Healthcare IT has long been dominated by large institutional players; these larger vendors had the capacity to withstand the long sales cycles and large up front development costs.  However, they have not had the same incentives to integrate and partner as smaller companies. Much to frustration of healthcare providers, this has resulted in fragmented systems that are not interconnected.

Thankfully, things are about to change, a new slew of digital health start ups supported by health accelerators like Healthbox, Startup Health and Rockhealth have begun to gain market traction. You learn quickly as a start-up that you need to “collaborate or die.”  . You can’t do everything, so work with the right people to create meaningful solutions to real problems. This is particularly relevant in the case of electronic health records communicating and interacting with decision support systems like ONCOassist.

Wouldn’t it be great if all of the ONCOassist’s calculations and prognostic algorithms were auto-populated providing instantaneous decision support information? A recent study by the West Institute estimated that software interoperability could save $30 billion annually.

In the long run interoperability seems like it makes sense to everyone; look at the success of the Apple and Android App Stores. This is an example of large company opening its doors to developers and entrepreneurs who create win-win situations. Customers get great niche products that add value to their existing platforms and both the developer and the hardware vendor share in the profits.

We haven’t seen this kind of success yet in digital health. Some of the newer electronic health records are beginning to open their platforms and invite integration. Examples of this include Medopad, Evolve and Dr. Chrono(who recently opened their API). Before the dream of interoperability can be realized there are numerous obstacles that need to be overcome, these include :


Apps vary in the dangers they pose to patients. The FDA and the EU stratify these into classification systems. The more danger your app poses the greater the overhead. This is a new space and regulatory agencies are just starting to get to grip with how to manage healthcare apps. Integration between apps and EHR is a whole other quagmire that needs to be managed. The FDA has recently announced that they will be issuing draft guidance on interoperability in the coming months.


Unlike the development of apps where you have 3 main players, Android, Windows and Apple, the electronic health record market is massively varied.  There are numerous EHR vendors; some are built using old technologies which makes them more difficult to access. This provides a huge challenge for even the most well resourced development teams.


Like everything in Healthcare a good business case is required before a customer will sign off on paying for the integration of an app with an existing system. Whereas the efficiency gains may seem obvious to us, they may not to be so obvious to the CFO of a large healthcare institution. Also, agreements must be made between the electronic health record provider and the app developer. Both parties must be incentivised correctly.

Although a hospital where all software systems speak to each other is inevitable, as a developer of a fully compliant medical app we see a number of challenges that must be overcome, collaboration between entrepreneurs, providers and vendors (both big and small) over the coming years is critical in overcoming these obstacles and giving the providers access to the systems they deserve.

Are you a healthcare provider,EHR or entrepreneur? Want to work together? Contact us, we want to hear from you.