"For example, inside a hospital, operating rooms (OR) are often profit centers, and emergency departments (ED) are often cost centers. The hospital may be receiving subsidies to maintain its EDs based on its ratio of OR profits to ED losses, in which case a product that ultimately makes ORs more profitable may not be worthwhile to the hospital."
To an ambulance service (emergency and pre-hospital medicine is my area/passion), IFT (Inter-facility Transport) is a near guaranteed paycheck, 911 response is generally a cost center.
DrChrono has it good, because the government will pay their customers (the doctors and facilities) for the implementation.
But it's definitely an area that could do with some work in unseating some entrenched and ultimately complacent incumbents.
> DrChrono has it quite good, because the government will pay their customers
Only if their customers can document, attest, and verify that they meet the standards for Meaningful Use as required by federal law to receive their subsidies. And this can be a considerable burden for the smaller practices that DrChrono targets.
Plus consolidation within the industry means their market is shrinking as larger hospital systems buy up small practices and move fold them into to their hospital-grade EMR systems such as Epic, Cerner, and MEDITECH - all while these larger EMR companies are concurrently giving their products to small practices in order to become regional standards.
Plus, for those remaining practices they have a LOT of competition - there are literally thousands of outpatient EMR solutions, including Practice Fusion, which is well established and free, meaning providers can pocket the subsidies.
DrChrono is a great technology, but don't think they don't face their own challenges.
Is 911 response REALLY a cost center? Around here, to get an ambulance, it's $500 (IIRC) up front + $16(!!!!!) a mile. And the closest hospital might be 10 or 15 miles away. And I dont think this includes material costs (any drugs, etc.)
911 response, unless ran very well, and / or miserly, is absolutely often a cost center. You have "frequent fliers" who you may see several times a week, without insurance. Billing sends them a bill, but there's no realistic expectation of payment.
You can't, even as a private agency (and should 't - for better or worse, I'm a proponent of "socialized" medicine, even in bastardized form) refuse a patient transport, though about the best you can do is advise a patient that their insurance is unlikely to pay if the ambulance transport does not have. "medical necessity", even with (especially with) Medicare (who requires us to get a document from the physician stating the necessity of "transport in a fully equipped BLS/ALS ambulance").
Add to that Maintenance, drug purchase (must be kept stocked and current, even if rarely used), fleet Maintenance (driving code in a truck carrying N extra 10-15000 lb at high speed places a lot of strain on a vehicle), insurance (likelihood of an accident), insurance (malpractice in this area is usually carried by the agency, not individual), regulatory and other costs, costs of maintaining sufficient crews on duty so you can respond even when others are out doing long distance transports (hospitals to nursing homes, home, or stabilized patients to bigger or more appropriate hospitals) or transporting your frequent fliers, and it begins to add up.
"For example, inside a hospital, operating rooms (OR) are often profit centers, and emergency departments (ED) are often cost centers. The hospital may be receiving subsidies to maintain its EDs based on its ratio of OR profits to ED losses, in which case a product that ultimately makes ORs more profitable may not be worthwhile to the hospital."
To an ambulance service (emergency and pre-hospital medicine is my area/passion), IFT (Inter-facility Transport) is a near guaranteed paycheck, 911 response is generally a cost center.
DrChrono has it good, because the government will pay their customers (the doctors and facilities) for the implementation.
But it's definitely an area that could do with some work in unseating some entrenched and ultimately complacent incumbents.