Electronic Health Records: Lessons from the iPhone

Open programs to third-party developers, say two tech-savvy physicians.

Thanks to the $19 billion designated for health-care information technology in the recent stimulus bill, electronic health records (EHRs) have garnered a great deal of attention in the past few weeks. The bill sets aside $17 billion in incentives for physicians and hospitals that use qualifying EHRs beginning in 2011, and $2 billion for the development of standards and best-practice guidelines over the next two years.

Improving EHRs: Isaac Kohane, top, and Kenneth Mandl say that the designers of electronic health records (EHRs) could learn something from the iPhone. Credit: Bachrach Photography, Joon Lee

The bill does little to specify the types of technology that health-care providers must use, leaving the details to a newly appointed national coordinator for health information technology. Given the amount of money at stake, both EHR vendors and the medical community are anxious to see exactly how these details will unfold over the next two years. In an article in the current issue of the New England Journal of Medicine, physicians Kenneth Mandl and Isaac Kohane outline their prescription for creating an effective EHR system. Their approach is modeled on successful IT products outside of health care, including the iPhone and Facebook, which rely on innovative applications from third-party programmers. Mandl and Kohane propose what they call a platform approach, in which EHR vendors sell a flexible, basic platform that is designed to work with components from other vendors, much as the iPhone works with applications made by a myriad of third-party developers.

Mandl and Kohane, both members of the Harvard/MIT Health Sciences and Technology Program at Children's Hospital Boston, spoke with Technology Review about why their approach is crucial in digitizing health care.

Technology Review: Why should EHRs be more like the iPhone?

Isaac Kohane: On the iPhone, if you don't like how an application does a particular task--managing a to-do list, for example--you can download one of ten other available task-management software systems. That's because Apple created a market for third parties to create new applications. Consequently, better applications are being developed, creating a competitive market.

TR: How does that compare with health-care IT systems?

Story continues below

IK: The contrast is stark. Most existing programs are these big monolithic applications designed to solve all the challenges and tasks that developers conceived there to be at a hospital or doctor's office. If the practitioner doesn't like a specific thing, they can't replace it. They either have to tough it out and deal with a system that doesn't fit their needs, spend lots of money and more time with the vendor to customize the application, or throw out the whole system and start again. We know from the iPhone and Facebook and their widgets that this just isn't necessary.

Kenneth Mandl: We have to assume that we don't know what functionality we [will] want five years from now. We need to build a system that will evolve with our thinking, with our science, and with our health-care system.