Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.
Mass General Brigham, Boston, MA, United States.
J Med Internet Res. 2020 Dec 11;22(12):e24824. doi: 10.2196/24824.
The 21st Century Cures Act and the recently published "final rule" define standardized methods for obtaining electronic copies of electronic health record (EHR) data through application programming interfaces. The rule is meant to create an ecosystem of reusable, substitutable apps that can be built once but run at any hospital system "without special effort." Yet, despite numerous provisions around information blocking in the final rule, there is concern that the business practices that govern EHR vendors and health care organizations in the United States could still stifle innovation. We describe potential app ecosystems that may form. We caution that misaligned incentives may result in anticompetitive behavior and purposefully limited functionality. Closed proprietary ecosystems may result, limiting the value derived from interoperability. The 21st Century Cures Act and final rule are an exciting step in the direction of improved interoperability. However, realizing the vision of a truly interoperable app ecosystem is not predetermined.
《21 世纪治愈法案》及最近发布的“最终规则”定义了通过应用程序编程接口获取电子健康记录 (EHR) 数据的电子副本的标准化方法。该规则旨在创建一个可重复使用、可替代的应用程序生态系统，这些应用程序可以在一次构建后在任何医院系统中运行，“无需特殊努力”。然而，尽管最终规则中包含了许多关于信息阻塞的规定，但人们仍担心，管理美国电子病历供应商和医疗机构的商业惯例仍可能扼杀创新。我们描述了可能形成的潜在应用程序生态系统。我们警告说，利益不一致可能导致反竞争行为和故意限制功能。封闭的专有生态系统可能会导致，限制从互操作性中获得的价值。《21 世纪治愈法案》和最终规则是朝着提高互操作性迈出的令人兴奋的一步。然而，实现真正互操作的应用程序生态系统的愿景并非是预先确定的。
