"Is HITECH working?" That was the question posed by Vince Kuraitis, principal of Better Health Technologies, at the Mobile Health Expo in Las Vegas on Wednesday.

Specifically, Kuraitis, who runs the e-CareManagement blog (e-caremanagement.com), sought to explore how the stipulations of the stimulus might alter the healthcare IT business model – changing how the technology is developed and put to use.

He discussed ongoing debate in the larger technology industry about which is best: locked-down proprietary business models, an intermediary "walled garden" approach, or a free-floating and collaborative "open Web" model that allows for more opportunity for smaller players and, adherents believe, more fertile growth.

Healthcare, Kuraitis said, "has had almost nothing to do with this debate ... until today."

The broader implication of HITECH, he said, "will be that as healthcare gets dragged into the network economy," suddenly that "walled" vs. "open" debate becomes something the industry could find itself having – and by which it could find itself transformed. In fact, he said, it's already happening.

HITECH meant to address some obvious flaws in the healthcare system: most notably the fact that data isn't shared, it isn't electronic and that EHR adoption is low.

Whether it's able to remedy those issues remains to be seen.

Until just recently, Kuraitis said, "health IT has been built on technology and business models that were non-interoperable and proprietary."

Inherent in the system was a high cost of switching technology. That had the effect of locking providers in – and contributed to the high stress of selecting an EHR system. (A decision that led to a relationship that was "almost like a marriage," Kuraitis said).

Moreover, data has too often been looked at far more as a competitive asset and not so much as an asset for the patient, he added.

This "closed, monolithic system" is due for some changes.

Currently in healthcare there are "lots of islands of applications" – mobile health monitoring, PHRs, portals – in search of a common data platform that would allow them to interoperate.


'Walled garden'

HITECH has enabled a movement towards more of a "walled garden" model, with an EHR platform and attendant applications – not unlike Apple's iPhone/iPad/iTunes/app store ecosystem – where the platform is very powerful but the apps aren't as able to create value.

Before long, he said, that will evolve further into an open EHR technology platform, with makers scrambling to attract the best app developers.

After all, your iPhone gets better the more apps you download to it. They create value. Add-ons to EHRs from outside developers should hold the same appeal for vendors.

So the big question: Is HITECH working?

"It's early in the game," Kuraitis said. "Top of the third."

But so far he's encouraged – especially insofar as it has been good for "companies that are trying to build disruptive business models."

The ONC got it right on the three major policy decisions, he said. First, it ensured that meaningful use put the emphasis on the "meaningful." Second, it leveled the vendor playing field with its certification requirements – and opening the field to other certifying bodies besides CCHIT. Third, it did well by prescribing "lightweight, open standards to promote EHR interoperability and modularity."

Good news for mobile vendors

As such, the supply side of healthcare IT is already changing. "What we have seen on the vendor side is nothing short of miraculous," said Kuraitis. Within a matter of mere months, we find ourselves already "squarely, the era of walled garden business models."

Consider the recent announcements that Medicity would throw open the doors to its HIE Platform to third-party app developers. Or that MEDecision launched Alineo, its collaborative healthcare management platform.

That trend of EHR makers and other health IT vendors opening their vendors have opened up their application programming interfaces to outside developers will continue, Kuraitis said.

The fact that it has begun in earnest at all means that HITECH is "working and working significantly."

And as the ONC predicted, interoperable and swappable modules are increasingly adding up to effective and meaningfully-used EHR technology.

That's good news for mobile vendors, he said. Because as open EHR platforms become the norm, big vendors will want to attract the best apps and make a product that's developer-friendly

After all, "you'll want to develop for one winner, like Apple, not 13 Apple wannabes."

(It's good news for payers, too. "The people who most want to see healthcare open up are the people who are paying for it," said Kuraitis. "They don't like the oligopoly that's incentivized by cranking up volume.")

If Stage 1 of HITECH/Meaningful Use has laid the groundwork, Stages 2 and 3 are where it really plays out for mobile. There, measurement begins to assess whether data is being shared, and whether it's improving outcomes.

"Disease management and clinical decision support really hit the sweet spot for mobile health app developers," said Kuraitis.