Long Term Sustainability of Client Server EHRs

Could Interoperability Requirements Spell the End of Client Server PM-EHR Deployments?

John Tempesco

As recent headlines reverberate around Meaningful Use stage 1 delays, the changing of Meaningful Use Stage 2 requirements, ICD10 implementation delays, 5010 implementations and accountable care payment reform modifications, I begin to wonder if the EHR vendors will go through the same evolution as practice management companies did during the deployment of the HIPAA ANSI administrative transactions of the early 2000s. Most of the large, well established practice management (PM) companies with a large legacy installation base saw drastic declines in customers and market share.  The reasons were numerous but the biggest reasons stemmed from the following:

  • Each PM application had multiple versions deployed in the field and there was no easy upgrade path to compliance with these new standards
  • The applications were deployed on several different operating systems further complicating the upgrade process, timing, testing and retrofitting
  • Because of the rapid developments in hardware, the applications were deployed on a variety of hardware platforms

PM software companies established special teams to make changes to software in order to meet the new standards; created special units to upgrade the various versions, operating systems and hardware configurations; and trained support staff in both the software and EDI aspects of the new applications and electronic transmissions. Although the planning was developed over almost 18 months, changing interpretations of standards, as well as delays in requirement deadlines and procrastination of clients created a support nightmare for established vendors in the market. Many of the PM companies saw this as a time to re-tool their entire product suite.

Each of these factors led physician practices and hospitals to rethink their vendor of choice for the first time in decades. Implementation of the new ANSI standards for claims, eligibility and authorization transactions created more turmoil and turnover with the PM industry than any other single event. Burgeoning new start-up companies introduced SaaS and ASP deployment models of PM applications. These new companies sprung up regionally and began competing robustly with the PM giants of old stealing market share and sending established market names into consolidation and foreclosure. Many of the household names in the PM business disappeared from the landscape because they failed to anticipate the gravity of this monumental event.

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