One of the biggest obstacles facing EHR adoption is the sheer cost. Hardware, data storage, training, and software make up a small slice of the pie. Most of your IT dollars will inevitably go to highly paid developers, consultants, and support staff who make a princely sum off hourly rates and bamboozled clients. Meanwhile, a new generation of technology experts, hungrier for success and client satisfaction, are offering their services at a fraction of the cost.
To be certain, healthcare IT is a unique market, and cannot follow in the footsteps of other industry outsource models. After all, patient's lives are on the line.
But don't be fooled by the popular (and flawed) picture of outsourcing as a room full of unqualified amateurs working in "sweat shop" conditions. The fact is most offshore professionals hold prestigious degrees from US-based institutions, or graduated at the top of the class in their home countries.
Meanwhile, transcription, billing, and even radiology services are being outsourced to India. Take the example of Dr. Arjun Kalyanpur, a U.S.-licensed and credentialed radiologist, with postgraduate training at Yale University, who runs a respected two-man service from Bangalore, India, called Teleradiology Solutions.
An IT emergency at 2AM? No need to stir your highly paid radiologists, It's daytime in India, and Dr. Kalyanpur is standing by.
Successful Indian entrepreneurs are also making it big stateside. eClinicalWorks, the rapidly-growing EHR vendor who has partnered with Wal-Mart, was co-founded by practicing physician Raj Dharampuriya, his brother-in-law Mahesh Kumar Navani, and his cousin, Girish Kumar Navani. When asked about the role his Indian heritage played, Dharampuriya says:
Our family values then and now meant that we live next to each other with the entire family -- everyone together. Traditional Indian values play a big role because our families stay together.
On the business side, it helps the three of us stay together and focus on one goal, which is not just to build the company and take care of our employees, but to eventually make a big impact on the way health care is delivered in this country.... Our Indian background has helped us as owners of the company stay together for a very long time and work together.
The United States EHR market is currently dominated by a cadre of corporate vendors such as Cerner, Epic, Eclipsys, GE Healthcare, McKesson, Siemens, Meditech etc. But top-notch service comes with a price - they are able to charge sky-high rates without the threat of low cost competition.
Still, physicians should not wade blindly into the outsourcing market hoping to reap "meaningful use" benefits at no cost. An August, 2008 report by the American College of Radiology raised concerns over sending a hospital's most important IT challenges offshore. The ACR said foreign workers should "meet or exceed" standards for US physicians, have liability insurance, a license to practice in the states they serve, as well as staff privileges at hospitals where work is performed.
It is only prudent that one perform due diligence and ample research on any potential offshore company before signing on the dotted line. But the fact remains that many of these tech companies are on par, if not ahead of many American developers and IT professionals. They are surely hungrier, focused on client satisfaction instead of racking up billable hours to ensure their own bottom line.
The market is new, and the waters untested, but US-based physicians hoping for a piece of the ARRA pie might be wise to investigate offshore services. The trend is beginning with transcriptions and billing, but full-blown EHR installations may not be far behind.
