No Small Change for the Health Information Economy

...substitutability goes beyond interoperability. Just as consumers may swap out applications on their iPhones, physicians should be able to readily replace one referral-management system with another. Companies are beginning to offer modular services driven by common data elements found in claims, EHRs, and PCHRs.

Third, the platform should be built to open standards, accommodating both open-source and closed-source software. Though installation of open-source software is not free, its use decouples the software code from implementation and integration tasks and facilitates customization, extension, and innovation.

Finally, just as evolution requires variety in order to create ecosystem niches, a platform that supports diverse applications will lead to a robust health information economy. This architecture reduces dependence on individual systems by allowing competition and “natural selection” for high-value, low-cost products. This approach contrasts sharply with design of a national system by committee.

Like standards, system design must be driven by successful, real-world innovations; an incremental and iterative process is more likely than a wholesale advance prescription to be successful.3 The platform model allows disruptive technologies to emerge and enables evolution to proceed organically. New companies and players that will contribute to transformation must be recognized and welcomed.