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Imagine being able to buy just the parts of an EHR system that you need.
The remarkable report "Initial Lessons From the First National Demonstration Project on Practice T ransformation to a Patient-Centered Medical Home," in the May/June Annals of Family Medicine,1 makes this point about the state of primary care information technology (IT): "Technology needed for the PCMH [patient-centered medical home] is not plug and play. The hodgepodge of information technology marketed to primary care practices resembles more a pile of jigsaw pieces than components of an integrated and interoperable system."
Surprise! Well, actually, no surprise. We all recognize that health IT implementation in family medicine practices, even under the best conditions and with the best of planning, is difficult and can be an ongoing challenge. What is surprising to me, however, is this comment in the recommendations section of the article (which I'll call the Nutting Report, after lead author Paul Nutting, MD, MSPH): "?[I]t is possible and sometimes preferable to implement e-prescribing, local hospital system connections, evidence at the point of care, disease registries, and interactive patient Web portals without an EMR."
This is real wisdom, borne of collective experience placed under the microscope by a study of PCMH demonstration practices. The idea that it is "possible and sometimes preferable" to implement components or modular applications instead of a comprehensive electronic health record (EHR) from a single vendor is a noteworthy recognition of how our changing business models in primary care intersect with a major shift in the health IT market of products and services aimed at primary care practices. It also signals that it's time for the AAFP to reconsider its recommendation that members adopt comprehensive EHRs.
Modularization of the EHR
The shift from a vendor-centric approach to one that is platform-centric and modular has been described at length in the business and computing literature. Clayton M. Christensen, PhD, the noted Harvard Business School professor and author of several books on innovation, has described this evolution at length, even coining a "law of the conservation of modularity."
Christensen explains that in some industries, when the products are relatively new and not very good in terms of...