I must admit that I don’t post that often about healthcare reform and the changing doctors practice. Not to mention things like the Accountable Care Organizations (ACO) and other trends in healthcare. Although, I do watch them peripherally and in many cases these changes are important in relation to EMR since they impact what the future of EMR might look like.

So, I was pretty interested in a post by Barbara Duck about the impact of Healthcare Reform on medicine as we know it today. Barbara has a quote which describes the change:

“Healthcare reform will usher in a new era of medicine in which physicians will largely cease to operate as full-time, independent, private practitioners accepting third party payments.”

Then, she quotes a study which describes how medicine will change and the four possible courses that physicians will take amidst all this change.
• Work as employees of increasingly larger medical groups or hospital systems
• Establish cash-only practices that eliminate third party payers
• Reduce their clinical roles by working part-time
• Opt out of medicine altogether by accepting non-clinical positions or by retiring.

This information isn’t all that new. I also have read many people who just see this as the same cycle that we’ve seen before. I think that’s probably true, but it’s still a cycle that should be considered going forward.

Assuming the above assumptions are correct, does that spell the end of the small practice EMR software? Essentially it would leave only EMR software that supports larger medical groups or hospital systems and EMR software that handles cash only practices (something every EMR vendor would probably love to do).

Personally I don’t see it as the end of small practice EMR software. Although, it definitely will see a shrinking of the market for that software. At least temporarily.

Hospitals are buying EMR systems for the Physician Groups that they own and they are allowed to pay 85% of the software and training costs for their independent physicians (physicians that they do not employ, but who refer patients to their hospital).

They are doing this for a number of reasons. It will improve communication for better and more efficient care and it will “connect” these physicians to that hospital (in multiple ways). Keeping the referral pipeline flowing is very important to hospital systems. This type of arrangement makes it more difficult for doctors to move their patients to other hospital systems and it builds loyalty.

Most hospitals are picking ONE system for their employed physicians and then they are going to offer to pay 85% IF independent physicians use this ONE system.

Although well intentioned (hospitals are trying hard to pick the best system for their doctors), I believe this approach is doomed to fail and will cause hard feelings and other problems.

Hospitals want all their doctors on one EMR system because of volume discounts and because they believe in maximal connectivity. Again, their intentions are logical and well-founded, but miss the mark.

Why will it fail? Because different doctors and different physician groups have different needs, different styles and different preferences. Doctors also need to be “masters of their own fate”, if they fail, they need to “own” the problem. In addition, hospital systems are only considering EMRs from the “big EMR companies” because they believe that “connectivity” trumps “usability”. When you limit your options to the “big EMR companies” you are choosing some of the least usable systems on the market.

Doctors need choice! They need to make the final decision on the system they purchase. Only they can find the best system for their practice and their practice style. One size does not fit all.

When the doctors become unhappy with the EMR software that their hospital chose for them (not usable, difficult to learn, decreases their productivity), they are going to become unhappy with that hospital system and their administrators. Since failure to implement EMR software is very high, we know this is going to happen not uncommonly. I anticipate lots of problems a few years from now. Let’s see how this plays out.

I am hoping that hospital administrators are smart enough to stay out of this EMR software trap. Give doctors a choice. Give doctors options. Don’t believe the big EMR company salespeople who tell you that you all need to be on the same system.