I’d be curious to hear your thoughts. It’s on the e-patient blog.

Dave, what I’m most optimistic about is that the migration away from monolithic EMR 1.0 will begin to offer CHOICES — to developers, patients, caregivers, and many others.

Your questions go to HOW those choices will unfold and play out, and that’s not easy to see…but yet its very exciting!

I expect the walled garden model to be competitive because one of the lessons we have learned from the iPhone is the ability to create a great user experience through tight control by the platform owner (Apple). Thus, there are both technical and business model issues driving strengths of the walled garden approach.

We need to be careful NOT to equate “walled garden” with “bad” and “open” with “good” — the more realistic view is that the market will figure out the optimal amount of openness, which likely will be some combination of open and closed technical and business model components. It’s probably more realistic to think of “monolith–walled garden–open” as a continuum rather than as discrete categories.

As to your point that developers will not want to develop for a dozen or more walled gardens — Yes, you’re absolutely right, and if there were a viable open EHR tech platform I agree that’s likely where developers would go.

It’s certainly possible that one or two of the walled garden EHR tech platform could become dominant and attract a disproportionate amount of developer talent (again ala Apple iPhone).

So I agree with David, we’re likely to see both intra walled garden competition and competition BETWEEN walled garden platforms collectively and one or more open EHR platforms.

How will all this come out in the wash? I have no clue, but that’s not the point.

The point is that we’re beginning to get choices and competition in a market that has been stagnant.

Let the disruption continue.

If I were a developer, I’d be developing in both .NET and Java, and looking for whose platform(s) seems likely to come out on top. Or, if the occasion arises, if there is an Android in the space, writing to that platform. But health care and EHR technology is quite complex, and I don’t see a Linux or Apache coming along any time soon.

All the best, DCK

When you say “the walled garden EHR technology platform model will be highly competitive”, in what sense do you mean “competitive”? Do you mean the model (all vendors) will compete well against the monoliths, or that there will be strong competition among vendors within this model, e.g. Dell vs Verizon vs Quest?

If I were an app developer I’d shudder at the idea of a dozen platforms (gardens). Of course, I’m assuming that the purpose of allowing plugins is to achieve enhancement with risk: let others gamble on what features users will buy, thus growing your capability (and your ecosystem) without risking your own resources. Am I missing something?

I’m guessing that 98% of the app developers will want to put their eggs in the more open basket, hopping right over the garden, walls and all.