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Enterprise EHR Vendors Consolidating Hold On Doctors

Posted on September 9, 2016 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 I stumbled across a recent study naming the EHRs most widely used by physicians, I don’t know what I expected, but I did not think big-iron enterprise vendors would top the list. I was wrong.

In fact, I should have guessed that things would play out this way for giants like Epic, though not because physicians adore them. Forces bigger than the Cerners and Epics of the world, largely the ongoing trend towards buyouts of medical groups by hospitals, have forced doctors’ hand. But more on this later.

Context on physician EHR adoption
First, some stats for context.  To compile its 2016 EHR Report, Medscape surveyed 15,285 physicians across 25 specialties. Researchers asked them to name their EHR and rate their systems on several criteria, including ease of use and value as a clinical tool.

When it came to usage, Epic came in at first place in both 2012 and 2016, but climbed six percentage points to 28% of users this year. This dovetails with other data points, such that Epic leads the hospital and health system market, according to HIT Consultant, which reported on the study.

Meanwhile, Cerner climbed from third place to second place, but it only gained one percentage point in the study, hitting 10% this year. It took the place of Allscripts, which ranked second in 2012 but has since dropped out of the small practice software market.

eClinicalWorks came in third with 7% share, followed by NextGen (5%) and MEDITECH (4%). eClinicalWorks ranked in fifth place in the 2012 study, but neither NextGen nor MEDITECH were in the top five most used vendors four years ago. This shift comes in part due to the disappearance of Centricity from the list, which came in fourth in the 2012 research.

Independents want different EHRs
I was interested to note that when the researchers surveyed independent practices with their own EHRs, usage trends took a much different turn. eClinicalWorks rated first in usage among this segment, at 12% share, followed by Practice Fusion and NextGen, sharing the second place spot with 8% each.

One particularly striking data point provided by the report was that roughly one-third of these practices reported using “other systems,” notably EMA/Modernizing Medicine (1.6%), Office Practicum (1.2%) and Aprima (0.8%).

I suppose you could read this a number of ways, but my take is that physicians aren’t thrilled by the market-leading systems and are casting about for alternatives. This squares with the results of a study released by Physicians Practice earlier this year, which reported that only a quarter of so of practices felt they were getting a return on investment from their system.

Time for a modular model
So what can we take away from these numbers?  To me, a few things seem apparent:

* While this wasn’t always the case historically, hospitals are pushing out enterprise EHRs to captive physicians, probably the only defensible thing they can do at this point given interoperability concerns. This is giving these vendors more power over doctors than they’ve had in the past.

* Physicians are not incredibly fond of even the EHRs they get to choose. I imagine they’re even less thrilled by EHRs pushed out to them by hospitals and health systems.

* Ergo, if a vendor could create an Epic- or Cerner-compatible module designed specifically – and usably — for outpatient use, they’d offer the best of two worlds. And that could steal the market out from under the eClinicalWorks and NextGens of the world.

It’s possible that one of the existing ambulatory EHR leaders could re-emerge at the top if it created such a module, I imagine. But it’s hard for even middle-aged dogs to learn new tricks. My guess is that this mantle will be taken up by a company we haven’t heard of yet.

In the mean time, it’s anybody’s guess as to whether the physician-first EHR players stand a chance of keeping their market share.

AAFP EMR Survey Offers Food For Thought

Posted on December 24, 2012 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.

Even the authors admit that the following study has got flaws, given that respondents weren’t randomly selected and some vendors screened out by its design.  Nonetheless, new EMR satisfaction research by the American Academy of Family Practice gives us some interesting stats to consider.

The study, which was published in the November/December issue of its Family Practice Management  journal, draws on 3,088 responses from AAFP members, who responded to a series of questions regarding which EMRs they used and how comfortable they were with those EMRs.  Respondents reported using a total of 160 named EMRs, but the study dropped 129 which were used by 12 or fewer practices in an effort to simplify the results, leaving 31 systems for analysis.

The systems with the strongest satisfaction ratings, ranging from roughly 80 percent too over 50 percent, were Praxis, HealthConnect, MEDENT, Amazing Charts and SOAPware. eMDs,  Practice Fusion, Point and Click EHR, EpicCare Ambulatory and Vista CPRS followed closely, with scores clustered around 50 percent.

Not too surprisingly, EMRs that were ranked easy to use were largely the same ones which got high satisfaction ratings. Topping that list was Point and Click EHR at nearly 80 percent, followed by Amazing Charts, Practice Fusion, Praxis, SOAPware, Aprima, MEDENT,eMDs, HealthConnect, Vista CPRS, with Care360 EHR rounding out the bottom of the top 10 at roughly 47 percent.

The only surprise the authors highlighted came in response to a question asking which EMRs helped doctors see more patients or go home earlier than they could with paper charts. In that case, Praxis stood out, with doctors who agreed hitting about 80 percent. The number who agreed for the next on the list, SOAPware, fell immediately to just over 40 percent, with the other players falling even lower on the scale.

Even with its deliberate statistical laxity — authors described their intent as being more of an “advice from colleagues” format — this certainly offers some stats to chew on. In particular, I’d love to know what Praxis is doing right. After all, when it comes right down to it, productivity is king.

Yet Another Top EMR List

Posted on June 5, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As any reader of this blog would know, there may be more EMR rankings out there than there are EMRs themselves. Of course, some lists are taken more seriously than others — KLAS comes to mind — but these days, with the money flowing, virtually everyone who can make a PDF is dipping an oar into the EMR ranking game.

The following list, from a a site called Business-Software.com, is particularly cute in that it would appear to be entirely bought and paid for by vendors — there’s nary a critical analysis to be found in the paper.  (Most of the lists I’ve seen at least pretend to be neutral.)

That being said, I still thought it might stimulate conversation among us to share the list.  I’d love to hear whether you think Business-Software.com has provided any value here, and whether you’ve had particularly good (or bad) experiences with listed EMR sellers.

Here’s Business-Software.com’s list, seemingly in no particular order. Where available there’s a link to get a demo/price quote from the vendors on the list courtesy of Medical Software Advice.

* AdvancedMD: Provides Web-based practice management, medical billing and scheduling software as well as an EMR. Includes a patient portal, e-prescribing and mobile access option.

*  Allscripts: Offers EHRs, practice management, revenue cycle management, document management, e-prescribing. Focuses on emergency department and care management systems for hospitals. Get Price of EMR Vendor EMR Vendor Demo

* Greenway: Offers EHR, integrated with practice management system, along with a database integrating clinical, financial and administrative data. Get Price of EMR Vendor EMR Vendor Demo

* Sage: Products include practice management, EHR, document and image management and point-of-care documentation.

* Aprima: Company offers EHR, practice management and revenue cycle management products, all aimed at medical practices. Get Price of EMR Vendor EMR Vendor Demo

* Kareo: Focuses on small medical practices. Key products include Web-based EHR, medical billing and practice management offerings.

* Abraxas Medical Solutions: Sells unified EMR and practice management solution. Product is powered by a single Microsoft-SQL database.

* Celerity Solutions Group: Provides EHR conversion and systems integration solutions to both large and small medical practices.

* NextGen Healthcare: Offers a very wide range of products, including EHRs for physicians, hospitals, health centers and healthcare providers, as well as practice management and financial management systems, HIE and patient portal options. Get Price of EMR Vendor EMR Vendor Demo

* meridianEMR: EMR focused specifically on urology specialists, as well as a product aimed at general surgery.

What bothers me about this list, by the by, is that while it’s almost certainly a series of advertisements, that’s not marked anywhere.

While physicians aren’t dummies by any means, my guess is that some might get sucked in by any list that says “top” in it if they’re feeling desperate enough.  Here’s hoping physicians catch on to the bias here.