Convention or Configuration in Healthcare?

This post originally appeared on HIStalk

One of the classical debates in computer science is convention versus configuration. This debate manifests in programming language design, product design, marketing, what hardware and software can and cannot do, and how they do it.

In the early eras of computing, configuration reigned supreme. The first computers had no security, no encryption, no rules, and very little if any software infrastructure to sit on top of. The early computers were in many ways a clean slate, akin to John Locke’s tabula rasa. Software and hardware were completely configurable. Before the Apple II, the only people who could acquire a personal computer were those who knew where to buy all of the components and how to assemble them. Assembly often times required soldering. Talk about high barriers to entry.

Apple has risen to become the world’s most profitable company because it embraces convention and eschews configuration wherever possible. Apple pioneered the first personal computer hardware that people couldn’t physically open or configure. Just as importantly, Apple makes software design decisions for its customers so that they don’t have to. It turns out that people want computers that "just work." They don’t want to deal with hundreds of settings and options.

So how has healthcare IT faired in the continuous march towards convention in favor of configuration? It’s been a mixed bag.

In many ways, healthcare IT has always been very conventional. Follow the rules, fill in the boxes, and get paid per Uncle Sam’s protocol. If you deviate slightly, you don’t get paid. Vendors reflect their customers, who in turn reflect the reimbursement system.

In other ways, healthcare technology has become far more configurable. Many EHRs boast over 500 or even 1,000 templates to expedite data entry. There’s no need for that many templates, but their existence reflects the underlying reality that most doctors would in their ideal world document according their own standards.

Epic takes a lot of heat for not being configurable enough. Many say that’s not true. Most of Epic’s practices that limit configurability are probably made in light of the fact that hospital EHR vendors are service companies, not software companies. They know that once you open the Pandora’s box of customization, it never ends. Epic focuses on the proven (and extremely difficult) training and deployment process. Cerner accommodates more configurability but has a poorer deployment record.

Which way should healthcare IT trend? Should vendors make more decisions on behalf of their clients? Because of their access and insight at other organizations, vendors may be more qualified to many decisions given how crucial IT is to most clinical functions today. Or not. Leave a comment with your thoughts.