Is the EHR Market Saturated?

Shameem C. Hameed“Hey, the EHR market is saturated, we don’t really think there is any play left there,”  this comment came from a reputable venture capitalist (VC) in the healthcare industry.  And I sat there wondering what it is that he is talking about. Every single day I am taking calls from doctors who want an EHR that suits them, and they are willing to pay for it.  

And I ask them, “why do you not want to use the free EHR that everybody says is taking over the world?”  They come up with answers that are all over the place.  The only common factor is that they are not happy with the assembly-line product. Doctors are an embattled group in the United States today. It used to be that a doctor was what every middle class family aspired their children to be.  Today they are being exploited by the insurance companies on the one end and government regulations on the other.

As part of our services, at ZH Healthcare we offer Medical Billing Services or, if you want to be fancy, Revenue Cycle Management (RCM) services. I am constantly bewildered at how little money, relative to the effort and the investment, that the doctors make.  

Compounding their frustrations are the rules that are set forth about maintaining medical records. And the government offered billions of dollars to help implement it. The government said, let it be written and let it be done, and the numerous innovators ran to their hot presses and churned out EMR/EHR  solutions that everyone can use.

As  Dr. Lawrence ‘Rusty’ Hofmann In the Huffington Post, puts it, “EHRs are like Model T Ford: Any Color You Want As Long As It’s Black” So now we have thousands of EHR systems in the country today. So there are now products that exists solely because the government mandated and funded it.  Hey, problem solved, isn’t it?  And then the VCs declared the space saturated and they move on.

Now we hear tremors from various parts of the healthcare system. Doctors are complaining that EHR systems are too difficult to use and get in the way caring for their patients.  Others are threatening to shut down their practices rather than learn new systems because most of the EHR systems are asking them to change the way they have been practicing medicine.

When you go to doctors' offices these days, you will find them looking at a computer screen and asking you questions which they promptly type.  During this entire conversation the only eye contact you are probably going to get is when they walk in the door.

Dr. Hofmann goes on to say “When speaking with patients, it’s important to pay attention to their facial and body expressions (i.e., why did you squint? Why are you shrugging your shoulders?) Doctors need to make sure patients are comfortable with the situation and understand the recommendation, and you can’t read body language when you are looking at a screen.”

Each doctor is unique in the way they treat patients. Each of them perfected their own techniques over years of practicing medicine. And what arrogance should we, as software developers, have to tell them that what they are doing is wrong.  Each of the forms they use is designed by them after a considerable amount of thought. It is imperative that we accommodate them rather than the reverse. 

The current EHR 1.0 bunch does not allow the doctor to exercise his individuality and expertise. Many of the first generation EHRs saw this problem and did the best they could: they called their software customizable.  What does that mean? In real terms you can make additional fields in the forms. This is what we call, “configurable,” not customizable. A feeble attempt at truly meeting the needs.

What physicians require is an easy to use system that molds to the way they practice.  Something that is intuitive and customizable without having to spend hundreds of thousands of dollars to achieve usability. Well, not every doctor has a booming practice with money to spend on expensive customizable systems. Everyone should have access to a usable EHR. That is why study after study report a 45-50% churn in the EHR market. The market is nowhere near saturated. 

The market needs a product that addresses the need and the pain of providers. This is what Dr. Hoffman had to say:

The next wave of EHRs need to evolve like the Model T, adding new features and offering customers and physicians customizations while making them usable to all. They need to be created by doctors, who understand the data and process, and engineers, who understand the technology. Three years from now, you should be able to access all your health files from any device, and share them with your Sherpa, shaman or surgeon.

The thing is that the next wave of EHRs is already here, and has been here for some time. These EHRs are open source and have been built from the ground up by users to be usable, customizable, and interoperable. One of these open source EHRs is OpenEMR. The OpenEMR movement started 16 years ago by doctors who actually needed an EMR to help them better care for their patients, and not because it was mandated. OpenEMR has beeen downloaded over 300,000 times in the last four years while the leading free SaaS platform only has 100,000 users in seven years. There are OpenEMR implementations at sites in 182 countries and it has been translated to 34 languages. The Peace Corps is implementing it in field offices in more than 70 countries around the world.

So the real answer is not to wait for proprietary EHR vendors to add usability and interoperability to their "lock-in" products, but to take advantage of existing open source solutions. We at ZH Healthcare have built a "Freemium" SaaS Electronic Health Solution (EHS). It is called BlueEHS-inspired by OpenEMR it takes all the good features of OpenEMR and then enhances them with a series of components that transform it into a full-fledged electronic health solution. 

And we believe this is what the market needs. Building solutions based on tried and true open source products that have whole communites contributing and enhancing them, yet allow for addons and enhancements that provide for a fully customizable EHS systems that let physicians practice their way. One of the key enhancements that BlueEHS has made is its ability to be “customizable on the cloud.” This brings down the overall costs of an EHR implementation. This approach leads to customizable and inexpensive solutions today, not at some hypothetical future date.