Simply put, 2014 is a big year for electronic health record vendors. They must adhere to stricter standards under the federal government's meaningful use program while convincing healthcare providers that they can meet future needs for information exchange, patient engagement and data analytics. Not everyone will make the cut.
The healthcare industry has known for years that the electronic health record (EHR) market, dominated by a handful of EHR vendors but also populated with literally thousands of disparate systems, can't maintain status quo forever. Mergers, acquisitions, consolidations and bankruptcies, though seldom mentioned, are nonetheless inevitable.
这种信念存在，尽管政府的有意义的使用激励计划，这给医院和符合条件的医疗服务提供者的钱，如果他们能证明他们使用的是电子病历系统 - 和，有人说，创造artificial demand for EHR softwareand thrown less-than-stellar systems a much-needed life preserver.
Stage 1 of meaningful use, which began in 2011, was a "low hurdle to get across" for EHR vendors and healthcare providers alike, says John Moore, managing partner of healthcare IT analyst firmChilmark的研究。
第二阶段始于今年要困难得多,密苏里州ore says. There are more clinical quality measures to track and more patient matching and data mapping requirements; vendors must demonstrate interoperability (both creating and pushing records as well as consuming and populating them) with at least one other EHR system built by another vendor, and systems must let patients view, download and transmit their own electronic records.
As a result,EHR厂商与阶段2挣扎- to the point thatonly 13 percent of physicians have an EHR that meets stage 2 criteria，according to the Centers for Disease Control and Prevention. Not surprisingly, then,医生一半的人认为EHR成本超过他们的利益，according to a survey by cloud EHR vendor Athenahealth, while a RAND Health report says that, "for many physicians, the current state ofEHR technology significantly worsens professional satisfaction以多种方式“。
The remedy, RAND Health concludes, is better EHR usability. That, experts say, is where the wheat in the EHR market will be separated from the chaff.
在Most EHR Systems, the Workflow's the Problem
Reports on the tumultuous state of the EHR market have come hard and fast in the last several months. Black Book, which surveyed close to 900 consultants, analysts and managers last summer, suggested thathalf of EHR vendors won't make it to meaningful use stage 3; those that placed meeting meaningful use criteria before usability will likely suffer the most, Black Book found.
Meanwhile, multiple surveys also released last summer said more than one-third ofhealthcare providers aren't happy with their EHR systemsand want to switch, even if it will cost time, money and efficiency.
Part of the problem, says Dr. Heather Haugen, managing director of在突围集团内施乐的是，有电子病历之间的差异implementation和EHR采用。
Because theEHR激励时间表is so short - healthcare providers who are eligible for meaningful use but don't participate will receive reduced Medicare reimbursements starting in 2015 - corners have been cut, says Haugen, co-author of除了实施：处方持久EMR收养。
[分析：EHR Implementation Rising, But Hurdles for Healthcare Remain]
Organizations know they should analyze workflow, but they want to get EHR software installed first - but workflow analysis never happens, providers adopt "a million workarounds" andEHR实施的最佳实践aren't followed, she says.
Mistakes are common - copying a note or diagnosis pertinent to Patient A into the record of Patient B, for example, because it's quicker than retyping everything - and, according to the Office of the Inspector General at least, can constituteEHR fraud，即使提供商的复制和粘贴活动没有被充分考虑更高的报销完成。
培训可以解决这样的问题，豪根继续，但企业往往专注于通用的，基于事件的培训，以冲突与临床的时间表。今天的医生，护士和技术人员学习不是通过死记硬背，而是从“把他们的手在控制，”霍根说，使用说明飞行员如何使从模拟在20世纪80年代转向数字驾驶舱的术语。什么是通过共同的EHR软件的方案提供更多的洞察力，只需步行用户他们如何执行常见任务，这样可以帮助培训人员加强良好的生活习惯，进而帮助用户构建“肌肉记忆，以它是如何做。”
EHR的工作流程很重要，因为电子病历是至关重要的数据源
Workflow is so important to the success of an EHR system than Kristin Russell, senior director of product development and marketing withOmnicell，sees workflow integration as the remedy for healthcare IT's longtime nemesis:在teroperability。
两个因素迫使这一变化,拉塞尔说。first is the juxtaposition of consumer systems that easily sync with Facebook, the Wii and other services with, say an automated medicine dispensing cabinet that forces a nurse to log in, pull a patient's record and dispense medication, only to enter the same information in the EHR moments later. Nurses want to "close the loop," she says.
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The second factor is the healthcare industry's push toward more coordinated care. Groups such as theCleveland Clinic罗素说，现在采取“放大，缩小，放大无处不在”的方法来护理 - 在护理个人水平在放大，缩小人群健康管理的目的和缩放处处连接到wellness devicesand the Internet of Things.
在this model, the EHR serves as, well, the data source of record for a range of purposes, includinghealth information exchange，计费big data analytics。To paint a more accurate picture of a patient's health, an EHR should also collect and display data from medical devices as well as consumer fitness monitors or applications. Here, Russell says, EHR systems built as platforms as opposed to standalone, monolithic systems are better positioned to share data, work together and support workflow needs.
Ill-prepared EHR Vendors Will Fall Victim to Meaningful Use
Those points are consistent with the Center for Medicare and Medicaid Service'smeaningful use stage 2 criteria，从而超越简单地使用电子记录实际上他们共享 - 通过电子处方与实验室内院，与其他医院，药房同和，重要的是，与患者。（许多人认为，病人参与基准是太难以实现，但它确实只是communicating with patients electronically。)
所述EHR厂商即斗争这样做 - 和呈现在该共享数据临床决策支持environment, which aims to helps physicians make more informed care decisions - will have the most trouble with meaningful use stage 2, says朱迪·汉诺威与IDC健康洞察研究总监。
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市场的整合更可能在饱和门诊电子病历的空间，在那里五大厂商控制了一半以上的市场。Ambulatory EHR vendors who aren't Epic Systems, Allscripts, eClinicalWorks, NextGen Healthcare or GE Healthcare find it increasingly difficult to find new customers, especially for software installations and not perpetual subscriptions, Hanover says.
On top of that, achieving有意义的使用阶段2认证是一种代价昂贵的，汉诺威说。整合是必然的，她说，应继续贯穿全年。（其他建议EHR market shakeoutwill last several years.)
The less-mature inpatient EHR market, though also due for consolidation, is likewise due for innovation. Moore says meaningful use created a "false market" that led many providers to implement rigid, inflexible EHR systems (with poor usability and customer service to boot) simply to cash in. Here, themeaningful use stage 2 deadline extension在12月宣布因此应该谁正在寻找一个新的电子病历系统或谁帮助提供商需要“喘口气赶上，”汉诺威说。
If nothing else, the fact thatsmaller practices lag in EHR adoption可以提供灵活的开口（或甚至自由) EHR vendors as well as companies providing components, modules or "augmented functionality," Hanover says, adding that platform-based systems outside the EHR itself but interacting closely with it could help those practices meet their patient engagement, quality reporting and population health management needs.
The Days of EHR As 'Deposit-only System' Are Numbered
Stage 3 of meaningful use, meanwhile, will further disrupt the EHR market. For starters, Hanover says, it places even more emphasis on interoperability to "bend the cost curve." EHR vendors that have found it to their advantage to be insulated will find that "their excuses are getting smaller and smaller," she says.
在addition, stage 3 essentially redefines the EHR as a "collaborative health record," Moore says. In the context of patient-generated data, he asks, how will EHR software bring in this data, validate it, make sure it in fact came from the patient, accept the most appropriate date for clinical decision support and aggregate it from multiple sources - and, oh, on what frequency? The status quo won't cut it; physicians are "pretty fed up" with their EHRs, Moore says, with one describing the software to Moore as a "deposit-only system."
丹·里斯，CEO和联合创始人Health Fidelity，suggests that healthcare has built an EHR industry that merely captures data. It's like looking at a bowl of flour and insisting it's a cake, he says; many other ingredients are needed. Getting EHR software up and running, isn't the goal, he says; it's reducing costs and improving care.
The logical next step, Riskin says, is getting that full set of clinical data into a data warehouse - not just for reporting requirements, mind you, but for analytics and population health management. That requires full data sets. Right now, most EHR software provides only a tiny fraction of the data. Thanks to poor workflows, users ignore the myriad dropdowns in their EHR systems and instead make extensive use of free-form text notes that, as unstructured data sets, don't make it into the data warehouse.
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Like Hanover, Riskin says turnkey systems, not EHR software itself, will be the answer here. (As an example, he points to the meaningful use stage 2 reporting modules popping up in today's EHR systems.) Why? Organizations with underperforming EHR systems face the Catch-22 of solving immediate problems with a bad architecture now or trying to re-architect in a few years' time.
如果不出意外，市场的压力将开始发挥作用。有“没有可以预见的将来，”他说，当任何EHR模块会得到它需要有一个组织，它惯于有结果提高或降低成本，无论是通过负责保健组织（ACO），Medicare Home Health Compare或其他无风险和价值为基础的模型。
Or, as Hanover puts it, "It's about monetizing those EHR investments, and hospitals can't do that without analytics."
成功源于EHR最佳实践
Given the state of affairs, cananyone在支离破碎EHR市场上取得成功？在Software Advice's不断的EHR Software User Survey，the top system that respondents use, by a huge margin, is其他。
As it stands,the EHR market is poised to growfor a few more years; only about half of U.S. hospitals have an EHR system. The challenge for vendors, of course, is that that segment is harder to convince than EHR early adopters. That said, many hospitals must replace homegrown or legacy EHR systems to meet stages 2 and 3 of meaningful use, as well as the more complex needs of theACO模型。
This prompted KLAS Research to conclude thatthe EHR market isn't as close to saturationas previously reckoned. KLAS also found that Epic Systems, the unarguable market leader, which claims to holdpatient records for half of Americans不像从前那样赢得尽可能多的合同,creasingly losing out to Cerner. On top of that, in the most recent KLAS ranking,Epic lost its best EHR software rating to athenahealth，ending an eight-year reign.
Contracts and rankings, though, aren't going to get physicians to use EHR systems. Four things must happen for this to occur, Haugen says:
- Engagement with the clinical leadership team (and not necessarily the C-suite);
- Role-based training focused on what a class of user will be doing 80 percent of the time, not on advanced functionality;
- 的能力衡量成功或失败，完全与反馈机制，谁在使用特定功能的精确定位，并
- 的持续过程中，随着临床领导的支持下，强调采用电子病历和持续的培训。
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可能发生，豪根说，最糟糕的事情是为那些领先的电子病历实施努力上线日期后回到自己的老角色。该点后的工作也同样重要 - 如果不是更应如此 - 且涉及不同程度的参与。
否则，一个组织可以在所有太熟悉的位置找到本身：超过EHR使用十年比纸质记录时代后，效率较低。这个问题几乎是不可能解决的，不管你的供应商选择哪种EHR。
布莱恩·伊斯特伍德is a senior editor for CIO.com. He primarily covers healthcare IT. You can reach him on Twitter@Brian_Eastwoodor via电子邮件。Follow everything from CIO.com on Twitter@CIOonline，Facebook，谷歌+andLinkedIn。
Read more about health carein CIO's Health care Drilldown.
This story, "Why the EHR Market Is Poised for Disruption" was originally published byCIO 。