Digital Health is Underfunded

digital health is underfundedOverall venture capital funding made a sharp decline in the last two quarters amid worries (justifiable or not) of a bear market and a funding bubble in technology investments. In contrast to the tech market, however, digital health funding continues to grow at a record pace. According to Rock Health, $4.5B was invested in digital health in 2015 (an increase from $4.3B from 2014) and $981 million has already been invested in the first quarter of this year. It seems on pace to be another stellar year, which is remarkable considering what is going on in other sectors.

Many are skeptical about the investment potential of healthcare technology investments and have been wary to enter the market (perhaps especially so with all the negative media that companies like Theranos and Zenefits have attracted). Additionally, regulatory barriers and the longer timeline needed with healthcare innovations tend to scare potential investors away.  But anyone familiar with the sad state of technology in healthcare can see, even with the record-breaking investments thus far, that there continues to be an enormous untapped opportunity in healthcare–greater, I believe, than in any other sector.

Digital health is vastly underfunded.

Technology is taking over most of our personal and professional lives with indispensable apps, wearables, and other connected devices and software. At home, we have smart appliances, lighting, thermostats, security systems, media systems, and even smart cars. And we have Siri, Cortana, and Alexa doing our bidding. But in healthcare, we’re still in the Stone Ages in terms of technology. Communication via faxes, for example, is still common between hospitals and doctors offices. There are small glimmers of hope, such as patient portals, higher-functionality EMR systems, and telehealth services, but the fact is that we are still a far cry from the ideal vision for healthcare, which includes a seamless cloud-based network of devices and software that can track and record a vast spectrum of patient information, the ultimate goal being the use of computational technology to help prevent, predict, diagnose, and yes, even treat disease. Ultimately, collecting information on large populations of patients could have profound impact through public health measures that can prevent disease and thereby reduce healthcare costs. This can only be accomplished with a wide-spread network of software and devices, that includes electronic health records, wearables, devices based in the hospital, office, and at-home, and with telehealth capabilities. In addition, there are too few companies working to collect, store, manage, and interpret health data.

There is still a lot that needs to be done.

According to MarketResearch.com, the healthcare “internet of things” (IoT) is expected to reach $117B by the year 2020. The fact is, the full potential of digital health won’t be seen until every hospital and doctor’s office and home is connected via cloud-based devices and software and with the development of machine learning platforms that can make sense of the reams of health information.

It is a little challenging to think of all of this in the abstract, so here are a few examples of the potential of the healthcare IoT. Imagine that a spike in certain population health data (like temperature) is detected in a region of the country that alerts public health officials to early to a disease outbreak that can then be contained to prevent an epidemic. Imagine that a change in an individual’s biometric data alerts that person to seek medical care, detecting a life-threatening disease, like cancer, early and improving the chances of cure. Imagine chronic health conditions like diabetes are monitored routinely and continuously with real-time blood glucose levels, with immediate adjustment by doctors of insulin dosages, thereby preventing hospitalizations due to uncontrolled diabetes, and also preventing long-term diabetic complications, such as kidney disease.

These are only a few examples.  There are countless other opportunities in healthcare.

In addition to the opportunity to improve healthcare delivery, there is the opportunity to improve the quality of care through tools that provide greater communication and transparency of information with patients and improve care coordination between the providers of those patients. And by changing the focus of medical care to prevention and early diagnosis of disease, there is the opportunity to decrease the outrageous cost of healthcare as well, by decreasing the need for excessive medication, surgery, unnecessary visits, and hospitalizations. According to the Commonwealth Fund, in the US we spend an outsized proportion of our GDP on healthcare versus other countries. Other developed countries spend between 8.8%-11.6% to our 17% of GDP, related in part to better-connected health IT networks.

It’s hard to fathom how much digital health tech is needed to serve a US population of 318 million and a global population of 7 billion, but one thing is certain: the market is huge.  We should stay bullish on health tech investments now, and probably for a long while to come.

 

Don’t Count Out Theranos

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The past few weeks haven’t been easy for Theranos, the pioneer hoping to make blood diagnostics a whole lot easier.

A scathing account by The Wall Street Journal, followed by some troubling documents released by the FDA, armed critics of the upstart start-up. The company clearly needs to counter these charges and demonstrate efficacy of its tests and the soundness of its business model.

However, change isn’t easy even in an industry like blood testing, which must be disrupted. We are literally still drawing vials and vials of blood for laboratory tests. This procedure seems only a shade better than the days of medical bloodletting with leeches. Also, these tests are notoriously expensive and have slow turnaround times.

What if Theranos CEO Elizabeth Holmes is on to something here?

What if her vision of easier, faster and cheaper blood testing is really possible? Wouldn’t we all like to see that? Blood testing is a very fundamental aspect of medicine and improving the current antiquated process has the potential to truly transform health care in a big way. Imagine how many more people might be compliant with their blood tests with this type of testing. Imagine how much faster we’d get results in critical situations, and how many lives might be saved. Imagine how much we could save our very wasteful and expensive health care system by making this process cheaper.

Before you say it’s impossible, let’s remember that the FDA did approve one of Theranos’ tests via its nanotainer technology, a test for the herpes simplex virus (HSV). That is an impressive feat, and quite frankly, I’d really like to see what other tests Theranos has been able to do via its tiny nanotainers. According to Holmes, the firm has something on the order of 120 tests submitted for approval with the FDA. Squash them now and the world may never know.

The media frenzy circling Theranos is unfortunate, and we should all hope it won’t kill off something that could really transform health care for the better. We shouldn’t be trying to protect the status quo in our dysfunctional health care system. Instead, we should be less hasty to judge Theranos.

Let’s keep in mind when we read media reports that there are a lot of stakeholders embedded in the health care industry – from equipment makers to laboratories to walk-in clinics and pharmacies – that might like to see Elizabeth Holmes fail. Some of these players currently own the market. That means they dictate the availability, the turnaround times, and yes, the price of these tests. Sure, maybe they could innovate also, but there’s inherently less motivation when you’re already a market leader. How about we introduce some competition to drive prices down and introduce more motivation to innovate?

Theranos, admittedly, has a lot of work to do. It is trying to disrupt the entire laboratory industry, while currently having just one FDA-approved test. I’m hoping more of its technology will meet FDA approval. In the meantime, it makes business sense to offer venous blood draws. If the company wants to capture enough of the market, it needs to offer the full spectrum of services to customers, be it using its proprietary technology or the industry standard.

As for Holmes, I can’t blame her for being protective of her nascent company. Unfortunately, people tend to be suspicious of things they don’t know much about, so that approach is not going to work anymore. Her challenge in the coming months will be how to effectively share more information with the media and increase transparency, now that she and Theranos are much more in the public eye.

There’s reason for optimism, not paranoia, about Theranos. Let’s allow some room for its visionary leader to carry out her ambitions. Maybe, just maybe, she’s on to something that can change health care, and the world, for the better.

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Conflict-of-interest disclosure:

I have no financial or other ties to Theranos or Elizabeth Holmes. My biases include wanting to see positive health care change and more women leaders. The opinions I’ve expressed here are my own and not those of any of my employers or affiliates.

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This article was originally published at www.digitalhealthcaresummit.com.

Cool Startup: RubiconMD

RubiconMD team sitting 2

Primary care practice stands on the precipice of radical transformation as emphasis shifts from offering volume-based to value-based care. Look no further than the recent Supreme Court ruling to see that the ACA and its mission are becoming further cemented into the U.S. healthcare system. The goals are lofty: higher quality and greater access to healthcare at a lower cost. For most, it’s hard to imagine what this healthcare landscape will look like in the future.

But Gil Addo, the CEO and founder of the NYC- and Boston-based healthcare startup RubiconMD, seems to know. His novel vision of the future involves shaking up the traditional model of primary and specialty care practice in medicine.

A Yale and Harvard Business School graduate, Addo’s experience as a consultant and in commercializing innovation has included industry stints at both large and small tech and biotech companies. In early 2013 he met co-founders Dr. Julien Pham, a physician formerly on faculty at Harvard Medical School, and Carlos Reines, another Harvard MBA.

As of December 2014, they have raised over $1.4 million funding and support from major investors, including athenahealth and Waterline Ventures.

We sat down with Addo recently to talk about this innovative company and discuss his plans for the future.

Tell us about what you do at RubiconMD.

RubiconMD is meant to enhance access and bring appropriate specialist expertise into the primary care setting. The patients will see their primary care providers and whatever the issue is–if it is outside the PCP’s expertise and results in a referral—the physician can upload any relevant information, such as images, labs, and studies, and ask questions. We figure out who the most appropriate specialist is and then route the case to them so that they can respond within a few hours.

That’s the crux of the entire interaction. It’s a clinician-to-clinician electronic consult.

How did you get the inspiration to start RubiconMD?

I was very interested in this problem of enhancing access and wanted to find a way to solve it. I had a personal experience that motivated me to take this on. I had a grandmother who had to travel thousands of miles to Boston for treatment of a brain tumor, and then back and forth for all the follow-up. Why couldn’t her local provider oversee her care with appropriate support? There had to be a better way.

I traveled to India and looked at different healthcare delivery models and found that better way. There they have an extreme version of what you see everywhere: the appropriate expertise is in a concentrated area and people are everywhere else, so they bring the appropriate expertise into community health centers.

I started iterating on that model and borrowed things from other settings until I arrived at a solution that fit the U.S. healthcare market. RubiconMD allows increased access to the right specialist and brings that expertise into the primary care setting, to the front line.

How did you figure out if this might be something that primary care physicians would actually be interested in?

Once we figured out that the idea made sense at a system level, we had to figure out if this was a solution that physicians would use. Julien brought his clinical expertise and introduced the idea of “curbside” interaction, an informal and natural way that physicians interact with each other. We were able to validate the model on a small scale and see that physicians would actually use it and find value.

We ran a larger scale pilot to see if this would save people money. We used two large clinics with a panel of specialists and ran it across 15 or so specialties. The findings have been remarkably consistent.

  • In a third of the time, this support avoids a specialist visit. This has been consistent across all deployments and different populations.
  • Another third of the time this process improves the referral. You’re able, even though you’re referring, to send along the appropriate labs and studies and waste less time. And you make sure the patient goes to the right specialist.
  • For the remaining third of the time, it’s peace of mind. It validates what you were going to do.

The cost savings is from improving care outcomes and avoiding duplicate and inefficient use of resources. Almost $300/per opinion is saved, aside from other benefits such us reducing wait time and avoiding ancillary costs to patients.

Is this billable to insurance?

It is not. Right now, we work with value-based organizations incented to provide high quality primary care in the most affordable way possible who see this as a way to extend their capabilities, provide better and more timely care in the primary care setting and avoid unnecessary services.

Payers show interest, as this is a great tool to enhance outcomes and reduce costs while improving patient satisfaction.

What are the challenges that you’re having? 

No shortage of challenges. We focus on the sphere of healthcare that is value-based and incented to provide high quality care at the lowest cost. But U.S. healthcare still has a very large fee-for-service component and the biggest challenge is that we’re dealing with so many groups fighting themselves. It’s a system in transition. We’re trying to bring this into that environment and show them how we help them transition. It’s tough but enough of the market has moved and enough changes in primary care have happened that we have been able to gain momentum quickly.

What are your next goals, short-term and long-term?

Short term, we want to continue better servicing our customers, provide better tools to meet their needs and fit even better into workflow. We’re obsessed with enhancing workflow and not making additional work — providing a tool that syncs with the way physicians want to practice medicine.

Long term, we’re focused on the idea of democratizing medical expertise. As our longer-term vision, we want this to be the default. We want people to think of RubiconMD as the way to get high quality consults more efficiently and locally so that there’s no barrier for clinical expertise.

This article was originally published at MedTechBoston.com.

A Peek Inside the Harvard Forum on Health Care Innovation

Prof. John Quelch discussing the Bloodbuy case study.

The Harvard Forum on Health Care Innovation, a joint collaboration between Harvard Business School and Harvard Medical School, was recently held in Cambridge, Mass, on April 15-16, 2015. This private, invitation-only event assembled an elite group that included HBS and HMS alumni and faculty, as well as other key opinion leaders in healthcare. Cara Sterling, Director of HBS’s Health Care Initiative, who organized the event, shared that the goal for the event was to provide an opportunity for “people from different sectors to come together and talk freely” in order to “spur innovation in healthcare.”

One key aspect of the event was the introduction of the finalists of the HBS-HMS Health Acceleration Challenge, a contest that was launched to seek innovative, early-stage healthcare ventures that have great potential for transforming healthcare.

Out of a total of 478 applicants, 18 were selected as semi-finalists; from those, four of the brightest were chosen as finalists to share a $150,000 Cox Prize. They’ve also had an HBS case study written about them, and each team presented and received feedback at this year’s Forum. The final winner will be decided in a year’s time, by identifying the startup venture that is most successful in disseminating and scaling their healthcare solution.

Look out for the great work of these four finalists in the coming year:

  • Bloodbuy is a startup that aims to improve the efficiency and price transparency of the blood supply market by matching blood centers and hospitals through an online, cloud-based platform. In a pilot program, this system was found to decrease hospital costs by 23% while also decreasing the risk of blood shortages and the waste of blood products.
  • The I-Pass Patient Handoff Program is a training curriculum developed by six clinicians to improve the exchange of patient information between providers that occurs at the change of a shift. A research study of this intervention, published in the New England Journal of Medicine, found that use of I-Pass led to an impressive 30% reduction in medical errors.
  • Medalogix is a predictive analytics company that has created a product to that can assist those in the post-acute care sector to better identify hospice-eligible patients. Through working with Medalogix, clients have been able to successfully increase transfers to hospice from home health care and decrease the number of live discharges from hospice.
  • Twine Health is a startup that has created a cloud-based, collaborative care platform of the same name that enables providers to partner with their patients through coaches to provide seamless care and support for the management of chronic disease. In a recent clinical trial, Twine more efficiently helped patients achieve blood pressure control, which resulted in cost-savings (versus the traditional model of care).

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In addition to the Health Acceleration Challenge finalists, there was also an impressive line-up of healthcare experts that shared their thoughts throughout the two days in keynotes and panel discussions. Below are some of the highlights:

Value in Healthcare

Speaker Peter Orszag, Vice Chairman of Corporate and Investment Banking and Chairman of the Financial Strategy and Solutions Group at Citigroup, discussed three major structural forces that he feels will have a major affect on healthcare quality and spending, including the shift to value based payments, digitization of healthcare, and the increased role of the consumer in healthcare spending. He also discussed three big unknowns and their future impact on the heathcare cost curve, namely: future policy changes, increasing consolidation of the healthcare market, and emerging healthcare innovation.

A Blueprint for the Future

Mark Bertolini, Chairman and CEO of Aetna, gave a keynote speech entitled “A Blueprint for a 21st Century Health Care System” in which he highlighted five key measures that hold promise to improve healthcare:

  • System re-design that enables lower cost, higher quality care with increased access
  • Sophisticated health IT systems
  • Care optimization, especially to coordinate care for the 5 percent for whom most healthcare dollars are spent
  • Aligning economic incentives with healthcare goals
  • Increasing patient engagement.

Employers as Innovators

In an engaging panel discussion, moderator Bryan Roberts, Partner at Venrock, discussed the growing role of “employers as innovators” with expert panel members Ellen Exum, Director of Benefits/Global Design and Strategy at IBM; Adam Jackson, CEO and Cofounder of Doctor on Demand; Brian Marcotte, CEO and President of the National Business Group on Health; and Derek Newell, CEO of Jiff.

There was a robust discussion regarding the use of wearables and other tools as part of wellness programs to increase engagement and compliance, and to hopefully improve outcomes. One example was Adam Jackson’s Doctor on Demand which, for $40 per telehealth visit, has been found to decrease costs, decrease absenteeism, and increase productivity and morale.

Focus on Neurologic Disease

In a discussion with William Sahlman, Professor of Business Administration at HBS, Deborah Dunsire, MD, President and CEO of FORUM Pharmaceuticals shared her company’s mission of tackling neurological disease. Costs to society due to neurologic disease are great, she argued, not just in terms of direct costs, but also indirect costs – and there should be increased focus in developing treatments for these disorders. One significant challenge is the lack of mental health advocacy, which is an obstacle to obtaining funding for research.

The “Retail-ization” of Healthcare

Speaker Helena Foulkes, President of CVS/Pharmacy and Executive VP of CVS Health, shared the key factors that she feels are driving the “retail-ization” of healthcare:

  • Excessive spending on chronic disease
  • Increasing number of baby boomers on Medicare
  • Rising use of the internet to research health information online
  • Growing numbers of employers with high deductible plans.

She also shared the initiatives that CVS has begun to help tackle these problems, which include drug adherence programs, a focus on patients with the greatest needs, and integrating digital tools.

Dr. Watson Will See You Now

Speaker Mark Megerian, Senior Tech Staff Member at IBM Watson Solutions, shared the exciting (and for some, frightening) prospect of using machine learning and predictive analytics to make clinical recommendations via IBM’s Watson program.

Trained at Memorial Sloan Kettering (MSK), Watson has been shown to be capable of making recommendations similar to MSK oncologists, with 97 percent accuracy, for breast, colon, rectal, and lung cancers. They are now scaling to include other types of cancers and also to involve other organizations.

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Closing remarks were given by Dr. Jeffrey Flier, Dean of HMS, who shared that he feels healthcare delivery innovation has been sorely lacking, and that HMS and HBS are now deeply committed to medicine and entrepreneurship. Harvard hopes to lead healthcare innovation in the future. From the look of this year’s very promising Health Acceleration Challenge finalists, it seems his wish is likely to come true.

This article was originally published on MedTechBoston.com.

Electronic Health Records: Opportunities

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As discussed in the previous article in this series, the broad adoption of electronic health records (EHRs) has presented healthcare professionals with numerous challenges. It’s not surprising that many of us are left wondering: Will all of this effort to rapidly adopt EHRs even be worth it in the end?

Where We Are Now

To better understand this, it’s helpful to first take a closer look at the current state of the U.S. healthcare system. In 2000, the Institute of Medicine released their landmark report, To Err is Human, which exposed the alarming number of deaths that occur as a result of medical errors in the U.S. This was a big shock to many who assumed that the American healthcare system was the best in the world. To add insult to injury, we also discovered around that same time that healthcare costs were skyrocketing – in fact, they had doubled from 1993 to 2004.

According to the Commonwealth Fund, the United States today has the most expensive healthcare system in the world, spending about $8,500 per capita, or nearly 18% of our GDP, while also consistently ranking dead last in overall performance and quality compared to all other industrialized nations. One can’t help but wonder: What are other countries doing that we’re not? Well, two things in particular stand out when we compare our healthcare system to theirs: 1. A lack of universal healthcare coverage; and 2. A lack of high-functioning, fully-integrated health information systems. It turns out that our international counterparts have surpassed us when it comes to providing high quality, affordable, and accessible healthcare. One of the key elements of their success has been harnessing health IT.

Opportunities to Consider

Considering all of this, it’s no surprise that we have had bipartisan support for the expansion of EHRs from both Presidents Bush and Obama and that we continue to invest in creating a fully interoperable, nationwide network for health information. If EHRs can be harnessed properly, they promise to deliver lowered healthcare costs, improved quality, increased access, and improved population health. Let’s take another look at those challenges presented in the last part of this series. Where are the opportunities in these challenges?

1. Cost

Despite the high costs of implementing new EHR systems, there are also numerous studies that report that high-functioning EHR systems can help to decrease costs in the long run. One study found a 12.9 to 14.7% reduction of duplicative testing with the use of computerized provider order entry (CPOE) and clinical decision support (CDS) in an outpatient setting. Overhead costs may also be decreased through the reduction of chart pulls and from reduced paper, supplies, and storage costs, as well as via decreased transcription costs. Efficiencies can also be gained in billing processes with improved and complete documentation, improvements in the charge and capture process, and through decreases in billing errors. A study from Massachusetts found that paid malpractice claims may also be minimized with use of EHRs vs. paper records (6.1% vs. 10.8% paid claims).

It remains to be seen if EHR-induced savings will be favorable versus the cost expenditures required to operate them. But these studies show that there’s reason to be hopeful.

2. Quality & Communication

Investing in a high-quality EHR system has also been shown, in some studies, to result in higher overall quality, improvements in safety, and decreases in delayed medical decision-making. A study of hospitals in Florida found that those with greater investments in health information technology scored higher in quality measures. A similar study found that those hospitals with greater investments had lower patient complications and lower mortality rates as well. Other research has demonstrated that high-quality EHR systems improved prescribing patterns, too. In these ways, EHRs may support improved outcomes and thereby reduce malpractice and liability risks.

Highly interoperable EHR systems have also been credited with improving the communication and coordination of care between providers, and with decreasing delays in medical decision-making that can result from having to wait for the transfer of medical records. A strong health IT system can also enhance communication between providers and patients and help to foster increased patient engagement through the use of applications such as patient portals and interfaces with radiology, laboratory, and medical devices. Patients may be more apt to become actively involved in managing their health and participating in shared decision-making as a result of having easier access to their health information. 

3. Access 

Another advantage of EHRs is that they can help to provide convenient and timely access to a patient’s health record. We’re still a far way away from a fully transparent nationwide (or global) healthcare network, but these advances are coming. In addition, as the telehealth and mHealth market grows, and as we see better integration of other platforms with EHRs, we will likely see a huge revolution in access to personal health information. This need is especially urgent in light of the dire shortage of primary care physicians. Telehealth capabilities of EHRs may very well be the solution to providing access to medical care for patients in underserved or remote regions.

4. Population Health

As we succeed in integrating systems and improving interoperability, we will have the ability to aggregate huge amounts of health data for entire populations of patients. This “big data” can be used to conduct population health research, which can help identify patterns such as risk factors for diseases. With this, physicians will be better able to recommend preventative measures and evidence-based best practices. This information can also be harnessed to change practice patterns and hopefully, to affect positive healthcare outcomes on a broader scale. EHRs can also help to enhance reporting capabilities, which may help identify potentially dangerous outbreaks or treatment-related risks quickly, so that they can be managed in a more timely and effective manner.

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The Bottom Line

EHRs hold a great deal of promise to truly transform our ailing healthcare system. How well we succeed will depend in large part on how we can overcome and manage key challenges affecting cost, interoperability, safety, and patient-centered care. It remains to be seen if the cost-to-benefit will be ultimately favorable, but these preliminary findings and evidence of international success give us reasons to be hopeful.

This article was originally published on MedTech Boston.

Electronic Health Records: Challenges

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In just a decade, medical documentation has transitioned from mostly paper records to mostly electronic records. According to the Department of Health and Human Services, 78% of office-based physicians and 59% of hospitals use a basic electronic medical record (EMR) or electronic health record system (EHR).

The Beginning

This move came about largely due to a strong governmental push that began in 2004 with the establishment of the Office of the National Coordinator for Health Information Technology (ONC) by then-President Bush. The office was tasked with the goal of supporting the expansion of EHRs and helping to create a nationwide network. Not long after, in February 2009, the American Recovery and Reinvestment Act was passed under President Obama, pushing $19 billion toward the development of health information technology through the HITECH Act. This was further bolstered the following year with the passage of the ACA, which infused even more money into the system, established Meaningful Use measures and began innovative pilot programs to study ways in which high functioning EMR systems could help to improve quality of care and reduce healthcare costs.

Challenges, Galore

These rapid regulatory changes have presented major challenges to office practices and hospitals as they try to adapt to the new requirements while also remaining operationally and financially sound. Despite the huge investments that have been made in new technology, there are conflicting opinions about the value of EHRs and whether or not they will truly help improve quality of care while decreasing costs. A recent study by Medical Economics indicated that 67% of physicians are displeased with their EHR systems. Complaints about EHRs abound, but the most common include the following: high cost, weak functionality and interoperability, safety and liability risks, and interference with physician-patient and physician-to-physician relationships.

1. High Cost

Investing in EHRs can seem ironic when one of our major concerns in healthcare is skyrocketing costs. System-wide implementation of best-of-breed EHR systems, such as Epic, can run in the hundreds of millions of dollars. Beyond the up-front investment, budgets can also be blown by unexpected vendors’ fees, upgrades or ongoing maintenance needs. Unfortunately, it’s not uncommon these days to hear of hospitals going bankrupt as a result of underestimating their technology spending. Organizations must consider not only the hardware and software, but also the costs of implementation, training, support, and the potential loss of productivity during the startup phase. There’s also the concern that as consolidation occurs (with larger vendors buying up smaller ones), organizations may need to purchase entirely new EHR systems as their present systems become obsolete.

2. Functionality & Interoperability

Incredibly, there are over 1,000 electronic medical record platforms out on the market today. There are the big players with recognizable names – Cerner, Epic, Allscripts, NextGen, athenaClinicals – but there are also countless smaller vendors, some of which provide customized EMR systems for specialists. Functionality varies greatly with each system: data entry can be inefficient and time-consuming for certain systems, but not others. Other functionality issues can include slow processing, formats that are not user-friendly, or limited capabilities. Most of these systems are also highly proprietary and may not communicate well with each other. This lack of interoperability presents a barrier to the transparent communication of health information, preventing adequate coordination of care on the small scale and obstructing population health management on a larger scale. The ONC is currently working on an interoperability standards advisory that will hopefully better guide organizations as they try to develop networks with disparate EMR systems.

3. Safety & Liability

As the saying goes: “garbage in, garbage out.” An EHR system is only as good as the information that is put into it. If documentation is poor, unreliable, or unable to be accessed when needed, it poses a threat to quality of care. Additionally, there may be information in the record that should be reviewed but isn’t brought to a provider’s attention, which poses yet another kind of safety risk. We saw this happen at Texas Presbyterian Hospital in Dallas during the Ebola outbreak. Technology can also be at risk for programming errors, glitches, and power failures, paralyzing normal day-to-day functions. And, as we have heard many times in recent days, technology is at risk for data breaches, posing a threat to patient privacy and confidentiality by exposing personal health and financial information. In all of these cases, organizations can become susceptible to significant malpractice and/or liability risks.

4. Professional Relationships

Physicians like Dr. Adrian Gropper, CTO of the non-profit Patient Privacy Rights, are concerned that current systems are interfering with physician-patient and physician-to-physician relationship. Providers often complain that EMRs interfere with clinical care, making interactions more impersonal and less face-to-face, while also degrading clinical documentation. And disparate systems with poor interoperability make it difficult to communicate with other providers as well. Additionally, as organizations adopt legacy systems, referral patterns change, favoring those providers that are network-enabled and putting other, independent providers at risk of being marginalized. There’s also the growing pressure for physicians to meet state and federal health IT mandates. In an environment where there is already a shortage of primary care physicians, there is concern that EMRs will heighten physician dissatisfaction and drive a further shortage of physicians.

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These challenges are formidable, but can they be overcome? Read part 2 of this series tomorrow to learn how EHR systems can create opportunities for improving healthcare delivery.

 This article was originally published at MedTechBoston.