By Dr. Dave Levin

Over the last decade, U.S. health care providers made enormous investments in electronic medical records (EMRs). Given the scale of this investment and the ever-increasing pressure to do more with less, many have pursued a strategy of widely deploying a single, uniform EMR and leveraging it for as many uses as possible. It’s a logical and sound strategy as far as it goes, but it only goes so far.

It turns out there are significant limitations to the “One Platform” EMR strategy that often result in major gaps in IT coverage and performance. The good news is that, while these gaps are inevitable, application programming interfaces (APIs) go a long way towards closing them.


The “coverage” gap

By coverage I mean the ability of an EMR platform to enable collaboration and communication consistently and reliably across the continuum of care. Supporters of the one platform approach envision that platform providing this kind of coverage. In reality, there is almost always a gap between the coverage needed for clinical and operational success and the actual footprint of the EMR. There are three common causes of significant coverage gaps: mergers and acquisitions, diverse clinically integrated networks and legacy data management.

Mergers and Acquisitions. On-going consolidation of health care providers frequently creates mixed-EMR configurations. When two organizations with different EMRs merge, they find themselves wrestling with choices about which one should “win.” Large organizations acquiring smaller practices also struggle with the economics of this approach as they try to determine if it is even worth the cost to “rip and replace” the old EMR.

Clinically Integrated Networks. Revenue from value-based care activities is increasingly important for health systems. Delivering that care entails assuming and managing medical and economic risk. Often, this involves a diverse network of providers who must connect and collaborate as a team to efficiently delivery high-quality care. A robust IT platform is essential for success. Often, they are not on the same EMR and have no intention of migrating or consolidating. A big orthopedic group that is mission critical to a joint-replacement bundle initiative is not readily going to give up their finely-tuned, specialty-specific, office-based EMR so they can adopt the generic, workflow-busting EMR used by the hospital. Neither is the post-acute rehab facility. Yet, they all must be IT-enabled to be successful.

Legacy Data. Even the process of consolidating to a single EMR platform has an inherent problem: what to do with the legacy data stored in the EMR that is being retired? That legacy data is valuable for many reasons, not least of which is continuity of care. Ask a clinician and she will likely say that it is difficult to predict exactly what data she might need in the future. But, when she needs it, she really needs it. From this perspective, EMR transitions and consolidations have a built-in coverage gap. One that is often neglected due to the cost and hassle of traditional migration and integration approaches.

The Performance Gap. Single platform strategies also lead to gaps in performance. Here, we define performance as the ability to efficiently use the system to deliver care, to generate the data and analytics needed to drive operational and clinical outcomes and to support innovation. Relying on a single platform strategy means tightly binding your organization to an EMR vendor and becoming highly dependent on their ability to execute and innovate. As long as the pace, breadth and strategic priorities of your EMR vendor matches your own, all is well. But, when misalignment occurs, being highly dependent on an EMR vendor can create serious problems.

For example, suppose your organization has decided to place big bets on advanced analytics and patient engagement. Do you want to be limited by your EMR vendor’s capability or interest in these areas? Wouldn’t it be better to freely choose and pursue strategic priorities based on what’s best for you? Do you want to be dependent on your EMR vendor to finally deliver elegant workflows and well-designed user interfaces? What if you need a wiz-bang cardiology application but your vendor is focused on orthopedics this year? Can you safely rely on EMR vendors to deliver high-impact solutions for predictive analytics, genomics, telemedicine and artificial intelligence when you need them? Obviously, being highly dependent on a single EMR vendor severely limits agility and innovation.


Gaps are inevitable – APIs close them

The good news is that organizations now have the choice and flexibility that is enabled by APIs. APIs close the coverage gap by making it easier to connect applications to different EMRs, and different EMRs to each other. APIs can alter the cost or timing of an EMR “rip and replace” – or even obviate the need to replace. Managing legacy data becomes much simpler as APIs provide real-time access to that data from inside the new EMR. APIs also enable formation of heterogeneous clinically integrated networks by letting providers on different EMR platforms connect and collaborate efficiently.

APIs also have a profound positive impact on performance gaps. By providing robust integration they empower market-driven competition and create choice. In an API driven world, you use your EMR’s native functions and user interfaces where they meet your needs while simultaneously being free to choose the best solutions knowing they will integrate with your main EMR. APIs allow organizations to pursue the strategies that are most important to them by reducing their dependence on a specific EMR vendor.

APIs are a proven way to unleash the true value of EMRs. They close the gaps inherent in the single platform approach and give organizations greater strategic flexibility and the freedom to choose the best applications for the job. APIs have transformed the rest of the digital economy. They can do the same for healthcare.


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Dave Levin, MD is Chief Medical Officer for Sansoro Health where he focuses on bringing true interoperability to healthcare. Dave is a nationally recognized speaker, author and the former CMIO for the Cleveland Clinic. He has served in a variety of leadership and advisory roles for Health IT companies, health systems and investors. You can follow him @DaveLevinMD or email


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