Brad Holmes from Forrester breaks up docs by age (under 44 makes them much more accepting of technology). Breaks up demand for software based on what docs want. Want ePresribing and charting, get Medicalogic (GE). Want diagnosis, use Next Gen. So you buy based on what you do. No one size fits all. BUT PMS systems revenues going down, EMR applications are taking off and 2004 will cross the line of PMS revenue

Blackford Middleton (ex Medicalogic, these days at Partners Healthcare in Boston) has worked out the cost-benefit model for rolling out their "LMR". Now used by 3500 of their 7000 affiliated physicians. The biggest impact is for drug savings, by using the on-formulary drugs. For CPOE there are levels; most basic is structuring data capture, second is providing some patient data, third is decision support based on algorithms and the patient record. Partners has the most advanced, and the result is that per provider saves up to 9 ADEs per year and costs savings of up to 28K per year per provider. Most valuable ones have by far the most impact ($28K per year vs $3k). For systems capitated at 14% they think this will cost solo providers a whole lot, and only save money for big groups. BUT Of all the benefits, only 11% go to the physicians. The rest goes to everyone else in the system, primarily the payers.

Gloria Austin from Brown and Toland, a 100% capitated group in San Francisco is just getting their EMR modules up (and now have lab data online) by working with affiliated hospitals, etc , etc. It’s an interesting talk (although her charts suck for readability) but I think it’s mostly irrelevant to most physicians in the US. But they are focused on implementing the EMR by concentrating on providing the physicians with the benefits, and creating the infrastructure foundation to do that. This process started for B&T in 2000 and its taken them till now to get it up. What is it costing them? $8m in first 4 years and another $10-12m going forward. Using IDX Flowcast and Allscripts Touchcast (because they were already using them and the integration was easier) plus you can import this into the Business Intelligence tool they use (Cognos). And in a nutshell this is really, really hard work, and costly organizationally to do. But she believes that you can create a seamless group that looks like a Palo Alto clinic, or a Kaiser.

Blackford said it, in reply to a question from me….there are potential operational improvements for small and solo docs (not just savings to capitated systems) but we have a major public policy problem getting these physicians to the table. And (he didn’t say) no real answers.