The Un-Intended Consequences of ASP EMRs

In the past it was all about encouraging doctors to adopt EMRs.  Part of using an EMR meant maintaining the computer systems upon which they run.  But that is not core to a medical practice – and not something most physicians want to deal with.  Doctor’s don’t want to be bothered with maintaining computers, doing backups, worrying about what version they are running, etc.  They want to practice medicine.  So – a reasonable solution in the last 5 to 10 years was to move all the maintenance, backups, etc. into the world of Application Service Providers (Hosted Applications).  This solved the doctor’s issues with having to take care of the computer ‘stuff’ and let them concentrate on what they do best – help patients with their medical issues.  Yes – there were higher monthly fees and the occasional issue with Internet connectivity, but the computer hassles were largely taken out of the day to day lives of the clinics and it was seen as generally a good thing by most physicians and clinics.

 However, looking at it in view of what is happening today in the field of Health Care Analytics, it might not be as positive, moving forward, as it was once viewed.  The real value is no longer in the EMR itself – but in the data they contain.  Over the next few years Health Care Data Analytics will only continue to get bigger and drive more of the revenue in the medical system.  Whether we are talking about changes to the ‘Fee for Service’ model, or just being able to do real research on medical conditions – the data will be the driver.  Just look to the USA’s Meaningful Use push to see where the world is moving.

 Now, if the data is now the most important asset a clinic or physician might have – then it should be important for them to be able to control and utilize that data.  If an organization does not understand and utilize their most important asset – then they are doomed to be controlled by those that do.  This brings us to an un-intended consequence with ASP EMRs.  The doctor does not have real control of their own data.  It is stored remotely in data centre controlled by their EMR vendor.   What happens if the clinic would like to participate in an EMR research study?  How do they get ‘access’ to their data?  The simple answer, in most cases, is that they are dependent on the EMR vendor to provide the data to them so that they can provide it to the research organization.  How long will it take to get the data?  Does the vendor already have the export format that the physician will need?  Or will it have to be developed?  Then there is the subject of cost!  The vendor will charge the clinic to get access to their own data.  The vendor has to in order to stay in business.  The question is what is a fair charge?  I have seen a vendor charge $2,000 just to provide a single backup of the clinic’s database (which took a grand total of 15 minutes to create).  How many studies could a clinic participate in if they had to pay that fee each time?

 I am not against ASP EMRs, in fact I think they can offer some excellent value to clinics.  However, with the health care world moving toward a more and more data centric view – where will clinics that have their most valuable resource under someone else’s control fit in?  Will they be able to participate in the studies and research initiatives?  Will their patients be able to benefit from being part of these studies?  What if any are the possible solutions to the situation?  Standard APIs would be nice – but as we have seen getting everyone to cooperate and exchange data nicely is still just a pipe dream…

 What are you thoughts?