exCernerite: Alert Life Sciences’ (no “Health” in there) stuff looks pretty cool, but I hate that I have to register just to be able to see the user interface and not just a bunch of Flash, well done as they may be. Have you used it? – Gregg

1) Market size: Various reports place the total US sales of MP3 players at about $2B in 2006. With a few minutes of Googling I could not find a more recent number. Other reports say that Apple owns about 70% of that market. In 2007 Apple had already sold 100 million iPods. These numbers are huge and the profit substantial. The huge market share that Apple owns also makes it easier for new models to be accepted and profitable. The EMR market does not have these attributes — no one player owns 70% of the market nor are we pushing $3B/year in sales just yet. One research note said that the EMR market was “at $1.8 billion in 2006 and are anticipated to reach $3.2 billion by 2013.” However, this number included sales of “EMR software” to large hospitals and said the average cost per deployment was $1.95M. It would be very interesting to see the numbers of just the physician EMR market size — how does it compare to the iPod market?

2) The complexity of the data stored and the user interfaces needed are clearly different. I’m sure Apple engineers would successfully argue that they rightfully spent a huge amount of development time creating the iPods and associated infrastructure. Clearly this is very true in the case of the iPhone/iTouch — it is an entire operating system and user experience. Yet is is equally fair to argue that the total amount of data stored, viewed, and archived in an EMR is much more complex. Said another way, the engineers-per-line-of-code ratio is likely very different. Most EMR vendor’s development teams are tiny compared to the number of engineers working on a product like an iPod launch. A Wired article from January this year said that in 2005 “Steve Jobs had tasked about 200 of Apple’s top engineers with creating the iPhone.” Layer on a multiplier for back end support and you’ve exceeded the development staff of even the largest EMR company on the planet.

Change in a practice is the most vexing problem for an EMR vendor, not lack of a slick user interface and coolness factor. Unless you have witnessed Nurse Ratched, standing hands-on hips, heels firmly planted, ignoring your pleas to at least try the new EMR, to at least consider a training session, you have been involved with only several installs……your own most likely.

Change in a practice, particularly when moving from a paper-filled to paperless environment, represents a significant threatening factor to the established old guard. For example, Nurse Ratched (if you don’t mind me referring to the battle ax from One Flew Over the Cuckoo’s Nest), ruled her domain because she was aware of everything. Introduce new technology where there is unfamiliarity, and these battle axes feel threatened. They fear losing the keys to the kingdom to some younger….and less technologically challenged…staff member. They might feel threatened with that pimply faced, young nurse’s aid/tech simply based on their ease with using a computer.

The change factor is least written about, least understood, and quite disruptive to implementation.

Here’s the test- if the staff member can’t even find time for training……..without even casting a glance at the user interface…..it’s a pretty good indication that the change factor has reared its ugly head.