The FHIR standard has enormous potential to facilitate the integration of third-party apps within electronic health records. But IT leaders at many health systems are still focused on efficiency and reliability rather than innovation – and some worry that bureaucracy can inhibit a responsive, agile response to changing healthcare technology needs.

Despite the ongoing push for interoperability among health systems, for instance, the trend of mergers and acquisitions means many chief information officers are having to focus on a heterogeneous system of information within their own, experts said Monday at the American Medical Informatics Association virtual annual symposium.

Adam Landman, CIO at Brigham and Women's Hospital, described a "patchwork quilt" of different clinical, administrative and revenue cycle programs that Mass General Brigham faced before it finalized its migration to the Epic EHR in 2018.

"Approximately 675 applications and 200 interfaces were in place and not integrated across Brigham Health or the Mass General Brigham Network," Landman said.

The transition took about five years, he explained. But "it truly has transformed the practice," allowing for more seamless information sharing between departments.

At the University of Utah, meanwhile, CMIO Maia Hightower said the EHR had "operational, foundational elements in place."

Other areas of the platform were less mature, she said: "Our approach had been quite siloed and business-focused."

Hightower noted the need for agility and speed in response to crises – particularly the COVID-19 pandemic, which triggered a short-term scale-up for which the team now has to pay the piper, so to speak.

With telehealth, she said, "We needed to solve a business problem immediately in a short amount of time." Now, with a little more breathing room, "we're doing cleanup," because the solution that "solved the immediate business problem was a bridge to an unsustainable amount of technical debt."

An open question, noted the experts, will be whether most successful innovations will end up as part of the EHR rather than as separate apps.

The "coolest app in the world" may not be enough to overcome the barrier of logging out of Epic to use it, said Hightower.

"Our clinicians will use a clunky app that's integrated in the workflow over a sleek app" outside of it, she explained.

And when it comes to integrating externally developed apps, she said, her system's experience has been generally positive.

"Ultimately, the vendors do want to be responsive in this space," she said.

"We all agree we need innovators," said Titus Schleyer, research scientist at the Center for Biomedical Informatics at Regenstrief Institute. "We need EHR platforms. But I'd love to see one not eat the other over time, stifling innovation in the process."

The experts also pointed out that, when done right, app-based ecosystems can be designed to help reduce health disparities. 

Christopher Harle, professor and chief research information officer at the University of Florida, said he hoped to see an ecosystem that would "foster more equity in development."

"As we start thinking about these patient-facing apps, who are we designing for?" asked Hightower. "When we overbuild to a specific population, we are undeserving another population." 

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.