I recently received a comment from a healthcare blogger, Dr. Peter Kim, in response to my note about Microsoft's EMR product, Amalga (see: Amalga Makes Inroads in the EMR World). It raises some interesting points so I reproduce it below. You may want to take a look at Dr. Kim's blog (see: The EMR/EHR Show). He has also blogged specifically about Google's role in EMR development (see: Is Google The Answer To EMR?).
...I have strong doubts that either company [Google and Microsoft] will successfully make it into the EMR/EHR market as we know it. By that, I mean, with local interfacing with the myriad of very specific, idiosyncratic systems. EMR's today exist at the hub of each office/implementation's world, including interfaces with hospital systems, local lab services, radiology groups, specialists' systems, etc. Each interface is unique, and requires major man-hours of locally expert debugging...and political negotiating. MONTHS is more the actual norm.
I wouldn't want to bet money against Big G or Microsoft, but that's a snarly, entrenched tech version of the proverbial "land war in Asia (or the Middle East)" that I'm not sure even the big boys can afford. And EMR's must be reliable for the long haul -- patient *lifetime* order of magnitude -- if anything. Are Google and Microsoft going to send a team of specialists to each doctor's office, and troubleshoot their systems at a moment's notice (medical system downtimes must be in minutes, not days), for the years required? Or are they going to change the ENTIRE infrastructure of how every aspect of the medical system communicates with every other aspect, to a degree that support staffer can be in Bangalore and still fix issues in seconds? It hasn't happened, yet.
First of all and for the sake of clarity, let's not refer to EMRs in a generic way. I am most comfortable discussing (1) hospital EMRs, (2) office/clinic EMRs, and (3) personal health records (PHRs). Dr. Kim seems to come at this problem from the perspective of an office physician and asks the rhetorical question: Are Google and Microsoft going to send a team of specialists to each doctor's office...? The answer to this question is obviously no. Neither Google or Microsoft will get anywhere near the specialized office EMR market. It's too fragmented, office personnel require too much hand-holding, and the market penetration is low. Not going to happen! Dr. Kim and I are in agreement on this point.
Microsoft's healthcare strategy is more obvious to me at this time than that of Google and consists of at least the following three elements:
- Develop a hospital EMR with Amalga starting with selected alpha sites as noted in the first paragraph above. The company will thus be able to determine whether their product is competitive in the U.S. market.
- Sign high-profile deals with major health systems (see: Kaiser tiptoes into HealthVault) to offer the HealthVault PHR to patients served by these health systems. Turf to the central IT groups of these health systems the task of replicating selected clinical data elements from their EMRs to the HealthVault PHR as a service to their patients.
- Develop high-profile deals with national reference labs like Quest similar to that already announced by Google: Quest Diagnostics, the world's leading provider of laboratory testing, information, and services is providing patients secure access to their Quest Diagnostics lab test results through their Google Health Account.
You can also throw into the Microsoft mix the deals that the company has announced regarding physician networks (see: Microsoft HealthVault announces new partners in health info sharing quest). Here's the description of such a project:
Microsoft's HealthVault has announced a collaboration deal with communications giant AT&T and computer platform service provider Covisint that will allow patients to share medical information with participating doctors via the Internet. Through the initiative, AT&T will provide broadband access and a dashboard for physicians to access the healthcare information, while Covisint will provide the underlying software that vets the patient info. Microsoft's HealthVault acts as the online storage system for the patient data.
Note the reference to "participating" doctors. Physicians will be required to use a special dashboard. This is not an office EMR -- it's a connectivity solution for office physicians and their patients that the physicians and their office staff will be required to adapt to.
:: Update on 9/30/2008 @ 8:25 a.m.
John who blogs over at Chilmark Research comments on HealthVault versus Google Health (see: HealthVault Surges, Google Flounders).