The time is now for a "3rd Platform EHR," according to IDC -- systems that operate primarily in the cloud and provide more flexibility than today's "2^nd Platform" client/server technology.

"The 3rd Platform, with cloud as its foundation, is widespread and growing across the country today," but mostly for discreet elements of healthcare, such as population health, IT operations and patient engagement, IDC analyst Judy Hanover writes in a new IDC Health Insights report, "Business Strategy: Crossing the Innovation Gap from 2nd Platform to 3rd Platform Acute Care Systems — the athenahealth and BIDMC Collaboration."

IDC sees 3rd Platform systems as "characterized by ease of access, and ubiquitously available applications that can be securely accessed from multiple endpoint devices, coupled with the use of commodity infrastructure available from service providers through software-as-a-service, platform-as-a-service, and analytics-as-a-service offerings, among other constructs," according to the report.

There are no 3rd Platform EHR options available yet, as IDC defines them, but Hanover expects them to be available in three to five years, and she's seen the first glimmer in the athenahealth and Beth Israel Deaconess Medical Center collaboration launched last month.

In that deal, athenahhealth purchased BIDMC's home-built clinical applications and EHR platform, called webOMR, and BIDMC agreed to roll out athenahealth's EHR, revenue cycle management and patient engagement services to its physician network of 185 providers across 38 locations in Massachusetts.

[See also: Athenahealth, Beth Israel forge unique EHR deal.]

While dozens of large health systems have been rolling out 2^nd Platform EHRs with recognizable names such as Epic, Cerner and Allscripts, John Halamka, CIO of BIDMC has resisted replacing the hospital's homegrown EHR -- what Hanover would call "1^st Platform."

But the deal with athenahealth seemed right, said Halamka, what he called an "alignment of interests," offering athenahealth an EHR platform that could be improved -- and could at the same time help accelerate its athenhealth's entry into the hospital and health system market, begun with its acquisition of inpatient vendor RazorInsights. Meanwhile, BIDMC would be able to capitalize on the scale offered by the cloud vendor.

"When I saw the athenahealth-BIDMC release, to me it represented really the first entry into the 3^rd-Platform into the EHR/HIS in the U.S.," Hanover tells Healthcare IT News. "I think this really does represent the beginning in the U.S. for hospitals and health systems to really realize that promise.

"I absolutely see this market in the three-to-five year time frame starting to build platforms in the cloud, where they're housing their data, they're housing their information," she says. "There's a huge appetite for getting better workflows into healthcare, looking at department specific and department specific mobile apps. I would see an environment where hospitals and health systems would perhaps rip out and replace in some cases."

Hanover says she's talked with CIOs who "are barely keeping the lights on with what they have now" and would grasp any opportunity to go to a 3^rd Platform EHR. For those hospitals with Cerner or Epic EHRs, they will likely replace incrementally, she said.

"They'll build a data platform, they'll store in the cloud."

Today, though, there's nothing to buy.

"You can't rip this out right now because it's all you've got," Hanover said. "Short of having a product, the hospitals are stuck. But, it's exciting to see new entrants like the athenahealth-BIDMC collaboration because it has the opportunity to transform the space."

What about the work that Cerner is doing with Intermountain Healthcare, which makes it possible for Intermountain to embed longstanding care process models into the EHR?

"I wouldn't be surprised if they don't take advantage of a partner like Intermountain to start to redevelop some of their functionality on a 3^rd Platform," Hanover said. "That's another thing I expect the 2^nd Platform vendors start to do."

"One of the things I thought was particularly exciting about athena working on it is they have a history of innovation. They have a history of reinventing business processes. From that perspective, I think they're a great candidate for moving EHR to a 3^rd Platform."

As she sees it, the industry should not try to duplicate in the cloud the way 2^nd Platform EHRs work today, but rather reengineer and innovate new platforms.

"We're not necessarily looking for functional parity," she said. "We're looking for better ways to deliver healthcare in an accountable care environment."