Health information technology professionals charged with selecting, implementing, updating, and paying for health IT in hospital and care delivery settings are essentially the first-line “consumers” of health IT – specifically, electronic health records.

But these health IT leaders feel far from empowered and choiceful as consumers in todays EHR vendor “monoculture,” Harm Scherpbier, MD, explains in his book, Unvendor.

 

 

 

 

 

 

 

 

 

I spent time with Harm to discuss the book, its backstory, and what he hopes to accomplish by raising the issue of single-vendor health IT and how clinicians, health IT staff, and patients could all benefit as consumers of health information in a multi-vendor world.

First, I asked Harm about the origin story for Unvendor: I note that Harm has worn many professional hats in health care in his career, including those of a physician, a chief medical information officer, a healthcare informaticist, and a software developer. With this background, how did the idea for authoring the book gel?

“I’ve worked in the health IT industry for many years, recently on the provider side as Chief Medical Information Officer (CMIO) of a large health system. I used to tout the benefits of single-vendor architecture, how it has made sense to have a single vendor making it easier to integrate data systems, and I understand how we got to the reality of health IT monoculture.

“I also started to see the downsides of doing this. First, those downsides are getting bigger – the lack of innovation in a health care operational world where our reimbursement models and care models are changing, but the EHR structure does not change. We need innovation and the ability to be flexible and keep up with changes in our models and the market, which is limited by the single vendor mindset.

“Second, consider user experience. If you speak with users in a health system that purchases a very expensive health record, you expect those users to be productive and given the level of investment, even enchanted with the experience. But in fact, that has not been case and users haven’t been given the same experience as they have found in other aspects of their lives.

“Third, the cost of health IT: it is extremely expensive and doesn’t need to consume that level of budget,” Harm believes.

Given those three factors that brought Harm to the realization that it was a single-vendor mindset hampering innovation, experience, and high cost, I asked him how he got to creating a new verb in our health care parlance: “to unvendor?”

“This can be misunderstood,” Harm cautioned. “My meaning and intention are to get out of the single vendor mindset. I’m not against vendors — some of our top vendors are fantastic. So I’m not anti-vendor. ‘Unvendor‘ means being anti-single vendor in favor of creating a more diverse health IT stack that uses the EHR as a core or platform with many applications interchangeable on top of the platform – changeable over time as conditions, business models, and technology evolve,” he explained.

Given that Harm recently participated in the annual 2025 HIMSS conference, I was keen to know how his collegial physicians and health IT professionals were reacting to the idea of “unvendoring.”

 

 

 

 

“At HIMSS, I hosted a panel discussing robotic process automation,” Harm shared. “RPA is a great example of health technology in the unvendor environment. It is not yet something you would find in a typical EHR, although some of the largest firms might say it’s part of their future roadmap. [JSK note: more on the word “roadmap” later in this post].

“RPA can now be used for administrative and financial applications – say, for billing, denials, registrations. Deploying RPA for these workflows conserves labor intense steps that RPA can do via bots or AI powered agents (i.e., agentic AI), learn from humans and mimic the human users in these workflows to take on repetitive tasks. This is a great example of the power of un-vendoring,” Harm asserts.

RPA is but one of many examples Harm pointed to: one of the areas that strongly resonated with me was population health, which is not easily managed through the single-vendor EHR. While these high-cost investments might have a pop health module, these don’t work as effectively, or comprehensively as dedicated pop health systems created for that purpose do. “I don’t think this is necessarily an either/or scenario,” Harm told me. “The buyer can keep a single vendor for core business functions and start adding applications that do a better job for specific business and clinical objectives,” he explained.

I asked Harm about those buyers, the demand-side of health IT systems whom I consider to be the first-line “consumer” of health IT as the purchaser, shopping among available choices in the EHR space. My question to Harm: “What would you like to see happen among the health IT buyers once they open up to the Unvendor concept?”

Harm responded that these health IT professionals should ask more from their single-source vendor such as demanding interoperability that is user-experience grade. This could translate into the health IT customer demanding the use of standards such as FHIR, to enable greater interoperability and “appification” of the EHR (my word).“This is one of my book’s messages,” Harm said. “We have to start using these standards like FHIR, which part of our evolving toward more open, flexible systems. Don’t necessarily expect your (single) vendors to do this – they are well suited to staying single vendor. But ‘you’ need to open the door yourself,” Harm encourages health IT buyers. “Get FHIR, hire people who know interoperability, and make the investment on the health IT leadership side.”

We couldn’t spend an hour chatting about Unvendor without addressing AI, which of course was another hot topic at HIMSS 2025. “As I was writing the book,” Harm told me, “AI was taking hold especially in ambient scribing and as an enabler of interoperability.”

 

 

 

 

 

 

 

 

One company with which Harm is familiar in Tennr, which takes faxes as input and leveraging AI, the system detects what is missing from the fax (say, a referral) and automate the workflow, versus a human having to look at an eFax and re-enter a transaction into the (single-vendor) EHR system.

“The Tennr/AI solution helps to make that data on the fax consumable and actionable through interoperability,” Harm said, joking that, “we thought faxes were supposed to go extinct, but there is something powerful here.” I added that indeed, behavior change is hard and fax machines still proliferate health care delivery settings from hospital labs and admissions to doctor’s offices.

I followed up my question about what behavior changes Harm would like to see when his health IT buyer colleagues might lean into Unvendor. He responded, “If I am a CIO or CMIO and I have annual meeting with my big EMR vendor, they will use the word ‘roadmap’ – that is, “we’re thinking about this, but we can’t yet offer this to you.’ I want that word ‘roadmap’ to be a trigger word,” Harm asserted.

“’Roadmap’ means the vendor doesn’t have it, we realize you may need it, we’ve heard about this, but we are stalling and freezing the market,” as Harm read the script he’s heard over his many years in such negotiating conversations. “We are asking you to not go somewhere else,” Harm coined that script. “It’s always, ‘just wait 18 months.’ That word ‘roadmap’ should be a trigger. For me, it got to the point where if a vendor said ‘roadmap,’ I would go outside to a third party vendor,” Harm shared.

By going to a third party and taking on a managed risk, say signing a short-term contract for a specific application and function, it helps a health system become more competitive, get early experience with new technology, and grow staff expertise.

That was the demand side covered, so I turned to the supply side of technology innovators – the start-ups and leaner organizations who offer those third-party solutions. Harm found resonance in the start-up and smaller-vendor community in his recent discussions about Unvendor because these folks have found doors shut on them in the single vendor environment.

“When I was CMIO for a large health system, I might have argued against the Unvendor approach. Now it’s time to re-think that and to take a calculated, strategic risk – not just to buy ‘something,’” Harm explained, ‘but go back to the beginning, align your payment model, your care model, and technology model.”

In other words, the payment and reimbursement model(s) drive the care, and the care drives the technology, in Harm’s Unvendor Holy Grail vision.

Health Populi’s Hot Points: As a health economist, a major concern for me in looking at a very uncertain payment/reimbursement and health policy future is sustainability of health systems, providers and clinicians, and patients’ ability to cover the costs of their medical care.

With the cost of a new EHR system running $200 million or more, we can simply agree that these are extremely expensive purchases, and that cost-model is unsustainable for the vast majority of U.S. health care providers operating on slim margins.

By un-vendoring and moving toward a diverse set of open, interoperable solutions, health IT purchasers have the opportunity to allocate scarce capital resources to optimal architectures that deliver for their specific payment/reimbursement situations and clinical care processes relevant to their patient populations.

As Eve Cunningham, MD, MBA, Chief Medical Officer at Cadence, writes in the introductory section of Unvendor,

“Relying on a single vendor for all clinical healthcare IT needs is not only unsustainable but also breeds monopolistic inefficiency. True innovation cannot be monopolized: it demands a diverse, adaptable approach to meet the challenges of tomorrow and deliver the exceptional care our communities deserve.”

The book Unvendor is now available to pre-order at your favorite book sites, with a publication date of April 29, 2025.