The phase of digitizing medical records is passing by, giving way to the next set of tasks. The three most prominent challenges now are:

  1. Exchange – how to break the silos of isolated EHRs, and enable sharing based on geography (think HIEs) or affiliation (think ACOs)
  2. Consumer Engagement – If the official record is electronic, how to make it accessible to patients and open to contribution of self-reported data from increasingly commodity health monitoring devices and tools.
  3. Analytics – how to derive actionable insights (for all stakeholders – patients, providers, payers) from the avalanche of incoming electronic health data due to #1 and #2 above.

MyHealthDirect aims to tackle #1 in a specific way. Founded in 2006, the Wisconsin-based company raised $4M series A in 2009 and claimed a customer base of 104 back in mid-2011. They provide a subscription-based system for facilitating exchange of scheduling information across care delivery organizations in a community. The value proposition is for overburdened ERs that can triage away non-emergent cases with a confirmed outpatient clinic appointment. Call centers, disease managers and inpatient discharge planners can also use it to schedule follow-up PCP or specialist visits.

The alternative would be for the ER staff or case worker to call other clinics and manually confirm appointments – a predictably slow and inefficient process. By giving a confirmed appointment with someone that speaks the patient’s native language at a convenient location, the no-show rates are bound to decrease as well.

Referrals are key transition points in care delivery, and scheduling is a critical part of referral management. A number of Healthcare IT players are trying to make the process better. Big EHR players like Epic are pervasive enough in certain areas that they can provide de facto centralized scheduling. If a community has a functional HIE, doing scheduling may be possible through HL7. There are some new kids on the block, like Par8o and Kyruus, trying to enhance other aspects of the referral process. And with respect to healthcare scheduling, no review is complete without mention of ZocDoc, the startup with most-impressive backers and a mind-numbing $95M in funding.

Note that MyHealthDirect solves only a part of the referral puzzle. You still need functionality like messaging and clinical document exchange to enable complete referral workflow. Nevertheless, I think there is more fundamental insight here. Mammoth system offerings like EHR (handling all local clinical workflows) and HIE (connecting all healthcare organizations in a community) perhaps are reaching a point where they are too complex to deliver satisfactorily on everything. Maybe that is why the vendors in these categories have broad functional parity, rather than excellence in narrow niches. So it makes sense that a company that has a laser focus on doing one or two aspects right may end up creating a superior offering. Which is why I’m hopeful for the prospects of what MyHealthDirect brings to the table. If they branch out into letting patients self-service an appointment across community, that would be almost revolutionary.

Clinical Messaging (esp. Direct-based) between providers or provider-patient is another potential area that is prime for some startup’s laser focus. It can theoretically be done (and claimed to be done) by incumbent EHRs/HIEs, but they all suck at it. If done right, it can be the foundation for some great care collaboration or care transition offerings. Maybe it’s time the pendulum started swinging away from systems that do everything averagely, to systems that do few things exceptionally.

Nov 2012 Update: Just read a NEJM article by Kenneth D. Mandl and Isaac S. Kohane that makes a similar point about EHRs being bloatware (much more eloquently though). Succinct and upfront analysis… a must read.