News from the healthcare front: Eclipsys and Allscripts merge.
This type of convergence has taken longer than I thought it would (doesn’t everything in healthcare IT?).
As I remember from a selection process a few years ago the market for ambulatory EMRs (from an infrastructure perspective) included Microsoft -focused dot-net architectures (Eclipsys was a prime example), Java-based architectures (eg., McKesson), legacy architectures (eg., Meditech), and a mix of in-house architectures, java, and dot-net (Siemens (Invision, Soarian), Cerner, Epic, GE, and the rest).
I am certainly not suggesting that the underlining engine is the only decision factor (usability and clinician input is key), but it is a consideration – especially if you are concerned about long term architectural design and vendor allegiances. The underlying architecture is also a factor in consolidations – it could determine how easily (and quickly) the products can interoperate and look like a seamless single offering.
At the time we decided to go Eclipsys for our ambulatory – for a variety of reasons. But one of the big factors that came into the decision process was buy-out potential: Eclipsys was struggling financially, had management turnover, and seemed a good candidate for takeover. This had a lot of minuses and a few pluses (depending on who the partner would be). It has finally happened, in what most people think is a strengthening of the overall offering.
Vendors continue to jockey for position, and this type of thing will continue for some time. The market is quite fragmented, but the dollars flowing into healthcare IT, and the ramp-up of usage, will eventually lead to the same kind of effect that happens in all markets – fragmentation followed by consolidation (ala airlines and phone companies).
But then again – that’s what we thought 10 years ago, and it is taking longer than we expected….
One of the stories I like to tell about selecting an ambulatory EMR is about sitting in a conference room in Malvern, PA, in the throes of the selection process. The case was being made for a User Interface (UI) that was locked down, uncustomizable, and entirely at odds to Windows UI standards. When I questioned that, the answer was basically “we’ve studied this, we know best, healthcare is different”. What they didn’t know was that clinicians were succumbing to consumerization. The nurse that uses Windows at home is much more comfortable with a windows interface on the floor – and not having to relearn a whole new interaction framework. Physicians that want access to the EMR from their home computers don’t want to download a whole different client app with a different UI, or use a web front end that is so discombobulated that it it is counterintuitive. My gut instinct was born out in user trials later, and the Siemens Soarian offering fell by the wayside…