Though doctors likely don’t consider their EHR a cutting-edge technology, the EHR space is actually a front line for change and innovation in healthcare. And that change is happening on a number of different axes: interoperability and open standards, personal health records, and the move into public cloud infrastructure are some of the biggest change narratives.

Microsoft, which provides technology to power many of the major EHR vendors, has a dog in each of those fights, and Microsoft Chief Medical Officer Simon Kos will be one of a handful of presenters on a Health 2.0 panel called “EMR Evolution: How the Big Players are Changing the Game,” along with representatives from Google Cloud, Cerner, and Allscripts.

“As we’ve come to the era of the cloud, it’s created a really interesting dynamic,” Kos told MobiHealthNews. “When you saw once upon a time the [EHR] providers being producers of software, in more recent times they’ve become remote hosting organizations on behalf of their customers. … So we’re having discussions with those large providers. Do you see yourself for a long time in remote hosting for managed service delivery, or would you instead like to leverage a public cloud infrastructure, do the same sort of thing, but have someone else in charge of building out and running the data centers?”

Microsoft is also keeping a close eye on the strides being made in interoperability standards, even bringing on some very high-profile hires like Verily’s Josh Mandel.

“The reason the appointment of Josh is so interesting and so important for us is his foundational work in developing the FHIR standard and also one of their projects, which is how do we make the cloud health-ready from a compliance perspective, from an interoperability perspective, from a functional perspective,” Kos said. “Josh in the research group is working really closely with engineering and our commercial group to bring us from this fragmented, on-premise data silo to [using] the cloud as a strategic enabler of how health information flows. How do we bring that together in an interoperable sense? How do we make that easy?”

As EHR vendors move into the cloud and find ways to get closer to interoperability through APIs, app stores, and third-party integrations, they’re also grappling with the reality that their data sets are becoming a more viable value proposition than their operational tools.

“Now as information starts to get aggregated at scale, and some of them have more than a half a million patient lives in those records, what does it mean to start to use all that data intelligently?” Kos asked. “So, how do we use artificial intelligence as an asset to not just digitize what we do, but give something back in terms of equality, efficiency, and safety?”

Finally, the idea of a personal health record has seen a resurgence lately thanks to Apple’s efforts with Apple Health Records. Kos is skeptical, and with good reason — Microsoft’s own entrée into that space, Microsoft HealthVault, is generally regarded as a failure.

“In retrospect, we created a product that asked patients to do a lot of work and manage a lot of their own information. And the response was that that sort of overhead doesn’t have broad-based mass appeal,” Kos said.

He thinks the most likely path forward is more targeted tools.

“We now think that when you look at all the patients in the world, 60 percent are well enough that they don’t need a [personal health record] to manage. Maybe there’s another 15 percent that are so acutely unwell or mentally incapacitated that they don’t get value from self managing. So rather than trying to provide a personal health record for all, the strategy increasingly looks like targeting the chronic disease population where a degree of active self-management will result in better outcomes. That’s probably the right market for [personal health records] and to deliver value, and there you’ve got to be specific about the chronic diseases you’re tackling, whether that’s diabetes or cardiovascular disease or renal medicine.”

In addition to talking about the evolution of EHRs at Health 2.0, Kos will also present on a panel on natural user interfaces in healthcare, where he’ll discuss healthcare use cases of the Microsoft HoloLens.

“I’ll be talking a little bit about how that’s changing how we educate medical professionals, how we train up our existing doctors and nurses to perform procedures, how it’s being used in surgery to plan procedures and also to execute surgery, and even for follow up at home with telehealth scenarios,” he said.

“EMR Evolution: How the Big Players are Changing the Game” will happen on the main stage at 3:30 p.m. on September 18th.