Specialist EMRs: Pros and Cons

Right now, the bulk of well-known vendors are fighting for hospital and multispecialty/primary care group business.

But specialist EMRs are a thriving market, too, and one analysts like myself don’t cover often enough. To get an idea of how many specialist EMRs are out there, check out this list of EMR specialties my colleague John Lynn compiled. Though it’s from 2009, it should give you an idea of what we’re dealing with here.

Is it really necessary for specialty physicians to buy an EMR dedicated to their profession?  One specialty vendor offers a thoughtful argument as to why their approach is better:

 Clinical content is required to sufficiently document exam findings, diagnoses, and medical plans. To be truly effective, an EMR must possess a comprehensive library of information that alleviates the need for physicians to document from scratch. Otherwise, both the workflow efficiencies and the documentation improvements touted by EMR vendors suffer.

But, according to [Peter] Waegemann, “most medical specialty societies simply are not ready to ‘come up with the data’ around which vendors can design specialized systems.” Therefore, most generalized EMR vendors put the responsibility for developing clinical content on the shoulders of their customers. But, therein lies the problem.

Writing a comprehensive, usable library can take up to 400 hours of a physician’s time – time that is already in very short supply and very expensive. The sheer amount of time required for such a task oftentimes delays implementations, frustrates users, and is one of the top reason behind EMR failures. Some vendors rely on third party resources to sell libraries to specialty customers, but doing so oftentimes raises the overall cost and complexity of the solution to unacceptable levels.

On the other hand, I can think of at least a few reasons why a specialty EMR might not be the best choice for a practice:

* Interoperability:  If your practice joins a health information exchange (and let’s face it, that day is coming for most physicians) will your specialty EMR be able to link up comfortably with mainstream systems?

* Connections with hospital systems:  Another interoperability issue. If the hospital where you do most of your business is an Epic shop, and you’re using, say, the

* Workflows that don’t fit with major systems:  It’s all well and good to be really comfortable with your specialty EMR, but how will that work when you’re forced to “switch gears” and use mainstream systems in settings outside your practice.

So folks, which side do you come down on in this discussion?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Hi Anne,

    Your observations, about how different kinds of EMRs need to fit together, are spot on. You motivated me to rename a blog post that used to be about pediatric-specific EMRs, but whose argument is more generally applicable and relevant to what you have written. Just replace “pediatrics” and “pediatrician” with another specialty and I think my argument still holds water.



    Why Specialists Need Speciality-Specific EMRs That Understand More Than Their Specialty


    Communication of Shared Meaning across Specialty Boundaries

    If you are a pediatrician, reflect on how much you know about the other medical specialties that you call on when you refer a patient. Throughout your career, starting in medical school, you’ve been exposed to much more than pediatric medicine and you use this knowledge to better coordinate your patients’ care. Consider how you communicate with a physician from another different specialty. Each of you share a common foundation of basic medical knowledge, plus you both understand enough about the other specialty in order to communicate. You use words to mean the same thing.


    What’s my point?

    Intelligent systems (you, or increasingly, EMRs) cannot communicate about concepts they cannot represent. Specialty-specific EMR databases need to “know” a lot more than just their specialty focus, if they are to participate in creation of virtual medical home enterprises.


    “I am a solo pediatrician, why should I care about multi-specialty EMRs?”

    To future proof your practice:

    You may eventually add a pediatric subspecialty or other primary care specialty to your list of board certifications.

    Your practice may add a subspecialist or non-pediatric primary care partner—specialty-specific workflows will allow you and your partners to “Have It Your Way” while not stepping on each other’s toes.

    Or you may need to communicate and coordinate with other general-purpose or specialty-specific EMRs as part of a high performance virtual medical home.

  • Interesting points Charles. I guess you don’t think a nice HIE in the middle could solve these issues of connecting multiple specialties?

  • Hi John,

    Possibly necessary, but unlikely sufficient without considerable semantic translation functionality. But that will be true without an HIE too. Different layers.

    Wait until we begin to grapple with workflow/pragmatic interoperability! That’s yet another layer.



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