Most Expensive Purchase is Second EHR

At an event this fall I happened upon an executive at one of the major EHR vendors. We had a brief discussion in the lobby, but he said something that I found really interesting and I think describes the strategy of many of the large ambulatory EHR vendors. Here’s what he said:

“The Most Expensive Purchase is Their Second EHR”

A popular EHR consultant was in on the conversation and he started shaking his head in agreement.

I’ve long suggested that practices usually get their second EHR selection and implementation right. It just makes common sense that a practice would use the lessons learned from their first EHR implementation and be able to do a better job selecting and implementing the second EHR implementation. Although, I have heard of cases where it took the third implementation to do it right.

What intrigued me more was that this EHR vendor executive tied the purchase price to a second EHR. He’s right that price becomes a very different discussion when you are talking to someone who is buying their second EHR. In a lot of cases, price becomes a non-issue for those implementing their second EHR. They will spend whatever amount is needed to be able to get an EHR that they like to use. This is reflected in the quote above. I expect that’s why a second EHR is the most expensive purchase.

I wonder how many EHR companies are capitalizing on this fact. I’ve heard from numerous people that there’s a lot of EHR switching that’s happening right now. So, the idea of a second EHR is not outlandish. For many, the second EHR implementation has become a major reality.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, 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 agree completely, BUT…I say the most expensive EHR you purchase is your FIRST one. The one that killed your efficiency, the one that taught you what you really need. Practices should apply the expense of the second EHR on the one they are leaving, not the new one.

  • No doubt a second EHR is expensive.

    But whether first, second, third or fourth EHR, if the practice doesn’t get the importance of this, and actually assign someone who understands to head the process, they will once again end up with a bad/mediocre choice and a lousy implentation process that will not improve their situation.

    I’m surprised at the number of practices where the doc is also trying to be the IT guy.

  • I totally disagree. The second EMR could be cheaper than the first, and it could be a better selection. First of all, most of the first EMRs took advantage of the providers who were getting incentive money. Also, their support became terrible. Now you have several hundred Vendors that are much cheaper and better! They have learned from the issues with the others. I am working with providers everyday that talk about making the switch. There are better selections that will be more cost effective and easier to use.

  • I agree! But I think that the only reason the second one would be expensive is because the providers are switching for the wrong reasons. I heard providers wanting to switch all the times. If they feel like they are forced to use EHR, they are not going to like any product.

  • I agree most w/ John Brewer’s comments. Many organizations, large and small, are still not understanding the type of resource(s) they need. Most folks agree that a physician is not best utilized as an IT resource.

    The next point I’d like to see more agreement on is this: Even though EMR projects have a large IT component (just as most any project does these days), IT should not “own” the project. There are so many operational challenges. Yet I still see and hear that EMR projects are IT projects.

  • Pete,
    You make a really good point. Although, I’d say it “should” be as you describe. Sadly, many lose their minds and say essentially “money is no object” and spend whatever with the idea that if they spend more they’ll get more in return. We all know that’s not the case. Sounds like a good future blog post topic too.

  • I have installed and maintained many different EMR solutions in the medical industry. I was in medical IT for a long time. I agree completely with Wes Kemp in the fact that IT should not own any of these projects. I can spec the servers needed, setup all networking and desktops as required by the vendors, but at the end of the day that is where my comfort level stops. I am not a doctor or a nurse and have no idea how your practice functions day to day. When I was responsible for clinics housing these solutions I would cringe when they would ask me why this isn’t printing, or why the electronic fax feature wasn’t functioning as needed. These are very complicated pieces of software that require A LOT of training and continuous support from the vendor. Call me when hardware or networking is broke, not when a vendors software isn’t working properly. I am no longer practicing IT in the medical field, and that was one of the reasons. No IT guy wants to learn your proprietary EMR software because at the end of the day, my next gig will have nothing to do with it. IT people focus on learning industry standards so that they do not become obsolete.

  • Daniel,
    I think you have to be careful generalizing too much. There are many in IT that feel the way you do, but there are IT people like myself that enjoy learning the complex software and helping them solve those problems as well as the other tech issues. You’re offering an important message though. It’s important for a clinic to understand which type of IT person they’re working with in their clinic.

  • IMO, time is best spent learning what will universally be useful in your career. In IT it is unlikely that your career will always reside in medical. If you spend all your time chasing down bugs and other issues with a piece of proprietary software that will be obsolete in a few years, you lose precious time that you could of invested in keeping up with industry standards such as visualization, networking, storage, active directory and so many other areas that should already fill a system administrators time. I also see a new trend for EMR’s to be completely web-based (hosted elsewhere). Once this takes over, which I know many clinics already using these solutions, all of your spent time will have been wasted. If a clinic is going to use a self hosted EMR, I would recommend keeping up with your support contract so that your IT people can be better used where they are needed. With the high cost of servers needed for self hosted solutions and backup solutions required it seems a wash to self host your own EMR these days. I can setup a tape backup with Symantec Exec and the clinic still fails to change tapes. Setup a rotating drive and they still never remove a tape from the site. Setup a simple external drive backup that they switch weekly between two external NAS drives and they also forget to do that. To me it is not safe to trust a clinic with it’s own EMR. Not for the clinic and certainly not for the patients. I was over 250 clinics using a wide variety of EMR solutions and I know that most times when there were issues, the EMR company had to chime in anyways because it was proprietary to their software development and not based on an operating system issue.

  • Daniel,
    So once they all move to hosted EHR, many of those general skills you’re learning will become obsolete unless you want to go work for a data center company.

    I don’t have any problem if that’s how you want to focus your skills and expertise and if that’s the type of job that you want to have, but don’t generalize those comments for all tech people. Learning a specific EMR technology can certainly still be transferable. The ability for a tech person to be able to communicate with both the tech side of the house and the medical establishment is an incredibly valuable skill and requires more than just staying up to date on tech. Plus, that skill will carry with you regardless of which healthcare technology you’re working on. In fact, the ability to bring two sides that speak different languages can apply to pretty much any industry. Plus, the specialized skill usually plays more than someone who just knows general tech stuff that they can get from anyone.

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