With Medicare's push toward shared savings and accountable care organizations, healthcare business models are getting more complex, said Shahid Shah, software IT analyst and author of the blog The Healthcare IT Guy. And according to him, the industry needs software to implement these new models. 

“Due to the new intricacies of organizational connections between different providers, standardization of workflows on existing EHRs won’t really be possible," Shah says. "Most EHRs are not up to the task of handling the complexities of newly shared accountability and what I call ‘patient team’ business models, so we need EHRs to become more social, more collaborative, and far more integrated than they are now, EHRs need to grow up from the adolescence of basic electronic typewriters and chart storage systems to mature real-time care coordination and collaboration platforms.”

Shah gives us five more reasons EHRs need to “grow up.”

1. It’s all about the apps. According to Shah, the looming shift toward mobile technology will mean smaller and more “nimble” apps (both web-based and mobile) will begin to take on some of the burdens being “thrown in by new business models.” He added this is because EHRs can’t change fast enough to accommodate new requirements. “However, these nimble apps will proliferate and their data needs [will need] to be ‘coordinated’ by next-generation EHRs to be truly successful,” he said. “EHRs must recognize they aren’t apps themselves, but containers for other apps or other apps’ data.” 

2. Vendors will jump onboard. The “common wisdom” in the industry today is there will be fewer EHR vendors in the future as consolidation occurs. But that’s not true, said Shah. “I think that interfacing, interoperability, and real service-based platforms will be created, which can handle the next level of more sophisticated requirements being thrown at EHRs.” He said EHRs that survive in the long run will have “graduated” from basic record-keeping and document management to more refined patient management, patient engagement, and collaboration-driven software. “The older vendors will start to hear the collaboration siren songs and jump onboard pretty quickly,” he said. 

3. Everyone needs to be on the same page. “Today’s reality of patient management is ‘disjointed care,’ and most of the players in a patient’s care don’t know what each other is doing for the patient in real time,” said Shah. Knowing all the participants in the patient’s care team, and coordinating their electronic activities, is what future successful EHRs must “handle with ease.” In addition, Shah mentioned current EHR apps are typically restricted to “legal entities” or a single hospital or hospital system. “However, to manage coordinated care, successful EHR systems must open themselves up beyond legal boundaries into ‘trust federations,’” he said. These trust federations, said Shah, are more than health information exchanges; they’re platforms that both welcome and encourage real-time data integration for activities beyond clinical data. 

4. Flexibility will be key. Shared savings programs, capitated payment models, ACOs, and PCHMs require a level of coordination and measurement of quality metrics that are tough to define, implement, and secure, said Shah. Future EHRs, as care coordination platforms, must “allow dynamic business models that can accommodate a great deal of uncertainty and flexibility,” he said. “When you move from the uncertainty of supporting users inside a single organization to working with the uncertainty of multi-organization relationships and user communities, application architectures must accommodate more fluid workflows that can change daily or weekly based on the demands of new participants.”

5. Integration and interoperability will be front and center. Integration has to be more than lip service, said Shah. “Most EHRs today, after being dragged kicking and screaming into the new ‘Meaningful Use World Order,’ are marketing more interoperability, but they’re not doing so in reality,” he said. In the future, EHRs will have integration and interoperability as an architecture requirement and not an add-on, he added. “Data liquidity into and out of EHRs must be natural and need to be handled without resorting to excuses about privacy and security,” Shah said. “There are many ways to tag and secure liquid data based on patient consent.”

Follow Michelle McNickle on Twitter, @Michelle_writes