As physicians and mid-size provider groups begin to ponder a major purchase this year, they should proceed with caution.  Software vendors, with the support of Uncle Sam, are making a glitzy sales pitch to physicians in hopes that they will purchase their particular EHR product. Additionally, large hospital systems are wooing their referring outpatient practices to ‘link in’ through their software product to create a more seamless transfer of patients to their facility.

Doctor: don’t rush to the cashier just yet. Aside from the worry that some products will not be up to “meaningful use”—the federal requirement for EHR stimulus package reimbursement—remember that smaller providers are an entirely different beast than large hospitals and medical centers. The needs are different; therefore and the product should be different. This concern raises some interesting glimpses into how the technology market for EHRs will evolve.

Large medical centers, such as an academic health center, often have ‘legacy’ systems that were put in place eons ago to support data storage and some medical record keeping for these massive health systems.  Smaller providers, however, may only have one computer for billing and administrative record keeping but have never used technology for patient information other than storing a mailing address. Therefore, small and mid-size groups, less familiar with technology, may not have any interest in making the fiscal and physical investment in purchasing servers and other equipment that will internally run an EHR product.

This is where the newer trend of using a browser has a tremendous advantage for these smaller providers. Much like Google’s personal health record (PHR) and Microsoft’s Health Vault, a Web-based application gives docs in smaller settings a secure and cheap way to store and transfer patient information.  It is less hassle, it saves money and space, and it is a more familiar, user-friendly tool.

Larger institutions, however, do not care to be left out in the Luddite wilderness. New portal technologies are allowing them to evolve with Web-based tools—but at a high cost and with no guarantee of success. Equipment and some EHR installations may cost anywhere from $20-$100 million, according to the Wall Street Journal.  And one study found that nearly one half to two-thirds of large enterprise projects fail in the sense that they are delivered late, over budget or, more importantly, without the anticipated benefits.

Granted, we are now four years into improved technology but do not forget the IT headaches and frustrations that go hand in hand with merging old and new technology—just ask the VA and DoD.  So, a word of caution to all those shoppers out there contemplating using stimulus dollars to pick up an EHR system: if you don’t have an IT department, look to Web-based products.  And if your partnering institution (e.g. large medical center) tries to convince you that their EHR system, clad with bells and whistles, is the best choice…well, buyers beware.

More on EHRs:

[+] Doctors aided by emerging offshoot of EHR software

[+] EHR standards committee meets and prepares to sprint

[+]New study cites poor uptake of electronic health records