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| IBM "cloud" computing - circa 1975 |
According to dictionary.com, a Legacy system is a “computer system or application program which continues to be used because of the cost of replacing or redesigning it and often despite its poor competitiveness and compatibility with modern equivalents. The implication is that the system is large, monolithic and difficult to modify”. Well that little DOS EMR was anything but large and monolithic, but nobody was going to invest a penny in redesigning it, and competitiveness wasn’t a term that came to mind when you looked at it, and replacing it is sure going to be an expensive proposition. The DOS EMR is definitely out then. The only question remaining is what it should be replaced with. Which EMRs in the marketplace should be avoided since they are truly Legacy EMRs sold under false premises to unsuspecting buyers? Well, it depends on who you ask.
You ought to separate the diverse EHR constituencies primarily based on programming generation (e.G. MUMPS vs. .NET), based on promotional labels (e.G. Cloud hype vs. The whole thing else), based totally on software structure (e.G. Included vs. Modular), and a number of other technical criteria, most of which can be overlapping to numerous degrees. A an awful lot clearer and natural separation takes place if you divide Health Information Technology (HIT) companies into two organizations: the ones who've plenty of customers and those who don’t. According to the latter, the previous are all peddling Legacy systems. It seems that a veritable tsunami of innovation is constructing up outdoor the notorious walled gardens of present, Legacy EHR providers, threatening to deliver those partitions down any minute now.
As with any profitable technology innovators, the inexperienced persons to the EHR market have top notch Silicon Valley pedigrees and exquisite Web 2.0 style websites, along with iPhone/iPad/Android local (i.E. Consumer/server proprietary) apps to supplement, or maybe supersede, the web presenting. Actually the usage of an “old style” computer or laptop is starting to feel a bit Legacy in and of itself. The revolutionary merchandise themselves may be divided into two classes as properly: complete-fledged EHRs and an expansion of self-contained pieces, or modules, of what is currently considered a entire EHR. [Note: I am not including products like athenahealth here, since they are not new, do have a respectable customer base, and had no disruptive effects on the rest of the market.]
In the meantime the Legacy EHR market seems to be thriving, and no, the recent Allscripts misfortune (or mismanagement) is not an indication of an impending disaster any more than this year’s snowfall in Texas is a sign of global cooling. The reason for this seemingly inexplicable prosperity is threefold: a) the government is subsidizing EHR purchase b) there are no viable alternatives to existing products c) innovation is occurring within the established market leaders. Let’s look for example at one of the more popular ambulatory EHRs, which shall remain unnamed. A few short years ago, the product consisted of a basic integrated EMR/practice management system, with very few bells and whistles and lots of bugs. Today, the product comes with a solid Patient Portal with iPhone apps for patients, a full featured disease registry, an iPad version, natural language processing, disconnected mode operations, peer-to-peer communications, and of course a much improved EHR and all sorts of other features and modules. I don’t know about other folks, but somehow this does not seem like a Legacy product to me, and there are a few more just like this one. There may be Legacy products out there, but today’s top selling EHRs do not fit the description.
A very unfortunate side effect of the forced march to HIT innovation is the confusion created by the constant barrage of misleading statements from the various Southwest Airlines wannabes. I sometimes wonder if these new folks have ever seen an EHR, let alone use one or participate in building one. A quality EHR is much more than a handful of rudimentary web pages allowing patients to communicate with providers, no matter how loud and trendy the consumer movement is. A modular architecture is much more than a collection of disparate bits of software interfaced together with duct tape, no matter how standardized the duct tape is. There is a reason why the new iEHR for the VA and DoD was allocated $4 Billion for development over five to six years. There is a reason why it took Kaiser about the same amount of time and money to take Epic from its original state to the powerhouse product it is today. There is no room for Southwest Airlines type of innovation in an industry where the routes, the meals, the fuel and the seating arrangements are regulated by the Federal Government. Innovation is coming and will continue to come from within the established systems, NASA style.
So if you are still looking to replace that little DOS EMR, or an aging and no longer supported practice management system, find a good size EHR vendor, with a hefty customer base, who develops its software in-house, instead of randomly buying shiny things, and hitch your wagon to theirs. It will not be a perfect ride because there are no perfect rides, but it will get you where you need to be. There are no miracles, there will be no miracles, and every day you waste looking for one, will make it harder to catch up, because whether we like it or not, whether it is a smart thing or not, health care is moving up the IT escalator at a very brisk pace. It’s too late for partial, gradual or “lite” solutions. The time for dabbling with a little electronic prescribing and a little email, has long since passed. You’re either all in, or all out, and your patients desperately need you to be all in.
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