The Next Five Years: The EHR Network Effect

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Last week I gave an invited presentation to the Columbia chapter of the South Carolina Health Managers Association on EHR topics. Having never been to Columbia, or tasted the famous South Carolina yellow barbecue sauce, I went (as they say) with relish.

My presentation was “The Next Five Years:The EHR Network Effect” and I thought I’d summarize it here. (What it has to do with EHR Workflow Management Systems will become apparent towards the end.)


A network effect occurs when adding products or service increases the value of existing network products or services. The classical example is (a) one telephone is not worth anything, (b) two telephones connected to each other are perhaps worth a little bit, (c) but millions of networked phones are worth a whole lot.

There is much current discussion about health information exchanges (HIEs) and sustainable business models. To the degree that an HIE facilitates the creation of a network of EHRs a network effect may be to increase the value of each individual EHR. The more valuable a network of EHRs is, the more whoever benefits from that value will pay to sustain the HIE. Over the next five years (to pick an arbitrary planning horizon) exploiting the network effect will likely be key to creating financially sustainable HIEs.

The rest of my presentation consisted of examples of existing and potential EHR network effects. An obvious example is an EHR user relying on data from another EHR to provide patient care. If we expand our scope to the network effect of adding health information systems to a network, then there is the (again, obvious) value of EHR messaging: incoming lab results, refill requests, decision support, etc.; outgoing E-Prescriptions, disease and vaccine registry data, payment for outgoing quality data, etc.

However, the three network effect examples I focused on were:

1. Biosurveillance

Adding EHRs to a network of EHRs that participate in a biosurveillance program increases the ability to accurately red flag potential bio-terror events and this increased accuracy causes an increase in value that accrues to each member of the EHR network.

2. Population Management

Adding EHRs to a network of EHRs that participate in a population management program increases the quality of inferences about population health state which, when fed back to individual EHRs to affect patient care, increases the value of each participating EHR.

3. Process Benchmarking

EHRs generate considerable process data that is not part of the official patient record. This data includes who did what to whom, where, when, how and often even why. Much of this data is gathered for privacy and security audit trail purposes. Some, depending on the EHR, is actually a byproduct of internal task management mechanisms.

Chose an output metric or weighted combination of metrics; compare your EHR productivity to the average and the best productivity of other EHRs on a process benchmarking network of EHRs; now drill down and explain the differences between your productivity and that of other EHR installations. Use these explanations to change your processes and improve your productivity.

Of all of these EHR network effects, I believe that process benchmarking may potentially be the most compelling value proposition for a majority of medical practices. Of course, everything looks like a nail when you have a hammer, and this blog is titled “Electronic Health Record Workflow Management Systems…”

More on process benchmarking in a later post.

Oh, the yellow barbecue sauce at the Palmetto Pig near the Devine Street Bridge was…divine (and the hush puppies were the best I’ve ever had).


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