A best-of-suite EHR or best-of-breed?

"The best-of-suite EHR is an illusion"

The best-of-suite approach ostensibly has several advantages: there is a reasonable degree of cost clarity and there is one vendor for all parts of the EHR. In theory, integrations with archaic technologies are a thing of the past. But is this true?

In the words of Martin van der Meer, director at CODE24, "The best-of-suite EHR is actually an illusion. In practice, there is no real all-in-one solution in the EHR area. Within a healthcare organisation, every EHR becomes part of an EHR-landscape with several other linked subsystems." So even the so-called best-of-suite must necessarily be linked with all kinds of subsystems that are part of this landscape (think, for example, an EVS, ROM, lab and other e-health applications).

A barrier to innovation and collaboration

Nevertheless, until now, especially within the Netherlands, a best-of-suite solution has often been chosen. It was long seen as the safe choice - but the way a 'traditional' EHR is set up creates challenges in the practical EHR landscape we outlined. Vendors of traditional EHR's build a thick wall around their systems and maintain a high degree of control over what is technically possible. This limits the ability to integrate with external systems to what the vendor facilitates, and the vendor also sets the price tag for this.

However, technological innovation is moving at lightning speed in several areas and EHR suppliers can never keep up in every area. Martin argues that the need for an open architecture only increases because of this. "However, an open architecture alone is not enough; healthcare data will also have to be standardised. After all, systems can only communicate if the different systems actually have a placeholder for storing the same dataset."

Keep the door open

So does this mean dismissing the whole best-of-suite concept? Not necessarily. There will still be a place for EHR's that have, out-of-the-box, various integrated modules that work together optimally. But we must be mindful of the reality of what healthcare organisations need within an EHR landscape and how also innovation can be optimally facilitated - this requires an open architecture with standardised storage of healthcare data. "Healthcare organisations should demand this from vendors before signing contracts," Martin said.

When EHR's are built based on an open architecture with standardised healthcare data, integrating with subsystems becomes a lot easier and more accessible. This way EHR-suppliers can really help healthcare move forward.

And the future?

A modern EHR, in addition to having an open architecture, will also be modular. Basic functionalities will be made available as separate modules by different vendors. These basic functionalities integrate seamlessly with each other and act together as a single system. This makes the sustainable deployment of various innovative best-of-breed systems both more accessible and effective.

This may sound somewhat like a utopia - yet it is very real. At two healthcare institutions in the Netherlands, such a EHR set-up is already operational in production.