EMR – Bespoke Vs Off The Shelf

The recent surge in health IT has helped several innovative companies proliferate the healthcare market. Healthcare in the US has traditionally lagged behind other industries in terms information digitization, but the government’s backing has lead to the rapid growth of health IT with CDC reporting an overall EMR adoption of 55% with the country.

While electronic medical records have existed for a long time, it was not until late 1990s that vendors began to produce commercialized solutions. Some hospitals at that time had already been using bespoke EMRs, that were specifically designed for their requirements. With limited information exchange at the time, these bespoke systems worked through intra office networks utilizing standard security protocols. Health Insurance Portability and Accountability Act (HIPPA) was introduced in 1996 anticipating growth of health information exchange.

Today providers have a choice between 800 EMR vendors providing a range of specialist products. EMRs have come a long way. Working closing with the early adopters, EMR vendors were able to focus on usability leading to the development of interactive solutions. However, with bespoke EMRs there was no standardization and interoperability was always an issue. The government attempted to sort this out through the meaningful use (MU) campaign, highlighting effective methods of EMR utilization.

While Health IT had already started to gain momentum by that time, the government’s support under the American Re-investment and Recovery Act brought a host of IT vendors to the healthcare industry. With the basic functionality outlined in the MU program, vendors had a base to build upon. More license based applications started making their way into the market. This trend also instigated a change in deployment models, as cloud and web-based models quickly began capturing significant market shares.

The license based products were more cost effective than their predecessors. Deployment time was quicker and there was a marked improvement in functionality while they lacked the extensive flexibility of bespoke systems. Bespoke design is in accordance with the organizational model, hence increases its competitive advantage.

However, since the application is uniquely configured, the organization’s reliance on the vendor increases significantly as well. Bugs and errors are a common place for bespoke software as testing is limited. Modifications and upgrades are expensive while development takes time and requires significant resources. Lastly, bespoke vendors usually don’t provide support services and practices have to employ technicians privately in most cases.

These hassles are greatly reduced by purchasing licensed software. Training manuals and support is readily available while extensive testing, modification and live runs reduce the chances of unexpected errors. In the world of health IT, established EHR vendors were quick to gauge the discrepancies in workflows. Application rigidity was a discouraging aspect for most providers, hence established EHR vendors allowed basic customization to increase flexibility.

“Off the shelf electronic medical records are less of a hassle. Most physicians today are more tech savvy. I myself use a tablet for most tasks. I think it’s more about getting a good vendor with reliable support and decent functionality. Everyone would like a custom-made EMR but simply cannot afford it. More importantly, we just don’t have the time.”, says one physician.

While there are advantages and disadvantages of both types of EMR systems, the size of the enterprise is the key factor in determining product selection. However, there are plenty of good off the shelf EMRs to choose from today. All you need is to find the right fit for your practice.


One thought on “EMR – Bespoke Vs Off The Shelf

  1. Thank you for the post Frank. You refer to some of the costs healthcare organizations face in the space. Could you expand more on that? When EMR vendors pitch their offerings, how do they typically structure costs? Up front installation/onboarding fee + monthly maintenance? Seat licenses?

Leave a Reply to Rick Rosenthal Cancel reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s