“Best of Breed” Software is Alive and Well

Scott Smith
June 16, 2023

As an “alumni” healthcare administrator with years of experience working in hospitals and then pivoting my career to join an EHR company, many of my colleagues kidded me about joining the “dark side” by signing on with a vendor. In truth, I was recruited to Cerner by Paul Gorup and Dick Flanigan to assist them rolling out an EHR offering for community hospitals which now has become their CommunityWorks(sm) solution. Twenty years ago, the concept of an integrated software offering sold with a pre-built implementation which was remotely hosted was revolutionary for Cerner. The key for success with this model was utilizing all Cerner solutions with minimal changes to the pre-built implementation offering. This approach worked well (and still does) with smaller hospitals but fell short of the more complex needs of larger care providers.  Organizations that wanted to include non-Cerner solutions to meet the needs of their physicians couldn’t utilize the community model and were relegated to the more traditional EHR software model. I worked with several such organizations during my Cerner tenure that used HL7 interfaces to meet their care delivery goals and this approach worked well for that time.  

Fast forward to today, we see a very different landscape in the EHR world. EHR companies have worked diligently to either purchase or create new solutions to build out their software “suites” and minimize the need for healthcare organizations to consider “non-native” EHR software options. As the complexity of healthcare delivery continues to evolve, the realization that while the allure of an integrated EHR software suite is intriguing, EHR departmental offerings often fall short of physician and staff needs. This shortfall in departmental software capabilities has allowed “best of breed” solution providers to flourish and many healthcare organizations have realized that the “sum of the parts is not greater than the whole” when it comes to EHR software suites. Added to this dynamic is the incredible amount of innovation that is occurring in healthcare organizations now. Almost every week I hear about the creation of new “point solutions or apps” that physicians and healthcare providers are developing to improve patient care.  

Normally all this would be great news for physicians and caregivers who prefer non-native EHR solutions to care for patients but unfortunately the EHR companies aren’t quite ready to relinquish their software supremacy. Contemporary EHR software is essentially designed to be a “closed” system with limited options to integrate third party solutions or apps. The HL7 solution that we used decades ago is today seen (rightly so) as too expensive, time consuming and burdensome on IT departments to be a solution for today. The advent of FHIR as an interoperability standard was a needed leap forward but unfortunately FHIR has limitations when it comes to custom software integration needs. The internal integration strategies that several EHR companies have initiated (for non-competing software) are focused on trying to monetize access to their EHR’s by non-native software and even these efforts aren’t designed to provide total access for third party solutions to fully utilize their features.  

Fortunately, the introduction of the RESTful API standard has provided healthcare organizations with the option of seamlessly integrating superior non-native software apps with their EHR. Forward thinking organizations who recognize the limitations of software included in their EHR’s now have the option of adopting RESTful APIs as their integration standard thus avoiding the shortfalls of HL7 and FHIR. While the adoption of RESTful APIs by healthcare organizations is slowly gaining momentum, the EHR companies continue to try and styme their clients from adopting a strategy which would, in effect, open their architectures and effectively break apart their existing software suites. This of course, would be detrimental to their profitability goals and is why our healthcare system continues to struggle with true interoperability.  

In conclusion, I admit to seeing both sides of this dilemma. The “EHR executive” in me understands the desire for the “one size fits all” approach of a unified software suite. This approach is the easiest to sell, implement and support for EHR companies, and also for many clients. However, the “hospital executive” part of me struggles with paying multi millions for an EHR and then being told what I can and can’t integrate with it – even when my physicians and staff are clamoring for a better solution to improve patient outcomes. In the end, the healthcare side of me prevails in this situation and I vote that healthcare organizations have the option of seamlessly integrating any non-native EHR solution they choose. For now, RESTful APIs are the best solution for hospitals to pursue for integration and I’m glad my colleagues have that choice.  

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