I have discussed the federated architecture for hospital EMRs in previous notes. I believe that the current hospital EMR architecture, adopted by virtually all vendors, will be eventually unable to accommodate to the increasingly complex information being generated in radiology, pathology, and the clinical labs. Under a federated architecture, these departments will be allocated their own space in hospital EMRs, allowing the content experts in them to populate it with the information that they generate and that they are the most skilled in formatting. This will avoid the current restrictions being placed on the diagnostic information being replicated to the EMRs.
I have little expectation that EMR vendors such as Cerner would adopt such a federated model for their EMR products because to do so would highlight the deficiencies of the current systems. In addition, I also think their underlying philosophy is that the ancillary systems, and the information that they generate, need to adapt to the constraints and rules of the EMR. Put another way, I think that these companies view the "ancillary" information systems as feeders of the higher level and integrated EMR. I personally view the LIS, the RIS, and the hospital EMR as peer systems.
Interestingly and in contrast, EMR vendors such as GE and Siemens have now unveiled a much different healthcare strategy and philosophy than Cerner. Both companies are now on record as pursuing what I will call a "diagnostic-centric" vision for healthcare delivery. Siemens refers to this approach as a full service diagnostic model and GE refers to it as an early health model. In the long run, neither company will benefit from developing and selling an EMR that places significant constraints on the major diagnostic information systems, the LIS and the RIS.
I think that it would be in the best interests of both of these companies to begin to develop an EMR based on a federated architecture. After several years in a development phase, such a system could be sold to those hospitals that place a high premium on the reporting of complex diagnostic information to their clinicians. If they truly believe that the "center of gravity" in healthcare delivery is moving toward the major diagnostic departments (i.e., pathology, clinical pathology, and radiology), their EMR philosophy and architecture should be modified to reinforce this business model.