Independent Thinking of Doctors Limits EHR Vendor Consolidation

I’m not sure all the details of why this is the case (but I’m sure some will tell me why in the comments), but doctors are some of the most independent thinkers that I know. I’m not saying whether this is a good or a bad thing. It’s just an observation based on thousands of interactions with doctors from all specialties. This independence is shown in a plethora of areas from charting to treating to diagnosing to the business of medicine.

Turns out, this independence is part of why I’ve heard doctors say hundreds of times that they basically want their own EHR and not a mainstream one. Doctors want an EHR that fits their unique practice style. Thus they have an expectation that whatever EHR they choose should understand that each doctor is different and naturally adapt to each unique doctors need. Ok, that’s a pretty broad generalization and no one would ever vocalize it that way, but it’s an undercurrent that I’ve seen time and time again.

I believe this is an important characteristic of the EHR market that must be considered. If you don’t accept the broad theory of doctor independence in practice style and approach, then most of you will appreciate that doctors from various specialties have unique needs. The easy to understand examples are Pediatricians and OB/GYNs. Everyone can quite readily see that tracking child growth and pregnancy require different charting and documentation requirements. I believe each specialty could describe similar requirements that are unique to that specialty.

This doctor and specialty independence is why I’ve long argued against what everyone loves to call mass EHR vendor consolidation. Certainly we can all agree that we have too many EHR vendors right now. However, I’ve read many many people argue that there’s only going to be 3-5 EHR vendors left standing after the mass EHR consolidation (or EHR vendor failure). I just don’t believe that’s the case. If we get down to 100 EHR companies, I’ll be impressed.

There are two things that might partially affect my EHR consolidation prediction.

First, I won’t be surprised if some really smart company comes along and scoops up each of the best of breed EHR companies for various specialties. However, instead of sunsetting the acquired EHR software, they continue to offer that same EHR software to a specific specialty. Then, they do this over and over again across all the specialties. So, the larger company would own a pediactric EHR, an OB/GYN EHR, a Family Practice EHR, a Cardiology EHR, a Orthopedic EHR, an Oncology EHR, etc. You get the idea. Instead of getting benefits from software development consolidation, they get the benefits in other areas of their business. It would be really fun to run a company like this.

The other healthcare trends that could have a serious impact on this is the ACO movement and hospitals buying up clinics. I’m still not sure how those two trends are going to play out. However, this type of consolidation of healthcare entities could impact whether a specialty specific EHR is a viable option. Clinics that are bought by a hospital or become part of an ACO lose some of their independence. At least their independence in selecting an EHR software.

Are there things I’m missing? Any other trends that are happening that will change the EHR consolidation landscape?

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.

10 Comments

  • Let us not forget what a medical practice is: a small business.

    Most small biz owner reinvent the wheel.

    Franchises are the exception.

    Most docs reinvent the wheel with their practice.
    And Yes…customization is a HUGE part of standing up an EHR because a Doc wants it work like their practice does…NOT like the vendor thinks it should.

    A standard remark is, “Yes, but my practice is different.”

    This is reality.

  • John,
    The sound I hear are vendors having your ear more than you listen to the frustration of our doctor’s deploying these systems…
    Your premise is all wrong… Vendors are not the driving force behind EHR’s, business need is.
    Vendors should work to create a platform (i.e., tools) which allow for unique preferences to meet the needs of different practice requests. Technology should empower not limit and ought to be flexible not rigid.
    Healthcare needs individual doctors and their “independent thinking”. It’s these entrepreneurs’ ideas which will improve processes, expose savings and advance care.
    Seems inane to think we should place doctors in a box and then expected them to think out of the box to solve healthcare’s dilemma. At the least analog records allowed doctors to practice their trade; it’s beginning to look as though EHR’s are forcing doctors to trade their practice.
    What exactly is the need for EHR consolidation other than to unite all the data into a standard format and eventually a single data center? Where’s the patient care it that?
    Sometimes a 10,000 ft. view can reveal EHR’s forgotten original intent (data) and help clarify the purpose of efforts on the ground…

  • packets,

    While I agree with you in that technology should empower, not limit and out to be flexible, being a technologist, I counter that the customizations that providers as for cause additive support issues and also increase the risk involved with the application being compatible going forward.

    As John Halamka wrote on his blog (http://geekdoctor.blogspot.com/2008/02/provider-order-entry.html), “Automating a bad process does not improve anything.” Would you agree that most providers independent thinking sometimes leads to the pursuit of automation of a bad process?

    Also, should the providers be relying on automation for ALL aspects of their trade? From a point to ponder in Health Data Management (http://www.healthdatamanagement.com/issues/19_7/a-point-to-ponder-42691-1.html): “Not sure anyone would argue the health care industry is in any immediate danger of being over-automated, but the question of whether automation serves the user, or vice versa, is an important one. Industry gurus typically point to aviation as a model for medical reform, and there is absolutely no question that automation has increased aviation safety. But automation shouldn’t lead us to a point where a pilot stops being a “real” pilot, or a clinician a “real” clinician.”

    -Justin

  • I think you probably could have just ended your post at the headline because you’re exactly right and the subject says it all. The individuality of each doctor is such a strong presence in every practice that this mere fact is no doubt the cause of the deluge of EHR’s we’re seeing in the market right now. It’s this simple fact that allows over 300 EHR’s to exist in the market right now and all survive. Additionally the different medical specialties inherent to the industry help to feed the EHR machine by allowing specialty-specific EHR’s to crop up everywhere.

    As usual in any budding industry though, we’re seeing the intervention of government begin to push the little guys and aspiring developers out. The cost of certification is a huge wall to anyone with the intention of creating a new EHR that only serious funding could overcome. Most serious entrepreneurs would more than capable of overcoming this hurdle but think of the little guy with a big idea or the doctor programmer who makes his own EHR in his spare time who could have developed an great EHR and distributed it among the masses.

    Now, while certification is not a requirement, the lack of it is a mark of death on any EHR hoping to succeed in this market.

  • @Packets, Huh?

    Did you read what I wrote?
    Have you read what I’ve written previously?

    The last 3/4 of your post echo my standard view.

    It is “inane” to think docs should conform to the software (though this is what many small biz’s do with quickbooks).

    I don’t see a need for consolidation, it is just a standard process in the business cycle.

    My premise is not wrong:
    Vendors are the driving force.

    If “business need” were the driving force behind EHRs, there would be no need for incentive money. Docs would already be using them because of the great efficiencies they create. Guess what? An EHR does NOT create many efficiencies. A PM does, an EHR does not. Most practices already use a PM because there is an ROI to show.

    The day a vendor has my ear more than my client is the day I leave this business.

  • Justin,
    Shouldn’t care providers have the ability (to decide) whether a process works or not? And shouldn’t patients have to option to choose a value of care which best meets their needs?

    John,
    “Did you read what I wrote?”
    Yeah, a couple of times…
    “Have you read what I’ve written previously?”
    No, I was just commenting on this article.
    “Vendors are the driving force.”
    You said it yourself; “doctors want their own EHR…that fits their unique style”. I completely understand why software vendors are complicit in this EHR push…it makes business sense. It’s obviously a great time to be a healthcare software vendor. ChaChing! I agree business need (i.e., doctors) was not the driving force behind EHR’s adoption, but it should’ve been. EHR’s forced by the state is a hard and bitter pill for many to swallow, and the rosy result promised, many doubt can be realized. O’well…
    As far as the incentive money you spoke of, if you have to persuade a mature industry to adopt a practice that may not empower or positively affect their business, costs more than they want to afford, and at the same time force their competitors to incur a similar cost (without incentive) just to continue business… Well, it doesn’t seem right, and frustrates many doctors as you clearly stated.

  • Can you clone ALL citizens of this country as one patient model or even groups of patients as groups of patient models. If the answer is yes then the current EHR technology is ready to go.

    Blaming doctors who provide individualized treatment plan(which is the way patient care is to be done so that the patient is safely treated, offcourse there are bad apples in every basket) is incorrect. Each patient is different and hence patient care/treatment package is different.

    So make the shoe fit the foot and not the otherway around..ehm the shoe being the EHR technology/software and the Foot being the patient care package. You see there is no doc in this scenario…So I just do not understand why everybody is against the poor providers who slog away with no one to defend them. AMA is full of retired/senior doctors who practiced a while back and made their hay when the sun rapidly shone for them…

    Addiitonally with this PV modifier pay for treatement/cure rather than point of care…a lot of it makes sense ie not paying repeatedly for same treatment plans…However somebody needs to realize there is also an element of patient accountability and not one industry “expert” or CMS official is attempting this part of the medical deal. Providers cannot treat patients if they do not comply and take immediate actions for treatment plans before, during and after….It is like asking the providers to wave a magic wand to fix patient problems…..Will any industry accept this kind of mandate. As with anything else the providers are defenseless and at the mercy of industry experts, lobbyists,private insurance companie slike UHC who have the governmental contract for national health care takeover/monopoly of an industry ….These who are deciding what is right for payment, treatment and operations of patient care. ie They have the authority while the toothless providers have the responsibilities…Has this kind of dichotomy worked in any industry. Ask the industry experts on getting results…NOPE it will not work…the end result is heavy bureaucracy and red tape where all parties other than the actual providers and patients benefit with the dollars lost in such adm. transactions.

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