Q: Having dealt at Partners with different systems, from different vendors, do you think that gives you a leg up on some of the integration challenges that will be facing you in the coming years with this deal?

A: I think so. We have people, and Cerner does too, to deal with not only how do we get these two systems to talk to each other, but you do become quite aware of what the real difficulty is, and you also become aware of the political realities that lead to that happening in the first place. So there's a lot of understanding of what it takes to run an IT organization – the pressures they face, the constituencies they serve – that are in addition to the things about the technical work of making system A talk to system B.

Q: In broader terms, industry-wide interoperability obviously continues to be a vexing problem for healthcare. Cerner has paid lip service to fixing this problem with, among other things, its founding membership in the CommonWell Health Alliance. What will you guys be doing in the coming year to help drive progress on this front?

A: A couple of things. Both we and Cerner have a deep, visceral value belief that you have to interoperate well, you have to be open. We're in a heterogeneous world, and if you're going to serve providers well, you have to help them connect. Not just other health IT applications, but patient-facing technology and the systems of health plans, etc. You've got to walk into the conversation with a core, strategic belief that that is really, really important. I think Cerner and we both share that.

In addition to that, you spend time, as we have done and they have done too, being very engaged, in the standards committees, the policy committees, conversations with ONC, to give them feedback about what it takes to do these things.

The other is when standards come out, from the standards-setting process, that you quickly embrace some of the (processes) that are sometimes imperfect. And you also do things like the CommonWell alliance, where you say, 'We shouldn't just wait for the government to do it. There really is a role for the private sector to come together and do this stuff.

But I think this is a really hard challenge. And there's nothing vendors or providers can do quickly that's going to make this easy. We still have to grind our way through it as best we can. But at the end of the day it all rests on this core, strategic understanding that this heterogeneous world is here to stay, and has a lot of value to it, and you have to make it work by having things interoperate as well as they can.

Q: Neal Patterson made a point to say that this deal is meant to position Cerner for the "post-meaningful use era." And you also hear some folks these days talking about the "post-EHR era." What are some of the opportunities and challenges you see in the next few years?

A: I'd be a little careful with the "post" word. Because there are a lot of EHRs in place that are not used as well as they should be. The technology has been installed, but the organization hasn't leveraged it as well as they should to reengineer their processes and improve care.

But there is this point at which you shift from installing the technology to really making it work, and work well. And we're still there. So, it's better to say "post installation," for lack of a better word.

I also think – and we see this across industries and across time – that the technologies you put in place today, over the course of 10 years, become obsolete, or are certainly overtaken by new, cool, much more potent stuff. So you might have an EHR installed, but you might be shifting it to something with a better consideration or approach to events that have occured. It might still be an EHR implementation, but the underpinnings, and the way it's put together, are really different. So we'll see waves of replacements, because the technologies will just offer more opportunities.

Now that being said, I think a lot of folks are saying, 'Allright, I've got it in. I've got my Stage 1. Hopefully my Stage 2. … I really need to get on to population health management, care coordination and stuff like that.' And certain technologies that can couple with or wrap around the EHR.

And a number of them also say, 'Golly, while we were all up in this EHR stuff, our revenue cycle was kind of neglected. And given the changes in payments, we're going to have to do something about the revenue cycle.'

So there's a series of waves coming: a revenue cycle wave, a population health management wave, but also next-generation of EHR wave that is probably a couple years out but coming nonetheless.

Q: What will that look like?

A: In a lot of ways it will look the same: I can still write a prescription, look up results – those are core capabilities that will still be there. But to give you an example, I see two fundamental characteristics.

One is they will be much more intelligent. I was a CIO for a bazillion years and have put in a lot of EHRs and CPOEs. It's fundamentally a form of transaction: write a prescription, retrieve the results, document care. And there's a lot that can happen as a result of that. But increasingly we're going to surround that transaction and that data with intelligence. An example I sometimes use is that if I go to Amazon to buy a book, you get all these suggestions about other things to buy. There's intelligence wrapped around this very simple transaction of buying a book, which leverages your interaction with them.

We'll see a range of these things: decision support, workflow engines, predictive algorithms, logic that looks at EHR data and cleans it up so it stays consistent. Advanced diagnostic technology which takes in the image, molecular medicine data and EHR data. Intelligence that brings in stuff from your device to my device.

Now, at the service level it will be very similar to now, but deep in the interface it will be quite different. This is a major invasive architecture thing to do. I think that will be one of the ways EHRs will be very different.

The second big change has to do with the notion of teams. Most EHRs today are directed toward a single clinician: Your worklist, or your notes. One of the things we will all be doing more of is team-based care. So, in managing Mrs. Smith we'll have a team-based approach, where I, the doctor, do my part, the nurse does her part, the patient does his part, and we have shared worklists. A lot of what we do will shift from individual support to team support. And that's easy to say, but it's actually quite challenging underneath the sheets to make all of that really happen: Which team members can do what, who's on the hook for what, stuff like that.

So those are just two ways, very fundamental ways, that the EHR will change. And these are non-trivial, when you look at how you put these things together.