Two articles I’ve written in the last 24 hours have gotten me thinking that we’ve already entered the post-implementation era of EMRs, even as implementation remains in progress at so many healthcare organizations. While the vast majority of hospitals and physician practices in the U.S. still don’t have full-featured EMRs in place, many are already looking well into the future.

As you may already know, HIMSS on Tuesday released its first-ever survey on “clinical transformation.” According to HIMSS and survey sponsor McKesson, “Clinical transformation involves assessing and continually improving the way patient care is delivered at all levels in a care delivery organization. It occurs when an organization rejects existing practice patterns that deliver inefficient or less effective results and embraces a common goal of patient safety, clinical outcomes and quality care through process redesign and IT implementation. By effectively blending people, processes and technology, clinical transformation occurs across facilities, departments and clinical fields of expertise”

As I reported for InformationWeek, 86 percent of organizations surveyed had a plan for clinical transformation in place or at least under development, and just 12 percent of respondents called organizational commitment a barrier to reporting on quality measures. And though nearly 8o percent indicated that they still gather quality data by hand and 60 said they don’t capture data in discrete format, more than half already had software specifically for business intelligence. This tells me that analytics is here to stay.

I kind of knew that anyway, since the bulk of the program at last week’s Wisconsin Technology Network Digital Healthcare Conference was devoted to BI, data governance and advanced analytics tools, even in the context of Accountable Care Organizations. (My story about this for WTN News appeared this morning.)

“I’m ready to declare the era of business intelligence,” said Galen Metz, CIO and IS director for Madison-based Group Health Cooperative of South Central Wisconsin. Though he criticized the proposed ACO rules for being too “daunting” for the average provider, Galen and other speakers said that it’s time to harness all the new, granular data being generated by EMRs and, soon, ICD-10 coding.

It may seem “daunting” now in the midst of all the preparations for ICD-10 and meaningful use, but it’s good to know that many healthcare organizations see a light at the end of the tunnel and know that the future bring better healthcare information in exchange for all the hard work and investment today.

A few months ago, the blogger over at Health Finch wrote blog post which analyzes 3 of the top health care IT companies and how they were started. It is very interesting to see the evolution of the large health care IT companies. Here’s the summary of the 3 companies Health Finch looked at:
Epic Systems – Started with Scheduling and Billing
Cerner – Started as a Laboratory Information System
McKesson – Started dong Rx Management

As a PS to the post, they point out Epocrates working on the same model with their Epocrates EMR. That is one of the most interesting things I’ve noted when attending the various EMR related conferences that I attend. There’s a whole variety of ways that EMR companies are approaching the market.

Another example of this trend is the Care360 EHR from Quest. Think about all the benefits that Quest has over many other providers. Sure, the most obvious one is that they have easy access to the lab data. You can be sure that an interface with Quest labs will be free (unlike most other EMR vendors). Although, certainly it also could be a challenge if you want your EMR to interface with another lab. That could be interesting.

However, Quest has a number of other advantages over a new EMR company. They have an entire sales force (which I think they prefer to call consultants) that already have existing relationships with thousands and thousands of doctors. Quest could literally only sell EMR software to their existing lab customer base and do fine. Of course, that’s probably not the best strategy, but that’s a powerful advantage over the other EMR companies.

There are a ton of other companies that we could talk about. Those entering ePrescribing first. Those transcription companies that are offering an EMR solution. I find it absolutely fascinating. So, if you know of others, I’d love to hear your EMR vendor’s story in the comments.

Suffice it to say that we’re in the middle of an all out war by EMR vendors. The good part is that it’s not likely to be a winner takes all affair, but there will be many many EMR vendors that will end up on the winning end.

No doubt many small EHR companies have been looking at themselves in the mirror long and hard and asking themselves how they’re going to survive this rough market. Not only did the HITECH act slow purchasing of EHR systems, but between “certified EHR” and “meaningful use” many are questioning where the small EHR vendor will fit into the EHR market.

I could (and probably will at some point) expound on each of the topics above, but I think that EHR vendors have an even more difficult challenge on their hands. The challenge comes in the form of incredibly large number of marketing dollars and splashy partnerships.

Here’s just one simple example of what I’m talking about. It was just announced that HEALTHeLINK, The Western New York Clinical Information Exchange, now has formal agreements in place with Allscripts, eClinicalWorks, McKesson, MedAppz, NextGen Healthcare Information Systems and Pulse Systems. [Hailing out of Buffalo, I'd love to meet up with the people at HEALTHeLINK sometime when I'm visiting family in the area.]

I’m not sure how much of an impact this particular partnership will have on EHR adoption in upstate New York. However, that’s not really my point. My point is that this is just one small example of a partnership that the “big boy” EHR companies are going to use to market their product. Consider that the marketing budget for these large EHR companies is quite possibly larger than some smaller EHR companies entire budgets. That’s pretty formidable.

I’m not saying that small EHR companies should close their doors and stop competing. In fact, I hope just the opposite happens. I’m all for innovation and the most innovative products usually come from small companies who have to be innovative to survive. I’m just saying that these small EHR companies better come ready to fight. It’s not going to be a pretty couple months in the EHR industry. Only the strong will survive.

Of course, all is not lost for small EHR vendors that survive. Assuming EHR implementation failure rates continue at their current dismal rates, then there will be a tremendous opportunity for a number of companies to take care of those who fail to implement unusable EHR systems.