Many in the health IT industry argue that meaningful use has inhibited EHR usability because electronic health record systems vendors have been forced to meet federal criteria rather than focus on building innovative products. But meaningful use now is winding down. So what does that mean for EHR vendors?
“The regulatory oversight list of desires is not going to go away; there will continue to be a high regulatory-driven bar of capabilities that will have to be there,” said Rick Poulton, president of EHR maker Allscripts. “But vendors need to start moving from regulation-driven investments to things that will deliver value to healthcare providers, things that will allow providers to continue to be effective in a highly changing healthcare world.”
Among the forces changing healthcare today are new, value-based reimbursement models, where providers increasingly are being paid for value delivered versus procedures performed.
“That will require modifications if not wholesale changes to the IT tools today,” Poulton said. “At Allscripts, we are trying to think of these macro trends as we spend our innovation dollars. Reimbursement changes and personalized medicine, for example, will become bigger parts of healthcare delivery in the future, and this change to a much more consumer-empowered world. And all of this has to be accounted for, for our healthcare providers. So these are areas we are thinking about a lot, in terms of where do we go from here. We have made investments in these spaces.”
On another note, many EHR market observers say the fray is on the cusp of a big switch, where hospitals tear out existing EHR systems and replace them with systems from different vendors. Allscripts, however, does not view providers taking that direction, especially for hospitals that have made large, enterprise investments. The key word there: enterprise.
“From our perspective, switching costs are large when you make a switch with a large enterprise system,” Poulton said. “So we adhere to ‘the four C’s’ – confidence, competence, cost-effectiveness and care. Do I have confidence that my vendor will be around for the long run and continue to invest in this platform? Is the vendor competent, delivering high-quality code? Is their solution cost-effective in this world of increasing financial strain? And does the vendor care about my success?”
Poulton acknowledged that every EHR vendor has at times failed on one or more of these C’s in the eyes of their clients. In other words, nobody’s perfect.
“But when you fail, that creates questions about where you go from there,” he explained. “Can you restore confidence or not? However, with confidence, the question then becomes, as a vendor, what can you do with that clinical repository of data in the EHR to help providers deliver better care? It is a tough business case to make to rip out a perfectly good EHR that is checking off all four of the four C’s. You are just spending money to spend money.”
And then there’s the issue of interoperability hovering over the health IT industry. All IT vendors, including EHR vendors, have to be moving in the direction of making their systems work well with other systems, passing data back and forth. Poulton said Allscripts has been working diligently on interoperability, especially when it comes to APIs.
“There is a story that doesn’t get a lot of attention,” he said. “There were two ways to achieve interoperability: One way was a national standard that governs how data would go from system to system, and the other approach is the one that happened, where the industry got there on its own as well as through incentives the government provided, and thus there were disparate solutions. A commercial market approach as opposed to the public sector dictating standards. And we might all be dead waiting for that standard to be developed to get IT tools out in a widespread fashion.”
When the dust settles and more progress is made on interoperability, there will be a consensus that the commercial avenue taken was indeed the better road, Poulton added.
“The real thing to focus on today goes to the prefix: interoperability as opposed to intraoperability,” he said. “Passing data elements within a single vendor’s set of solutions is easy, clients expect it. But how do we pass data between different vendors? That takes an attitude as much as technical delivery.”
Poulton points to the APIs as success with interoperability.
“That to us is the real definition of interoperability,” he concluded. “That is the real measure of things like interoperability. It’s actually happening today.”