Dr. Lumpkin serves as director of the Robert Wood Johnson Foundation's Health Group, where he is responsible for planning and program management. Prior to joining RWJ, Dr. Lumpkin led the Illinois Department of Public Health for 12 years. As  assistant vice president, Downs plays a leading role on the Foundation's Pioneer Portfolio team. During his tenure at the Foundation he has created, developed,  or overseen the  Foundation’s investments  in such key initiatives as Project HealthDesign, InformationLinks, the Health e-Technologies Initiative, the Public Health Informatics Institute, Connecting for Health, and Common Ground.  His writings may be found at Pioneering Ideas, where this post first appeared.

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.

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 Pioneering Ideas 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.

This blog originally appeared at The Health Care Blog.

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Calendar: NIH Conference on the Future of Telehealth June 25-26, 2009