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Will Hospital EMR Prices Ever Fall?

Posted on May 9, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In most industries, prices fall as supply rises. Basic economics, right? Well, if that’s true, will the price of EMRs fall as the industry matures?  A recent discussion on LinkedIn demonstrates – as you might expect – that there’s a lot of room for debate on the topic.

Davíð Þórisson, an emergency physician at Landspitali University Hospital in Iceland, kicked things off with this question:

Now that the major workflow has been designed in all major EHR systems available it would seem the biggest part of the hospital needs are addressed. Competition should increase as more vendors catch on… prices surely must go down from here?

Nelson Wong, a senior consultant with Fuji Xerox, responded that price increases are all but inevitable when EMR vendors compete with proprietary technology:

The only way out is a vendor neutral EHR providers to integrate all systems with international standard like HL7.

Zac Whitewood-Moores, a clinical data standards specialist who’s helping to implement SNOMED CT in systems across the NHS in England, noted that EMR vendors currently have little incentive to switch to a cheaper, less-customized EMR model:

Vendors appear reluctant to share work from previous deployments and part of this has to be that the commercial model is built on consultancy, not just licensing of the IT product itself.

But Whitewood-Moores also holds out hope that true data interoperability could do the trick:

When there is more use of SNOMED CT and common interoperability models forced by purchasing goverments/health providers…this may bring down costs if customers are not locked in by their data and the costs of migrating large amounts of it.

And Ryan Pena, social media manager at MentorMate and MobCon, argued that innovation might yet reduce health data management costs:

I think the key with EHRs is to ensure the industry continues to innovate on how information is captured. Perhaps secure automation will drive down this cost as we learn ways to transfer health data from medical grade wearables?

On the other hand, other people who commented felt that even some kind of open source reference EMR wouldn’t do the trick. John Shepard, president and co-founder of HIT software vendor Shepard Health, points out that there’s actually surprisingly little pressure on vendors to lower prices, in part because the market is still evolving:

The cost of EHRs has already gone down but also up. For example, you can buy an EHR out of the box at Costco or utilize one of the open source EHRs for free. However, to get a supported enterprise-level EHR (Epic, McKesson, etc.) then the price is very high and I don’t think it will come down anytime soon…[After all,] the cost of the EHR is not preventing sales because there is minimal change in demand based on increase in cost.

Meanwhile Pim Volkert, terminologies coordinator for Nicitz, the National IT Institute for Healthcare in the Netherlands, shared an interesting view of the future. He seems to suggest that paying more for EMRs may actually be justified as they grow more sophisticated:

EHRs will move more and more into the clinical domains. [They] will become a medical device just like an MRI or DaVinci robot. Development, testing of software and liability insurance fees will increase costs.

Obviously, there’s no way to predict exactly where EMR prices will go, but I’m more on the side of the posters suggesting that enterprise EMRs have nowhere to go but up. I hope I’m wrong!

Mayo Clinic’s Shift To Epic Eats Up Most of IT Budget

Posted on May 6, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Mayo Clinic has announced that it will spend about $1 billion to complete its migration from Cerner and GE to Epic. While Mayo hasn’t disclosed they’re spending on software, industry watchers are estimating the agreement will cost hundreds of millions of dollars, with the rest of the $1 billion seemingly going to integration and development costs.

The Clinic said in 2014 that it would invest $1.5 billion in IT infrastructure over multiple years, according to the Minneapolis/St. Paul Business Journal. Then last year, it announced that it would replace Cerner and GE systems with an Epic EMR. Now, its execs say that it will spend more than $1 billion on the transition over five years.

Given what other health system spend on Epic installations, the $1 billion estimate sounds sadly realistic. Facing up to these costs is certainly smarter than lowballing its budget. Nobody wants to be in the position New York City-based Health and Hospitals Corp. has gotten into. The municipal system’s original $302 million budget expanded to $764 million just a couple of years into its Epic install, and overall expenses could hit $1.4 billion.

On the other hand, the shift to Epic is eating up two thirds of the Mayo’s $1.5 billion IT allowance for the next few years. And that’s a pretty considerable risk. After all, the Clinic must have spent a great deal on its Cerner and GE contracts. While the prior investments weren’t entirely sunk costs, as existing systems must have collected a fair amount of data and had some impact on patient care, neither product could have come cheaply.

Given that the Epic deal seems poised to suck the IT budget dry, I find myself wondering what Mayo is giving up:

  • Many health systems have put off investing in up-to-date revenue cycle management solutions, largely to focus on Meaningful Use compliance and ICD-10 preparation. Will Mayo be forced to limp along with a substandard solution?
  • Big data analytics and population health tech will be critical to surviving in ACOs and value-based payment schemes. Will the Epic deal block Mayo from investing?
  • Digital health innovation will become a central focus for health systems in the near future. Will Mayo’s focus on the EMR transition rob it of the resources to compete in this realm?

To be fair, Mayo’s Epic investment obviously wasn’t made in a vacuum. With the EMR vendor capturing a huge share of the hospital EMR market, its IT leaders and C-suite execs clearly had many colleagues with whom they could discuss the system’s performance and potential benefits.

But I’m still left wondering whether any single software solution, provided by a single vendor, offers such benefits that it’s worth starving other important projects to adopt it. I guess that’s not just the argument against Epic, but against the massive investment required to buy any enterprise EMR. But given the extreme commitment required to adopt Epic, this becomes a life-and-death decision for the Mayo, which already saw a drop in earnings last year.

Ultimately, there’s no getting past that enterprise EMR buys may be necessary. But if your Epic investment pretty much ties up your cash, let’s hope something better doesn’t come along anytime soon. That will be one serious case of buyer’s regret.

NYC Epic Rollout Faces Patient Safety Questions

Posted on March 30, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In the summer of last year, we laid out for you the story of how a municipal hospital system’s Epic EMR installation had gone dramatically south since its inception. We told you how the New York City-based Health and Hospitals Corp. was struggling to cope with problems arising from its attempt to implement Epic at its 11 hospitals, four long-term care facilities, six diagnostic treatment centers and more than 70 community-based clinics.

At the time of last writing, the project budget had exploded upward from $302 million to $764 million, and the public chain’s CTO, CIO, CIO interim deputy and project head of training had been given the axe. In the unlikely event that you thought things would settle down at that point, we bring you news of further strife and bloodshed.

Apparently, a senior clinical information officer with the chain’s Elmhurst and Queens Hospital Centers has now made allegations that the way the Epic install was proceeding might pose danger to patients. A New York Post article reports that in a letter to colleagues, outgoing HHC official Charles Perry, M.D. compared the EMR implementation process to the 1986 Challenger space shuttle disaster.

In his letter, Dr. Perry apparently argued that the project must be delayed. According to the Post, he quoted from a presidential panel report on the disaster: “[For] a successful technology, reality must take precedence over public relations, for nature cannot be fooled.” Another Post article cited anonymous “insider” sources claiming that the system will crash, as the implementation is being rushed, and that the situation could lead to patient harm.

For its part, HHC has minimized the issue. A spokesperson told FierceHealthIT that Perry was associate executive director of the Elmhurst hospital and liason to the Queens Epic project, rather than being CMIO as identified by the Post. (Further intrigue?) Also, the spokesperson told FHIT that “if a patient safety issue is identified, the project will stop until it is addressed.”

Of course, the only people who truly know what’s happening with the HHC Epic implementation are not willing to go public with their allegations, so I’d argue that were obligated to take Perry’s statements with at least a grain of salt. In fact, I’d suggest that most large commercial Epic installations (and other large EHR implementations for that matter) got the scrutiny this public hospital system gets, they’d probably look pretty bad too.

On the other hand, it’s fair to say that HHC seems to crammed enough scandal into the first few years of its Epic rollout for the entire 15-year project. For the sake of the millions of people HHC serves, let’s hope that either there is not much to these critiques — or that HHC slows down enough to do the project justice.

Hospital EMR Buyer Loyalty May Be Shaky

Posted on February 22, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

When it comes to investing in enterprise software, just about any deal can turn sour. If you’re acquiring a mission-critical platform, there’s an even bigger risk involved, and the consequences of failure are typically dire. So any company making such a purchase may feel trapped after the contract is signed and the die has been cast.

One might hope that when hospital and health systems buy an EMR — probably the most expensive and critical software buy they’ll make in a decade — that they feel comfortable with their vendor. Ideally, hospitals should be prepared to switch vendors if they feel the need.

In reality, however, it looks like many hospitals and health systems feel they’re trapped in their relationship with their EMR vendor. A new study by research firm Black Book has concluded that about a solid subset of hospitals feel trapped in their relationship with their EMR vendor. (Given what I hear at professional gatherings, I’m betting that’s on the low side, as their EMR has driven so many hospitals deep into debt.)

Anyway, Black Book compiles an HIT Loyalty Index which assesses the stability of vendors’ customer base and measures those customers’ loyalty. For its current batch of stats, Black Book drew on 2,077 hospital users, asking about their intentions to renew current contracts, recommend their inpatient EMR/HIT vendor to peers and the likelihood of their buying additional products like HIE and RCM tools from their existing vendors.

The results shouldn’t give any great pleasure to HIT vendors. All told, loyalty to inpatient EMR/HIT vendors fell 6%, from 81% to 75% committed clients. While it’s not horrible to have 75% truly happy with your product, this is not a metric you want to see trending downward.

When you combine these numbers with other signs of dissatisfaction, the picture looks worse. Roughly 25% of respondents said that they were only loyal to their vendor because they were forced to follow administrative directives. And as we all know, ladies and gents of the vendor world, you can’t buy love. These 25% of dissatisfied professionals will do their job, but they aren’t going to evangelize for you, nor will they be quick to recommend more of your products.

All is not bleak for EMR vendors, however. Some HIT vendors saw year-to-year growth in hospital client loyalty. Vendors with the biggest loyalty increases included Allscripts, Cerner, CPSI, NTT Data and athenahealth/RazorInsights.

By the way I noted, with a touch of amusement, that mega-costly Epic doesn’t appear on the latter list. Just sayin’.

Even Without Meaningful Use Dollars, EMRs Still Selling

Posted on June 10, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

I don’t know about you, readers, but I found the following data to be rather surprising. According to a couple of new market research reports summarized by Healthcare IT News, U.S. providers continue to be eager EMR buyers, despite the decreasing flow of Meaningful Use incentive dollars.

On the surface, it looks like the U.S. EMR market is pretty saturated. In fact, a recent CMS survey found that more than 80% of U.S. doctors have used EMRs, spurred almost entirely by the carrot of incentive payments and coming penalties. CMS had made $30 billion in MU incentive payments as of March 2015. (Whether they truly got what they paid for is another story.)

But according to Kalorama Information, there’s still enough business to support more than 400 vendors. Though the research house expects to see vendor M&A shrink the list, analysts contend that there’s still room for new entrants in the EMR space. (Though they rightfully note that smaller vendors may not have the capital to clear the hurdles to certification, which could be a growth-killer.)

Kalorama found that EMR sales grew 10% between 2012 and 2014, driven by medical groups doing system upgrades and hospitals and physician groups buying new systems, and predicts that the U.S. EMR market will climb to $35.2 billion by 2019. Hospital EMR upgrades should move more quickly than physician practice EMR upgrades, Kalorama suggests.

Another research report suggests that the reason providers are still buying EMRs may be a preference for a different technical model. Eighty-three percent of 5,700 small and solo-practitioner medical practices reported that they are fond of cloud-based EMRs, according to Black Book Rankings.

In fact, practices seem to have fallen in love with Web-based EMRs, with 81% of practices telling Black Book that they were happy with implementation, updates, usability and ability to customize their system, according to the Q2 2015 survey. Only 13% of doctor felt their EMRs met or exceeded expectations in 2012, when cloud-based EMRs were less common.

Now, neither research firm seems to have spelled out how practices and hospitals are going to pay for all of this next-generation EMR hotness, so we might look back at the current wave of investment as the time providers got in over their head again. Even a well-capitalized, profitable health system can be brought to its knees by the cost of a major EMR upgrade, after all.

But particularly if you’re a hospital EMR vendor, it looks like news from the demand front is better than you might have expected.

Hospitals Favor IT Investments Over Cash on Hand

Posted on June 5, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Today I was reading a piece in Healthcare Finance News concluding that now more than ever, hospitals are being judged by financial analysts by the number of days’ cash they had on hand. At the same time, the story noted that hospitals are facing some of the biggest financial stresses they’ve faced in decades, with high patient deductibles and copays leading to drops in collections, switches to risk-based compensation cutting margins and the ever-present need for EMR and other IT investment looming.

When you boil all of this down to the essentials, you’ve got a pitched battle going between the need for current liquidity and the need for future liquidity. While having cash on hand shored up for a rainy day makes analysts like Moody’s happy, failing to spend on the right IT infrastructure undercuts the chances of making it work a few years in the future.

After all, if you don’t have a current revenue cycle management system in place, payments can slip through your hands that could have been collected.  Without spending the right amount in (on the right product, at least) on tools that help manage risk-based contracts, health systems and ACOs can end up losing big money on these contracts.

And even hospitals that aren’t in robust shape are betting their financial future on big EMR investments because they clearly consider it necessary to do so. For example, as I noted in a post earlier this year, Chattanooga, TN-based Erlanger Health System just committed to a 10-year, $100 million deal to put Epic in place despite its only recently having recovered from serious financial challenges.

So the question becomes whether hospitals can risk being cash-poor for now — at least by one measure — in an effort to keep the IT tools they need at hand. Obviously, there’s no one-size-fits-all answer, but industry strategies seem to offer a hint.

The reality seems to be that many health systems and hospitals feel they need to invest in IT upgrades and new technologies whether the traditional metrics fall into line or not. As scary as the regulatory issues (such as the ICD-10 upgrade) and changes in compensation are, health organizations like Erlanger are making the bet that even if it makes them uncomfortable now, having the right IT in place is a must-do.

While I’m no financial genius, my guess is that this means hospitals are going to voluntarily let key metrics like DCOH slip in favor of building for a solid future. I suppose we’ll know in five years or so whether taking such a risk pushed a bunch of hospitals over the cliff.

Partners Goes With $1.2B Epic Installation

Posted on June 2, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

After living with varied EMRs across its network for some time, Boston-based Partners HealthCare has decided to take the massive Epic plunge, with plans to spend an estimated $1.2 billion on the new platform. That cost estimate is up from the initial quite conservative spending estimate from 3 years ago of $600M, according to the Boston Globe.

As is always the case with an EMR install of this size, Partners has invested heavily in staff to bring the Epic platform online, hiring 600 new employees and hundreds of consultants to collaborate with Epic on building this install. The new hires and consultants are also tasked with training thousands of clinicians to navigate the opaque Epic UI and use it to manage care.

The move comes at the tail end of about a decade of M&A spending by Partners, whose member hospitals now include Brigham & Women’s Hospital, Massachusetts General Hospital, the Dana-Farber Cancer Institute, McLean Hospital, Spaulding Rehabilitation Hospital and the North Shore Hospital.

The idea, of course, is to create a single bullet-proof record for patients that retains information no matter where the patient travels within the sprawling Partners network. Partners can hardly manage the value-based compensation it can expect to work with in the future if it doesn’t have a clear patient-level and population level data on the lives it manages.

Even under ideal circumstances, however, such a large and complex project is likely to create tremendous headaches for both clinical and IT staffers. (One might say that it’s the computing equivalent of Boston’s fabled “Big Dig,” a gigantic 15-year highway project smack in the middle of the city’s commuting corridor which created legendary traffic snarls and cost over $14.6 billion.)

According to a report in Fortune, the Epic integration and rollout project began over the weekend for three of its properties, Brigham & Women’s, Faulkner Hospital and Dana Farber. Partners expects to see more of its hospitals and affiliated physician practices jump on board every few months through 2017 — an extremely rapid pace to keep if other Epic installs are any indication. Ultimately, the Epic install will extend across 10 hospitals and 6,000 doctors, according to the Globe.

Of course, the new efforts aren’t entirely inward-facing. Partners will also leverage Epic to build a new patient portal allowing them to review their own medical information, schedule appointments and more. But with any luck, patients will hear little about the new system going forward, for if they do, it probably means trouble.

Is Epic Too Big To Fail?

Posted on May 27, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While there’s a chance an Epic purchase can endanger a hospital’s financial health, I’ve never heard a whisper of gossip suggesting that Epic is in financial trouble.

In fact, it appears virtually unstoppable. Though Epic is a private company, and doesn’t disclose its financial information, its 2014 revenue was estimated at $1.75 billion, up from $1.19 billion in 2011. And despite the fact that the hospital EMR market is getting saturated, the giant EMR vendor is doing quite nicely with the estimated 15% to 20% of the market it is reported to hold.

Still, what would happen if Epic took a body blow of some kind and stopped being able to support the implementation and operation of its products?  After all, buying an EMR isn’t like picking up, say, a fleet of trucks that the hospital services and maintains. For years — sometimes a decade — after a hospital goes with Epic, that hospital is typically reliant on Epic to help keep the EMR lights on.

Which brings me to my core question: Is Epic too big to fail? Would it create such a disaster in the healthcare market that the U.S. government should step in if Epic ever had a massive problem meeting its commitments?

As little as I like saying so, there’s a strong argument to be made that Epic simply can’t be allowed to stumble, much less crumble.

As of April 2014, Epic reportedly had 297 customers, a number which has undoubtedly grown over the past year. What’s more, 70% of HIMSS Analytics Stage 7 hospitals, i.e. hospitals for which their EMR is absolutely mission critical, use the EpicCare inpatient EMR.

If Epic were to face some financial or operational disaster that prevented it from supporting its hospitals customers, those hospitals would be very compromised. Epic’s customers simply couldn’t leap abruptly to, say, a competing Cerner system, as the transition could take several years.

Depending how far along in their Epic install and launch they were, hospitals might try to limp along with the technology they had in place, switch temporarily to paper records or try to keep their progress going with whatever Epic consultants they could find.

In an effort to recover from the loss of Epic support, hospitals would be forced to bid high for the services of those consultants. Hospitals could have their IT budgets decimated, their credit harmed or even be driven out of business.

In the crazy shuffle that would follow, there’s little doubt that many medical errors would occur, some serious and some fatal. It’s impossible to predict how many errors would arise, of course, but I think it’s easy to argue that the number would be non-trivial.

Given all this, the feds might actually be forced to step in and clean up Epic’s mess if it made one. Mind you, I’m not saying that, say, HHS has such a plan in place, but perhaps it should.

Ultimately, I think the healthcare industry ought to do some self-policing and find some ways to reduce its reliance on a single, frighteningly-powerful vendor. Over time, I believe that will involve gradually shifting away from reliance on existing EMRs to next-gen EMRs built to support value-driven payment and population health analysis. In the mean time, we’d better hope nobody drops a giant rock on Epic’s executive headquarters.

The Hospital With No EMR

Posted on May 20, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

This weekend, feeling a bit too ill to wait to see my PCP, I took myself to a community hospital in my neighborhood. For various reasons, I went to a hospital I don’t usually visit, one about 10 miles away from my home.

When I entered the emergency department lobby, nothing seemed amiss.

In fact, the light-filled, pleasantly-constructed waiting room was comfortable and modern, the staff seemed bright and knowledegeable, and the triage nurse saw me promptly.

But I got something of a surprise when I checked in with the triage nurse during my initial assessment. Noting that she had not taken my medication history, I told the nurse that I assumed someone would be entering it into their EMR later.

“We don’t have an EMR,” said the kind and sympathetic triage nurse apologetically. “Everything is still on paper. We might have an EMR in a year or so, but we’re not even sure about that.”

As it later turned out, she was mistaken. The hospital did indeed have an EMR in place, one by MEDITECH, but had put all new upgrades on hold, leaving the clinical staff to do almost all documentation on paper.  Regardless, the staff didn’t have access to the higher capabilities of an EMR, and that’s the message that the triage nurse had gotten. (And no one ever did take my list of medications.)

Now, it’s not necessarily the case that this hospital had no grasp of its data. In fact, to my surprise, the front desk was able to tell me that I had been seen there in 2002, something of which I had no memory.

But it’s hard to imagine that the very long wait I endured, which took place in the attractive lobby of a quiet, prosperous suburban hospital, was not due in part to the hospital’s lack of automation. It should be noted that within the next several months to a year, the chain to which the hospital belonged expects to bring the hospital I visited onto its Epic platform. But again, the staff was stumbling around in the dark, comparatively speaking, the day I visited the ED.

Now, hospitals survived on paper documentation for many years, and there’s no reason to think this one won’t survive for a year or so using paper charts. What’s more, it may very well be that the real problem this hospital faced had to do with patient mix and staffing concerns. I did note that many of the patients coming in seemed to be seeking weekend primary care, for which the hospital may not have been as prepared as it should have been.

That being said, an EMR is not just a clinical tool. Put coldly, it’s an instrument of industrial automation which can keep patients moving through the assessment and discharge process more quickly and effectively.

I’m not saying the facility needs to have a fully-launched marquee EMR just to impress patients like myself. In fact, postponing expanding the Epic EMR for a while may be a great financial decision, and from an IT standpoint, better to roll the Epic system out at a sustainable pace than throw it at an unprepared workforce.

But watching nurses and doctors record details on endless sheets of paper, and struggle to track down paper charts for acutely ill patients, was a harsh reminder of what the industry has left behind.

What If Doctors Owned Part of Hospital EMRs?

Posted on May 19, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

After this many years of widespread use, you’d think that physicians would have accepted that EMRs are an inevitable part of practicing medicine — and at least sometimes, a useful tool that helps doctors manage their panel of patients more effectively.  But it seems some hospital administrators have concluded that a significant percentage of doctors loathe EMRs.

I draw this conclusion not from casual conversation with physicians, but from a hospital recruiting advertisement quoted in The New York Times.  The advertisement, which was attempting to attract doctors to a facility in Phoenix, closed its glowing description of state-of-the-art equipment and an attractive location with a single provocative line, all in bold: “No E.M.R.s.”

While EMRs are getting long in the tooth these days, they haven’t won over many doctors. As physician Robert Wachter notes in his NYT piece on the subject, a 2013 RAND survey found physicians most unhappy with EMRs, citing “poor usability, time-consuming data entry, needless alerts and poor work flows.”

I think it’s pretty obvious why EMRs continue to stay user-hostile. While doctors are the end users of  EMRs, hospital IT leaders and other CXOs make the final buying decisions. And he (or she) who writes the check makes the rules.

In theory, it’s strongly in hospital management’s interests to force EMR vendors to clean up their usability act.  After all, not only do hospital leaders want their EMRs used effectively, they want the data to be robust enough to be usable for value-based care delivery. But the truth is that hospital leaders are nowhere near demanding enough of EMR vendors. And because they’re the ones writing the checks, doctors get stuck with the ugly results.

But what if there was a way to involve both doctors and hospitals financially, as partners, in buying EMRs?  Not being the world’s greatest finance wizard, I don’t know how a hospital and a group of physicians could structure a deal that would allow them to jointly own the hospital’s EMR system. And I’m aware, though I don’t know how they would be addressed, that there could be significant legal issues to be resolved if the hospital was a not-for-profit entity.

But at least in theory, if doctors were paying for a percentage of the EMR, they’d have a lot more say as to what level of usability they’d demand, what features were most important to them, and what price they’d be willing to pay for the system. In other words, if doctors had skin in the game, it would put a great deal of pressure on vendors to make EMRs doctors actually liked.

Now, I realize that doctors might have no interest in buying into a technology which has let them down again and again. But there’s a chance that more visionary and tech-friendly physicians might grab the chance to have a substantial say in the EMR-buying process. The idea is worth a look.