I showed this to a friend who has created software for the medical industry and has close ties with/knowledge of the industry. He allowed me to copy his thoughts here, with some very minor edits for privacy:
Regarding Drchrono app:
> a) [...] compared to PAPER it's pretty good! but its not built with speed in mind, iits built to tackle other things like billing, and assumes a more traditional practice. it aint gonna make you more $$ in an office as it does nothing to speed up the workflow and allow a doc to cut staff, which is THE overhead in a practice.
> b) that 44k comes with a lot of strings. main one is that you have to have 30% medicaid patients. that alone can bankrupt a practice, as medicaid pays a fraction of what insurance/medicare pays for visits. an efficient practice, for example, would look at the 44k and say 'f that'.
> other strings is what [some doctors] refers to as the 'thought police ' - you have to regularly submit reports on your patient stats to the gov't. not nec.a bad thing, but few doctors want some beauracrat to be eyeballing their stats without knowing anything about the actual patients. i'm not sure how the data will be used... i generally dont think "outcome based" compensation is a great way to pay either bc its hard to quantify health and management of chronic stuff etc.
And opinion on medicine more generally:
> medicine has been, and ought to be, a relationship business - which defies a lot of efforts to quantify it. a lean practice [with] deep personal relationships with patients (as opposed to a clinic style 35 patients/day practice, which is mayhem and prone to problems) ought to be what ppl strive towards. thats not the trend... trend is towards big groups bc individual docs are dumb and cant run their practices well.
> anyway, its' a long discussion... :-) not clear what the next 10 years will bring. hunch is we'll be big losers when primary care is mostly atrophied and big groups with salaried docs are common. remember how much innovation comes from large entities. [a certain private practice he knows of] is 10 years ahead of anyones bc [it is] lean and innovative.