For most healthcare providers, 2014 was the deadline for bringing their facilities into the 21st century. While some larger facilities had been eschewing paper-based records systems for several years, 2014 was the deadline for smaller facilities, rural facilities and critical access hospitals (CAH’s) to install an Electronic Medical Record (EMR) system in their facilities. Mandated by the Federal Government as a way to decrease costs and provide better patient care, all medical facilities were charged with installing and beginning to use an EMR system in 2014 in order to meet Stage I Meaningful Use Criteria to continue eligibility to receive Federal Funding. In some cases, if a certified EMR could not be installed before the end of 2014, facilities were given an exemption so long as they had documented proof that the delay was unavoidable and that the EMR would be in use no later than 2015. The loss of eligibility to receive federal funding is nothing to shrug off either; according to a 2013 blog post from the US Census Bureau, the percentage of the US population receiving either Medicare or Medicaid benefits was 32.1% and rising.
With the deadline for having and using an EMR system of some form behind us, what does the market look like for vendors of EMR systems? Are it’s best days behind them, or is there still room to grow? Two new surveys show that the market for EMR systems is still going strong…provided you are already in the game.
Healthcare IT News recently profiled both surveys, one conducted by medical research firm Kalorama Information and the other by marketing research firm Black Book Rankings. Both surveys show that the market for EMR’s is expected to grow through at least 2019, as the last stragglers find their way onto EMR’s and existing facilities upgrade or change vendors. They also found that there are approximately 400 different EMR vendors in the US, although that number is expected to shrink as mergers and acquisitions build steam. The author of the profile at Healthcare IT News notes that there is still room to get into the game, but that the high cost of starting up is a significant barrier.
To be honest, I was surprised to learn that there are so many vendors in the field. I also found it a bit concerning simply because now that most medical facilities have adopted EMR’s, the next shift is towards interoperability. Even looking at the big players in the EMR market, there is no interoperability currently. It can be done on a customized, piece-meal level. But there is nothing of true interoperability in the market.
The point of shifting towards digital medical records in the first place, as opposed to paper-based records, was that having real-time access to a patient’s records can increase the quality of care the patient receives, and decrease the risk of AHE (Adverse Health Events) and medical errors. Our society is increasingly mobile, and as people re-located to different areas, paper records inevitably don’t make the trip. They get lost in the shuffle. Those paper records may contain vital information, such as a medical allergy diagnosed as a child that the now grown adult has forgotten. Think about the last vacation you went on; what would have happened if you had an accident or had gotten ill on the trip? Before the advent of digital medical records, doctors would have to treat you based on what they knew about you, which is not a lot if you are in another state. If the accident or illness strikes after hours, calling your physician to request copies of your medical records to help them make more informed decisions is impossible.
EMR’s were supposed to help stop these kinds of problems by operating according to set standards. Now if you take ill on vacation, the doctors could simply e-mail a request for copies of your digital file from your physician, saving valuable time. But that is where interoperability comes into the picture. With 400 different vendors in the market, the odds that any two facilities in this scenario would have the same EMR system to be able to open the records are slim. While there are mandates about the software systems being built using standardized vocabularies, it still makes for a giant mess if you try to open a digital file from one system in another system.
Because EMR’s are a growing field with intense competition among vendors, there is also a significant amount of stonewalling going on. After all, true interoperability would require someone to open up their software system to other vendors, a.k.a. the competition. No one seems to be willing to take that step. The vendors won’t even make their systems available to students seeking to enter the Healthcare IT field. I recently completed HITECH Certification as a Workflow Management and Training Specialist, and one of the criticisms of the certification is that graduates are ill-prepared to work with EMR’s because they have never seen them. I went into this thinking that I would at least get to see a few EMR’s at an introductory level, but I ended rather disappointed that this was not the case.
I understand the hesitation on vendor’s parts. As a current employee of a software vendor in the Banking/Finance sector (which I strongly believe currently resembles what Healthcare IT will look like in a decade or so), I know how much emphasis is placed on security of the software product. I have only seen the briefest of looks at our competition’s products. But most of the banking products have the interoperability challenges ironed out; funds can be transferred between systems and institutions with ease. Of course, currency is far less complex than detailed medical records.
Interoperability is the future of EMR, and the current climate of so many vendors/products makes it very difficult to achieve that goal. The market is currently strong, but I think that in five years it will look very different from how it looks now. The number of products on the market will inevitably shrink as the weaker and less popular systems are weeded out through competition. Hopefully this will bring interoperability closer to reality, so that the goals that EMR adoption was meant to achieve can be realized.