Why does it seem like so many physicians have embraced the iPhone, but only 15 percent of them are using some form of electronic health record EHR technology? That's one of the questions that Dr. David Kibbe posed to the audience at Healthcare Unbound here in Seattle, Washington. 

Kibbe suggested a number of reasons for why physicians are adopting smartphones like the iPhone while shirking EHRs, but the most striking reason was accompanied by a drawing of Apple's basic UI: A screen with a button that said Push. On the following slide Kibbe showed what he called the typical EHR user interface design: A big mess of buttons and blinking boxes, including a blinking box that lights up when there's an error. Design and ease of use are crucial barriers to any new technology's adoption and Kibbe is wise to point out this simple but important point.  

Once EMR vendors begin to open up their APIs, the industry will begin to see thousands of new applications built on the EHR platform just like Apple's AppStore, Kibbe predicted. Those apps would include remote monitoring apps, he said. Kibbe also predicted that in the beginning a number of EMR platforms will emerge and some of them will come from outside of traditional healthcare incumbents, but the ones to succeed will be the ones that create clinical groupware that is interoperable, substitutable, low-cost and low risk.

The fact that 15 percent of physicians are using some form of EHR indicates that the other 85 percent don't want them. 

This situation is ripe for disruptive innovation, a term often misused and misunderstood, Kibbe explained. Clayton Christensen's theory of Disruptive Innovation actually begins with disruptive innovations or technologies that are actually "crummy" in the beginning. The key is that they are good enough, open enough and substitutable to the point where they overtake the incumbents' offerings, despite the obvious gap in quality.

We recently reported that Boston's Children's Hospital's Informatics Program published a group of principles to guide the creation of a new health information infrastructure for the U.S. The piece was a follow-up on an article published in The New England Journal of Medicine in March. The latest article argued for the development of a platform model, very much like Apple iPhone's setup, to encourage the development of "substitutable" health care applications.