Does the Stockholm Syndrome Apply to EMRs?

Paul Levy wrote an interesting post comparing Stockholm Syndrome to EMR software. For those who aren’t familiar with it, here’s a description of Stockholm Syndrome:

Stockholm syndrome, or capture-bonding, is a psychological phenomenon in which hostages express empathy and have positive feelings towards their captors, sometimes to the point of defending them. These feelings are generally considered irrational in light of the danger or risk endured by the victims, who essentially mistake a lack of abuse from their captors for an act of kindness.

Paul Levy makes the case for EMRs being similar to the Stockholm Syndrome based on Epic’s decisions to not integrate with other medical record systems and some of the controlling tactics that Epic uses with its customers. They are interesting and it’s amazing what a hospital CIO will put up with from an EMR company like Epic.

I’d take this idea one step further. I’ve recently heard a number of people ask the question, “Is Epic really that good or is it just the best of the worst?” Doesn’t this sound a lot like the Stockholm Syndrome? Basically defending something that really isn’t all that great, just because it was better that the bad treatment they got from other EMR vendors before.

Paul Levy describes the myth that he thinks is why we are where we are today:

It is a widely accepted myth that medicine requires complex, highly specialized information-technology (IT) systems. This myth continues to justify soaring IT costs, burdensome physician workloads, and stagnation in innovation — while doctors become increasingly bound to documentation and communication products that are functionally decades behind those they use in their “civilian” life.

We believe that EHR vendors propagate the myth that health IT is qualitatively different from industrial and consumer products in order to protect their prices and market share and block new entrants. In reality, diverse functionality needn’t reside within single EHR systems, and there’s a clear path toward better, safer, cheaper, and nimbler tools for managing health care’s complex tasks.

The two killer points for me are the “stagnation in innovation” and the “functionally decades behind” comments. Those who argue against these things usually use a few specific cases of advancement and innovation as opposed to the industry as a whole.

I’d suggest that one of the biggest impediments to innovation is the barriers to entry for a startup company. How many hospitals do you know that would buy software from a startup company? It’s pretty rare. Yet, this is where the very best innovation comes from in other industries.

I still think that there will be opportunities for some startup companies to come along and disrupt the current EHR providers. Epic did it to Meditech in many ways, and I’m sure we’ll see another come along and do the same. However, I think the number of people that can do this is limited to a very small group of people thanks to the way healthcare is organized and done in hospitals. This lack of access leads to a lack of innovation.

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.


  • I applaud Levy for his article, and to you, for referencing it. Epic’s business practices of “strong arming” their clients to use only Epic products is unconscionable.

    With their purchases being driven by government mandates and funding for meaningful use, I can’t understand why the Feds haven’t made it MANDATORY for all EHR vendors to fully integrate with other systems, or lose the ability to be a qualifier for meaningful use dollars.

    Under those circumstances, competition would thrive. The large vendors would be forced to innovate and provide better service to compete against small and medium sized businesses. At a minimum, healthcare providers could purchase best-of-breed solutions to complement the EMR, improving the entire environment.

    Right now, the Epic’s of the world are scoffing at their clients’ needs, laughing in the federal government’s face, and taking their money as well.

  • Thank you, too for bringing to light Paul Levy’s article as it highlights the bigger picture about the negative impacts of an EHR that has monopolized the hospital market with no clear benefits for the health care system and for patients in the end.

    I know that in the Portland, Oregon metro area, EPIC has become the defacto standard EHR for all the hospital systems. It started with one and it became a domino effect because EPIC probably did a great job promising interoperability between the hospital systems.

    The reality, though, was that interoperability was not in the cards…EPIC offered slightly different versions of their software that actually didn’t operate well with each other. Furthermore, they set up EPIC within each hospital system as a patchwork of other legacy products that in the end became a house of cards and if one part doesn’t function well, the whole thing falls apart.

    I know that it may take a lot of effort to penetrate the hospital market since most hospitals feel compelled to follow along by using the same product, thinking that it will help them compete in the marketplace. I know of a few outlier hospitals that have bucked the trend by adopting an open source solution. It’s like the Microsoft vs Linux business/enterprise software competition. Microsoft has the $$ and targeted marketing to attract a large number of customers right at the gate, but over time, the businesses that actually thrive and succeed are the ones that have adopted an open source solution that actually focuses on the business rather than forcing the business to conform to the software. Will that translate to the health care industry? Only time will tell.

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