No doubt many people that come to this website find my long list of EMR companies and are just in awe at the number of EMR companies on that list. That list was posted back in February of 2006 and so no doubt the list is missing a lot of newer EMR companies as well. What we do know is that there are somewhere between 300-400 EMR companies in existence right now.
As if that weren’t a big enough challenge, but I recently saw this list of medical specialties which I’ve pared down a little bit below:
Allergy and Immunology
Dermatology
Family Practice
Internal Medicine
Cardiology
Endocrinology
General Practice
Gastroenterology
Geriatric Medicine
Hematology
Infectious Disease
Nephrology
Oncology
Pulmonology
Rheumatology
Sports Medicine
Orthopedics
Obstetrics-Gynecology
Ophthalmology
Pediatrics
Physical medicine and rehab
Neurology
Psychiatry
Surgery
Urology
Behavioral health (Psychology)
Cardiovascular-Metabolic
Dermatology
ENT (ear/nose/throat)
Gastroenterology
Hematology and Oncology
Ophthalmology
Respiratory (pulmonology)
Urology
Vascular Surgery
36 different medical specialties (and I may have missed some) each with their own EMR needs. I’m sure the fact that there are so many specialties is not news to anyone in the medical industry. However, I’d never really seen the list and so when I saw it I realized what a vast challenge we have ahead of us.
Can you imagine HHS and/or CCHIT trying to certify the EMR needs for each of these specialties? By the way, this list doesn’t even include emergency room or long term care facilities which are kind of an EMR beast in their own right.
Yes, many could make the argument that there are many similarities between what’s done in all these various practices. Certainly this is true to a large extent. However, I’ve recently seen a growing trend with EMR companies becoming more and more specialty specific. Not the big EMR companies. They’ll also try to be all things for everyone. I’m talking about smaller EMR vendors which are carving out their niche in the EMR market by focusing on certain specialties.
Many specialized EMRs are born out of necessity. I have seen a few surgical EMRs which are offered by surgeons who got frustrated with the “generic” EMRs. They made their own EMR, liked it and then decided to offer it to others. This “organic” growth of EMRs is probably a very healthy thing!
In addition to your list, there are still more specialties and sub-specialties for example – Hospitalists, Surgicalists, Laborists, Medical Geneticists, Intensivists, and several more. It will be quite challenging to integrate all the various specialities needs and functionality, especially in the systems used by multiple specialties in one department (e.g. ICU- hospitalists and then the patient’s regular IM doc, pulmonologists, etc…)
I was involved in a research document on the ‘Medical Specialties of the Future’ (2007) if you’re interested, I can send it on to you.
Jeff,
That is how many of them came about. The problem is that many of the organic home grown are missing some important features. Plus, as they start to grow and be a business they often branch off to other specialties and lose their focus.
Shelley,
Thanks for illustrating my point even more. I knew there were probably some missing, but that fact just explains how it’s even harder to fit the various specialty needs.
The core of any EMR is how it documents the progress note. The other stuff is easy (relatively). The home grown EMRs can be developed from a healthy core. If you have an unusable core (like the big company EMRs) then the other stuff does not matter much. The best EMRs available today have evolved from home grown cores done by primary care doctors. For example, AmazingCharts, SOAPware and e-MDs. The home grown core for specialists might be SRSsoft.
Although there are many specialized EMRs, I think that specific EMRs defeat the purpose of having your medical records in the same location. More general EMRs today contain all of that information from general practice to cardiology. It’s amazing what modern day technology has allowed us to do. Before it would have taken several hours if not a few days to gather the needed information from different offices, now we can have it all combined in one location that’s small enough to fit in your pocket.
Elizabeth,
That’s not completely true. Even if every specialty has the same EMR, that doesn’t mean that the various specialties share the information in their EMR. This is true in a few places where they share the same database, but is pretty rare.
The real key to what you’re talking about is creating solid standards for healthcare data interoperability so that even specialty specific EMR companies can share the pertinent healthcare information with other healthcare providers regardless of which EMR is used.
Great article. Seems like there are opportunities for developers of a lower-level EMR solution for small group practices.
Jeremy,
There’s certainly some opportunities, but there are also about 300 EMR vendors that are trying to seize those opportunities.
I’m wondering about small primary care groups (IM, FP, PEDS); either their affiliated hospital/IDN will offer the EMR as an application service provider or they will have to implement their own. These practices tend to have with inadequete IT infrastructure. So either way, they need IT infrastructure and a solid application vendor.
Most do need IT infastructure help. However, many don’t get it done early and so that becomes part of the reason why their EMR implementation fails. The EMR vendor usually takes the blame for a crappy product when it’s really the IT infastructure of the office was poorly done. Doesn’t matter how good the software product is if the baseline IT isn’t done right. I think EMR vendors are quickly learning this and are starting to be more selective and detailed in their IT infastructure requirements. However, many offices will still ignore it.
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John,
Thanks for addressing this issue – I find it ignored completely by mainstream media and government so often that it frustrates me.
I am in a highly specialized area, working for a small EMR vendor who has built/customized a complete end-to-end system for our niche for over 25 years. We are sincerely challenged to fit a “certified EHR” approach to something which has a lot of unique differences.
We are also threatened by this move to “generalization” which is so primary care and hospital focused.
Many of our customers are not technically even allowed to receive incentives under meaningful use, nor would they benefit from some aspects of a certified EHR, but yet are expected to participate. Lastly, the “big corporate certified EHR” is a major threat to us, simply because of marketing and perception, among other things.
It’s a rough time, but we’re fighting/competing by continuing to innovate and navigating around these challenges. Only time will tell if “certified EHR” blows us out of the water, and maybe even our customer’s niche!
Jon,
Yes, that’s the thing I hate most about meaningful use and certified EHR, they’ve mostly killed innovation. So sad.
I wonder how your specialty feels that they can’t participate in MU, but they could get the penalties. You might want to submit comments on the MU stage 2 rule about getting an exception for your niche.
John,
Thanks for your response. Indeed, I have looked into the comment period of MU2. There is an industry lobbying group who has been pushing for the definition of an eligible professional or hospital to be extended to include the specialists in our niche. Also, sad that it takes such a complex public/private interaction to try to get something like that to happen.
The physicians that work in this area spread their workload over multiple locations, so ultimately they will suffer the penalty which indirectly affects all the locations they work at. It also makes it less clear to which entity the physician might assign their incentive.
Oh, and I forgot, the other side of this is the practical side of health information exchange – primary care and hospitals want the data that our niche has (and our niche could possibly benefit from also receiving data from other providers). In some places, it has become a requirement to have a certified (or nearly certified) EHR simply to provide the exact data necessary for CCDs/HL7, using the exact same nomenclature.
I’m all for information exchange and sharing, but not at the cost/burden of everything else that comes with MU and EHR certification. The size/requirements of MU2 are especially burdensome.