Specialty-Focused EHRs Re-Entering The Picture

Over time, I’ve read a great deal on whether specialist clinicians should invest in EHRs designed for their area of practice or not. One school of thought seems to be that specialists can do just fine by buying broadly-based systems and implementing practice-specific templates, a move which also offers them a longer list of EHRs from which they can choose. Another, meanwhile, is that EHRs designed for use by all clinicians can undercut practice efficiency by forcing specialist workflow into a one-size-fits-all straightjacket.

But the arguments in favor of specialized EHRs seem to be taking hold of late. According to the latest data from Black Book, specialist surgical and medical practices have been switching over to specialty-driven EHRs in overwhelming numbers during the first half of this year. Its researchers found that during the first and second quarter of 2016, 86% of the 11,300 specialty practices it surveyed were in favor of switching from generalist to specialist EHRs.

According to the research firm, 93% of specialists surveyed felt that templates available in specialty EHRs offered a substantial benefit to patients who needed individualized documentation, especially in practices that see a high volume of predictable diagnoses.

If that’s the case, why did so many specialists start out with generalized EHRs?  Eighty-nine percent of respondents said that they bought the non-specialist EHR they had because they were focused on meeting Meaningful Use deadlines, which left them too little time to vet their original EHR vendor sufficiently.

Lately, however, specialist practices have decided that generic EHRs just aren’t workable, Black Book found. Nearly all respondents (92%) said that given their workflow needs, they could not afford to spend time need to shape all-purpose systems to their needs. When they switched over to purchasing a specialty-driven EHR, on the other hand, specialists found it much easier to support ultra-specific practice needs and generate revenue, Black Book reported.

That being said, specialists also switched from generalized EHRs to practice-specific systems for reasons other than clinical efficiency. Black Book found that 29% of specialists make the change because they felt their current, generic EHR was not achieving market success, raising the possibility that the vendor would not be able to support their growth and might not even be stable enough to trust.

Specialists may also be switching over because the systems serving their clinical niche have improved. Black Book researchers note that back in 2010, 80% of specialist physicians felt that specialized EHRs were not configurable or flexible enough to meet their needs. So it’s no surprise that they chose to go to with more robust multi-use and primary care systems, argues Black Book’s Doug Brown.

Now, however, specialized EHRs perform much better, it seems. In particular, improvements in implementations, updates, usability and customization have boosted satisfaction of specialist EHRs from 13% meeting or exceeding expectations in 2012 to 84% in the second quarter of 2016.

Still, practices that buy specialty EHRs do make some significant trade-offs, researchers said. Specifically, 88% of specialists said they were concerned about a lack of interoperability with other providers, particularly inpatient facilities. Respondents reported that specialty-specific EHRs aren’t fitting well within hospital network and regional health information exchanges, imposing a considerable disadvantage over large multispecialty EHRs.

And not surprisingly, investing in a replacement specialty EHR has proven to be a financial burden for specialist practices, Black Book concluded. Forty-eight percent of all specialty practices switching EHRs between June 2014 and April 2016 said that making such investment has put the practice in an unstable financial position, the research firm found.

My general sense from reading this research is that specialist practices have good reasons to replace their generalized EHR with a specialist EHR these days, as such products appear to have matured greatly in recent years. However, these practices had better be ready to deploy their new systems quickly and effectively, or the financial problems they’ll inherit will outweigh the benefits of the switchover.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

5 Comments

  • And then the specialists can opt for yet a third choice – a generalized EHR that has as it’s foundation BPM (Business Process Management) or, better still, one that supports ACM/BPM (Adaptive Case Management).

    BPM is a flowgraphing methodology that comes in two flavors, one where programming is needed (skip these), the other where anyone who can “think” process can map out their process “without” programming. The caveat “without” is important because anyone undertaking to map out their processes will need rule sets a various stages and these are likely to require programmer or super-user assistance. The result involves little more than drawing circles and connecting these with directional arrows.

    Clearly, any specialty practice has to face the fact that few of their specialists have either then time or the inclincation to develop their own practices.

    Independent consultants can, however, over several days, evolve a specialty EHR.

    No problem at all with interoperability with some of these generalized BPM-based EHRs.

    The big questions are a) how flexible are specialty EHRs and b) what is the relative cost of a specialty EHR compared to a generalized EHR that has its foundation in BPM.

    BPM is used across thousands of industry applications (healthcare, insurance, law enforcement, manufacturing, b2b). BPM is not a new buzzword.

    See one active BPM community and the topics that get discussed each week at wwww.bpm.com.

    See 250+ plus articles on BPM/ACM, a fair number of which have a focus on healthcare, at http://www.kwkeirstead.wordpress.com.

    No commercial content at any of these sites aside from banner ads.

  • Great article! I think this really resonates with the healthcare market today; we have noticed that many specialty practices are experiencing the limitations of using broadly-based systems. T

    here are vendors out there today that offer a solution more appropriate to practices needing specialized content. However, as well as being able to support interoperability and be deployed quickly to prevent disruption, a critical element to consider is which technology and architecture will support practices future success.

    With the ever-changing regulation and clinical landscapes (value-based outcomes), the solution needs to able to capture any data at any time, and share that data effectively, in order to achieve optimal outcomes.

  • Great article! I think this really resonates with the healthcare market today; we have noticed that many specialty practices are experiencing the limitations of using broadly-based systems.

    There are vendors out there today that offer a solution more appropriate to practices needing specialized content. However, as well as being able to support interoperability and be deployed quickly to prevent disruption, a critical element to consider is which technology and architecture will support practices future success.

    With the ever-changing regulation and clinical landscapes (value-based outcomes), the solution needs to able to capture any data at any time, and share that data effectively, in order to achieve optimal outcomes.

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