The Walking Dead: Why it's already too late for most current EPR systems
So this blog is probably best described as being catalysed by an outpouring of hope at Simon Eccles’ (NHS National CCIO) recent tweet about making interoperability a contractual requirement for the next generation of GP SOC. We have never seen such a direct and encouraging statement of intent in this space. Ever. It’s brilliant, but only if it comes to fruition and Simon can navigate the commercial red tape. But still, Simon has made us so happy.
However, this blog isn’t really about that, it’s about how Dr Eccles’ statement is just part of something that means the death of the current generation of clinical systems out there over the next 10 years. Maybe less. And Apple, Amazon, Microsoft and Google. Everything is about them nowadays.
Simon’s tweet was an indirect response to Apple announcing that they’re making their health records platform open (with citizen consent of course). Our choice of words is very deliberate there- Apple are building a platform. They’re absolutely not trying to build a monolithic EPR. This is intentional.
They are building a platform that will contain millions of health records, in a standardised, normalised and consented way. They are removing pretty much all barriers to entry to the healthcare software market, creating a potential causing an explosion in digital health innovation.
But why would they do this? It’s down to the platform business model- in providing a large-scale platform, they are essentially creating their own innovation playground. Amazon, Apple et al., in other words platform providers, will all have a helicopter view of what is doing well on their platform and will simply buy whatever that is, absorb it and let it make money for them. It’s a simple, and very successful business model. They get to buy their future competitors before they become competitors, but don’t do any of the innovation hard work themselves. Look at Google buying Deepmind, or Facebook buying Whatsapp. They then become even more dominant in that sector, and so the virtuous circle continues.
So what will happen next? We reckon that:
- Apple, Google, Microsoft and Amazon (amongst others) will continue to create their healthcare data platforms, catalysing a whole new generation of innovation of patient/citizen facing healthcare software;
- The NHS will mandate interoperability but…
- Apple etc. will become the dominant voices in interoperability instead, setting data and messaging standards just by the sheer popularity of their platforms and apps sat on their platforms. Users will expect the systems in their providers to access these health clouds, so the NHS bureaucracy will have to keep up with these standards (which of course it won’t be able to, but Simon Eccles’ intentions are to be lauded nonetheless);
- The current monopoly of the existing supplier community will be broken and come under attack from pretty much anyone that wants to have a go at writing a better system than those that exist right now. When you don’t have to worry about building a proprietary data model before you build the software on top of it (because someone has already built that platform), this makes things a lot easier.
- So we predict that the current suite of suppliers will actually be taken down by their own customers. Clinicians will, directly or indirectly, build their own systems, and they will be better.
Interestingly, we think Cerner are one of the only suppliers who seem to have got this, pushing their Healthcare Information Exchanges heavily. They are making it about the data and interoperability. They see the power in people needing to come to them for access to data. I imagine they might even have aspirations to buy smaller apps that can connect to their exchanges. However, they’re too late, they just won’t be able to compete with the size of Apple et al. The big companies will dominate the standards space and have infinitely more buying power.
The other people we think are on the right track are IMS Maxims, with their open source solution. Their non-proprietary model means they should be able to adapt their data model and standards to link to whatever the big companies say it should be. At least more easily than most.
As proven by the suite of globally dominant uber-applications such as Facebook, people’s data is the new currency. These apps are not free, we all pay for them with our data. Those who control the data have all the power. What we see happening in the next 10 years will be the gold rush and marketisation of health and care data. It’ll be interesting to see who comes out on top, but we very much doubt it will be the current crop of suppliers with systems built around data intransigence. For them, it is already too late.