IT, it rolls Downhill

I was having lunch with one of my more technical savvy, or so she thinks, doctor friends the other day. Just like most physicians, she’s contemplating implementing an EMR application for her family practice. After visiting with several EMR vendors, she decided that she was going to implement an open source EMR solution because of its cost effectiveness, plus she has a longstanding relationship with her current system integrator.

Since our last discussion, someone, another vendor, had convinced her that a software as a service (SaaS) solution was the way to go. It's quite possible that a good financial case can be made for an EMR SaaS solution as opposed to other EMR solutions. But what surprised me was that she was not aware of the inherent risks of implementing this type of solution. I reminded her of when her web site hosting company closed. The frustration it caused and length of time it took to get her site back online. Actually, the bulk of the frustration came from her trying to get the source code for her site (she never had a copy). I warned her that experience would be very similar if her SaaS provider tanked, only it would be MUCH worst. After our discussion, she realized she had more work to do before coming to decision.

I begin to wonder who responsibility is it to outline the risk of the various EMR solutions to a potential customer? Should each vendor outline the inherent risk associated with their solution? Or should a physician research and understand the inherent risk involved for each possible solution? For large clinical practices and hospitals, this is not an issue because this falls squarely on the CIO, IT Director, or to the most senior ranking IT executive. However, an IT executive would be aware of the inherent risk in each solution platform and would carefully and thoroughly explained the risk to all stakeholders ;)

As the healthcare IT reforms begin to be implemented, vendors, software developers, and system integrators will merge, disappear and possibly default. "Things" will begin to roll downhill and IT will be sitting at the bottom of the hill. If the magnitude of this problem is great, that hill will be Capitol Hill. We all saw what happened to the last industry execs that visited there.