HealthLeaders: Have you been concerned about reports of lots of rip-and-replace of EHRs? Some of it has been attributed to a provider that bought a product maybe for Stage 1, but found that product was inadequate to cover what Stage 2 demands.
Mostashari: Stage 2 is more demanding. It's supposed to be more demanding. I guess I'm of two minds. If there is replacement happening because providers are changing their affiliations and there's been mergers or acquisitions, that's understandable, and there's a lot of that going on, and there are reasons for people to want to be on a single system. There may also be good reasons why someone might say, 'I like that better, and I'm not locked in to a single vendor.' Markets work well when you get to choose one, but then you're not stuck with a vendor for the rest of your life. Good markets exhibit switching behavior, and if there are vendors who are more agile, more responsive, better customer service, better usability, that people want to switch to, then the overall quality of the marketplace will improve, and innovation will be rewarded.
That's a good thing. If, on the other hand, people are left high and dry because there are poor business practices, if someone is a perfectly good vendor that people like that is bought out and that product discontinued to force people to switch over to another market, then that is less good for the overall benefit. I would say this is another one of those where we have to really observe and understand what's happening, not only [with] the only remedy being to slow down, but think about how the market participants, including importantly the customers, can exert their influence on creating a more perfect market.
Next week, the second half of my conversation with Mostashari: too many quality measures, how much credit IT should get for lowering costs, and whether today's EHR software is outdated.