In response to a recent note, Barbara Duck who blogs over at The Medical Quack submitted a long comment (see: On the Future of EHRs: A Continuing Deep Dive). One point toward the end jumped out at me and I quote it below:
The EMR monsters just grew with adding more software on top of other software and that's the way the business works and you get a mess with a lot of complexities at some point and insurers did everyone one in with their payer input as well to even add more complexities.
This got me thinking about the longevity of healthcare IT companies. They have a finite lifespan. This applies to all systems including LISs, RISs, and EHRs. There has been almost a complete turnover in LIS companies in the four decades that I have been in the business. Each cycle is roughly twenty years. Often the one preeminent companies don't exactly disappear because they have hospital clients that continue to use their software and seem to be satisfied. It's just that they slip back in the pack and lose their cutting-edge reputation. Barbara's point refers to one of the reasons for this eclipse, which I list below with some of the other factors:
- Healthcare system grows by a process of accretion with the older software at their core. The whole system can never be reengineered from scratch because the current client base would squawk. Sooner or later, the whole thing just collapses or loses steam based on its own weight and inefficiency. Any physician who uses the Epic EHR knows that there is often little consistency with commands from one screen and app to another. That's the older software peeking through and causing inefficiencies borne by the users.
- A correlary to rule #1 is that new entrants to the IT software market use newer software engineering techniques and computer languages, displacing the incumbents by doing work faster, better, cheaper. This phenomenon takes longer in healthcare because of the innate conservatism of the industry, the lack of sophistication about IT, and the widely accepted convention that most of the business of a hospital can accomplished by the EHR (see: What's Really Wrong with EHRs: Beginning a Deep Dive). There is no other industry that operates under this convention; they choose instead to use specialized systems for separate lines of business.
- Healthcare's aversion to cloud computing has its roots in concern about patient confidentiality and privacy. Executives continue to cite HIPAA as the rationale. This aversion continue to this day but is now based on the innate conservatism and lack of IT sophistication that I mention in #2 above. Until recently, hospitals have operated on a cost-plus basis for reimbursement so have been able to bear the cost of computer "machine rooms" and overpriced software. As reimbursement gets ratcheted down by the federal/state governments and health insurance companies, reasonably priced cloud computing will become more attractive for hospital executives. They may also pay more attention to specialized systems rather than the monolithic, EHR "monsters" that Barbara refers to above in her quote.