I just ran across a blurb today pointing to this article on the web discussing changes in EHR purchasing between 2010 and 2013. I acknowledge that I have not done full due diligence to examine their methodology and biases, but I see no reason to believe that the figures they present are grossly distorted for any obvious reason.
Briefly, what caught my attention is that the proportion of those looking to buy an EHR in 2013 vs. 2010 who are replacing an existing EHR jumped from 21% to 31% (but this article suggests it could be as "low" as 17% in 2013). My first thought was that maybe these were people changing from discontinued/unsupported systems; this is why a couple of community health centers I know of here in Massachusetts made that move, because they had MISYS and AllScripts bought and shot it. However, a bit farther down, data are shown that by far the largest reason for switching was dissatisfaction with the old system and this was more common in 2013 than 2010, with >60% citing this as their reason for switching in 2013. Given the issue of EHR lock - the systems are very expensive and vendors make it as hard as possible to get your data out to move to another EHR (generally not even providing users a data dictionary to understand how their own patient data are stored) - jumping ship to another EHR because of dissatisfaction means you really hate the one you have. Then think about all the costs of retraining clinical and support staff for the new EHR, the lost productivity as they go through another learning curve - the costs are likely not much lower than buying an initial system, though I've never seen any articles with data about the costs of switching. You truly have to hate your EHR to switch because you don't like it rather than because it is no longer supported or doesn't qualify for Meaningless Use incentives. (And let's not even think about the poor schmoes who bought an "EHRMagic" EHR and learned that the magic was that their MU certification would disappear.)
Strong incentives to buy black box products with penalties coming soon for not using them (e.g., not using e-prescribing), when there are huge exit barriers, bears no resemblance to the assumptions of a "free market." I really wish that the "anti-big government" forces in Congress would go after this one. Unfortunately, as we all know, they are quite happy with a forced subsidy to big business, even at the price of more expensive, lower quality health care and worse health for Americans. But nobody gets elected, or voted out of office, on the basis of their positions and votes related to EHRs, do they?
And I can think of no better way to end this rant than with a turkey photo or two.
Briefly, what caught my attention is that the proportion of those looking to buy an EHR in 2013 vs. 2010 who are replacing an existing EHR jumped from 21% to 31% (but this article suggests it could be as "low" as 17% in 2013). My first thought was that maybe these were people changing from discontinued/unsupported systems; this is why a couple of community health centers I know of here in Massachusetts made that move, because they had MISYS and AllScripts bought and shot it. However, a bit farther down, data are shown that by far the largest reason for switching was dissatisfaction with the old system and this was more common in 2013 than 2010, with >60% citing this as their reason for switching in 2013. Given the issue of EHR lock - the systems are very expensive and vendors make it as hard as possible to get your data out to move to another EHR (generally not even providing users a data dictionary to understand how their own patient data are stored) - jumping ship to another EHR because of dissatisfaction means you really hate the one you have. Then think about all the costs of retraining clinical and support staff for the new EHR, the lost productivity as they go through another learning curve - the costs are likely not much lower than buying an initial system, though I've never seen any articles with data about the costs of switching. You truly have to hate your EHR to switch because you don't like it rather than because it is no longer supported or doesn't qualify for Meaningless Use incentives. (And let's not even think about the poor schmoes who bought an "EHRMagic" EHR and learned that the magic was that their MU certification would disappear.)
Strong incentives to buy black box products with penalties coming soon for not using them (e.g., not using e-prescribing), when there are huge exit barriers, bears no resemblance to the assumptions of a "free market." I really wish that the "anti-big government" forces in Congress would go after this one. Unfortunately, as we all know, they are quite happy with a forced subsidy to big business, even at the price of more expensive, lower quality health care and worse health for Americans. But nobody gets elected, or voted out of office, on the basis of their positions and votes related to EHRs, do they?
And I can think of no better way to end this rant than with a turkey photo or two.
Changing to a new EMR brings such pain and suffering that it can't be done under any but the worst of circumstances. Similar to Thomas Jefferson's version of the Declaration of Independence, doctor people will suffer great indignity before rising up to throw off their shackles. That being said, I have wondered if the normal lifespan of an EMR implementation lies somewhere between 7 and 12 years... simply due to product and feature drift over time. How often does any software product stay true to whatever it was and how often do they hold onto market share over a prolonged period of time? Myspace vs. Facebook comes to mind, but a more rigorous survey of software lifespans could be very useful to the discussion. Is it always deep pain or maybe merely sometimes greener grass in another field?
ReplyDelete2:19 PM