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Goldilocks and the Three Bears Commentary 

Goldilocks and the Three Bears

In a recent article on emrdailynews.com titled “EHR Re-evaluation and Replacement is on the Rise”, Stephen Campbell reports that the replacement market for EHR systems is being driven by ‘systems that are too complex (in form and function)’ and the trend to cloud-hosted systems that run on mobile devices. He defines the ‘Goldilocks’ Principle as finding the right application for a hospital or clinic.

The three bears implied in this article are:

• Cumbersome user interfaces that are not easily adaptable to the needs of a hospital or clinic. Older systems that were built on top of billing platforms tend to have more clicks and screens to get the job done than are needed and add up to expensive clinical employee time.
• Server-based applications that require a high degree of internal IT support, regular updates, and maintenance of firewalls and other security measures require sophisticated IT staff who expect generous salaries and can be difficult to recruit in a tight job market.
• Extensive training requirements that make it difficult to integrate new staff and can cost more than the software. When the learning curve for the EHR is steep, employee turnover becomes even more expensive.

The rapid introduction of EHR systems under the Hitech program left a bad taste for many hospitals and physicians once the real cost of maintaining systems became known. According to Campbell, 24% of EHR users says that their current system is too cumbersome. Of those that look for an alternative, 60% switch to another system.

These trends are likely to continue as hospitals and clinics are faced with shrinking margins and lower reimbursement. Campbell also points out that mergers of software companies will often eliminate products and push customers into having to migrate, which in turn pushes them back into the market to examine their options.

Another trend that is about to hit the EHR market is the inevitable disruption as new startups look to dethrone the expensive EHR systems with more affordable and customizable applications that run on mobile devices and move IT maintenance into the cloud, allowing hospitals and clinics to focus on providing clinical care instead of maintaining hardware and software systems. IT budgets that bloomed because of Hitech rewards are now under increasing pressure to provide a ROI; complex, expensive to maintain systems will eventually have to change or be thrown out like a bowl of cold oatmeal.

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