Goodbye enterprise EHRs; Hello person-centered data records

The future according to former National Coordinator for Health IT Dr. David Brailer
By Jonah Comstock
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Dr. David Brailer may be best known as the first ever National Coordinator for Health Information Technology. But Brailer has held a diverse range of roles before and since that give him a uniquely well-rounded perspective on digital health.

“I’m a physician,” Brailer told MobiHealthNews in a recent interview. “I’m a PhD economist, but spent most of my career as an entrepreneur in the digital health space and formed a number of companies. I did a stint in Washington as the first National Coordinator for HIT. And more recently I’ve been investing in and sitting on boards of a number of digital health companies. So I think I’ve been on every side, from policy, to building and running, to investing, and it’s always been around the digital health space.”

Brailer will be sharing his perspective on the space, and his roadmap for its future, in his keynote presentation at the Health 2.0 Annual Fall Conference. He says you can define eras in healthcare by the data sources they rely on, and we need to move out of the age of the EHR.

[Health 2.0’s Annual Fall Conference will be held October 1st through 4th at The Santa Clara Convention Center. It’s not too late to sign up for Health 2.0’s flagship event focusing on the cutting edge of healthcare innovation!]

“I think for years we went as far as you could with health data model one, which is claims data,” Brailer said. “I think we’re rapidly running out of opportunities for health data model two, which is the electronic record — enterprise result-oriented and test-oriented stuff. Now I think the next big model will be data on your life and what’s going on with you, your inputs, your lifestyle, your culture of health. That data model which is now being built is going to be the next big leverage point of transformation.”

The move Brailer is predicting is similar in some ways to personal health records — products like Google Health or Microsoft HealthVault which have been tried various times in the last 10 years. The record will be centered on the patient and will include lifestyle data from wearables and apps, various -omics (genomics, proteomics, microbiomics), and even new data sources that haven’t yet been conceived. The difference is that success in person-centered records is going to require a stark departure from the enterprise world.

“Those platforms failed because they were trying to graft an overlay, a solution on top of an enterprise system,” Brailer said. “And the technical/legal/financial gravitational pull is away from the enterprises. They could not overcome the enormous resistance or other challenges that resulted in them struggling … What I believe is that a redesign that will re-architect how the data is built around a person will be Google Health or Microsoft Health on steroids and will not be contingent on consumers being that interested. I think it’ll drive consumer interest because they’ll finally have something that is theirs. What I’m saying is an uphill battle, but it is the challenge of this decade.”

This change could be led by tech companies like Apple, Amazon, Facebook, or Verily. It could be led by startups. But it won’t be led by the likes of Epic and Cerner, Brailer says.

“I think their place in the ecosystem is secure for time to come,” he said. “I can’t imagine a world without electronic architectures in the enterprise for a long time. I also think they have become the legacy companies that are trapped by their success as we’ve often seen. They cannot reposition to become that person-centered platform. I think they lack the ability to move against their customers. They lack now the public credibility. I think they lack the business model. So they will be secure and gracefully age for a long time, but I don’t think they’re the ones who are going to lead that. I think that’s been clear for quite a while.”

What advice does Brailer have for startups going into a post-EHR world? When it comes to data, don’t get stuck in the past.

“If I’m a startup and I’m thinking about what to do with the current data models, I’ve already made the first enormous strategic mistake,” he said. “I think you start by thinking about the data you need to add value and how do you get that data. It’s a very different kind of problem.”

[Don’t miss out! Click here to register for Health 2.0’s Annual Fall Conference.]