Reflections on EHRA, Past and Future

By Mark Segal, PhD, FHIMSS

Mark Segal Morocco

Mark Segal welcomed ‘retirement’ by exploring Morocco with his son.

Late in 2017, I left GE Healthcare via an early “retirement” opportunity. Retirement is in quotes but that is a story for another day; suffice it to say that I intend to remain active in the digital health policy world.

One of the biggest changes with my departure from GE is that I also left the EHRA Executive Committee, on which I had served in both elected and ex officio capacity for years. This was a double whammy of many fewer conference calls per day.

My involvement with EHRA, wearing many hats, has been one of the most important and satisfying aspects of my professional life.

Starting in the summer of 2008, just before HITECH/Meaningful Use burst on the scene, when my role at GE shifted to policy and industry relations, I found that one could very easily become actively engaged in the Association, which had and still has a culture that is flexible and open and not biased to only listen to the “old timers.” Active engagement required just two things, being active and being engaged; in other words, show up and speak up.

Why did I choose to work with EHRA and why did I stay involved? At the most basic level, I got involved because it was my “job.”  But I stayed involved because it provided personal and professional satisfaction, helped me do my job better and gave my company an outstanding return on the investment of my time.

In my work (and play) with EHRA, I made what I expect to be life-long friendships and had opportunities to learn from competitors, consistent with the Association’s role as a trade association. (EHRA has very effective guardrails that enable competitors to learn from each other while entirely avoiding topics that cannot be discussed in a trade association setting.) I learned how one can compete at one level but cooperate at another for the good of the industry.

I had so many opportunities, as a leader and as a member. Among the most notable were the privilege to interact with federal government officials at the very highest level, in calls, meetings at HIMSS, and at federal agencies. These meetings provided opportunities first and foremost to listen, to get to know our government counterparts and where they were coming from, and to better understand their goals and objectives. It also provided an opportunity to provide a developer perspective that could lead to policies that reflected the concerns and experience of our companies and our provider customers.

The last nine years have been a period of tremendous change for the EHR/HIT industry and for EHRA.  Government programs, especially Meaningful Use, MIPS, 21st Century Cures, HIT safety, ONC certification, and the push for more interoperability have dominated our time and attention since 2008.  In many ways, both the EHRA and industry structure were transformed by these policies and priorities.

As I look ahead, I think we are entering a new period likely to be defined by positive and negative lessons from the past decade.  There is a better appreciation for how regulation can help drive technology use and how it can also hinder innovation, flexibility, and usability/user satisfaction.

New technologies and development approaches are likely to transform the EHR industry and the definition and roles of EHRs. These technologies are influenced by and are influencing government policy and regulation but, at the end of the day, I tend to think that technology “eats” policy, to borrow from a familiar cliché.

Increasingly modular software, the ubiquity and acceptance of cloud solutions, the rapid adoption of HL7 FHIR®-based APIs (for both “internal” and “external” use), agile development, new health information exchange models that are not geography-based, the recognition that the art and science of user experience are critical to good software, and the (re)emergence of AI and machine learning will transform our world, our customers and our products and I expect, the EHRA as well.

I’m looking forward to the ride. I hope you are as well.


Mark Segal is Principal of Digital Health Policy Advisors, LLC, a digital health policy consultancy, and former Chair and Vice Chair of EHRA. Follow him on Twitter @msegal111 and LinkedIn at He can be reached at


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