Does Patient Interaction Lock a Doctor In to an EHR?

I’ve been thinking a lot lately about EHR vendor lock in. I think this was prompted by some stories I’ve heard of EHR vendors holding clinics EHR data “hostage” when the clinic chooses to switch EHR software. I heard one case recently that was going to cost the clinic a few hundred thousand dollars to get their EHR data out of their old EHR software. It’s a travesty and an issue that I want to help work to solve this year (more on that in the future).

I think it’s such a failed model for an EHR vendor to try to keep you as their EHR customer by holding your EHR data hostage. There are so many other ways for an EHR vendor to keep you as a customer that it’s such a huge mistake to use EHR data liquidity to keep customers. EHR vendors that choose to do this will likely pay the price long term since doctors love to talk about their EHR with other doctors. If a doctor is locked into an EHR they dislike, then you can be sure that their physician colleagues won’t be selecting that EHR.

There are a whole series of better ways to lock an EHR customer in long term. The best way being providing an amazing EHR product.

I recently considered another way that I think most EHR vendors aren’t using to create a strong relationship with their physician customers. Think about the strength of a company’s relationship with a doctor if a doctor’s patients are all familiar with their connection to the EHR. If a physician-patient interaction occurs regularly through the EHR, then it’s very unlikely that a doctor is going to switch EHR software.

The most obvious patient interaction that occurs is through a patient portal that’s connected to a provider’s EHR. Once a clinic has gotten a large portion of their patients connected to an EHR patient portal, then it makes it really hard for a doctor to consider switching from that EHR. It’s one thing for a doctor to change their workflow because they dislike their EHR. Add in the cost of getting patients to switch from a portal they have been using and I can see many doctors sticking with an EHR because of their patients.

Of course, from a doctor perspective, there’s some value in selecting an EHR that uses a 3rd party patient portal. That way if you choose to switch EHR software, then you can still consider keeping your interaction with patients the same through the same third party patient portal. Although, there’s some advantage to using the patient portal from the EHR vendor as well. It’s not an easy decision.

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.


  • It would be instructive to hear the details surrounding the multi hundred thousand dollar data conversion. Why?

    Are the from and/or too systems too convoluted?
    Is there data missing from one or the other that needs to be added?
    Do records and fields need to be “fixed” manually one-by-one?
    Is the from vendor intentionally putting up road blocks.

    Since HITECH/ARRA, the data structures should be fairly consistent.
    Mapping two systems should not cost 6-figures+.

  • AXEO,
    Actually what you describe is the easy part except for the last question. The six figures I mention above was just to get the data out of the vendor. Everything else that you describe is necessary on every system, but that’s the easy part. The hard part in most cases is just getting EHR vendors to release the data.

    HITECH/ARRA does very little to make the data consistent. The CCD is the closest thing, but it leaves out so many pieces of the documentation that it can be used for a conversion from one EHR to another.

  • I believe that this is one of the greatest fears that doctors have when they are choosing their first EHR; that they will make a mistake and then have their data held hostage.

    This won’t make you feel any better, but this is not a new issue in IT. Financial and other systems in all sorts of companies that want to move to something new can face huge problems in transferring their data out of the old and into the new. And in the financial services world, pricing and other financial market data uses proprietary symbology which typically spreads out into many systems and spreadsheets. Not only is converting from data source to a new one (IOTW one financial Market Data vendor to another) involve all sorts of cross referencing issues, there are usually license issues that can make it impossible (without violating contracts) to do the switch.

    It would be nice, though, if the HealthIT world and related government regulations would eventually require a viable, consistent solution to the data hostage problem.

  • “The six figures I mention above was just to get the data out of the vendor.”

    Was the issue legal, or logistical. Still trying to see how just to get YOUR data from YOUR vendor was multi hundreds of thousands of dollars.

    We just converted a 4 million record database in less than two weeks.
    We aren’t charging enough. 🙂

  • John,

    I don’t think patients know or care which EHR vendor their doctor uses. I know my doctor just started using an laptop-based EHR during our visits and I have no idea or interest who made/sold it.

    In other words EHR vendors are totally disintermediated from the patient. The doc could change their EMR 100 times and the patient would care…but would wonder why they are being asked the same questions 100 times.

    Steve Wilkins, MPH
    Min the Gap

  • Steve,
    What if those patients are in a portal that’s connected to the EHR? If the doctor switches, then all of those patients are going to have to register on the new portal for the new EHR. That’s going to effect a decision on if the doctor switches EHR.

  • Depends on how the main EHR database is structured. The Patient portal feature might just treat the Patient as another user with added security, and limited rights and privileges.

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