Catalyzing the app store for EHRs

Posted by Steve Downs and John Lumpkin, Senior Vice President, Health Care Group

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 prize.  Bob Hughes has posted before on this blog 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.

Comments

[Ravi Sohal]

The interesting part here is looking at the Apple ecosystem and seeing that the platform and distribution channel are essentially the same which allows for powerful, cheap apps, from thousands of vendors. On the demand side, there's a motivated consumer base looking for apps.

EHR vendors, as far as I still know, have to maintain a sales force, pitch to doctors - adding to the cost of sales. Doctors are not as motivated to acquire "apps". I think there are some stats out there that show that even if a doctor's office has web access to patient lab tests, they still overwhelmingly prefer a faxed report.

The key is getting the healthcare market/industry aligned along reinforcing incentives that lower the cost of development, acquisition, and use. It may not be between EHRs and docs, or even PHRs and patients - but I think the idea is a good one to keep mulling over.

[MarkS]

You don't need a 'platform'. An interoperability specification is the platform and it needs to be open to ensure wide adoption and innovation. EHRs now are closed systems with limited data import and export over largely proprietary and/or obscure protocols. This keeps the customer captive but stifles the kind of innovation you are trying to foster.
In order for this to work, you will need to have open interoperability specifications. You need to have a way that an eRx application can talk to the patient index to get patient demographic information and also talk to the EHR to get allergy and current drug information.
Each of these modules needs to be able to generate and respond to messages to send and receive the information it needs. This should all be done through open interoperability specifications.
If you do this, anyone can create a new application that can find the information it needs and adds value.
You can give grants and prizes but I think these should be given for the open interoperability specifications and implementations. Once these are in place, the new applications will arrive.

[Steve Downs]

Thanks Ravi and Mark for the comments. there are clear differences between the Apple ecosystem and the HIT industry and I appreciate your highlighting some of those. I'm intrigued by the notion that the key is interoperability -- perhaps the solution lies in having EHR vendors develop a common API that enables app developers to build apps that can work on multiple EHR products.

For those interested in this topic, this post was re-posted on the Health Care Blog at http://www.thehealthcareblog.com/the_health_care_blog/2009/06/catalyzing-the-app-store-for-ehrs.html#more and is getting a robust dicussion.