EHR Is Not Disruptive…And Never Will Be

Ben Wanamaker and Devin Bean have an outstanding blog post on the Disruptive Innovation blog (Clayton Christensen Institute for those following at home) called Why EHRs are not (yet) disruptive. If you care about the EHR market, you should go and give it a slow thorough read. Well worth pondering what they’re saying. For those who don’t want to read the whole article, here’s a small excerpt:

The reason EHRs are not “roiling the health care landscape” with disruption is not that the technology is bad—rather it’s the business model in which they are being implemented. While there is some evidence that EHRs can help increase clinical quality, the technology is by and large being crammed into sustaining business models and used as an expensive sustaining innovation to replace paper records with complex electronic systems. Implementing new technology to sustain the way you already make money almost always keeps costs high and prevents true disruption. Indeed, the history of innovation is littered with companies that had a potentially disruptive technology such as EHRs within their grasp but failed to commercialize it successfully because they did not couple it with a disruptive business model.

Plus, this powerful quote:

EHRs have little reason to use the new electronic system differently from the old paper system, and so EHRs often neither decrease cost nor increase quality. They’re just next year’s more expensive model of paper-based patient records.

As I read this I thought, EHR weren’t meant to be and they won’t ever be disruptive. In fact, they cement in the status quo. I think we see this playing out more and more every day.

To be disruptive, we’ll need something to come from outside of EHR. It likely will have to buck the current reimbursement model. Payers and government really control the environment. As Steve Case said at SXSW V2V, government is the biggest customer of healthcare. That makes disruption difficult unless you go outside the current system.

The disruptive technology that comes will in many ways feel like an EHR, but it won’t be an EHR like we know it. My point is that technology will disrupt healthcare and many in the EHR world will see the disruptive technology and say that it looks very much like the EHR software of today. However, what they won’t realize is that it’s not the technology, but the business model that’s paired with the technology that’s so disruptive.

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.

1 Comment

  • Lord knows, there is a need for disruption in the EHR market, but I disagree with some of the points they make:

    o They state as a fact that “paper records still cost less and are much more convenient than electronic versions.”

    What costs might that be? Creating, storing and retrieving an electronic record is hands down cheaper. Writing an eRx is more costly than faxing paper?

    Convenience for whom? It’s a given that it’s easy to just jot something in a paper record, but what about the poor soul who has to find it when its lost, if ever? What about the convenience to the person who tries to figure out what’s been written? Or the convenience of the person who gets to Xerox and fax a record to another practice?

    o They say there’s a “need to create teams with the authority to implement systems that use EHRs to replace not just paper-based record systems but also patient check-in, insurance processing, and all other information-limited processes.” EHRs don’t do this now? This is Practice Management 101 kind of stuff.

    o They cite how micros displaced mainframe, etc., with cheaper, lower performing technology. The cheaper part is true. However, micros introduced a critical technical innovation that allowed them to become disruptive. A technology unavailable in mainframes and micros: They could read a keyboard’s state.

    That is, micros constantly poll each of its keys to see if it is up or down. Mainframe’s, etc., had to build a string in a buffer wait for Enter and then send it up. That’s why you can play an interactive game on a micro or your spreadsheet can recalc with each new entry. If it were not for reading the keyboard, VisiCalc, the first disruptive app, would never been born.

    Disruption can from many places. It may come from a new business model or from other sources. Wanamaker and Bean’s model may prevail or not. The only thing that is certain about disruption is that it usually a surprise.

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