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The big battle: Best of breed vs One stop shop

The world of economics has decided on this debate a long time ago: monopolies are bad, diversity is good. No matter what a monopoly promises, you can rest assure that over time the lack of competition will cause prices to go up and quality to go down.

When it comes to healthcare IT, however, there is one unique factor that flips the coin – interoperability. Despite various attempts the healthcare industry has yet to solve the interoperability challenge in a satisfactory manner which will enable a full continuum of care across different health information systems within a health delivery organization.
Taking a common scenario of prescribing a medication order in theatres using a surgical system to be later administered in a ward requires significant investment to achieve, even using the modern Fast Health Interoperability Resource (FHIR) protocol. The investment required to streamline the data flow across systems raise in an exponential order with every new system that is thrown to the mix. Very quickly the development and maintenance cost of a best-of-breed organization can spear out of control.

The benefits of a best-of-breed strategy are clear both in functional and financial terms but so are the obstacles: managing multiple vendor relationships, maintaining a workforce with organizational memory and technical skills. The interoperability challenge however makes the best-of-breed a viable alternative only for large and wealthy organizations with a "development shop" mentality.
One of the big benefits of a one-stop shop solution is ensuring seamless integration.
Smaller organizations are ,therefore, left to the mercy of the big monopolies, or worst, adopt what I call a bits & bites strategy, which means buy the best (or cheapest) product for every division without a coherent strategic approach, and not bother at all with interoperability.

In practice the situation is not dichotomic as I paint it and every organization is positioned somewhere on the best-of-breed – one-box spectrum.  Statistics provided by Digital Health Intelligence showed that the majority of acute NHS trusts in England ,for example, took a best of breed approach to IT, however it is safe to assume that none or poor integration exists between those systems.

The healthcare IT industry is paying a heavy price, literally, for the inability to solve the interoperability challenges, and awaits for new overarching interoperability model to emerge to disrupt the current status.


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