Baseline EMR?

In previous posts, I've written about two very separate ideas -

1) A universal health insurance model in which everyone is guaranteed a baseline level of coverage, while those with added medical needs or monetary ability can purchase more insurance on the private market.

2) The need for not only widespread use of EMRs, but the importance of EMR systems being able to communicate with each other.

What if we combined these two ideas in the movement to spread the use of digital medical records? We would create a two-tiered system in which the baseline is an EMR system that is low-cost and has basic functionalities, perhaps even something that is opensource (similar to the OpenMRS used by community-based health providers and nonprofit groups such as Partners in Health). This baseline offering is cheap to purchase, easy to customize and use, and addresses the basic needs of a provider practice. At the same time, the market already provides a variety of more comprehensive (and costly) EMR solutions that larger provider systems would favor to cover the level of complexity in their organization. This second tier market wouldn't change, but the problem of compatibility needs to be address. These more complex solutions should be built to encompass the basic capabilities of the baseline product, so that a basic level of communication is possible across all health care providers.

Part of the $20 billion in the stimulus package slotted to go towards EMRs can be used to help physicians in rural areas and small group practices implement the baseline EMR package. Using funds this way is both cost effective and high impact, as it addresses the needs of those providers that are easily left out of larger, more complex systems. Their smaller size also means that they may not need the level of complex detail that are built into EMRs current supplied by the private market (as a health IT consultant, I've gotten to see how needlessly complicated these systems can get). A two-tiered EMR market would ensure that all provider organizations can find a product most suited to their size and financial ability, and it would improve the likelihood of intersystem communication.