Uncertainty remains in EMR market
Mergers, user acceptance, and ongoing developments in interoperability standards are driving significant change in the U.S. EMR (electronic medical record) market, said C. Peter Waegemann, CEO of the Medical Records Institute during a conference earlier last week.

Waegemann said there are about 95 RHIOs right now, but despite a big push for connectivity, some already are disappearing and experts predict that only two or three will survive. Unfortunately, he said, people did not consider what went wrong with past efforts to establish connectivity and learn from those mistakes.

Meanwhile, there are about 230,000 medical practices in the nation and 70 percent of healthcare is delivered by practitioners in small practices of three or fewer doctors. More than one-third (36 percent) of new EMR sales is due to theses small practices. Waegemann said that certain medical specialties, such as pediatrics and family practice, are pushing EMRs more than others.

One thing that could dramatically change the EMR landscape, Waegemann said, is if one or more large companies got involved. He cited Google and Intuit as two organizations that might enter the market. Companies with such strong influence on consumers could increase the use of personal health records and drive numerous other changes regarding digital patient information.

Until that happens, there are plenty of hurdles to EMR implementation. Market uncertainties, professional change, costs, user acceptance and thousands of standards top the list. There have been several significant mergers and the marketplace is abuzz with rumors of more to come. Despite this, the EMR market value has increased from $2.6 billion in 2005 to $3.7 billion in 2006, Waegemann said.

That growth is driven by the increasing focus on evidence-based medicine, state EHR initiatives, development of more RHIOs, relaxation of Stark and anti-kickback regulations, EMR product certification by CCHIT, payment reform, and greater momentum to interoperability. “Healthcare is more and more of an information business,” Waegemann said. The industry spends $40 billion on HIT and $25 billion on transcription.

The lack of standards is a primary barrier of EMR adoption, he said. Product certification was one path designed to address that barrier. Last year, the Certification Commission for Healthcare Information Technology (CCHIT) certified several ambulatory EMR products. CCHIT was needed, Waegemann said, because there is so much uncertainty in the marketplace but the commission formation “was rushed and they took a watered down approach.” The certification process started with low standards, he said, and plans to increase the rigor of the process but some say it’s geared to larger companies since many smaller companies don’t have the resources to meet the requirements of the certification process.

Despite the uncertainty, Waegemann said that waiting isn’t the best option. When a big change does occur, “facilities not already in a relationship with a vendor could get left behind.”