by jantzl on May 26, 2020

Long ago, you may not even remember the 1980s, when you bought a computer, you had to buy all of your components from the same brand. If your computer had a really fast processor but that company did a really bad job of making keyboards, you were stuck with it, at least for a little while. And maybe that wasn’t so bad, your computer was as fast as you wanted it to be and if you had to replace your keyboard every couple of months, not a terrible price to pay. (Everything that’s old is new again. If you have a semi-recent MacBook Pro, you’ve also experienced having a preferred system with a terrible component)

But then, the technology decoupled and standardized, and suddenly you could select the computer you wanted and any components you preferred. You could have the top of the line processor, keyboard, monitor, disk drive, joystick, whathaveyou. You could even select all of the individual components inside of your computer to build a system custom to your needs.

Decoupling brings you choice and optimization. It also forces vendors to compete and improve.

Hospitals have invested in a couple major players in EHRs, understandably, because regulation incentivized quick action. The major EHR vendors offer the equivalent of a computer in a box. They perform the majority of software functions a hospital could want all in one easy to purchase unit. And there are benefits to this, primarily making purchasing easy and reducing decisions. But there are also drawbacks, primarily choice and competition are limited and not all of the software components are equally good.

I propose that medicine is better served by decoupled solutions. Yes, it does increase time spent on discovery and purchasing, but the benefit is worth it: in increased choice, increased competition to drive up innovation and drive down cost, and improved quality and experience.