Q: How much does it cost to serve a web page ?
A: Getting close to free.
Q: How much will ASP EMRs cost in the future ?
A: Near free.
Will most things be free, including EMRs
For once, Dr. Murdoch and I may be in somewhat of an agreement. Many technologies that have been around for a very long time, such as web serving, are getting close to a baseline price that is near free. In fact, many technologies are like that.
So as a computer science graduate, I must be getting afraid of all that, right?
Wrong. Here's an example why:
In the 90's, one of my responsibilities for the company I worked for was to maintain a strict eye on storage. Files that were not needed were to be deleted as per the company retention policy or moved to tape or whatever. The reason was simple: back in those days storage space was expensive. Most hard drives were stilled measured in Megabytes, not Gigabytes. Today, 1 Terabyte drives are available on the shelves at Best Buy so that means jobs like the ones I have are gone. Well, yes and no. The job of making sure you don't run out of space is gone but not because it was eliminated - because it was transformed. Today, my company and my clients have so much information stored on hard disk I am now focused on making sure disaster recovery is able to recovery it all and I spend a great deal of time helping people sort through all their crap to find what they are looking for.
Yesterday: Make sure we don't run out of space by deleting or archiving to tape.
Today: Find efficient ways to help my clients sort through limitless GB's of junk to find what they are looking for because they have to much space.
JamesNT
DrMurdoch: Q: How much does it cost to serve a web page ? A: Getting close to free. Q: How much will ASP EMRs cost in the future ? A: Near free. Will most things be free, including EMRs
There's been a lot written about online items approaching the free threshold. Free music being the most popular one. However, I don't see this applying to EMRs, because of the privacy required for the information.
The key to website being able to approach free is that incremental increases in traffic cost almost nothing. However, the initial outlay does cost. Even the incremental increases in traffic cost something, but it's just very little. The problem is that large amounts of traffic combined with very little is still a cost. A much smaller cost than before, but still a cost that needs to be offset by some revenue.
The question is that if an EMR is offered for free, where will they find the revenue to offset those costs? Premium services? Ads? Selling marketing data? etc etc.
There are a lot of revenue models that work well for web applications, but I think that HIPAA privacy stifles most of them. All of this means (in my opinion) that EMR won't be free, but many many other services will be.
My EMR and HIPAA Blog
My (Unrelated) TV Blog Network
Free isn' t really free. Somehow you or someone else will pay something to use the product. What if it was free provided you adhered to a minimum threshold of quality metrics? Ideally the government and insurance industry pay you (or use of the EMR) when you use the EMR to deliver benchmarkable, higher quality of care. Somehow I don't see that happening though.
Disclaimer: I am the founder of e-MDs. Highest rated by doctors. All posts are opinion only
There is no such thing as free. For those who believe in the word free, I highly recommend you attend an economics class at your local community college.
It is true that many items become commodities and begin to approach free. However, approaching free is not the same as actually being free. For example, there are some companies that say they will host your website for free, HOWEVER, they want to do one of the following:
a. Embed advertising on your website from their sponsers
b. Take statistics from your site for data mining purposes
So tell me, are they hosting your site for free?
Lastly, the reason many things approach free is because they are being replaced by technologies that fit a greater need. For example, back in the 90's companies paid big bucks for IT specialists that knew Windows NT like the back of their hands. Today, you cannot get a job specializing just in Windows. You are expected to know Windows nonetheless, but you cannot get a job if that is all you know. Now you are expected to know DNS, Active Directory design and deployement, SQL Server, Exchange, Sharepoint, and so much more like the back of your hand. Your knowledge of Windows has begun to approach free but it will never get their.
In some forseable future EMR software may approach commodity level or may even be offered for free. However, by that time an EMR like we have today will no longer fit the bill for the needs of a doctor's office. It's like open source. Companies like IBM and Novell give you Linux and a lot of tools for free. But if you want the big stuff to run your enterprise or if you just need support for the free stuff, it's time to pony up some serious cash.
I'll never understand those who waste their time saying the word "free" as such a word does not exist.
In regards to the music comment - music isn't free, it's stolen.
I recently got an email about Practice Fusion which is making a run at "free emr." They described to me their revenue model as follows
"We generate revenue by embedding advertising, including pharmaceutical products, into our physician tools. We also incur revenue through the sale of anonymized patient data to research groups, pharmaceuticals, and health plans."
Essentially free software in return for advertisements and the selling of aggregate data. Should be interesting to watch how this company and their "free" model works.
JamesNT: In regards to the music comment - music isn't free, it's stolen.
Not all free music is stolen. There is a whole lot of free music offerings out there that are free and getting more every day. Plus, even more "free" music offerings that "cost" you viewing ads.
techguy: I recently got an email about Practice Fusion which is making a run at "free emr." They described to me their revenue model as follows "We generate revenue by embedding advertising, including pharmaceutical products, into our physician tools."
"We generate revenue by embedding advertising, including pharmaceutical products, into our physician tools."
Great EMR companies are now pharma whores. Lovely. This practice should be banned.
We also incur revenue through the sale of anonymized patient data to research groups, pharmaceuticals, and health plans."
POP QUIZ: Name another EMR who promised to make money this way ?
I believe that there is plenty of room for a mix of free and commercial in the EMR/EHR world. We need our health record to be truly compatible between different providers and institutions.
In order to achieve thism the basic underlying EMR should be a single, prefereably open source standard. The interface, however, is where differences could and should abound. Physicians and other health care providers are practicing only part of the whole totality of medicine, and they are practicing in different environments. However, the backend of the system could be a database system which would be consistent between clinics, hospitals, outpatient labs, and so on. This would improve communication between providers immensely.
I would liken this to the current web model. While a site may serve up webpages with Apache, the websites themselves can be read with ie, firefox, safari, konqueror, opera, or a plethora of various other browsers - on desktops, laptops, cellphones, etc. Browsers even exist that can be used from the command line (like lynx). Apache is very scalable - I can run Apache on a Pentium II on up to an eight core xeon machine, depending on my needs. Thus, in this model the Mayo Clinic could be running the same backend as a small physician's office, with only the hardware being variable. Running on a Linux or BSD machine with open-source MySQL or similar systems, the basic cost of the backend could be negligible. The front ends would be where most of the action would be.
Of course, currently there are many different webservers available, like IIS, Apache, lightHTTP, and so on. However, in our system of medical care, the backend should be standardized for improved ability to communicate. The current system of hundreds of incompatible EMRs really represents the software model of the 1980s, not the 1990s and 2000s. A newer model of compatibility and standards must be adopted.
Bryan Siegfried, M.D.
Staunton Clinic
JamesNT: There is no such thing as free. For those who believe in the word free, I highly recommend you attend an economics class at your local community college. [...] In some forseable future EMR software may approach commodity level or may even be offered for free. However, by that time an EMR like we have today will no longer fit the bill for the needs of a doctor's office. It's like open source. Companies like IBM and Novell give you Linux and a lot of tools for free. But if you want the big stuff to run your enterprise or if you just need support for the free stuff, it's time to pony up some serious cash. I'll never understand those who waste their time saying the word "free" as such a word does not exist. In regards to the music comment - music isn't free, it's stolen. JamesNT
[...]
I agree that the term "free" can be easily misconstrued. I think two separate processes are occurring here. One, the residual cost of simply webserving is getting cheaper. The other issue is that software is becoming cheaper, mostly through open source.
The falling residual cost of serving webpages is great, but it does not change the cost of producing webpages, or managing security on the web. That will continue to be an issue that will require the blood, sweat, and tears of computer scientists and programmers.
Open source solutions such as MySQL, Linux, and Apache are steadily reducing the cost of the software. This is great in that it makes software available to everyone who can use it. However, even the most computer proficient doctor is hardly going to create his or her own EMR from a collection of such software. However, a programmer or company could write their EMR to use Linux and MySQL instead of requiring Windows Server and Windows SQL and suddenly cut the cost of their software by the thousand+ dollars that this additional software would have cost. The service of supporting the software would continue.
So, the twin movements of falling webserving costs and open source software are bringing down the cost of software. Since much fo the EMR market has not yet even been tapped, we would do well to encourage these developments within the EMR industry.