Competition Rising for EHR Providers

At Epic’s user conference in late September, CEO Judy Faulkner called for a name change to the electronic health record (EHR).  The label change would rebrand EHRs as comprehensive health records (CHRs). To read the coverage, one would think healthcare on-demand  was well under way beyond the physician’s office and hospital walls.  Last I checked, a number of healthcare REITs were doing quite well, indicating that the promise of remote patient monitoring and healthcare without hospital campuses  remains a distant one.

Splash 4 finds that, the number of physicians a patient might see has risen over the past two decades.  Anecdotally, my friend’s coverage has changed four times in as many years due to changes in coverage by his employer.  Then the healthcare exchanges have led him to see a new primary care physician every year for the last four years.  Such an increased number of care settings leads to fracturing of the patients’ EHR.  In most such cases, the patient must take charge of centralizing his own records.  Out of the 8.3 million Veterans Affairs patients, more than 50% see a specialists, many of whom are located at facilities separate from their primary point of care, or outside the VA all together.  In response to the fractured health records of their patients, the VA is building a costly health information exchange to centralize patient records, thereby improving treatment outcomes.

Given that channels for delivering care continue to increase—minute clinics, urgent cares, and direct-to-patient telemedicine applications—and the rate of specialization in healthcare persists, the problem of fractured health records will only continue to grow as telemedicine opens the frontier for care delivery.  Second opinion services—Best Doctors, Grand Rounds—and care coordination companies—Care Sync—already stand poised to help build comprehensive health records on a patient-by-patient basis.  In the case of second opinion services, third party payor reimbursement is not an option, which places the cost of a comprehensive medical record on the patient in the form of time, money, or both.

Epic’s called-for name change from EHR to CHR is not driven by care  delivered far from hospitals, but by the rising rate of coordination in patient care .  Telemedicine platforms designed and distributed by Avizia, Teladoc, American Well, and MDLive pose an omnipresent threat to dominant EHR incumbents, like Epic and Cerner.  Payors increasingly want to pay for value and results, not simply fee for service, and comprehensive health records help providers manage toward value-based care.

Epic and Cerner’s answer to the growing crowd of HCIT companies has been to serve as the cornerstone of digital health software for providers by allowing for APIs, and, when prudent, acquiring software companies to extend feature functionality.  Both EHR companies have developed their own telemedicine modules that allow physicians to cue up consults from the EHR.  However, other homegrown features, such as patient charts accessible in Spanish, have been lost in the gaudy, Christmas-tree design—too many features for the user to intuitively find—that now plagues most EHRs.  

Payors have embraced the expansion of points of care in an attempt to lower their reimbursement costs by getting care to patients outside of the emergency departmentProvider networks have adopted direct-to-patient (DTP) telemedicine programs, alongside the acquisition of primary care practices over recent year in order to expand the number of lives they serve in a gambit to gain negotiating power with third-party payors.  Without changes to reimbursement incentives, the fracturing of patient medical records is not going away.  In recognition of this fact, in 2015, CMS unveiled a new CPT code to encourage care coordination for patients with chronic conditions that require treatment by multiple clinicians. 

Logically, one would assume EHR companies will continue to invest in their own telemedicine applications and support software interoperability with third-party providers.  Further fueling their investment is the increase in features that pull telemedicine platforms closer to an EHR.  Telemedicine and increased brick-and-mortar healthcare services locations have ensured the battle over patients involves a growing number of technology vendors.  Providers’ IT budgets can only grow so large.  Therefore, consolidation is likely to occur over the next three-to-five years as interoperability becomes an industry standard and feature functionality converges across HCIT platform providers.

Jacob Grosshandler