Will APIs and healthcare apps repeat the mistakes of the past?
When I think about the profound changes taking place in health information technology today, a song often pops into my head: “History never repeats, I tell myself before I go to sleep”.
The song is by New Zealand band Split Enz, members of whom later formed Crowded House, which we often claimed as Australian. It’s a great song, not the least because it brings to mind a famous quote: “Those who cannot remember the past are condemned to repeat it.” — George Santayana, The Life of Reason, 1905.
What have these musings got to do with changes in health information technology?
It was not so long ago that health care moved away from best-of-breed solutions — which were almost invariably poorly integrated — in favour of large, unified enterprise systems. Unlike best of breed, unified systems can support entire patient journeys within a healthcare organisation and provide clinicians with access to longitudinal, patient-centric records to help inform decision-making anywhere, anytime.
However, shortly after unified systems were implemented, we saw the pendulum swing again. People began to dislike their comprehensive but often complex systems, and resented the massive investments made in them. Today, it seems everyone loves to hate their electronic medical record (EMR) systems and they are in danger of forgetting why they implemented them in the first place.
Now it looks like many are putting their hope in application programming interfaces (APIs) and apps. An app for this, an app for that! That sounds very much like best-of-breed solutions to me, only on a micro scale. It also reminds me of a painting by René Magritte, titled: ‘“Those who cannot remember the past are condemned to repeat it.” — George Santayana, The Life of Reason, 1905’. I kid you not.
I wonder if history really is about to repeat. Are we coming full circle? What will the consequences be when we end up with so many apps that we can’t remember which one to use, let alone where to find them (just like all those on our own phones)? How safe and reliable will they be? How long will the app creators be in business?
In fact, those hated EMRs, functionally deep and informationally rich, are actually fuelling the data needs of many new best-of-breed micro solutions. A whole new economy of healthcare IT is in bloom because reliable data sources do actually exist thanks to EMRs. In the rush to quickly plug functional gaps in EMRs or replace the bits we don’t like, we may end up breaking them so that they can no longer fuel the bright new shiny objects.
Luckily, today we also have a maturing interoperability landscape and technical capability. We have powerful standards and regulatory frameworks that drive collaborative data sharing and extract more value from the massive amounts of data we already have. All of this means that health care should be able to have the best of both worlds: EMRs that support daily operational and patient care needs while also enabling innovation. I hope healthcare organisations will not throw their EMR babies out with the bathwater, because that would be like going back to the past. We have already been there and we should not forget it.
Maybe the truth is that what we have in health IT right now is like all the pieces of the Lego set: rich, powerful EMRs, apps to draw data out from them, and interoperability to create a healthcare data fabric that surrounds a patient and enables clinicians to make better, more informed decisions. Organisations that rise to the challenge of assembling those pieces — and managing them successfully and sustainably — will be best placed to build something that works well and matters to their stakeholders.
It’s an exciting time. But whether it will be a case of “History never repeats” or “condemned to repeat it” depends on whether we learn from the lessons of the past.
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