Market Trends  

Accelerating Adoption of EHR  

The adoption of EHRs in the market is accelerating . Practices that once thought of an EHR as a distant issue that might affect whomever they sold their practices to when they retired, are suddenly faced with the need to computerize their practices and do it in the next 5 years, just in order to continue to do business as usual. The number of EHR-related topics offered at national medical conferences, including the family practice and specialty conferences (not just the I.T. geek conferences), has increased 10-fold. Until his resignation, you could find Dr. Brailer speaking about EHR at all the major healthcare conferences. Coupled with the formation of CCHIT (the Commission for Certification of Healthcare Information Technology), the message to both EHR developers and the nation's physicians was being widely broadcast, a message that was being punctuated by the massive failures of response to the Katrina disaster.

Will Certification End Vaporware?

With the potential explosion of the EHR market and the high risk that physicians face in implementing EHR systems, the tolerance for two decades of EHR vendor vaporware is gone. The diversity of participants in the newly-formed CCHIT organization bears testimony to the universal conclusion that continued vaporware is not in anyone's best interests and that integrity in delivering what is promised will become a significant factor in negotiations for ongoing new EHR business as the market expands. CCHIT plays a useful role in establishing a BASIC standard for EHR solutions, but doesn't yet address specialty-specific needs, or test all features offered by certified EHR products. These issues are however addressed by independent verification, an approach that is complementary to CCHIT standards and certification and addresses vaporware, safety and quality issues not addressed by a standards/certification approach. Both approaches were researched in the 12th Annual, 2006 Andrew & Associates EHR Benchmark, and here are some of the COPYRIGHTED results.

Figure 1 - Variation in Importance EHR Capabilities by Clinical Specialty

We studied several factors of importance in EHR selection, including physician interest, cost justification, vendor confusion, supportability, staff resistance to change, perception that EHR technology was unreliable, concerns about losing records, security of electronic records, disruption to office workflow and others -- where each factor was rated on a Likert Scale (1-5) by a wide variety of clinical specialties. What emerged was the fact that different practice specialties had different concerns. While cost justification was a high priority to OB/GYN practices, it was significantly less important in cardiology practices. Likewise while disruption of workflow was a high priority in Family practices, it was also of less concern in cardiology practices. This simply underscores that fact that a One Type Fits All (specialties) approach is flawed from the start.

If practices have DIFFERENT needs in an EHR and are concerned about vaporware, verification can address the issue, just as standardization can assure that basic functionality is included. If you are interested in what these basic Standards cover, browse the CCHIT website. Either approach, verification or certification independently increases the cost of marketing EHRs. The combination is of course additive. CCHIT costs about $28K in the first year, while verification adds another $7K. EHR developers have expressed concern about such costs. For the smaller specialty practices, say GEMMS - that sell into the 1200 specialty practices -- the CCHIT certification fees will add significant cost, not only in the fees themselves (which must be amortized over a subset of the 1200 practices that are GEMMS customers).

A Complementary Approach - Verification

Verification complements certification to standards. The notion of verification is that the EHR vendor defines what his system will do (whether or not it complies with some arbitrary standard) and a 3rd party verifies that the system does what's claimed, by interviewing a sample of the group practices that have purchased the same version of the developer's EHR. The very heart of the verification approach eliminates vaporware, because if the vendor claims a feature that cannot be verified, that become public knowledge, something that certification does not even address beyond the rudimentary standards designed so that all the major vendors can qualify. Verification is the next essential step the market must take to assure that physicians can buy EHR solutions with confidence that they are safe, and free of vaporware. For a comparison of the complementary nature of the two approaches, see the CCHIT page on this site.

Interoperability & Elimination of Vaporware Are The Real Goals

What the government seems to be doing through CCHIT is solving only part of the problem. The problems not yet addressed are elimination of vaporware, improvement in quality, and verification of capabilities in all EHR products that transcend common EHR functionality currently covered by CCHIT standards. We must avoid the costly mistake seen in the UK, where the government seeks to force standardized EHR system functionality on all doctors. That approach will fail in the U.S. just as it already has in the U.K. The U.K. failures are costing their citizens 6.5 billion pound per year, and drawing widespread public criticism. The U.K. did all the same things, standardized the solution and invited the physicians to come, but so far, few have. In putting a good face on an extremely poor outcome, the U.K. reported they were under budget in their 10-year program. What they didn't say, but was apparent in a 2006 TEPR keynote presentation is that U.K. physicians were avoiding the solution in droves, that none of the largest EHR players in the world (which happen to be well-known American EHR companies) were getting paid (because payment is tied to adoption - of which their is precious little in the U.K.) and that the losses to these same American companies on their U.K. contracts were rapidly mounting. Of course, these can be compensated for by raising prices on systems sold in the U.S. market. It seems to us that the U.S. government, through CCHIT may be rapidly progressing down the exact same flawed path. Here is a summary of the two different approaches.