CHARTSaaS RA-compliant Solution Can Mitigate Risk of EHR Demise

“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.”

The foregoing excerpt from the Health Data Management February 20, 2017, article by Fred Bazzoli entitled “EHRs, and companies that make them, are at risk for disruptive change” ( states an inevitable truth for the long run; but EHRs will be necessary for the foreseeable future because of the necessary “system of record” functionality that they and associated on-premise connectivity implement for healthcare provider organizations.

Having managed hospital implementation of three EHRs, I can attest authoritatively that the capital cost,  administrative and technical complexity, regulatory compliance effort and corporate culture shock endured to implement an EHR are non-trivial; and therefore that the implementing healthcare delivery organization should fully capitalize, literally and figuratively, on the benefits thereby accrued. However, the typical on-premise EHR client-server information technology (IT) platform care-and-feeding requirements, together with the typical keyboard data entry and request-and-response paradigms for functional requirement implementation, impede accomplishment of the pressing needs to mitigate medical mistakes (now the third leading cause of patient deaths, re BMJ 03 May 2016; 353 doi: and to migrate from volume-based to value-based care in a manner that facilitates medical knowledge accrual and optimizes case outcomes.

The solution to this problem is not to rip-and-replace the installed EHR but, rather, to leverage its hard-won connectivity and functionality by with a wrap-and-reuse approach. A cloud-based intelligent business process management suite conforming to the Cloud Healthcare Appliance Real-Time Solution as a Service (CHARTSaaS) reference architecture can implement such an approach by enabling healthcare provider subject matter experts to design, develop and deploy IT applications a.k.a. “apps” with minimal cost and complexity (i.e. — minimal IT staff support and no addition to installed IT systems). Such apps can provide the cognitive support (cognitive overload being arguably the root cause of medical mistakes) needed for cost-effective medical practice and healthcare delivery positive transformation with their included capabilities that can be implemented using a low-/no-code integrated development environment for continuous/real-time operation:

  • complex event monitoring using both parameter value and time specification,
  • similarity/Bayesian and predictive analytics,
  • rule-based/Boolean decision support,
  • state-managed/long-running process execution with system and staff choreography,
  • accessibility via any/all client system form factors (e.g. — desktop, tablet, phone),
  • connectivity to user/on-premise systems/applications and Web-accessible apps.

Please validate this proposition to your own satisfaction by reviewing the details of CHARTSaaS and the CHARTSaaS RA in these presentations, and then by imagining a CHARTSaaS-enabled IT solution:

Healthcare providers and their patients will benefit significantly from appreciating and then applying a CHARTSaaS RA-compliant IT solution. To do so will mitigate medical mistakes (currently the  third leading cause of patient deaths, per Makaray and Daniel,, thereby minimizing  patient adverse events; and also will optimize clinical case outcomes while maximizing the cost-effectiveness of care and treatment and accelerating the accrual of medical knowledge.

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