Been a lot of talk over the last year or so regarding the move to smaller, more modular, substitutable apps (think iPhone) to address healthcare IT sector needs, particularly for providers. This discussion has progressed to the point where HHS, in looking to certify EHRs, is also looking at how these small modular EHR apps might also be certified in the broader context of meaningful use.  Now how the hell HHS and in particular CMS will be able to determine whether or not a provider is using a host of modular HIT apps to meet meaningful use requirements remains a mystery and probably better left for some future post.

Chilmark has been seeing a progressive movement by a number of HIT providers, especially among HIE vendors (Axolotl, Covisint and Medicity) to open up their HIE platform (publish APIs) to potentially support a multitude of modular apps to meet various provider needs.  Basically, these vendors are moving to a Platform as a Service (PaaS) model, each taking a slightly different spin on a PaaS that will likely require Chilmark to produce a separate report to explore further.  What is important though for this industry is that this is a fairly nascent trend that will likely accelerate in the future.

And today, we can add one more vendor to the PaaS mix, Microsoft, who announced a partnership with EHR vendor, Eclipsys who has built several modular apps (Data Connectivity, Quick Order Entry and Visual Workflow) on top of Microsoft’s Amalga UIS.  Eclipsys will be demonstrating these apps next week at HIMSS.

What’s in it for all Stakeholders:

Microsoft is taking Amalga UIS from simply being a data aggregator/reporting engine to becoming a platform similar to HealthVault thereby making the data that it aggregates actionable by the apps that ride on top of it.  This creates a higher value proposition for Amalga UIS in future deals with large hospitals and IDNs.

Eclipsys & other HIT vendors now have an opportunity to enter accounts that may have been dominated by large, monolithic solutions from such companies as Cerner and Epic.  It may also provide smaller HIT vendors an ability to rise above the noise and gain some traction in the market.

Hospital CIOs & end users will no longer be strictly tied to only those apps provided by their core HIT vendor(s), but may now be able to “flex-in” certain “best-of-breed” apps as needed to meet specific internal needs/requirements.  In our briefing call with Microsoft yesterday, Microsoft stated that the Amalga UIS APIs will also be made available to customers allowing them to build their own apps, further increasing the utlity of Amalga UIS.

Sounds great, doesn’t it?

On the surface yes, but there are certainly risks, primary among them…

How will the hospital CIO and IT staff manage a multitude of these modular apps over time?  Yes, small modular apps give one flexibility and the opportunity to use best-of-breed apps but managing such can be become incredibly resource intensive and ultimately negate any net benefit.  There is also the issue of having “one throat to choke.”  When you have one or even just a selet few vendors, if anything goes wrong, it is easy to just put the pressure of them to fix it.  Not so easy when you may be using 20 or more modular apps from 15 or more vendors.

Next week at HIMSS, one of our research goals is to better understand the PaaS trend in healthcare from both the perspective of end users and vendors.  We’ll keep you posted.