Reaction Data recently published some research results that caught my attention: 39% of outpatient providers want to replace their EHRs and other technology tools in their departments.
The most common complaints? Poor fit, lack of features, and better alternatives on the market. Anyone who has spent time around health IT probably isn’t surprised by that list, although with only 5% citing it, I might have expected price to be a bigger factor. I’ve personally heard variations of some of the specific quoted complaints more times that I want to think about (“one system for an EHR and one system for billing that are not integrated, and are not equipped for the current needs of the practice” rings very true).
On one hand, it’s tempting to blame the vendors and think “man, none of this should be so hard!” because it probably shouldn’t be. Nobody at these companies is sitting around, twirling their mustache, and plotting out user-hostile business and product decisions. So why are so many failing their customers?
There’s no breakdown in Reaction Data’s report about the age of the tools used by the survey respondents, but I’m going to guess that most dissatisfaction is with older software. Here’s where I sympathize with the vendors: software development can be slow, hard, and expensive. In healthcare, that’s basically a given. Any company that’s managed to bring a solution to market and find a customer base has already beaten the odds, and it doesn’t necessarily get easier from there.
You still need a team to fix bugs, make updates, and otherwise maintain the application. That work also needs to be tested and pass QA, get integrated into production and then deployed and supported. Non-trivial updates are likely to require security and compliance reviews. Just keeping an application viable — to say nothing of market leading — might require the full-time work of a whole team.
Also, unless you want another mouse to come along and get your cheese, you need to be thinking about and building your next major update, which, given the speed at which the industry moves, might share little (if any) code with the current application. (It’s never felt quite right at the time, but sometimes it’s easier and faster to just start over from scratch. I have swallowed that pill.) This too can be full-time work, and may even require a new team depending on how different the new version is. Releasing a new version doesn’t mean the job is done: clients need to approve the update, new security reviews need to be performed, interfaces and integrations may need re-engineering, and users need to be trained. That work comes with weighty business decisions. The most obvious is probably whether to make upgrade free (the cost of doing business) or asking you clients to pay (risking, among other delights, unhappy customers and maintaining disparate application versions).
Even if it all works out, and despite your best efforts, the ground can always shift beneath you: a major EHR player adds a module or announces a partnership that directly competes with your application. Interoperability standards change. Again. A government incentive program gets cancelled. Related systems that don’t work with your application gain adoption and whomever pointed the finger first — spoiler alert, probably not you! — wins the political battle. With these challenges (and many others!), it’s no surprise that nearly 40% of providers are looking to change their systems. Still, there are reasons to be optimistic.
Although healthcare as a whole still lags behind other industries with respect to technology, the gap seems to be closing. The “just say no” approach that many of the gatekeeper have traditionally taken shows signs of softening, likely due in part to government regulation, increasing openness and better interoperability of systems, and the ubiquity of mobile devices changing everyone’s expectations about connectivity.
Small organizations now have a wide variety of compliant tech offerings available in the form “[insert noun] as a service” that make rapid development, deployment, and scaling possible. Four of the Big Five tech companies have made aggressive moves into healthcare. More and better APIs, the promised adoption of FHIR, and a move away from local applications and towards web-based and mobile applications will speed up development time and make it easier to find talent.
The current promise is to have healthcare and hospital applications be as simple to use and easily replaceable as the apps on a smartphone. That’s…probably not going to happen, but it’s a worthy goal to work towards that, ideally, will create an environment where vendors will have the ability to innovate, build, and improve their products and 39% of providers won’t be stuck with systems they don’t want anymore.