John Haughton MD left this thought-provoking follow up to his original post on the Obama administration's health IT plans. ("Stimulus Bill Offers Docs Incentives, But Demands Effective Use")

"Since writing the post 2 weeks ago, the Stimulus bill has now passed.  It does offer the $40K + bonus for "effective use" of a "qualified EHR" (DISTINCT FROM CURRENT DEFINITIONS OF EMRS / EHRS) – The bill specifically targets FIVE AREAs (which by the way are the evidence-based areas associated with HIT and care improvement):  1) Patient Info / History and Problem lists (Structured Data); 2)Clinical Decision Support.  3) Quality Reporting (performance measurement)  4) Ordering (including prescribing)  5) Interoperability (exchange and integrate with other sources).

All of the above can ENHANCE workflow and health by saving time and improviing care.  There is no push in the bill to completely change office workflow – there is a push to enhance patient care. 

The days of the $40K EMR are numbered.  Here's a prediction:  most physicians will spend no more than $10K each over a 3 or 4 year period (2010 – 2013) to acquire and use a qualified system – leaving an increase of dollars flowing into primary care – a great stimulus. What do you think?

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  1. There already are a number of EHR in the $10k a year range. The question is how many of the CCHIT certified EHR are in that range. Not very many. If CCHIT becomes the certification criteria that HHS uses, then your prediction will not come to fruition.
    Also, don’t be at all surprised if many doctors ignore the stimulus altogether. Those that do pay attention will hear about the missing bonus payments from ePrescribing due to some government requirement and shy away from this stimulus as well.
    The big winners are the EHR vendors who will sale many more EHR under what I consider false pretense. The next biggest winner is the doctors who have already implemented an EHR and can get higher reimbursements with only a little extra red tape and paperwork.
    Was the goal of the stimulus to increase EHR adoption? I hope not.

  2. “Here’s a prediction: most physicians will spend no more than $10K each over a 3 or 4 year period (2010 – 2013) to acquire and use a qualified system”
    Prices will go down, if for no other reason than economies of scale, but I doubt they’ll go down that much that quickly. A few SAS or partial SAS vendors are making headway and will continue to grow market share, but I’d be shocked if they took over 50% market share in 2010. That seems to be what your model requires.
    Don’t forget that of the current average $30,000-$45,000 per physician cost to implement an EMR, over half of that is not the software. It is extra hardware, staff training and lost revenues during and right after implementation due to reduced visits.
    Even an EMR that costs $1,000 for software and support will cost well over $10,000 on average to implement, assuming that it is actually used to do all the things HITECH requires.
    Of course, even at $45,000 total implementation cost, an EMR now becomes a good deal for physicians who qualify for the Medicare or Medicaid payments. Well, maybe not for physicians in solo practice or those near retirement, but everyone else.