Tough Sledding Ahead for the EHR Industry?

Perhaps this exchange best illustrates the clash of culture between the ‘medical boots in the ground’ aka CMIO’s and the EHR industry. The names have been changed to protect the innocent or guilty depending on your perspective.


A really smart and justifiably confident EHR engineer, programmer and system architect for a major EHR company with decent market share.

A passionate and ‘has drunk the koolaide’ CMIO (of a modest size East coast, stand-alone non-profit community hospital) of the EHR value proposition, with some rather compelling reservations and real time (garbage in/garbage out) concerns.

Paraphrased narrative over drinks and dinner:

CMIO: Your EHR (generically speaking) is going to kill hospitals like mine!

EHR Dude: Why do you say that?

CMIO: There’s too much unfinished translational work that invariably falls onto my desk as CMIO and therefore the de facto educator and implementer in chief of a program that few physicians want to try to learn let alone work with.

EHR Dude: Well then that’s your problem.

CMIO: No but you don’t understand, it’s killing my hospital and will take us down (i.e., out of service).

EHR Dude: Well, I doubt it. But if that is the case, then so be it…let it sink.

Ok, this oversimplifies and perhaps takes some literary license on the actual narrative, but this is what I basically heard.

I left dinner thinking that, man, isn’t CMIO the customer here? And if so,  shouldn’t EHR dude be listening, and learning from a first person boots on the ground report as an opportunity to make his or the industry’s product better?

What am I missing?


Join the Conversation


  1. Kind of looks like the CMIO may have not done his due diligence before purchasing the system. I fear that many are buying EHR without knowing what they are buying. It reminds me of a time when my company wanted to buy a plane and they sent me because I was the one that had taken ground school.

    The Dude may have been out of place and not listening to his customer but they may have been the wrong person for the CMIO to speak to about features and problems.
    Especially after a day at HIMSS and a few drinks. Like docs they are multiple types of HIT, from the guy that hooks up your PC to System Architects. You have to qualify the person that you are speaking to. Engineers, Doc, artist and musician are a lot alike. The Better they are the more disconnected they seem to be.

    EHR are like everything else that you purchase, Let the buyer beware. Make sure you have a game plan for purchasing and that you technical person hasn’t had only ground school before selecting your multi-million dollar enterprise software that could kill your organization.

    Jeff Brandt

    1. Hmmm…. Interesting take Jeff! Two thoughts: 1. sometimes the informal conversation with our without alcohol is where the sometimes ‘brutal honesty’ emerges, so minimally whether the setting is right or not, the ‘client’ in my view was speaking. 2. The due diligence part is real, and not sure what if any process the CMIO et al went through. I believe the ‘tag’ was more of a generic cry for help, than a specific appeal as a user on their (EHR Dude’s) platform. Bottomline, there is considerable translational work to be done with any off the shelf EHR, so all feedback from users need be taken into account. Simply suggesting you read page 62, may not be an example of ‘putting the client’s interest first’. In the end, if this is a ‘i’m right and you’re just not listening (or are too lazy to learn) competition, the process is doomed! Just sayin’…..

  2. As a CMIO, I feel much sympathy for the hospitals (especially community ones) trying to keep pace – Maintaining an EMR is a lot more work than it seems, and vendors often talk about the price of the car – Less so about the cost of the gas. But I think this post hit the nail on the head – This culture clash is where healthcare change is going to happen. 🙂

    1. At one level one can say, hey we have too much capacity in our $2.3 trillion dollar delivery (non) system, and what the heck one less hospital is no big deal. After all, we live in a competitive market where survival is not guaranteed, so let the adaptive, more nimble and market savvy entities survive (a Darwinian result). Yet, this is not likely to be just one hospital CMIO’s experience? We shall see. Thanks for your reply!!

  3. Fascinating conversation and exactly why I prefer to linger in the ambulatory world and not the hospital space. While certainly some of this can happen in the ambulatory space as well, there’s not nearly as much vendor lock in when you are paying a few hundred a month versus a few million dollar contract. It changes the way a vendor approaches a situation.

    Although, there’s no doubt that this approach by the EHR engineer will come back to bite the EHR company in a big way.

    1. Copy that John. Considerably less politics and platform (including personality) complexity in the ambulatory sphere! However, as mentioned by Jonathan Bush, with all the consolidation, merger and acquisition activities of medical practices by hospital systems, may be hard to avoid going forward? Thanks for the comment!

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