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Ripple: Making Waves in Healthcare IT

The Ripple Program, based out of Leeds and building upon the lessons learned from the Leeds Care Record, has recently been set up to positively disrupt health and social care towards those ends. Importantly the ethos of “open” is at the heart of the work and for very good reason. It is clear that interoperability between Health IT systems will drive real change but, what is even clearer is that only an open source approach will positively disrupt this health and social care landscape across the NHS and across the globe. Funded by NHS England and hosted by Leeds City Council, the focus of Ripple is to support health and social care organizations by providing six open source elements which can be used individually, in combination or as a whole, and are consistent patterns of need when embarking on an work towards healthcare improvement with information technology.

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The Postmodern EHR: What are the Enablers?

Traditional monolithic EHR architectures focus on stability and standardization at the expense of agility. Along with innovation, cloud based deployment and integration of things, agility is the main differentiator when describing the requirements of application architecture for the Postmodern EHR. Achieving agility is impossible for the vast majority of healthcare applications today as they are an inseparable mix of code for user interface, decision logic, workflows and data definitions. New architectures promote agility and reuse by turning the applications inside out and layering the four types of programming into portals, rule engines, process engines and XML data. Let’s look at some examples, layer by layer:

The Postmodern EHR: The Data Layer

This second approach entails defining a data layer, which is the most important aspect of the Postmodern EHR architecture from my previous post. Why is this the most important layer? Most healthcare organizations are beginning to realize that their data is more valuable than their applications. Data has become a key asset, since good data is key to improving outcomes, managing chronic disease and enabling population health management. And it needs to be managed for the lifetime of the patient. Which application is going to last that long? What happens to health data when we switch applications?

The Postmodern EHR: What can Health IT Learn from the Evolution of the ERP Market?

It seems the pattern is clear. From best of breed to integrated (mega)suite to a new world of innovative, agile, mostly cloud based and multivendor solutions. This is what Gartner calls “Postmodern”. According to Christensen, disruption like this becomes possible when the established players start exceeding the requirements and expectations of their customers, providing only sustaining innovation – i.e. adding more and more features to their products. This is what was happening in the personal productivity space with the Office products. Similarly, the ERP market today has well defined requirements and this allows the newcomers to disrupt, meeting the base expectations and adding innovation and agility while lowering costs.