Wagner said about a third of those ambulatory practice leaders surveyed said they wanted to buy systems distributed using the SaaS or, as they previously were called, “application service provider,” or “ASP,” delivery model in which the vendor pushes the software to the user via the Internet. Another third of KLAS survey respondents reported at least a willingness to buy one of these Internet-delivered systems.
“When a third says they need it and another third say they'd consider it, that was a significant change,” Wagner said.
The KLAS findings add a data point to a trend line moving toward SaaS/ASPs that was revealed in 2007 with a survey of osteopathic physicians conducted by the Medical Group Management Association on behalf of the American Osteopathic Association. It found that nearly 21% of practices surveyed who were using an EHR had a Web-based system.
Physicians have long had a bunch of issues with Internet-delivered EHR systems, including concerns about their speed, reliability, security and privacy, in addition to worries about the economic viability of Web-based systems providers—particularly in the wake of the disappearance of so many of them with the bursting of the dot-com bubble a decade ago.
If those reservations seem to be giving way to ASP acceptance, expedience appears to be one of the driving forces, according to Wagner. Moving the market, he said, is the press of adoption deadlines to have an EHR system in time to make the first “payment year” beginning Oct. 1 for the EHR subsidy program. It is administered by Medicare under the American Recovery and Reinvestment Act of 2009, also known as the stimulus law.
“Part of it is people's understanding of the limited time frame to the 2011 deadline to get up and running,” Wagner said. “The psychological bubble is bursting, and there is the forced migration. This has to happen and this is the only way to do it.”
In the decade following the collapse of the dot-com bubble, healthcare organizations have seen the successful deployment of SaaS-based systems not only in other industries, including the pioneering work by cloud-based, customer relationship management software provider Salesforce.com, but also in healthcare, with physician practice-management software providers like Athenahealth.
According to the KLAS report, the trend “is driven by price sensitivity and the proven success of the model with practice management systems and some smaller EHRs.”
Still, Wagner said, “It's kind of unfathomable that healthcare has taken so long accepting and adopting that technology," Wagner said, “but a lot goes back to the trust—or the lack of trust—doctors have with the customers recording and doing things different than they've always done it."
While three vendors—Allscripts, eClinicalWorks and NextGen Healthcare Information Systems—were mentioned by roughly a third of survey participants as vendors they were considering—the field is still wide open.
“This is especially true for small practices, where 72% are considering solutions outside the best-known vendors,” according to KLAS.
And yet, if all this sounds like the makings of a thrill ride for vendors, it isn't. For some vendors, the influx of federal funding could be a house of horrors.
Nearly a third of providers in the survey said they were replacing their existing EHRs; half of them reportedly because “their current solutions are not viable go-forward strategies in today's ARRA-focused healthcare environment,” KLAS reported.
And of those who say they are replacing their existing EHRs, 62% are replacing systems that are or were certified by the federally supported Certification Commission for Health Information Technology.
“System certification, or even satisfaction of meaningful use, does not guarantee that provider needs are being met,” according to the report.