Thursday, February 23, 2012

EHR Breakthroughs

The mass of men live lives of quiet desperation. Resignation is confirmed desperation.

Henry David Thoreau (1817-1862)

Success doesn’t necessarily come from breakthrough innovation but from flawless execution. The win comes from basic blocking and tackling.

Jain Naveen (1969--) business executive and entrepreneur

February 23, 2012 - I’ve been writing periodically about EHRs in my blog, my books, and in MIT’s Technology Review. In these venues, I have developed the sense that physicians are resigned to the inevitability of EHRs and have been desperately seeking solutions.

Statistics on the “hits” on my medinnovation blog bear this out. Three times more readers view my EHR blogs than read the #2 and #3 most popular subjects, the primary care shortage and accountable care organizations.

Of EHRs, it strikes me, physicians are saying: EHRs here to stay, let’s get on with them. Just show me a way to get around obstacles – cost, training my staff, integrating software with my current practice management system, and making EHRs user-friendly, clinically useful, and acceptable to the government so I can qualify for CMS “meaningful use” financial incentives – a total of $44,000 per doctor for Medicare, and $68,750 for Medicaid.

Meanwhile, in the background, 100 or so EHRs companies have sprung up to get a piece of the $27 billion for EHRs and HIT use embedded in the 2009 $787 billion stimulus bill. The leading companies, with number of physician users, in May 2010 were:

Epic 45,000

AllScripts 40,000

eClinicalWorks 40,000

GE Centricity 35,000

NextGen 35,000

SOAPWare 30,000

Practice Fusion 18,500

Eclipsys 11,000

Sage Health 10,000

Greenway Medical 6,000

This list doesn't include EHRs designed for specialists, who have their own special needs, or new entries into the market.

No doubt, these numbers have changed, as have the vendors, as they would in any dynamic market. Practice Fusion, for example, reports it now has 130,000 physician users. The other major vendors are not standing still. Kathleen Sibelius ,the Health and Human Secretary, reports a sudden uptick to 41,000 physicians qualifying for “meaningful use” incentives to meet a February 29 deadline.

The technologists of these companies have done a lot of systemic “blocking and tackling,” working out the kinks in their EHRs, and their marketers have been hard at work too – asking what physician clients need and want. At the same time, computer transistor capacity has been doubling ever 2 years, as Gordon Moore, co-founder of Intel predicted back in 1965, and new mobile applications have been proliferating.

To explain what has been going on, its successes and its failures, Harvard Business School Professor Clayton Christensen in The Innovator’s Dilemma (1997) advanced the Technology Mudslide Hypothesis:

“Coping with the relentless onslaught of technological change is akin to trying to climb a mudslide surging down a hill. You have to scramble with everything you’ve got to stay on top of it, and if you ever once stop to catch your breath you get buried.

Enter the concept of disruptive innovations, which allows vendors and physicians to ride the mudslide. Disruptive innovations are products that typically are cheaper, simpler, smaller, and, frequently, more convenient to use than traditional products.

There are many examples of disruptive healthcare innovations – desk top office computers rather than the phone or FAX; mobile devices(IPhone, IPad, IPod) rather than office-based computers; arthroscopic and endoscopic surgery rather than invasive surgery; angioplasty, rather than open-heart procedures; portable ultrasound rather than stationary MRIs or CTs; decentralized outpatient facilities rather than hospitals.

In the EHR field, disruptive technologies include a new business model, whereby: one, advertisers seeking to reach physician audiences and some health care plans, pay for installation and use of EHRs, and two, computing that takes place in “cloud,” on distant Internet browsers, rather than on EHR systems situated in physician offices.

These two disruptive innovations – “Free” EHRs paid for by someone else, and cloud computing, carried on outside the office, are a revelation and a revolution to small physician practices, primary care and specialty practices alike, who to date have not had the time, the skills, or the resources to install or use EHRs.

These disruptive innovations could be a breakthrough: As Bill Frist, MD, physician businessman, U.S, senator, and Senate Majority Leader from 2003- to 2007, has observed, “America has the best doctors, the best nurses, the best medical technology, the best medical breakthroughs. There is absolutely no reason we should not have in this country the best health care in the world. “

Tweet: EHR use is breaking through in the U.S., thanks to hard work by vendors and two disruptive innovations – “free” EHRs and “cloud computing.”

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