin.com/in/davidraths

David Raths’ blog focuses on health IT policy issues ranging from patient privacy to health...