To E(HR) or not to E(HR)

  • Patient apps — This is the category of consumer-facing health applications on mobile, web, or other platforms. These are typically pure-play software solving a specific health-related function for a patient. Direct to the patient (B2C) is one way these start, but often as they seek to grow further, they go en masse to groups of patients via employers or their insurances (B2B2C) that have a semi-captive audience and built-in distribution. It’s an interesting organizational transition, as traditional enterprise sales flex a distinctly different muscle than building brand awareness on Instagram and recruiting influencers to hustle your health products. Examples include Calm, OneRecord, or even Fitbit.
  • Provider software — These organizations sell software solutions to brick and mortar / traditional care provider organizations. This is the convergence of digital technologies with traditional non-digital health care delivery models. Companies in this subdivision make software intended to bring digital trends like telemedicine, artificial intelligence, machine learning, and wearables to disrupt and take market share from legacy health technology vendors. Examples include Solv, Murj, or Vital.
  • Provider organizations — Digital health companies that employ providers and are covered entities themselves fall into this category. Natively digital and designed from genesis to be customer-friendly, they on paper have distinct advantages over legacy organizations bolting on digital health solutions. Their revenue comes from the same places most traditional healthcare organizations find their revenue — patients, insurers, and employers. Examples are the ones I listed before — Cityblock, Iora, etc.
  1. Functionality — As they find product-market fit, these groups layer on new workflows and tools. This causes them to hit the common chokepoints that come as a function of playing in the broader healthcare ecosystem. Their nurses or doctors or care managers need to interact with external parties: e-prescribing, lab orders, clinical data exchange, all the things listed in the 2021 Healthcare Infrastructure Awards™.
  2. Compliance. As these companies grow and look for revenue, they often look beyond the patient themselves at insurers. Of course, in the United States, there is no larger insurer than Uncle Sam. For provider groups submitting for Medicare/Medicaid populations, the providers need to be using a certified EHR, which comes with a lot of baggage.

Buy an EHR

  • Athenahealth — The granddaddy of all cloud EHRs, it’s one of the most popular outpatient systems and has a really robust API with minimal fees that allows for manipulation of all the standard data, as well as many Athena-specific concepts.
  • DrChrono — Cloud-based and mobile-friendly, it has strong open APIs. I’ve heard of several groups stripping this down to its chassis and treating it as close to a headless EHR as any. However, you tend to max out and hit a wall sooner than Athena in terms of what you can do.
  • Elation Heath — Elation is used fairly frequently and I’ve heard good things consistently. Aimed at small practices, they have their API docs in clean ReadMe format with all the main elements (clinical data, scheduling/admin, and master data) and some goodies like webhooks. However, like DrChrono, there’s some implicit endpoint to what you can do.
  • Carecloud — Similar to Elation, It’s a simple outpatient EHR with a nice clean modern API. A lot of those API calls are unidirectional, though. You, again, meet your now good friend, the wall.
  • Azalea Health — Several groups asking about what EHR to buy brought up Azalea, who I don’t run into often. FHIR-based API that seems on paper pretty robust.
  • Kareo — Most groups using Kareo are looking to switch, as their API support is quite limited and fairly ratchet (sorry for the technical terminology). I think they might be inexpensive.

Continue to Build

  • Multi-factor authentication
  • Standard API for patient and population groupings
  • Transitions of care
  • Clinical information reconciliation and incorporation
  • E-prescribing
  • Send and receive a summary of care
  • CDA creation
  • View, download, and transmit to 3rd party
  • Clinical quality measures (CQMs)
  • Transmission to public health agencies — cases, labs, vaccinations, cancer registries, and more
  • Direct Messaging
  • Clinical Decision Support
  • EHI Export

A hopeful future

Common Functions Commoditization

A Headless EHR Rises

Digital Health Dogfood




Healthcare integration and interoperability advocate. Language learner. Fierce and unrelenting friend of dogs.

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Brendan Keeler

Brendan Keeler

Healthcare integration and interoperability advocate. Language learner. Fierce and unrelenting friend of dogs.

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