Implementation support needed for small practice EHR adoption to take off in 2012

Long ignored by leading electronic health record vendors because of the high cost of selling to them, small practices finally are getting the spotlight. Motivated by the government's EHR incentive program, Dell and Costco recently launched campaigns to market EHRs to these small businesses, which have adopted the technology at a far slower rate than have medium-sized and large groups.

Dell is selling a package of computer hardware, software and services to physicians in small practices through a network of 30 value-added resellers (VARs) that eventually will grow to as many as 150 firms. Physicians can choose among a dozen well-known EHRs, including those of Allscripts, Cerner, eClinicalWorks, e-MDs, Epic, Greenway, Ingenix, NextGen, Practice Fusion, McKesson, and MEDITECH.

Dell previously has shown it can help healthcare organizations implement and support these EHRs for their affiliated physicians; it claims to be providing technical support for about 40,000 clinicians. But it's unclear how good a job the VARs will do, since not all of them are familiar with all of the EHRs they're selling.

Costco, which has over 100,000 physician members, is using a VAR called Etransmedia to sell, implement and support Allscripts' hosted MyWay EHR to small practices. The big price club claims that its package--which costs roughly $30,000 per physician over five years--is significantly cheaper than competitive offerings. And, unlike Walmart subsidiary Sam's Club, which withdrew its eClinicalWorks EHR last March because of poor sales, Costco is focusing on the implementation support that small practices urgently need. But it remains to be seen whether Etransmedia can scale up to do this on a nationwide basis.

Meanwhile, the government recently announced that its regional extension centers had enrolled more than 100,000 physicians--mostly in small primary care practices. Some observers say that the RECs vary greatly in their ability to help physicians choose and implement EHRs, and that many of the participating practices are still in early stages of the process. Nevertheless, the enrollment of so many physicians suggests that small-practice EHR adoption may soar next year.

The big EHR vendors clearly see this as a possibility. Allscripts teamed with Costco partly because it believed that now is the right time to mass-market EHRs to the vast majority of physician practices. And in a recent talk to securities analysts, Steve Plochocki, CEO of NextGen parent Quality Systems Inc., noted that the two-thirds of physicians who still lack fully functional EHRs represent an enormous market opportunity.

If the EHR vendors, working in tandem with mass merchants and healthcare systems, can reduce their prices to a level that most practices can afford with the federal incentives, small-practice adoption could take a quantum leap forward. To prevent that growth from resulting in a lot of failed installations, however, the vendors, their resellers, and the hospitals will have to build enough latitude into their business models to do the handholding that small practices require. Assuming that these goals can be achieved, 2012 could well be the Year of the Small Practice in the health IT world. - Ken

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