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The exact definition of EHR (Electronic Healthcare Journal) isn’t clear in healthcare. Some talk about a narrow EHR solution platform, while other identifies it as a platform with several wider capabilities. One could argue, that the definition tends to rely on the overall strategy of the healthcare provider – whether it is best of breed or best of suite.

One thing that hospital professionals and ICT vendors agree on is the need for basic capabilities within EHR. What is basic in that perspective is a little more divided. As a suggestion, EHR capabilities could be divided into a tier formation, where tier 1 is the essential capabilities and tier 3 is more tertiary.

When choosing a platform or best of suite strategy, the healthcare provider often acquires one platform that covers most capabilities in tier 1, 2 and 3. When choosing a best of breed strategy and solution, healthcare providers choose an EHR platform of a narrower focus with only tier 1 and maybe a few tier 2 capabilities. They acquire the rest of the capabilities from different vendors and combine the architecture through a service oriented architecture or even through microservices.

Source: IDC 2017

IDC Health insights follow the healthcare market in Western Europe and there seems to be a trend especially in the Nordics towards best of suite with all tier 1, 2 and 3 capabilities from the same vendor in an integrated platform solution architecture. The fragmented healthcare market consolidates the coming years and vendors like EPIC (US) and Cerner (US) are more aggressive in their marketing and is teaming up with local system integrators like NNIT (DK) and CGI. When a wider platform vendor steps in local-based vendors with legacy applications will be decommissioned like in Helsinki (FIN) and capital region of Denmark (DK). The trend is interesting for several reasons.

Best of Suit versus best of breed

To leverage new technology like cloud, the healthcare organization should regard legacy management, application portfolio modernization and digital transformation as key strategic initiatives. But with a best of suite strategy, they might end up in vendor lock-in, with an obsolete platform, among bigger customers and with less agility. The platform might be designed originally on 2nd platform architecture with a few 3rd platform elements as add-ons. Healthcare providers with a best of suite strategy follow the roadmap of the platform, which sometimes is cheaper because more customers share the economic burden, but otherwise, is left to the majority to decide the direction.

If for example a hospital creates a cloud transition strategy and the suite/platform they have isn’t cloud based, the transition towards cloud cannot be done except on the few and often non-clinical applications. Another issue with the best of suite strategy is the transformation to a more integrated care focus. The best of suite platforms often is very hospital-centric, and cannot with great success transform their core architecture into a patient-centric model across the ecosystem.

On the other hand, a best of breed approach can have a high risk because the application architecture is more complex and the resources needed to embed or integrate various application can be high. Enterprise and solution architects are capabilities that will be increasingly important and ones that the healthcare provider might now have.  An application architecture based on a narrow EHR and a service orientated architecture with best of breed applications, also has the challenge of several data repositories across the enterprise. Data management and governance will be crucial areas that must solved before a successful SOA strategy can be implemented. Governance will be more complex, because the number of ICT vendors and contracts are higher compared to a best of suite.

Healthcare providers in Western Europe will prefer best of suite in the coming years. That might not be the best strategy for leveraging new technology and include digital transformation and 3rd platform technologies like cloud in the overall business strategy. On the other hand, it reduces risk and consolidates an often fragmented application landscape.

Other industries are moving to the 3rd platform faster than healthcare, enabling an agile environment and innovation accelerators like the internet of things with big data analytics and mobile capabilities – all from different vendors as an industry ecosystem. Healthcare isn’t the first mover on technology or that form of approach – maybe that will change someday.