Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Epic Belatedly Accepts Reality And Drops Interoperability Fees

Posted on April 21, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Unbeknownst to me, and perhaps some of you as well, Epic has been charging customers data usage fees for quite some time.  The EMR giant has been quietly dunning users 20 cents for each clinical message sent to a health information exchange and $2.35 for inbound messages from non-Epic users, fees which could surely mount up into the millions if across a substantial health system.  (The messages were delivered through an EMR module known as Care Everywhere.)

And now, Epic chose #HIMSS15 to announce grandly that it was no longer charging users any fees to share clinical data with organizations that don’t use its technology, at least until 2020, according to CEO Judy Faulkner.  In doing so, it has glossed over the fact that these questionable charges existed in the first place, apparently with some success. For an organization which has historically ducked the press routinely, Epic seems to have its eye on the PR ball.

To me, this announcement is troubling in several ways, including the following:

  • Charging fees of this kind smacks of a shakedown.  If a hospital or health system buys Epic, they can’t exactly back out of their hundreds-of-millions-of-dollars investment to ensure they can share data with outside organizations.
  • Forcing providers to pay fees to share data with non-Epic customers penalizes the customers for interoperability problems for which Epic itself is responsible. It may be legal but it sure ain’t kosher.
  • In a world where even existing Epic customers can’t share freely with other Epic customers, the vendor ought to be reinvesting these interoperability fees in making that happen. I see no signs that this is happening.
  • If Epic consciously makes it costly for health systems to share data, it can impact patient care both within and outside, arguably raising costs and increasing the odds of care mistakes. Doing so consciously seems less than ethical. After all, Epic has a 15% to 20% market share in both the hospital and ambulatory enterprise EMR sector, and any move it makes affects millions of patients.

But Epic’s leadership is unrepentant. In fact, it seems that Epic feels it’s being tremendously generous in letting the fees go.  Here’s Eric Helsher, Epic’s vice president of client success, as told to Becker’s Hospital Review: “We felt the fee was small and, in our opinion, fair and one of the least expensive…but it was confusing to our customers.”

Mr. Helsher, I submit that your customers understood the fees just fine, but balked at paying them — and for good reason. At this point in the history of clinical data networking, pay-as-you-go models make no sense, as they impose a large fluctuating expense on organizations already struggling to manage development and implementation costs.

But those of us, like myself, who stand amazed at the degree to which Epic blithely powers through criticism, may see the giant challenged someday. Members of Congress are beginning to “get it” about interoperability, and Epic is in their sights.

Where the Jobs Are – 2015 Update: Demand for EHR/HIT Certifications

Posted on April 7, 2015 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

One year ago, I looked at the demand for EHR related certifications. I found, as the old line goes, that many are called but few are chosen. Of 30 or so certificate programs, only about a quarter had substantial demand. In fact, 1 had no demand.

Study Update

Finding Certification Programs. To bring the study up to date, I looked for new certificates or ones I’d overlooked. I found one, CEHRS, Certified Electronic Health Record Specialist Certification from the National Healthcareer Association.

Searching for Jobs. As with last year’s study, I then used Healthcare Scene’s Healthcare IT Central to search for jobs posted in the last 30 days that require an EHR or HIT certification.

Certifications Reviewed

Table I lists the 12 certifications, which had at least one job opening. Last year, I found at least 16 certifications with at least one opening. That is, this year as shown in Table II, I found no mentions for 15 certificates.

Table I
Certifications In Demand
1 CCA 7 CHTS
2 CCS 8 CICP
3 CCS-P 9 CompTIA
4 CHDA 10 CPHIMS
5 CHPS 11 RHIA
6 CHSP 12 RHIT

 

Table II, lists the 12 certifications that had no openings in the last 30 days.

Table II
Certifications Without Demand
1 CAHIMS 9 CPCIP
2 CEHRS 10 CPORA
3 CEOP 11 CPHP
4 CHTP 12 CPORA
5 CEMP 13 HWCP
6 CHTSP 14 CPEHR
7 CIPCP 15 CPHIT
8 CMUP    

 

Review Caveats

What Counts. Each certification listed in a job counts as one opening. For example, if a job listed ComTIA, CPHIMS and CPEHR, I counted it as three jobs, one for each certification.

General certifications only. For practical reasons, this review only covers general certifications that have a one word abbreviation. Where the abbreviation isn’t unique, I’ve filtered out non certificate uses.

No EDUs. I excluded certificates from colleges, universities, etc., whether traditional or on line. There are scads of these, but I’m not aware of any that are in general demand. That’s not a judgment on their value, just their demand.

Vendor Certifications I excluded product specific certifications, for example, NexGen Certified Professional.

Dynamics. The openings for these certifications are a snapshot. The job market and the openings that Healthcare IT Central lists constantly change. What is true now, could change in a moment. However, I believe it gives you a good idea of relative demand.

Certification Demand

In the past 30 days, I found 322 openings that listed a certification. See Chart I. As with last year, AHIMA’s were most in demand. Two of its certificate programs, RHIA and RHIT account for 60 percent of certificate demand.

Chart I Certification Openings

RHIA’s designed to show a range of managerial skills, rather than in depth technical ability. If you consider certifications proof of technical acumen, then the strong RHIA demand is a bit counter intuitive. Where the RHIA has a broad scope, the close second, RHIT, is more narrowly focused on EHRs.

In third place, but still with a substantial demand is CCS, which focuses on a specific ability. Compared to last year, CCS has fewer openings. This is due to a change in my methodology not demand. Last year, I counted any CCS opening. This year, I only count those with a clear HIT relationship.

Certification Location Demand

After looking at certification demand, I looked at it by state. To do this, I merged the different certification job openings into a single list. That is, I added those for RHIA, RHIT, etc., and then eliminated duplicates.

After creating a consolidated list, I sorted and subtotaled by state. I then sorted the state totals. This gave me the data for Chart II. It shows the top ten states for openings, including/ two ties.

Chart II State Demand

State Rankings. As you might expect, states with the largest populations have the most jobs. California leads, which is what you’d expect.

To account for population, I take job rank from population rank. For example, Washington State is 13th in population. It’s eight in job openings. So, subtracting job rank eight from population rank 13 is five. That is, Washington State’s job share is five ranks above its population ranking. Chart III shows the result where states stand when you account for population.

Chart III Rank Adjusted for Population

Most notable is Colorado. Colorado is 22nd in population, but fifth in certification demand. That is job openings for it are 17 ranks higher than population would account for.

Others ranking higher than their population are: Missouri, Arizona, Tennessee, Wisconsin, etc. Conversely, those states, which have openings below their rank, include New York, Pennsylvania and Florida.

Missouri’s case is interesting. Almost all its openings are from one company: Altegra. Its openings are almost all for one position type: medical record field reviewer. At first, I thought this was a case of over posting, but it doesn’t appear to be. They’re recruiting for several different locations.

Certification Demand Trends

When I stated this update, I expected there would be more jobs due to economic growth, but that hasn’t happened. There’ve been shifts among states, but overall the demand is pretty much the same. RHIA and RHIT demand last year and this year are practically identical while demand for others has dropped. I don’t have any numbers for overall openings then and now, but I suspect that they’ve grown while certification demand has either gone down or been flat. However, as I’ve said that’s just a guess.

Certifications are a response to the demand for persons with demonstrated skills. The question is whether one will reward your time, cost and effort with something that is marketable. Demand alone can’t make that choice for you. For example, working on a certificate that has little or no demand might seem pointless. However, its requirements may be a good way for you to acquire demonstrate your skills, especially if your experience is iffy.

Personal satisfaction also can’t be discounted as a factor. You might be interested in an area with low demand, but when coupled with your other skills might make you marketable in an area you desire.

If you do decide to pursue one of these certificates, I think these numbers can help you know where to look and what to look for.

Are Pilot Implementations the New “Evidence”?

Posted on March 13, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve talked with hundreds of healthcare IT companies. Many of them are new healthcare IT startup companies. It’s a feature of being a blogger and also of me organizing the Healthcare IT Marketing and PR conference. One challenge that every healthcare IT startup company faces is proving that whatever they’ve built will actually achieve the results they describe.

In many ways, this is a chicken and an egg problem. You need some customers that are using the product and show that it works before you can get people to use your software. However, no one wants to be the first one to try the software. They’re all sitting on the fence waiting for someone else to try it out.

In the IT world, some example pilot studies are the “evidence” a healthcare IT company needs to prove their solution works. Theories don’t work. They can send it off to a lab that tests it and certifies that it works (although, that’s kind of what EHR certification did and we know how that turned out). The only effective way I’ve seen a company prove that their product will work is to have some customers that are using the product.

Although, one user using it is not enough. If you’re in the hospital world you need a trifecta of users: large medical system (often academic), medium medical system, and small medical system (usually rural or community). In the ambulatory world you usually need a user from each specialty. While we’d love to think that what works for one specialty will work just as well for another one (and sometimes it does), it’s really hard to get someone to buy something when someone else in their category isn’t using it.

The best way I’ve seen to solve this problem is to beg, borrow, and steal your way to an effective group of pilot users. I’m not sure this is such a bad thing. We all know that a product being used is very different from a product that’s only been developed. However, we need more leaders that are willing to be the pilot implementations.

I think many organizations would want to do this, but they’re just so overwhelmed by meaningful use and other regulations that they haven’t had the time. Hopefully now that MU is more mature, they’ll make the time. It turns out that there are some real advantages to being the first. It’s like having your own development team at your fingertips. We need more of this engagement in healthcare.

Epic Tries To Open New Market By Offering Cloud Hosting

Posted on November 26, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

When you think of Epic, you hardly imagine a company which is running out of customers to exploit. But according to Frost & Sullivan’s connected health analyst, Shruthi Parakkal, Epic has reached the point where its target market is almost completely saturated.

Sure, Epic may have only (!) 15% to 20% market share in both hospital and ambulatory enterprise EMR sector, it can’t go much further operating as-is.  After all, there’s only so many large hospital systems and academic medical centers out there that can afford its extremely pricey product.

That’s almost certainly why Epic has just announced  that it was launching a cloud-based offering, after refusing to go there for quite some time.  If it makes a cloud offering available, note analysts like Parakkal, Epic suddenly becomes an option for smaller hospitals with less than 200 beds. Also, offering cloud services may also net Epic a few large hospitals that want to create a hybrid cloud model with some of its application infrastructure on site and some in the cloud.

But unlike in its core market, where Epic has enjoyed incredible success, it’s not a lock that the EMR giant will lead the pack just for showing up. For one thing, it’s late to the party, with cloud competitors including Cerner, Allscripts, MEDITECH, CPSI, and many more already well established in the smaller hospital space. Moreover, these are well-funded competitors, not tiny startups it can brush away with a flyswatter.

Another issue is price. While Epic’s cloud offering may be far less expensive than its on-site option, my guess is that it will be more expensive than other comparable offerings. (Of course, one could get into an argument over what “comparable” really means, but that’s another story.)

And then there’s the problem of trust. I’d hate to have to depend completely on a powerful company that generally gets what it wants to have access to such a mission-critical application. Trust is always an issue when relying on a SaaS-based vendor, of course, but it’s a particularly significant issue here.

Why? Realistically, the smaller hospitals that are likely to consider an Epic cloud product are just dots on the map to a company Epic’s size. Such hospitals don’t have much practical leverage if things don’t go their way.

And while I’m not suggesting that Epic would deliberately target smaller hospitals for indifferent service, giant institutions are likely to be its bread and butter for quite some time. It’s inevitable that when push comes to shove, Epic will have to prioritize companies that have spent hundreds of millions of dollars on its on-site product. Any vendor would.

All that being said, smaller hospitals are likely to overlook some of these problems if they can get their hands on such a popular EMR.  Also, as rockstar CIO John Halamka, MD of Beth Israel Deaconess Medical Center notes, Epic seems to be able to provide a product that gets clinicians to buy in. That alone will be worth the price of admission for many.

Certainly, vendors like MEDITECH and Cerner aren’t going to cede this market gracefully. But even as a Johnny-come-lately, I expect Epic’s cloud product do well in 2015.

Microsoft Joins Battle for Wearables Market

Posted on November 4, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Following the lead of several other companies big and small, Microsoft has jumped into the wearables healthcare market with a watch, a fitness tracker and a cloud-based platform that condenses and shares data.

It’s little wonder. After a few years of uncertainty, it seems pretty clear that the wearables market is taking off like a rocket. In fact, 21% of US consumers own such a device, according to research by PricewaterhouseCoopers. That’s slightly higher that the number of consumers who bought tablets during the first two years after they launched, PwC reports. Not only Microsoft, but Apple and Samsung, as well as smaller players with a high profile — such as Fitbit — are poised to take the sector by storm.

Microsoft’s new entry is called Microsoft Health, a platform letting users store health and fitness data. The date in question is collected by a Microsoft Health app, available on Android, iOS and Windows Phone. The platform also gathers data generated from the Microsoft Band, a smart and designed to work with Microsoft’s new platform.

The idea behind pulling all of this data into a single platform is to integrate data from different devices and services in a smart way that allows consumers to generate insights into their health. The next step for Microsoft Health, execs say, is to connect all of that data in the platform to the tech giant’s HealthVault, a Web-based PHR, making it easier for people to share data with their healthcare providers.

Other tech giants are making their own wearables plays, of course. Google, for example, has released Google Fit, a fitness-based app designed to help users track physical activity. Google’s approach is  Android smart phones, relying on sensors built into the smart phones to detect if the user is walking, running or biking. Users can also connect to devices and apps like Noom Coach and Withings.

Apple, for its part, has launched HealthKit, its competing platform for collecting data from various health and fitness apps.  The data can then be accessed easily by Apple users through the company’s Health app (which comes installed on the iPhone 6.) HealthKit is designed to send data directly to hospital and doctor charts as well. It also plans to launch a smart watch early next year.

While there’s little doubt consumers are interested in the wearables themselves, it’s still not clear how enthusiastic they are about pulling all of their activity onto a single platform. Providers might be more excited about taming this gusher of data, which has proved pretty intimidating to doctors already overwhelmed with standard EMR information, but it remains to be seen whether they’ll find fitness information to be helpful.

All told, it looks like there will be a rollicking battle for the hearts and minds of wearables consumers, as well as the loyalty of providers.  As for me, I think it will be a year or two, at minimum, before we get a real sense of what consumers and providers really want from these devices.

HealthTap Offerings Track the Evolution of Health Care

Posted on August 15, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Health care evolves more quickly in the minds of the most visionary reformers than in real health care practices. But we are definitely entering on a new age:

  • Patients (or consumers, or whatever you want to call them–no good term has yet been developed for all of us regular people who want better lives) will make more of their own decisions and participate in health care.
  • Behavior change will be driven by immediate interventions into everyday life, and health care advice will be available instantly on demand instead of waiting for an annual visit to the doctor. Health care will be an integrated into life activities, not a distinct activity performed by a professional on a passive recipient.
  • Patient information will no longer be fragmented among the various health care providers with whom the patient comes in contact, but will be centralized with the patients themselves, integrated and able to support intelligent decision-making.
  • Mobile devices will be intimately entwined with daily behavior, able to provide instant feedback and nudges toward healthy alternatives.

I have seen this evolution in action over several years at HealthTap, a fascinating company that ties together more than 10 million patients a month and more than 62,000 doctors. I interviewed the charismatic founder, Ron Gutman, back in 2011 before they had even opened their virtual doors. At that time, I felt intrigued but considered them just a kind of social network tying together doctors and patients.

Gutman’s goals for health care were far greater than this, however, and he has resolutely added ratings, analytics, and other features to his service over the years. Most recently, HealthTap has moved from what I consider a social network to a health maintenance tool with continuous intervention into daily life–a tool that puts public health and patient empowerment at the top of its priorities. And it may go even farther–moving from seeking help on illness to promoting health, which Gutman describes simply and winningly as “feeling good.”

The center of the offering is a personal health record. Plenty of other organizations offer this, most famously Apple’s HealthKit. HealthTap’s personal health record is unique in supporting the service’s search feature, where patients can search for advice and get results tailored specifically to their age, medical conditions, etc.–not just the generic results one gets from a search engine. It also ties into HealthTap’s new services, including real time virtual consults with doctors.

09-TAKE-ACTION-Customized-Checklists-HealthTap
Sample update from HealthTap

Gutman is by no means interested in maintaining a walled garden for his users; he is looking for ways to integrate with other offerings such as HealthKit and with the electronic health records used by health providers. He says, “The only entity that will win the game is the one that adds the most value to the user.”

Other new features tied in to the HealthTap services include:

  • A recommendation system for apps that can improve health and well-being. The apps are rated by the doctors within the HealthTap system, must be in Apple App Store or Google Play, and must be approved by the FDA (unless they are part of the large, new category of apps that the FDA has chosen not to regulate).
  • Off-the-shelf checklists to help patients manage medication, keep track of healthy behaviors, etc. As part of HealthTap Prime, a concierge service ($99 per year for the first person and $10 for each additional family member), the user can get personalized checklists from doctors, as well.
  • With the concierge service, subscribers also have the opportunity to directly contact a doctor any time, 24/7, on all popular mobile platforms, using live video, voice, and text.
  • The “Get Help” module in the HealthTap app provides useful checklists through all mobile devices, and even Android wearables. Patients can get reminders, useful links to relevant content, and other content pushed to their devices, at a pace they choose.

Some of these features–such as the recommended apps and personalized checklists–go beyond advice and constitute a type of treatment that is subject to legal liability. HealthTap has covered all its bases insuring doctors have insurance against mistakes.

The numbers show that HealthTap is a big community; comments received from Gutman about patients who say they’ve saved their lives show that it is an effective one. I think the choices they’ve made are insightful and illustrate the changes all health care institutions will have to make in order to stay relevant in the twenty-first century.

I Want to Thank the Academy, Err, the Hospital CIO: EHR Hospital Market Share

Posted on July 7, 2014 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

We’re always interested in who’s up and who’s down. Whether it’s TV shows, Senate races, book sales or baseball stats, we want to know who’s up, who’s down and who’s going nowhere.

We’re big on trends, shares and who’s going where. The closer the race, the more avid the interest – My Nats would be sitting pretty if only the Braves weren’t so pesky. The EHR market place is no exception for interest, even if the numbers are a lot harder to follow than the National League East.

In my last foray into EMR market share, I looked at SK&A’s stats from their rolling survey of US medical practices.

Another company, Definitive Healthcare similarly tracks the hospital EHR marketplace. They’ve generously shared their findings with Healthcare Scene and I’ve used them here. Please note: Any errors, mistakes or other screw-ups with their numbers are mine alone. With that said, here’s what I’ve found.

How Many Divisions Does the Hospital Market Have?

Definitive divides the hospital market into several categories that can be daunting to follow. That’s not their making. It’s the nature of the market.

The major division that Definitive reports on is inpatient versus ambulatory systems. You might think that ambulatory systems are only for non hospital setting, but hospitals, of course, have many outpatients and use ambulatory EHR systems to serve them.

The Inpatient Marketplace

Among inpatient systems, EPIC leads with a 20 percent share shown in Tables I and II. The market is highly concentrated with EPIC, Cerner and Meditech commanding 54 percent. The remaining 46 percent scatters with no one breaking double digits.

Table I All Inpatient Hospitals EHR Vendor Market Shares

Table II All Inpatient EHR Shares

 The Ambulatory Hospital Marketplace

The picture for hospital ambulatory systems used is notably different. See Tables III and IV. While EPIC and Cerner vary slightly from their inpatient share, the other vendors shift all over the place. Allscripts barely registers 4 percent in inpatient, jumps to third place with 14 percent.

Siemens and HMS drop off the top ten being replaced by eClinicalWorks and NextGen. At 22 percent is the catchall, Other EHRs. This is up 8 percent from its inpatient 14 percent.

Table III All Ambulatory Hospitals

Table IV All Amb Hospitals

Inpatient EHRs: Health Systems and Independent Hospitals

Definitive also breaks down inpatient hospitals by health system hospitals v independents. Almost a majority of health systems, 47 percent, choose EPIC and Cerner. See Tables V and VI. Indeed, the top four vendors, EPIC, Cerner, Meditech and McKesson astoundingly have a 74 percent share. The other vendors are at 7 percent or less.

Table V Inpatient Healthcare Systems Hospitals

Independent hospitals differ a bit from this pattern. Non major vendors have 12 percent and open source Vista has 5 percent, but otherwise the pattern is similar.

Table VI Inpatient Independent Hospitals

Inpatient Hospitals by Size: Under and Over 100 Beds

Hospitals with 100 plus beds, no surprise, favor EPIC, Cerner and Meditech. These three have a monopolistic 64 percent. See Table VII.

Table VII Inpatient Hospitals with =>100 Beds

Small, Inpatient Hospital Systems: A More Competitive Market

Small hospitals are a different story. The top five vendors are bunched around 14 percent each. See Table VIII. The mix of vendors is starkly different. Meditech and Cerner lead with EPIC third. However, Epic drops nine percent from the prior group to 14 percent in this.

In the prior tables, the top three vendors have a market majority. In this group, 65 percent of the market belongs to the third through tenth vendors. You can see the difference in competition in Tables VIII and IX.

Table VIII Inpatient Hospitals =>100 Beds

Table IX Inpatient Hospitals <100 Beds

Hospital Ambulatory EHR Systems by Bed Size

The ambulatory market for hospitals with 100 plus beds is similar to the inpatient market. EPIC, Cerner and Allscripts have a 53 percent share.

The remaining share is split among several vendors, with eClinicalWorks, and athenahealth making an appearance. Significantly, Other EHRs ranked second.

Smaller hospitals’ ambulatory systems, as with smaller inpatient hospitals, show a competitive market. The category Other EHRs actually leads with a 21 percent share. Tables X and XI show the difference between these two markets.

Table X Ambulatory Systems =>100 Beds Table XI Ambulatory Systems <100 Beds

Market Shares: What’s the Conclusion?

In this and previous posts, I’ve looked at EHR vendor market shares sliced up in several ways. I’ve used what I consider reliable, independent data sources from SK&A and Definitive Healthcare. I used their information because they are careful to include all practices in their surveys not just those that bother to reply.

I also used them for the simple reason that they were freely available to us. There are other sources, such as KLAS, that produce market surveys, but they charge about $2,500 for their analysis. Moreover, they keep all but the most general findings behind their paywall.

What then is the message from all these numbers? It’s this: there is a competitive market, but it’s only robust among small practices. Those with three or less practioners have the most competitive market with eClinicalWorks in the lead. Within major segments, EPIC, Cerner and Meditech dominate. The non hospital market is more mixed, but EPIC, Cerner, etc., share increases as practice size grows.

For these larger practices, it’s monopolistic competition. If you’re looking for an EHR and you have ten or more docs, you can find any number of vendors. It’s most likely you’ll end up choosing among just a few big guys.

This reminds me of when we shopped for kitchen cabinets and counter tops. We were impressed with some dramatic possibilities. The sales rep, who we got to know well, laughed:

“When folks start out they focus on the avant garde. Then they realize they’re choosing for several years. Suddenly they get more conventional.”

If you come by our place, you’ll see our oak cabinets and white tile counter top. I think it goes that way with hospital execs choosing EHRs. They may toy with something different, but in the end, they’ll go with what they know. After all, no one every got fired for buying EPIC. Well, almost no one.

Next: Attribution and Market Share

If you still haven’t got your fill of market numbers, I have one more topic to explore. I’m interested in knowing how market share relates to MU attestations. That is, does a high market share guarantee a high attestation rate? The next post in this series will look at that.

If you have questions on market share, please post a comment or write me at: carl@healthcarescene.com

Allscripts And Team Battle Epic and IBM for DoD Contract

Posted on June 27, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Earlier this month,we shared the news that Epic and IBM had gotten together to fight for the DoD’s massive Healthcare Management Systems  Modernization project. The project is to replace the current Military Health System, which should serve some 9.7 million beneficiaries.  The winning team should make about $11 billion to do the work.

So it’s little wonder that another group of health IT giants have stepped up to fight for such a juicy prize.  A group lead by Computer Sciences Corp., whose partners include Allscripts and HP, has announced that it intends to compete for the contract.

The HMSM project is extremely ambitious. It’s intended to connect varied healthcare systems across the globe, located at Army hospitals, on Naval vessels, in battlefield clinics and more, into a single open, interoperable platform serving not only active-duty members, but also reservists and civilian contractors.

Before you burst out laughing at the idea that any EMR vendor could pull this off, it’s worth considering that perhaps their partners can.  It’s hard to argue that CSC has a long track record in both government and private sector health IT work, and HP has 50 years with of experience in developing IT projects military health and VA projects.

That being said, one has to wonder whether Allscripts — which is boasting of bringing an open architecture to the project — can really put his money where its mouth is. (One could say the same of Epic, which frequently describes its platform as interoperable but has a reputation of being interoperable only from one Epic installation to the other.)

To be fair, both project groups have about as much integration firepower as anyone on earth. Maybe, if the winner manages to create an interoperable platform for the military, they’ll bring that to private industry and will see some real information sharing there.

That being said, I remain skeptical that the DoD is going to get what it’s paying for; as far as I know, there is no massively interoperable platform in existence that meets the specs this project has.  That’s not an absolute dealbreaker, but it should raise some eyebrows.

Bottom line, the DoD seems determined to give it a try, regardless of the shaky state of interoperability in the industry overall. And its goals seem to be the right ones. After all, who  wouldn’t want an open platform that lends itself to future change and development?  Sadly, however, I think it’s more likely that will be shaking our heads over the collapse of the project some years from now.

Digital Health, Connected Health, Wireless Health, Mobile Health, Telehealth – You Choose

Posted on May 7, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Neil Versel posted a great poll asking people which term they prefer. You can vote on it below:

I usually don’t dig into the terminology and branding side of things. At the end of the day, for me it’s all about making sure that we understand each other. If you call something digital health or connected health or mobile health, they’re all the same genre of item. To be honest, I mostly ignore all of those words and want to know what the application actually does.

However, Neil brought up a good point in his post about the lack of consensus in his poll. Here’s his summary of the poll results:

In any case, these results, however unscientific they may be, are representative of the fact that it is so hard to reach consensus on anything in health IT. They also are symbolic of the silos that still exist in newer technologies.

Consensus in healthcare is really hard. I’m reminded of what someone at the Dell Healthcare Think Tank event I participated in said, “Healthcare is second only to florists when it comes to market fragmentation.” It’s like steering a ship with hundreds of rudders all pointing different directions. Certainly not an easy task and not something I see changing soon.

EHR Post Acquisition, 2014 Certified, ICD-10 and the Amazing Charts Future with John Squire, President and COO

Posted on April 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I had the chance to sit down and interview John Squire, President and COO of Amazing Charts. I was interested to learn about the transition Amazing Charts has experienced after being purchased by Pri-Med and the departure of Amazing Charts Founder, Jonathan Bertman. Plus, I wanted to learn why Amazing Charts wasn’t yet 2014 Certified and their plans to make it a reality. We also talk about the value of meaningful use and the ICD-10 delay. Then, we wrap up with a look at where Amazing Charts is headed in the future.

Check out EHR videos for all of my EHR and Healthcare IT interview videos and be sure to subscribe to the Healthcare Scene youtube channel.