Hospital EMR Offerings

I’ll be the first to admit that I’m not an expert on hospitals and their motivations. I have however found it very interesting to watch from the sidelines at the various methods that Hospitals use to get their outside doctors using an EMR. The hospital ambulatory EMR offerings come in all shapes and sizes. However, at the core of pretty much every offering I’ve seen is a hospital’s desire to be connected and engaged with the outside clinics. There is some real value for a hospital to be well connected to their doctors (sounds like a good topic for a future post).

The problem is that many times a hospital ambulatory EMR offering can backfire if it’s not done right.

The challenge is that a hospital has to narrow its “supported EMR” choices down to a very small list. It’s just not reasonable for hospitals to try and support a laundry list of outside EMR companies (at least with the current state of EMR data standards). Plus, this short list of EMR vendors often isn’t selected with the outside clinics best interest in mind. Instead, the short list of EMR vendors is determined based on the hospitals best interest and EMR vendors ability to schmooze the hospital C-level executive(s). Not always, but I’m just stating what other people are afraid to say.

Now let’s think about the result of a hospital providing a short list of EMR vendors who aren’t designed to meet the needs of these clinics. What was intended to be a strategy of engagement by the hospital with the outside clinics quickly becomes a disengagement strategy as physician offices shun the hospital provided EMR vendors and select a different EMR.

This could also be taken one step further for those that do select the hospital selected EMR and the EMR and/or hospital can’t/don’t provide the type of support that the physician offices expect. Yet another way that the hospital engagement strategy can quickly become a strategy of disengagement.

I’m not saying that doctors or hospitals shouldn’t consider working together on EMR. I’m just saying that hospitals should be careful in the type of EMR they offer physician offices or it might just backfire on them.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

9 Comments

  • John,

    This is a particularly thorny issue for hospitals who are trying to retain or attract physicians to use hospital services.

    Hospitals now are between a “rock and a hard place”. On the one hand, they have valuable services for the physician community. it should be a clear decision to support the hospital.

    However, hospitals are quite discriminatory on whom they want to shower favors and want certain specialties. Therefore, there is great incentives for particular physicians to carve out the special service from the hospital and create their own “facility” to gain that advantage.

    Since the creation of ambulatory care centers, ambulatory surgery centers, free standing imaging and free standing specialized hospitals, the umbilical that ties ambulatory medicine is getting more tenuous.

    In summary, the motivation to stay connected to a hospital is has transitioned significantly over the last ten years and that in some minds, that relationship has not kept up to the social, political and economic conditions. Thus the quandary of the EMR system of the office-based provider and of the hospital.

  • “Since the creation of ambulatory care centers, ambulatory surgery centers, free standing imaging and free standing specialized hospitals, the umbilical that ties ambulatory medicine is getting more tenuous.” Yes and this is one of the reasons the hospitals are trying to stay connected with the Referring Physicians in an effort to not only increase the stickiness but also for operational ease; for instance if the patient charts can be accessed from the hospital as well as the clinic and if the data is updated in both the places, etc.
    The couple of hospitals that we have intiated projects with, were recommended by our current Physician Clients and then the ‘C’ level executives got involved to do the due diligence. And agreeing with John, that the hospitals have only so much bandwidth to support a certain number of EMR/EHRs, interfacing with the hospital systems. And at least in our experience with 2 hospitals, they seem to be taking the feedback from the referring physicians before engaging with the EHR vendors.
    Its getting there; and like anything else in life, good things don’t come easy most of the time.
    And by the way an John or anyone else can post about PHR Smart Cards. Recently met with a company Kela Medical and they are in the PHR SmartCard space. Want to get your feedback on this. Thanks

  • Y’all might want to take a look at the work Patient Keeper is doing. http://www.patientkeeper.com.

    I ran across a Forbes article by their CEO Paul Brient recently:

    “…Consider the automation of clinical information at hospitals. Given that many physicians in the country practice in multiple hospitals in addition to their own practices, they are often faced with an array of different computer systems to access all the clinical information they need about their patients. If you couple this with the fact that each system has a different username and password, a different user interface (ranging from old “green-screen” terminal emulators to fancy modern Web interfaces), it creates quite a challenge for even the most technology-savvy physician. The path to the “meaningful use” technologies has been littered with failures related to the fact that using them makes physicians less productive.

    Our challenge in the Healthcare IT industry is to change this. Given the renewed focus on this and the increasing understanding that solution lies as much with changing the technology as changing physician behavior, the next decade looks like it will produce a much greater level of physician use of information technology than the past three…:

    Interesting.

    http://www.forbes.com/2010/05/12/hospitals-electronic-records-technology-healthcare.html?boxes=Homepagechannels

  • Doctors, in general, support a single sign-on paradigm. They don’t want the headache of memorizing a plethora of password and usernames.

    One thing to note, though, is the kind of physician who goes to multiple hospitals. I suspect that specialist physicians do this. From the ambulatory primary care physician, that mainly does outpatient, and rarely in patient, they are much less likely to travel to different hospitals. If this is the case, then the paradigm of multiple hospital associations prompting a single sign on incentive isn’t there.

    In general, the primary incentive for a physician to associate to a hospital is their services and subsidized medical office space. It isn’t their EMR. For the hospital, they need the physician to refer patients to the hospital for the extra services that are non-office-based. I don’t believe that a single sign-on EMR is sufficient in itself to keep a physician. Usually it is cold cash.

  • “the next decade looks like it will produce a much greater level of physician use of information technology than the past three”

    I think that this is a true projection. The EMR software is finally maturing. It still has a ways to go, but it’s getting there.

  • EMR software won’t be considered “mature” until the need for a “short list” becomes a moot point. The “laundry list” of EMR vendors shouldn’t matter if the data standards are in place so that they can talk to each other.

    I hate to keep harping, but cross-vendor standards for data are absolutely critical! I’ll wager it’s not happening in EMR.

  • Hi David, Interoperability Standards are key and most of the EHR companies who are in it for the long run are working towards meeting the requirements. Its getting there.

    Interoperability at a global level will be the ‘Utopia’ and I believe its not too far out.

  • Hi John,
    I appreciate the point you are making here.

    The adoption of an EHR system is similar and at the same time, not so similar to other major technology purchases made by healthcare provider and their constituent clinicians.

    I have seen it, time and again, when the hospital did not adequately engage its’ clinicians in the selection and implementation process, the technology/vendor, no matter how superior, was doomed to failure.

    In the case of an EHR system, we are dealing with a technology that is not necessarily “rocket science” like a PET/CT or MRI system, but one that is complex and will touch every aspect of the clinical practice.

    Teamwork and change management are now more important than ever. Is your vendor going to help you with that?

  • One of the issues that may further complicate a Hospital’s EMR out-reach program is the nature of the relationship between the “Hospital and its outside doctors”. Most people would assume that the Hospital and the doctors are distinct business entities, but there are several other relationships in this mix. Sometimes, they are distinct business entities but have a contractual arrangement such as income guarantees or incentives. The Hospital can also own the practice and the physician can be a salaried employee. The Hospital and the outside doctors may also be direct competitors, such as when physicians own ambulatory surgery centers or the Hospital has its own outpatient practices. All of these arrangements create a certain dynamic that would need to be addressed in any Hospital-sponsored EMR out-reach program. They are obviously specific to the individual Hospital, but if these dynamics not addressed then they would probably doom any initiative to failure before it is even started.

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