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Daniel Schwartz

The other factor we need to ensure as EMRs continue to add functionality and improve over time is the potential for true competition for existing physician EMR clients.

Currently, EMR vendors compete for new business and need to distinguish themselves. So we do see some drivers of competition, albeit limited by the relatively small provincial markets as Dr. Brookstone points out.

However, once we approach universal adoption, there will be little incentive for vendors to innovate. The vendors will only be competing for new grads and MDs moving between provinces - not much of a market and certainly not one worth investing in.

Currently, the barriers to moving between vendors are tremendous. The costs are exceptionally high and the data transfer results in the corruption of much of the data.

Even highly standardized laboratory data that adheres to HL7 doesn't necessarily move nicely between systems.

Content such as notes, consult letters, smoking history, reports, family history, medical history, etc does not have any data standards that all vendors adhere to. So when this data is moved, quality of the data degrades and often becomes unusable.

So, if barriers to moving between EMRs are high, Canada is doomed to highly mediocre EMR products over the long term.

We need to get to a point where it's as easy and cheap to transition between EMRs as it is to switch from Outlook to Gmail.

Imagine what would happen if a newcomer could enter the EMR market with a substantially better product with the realistic hope of having hordes of physicians from across the country migrate to their product.

However, in today's EMR ecosystem, a new EMR would need to be orders of magnitude better than the existing competition to make the weeks of heartache that accompany a transition worthwhile.

If we could agree upon rigorous and widely adopted data standards, we might get there.

We would have been in much better shape if we had agreed to store all EMR data in a fixed (but constantly expanding) data structure that any EMR company could "skin".

Then, the best user interface and feature set would win and physicians would not feel locked into mediocre products.

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