Note: This is a post by Katherine Rourke. Tomorrow watch for a post by John on EMR and EHR where he discusses some of his views on this discussion.
While it may not be immediately obvious, the EMR industry is at a major turning point in its history. Any day now, we’re going to see a bunch of mergers and acquisitions go off like a string of firecrackers, some of which may have a direct impact on your business.
Now, I don’t know how many EMR companies there are out there. In fact, I’m not sure anyone has a precise count. But can we agree that we’re looking at 1,000 or more, no? And, heck, there’s probably thousands of companies pitching practice management + EMR, medication management systems, clinical decision support, apps, mobile health plug-ins to EMRs and so on. Just visualize it all — you’ll get a headache but you’ll doubtless agree that we’re dealing with a raging flood of technology.
And most of it won’t stand alone forever. Every vendor likes to say that their product line has all the solutions, but even the most green sales rep doesn’t really believe that. Smart EMR tech firms and their natural allies are already beginning the mating dance, and quietly but inexorably, hooking up.
Since this isn’t the Wall Street Journal, I’m sure we don’t need to dig into deep financial discussion over this. And anyone who’s a regular reader of this site knows why software companies often buy rather than build the technologies they need to fill out their portfolio.
But I thought it was still worth noting that within, say, 18 months, the EMR world could look fairly different in the following ways:
* EMRs aimed at doctors are overabundant, to put it mildly. I predict that there will be a dozen or so well-publicized failures or buyouts in this space within the next year.
* Big vendors that pitch to both enterprises and medical practices will largely have to pick one,and it’s the enterprise side that will win. If you’re a doctor running a giant company’s EMR, stay in regular touch with your vendor and get their support promises in writing!
* There will be a flurry of mHealth activity, with EMRs that play nicely on tablets in center stage. It’s possible the market will even support another IPO or two this year by EMR vendors if they’re offering a nifty mobile health aspect integrated with their core product.
* Doctors, in particular, risk finding that their product becomes abandonware this year as the market consolidates. Have a Plan B available, and I mean a written plan developed by a consultant or tech-savvy senior member of your team.
So, what else do you think will happen as the market absorbs excess players and recombines relationships?
Great piece Katherine – I completely agree that within the next 18 months the market will look much different.
You mention a dozen or so “well publicized” failures or buyouts. I suspect your number is low and I wonder how many under the radar failures and buyouts we’ll see in addition to the highly publicized ones.
As a morbid side note this would make for an interesting contest.
Steve,
Thanks for the kind words. I agree, much of the activity will take place under cover of darkness, so to speak.
Maybe we should start a list. After all, F*cked Company, “the dotcom deadpool,” was certainly enjoyed by all.
-Anne
[…] Rourke recently did a post on EMR and HIPAA entitled, “Major EMR Vendor Consolidation On The Verge.” This is an incredibly important topic, and so I’m glad that she’s writing about […]
If there are way too many separate vendors out there with too many different systems, the result tends to be too little interoperability, too many for anyone to properly support, not enough support from the vendors. There needs to be consolidation, but that consolidation needs to also work towards tightening up on standards and better connectivity.
Mind you, I do believe in competition. And I understand that some vendors will go after different customers; small practices vs large vs hospitals, etc. But I think that consolidation is in order, and the sooner the better, so that practices don’t have to adopt one, then convert to another and another.
This is a standard cycle in any market.
Those who can will begin buying out the smaller players to build their client base.
It has been going on and will continue.
My initial gut reaction is this: if your EHR vendor is being bought out, expect that your EHR will be phased out sooner rather than later.
I would not run away from this until you see how it shakes out…because the vendor doing the buying will do a migration…
where, if you leave this situation, you’ll be expected to deal with the migration.
Migration has been talked about here in the past. It is a pain, but reality.
I’ve only dealt with migrations where the server was in house…I imagine migration from a web-based EHR could get very interesting.
I’m guessing that because all systems ought to be able to pump out their content in a standard format, and import the same, that the actual transfer of data from old to new should be relatively simple. BUT – the new system may have less functionality then the old, and then some of the data might not be usable. And work flows will be different. Lots of interesting problems, and it seems to me that given that this will happen over and over, there needs to be some standards for that purpose.
R Troy,
Your guess would be wrong. Almost all systems can’t pump out their data in any format. So, it makes getting the data from one EHR to another sometimes impossible and always a HUGE pain.
Ahh – this is getting good…
He is correct in that all systems “ought to be able to pump out their data in a standard format” but alas, for some reason the idea of open standards has not yet reached much of the EHR world.
I guess it’s a security thing. Oh wait, somehow banks, credit card companies, airlines and every other industry are able to use defined standards so maybe it’s not security. Maybe it’s just a choice to try and lock customers in for as long as possible.
I’m beginning to think that there are major holes in the standards. Just as bad, the standards that there are can be useless to patients. For instance, HealthVault can read ‘standard’ EHR records. But what records some patients might get from their insurance companies are often not in that format, they are more likely to be in some simple text or Excel file that HV can’t process.
R Troy,
HealthVault accepts a standard, but the standard isn’t the complete record. It’s just a subset of the full record. That’s why the standard can’t be used for transferring data from one EHR to another.
Understood. And add one more issue to the list of ones why clinicians don’t want to get into EHR’s. Too much chance that the one they pick might go away and leave them high and dry with no way to transfer their data into a new system.
And for patients, plenty of obstacles to establishing a viable PHR.
R Troy,
I agree completely. I’ve been mulling around an idea to solve the EHR data transfer problem. Some sort of certification for EHR vendors that make all of their EHR data available in an exportable format and commit to providing that data to their providers. This could be even more important for SaaS EHR users who want to store a copy of their data in a secure spot that they control. Just only so many hours in a day.
I was reminded recently that even though a medical provider uses cloud / ASP / SaaS, and that the service is required to provide security and backup, that the provider is still legally responsible for both. But if the system provides for no backup / dump (in standardized format), that just isn’t possible. Not that most doctor’s want to be maintaining backups themselves, but there needs to be a way for them to be protected.
R Troy,
You’ll find this post by William O’Toole interesting: https://www.healthcareittoday.com/2012/06/12/covering-your-practice-when-using-a-hosted-ehr/ He addresses some of the issues of responsibility from a legal perspective.
You are right; I read it and found it very informative. Mind you I’ve negotiated a number of expensive contracts with service providers but in another industry (Financial Market Data). There I always had an attorney to review such clauses but clearly I need to spend a lot more time reviewing them myself once I’m actually ‘working’ in EHR.
BTW, off topic, but I’m very impressed by the discussions here.
Just like somebody who has lost data now views backups as important, a physician who has been through more than one EHR views data migration as a major issue.
I’ve dealt with a dozen EHRs, and have 1 client who is on his 3rd.
HL7, a “standard” is a joke.
When I was asked which version of HL7 we were using, I knew this wouldn’t work.
SaaS: Many docs think a SaaS EHR washes their hands of having to do anything.
It really doesn’t change much; sure you don’t have to actually do backups, but you better have in writing crystal clear that your SaaS folks are backing up your data.
Additionally, you need to note this in you risk assessment for meaningful use AND have this in your data backup HIPAA policy.
There are a lot of in office policies & procedures that must be followed whether SaaS or in house server…don’t get sucked into the SaaS sales promise that HIPAA & Meaningful Use are taken care of for you…cause it ain’t true.
I’m beginning to think that all the money at stake and the massive pressure from the Fed’s is creating something of a Wild Wild West environment for EHR system procurement. Lots of vendors, lots of systems, wide range of compliance with questionable standards. And that not all the vendors are quite as good at security, backups, upgrades, transfers to and from other systems, etc.
[…] was highly intrigued by Katherine Rourke’s article on EMR vendor consolidation. While I may not agree with the entire article, Katherine has raised […]
[…] today (north of 300) and all the buzz regarding growth in health IT adoption. There was even a recent post postulating that major EHR consolidation was “on the verge.” Even I have wondered at […]
But hence a problem. Are we or aren’t we about to lose a bunch of vendors – and if so, which are the weakest and likeliest to go? Which vendors should we avoid – in which case we hasten their demise? And if we have to move ahead, how do we protect ourselves money wise – and make sure we don’t lose our data?
That’s not so simple. If today I go live on an EHR, and 6 months down the road, most of my data now scanned or keyed in, paper files no longer being updated, and one day my vendor goes belly up. It can, and will happen. If we are a small practice and don’t have an IT staff, or even if larger but go with a ‘cloud’ solution, what are our options in having at least last night’s EOD data? And better yet, every entry until the moment the vendor suddenly pulls the plug without warning?
And if we had all that data – what do we do with it, how do we get up and running in a matter of hours with a new vendor PLUS our old data?
Here are some of my views on why I disagree with Katherine about EMR vendor consolidation: https://www.healthcareittoday.com/2011/07/13/independent-thinking-of-doctors-limits-ehr-vendor-consolidation/
We will lose some EMR companies though. So, the comments you make about figuring out what to do if and when an EMR company closes shop is very important. Unfortunately, there’s no good answer right now.
Silly me, but I think that answering that question is far more important right now then getting State 2 MU. Because if consolidation leaves piles of practices holding the bag with months or years of now unreadable medical records, that would be horrific. Not exactly what we were looking to accomplish.
I’m coming to the conclusion that a practice considering EHR should not act – incentives or not, cuts in reimbursement or not, until if and when they are very, very sure that 1. they have all of their data in hand every day, and 2. that they have one or more other EHR vendors that could come in on a day notice and take in that data and get them back up and running.
Obviously, the biggest problem is in cloud based EHR’s, but even office based client server systems won’t run for long once their vendors go belly up. And with cloud based, some vendors do seem to have some way for you to get copies (daily?) of your data – but so what if you can’t load it into another system.
I’ve thought of creating a whole EHR certification for the issues you describe. Things like providing a full backup of the EHR data that you can host where you like. I think it would set apart EHR vendors that adopt the policies. Unfortunately, just no time to implement it.
It shouldn’t have to be you – this should be part of MU Stage 1. Certainly Stage 2 should not be adopted until this is handled.
[…] today (north of 300) and all the buzz regarding growth in health IT adoption. There was even a recent post postulating that major EHR consolidation was “on the verge.” Even I have wondered at times why […]