The largest e-records companies by market share are conglomerates like General Electric and Siemens. Among the second tier of smaller companies specializing in health records, Cerner Corporation, Eclipsys Practice Solutions, NextGen Healthcare Information Systems, and Epic Systems Corporation stand out. In general, companies focus on either the hospital or doctor segment but GE Healthcare is an exception, competing in both markets and building its business by acquiring smaller, specialized companies.
Smaller vendors like NextGen argue that because they deal solely with medical practices, their products are tailored more to doctors’ needs. GE and other large firms counter that they sell everything from hardware to software and equipment like x-rays, MRIs, and other scans, so they can better integrate electronic patient record systems into the broader medical setting — which is critical to achieving streamlined, less-expensive medical care. But if doctors and hospitals are served by different vendors, questions arise about how the two groups will eventually share information. Resolving that dilemma tends to play to the strengths of the big providers because they can more easily knit together all the elements of the disparate networks. GE is selling one product, for example, called a “health information exchange,” that should allow a hospital in California to instantly access the medical records of a visiting New Yorker.
The ultimate goal is to make all the systems interoperable, like a bank card that can be used at the ATMs of different underlying networks at different banks. But health-care files — packed with information on any number of procedures, treatments, prescriptions, and tests written in any number of ways — are far more complex than relatively straightforward bank account records. “Look at the transactions that are available on an ATM,” says NextGen’s Corley. “You can deposit money, you can withdraw money, or you can check your balance. Those are simple. But in health care, if the system is not using standardized codes for saying your big toe itches, we can’t easily share that information.”
CCHIT’s Leavitt agrees that there are still significant obstacles. “The work of making sure the systems are interoperable is just on first base,” he notes. But, he adds, “we could see substantial movement in five years; we could even be halfway to the ultimate destination by then because the incentives are powerful.”
William J. Holstein is the author of Why GM Matters: Inside the Race to Transform an American Icon (Walker, 2009). For more on his work, see www.williamjholstein.com.