Obama's Other Healthcare Victory: EHR Boom
forbes.com
forbes.com
Every encounter I've ever had with EHR systems, whether direct or indirect, has been a complete mess. My online EHR through Kaiser is completely unusable, and according to the people who evaluate these things, it's supposed to be one of the best. [1]
Last week I was at the doctor twice, and both times the doctors were complaining about their EHR software, once because it takes so long to boot up, and the other time because it takes longer to sort through allergy testing results in digital form than it used to take with paper charts.
The problem is, the incentive structure in place forces docs to either adopt what's out there or miss out on big incentives, and eventually get penalized [2]. This creates a twisted incentive structure for software companies where they basically can capitalize on the fact that the docs have to adopt a system. All the software company has to do is put out something that's compliant with gov't standards, even if its totally unusable by doctors. Just take a look at the website of the company touted as a great example of the success of the gov't incentive program in the article: http://www.medfx.com/ Would this pass muster in the consumer internet space? In enterprise SAAS? Not a chance.
So the startups are incentivized to get something out so they can get in on the scheme before the window of opportunity closes, what about the big companies who have been building these systems for years? Well, they make most of their revenue from implementing, training, and maintaining systems, not from licensing software, so their incentives are to sell contracts, not make their software any better, because that ends up hurting their bottom line [3]. All they have to do is maintain relative parity with emerging companies, and get real, real good at sales.
It's really a shame, because there is enormous room for real innovation in this space. There is a truly incredible amount valuable data is siloed off in these systems, thats sometimes not even available to the physicians themselves [4] let alone researchers who could use the data. And that, of course, is not mention the potential to help doctors spend less time wrestling with charts, and more time caring for their patients.
[1] http://thesash.me/who-will-fix-the-ux-of-healthcare-a-3-tril...
[2] https://www.cms.gov/Regulations-and-Guidance/Legislation/EHR...
[3] http://thesash.me/who-will-fix-the-ux-of-healthcare-a-3-tril...
[4] My dad had to hire a consultant to make updates to his EHR system so that he could run queries for certain things among his own patients
It might be a "Boom" for some vendors, but I think it will be harder for the small startup to get traction implementing innovative solutions in the EMR space, because it appears there are more artificial impediments to implementation with the new government intervention in healthcare.
I think you'll see monolithic software vendors like GE Health[1] with their Centricity EMR get the lion's share of government investment. They'll use their clout to impose more 'certification' on small vendors, raising the bar for participation and market entry.
It's already begun with groups like CCHIT[2]. A non profit certification body that apparently works in concert with the above mentioned large software vendors to create an expensive hurdle for small companies in terms of cost and compliance.
The hammer to get provider participation? Providers will have their future medicaid/medicare reimbursement rates cut if they don't use a certified EMR. With Obamacare/ACA - reimbursement is likely going to be a much bigger portion of the average doctor's revenue.
There is some incentive for 'meaningful use'[3] which is a cash reimbursement for adoption of the certified, monolithic software, but it's not clear if it completely offsets the cost of acquisition, training and support.
[1] http://www.gehealthcare.com/centricity/ [2] http://www.cchit.org/ [3] http://healthit.hhs.gov/portal/server.pt?open=512&objID=...
If you ask me, no amount of money is worth getting wedged between customers that don't want to deal with government regulation, and The federal government. One law could destroy your margins overnight.
I'll watch these "victories" from the sideline. I'd rather get my money from the customer and not indirectly through incentives paid out by tax dollars.
"... consider some other ways to profit from the EHR boom. Software will need to be written that will interface with these integration platforms and make it easier for those doctors and their staffs to navigate their patients’ histories. Customized devices, like tablets and handhelds, will need to be sold to those same doctors. Or perhaps some will prefer customized apps for their smartphones. If you’re not a hardware or software person don’t worry: all of this change will require services too – consulting, training, project management and support. "
In 2010 the top 25 HIT companies grossed over $26.7 billion, but on average, only 22% of revenue for each came from software. http://www.healthcare-informatics.com/article/healthcare-inf...