How about making EMRs easier to use? This includes personalization by physician or nurse, select versus enter, dictate complex orders in “human” terms; use voice recognition and personalization to present the order for review and approval.

Physicians and nurses are busy people. Make it easy and they will use it. Design it so they do more work and they will resist using it. But who wouldn’t respond the same way?

(1) EMR resistance will remain high, but P4P may help – Extra money for capital expenditures increases the ability to purchase IT equipment? Amazing. Reality is right now the P4P upside bonus potential just isn’t large enough to afford a top of the line “bells and whistles” EMR.

Even if the rate and size of P4P increases, it depends on what forms it takes. Still lots of debate about whether P4P targets should be a part of the annual fee schedule increase or a separate bump entirely. Early evidence that the the P4P upside have to be considerable (10% or more of their take home) and that physicians aren’t crazy about having half of their annual fee schedule bump suddenly tied to various quality targets.

(2) there won’t be enough HIT experts to implement all the EMRs being sold – Likely true to some degree but again the scope of the problem greatly depends on the adoption rate curve and what capacities you are talking about.

(3) Allscripts and Epic will use cloud computing to drive down the cost of today’s client-server systems and make them affordable to small medical practices – Frankly the most interesting prediction in the list although I would have been more interested to hear to what degree SaaS offerings will displace client-server systems and how quickly.

(4) risky EMR implementations will push small medical practices to band together or merge – Worst prediction among the list. This is already happening for several other factors due to market factors in most MSAs and has been for some time. What would have been interesting is a bit more insight into what specialties might be more effected by this than others and the physician organizations/contracting vehicles that might emerge as a result (group practice without walls, PHOs, IPAs, etc).

(5) Kaiser Permanente will take an active role in setting EMR-related best practices and standards – Sure to some degree but when are common laypeople going to realize that staff model HMOs like KP, Group Health, Geiseinger, Mayo, and others are the exception and not the norm in medical care. These organizations do not speak or are representative of a majority of the physicians and hospitals in the U.S.

(6) McKesson will use its logistics and value chain to increase its provider and payor IT offerings – Another big shrug. Only interesting thing with this prediction is if this means McKesson will create a host of organic new offerings/services and largely eschew acquiring companies as they have been doing the past several years.

We pay him to do that.