Comments on: Blueprint for Change: From EMR 1.0 to Clinical Groupware (EHR 2.0) http://e-CareManagement.com/blueprint-for-change-from-emr-1-0-to-clinical-groupware-ehr-2-0/ Chronic Disease Management • Technology • Strategy • Issues and Trends Mon, 15 Mar 2010 19:40:15 -0600 http://wordpress.org/?v=2.8.2 hourly 1 By: James Maldonado http://e-CareManagement.com/blueprint-for-change-from-emr-1-0-to-clinical-groupware-ehr-2-0/comment-page-1/#comment-12026 James Maldonado Wed, 24 Jun 2009 15:32:46 +0000 http://e-CareManagement.com/?p=887#comment-12026 Gentleman, Thanks for a succinct visual summary of Clay Christensen's ideas as applied to mainstream EHR vendor offerings. Alas, we who have been in the IT industry for awhile have seen this before. The dominant ERP vendors, SAP first and foremost, peddled bloated, exorbitantly priced, monolithic software for a couple of decades despite their egregious project failure rates and outrageous cost. Sound familiar? The Internet exposed the failings of this approach for collaborative commerce (like your clinical groupware) when customers veered away from these vendors for supply and distribution chain solutions. I think you have left one major layer off of your 1983 and 2002 computer industry slides. The missing layer is the database layer. A primary reason for the now needless complexity of SAP and the major EHR offerings is the approach taken to data persistence. Mike Stonebraker, who along with Ted Codd invented the relational database, has written recently that it is time for a re-write of what is now 30 year old database technology. This market is breaking up a la Christensen into several distinct markets--warehousing, streams processing, xml stores, Google GData, tranaction processing, etc. When you change the persistence model you change the software architecture profoundly. Take a look at WorkDay founded by PeopleSoft founder Dave Duffield. WorkDay is what happens when when you give a clean sheet of paper to engineers who have survived the ERP death march. Workday is also notable for the resource, event, agent (REA) accounting framework that it uses. REA could be very valuable as a better way to conceptualize the interface between clinical encounters and billable events--a big problem. It is time for a re-write of the outdated architectural assumptions underlying the current vendor offerings. We have already been there and done that in other industries. It is time to look forward in software architecture to the health care informatics challenges of the future--collaborative care, ontologies, semantic web, and personalized medicine to name a few. Keep up the good work. Gentleman,

Thanks for a succinct visual summary of Clay Christensen’s ideas as applied to mainstream EHR vendor offerings.

Alas, we who have been in the IT industry for awhile have seen this before. The dominant ERP vendors, SAP first and foremost, peddled bloated, exorbitantly priced, monolithic software for a couple of decades despite their egregious project failure rates and outrageous cost. Sound familiar?

The Internet exposed the failings of this approach for collaborative commerce (like your clinical groupware) when customers veered away from these vendors for supply and distribution chain solutions.

I think you have left one major layer off of your 1983 and 2002 computer industry slides. The missing layer is the database layer. A primary reason for the now needless complexity of SAP and the major EHR offerings is the approach taken to data persistence.

Mike Stonebraker, who along with Ted Codd invented the relational database, has written recently that it is time for a re-write of what is now 30 year old database technology. This market is breaking up a la Christensen into several distinct markets–warehousing, streams processing, xml stores, Google GData, tranaction processing, etc. When you change the persistence model you change the software architecture profoundly.

Take a look at WorkDay founded by PeopleSoft founder Dave Duffield. WorkDay is what happens when when you give a clean sheet of paper to engineers who have survived the ERP death march. Workday is also notable for the resource, event, agent (REA) accounting framework that it uses. REA could be very valuable as a better way to conceptualize the interface between clinical encounters and billable events–a big problem.

It is time for a re-write of the outdated architectural assumptions underlying the current vendor offerings. We have already been there and done that in other industries. It is time to look forward in software architecture to the health care informatics challenges of the future–collaborative care, ontologies, semantic web, and personalized medicine to name a few.

Keep up the good work.

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