EHR Stimulus Winners and Losers

Mr. John Lynn recently posted a provocative blog entry, "Big Winners from Obama EHR Stimulus" (2/19/2009). In it he listed 7 different groups that will be winners under the HITECH law. I'm not so sure about some of the winners, and I think that there are others that need to be added in. Here is my version of the list, broken down into 3 different categories:

Losers

EHR Vendors

—Although c-EHR vendors may win in the short run due to speculation, all vendors will soon see the effect of what I've been personally hearing and reading in blog sites throughout the Internet, ie, docs are telling each other to "stay in the sidelines." The $18 billion investment is way too little, and as long as it'll cost on average $300,000 over 5 years (on average), which is 8 times more than the trivial $44,000 to be doled out to a very small group of docs that do everything perfectly, from installing their complicated c-EHR systems (in which 50% fail), to having enough Medicare patients, from using their c-EHR "significantly," to reporting with their expensive c-EHRs exactly right. Already some non-certified EMR vendors are beginning to push the idea of how a c-EHR are bad for business overall (check out the mention of the SRS Hybrid EMR letter at www.histalk.com). One interesting number that I ran into the other day in Massachusetts, where c-EHR systems have been pushed even more forcefully for years, only 5% of physicians are using c-EHR systems in what will be regarded in the future as "meaningfully."

HIT Consultants

—If the number of c-EHR systems gets cut to about 6, then the need for consultants will drop rapidly. In similar HIT-government interventions elsewhere, s.a. in Massachusetts, Canada, and in England the number of EMRs available for offices to choose from is usually less than 3.

HIT Trainers

(I added this group in)—These guys will see work, but the profits may not be high, if at all. There is an interesting article at Histalk, "USF Health, Allscripts Launch Paperfree Tampa Bay, an E-Health Pilot Program" that is quite interesting. The second to last reader response is from "Steve" who states his heart-felt feeling that:

"The problem with being a trainer for this software is that there is no money in it. This is a loss leader product for Allscripts. They think they are gaining market share. The truth is that most of the offices that get this free technology (including hardware) abandon it within 4 weeks. I worked on this project when the e-prescribe software was released. Its kind of a joke."

Hospital Systems—Again, they all end up paying $300,000 per license... so as long as hospitals continue to operate with a 0% profit margin (from varous recent sources, the newest being the 3/2009 article), they will probably NOT increase their c-EHR use much either.

(HHS)

Health and Human Services —If the HHS loses again, like they lost under President Bush, then I don't see them as being a winner. They need to go back to doing what they do best- stick with protecting patients by improving health care in general, not with experimental HIT projects like HITECH.

Clinical Physicians

(I added this group in)—See my cost analysis of what HITECH will mean to physicians who do/don't participate here.

Medicare Patients (I added this group in)—This group will find it more difficult to find a physician as physicians stop taking on new Medicare patients or simply stop participating and discharge all of their Medicare patients due not only to low reimbursements but now pay for the "hassle factor" and for the need to have a c-EHR system.

Neutrals

Existing EHR Users

—I'll leave this one in "brown" because in reality, these doctors have to use these systems in ways that they haven't in the past. Studies have shown that only 10% really use their c-EHR systems in what would be considered a "meaningful way." So many may not qualify at the end, or their cost will increase further above what they've spent already (remember the $125,000 and $50000 over 5 years simply to do the extra charting and reporting per encounter as noted in the above URL).

CCHIT

(if they get chosen)—Although you would expect them to be a winner, if docs refuse to "meaningfully use" and accept c-EHR systems you will see the final demise of CCHIT. The emrupdate thread ("A Health Tech Monopoly") about the NEJM article "A Health Tech Monopoly — II," goes into this. Here's the best line of the article:

"Drs. Mandl and Kohane's critique is couched in the staid language of a peer-reviewed journal, but the implications are obvious. The stimulus hands the Obama Administration the power to define and approve "certified" records, therefore the power to create a health-tech monopoly."

When the NEJM starts throwing anti-certification statements, c-EHR systems, CCHIT and HITECH are in trouble.

President Obama

(I added him in)—Although he wins from collecting his lobby payments for promoting HIT, if HITECH and his over-sold universal healthcare ideas lose, it may make it difficult for him to be reelected.

Winners

President Obama's HIT Donors (I added this group in)—This group will get folks to see their "enterprise" systems and associate them as something special, at least for the short-term. They will get some sales, even if there is only a minor uptake in c-EHR use, since eventually only about a half dozen of these companies will be left standing getting all the few sales that will come from HITECH.

Other Politicians (I added this group in)—Even when HITECH fails, they will still win as they get paid their exorbitant lobbying fees/grants/other payments just for trying.

Part-time Employees Needed for "Meaningful Use" Reporting (I added this group in)—I see this as a rather good new entry-level job in the middle of a recession, making this job somewhat of a "winner" for those few that are hired in an era of increasing unemployment.

Nurses/Physicians (I added this group in)—EMR nurse technician jobs that are required for staff teaching and software implementation are usually a better-paid position than positions held by regular clinical nurses. Even computer-saavy physicians are seeing well paid HITECH-hassle-free job openings that will allow them to escape the future more poorly paid clinical positions.

HIT Bloggers like myself (and Mr. Lynn) who are busier than ever and becoming well known throughout the HIT industry. We are in a good position of being the well informed "Davids" going against a well funded "Goliath" whose position has very little following among the physician community.

I would like to hear from my readers about any more categories that we can add to this list.