The Shifting EHR Decision Makers

As each day goes by, a shift is happening in healthcare. It’s a shift that’s easy to see and many, including myself, have noted before. The shift is hospitals acquiring ambulatory practices. It’s happening at such a rapid pace and before we know it, a small percentage of doctors are actually working for themselves. This change is going to have a dramatic impact on EHR.

One of the biggest elements of this change is who is making the EHR decision. Previously, a large portion of ambulatory EHR decision making had been done by the doctors who owned the medical practice. As doctors have started working for hospitals, the decision making process has shifted to IT executives (To be fair, many IT executives are also doctors, but often not practicing).

This change in EHR decision making is having a dramatic impact on the health IT world and will continue to have an even greater one going forward.

I and others have noted that we believe that the movement of doctors working directly for hospitals is cyclical. As one person said today at AHIMA, “doctors are the most independent people I’ve ever met.” Independence and working for a big company don’t mix very well. So, I’m sure we’ll see many doctors go back to their independent practices. In fact, one guy I mentioned this to at AHIMA said, “It’s already happening, but it’s going to take a different form.”

He’s right about this. Doctors leaving their new found masters (hospitals), aren’t likely going to be able to go back to the traditional practices they did before being acquired. I’m not sure of all the ambulatory medicine models that we’ll see, but I think those entrepreneurial doctors who want to be on their own are likely going to have to be creative in their approaches to practicing medicine. Otherwise, they won’t survive in this rapidly evolving world of ACOs.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, 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,, 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.


  • Very insightful and appropriate observation. I think the key in this post is how ‘independent’ minded (read – ego centric) physicians are. They make the shift to working for other masters because they recognize over time that they are not good business people and want to focus on the practice of medicine solely. The reality is different when they make the transition. It is not as simple as ‘doing your own thing’. In their own practice, they faced the unpleasant reality of a business environment, in a hospital, they face a different challenge – that of politics and even some unpleasant clinical decisions that affect the way they want to treat their patients.

    They are bound to get frustrated with this environment.

    Something new will emerge. They will seek out ‘best of all world’ scenario. Is it there yet? Maybe so – if like minded physicians band together, create an organization and hire professional managers to take care of ‘business’.

    It will be interesting to see what happens.

  • This is somewhat analogous to Sarbanes-Oxley, where big businesses can afford all the red tape, but small businesses are inundated. EMRs on their own might compete to create a simple product “for the rest of us”, but since government is now involved, this is not likely — which was of course the whole point of those gov’t incentives. So I am not optimistic that this “cycle of dependency” will be broken.

    But you’re right that doctors are an independent sort. And I suspect some sort of “Tea Party” or “Atlas Shrugged” scenario to evolve.

  • The friction created by hospitals acquiring independent practices in many ways mirrors challenges that arise as a result of acquisitions in general, across any industry. I do agree that physicians on the whole tend to be very independent individuals, which certainly adds a layer of nuance hospitals need to possess when structuring the decision-making process across the existing hospital and its newly acquired entities. Very simply, though, I believe a sizeable portion of the EHR decision making process issue could be solved by empowering physicians within the newly acquired practice to have a voice alongside hospital IT executives in the selection and implementation of the EHR. With many of the hospitals I work with, efforts to bring collaboration to technology decision making has worked well. One of the big reasons why is because IT isn’t always the expert on the intricacies of clinical workflow and what process is best for the caregiver-patient interaction. By improving collaboration to draw on clinical expertise, the result is typically better technology being implemented, greater adoption of the technology by clinical staff and therefore a greater likelihood that patients benefit from it.

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