

Obama's Other Healthcare Victory: EHR Boom - gshakir
http://www.forbes.com/sites/quickerbettertech/2012/07/02/obamas-other-healthcare-victory/

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thesash
The EHR incentive program is "working" in the sense that adoption rates among
physicians are way up, but it's only because they're being forced, not because
the software is any good.

Every encounter I've ever had with EHR systems, whether direct or indirect,
has been a complete mess. My online EHR through Kaiser is completely unusable,
and according to the people who evaluate these things, it's supposed to be one
of the best. [1]

Last week I was at the doctor twice, and both times the doctors were
complaining about their EHR software, once because it takes so long to boot
up, and the other time because it takes longer to sort through allergy testing
results in digital form than it used to take with paper charts.

The problem is, the incentive structure in place forces docs to either adopt
what's out there or miss out on big incentives, and eventually get penalized
[2]. This creates a twisted incentive structure for software companies where
they basically can capitalize on the fact that the docs have to adopt a
system. All the software company has to do is put out something that's
compliant with gov't standards, even if its totally unusable by doctors. Just
take a look at the website of the company touted as a great example of the
success of the gov't incentive program in the article: <http://www.medfx.com/>
Would this pass muster in the consumer internet space? In enterprise SAAS? Not
a chance.

So the startups are incentivized to get something out so they can get in on
the scheme before the window of opportunity closes, what about the big
companies who have been building these systems for years? Well, they make most
of their revenue from implementing, training, and maintaining systems, not
from licensing software, so their incentives are to sell contracts, not make
their software any better, because that ends up hurting their bottom line [3].
All they have to do is maintain relative parity with emerging companies, and
get real, real good at sales.

It's really a shame, because there is enormous room for real innovation in
this space. There is a truly incredible amount valuable data is siloed off in
these systems, thats sometimes not even available to the physicians themselves
[4] let alone researchers who could use the data. And that, of course, is not
mention the potential to help doctors spend less time wrestling with charts,
and more time caring for their patients.

[1] [http://thesash.me/who-will-fix-the-ux-of-
healthcare-a-3-tril...](http://thesash.me/who-will-fix-the-ux-of-
healthcare-a-3-trillio)

[2] [https://www.cms.gov/Regulations-and-
Guidance/Legislation/EHR...](https://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms/)

[3] [http://thesash.me/who-will-fix-the-ux-of-
healthcare-a-3-tril...](http://thesash.me/who-will-fix-the-ux-of-
healthcare-a-3-trillio-44611)

[4] My dad had to hire a consultant to make updates to his EHR system so that
he could run queries for certain things among _his own patients_

------
harold
I've been working on EMR and similar tech for 15 years. As an entrepreneur I
look for opportunity where I can find it and I think there will be
opportunities for scrappy startups once ACA rolls out.

It might be a "Boom" for some vendors, but I think it will be _harder_ for the
small startup to get traction implementing innovative solutions in the EMR
space, because it appears there are more artificial impediments to
implementation with the new government intervention in healthcare.

I think you'll see monolithic software vendors like GE Health[1] with their
Centricity EMR get the lion's share of government investment. They'll use
their clout to impose more 'certification' on small vendors, raising the bar
for participation and market entry.

It's already begun with groups like CCHIT[2]. A non profit certification body
that apparently works in concert with the above mentioned large software
vendors to create an expensive hurdle for small companies in terms of cost and
compliance.

The hammer to get provider participation? Providers will have their future
medicaid/medicare reimbursement rates cut if they don't use a certified EMR.
With Obamacare/ACA - reimbursement is likely going to be a much bigger portion
of the average doctor's revenue.

There is some incentive for 'meaningful use'[3] which is a cash reimbursement
for adoption of the certified, monolithic software, but it's not clear if it
completely offsets the cost of acquisition, training and support.

[1] <http://www.gehealthcare.com/centricity/> [2] <http://www.cchit.org/> [3]
[http://healthit.hhs.gov/portal/server.pt?open=512&objID=...](http://healthit.hhs.gov/portal/server.pt?open=512&objID=2996&mode=2)

------
alttab
My mom has worked in health care for 25 years and she complains furiously as
she fights with EHR software. None of it is good.

If you ask me, no amount of money is worth getting wedged between customers
that don't want to deal with government regulation, and The federal
government. One law could destroy your margins overnight.

I'll watch these "victories" from the sideline. I'd rather get my money from
the customer and not indirectly through incentives paid out by tax dollars.

------
SlipperySlope
My takeaway,

"... consider some other ways to profit from the EHR boom. Software will need
to be written that will interface with these integration platforms and make it
easier for those doctors and their staffs to navigate their patients’
histories. Customized devices, like tablets and handhelds, will need to be
sold to those same doctors. Or perhaps some will prefer customized apps for
their smartphones. If you’re not a hardware or software person don’t worry:
all of this change will require services too – consulting, training, project
management and support. "

~~~
thesash
Consulting, training, and support currently represents the vast majority of
revenues generated by the Health IT industry.

In 2010 the top 25 HIT companies grossed over $26.7 billion, but on average,
only 22% of revenue for each came from software. [http://www.healthcare-
informatics.com/article/healthcare-inf...](http://www.healthcare-
informatics.com/article/healthcare-informatics-100-companies-
revenue?page=show)

