Guerra On Healthcare: Will Future Clinical Systems Be Modules Or Monoliths?Guerra On Healthcare: Will Future Clinical Systems Be Modules Or Monoliths?

The approaches couldn't contrast more sharply. On the one side are vendors who want to tightly control how their software integrates with outside products. On the other are the platform plug-and-play Applephiles.

The monoliths generally come to be described by competitors or niche vendors as "unfriendly" or downright hostile to integration. But despite the knocks they take, these vendors win deal after deal, proving that despite what naysayers claim, they're absolutely satisfying the needs of their target market.

"But that's not right," say critics. "They're resisting change, fighting the future. They must listen to reason!"

Well, perhaps, but maybe the reason they rarely lower the drawbridge to integration is because customers aren't clamoring for it. For example, if 90 percent of a health system's core needs are fulfilled by exchanging data among its internal parts and the remaining 10 percent of outside counterparties can be brought onto the system via ambulatory electronic health records, customers won't need third-party integration.

Or perhaps the reluctance to play with all comers is a means of protecting clients from potential points of failure and the eventual blame game that follows. Solid integration, of course, takes a commitment to excellence on both sides, and if I, as the core vendor, "own" that environment, I am taking on a certain amount of risk by letting other parties in.

"Look at what happened with the iPod," people say. "Apple set up a platform and opened it up to third-party developers, and 1,000 flowers bloomed." Well, that's true, but we're not talking about apps to enhance your mobile Twitter experience. These apps save or take lives.

For example, it's been generally agreed that having a computerized physician order entry (CPOE) app from one vendor and a pharmacy app from another is a patient safety disaster waiting to happen. If plug and play can't even work in these two areas--and many have really, really tried to make it work--how can people think a plug-and-play world awaits healthcare in the near future?

Maybe healthcare isn't a plug-and-play environment because there's just too much risk in stitching together applications from different vendors, no matter how appealing the concept is on paper, no matter what measures are taken to ensure interoperability. Maybe one-stop shop vendors are winning deals because their software is proven, integrated, and they have as much skin in the game as possible.

Will the future be one of plug-and-play, open source applications? Probably, but not for at least 10 years. Healthcare is a risk averse market, and that's with good reason. With more medication orders flying through IT systems every day, the potential is huge for the slightest formatting error to result in deaths; it's probably even inevitable.

I personally would want to buy my health information system from a company that's been around a long time, has a valuable reputation at stake, and is as rock solid as possible--anything less is still too risky for this business.

Anthony Guerra is the founder and editor of healthsystemCIO.com, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at [email protected].

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