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Deborah Leyva

Excellent analysis and commentary! I agree with your assertions that a market-friendly, pro-consumer EHR market is of maximum benefit to practices. There may indeed be disadvantages for those vendors who are not yet CCHIT certified, and this factor must be taken into consideration as physicians move forward with purchase of software for electronic records.

Another consideration is to analyze the market share for an EHR product. Although no one has that "crystal ball" that shines into the future, analysis for an investment in software that contains patient records should also examine the viability of the software vendor to sustain its business into the future.

I expect there will be consolidations and/or mergers (as seen recently with Misys/Allscripts) as we move forward. There will be winners and losers, that much is true, but facilities/practices investing in EHR software will have an opportunity to "ask the right questions" and get assurances, contractually, should this occur with an intended purchase.

And then...there's the question, "What business are you in?" Medicine or IT? Investments in technology for support, hardware upgrades, and staff training should be part of the budget forecast. I don't think physicians want to be distracted from their patient care responsibilities in order to address problems with infrastructure in-house. For this reason, and the total cost of ownership (TCO) for technology, it may be worthwhile seeking vendors who provide hosted products on the internet, who are CCHIT certified, and who are well funded and will be around for a long while.

Bob Coli, MD


The 2/5/09 Bloomberg story below: "Obama’s Health-Record Proposal Helps Bush’s Cousin (Update2)" suggests that the federal government proposing to pay physicians for EHR adoption over time through increased "incentive payment" reimbursements rather than up-front, lump sum grants or loans will produce winners and losers among the sellers. For example, ASP (SaaS) model ambulatory EHR products (like Jonathan Bush’s athenahealth) would have a competitive edge over client/server software model) products (like Glen Tullman’s Allscripts/Misys).

See:http://www.bloomberg.com/apps/news?pid=20601087&sid=aW3k.HBnTQ4Y

However, from what I have read so far about the HIT sections of the stimulus legislation (1), the law would provide temporary Medicare and Medicaid bonus payments over five consecutive years (2011-2015) ranging from $44,000 to $64,000 for physicians for meaningful use of electronic health records.” (2)

On the surface, this would appear to give a big edge, in a still fragmented marketplace, to the CCHIT-certified, integrated ASP Model EHR/PMS vendors with very competitive and transparent pricing. For example, Purkinje Systems EHR/PMS applications can be "rented" for as little as $399 per provider per month ($4,788 per year) or 3.0-8.5% of annual collections if the physician wants to totally outsource his/her A/R services management (3). Being lower cost sellers should make Jonathan Bush, Girish Kumar Navani at eClinicalWorks (4) and the other competitively priced and annually CCHIT-certified ASP model vendors happy.

Ideally, from a taxpayer and physician buyer/user perspective, EHR pricing and quality should both be transparent. To encourage rapid market growth and stability, once they are certified by CCHIT for basic functionality, interoperability and security (using the 275 criteria in 2009), all ambulatory EHR vendors should need to compete for customers based on value delivered, with market forces, not government pricing levels determining the ultimate winners and losers.

This value-based competition model was described in CCHIT’s 2008 Physician User Guide (5):

“HIT vendors will compete and innovate beyond the requirements of certification to differentiate their products and make them attractive to potential customers. Certification is not subjective or comparative. It provides a baseline, requiring products to meet basic standards of functionality, interoperability and security so EHR purchasers have a sound starting point to make more reliable buying decisions. Commission surveys show that newly emerging EHR companies continue to enter the marketplace and seek certification. As certification stimulates the adoption of EHRs, the competitive marketplace will grow, and this effect usually causes prices to drop.”

In order to maximize the physician EHR adoption rate and the chances for successful growth of HIEs and PHRs, government should continue expanding physician choices by creating compelling incentives for all vendors to compete on the actual value (quality/price) delivered by their EHR products. This market-friendly, pro-consumer strategy would serve to minimize EHR costs and maximize their usability. These two important issues would both be transparent in a buyers, market, yet only the former has been adequately recognized as a barrier to physician EHR adoption and implementation to date.

With billions of dollars at stake for the buyers, the sellers and taxpayers, it will be interesting to see how this important issue of value-based competition plays out in real time.

(1) http://www.wallerlaw.com/articles/2009/02/14/stimulus-package-provides-incentives-for-the-use-of-health-information-technology-electronic-health-records.8163

(2) http://www.healthcareitnews.com/news/healthcare-it-slated-19b-proposed-stimulus-package

(3) http://www.purkinje.com/ehr/careseries_pricing.cfm

(4) eCW -Top Rated EMR and PM --- 20,000+Physicians use eClinicalWorks $500/month for Web Hosted EMR+PM. www.eclinicalworks.com .

(5) http://cchit.org/files/CCHITPhysiciansGuide08.pdf

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