Healthcare Interoperability
Currently, there are many growing startups tackling the problem of healthcare interoperability (Smile CDR, Health Gorilla, 1upHealth, Redox, Particle Health). Why is it that these startups are working on fixing interoperability when big EHR vendors (Epic, Cerner, Meditech) are not? I understand EHR vendors do not need to innovate because they have a large portion of market share, but are there any other reasons (technology, software, etc.) that inhibit these big EHR vendors from improving their system?

I see great potential in being able to transfer records from one system to another. I have recently talked to physicians and staff in the Transfer Record Department at Norton Healthcare and The University of Louisville Hospital. There seems to be a problem. All large EHR vendors ship out different, isolated systems to each hospital. Thus, if one hospital using Epic wants to send medical records to a hospital down the street also using Epic, they will have to go through an inefficient process to transfer information because these EHR systems are isolated (even though they both use Epic). While Epic has ShareEverywhere (allowing records to be shared digitally), some hospitals do not have this software, making this software essentially useless to some patients. Alternatively, records are shared either through fax, phone calls, etc. In this method, whether it be through digitally or through paper, it is through a pdf format–it is pages upon pages of information. Thus, the actual medical records the receiving side view is not integrated within the EHR but a read-only view. Even then, the process could take up to 30 days (according to HIPAA regulations) and additional fees tagged along for patients.

Currently, there are startups working on interoperability. However, these startups are either physician-focused, developer-focused, and not integrated with EHR vendors. I was thinking about building a system that focuses on all the problems described above. Currently, there are two ideas to go about this.

1. Build a novel EHR system
With built-in audio-to-text recognition, AI-driven to ensure ease of use for physicians, better UI/UX that prevents unnecessary training time for physicians, bridges the gap between patients understanding medical information, patient-friendly apps, and integrated across all hospitals. (The features listed above are problems that patients and physicians have expressed in Stanford Medicine EHR White Papers, Stanford EHR National Symposium, etc.)

2. Build a system that increases interoperability between hospitals using the same and different EHR vendors.

The former solution seems difficult seeing market share is already dominated by other vendors (but what startup isn't difficult). However, there seems to be a need for a more innovative competitor that listens to patients and physicians, providing them with an experience incomparable to the current slow, sluggish vendors.

The latter solution is slightly less difficult but requires inside information about the individual EHR systems. Nevertheless, this would ultimately decrease administrative costs/time, provide all medical information about a patient since birth, and increase ease of use for patients and physicians.

That is one problem that I have been researching lately. I would love to hear your thoughts and corrections about anything I said. Let me know what you think :)

TLDR

Problem: Big EHR vendors do not innovate in interoperability and startups are not working on increasing patient-side interoperability. This leads to inefficient record sharing processes and fragmented medical information across different hospitals for patients.

Solution: A new EHR system or a system that can communicate between EHR vendors