Health IT innovation? Not without open platforms

The word ‘innovation’ gets bandied about with such frequency in healthcare analyses these days, you’d think it had some kind of magic transformational power.

Look, I get that small companies can rapidly and significantly create healthcare improvements before larger companies and the government can even form a research team. I agree completely with the philosophy of innovation.

But is the government’s role simply to unleash innovative forces, or is there also a regulatory responsibility to consider? Is it one or the other, or a balance of both?

The issue here is closed platforms, which enable most EHR vendors to position themselves as the single source of innovation. They also create dependent customers and glacial progress in two parallel areas of innovation—evidence-based medicine and information technology.  No one company can keep up with the natural pace of advancement in either realm, let alone both.

As other industries did long ago, HIT needs open platforms to support innovation.

The Apple Store currently has about 800,000 iPhone apps and roughly 300,000 iPad apps. Google Play has something like 600,000 apps. Even Salesforce Exchange, a store based on a proprietary CRM system, offers in the neighborhood of 1,000 applications.

In these industries, innovators can develop against an established platform without having to be actual customers of the platform developer.

In health care IT, this is a safety risk, as Epic CEO Judy Faulkner described it in a recent interview with Forbes magazine.

Faulkner: Let’s talk about safety. Cars are not a mishmash of pieces from different manufacturers. For the safety of the passengers, the manufacturer has figured out that you can’t put random components together because if you do, you won’t produce a safe vehicle. It’s the same situation in our industry …

Interviewer: What about allowing outside developers to build applications on your platform? …

Faulkner: Our customers already do that. Cleveland Clinic has really neat apps. They did that on their own. Developers have to work through a customer. We don’t let anyone write on top of our platform, come read our code and study our software. I worry about intellectual property at that point. With our customers, we make sure we have signed agreements. They know they have to respect our software …

True, cars are not a “mishmash of pieces from different manufacturers,” but neither are they coordinated components all created by one entity. Auto manufacturers rely on scores of sub-manufacturers for various parts, and yet the industry is still highly competitive and innovative. (And, on a related note, who thinks Apple lets app developers read the code and study the software?)