There were some interesting stories about HIT in the mainstream media
last week. Let's start off with the Wisconsin Technology Network. In a
follow up to their recent Digital Healthcare Conference, they report that despite the benefits, EMR adoption is not easy.
fairly expensive. And there are other significant barriers that need to
be overcome, said Dare, a participant in the recent Digital Healthcare
Conference presented by Wisconsin Technology Network. "It's not an
undertaking for the faint of heart," Dare said in a post-conference
interview, noting the many well-documented challenges involved in
It would be more accurate to just replace the word "can be" in the
above sentences with "is". Along with a review of the forces driving
adoption, interoperability is tagged as taking the longest to come to
the role physicians play in EMR adoption and describes a broad array of
EMR adoption efforts.. They mention all the usual issues, too old,
what's in it for me, resistance to practice standards, etc. The good (Inland Northwest Health Services), bad and the ugly (Cedars-Sinai CPOE debacle) are all mentioned.
Stalwart of the mainstream media, Time magazine, weights in with a piece titled, The e-Health Revolution (the title gives me deja vu, as in "bubble").
They picked a great character to profile for the story, Glen Tullman,
who founded one of the top three insurance claims automation software
vendors and went on to start Allscripts. The story goes on to note that
adoption is driving quarter after quarter double digit growth for both
Allscripts and Cerner. In between the usual statistics, they end up
hitting the nail on the head:
wired. Most health care in the U.S., however, is delivered by small
practices with fewer than 10 doctors, and these physicians don't yet
see any payoff. That's because so far there is none. The cost is high,
about $10,000 to $12,000 per doctor, and most of the benefits accrue to
other players in the system, such as hospitals, employers and insurers.
This is a thought that's echoed by Girish Kumar, President of eClinical Works in an interview
on Matthew Holt's Health Care Blog. eClinical Works is an EMR vendor
targeting the largest and most challenging segment of the physician
market, practices with 1 to 15 physicians. Regardless of how much the
government pays, er, helps, Girish believes that we are still 5 to 7
years away from peak adoption rates. This sounds about right to me,
given that this health care and adoption always takes longer than you
think. While he believes that the EMR market is advancing (rather than
going sideways), he hits the nail on the head regarding physician
chart in the outpatient environment, although that varies by specialty.
For example, no dermatologist cares, but an ObGyn or cardiology
practice might care. The big deal in terms of interoperability is
access to lab results.
During my ride on the Internet bubble with e-health connectivity startup, Pointshare,
I was struck at how our health care system is so much like a cottage
industry. Patients, employers, physicians, hospitals and payers --
everyone seems to be disconnected. Patients consume, but employers
pay. Physicians direct care at hospitals but work for themselves. And
payers seem to spend most of their time herding cats, with little
success. The two most widely adopted means of communications in health care are
the telephone and fax machine. (And most of the phone calls are either
to ask where the fax is, or to ask that it be resent, "because the
stack of pages on the fax machine is an inch thick and it would quicker
if you could just resend it.)
Broad EMR adoption is going to be like ERP and CRM implementation in
the commercial world; it will be hard, expensive, and there will be no
quick pay-off. The resulting common framework will provide an
invaluable foundation for automating this cottage industry one manual
transaction at a time. Change will be so profound that in twenty years
we won't recognize our industry.
If the scope of the effort and estimated time frame are too depressing,
you can always read one of any number of breathless press releases and
stories about the impending boom, like this one.