Looks like Estonia is the new model for system wide EHR http://bit.ly/liYLwe

June 19, 2011 10:27 pm via TweetDeckReplyRetweetFavorite

@boltyboy

Matthew Holt

I’m always fascinated by other countries EHR implementations. So many other countries are interesting to consider since they’re missing so many of the barriers that make EHR adoption and even more specifically health information exchange between EHR software so difficult. Nice to learn more about the success that Estonia has had adopting EHR software. I’d like to learn a lot more about what’s being done with international EHR implementations.

The difference between an ambulatory and hospital EHR http://goo.gl/fb/YDWaO

June 19, 2011 7:01 am via GoogleReplyRetweetFavorite

@kevinmd

Kevin Pho, M.D.

I often have an internal battle when writing on this blog when I’m writing something that’s ambulatory EHR specific versus Hospital EMR specific. In fact, I was struck when someone recently told me that this site focuses more on hospital EMR and not ambulatory. I had to laugh since when I write, I’m mostly writing from the hospital EMR perspective.

This stuff aside, there are distinct differences between a hospital EHR software and an ambulatory EHR software. The article linked above highlights some of those differences. Coincidentally, I’m going to be working to write more about specific hospital EHR issues on the aptly named Hospital EMR and EHR blog. If you like Hospital IT, then go and sign up for the Hospital EMR and EHR email list. It will be a nice compliment to this blog and the EMR and EHR blog. I’ve got 3 other writers that will be starting to write on that blog as well. I’m excited to learn more about large hospital EHR vendors like the mythical Epic. Plus, as I learn more about hospital specific EHR issues, I think the content on this site will benefit as well.

This recent Frost and Sullivan study (requires registration to access) has been making the healthcare IT and EMR blog rounds lately. The parts of the study that are most interesting to consider is their estimated EHR market size.

A study by Frost & Sullivan predicts that revenue for the U.S. ambulatory electronic health record (EHR) market will double from $1.3 billion in 2009 to an estimated $2.6 billion in 2012. Further, by 2013, the market will reach its peak, posting revenue of $3 billion. However, by 2016 market saturation will have occurred and revenue is expected to fall to $1.4 billion.

That’s right. They estimate in 2013 the ambulatory EHR market will be $3 billion. Now compare that number with the $36 billion of EHR stimulus money that’s available (or whichever ARRA EMR stimulus projection you prefer). Are hospitals really going to take that much of the EHR stimulus money? Something just doesn’t feel right about these numbers.

Other salient points from the study I wrote about in my posts about Complex Reimbursement as the Real Driver in EHR Adoption and the reshuffling of providers favoring Large EHR vendors.

She [Nancy Fabozzi, a senior industry analyst at Frost & Sullivan] said many physician practices are facing financial difficulties and the result is physicians are increasingly selling their practices to hospitals, entering into joint ventures with hospitals, or joining larger group practices.

“This whole reshuffling and realignment among ambulatory physicians is going to have a huge impact on the vendor market because many of these 300 vendors that we talk about are a lot of mom and pop EHR companies that have under a million dollars in sales annually,” Fabozzi said.

She added that if physician practices are going to be a part of a big hospital network or a large medical practice group they are going to buy EHR products from larger vendors.

It’s been becoming pretty clear that many small physician offices are selling off to hospitals or larger group practices. This consolidation has been going on for a while and really is going to change the healthcare industry in dramatic ways. I agree with Nancy Fabozzi quoted by Information Week above, that this consolidation favors the EHR Software that comes from larger EHR vendors. Right or wrong, hospital and large group practices generally select the larger EHR vendors.

The VA announced about 4-5 years ago that they would be releasing their Vista EMR as an open source package. Of course, the headline read “Government Gives Away Free EMR.” In essence, this was true. The government was making their Vista EMR available for free. In fact, I remember one of the people in HIM had an article on this subject and brought it to me when I first started working with EMR software.

I think this was a really smart move by the VA and the government and I think we’re just now starting to see some of the fruits of it being open source come to fruition. Check out this recent post about Vista on EMR and EHR. I have no doubt that the VA’s Vista EMR (err…the open source version of it) will be a player in the hospital EMR space.

The problem I have with it (and feel free to correct me if I’m wrong on this) is that Vista EMR isn’t meant for small practices like solo docs and small group practices in an ambulatory care setting. I’m not saying that it couldn’t be used that way, but it seems to me like taking a sledge hammer to a 1 penny nail. It’s overkill and is likely to cause more problems than good.

Here’s one example of a “feature” I’ve learned about the Vista EMR (and really the MUMPS database that powers it): “VistA is a multi-user system that actually can get faster with more people in the machine.”

I haven’t personally tested the statement, but it makes since why it could be the case. In fact, it’s a really cool feature for a large hospital with a large number of users accessing the same patients over and over again. Now let’s apply this to a small ambulatory practice. You only have a few people accessing a patient. Does this mean that Vista would actually be slower than other databases when you only have a small user base (ie. a small clinical practice)?

I’m not an expert on Vista (and probably never will be), but it seems to me that the marketing message for Vista should have read, “Government Gives Away Free Hospital EMR.”

Healthcare data sharing is one of the hottest topics when talking about the importance of EMR software. Some people call it healthcare data portability. One of the problems I have with these discussions is that everyone has different goals for why they want to share the information. Here’s a partial list of reasons people may want to share healthcare data between various EMR respositories (in no particular order):

• Clinical data sharing for reimbursement purposes
• Quality data sharing for broader research goals
• Quality data sharing to meet ARRA requirements/reimbursement
• Data shared for continuity of care between providers

There are probably other reasons to have EMR software be able to share clinical data. However, you get the basic point. There are a lot of reasons why people want the ability to share healthcare related data from an EMR. One problem in the discussion of EMR data portability is that the conversation often gets convoluted when clear lines aren’t drawn for why the EMR data is being shared. Kind of reminds me of what it’s like to discuss EMR and not differentiate between a hospital EMR and ambulatory EMR. There are important similarities, but there are also important differences which always seem to confuse the discussion.