Clearly there are issues in the VA that have been recently highlighted. They do not stop there, however. As pointed out by MedicalQuack, development of software is hard. Developing software using the typical waterfall methodology presents its own issues, especially in healthcare where requirements, processes, and workflows are not completely understood, standardized and regulatory issues continue to change with new initiatives including the latest Affordable Care Act and all the IT requirements that go along with it.
One needs to ask the question, can a single platform effectively address the needs of healthcare practitioners, offices, clinics, hospitals, health systems and governmental agencies? The current model of EHR development, deployment and implementation is clearly moving in this direction. With the continual expansion of EHR functionality to add new requirements, we make these systems more complex, add inter-dependencies, setting ourselves up for potential catastrophic failure of systems we are becoming more dependent upon. As each EHR vendor continues development and is in competition with other providers, we need to address the big question of why interoperability is good for their business model. The short answer is it is not and will only be added to comply with federal regulations and mandates. One has to wonder if this will be the concept of interoperability many of us have in mind from the provider as well as the patient consumer. Is there another solution?
At the core, all EHR's are databases, albeit, built on platforms and database technology from the 1960's, MUMPS. My concern is many of these have been developed and consist of millions of lines of code making re-factoring and expansion a difficult, if even possible solution. I agree with MedicalQuack in the concept of a middleware platform to interact with the data and allow for expanding these systems to meet local, regional, federal and evolving requirements. In exploring the Zoeticx platform and their recent announcement of an API allowing others to build applications and services on top of a platform, we open up development far beyond the EHR vendors (Zoeticx's New API Allows for Faster Medical App Development
). Much as iOS brought innovative ideas as well as major flops to the marketplace, a middleware platform connecting disparate EHR systems while maintaining security and integrity of the data being stored by these systems and the development of customized applications to address the needs of providers, clinics, hospitals, health systems, and governmental agencies. This moves the development from the waterfall process to a more agile one where ideas can be tested and the market can respond to the solution without having to rip and replace expensive EHR systems for a niche market within healthcare.
We have amassed a significant collection of healthcare IT failures and are likely to uncover many more. As with the art of medicine, we need to develop a system for healthcare IT that can be treated and managed with novel and creative solutions.
Donald M Voltz, MD