Healthcare organizations are increasingly choosing electronic health records systems from among a handful of leading HIT vendors. Depending on how you measure penetration, among the leaders are Epic, Cerner and Allscripts.

While the market is being dominated by major vendors now, Eric Topol, MD, recently said he anticipates radical change ahead. “I don’t see Epic, Allscripts or Cerner in existence in another decade,” Topol contends.

Joel Selanikio, MD, sees the rationale for Topol’s prediction. As healthcare morphs from an emphasis on institutional care to empowering consumers to become active participants in maintaining their health, current vendors need to change or risk irrelevance.

Selanikio, a practicing pediatrician and a former epidemiologist for the Centers for Disease Control, suggests that EHRs could possibly follow the evolution of other types of technology that have been changed in the lifetime of CIOs.

Addressing those top IT executives at the February 19 CIO Forum of the College of Healthcare Information Management Executive in Orlando, he highlighted the example of Nokia, which rolled out the E61 phone in 2006 to rave reviews and with designs to capture the business cell phone market from Blackberry. That year, Nokia reported $75 billion in revenue, the highest it had ever achieved, said Selanikio, who’s currently CEO of Magpi, which provides applications for mobile data collection.

Joel Selanikio, MD

That was the high-water for Nokia, as revenues shrunk from then on—eventually, the company was sold to Microsoft for only $7 billion, a fraction of its 2006 revenues.

The iPhone emerged in 2007, and that changed the cell phone market forever, Selanikio says. “There was a consumer mobile market back in 2006, but it was pretty small,” he says. “Apple realized that the consumer mobile market was going to be able to grow a lot faster. The things that consumers wanted to do on their devices were not what Blackberry and Palm were trying to do.”

Apple eventually circled back in 2011 to develop a line of service for business users, but only after transforming, and building a substantial lead in the consumer phone market.

“What we’re looking at here is a large company invading the market by looking at a piece of the market that the big boys weren’t interested in,” Selanikio says.

The competition in healthcare today is that the market for selling healthcare IT to consumers is a small spot in the market, but consumers’ focus on health and IT is growing rapidly. For example, the Apple Watch is “fascinating,” he says, “because it is regarded as a failure. Apple has revenue of about $10 billion a year from the Apple Watch, about the total made by large EHR companies.”

The Apple Watch and other consumer electronic devices are starting to provide more capabilities that consumers want, and bring together information, such as health administration and helping consumers track progress in achieving health goals.

Also See: ‘Medicalized’ smartphones to put health data in hands of patients

“What’s most interesting is that they are pulling stuff out of the healthcare system,” Selanikio says. “Things that used to happen in the doctor’s office or physical therapists’ office are now being provided outside the traditional healthcare system. Consumers can diagnose their own problems, with devices that use artificial intelligence, and prescribe a treatment for themselves. Artificial intelligence is the turbocharger for this new growth.”

Technology will be able to provide better health with less healthcare, and the consumer market will grow. The interest of large technology companies, such as Apple, Google and Amazon, will be piqued at that point, he predicts. “$10 billion isn’t enough to get Apple interested in going into a market that is so fraught with regulation,” he says. “But outside the healthcare system, there’s a much larger amount being spent on health. It can follow a very simple pattern—the large tech companies will focus on low end parts of HIT that incumbents don’t worry about, but have huge potential. Then, they’ll make a lot of money on that and then put it into taking the high end of the market.”

Selanikio says his feelings about Topol’s prediction isn’t intended to induce gloom. “What we’re talking about is a better way to maintain and improve our health,” he says. “It’s a real opportunity to meet needs that consumers will want.”

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