EHR Adoption

$3 Billion Ambulatory EHR Market

This recent Frost and Sullivan study (requires registration to access) has been making the healthcare IT and EMR blog rounds lately. The parts of the study that are most interesting to consider is their estimated EHR market size. A study by Frost & Sullivan predicts that revenue for the U.S. ambulatory electronic health record (EHR) market will double from $1.3 billion in 2009 to an estimated $2.6 billion in 2012. Further, by 2013, the market will reach its peak, posting revenue of $3 billion. However, by 2016 market saturation will have occurred and revenue is expected to fall to $1.4 billion. That’s right. They estimate in 2013 the ambulatory EHR market will be $3 billion. Now compare that number with the $36 billion of EHR stimulus money that’s available (or whichever ARRA EMR stimulus projection you prefer). Are hospitals really going to take that much of the EHR stimulus money? Something just doesn’t feel right about these numbers. Other salient points from the study I wrote about in my posts about Complex Reimbursement as the Real Driver in EHR Adoption and the reshuffling of providers favoring Large EHR vendors . Related posts: Reshuffling of Ambulatory Physicians Favors Large EHR Vendors She [Nancy Fabozzi, a senior industry analyst at Frost &... $18 Billion Might Be Spent to Stimulate EHR Adoption I love how people are saying that $18 billion will... EMR Market Share I regularly am asked what the market share of the...

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Reshuffling of Ambulatory Physicians Favors Large EHR Vendors

She [Nancy Fabozzi, a senior industry analyst at Frost & Sullivan] said many physician practices are facing financial difficulties and the result is physicians are increasingly selling their practices to hospitals, entering into joint ventures with hospitals, or joining larger group practices. “This whole reshuffling and realignment among ambulatory physicians is going to have a huge impact on the vendor market because many of these 300 vendors that we talk about are a lot of mom and pop EHR companies that have under a million dollars in sales annually,” Fabozzi said. She added that if physician practices are going to be a part of a big hospital network or a large medical practice group they are going to buy EHR products from larger vendors. It’s been becoming pretty clear that many small physician offices are selling off to hospitals or larger group practices. This consolidation has been going on for a while and really is going to change the healthcare industry in dramatic ways. I agree with Nancy Fabozzi quoted by Information Week above, that this consolidation favors the EHR Software that comes from larger EHR vendors. Right or wrong, hospital and large group practices generally select the larger EHR vendors. Related posts: Large EMR Vendor Bias Towards EMR Stimulus One thing I’m starting to notice is that it seems... EMR Implementation in Small and Large Clinics I always love to hear clinics talk about the challenges... Boston Health Network Requires All Physicians to Adopt EHRs by 2009 I recently came across a healthcare IT related blog that...

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The Surprise of Broad EMR Adoption

Pat Rioux on LinkedIn made the following comment about a possible surprise that could come from the move to broad EMR adoption: I hope the biggest surprise that we get from this huge undertaking is that we finally have providers wondering how they did their job without an EMR in the past. Improvement that is measurable speaks for itself. Patients who finally have access to their medical data and become participants in their own healthcare will be the best reward. Well said. I’d also add that there are going to be a whole group of doctors in 5 years who never knew how to practice medicine without an EMR. There’s challenges with this too, but it’s an interesting view. Not to mention doctors who’ve been on an EMR for 10-15 years and can barely remember what it was like using a paper chart. Yes, a few doctors will start using their EMR and miss the great chart hunt they use to embark on to find a missing chart. Or… Related posts: Real Hope for Broad EHR Adoption I have a theory about the reason healthcare IT is... The Real Long Term Benefits of Broad EMR Adoption Do we really know the true benefits of EMR or... Penguin Problem in EMR Adoption Vince Kuraitis opened my eyes to a new term called...

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Payment Reform and EHR Adoption

In a recent comment by Bobby Gladd (check out his REC Blog ), he makes a really interesting connection between the need for healthcare payment reform and EHR adoption. Here’s his comment: I would just observe that, absent significant payment reform (I won’t be holding my breath), there’s a very real problematic barrier to effective EHR use if we don’t change the basic paradigm. For example, fundamental to the concept of the “patient-centered medical home” trial initiatives now getting underway is the argument that primary care docs should properly be seeing no more than 8-10 patients per day (e.g., think about the typical hour attorney consult visit), that the customary 25-30 pts/day is driven by the need to bill, to keep the doors open; that roughly half of outpatient visits are of marginal to nil clinical value. I and one of my REC colleagues did a clinic assessment visit the other day. We interviewed 4 docs, one of whom was a severe Dr. NO!” on the topic of HIT. His beef was basically a “productivity loss” complaint, i.e. that seeing mostly older, complex problem list pts (he’s Internal Med) made it nigh impossible to effectively chart electronically in within the scheduling constraint. Now, perhaps with a lighter, more rational daily patient load (and more extensive EHR training) he might come around and truly “adopt.” I consulted with an attorney a couple of years ago regarding legal guardianship over my dementia-addled (now late) Dad. The initial hour cost me $300. The entire deal ended up costing about $4,000. A physician, however, is supposed to take in myriad data and make a comparably expert decision in 15-30 minutes — and hope he/she can eventually get reimbursed a relative pittance. It’s crazy. So, OK, where are we? We’re facing a current and projected shortage of perhaps 40-50,000 primary care docs, and under PCMH theory we propose to cut their pt volumes in HALF ore more so they can provide better care? All while bringing tens of millions of the previously uninsured into the (non-ER) system under Obamacare reform. Right. I don’t have a good answer for the skeptical docs who argue that the EMR gold rush is more about billing imperatives and vendor welfare, that the docs’ pt care-analytic needs are a distant 3rd at best. It’s a vexing circumstance. My only comment to the “productivity loss” complaint and the EMR gold rush that he refers to at the end is… Maybe they’re looking at the wrong EMRs. Unfortunately, the EMR stimulus does promote mostly the wrong EMR vendors. That’s why the EMR selection process is so important. Related posts: Simple Patient Information and Payment Portal Many of you know I’m all about keeping things simple,... EMR Adoption Rates Increasing – Why Are Doctors Adopting EMR’s Now? Dr. Rob Lamberts recently blogged about how EMR adoption is... EMR Stimulus Q&A: Government Incentives for EMR Adoption Outside of Medicare and Medicaid Time again for everyone’s favorite topic (or so it seems),...

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EMR Ethical Dilemma

I was really intrigued by this well done article by the EHR Guy about the Ethical Dilemma of the EMR . In it he describes the difference between the EMR technology world that will “sell anything at any cost” against the medical community values of things like the Hippocratic Oath. He ends the post with these stinging paragraphs: But medical angst persists. Because the EMR vendor is pursuing a “top down” sell, they bypass the medical leadership and pitch the C-level administrative staff. The medical input is usually an afterthought and the medical angst continues. Countering the medical angst and overcoming the perception of “business ethics” being ugly will not be easy. If there be a truth in medicine, it is the gaining and loss of trust. Trust is not a trivial matter that can be bandied about just for a sale. To belie the image of the untrustworthy EMR vendor, both vendors and medical professional must make this their primary goal and objective even before the first sales pitch is given. The reward is either an EMR project that is successful after two years or an unsuccessful project that lasted ten years. The shipwrecks of EMR failed projects are a testament to that result should we forget this difference in world perceptions. I agree that trust is really the key to a successful long term relationship with a doctor’s office. The sad part is that far too many EMR vendors aren’t interested in the long term relationship. They’re making the quick sale and then looking for the next sale. I really believe that a number of EMR companies are going to quickly scale to a level of sales where they can’t support the growth and then sale off to another competitor. However, more important might be those EMR vendors who go in for the quick sale and then leave the clinics hanging during the EMR implementation process. You all know stories of what I’m talking about. I suggest that it’s only going to get worse not better. Add in the EMR stimulus money and the natural increase in initial (at least) EMR adoption that will occur and even many well intentioned EMR companies are going to be caught in the trap of trying to support all these EMR installs. Lack of support from the EMR vendor is going to lead to even more EMR failures. Naturally, all of these increased EMR implementation failures will taint the EMR industry even more and slow EMR adoption worse than ever. Not to be all doom and gloom. I’m just highlighting one possibility. What’s the solution? 1. EMR vendors don’t over sale (this will be nearly impossible and takes a special vendor to not do this). 2. Doctors, do more research about the EMR vendor you select. I call it an EMR vendor background check. EMR is the future, but the question is how long until that future is the present. Related posts: Sink or Swim After EMR Purchase I find it really disturbing the number of stories I... Prepare for the Failure of Many EHR Vendors Just sitting back and taking a look at the current... EMR Hype, Hope and Hyperbole I’ve been exchanging emails with someone in the EMR industry...

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