First, let me say I wholeheartedly applaud Microsoft's efforts on NHIN and with CHF. We have to start somewhere.

I represent the small software developer who is trying to develop and market a new front-end product for the healthcare market with some ideas that have been piloted in a few places. What has led me to despair in the past is understanding where and how to start to interface with other medical systems. I am looking for an entry point that is going to guarantee that if I adopt it, I will have an instant marketplace because it will give me a competitive advantage to be able to state that my product can access heath data in a standard way, on a standard highway.

This year, we are stepping up our efforts to deliver a tablet solution for the mobile clinical professional. This product is called Field Clinician. We are trying to decide whether or not to target large private practices, or home healthcare agencies (REALLY mobile clinicians).

We realize that a standardized EMR would benefit everyone. A very large hurdle for us is the domination of corporations like Cerner, McKesson and MISYS, which refuse to open up their back-office systems to vendors like us. These players seek to dominate the market by casting fear on their clients that a "complete" system is best for their clients. They offer their own front ends and mobile solutions.These systems contain a mix of information that is structured in a proprietary way such as visit scheduling information, etc., and medical records which should be in a standard format and schema and open to consumption and contribution, but are not. I realize that their "published" services on the NHIN would cost someone like me if I subscribed. So, it's not like I want to hang off this information network at no cost.

My concern is, why would these big players be any more receptive to opening up their systems by assumedly conforming to an open interface architecture? Wouldn't they see this as a threat to their domination of markets? Will the government be mandating, or just prodding them to participate?

You put your finger where it hurts the most :-)

But there is hope...

Here are a few things to consider:

• The big players of today might not be the big players of tomorrow. They know that and you cannot win a market by holding information hostage. This is true not just for health, see what happened to Office file formats :-)
• Customers are demanding for more and more interoperable systems. Data and information needs to flow seamlessly across the continuum of care to enable better outcomes and business results. As an example see what is happening in the US with CCHIT, the certification authority for health IT: today they are testing functional specification but moving into the area of interoperability and support for select scenarios (the ones selected by AHIC and detailed by HITSP).
• Standards are (somehow) maturing in this area. Although we still have long ways to go, we are seeing a more concerted approach to information sharing based on use case scenarios rather than mere point to point interaction
• Moving towards SOA and more "composable systems". The whole software+services is not just a fad. Identity management services that today are local to your application or limited to the enterprise could tomorrow be a service in the cloud. That can easily be extended to terminology services, clinical guidelines and pathways, storage and so on. Who gets this in an industry that is 10 years behind in technology adoption?

Don't give up :-) if customers see value in what you're providing they will ask their vendors to open up. The pressure is building up and the market is ripe for change.