January 31, 2017

2017 Healthcare Trends Part 3: The Rise and Fall of the EHR

Travis Good, MD

Co-founder & Chief Technology Officer

This 3rd part of the 2017 healthcare trends series looks at problems with EHRs, raising the question of whether their peak value has already passed.

Meaningful Use (MU) is dead but it succeeded wildly in increasingly the adoption of EHRs. In fact, MU was so successful that physicians have become the most overtrained and overpriced data entry workers in our economy. All of this data entry has been at the expense of patient care as evidenced by the time and attention given to record keeping and not spending time with patients. To be clear, there are benefits to EHRs in terms of standardizing documenting, analytics, and billing.

EHRs weren’t built for the future of healthcare

“Your margins are my opportunity.” Jeff Bezos

The problem with EHRs is that the government and health systems spent billions of dollars on software and organizational change that doesn’t address any of the challenges discussed in the first, second, and fourth articles in this series. EHRs weren’t built for the future of healthcare. Thankfully, change in healthcare is slow so the past and current state of healthcare will be around for a while.

Additionally, as other sectors like life sciences move to own the patient as the end user, they erode the value of the EHR as the main hub of clinical data. I guess Walgreens is the example of the opposite case as it is rolling out Epic but my guess is Walgreens rolled out Epic for the reasons I cited above, namely ease of integration with existing providers and provider data.

Gaining access to EHR data

Just because EHRs weren’t built for a future based on quality and value doesn’t mean EHR vendors aren’t rapidly trying to adapt EHRs to remain relevant for the future. One major example is easing access to EHR data through EHR integrations. There are major EHR vendors that made, and still make, significant revenue by charging hefty fees for interfaces and data access. The industry is demanding, and the EHR vendors are finally conceding to grant, access to EHR data. That access is seen as essential to enable future-facing tools for things like patient engagement, population health, and clinical collaboration. For at least four to five years now, major EHR vendors like Epic and Cerner have been talking about providing modern web interfaces for EHR data. There’s now a standard called FHIR that has been getting tons of attention as an API for EHRs. In 2017, we will see more and more EHRs providing access to snippets of data on an individual patient basis. It’s hard not to see that as a very small and intentionally slow step towards opening up access to clinical data so the industry can really start to understand the power of that data.

The other alternative for EHR data access is for providers to query a network of EHRs for data about a patient they are seeing. These networks of different EHRs have in this way. Epic already enables this type of sharing, in an Epic to Epic only way, for participating customers. Having a provider click, request, and view data from a different provider isn’t really harnessing the power of data and is not going to significantly improve outcomes or lower costs. It will help with some inefficiencies in acquiring records from other providers but this is barely even the low hanging front of clinical data access.

Are the glory days of EHRs over?

This lack of alignment between EHRs, their business models, and the direction of healthcare as it onramps to the cloud shows EHRs as the hubs of care and clinical data, at best, are at their peak value and, at worst, have already peaked. This has massive implications as EHRs are the major software vendors for care delivery and behemoth companies that represent a significant part, in terms of dollars, of the total health IT market. Similarly to non-healthcare enterprises, EHRs over time will be eroded like Oracle, Siebel, and SAP were by Salesforce, Workday, and Slack. This is a ten to fifteen year process that is only now just beginning but will eventually usher in the new guard of enterprise health IT as it moves into the healthcare cloud.

This will have a major impact on enterprise IT departments since many of those organizations have large proportions of people and budgets dedicated to managing EHRs. Additionally, most of the new guard of health IT will be cloud based and not on-premise, as most EHRs are today. The cloud, specifically the public cloud, is here now in healthcare. It’ll be years before major healthcare enterprises fully adopt and move the majority of compute workloads to the cloud but the migration is starting, it’s a big migration, and it starts with SaaS solutions that will chip away at the EHRs dominance. The broader shift to the cloud will drive additional significant changes to how enterprise IT operates in healthcare.

Next week, for the fourth and final article in this 2017 trends series, I’ll share “Healthcare costs and challenges are about a lot more than healthcare,” a look at the quest to reduce costs and improve outcomes in healthcare. Don’t miss part 1 and part 2 also. Be sure to follow this series by subscribing to our blog updates below.

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2017 Healthcare Trends Part 1: The Rise of Patient as Consumer

Travis Good, MD

Co-founder & Chief Technology Officer

This is the 1st of a 4-part series about high-level healthcare trends creating turmoil and uncertainty along with new opportunities in 2017 and beyond.

event-note January 16, 2017

2017 Healthcare Trends Part 2: Trump and Putting the Genie Back in the Bottle

Travis Good, MD

Co-founder & Chief Technology Officer

Here, in part 2 of our 4-part series on 2017 healthcare trends, we look at how Trump's unpacking of Obamacare might affect the healthcare industry.

event-note January 24, 2017

2017 Healthcare Trends Part 4: Healthcare costs and challenges are about a lot more than healthcare

Travis Good, MD

Co-founder & Chief Technology Officer

This 4th part of our 2017 Healthcare trends series looks at some of the not so obvious costs and challenges that add into the healthcare equation.

event-note February 9, 2017