You may be a physician, software developer, or may just see a business opportunity. Millions of dollars are being invested in health IT and electronic health records. Healthcare costs continue to climb and the only logical solution appears to be process automation — as has happened in other industries such as travel and banking. EMR adoption has stalled in a number of provinces. There must be an opportunity for a new EMR system. Right?
This thought process seems to make logical sense. However, there is a lot more to the development of a successful EMR than building software. Even though there is always opportunity in any marketplace for a “better mousetrap”, the EMR market is challenging largely due to national and provincial policies, but also due to the variety and complexity of medical practice.
What should potential EMR developers consider? The following list provides some guidance:
- Canada is not one single EMR market; rather, it is multiple smaller markets ranging in size from Prince Edward Island to Ontario. Quebec is a completely separate market with vendors that specialize in the French market and little overlap with the other provinces. In addition, the dual language requirements of Quebec and New Brunswick create additional challenges for EMR vendors.
- There is no national EMR certification program in Canada. Most provinces operate their own certification program (Alberta — POSP; British Columbia — PITO; OntarioMD; Saskatchewan EMR Program; Manitoba eHealth; and Nova Scotia — PHIM). For more information on provincial programs, click here.
- In order to qualify for reimbursement funding from the provincial programs, vendors must meet provincial certification requirements. However, in some provinces vendor certification has been limited to a set number of certified vendors (BC, Alberta, Saskatchewan, and Manitoba). Unless there is a change in policy, it is not possible for new products to be certified under provincial funding programs.
- Recommendation: Choose your province carefully.
- Early adopters and early majority physicians have already implemented their first, second and sometimes, third EMR in provinces that have offered funding programs for some time such as Ontario, Alberta, British Columbia.
- In these markets, the group that are now adopting EMRs are the middle and late majority. This group of potential clients is much more difficult to convince regarding the value of EMRs. They are not interested in technology, simply want to practice medicine and need to clearly understand the value proposition of the EMR in their practice. In addition, they often require more training and support in comparison to the more tech-savvy early adopters.
- Recommendation: Unless you can offer a product that is incrementally better than other EMRs available, you will have a challenge selling into a market that has already made the early sales.
- The potential market is smaller than you may think. Based upon the 2010 National Physician Survey data - National Demographic Data, Canada's 66,906 physicians comprised 34,810 Family Physicians and 32,096 Specialists.
- If Quebec is not your intended market, subtract 16,457 physicians from the total number. This leaves a total of 50,449 with 26,450 Family Physicians and 23,999 Specialists.
- Not all physicians are a potential client:
- A larger percentage of Family Physicians overall will adopt EMRs. However one should make exclusions for those in academic medicine, hospital based primary care physicians (employed by hospitals or regional health authorities including hospitalists and emergency room physicians), those in administrative medicine, practicing alternative specialties such as cosmetics, retiring physicians, locums and a small group who simply refuse to adopt an EMR.
- Specialists who are unlikely to purchase EMRs include those that are in academia or administrative positions, anesthesiologists, radiologists, interventional cardiologists, laboratory medicine and pathology or other specialists who are hospital based and those that have highly specific requirements such as ophthalmologists.
- Because of these limitations, I estimate that the potential market ranges from 60% of overall numbers for Specialists to 80% of Family Physicians.
- These percentages translate into 18,515 Family Physicians and 14,394 Specialists in provinces and territories excluding Quebec
- While this may be sufficient to support a healthy EMR market, remember that provincial policy has dictated that each province functions independently in terms of EMR certification.
- Recommendation: Choose your initial province carefully and keep these numbers in mind as you consider entering other provinces.
- For regular readers of this blog, you will be aware of my concerns regarding the core infrastructure needed for medical practices to effectively implement and use an EMR. Unless physicians can refer patients and receive consultations electronically, E-Prescribe or transfer patient records (even a core set of data such as the UK GP2GP transfer system), every medical practice that implements an EMR is a hybrid of electronic and paper processes.
- Without this core capabilitiy, it is not possible to become an advanced EMR practice.
- In our current state without any of this advanced capability, we do not have advanced EMR practices in Canada - this is not a limitation of EMR vendors, but a limitation of the development, implementation and support of standards and policies that allow these capabilities to evolve.
- Recommendation: There are issues that are out of your control that you will need to consider
This is not a comprehensive list, however I hope it is useful guidance to individuals who are implementing new EMRs, considering the development of an EMR or existing vendors who are looking into expansion into new markets.
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