Shed the status quo in favor of a customer-centric approach to healthcare IT

The upfront investment, development charges and personnel costs associated with traditional electronic health record (EHR) implementations make clear that getting to Stage 1 Meaningful Use is only the beginning of the investment. Additional enhancements required for Stage 2, changes in the regulatory environment, even minor code fixes  -  all will dramatically increase the overall cost of an already expensive proprietary EHR system. 

Indeed, for hospitals, the overall cost of a traditional health IT relationship includes millions of dollars in both lost opportunity costs--the product of multi-year implementations and lengthy delays--and simply exorbitant pricing that far exceeds federal reimbursement. 

While most EHR systems enable hospital compliance with Stage 1 Meaningful Use, Stage 2 requirements are a whole new ball game. Stage 1 basically asked hospitals to implement a platform and capture data; Stage 2 will most likely require the use of that information to improve the quality of patient care. If hospitals pick an EHR platform that doesn't have Stage 2-ready features, the costs to upgrade are both exponential and unavoidable. 

Here's why. 

Proprietary systems are just that  -  controlled from start to finish by one vendor, with costs paid for up front. Additionally, the proprietary decision-making process required to develop and deploy upgrades is centralized, bureaucratic and determined by someone else's timetable. New features and function sets often don't meet the specific needs of any one healthcare facility. Even now, hospitals are faced with proprietary repercussions: high upgrade costs, few benefits to individual facilities and a significant risk of not meeting Stage 2 Meaningful Use standards. 

There is another way. An open-source platform comprises a technology ecosystem where clinicians, administrators and other technology users can share system enhancements, upgrades and best practices because the system is not owned by any one entity. Case in point: Over the past three decades, the U.S. Department of Veterans Affairs (VA) has invested billions of dollars in the development of VistA, the most widely used EHR in the world, which other healthcare facilities can now leverage for little to no cost.

Given the prohibitive expense of so many health IT systems and the financial challenges most hospitals face, the development of commercial open source platforms represents an unmatched opportunity: Hospitals can affordably improve patient care through open source technology paid for in total with federal reimbursement funds. Comparably robust traditional EHR systems average two or three times the cost. 

The suggested perspective shift from proprietary to open source solves two issues hospitals commonly face. First, EHR platforms based on open-source code can be implemented much more quickly and affordably than traditional proprietary solutions, freeing up precious human and financial capital for patient safety and other hospital initiatives. Second, at least one open source technology provider offers a subscription-based pricing model that enables hospitals, clinics and integrated delivery networks to pay for the platform from their operating budgets with no upfront costs or back-end balloon payments. Control shifts to the hospital, where it arguably belongs.

Also, much like the provision of medical care, open source is an inherently collaborative process that is improved by the coordinated sharing of information as part of a community of practice. Collaboration across a broadly engaged community works to counter communication silos and fosters creativity instead of stifling it.

While hospitals should leverage technology to make operations more efficient and patients more safe, they should not be beholden to their EHR platform vendor. Rather, proprietary healthcare IT vendors should earn hospital business every day. A customer-centric approach would eliminate costly contracts that ensure a steady revenue stream but also insulate the vendor from real competition. 

The traditional hospital / IT vendor relationship is built on an outdated premise that puts healthcare facilities at a decided disadvantage, and as hospitals discover more affordable, customer-centric approaches, it should soon be extinct.

About the author: Irv Lichtenwald is the president and CEO of Medsphere, developer of OpenVista, a portfolio of clinical support products and professional services that leverages an electronic health record system created by the Department of Veterans Affairs. He can be reached at irv.lichtenwald@medsphere.com