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Mulling Over EMR Market Consolidation

Posted on September 27, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

I had the pleasure of attending a Technology Association of Georgia Health Society event last week on mobile health. It offered me a chance to chat with colleagues, and hear from a panel of payers, providers, startups and vendors on the current state of and predictions for mobile health. While networking beforehand, I found myself trying to succinctly answer a colleague’s question of, “Where do you see the EMR market heading in the next few years?”

My short answer was, “It is consolidating and will continue to consolidate.” I had more details and theories on the tip of my tongue, but didn’t get the chance to back up my statements before we were ushered in to the evening’s presentation. It was a big question – one that I think has only one correct answer, but also one that potentially has a variety of explanations behind that answer. Needless to say, I mulled it over that night and into the next day, when, coincidentally, I awoke to news of the Vitera/Greenway Medical deal.

If I had the chance to do it over again, I’d break my response down like this: Meaningful Use obviously provided incentive for businesses to get into the EMR game. Some were already in healthcare, while others were on the fringes. Combine those new industry entrants with companies that have provided EMRs since before HITECH, and you’re left with a crowded market.

Implementations and go lives coinciding with Stage 1 left many providers dissatisfied with the EMR experience thus far, but still willing to forge ahead. As they look to Stage 2, some realize their vendors – whom many are already disenchanted with – will not be up to the task of helping hospitals meet digital patient engagement quotas, among other Meaningful Use guidelines. And so began the rip and replace movement.

Vendors deemed not up to par looked at their options. Many took a step back and reassessed product development and strategy, deciding to either: get out of the healthcare game, close up shop altogether, merge with a competitor, or make themselves available for possible acquisition.

That’s one wave of consolidation. I’m fairly confident we’ll see another wave in the next 12 to 18 months, if it hasn’t already started. (I don’t think we’ll see too many Phoenix-type situations like Google.) As providers dive deeper into using technologies around Stage 2 engagement requirements, they’ll experience a second wave of acceptance or denial. At some point, the EMR replacement market will die down, providers will settle into the technology they’ve settled on, and purchases of new systems will stagnate. EMR sales will thus dry up a bit, forcing vendors to again look at their options. I would think that many will turn into consulting services once the demand for new software has died down.

Now that I’ve put pen to paper and laid out my thoughts, I wonder what readers predict. I encourage you to let me know whether I’m on the mark, totally off base, or somewhere in between.

EMR Vendors Buying Physician Market Share

Posted on January 9, 2013 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.

Here at EMRandEHR.com, as well as in blogs across the web, we’ve been predicting that this will be the time when the EMR vendor market will begin to consolidate.  I stand by that prediction. But I have to admit that the first couple of deals I’ve tracked have turned out differently than I had expected.

Consider the acquisition of Amazing Charts by Pri-Med, a provider of professional medical education to more than 260,000 clinicians. I would have assumed that Amazing Charts would be acquired by a larger EMR vendor to fill out its offering physicians, but instead, Amazing sold to a publishing company with a huge physician base.  In retrospect, it makes plenty of sense, but for some reason I didn’t see it coming.

EMR vendor athenahealth pursued a similar strategy recently when it signed a definitive agreement to buy Epocrates, perhaps the most popular mobile application used by physicians today. athenahealth agreed to pay almost $300 million in cash for Epocrates, 22 percent more than what the mobile app vendor’s’ stock was worth on the day in question, in a move that the EMR company concedes tapped out its credit line.

But costly though the deal might have been, athena is getting a lot for its money. Buying Epocrates adds another one million physicians to its comparatively small provider base of 38,000.  If you consider the app itself plus the physician users, athenahealth’s investment seems pretty reasonable. When you consider how costly it is to acquire physicians as customers, a deal valuing them at $300 a physician doesn’t sound astronomical to me.

What I’m getting at, bottom line, is that other EMR players are likely to follow the model established by the Amazing Charts and athenahealth deals. I think this approach — buying, rather than begging for, new physician relationships — makes a great deal of sense.  What about you?

Why 2013 Will Be A Good Year For EMRs

Posted on December 14, 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.

Recently, I wrote an article listing some unpleasant, stubborn EMR problems that are likely to cling to the industry like sticky burrs in 2013. Being a fair-minded gal, I also wanted to stop and reflect on what’s likely to work in favor of EMR adoption, maturation and success next year, so here goes:

*  Consolidation will lead to a more-stable vendor market:  With the (in my opinion) wave of new EMR vendors beginning to recede, the shakeout will begin. Vendors that remain may not be the best, sadly, but they’ll be better funded and hopefully better situated to take care of customers.

*  We’ll have a good amount of Meaningful Use experience under our belts:  Starting out with Meaningful Use has been nerve-wracking for all. But by 2013 the industry will have begun to acclimate itself not just to meeting MU standards, but making them work for their particular clinic or hospital.

*  Vendors are likely to offer more mobile options:  Right now, EMR vendors are offering minimal efforts around mobile EMR applications. My gut is that in the coming year, we’ll see some definitive progress on Android and iOS-natve EMR apps. There’s just too much demand to ignore.

*  Template medicine will get more sophisticated:  When templates merely inconvenienced doctors, nobody seemed that worried about their potential side effects. Now that it appears that templates encourage costly upcoding, however, it’s likely that vendors will be forced to make them smarter and less prone to encouraging cut-and-paste documentation. (How, I  haven’t a clue, but the pressure will force something to happen.)

Now, none of these are exactly raving endorsements of the EMR climate for next year. I’m not suggesting that adopting EMRs will suddenly become easy, training a breeze or ROI will magically appear.  But I do believe that we’re going to be seeing a nice uptick in EMR maturity.

Early Signs Of EMR Consolidation Appearing

Posted on November 23, 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.

Some of you are going to tell me that I’ve jumped the gun, but I’ve got my feeling about this and I’m sticking to it. Though nothing massive has happened yet, I believe we’re officially beginning to see consolidation in the EMR world.

I was struck with this idea today when I came upon the news that physician EMR company Imagine MD was closing. According to MedCityNews.com, the cloud-based EMR company had pulled in $25 million in venture money, $10 million of that in the last 12 months. And until recently, it looked as though it had staying power; Imagine MD had been in business since 2006, well ahead of the pack of competitors pitching small medical practices.

Another sign that we’re seeing consolidation comes in the form of the acquisition of Amazing Charts by Pri-Med, a provider of professional medical education to more than 260,000 clinicians. (I wouldn’t have expected a medical education company to be the one to acquire Amazing, but that’s a story for another time.)

While I admit two examples isn’t exactly a statistical bump, it’s a clear enough sign for me that the market has begun to pull together. After all, with EMR adoption on the rise among medical practices, there’s only so many customers left to compete for, and that can only mean more closings and M&A.

The really important question, if you’re a doctor hoping to avoid a big practice disruption, is whether you can predict which direction your present or future EMR vendor is going.  That is, of course, a pretty tricky game.

But if you’d like some food for thought, you might consider checking out a previous post by John, comparing “fast EMR companies” fueled by venture capital to slower-moving types that grow organically and don’t tend to accept venture capital investments.

While there are exceptions — notably Practice Fusion, which seems to have an extremely solid business — the tech business is rife with examples of fast companies that soared high on venture capital drafts then plummeted to earth.  I’m not suggesting that you should avoid VC-backed EMR firms, physicians, but I am suggesting that you find out as much as you can about the size of their customer base, finances and strategy before you commit your business into their hands.

Otherwise, you could end up like ImagineMD’s EMR-less customers. And if that’s not a bummer I don’t know what is.

Patient Advocate, Multiple Screens, EHR Consolidation, and EMR Happening

Posted on August 12, 2012 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.

We’re in the middle of the dog days of summer. I can see the Fall Conference slam around the corner as I plan my various itineraries. Plus, my children just found out who their teachers will be this Fall. So, Fall is just around the corner. In the 110 degree heat of Las Vegas, that’s a very good thing. It’s always hot in the summer in Las Vegas, but this is really hot.

Enough with the digressions. Time to take a quick look at some of the interesting EMR and health IT tweets.

Ariana Markle ‏@GoldAtlantis
Dying for Data: Comprehensive #EMR systems promise to save lives and cut #healthcare costs –but how do you build it? http://spectrum.ieee.org/biomedical/diagnostics/dying-for-data

The article linked in this tweet is really interesting. It starts with a really compelling story. Something that the patient advocates will love if they haven’t seen it already. The problem is that EMR implementation on its own still doesn’t solve the problem that’s described in the story. The real solution is some sort of HIE or portability of patient data. EHR is one step towards that, but is still far away from that state of healthcare portability nirvana.


Nice to see a doctor who loves his EMR. Even better than a 27″ screen in most cases is dual monitors. I can’t imagine life without dual monitors. I’m not sure why doctors do without it as well.


I just don’t agree with all the people talking about widespread EHR consolidation. Here’s a great quote from the article that actually supports the lack of EHR consolidation as well:

Ironically, according to Mercom Capital Group roughly $150m in venture capital has been poured into the EMR/EHR market in the last 18 months, pointing to continued confidence (or overconfidence!) in this space.

It’s not ironic. We’re in the golden age of EHR. We won’t see many folding up shop for quite a while.


The core thing for me in this tweet is that EMR is happening. Doctors can continue to resist, but EMR is going to happen. It was temporarily delayed while doctors waited for meaningful use. Now, many are going after the EHR incentive money. Eventually doctors won’t know life without an EMR.

Allscripts Acquires Eclipsys

Posted on June 9, 2010 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.

Today, it was announced that Allscripts will acquire Eclipsys for $1.3 billion. This is a really big move and not all that unexpected. We knew that consolidation was coming and for that matter it’s going to keep happening. However, this is a very large merger that has a lot of questions. Allscripts and Eclipsys have created a new site for the acquisition.

Here’s a video of Glen Tullman talking about the acquisition of Eclipsys:

The comments made on the HISTalk post about the merger were really interesting. Here’s just a few:
From NYC EMR:
Allscripts hosted a meeting Monday showing integration options with Eclipsys with some of their mutual clients (NYP, Lahey, etc). This didn’t go well for Allscripts, clients dont like the product and hate the integration obtions. One client calling it an abortion, one other saying it is a good attempt but falls short. They also commented negatively on AllScripts management saying they sell well, but can’t execute. Privately the clients me and to a tee they said Eclipsys new release is what they want with more content, but that AllScripts is well off the mark for a go-forward Ambulatory solutoin. Hopefully Eclipsys will continue to build out thier solution instead of some hokey integration story that Allscripts is touting to make up for their lack of an acute care offering. Does anyone else know anything about this?

From Not Happy:
“Eclipsys, you have over 20 million a year from a client and what did that go to? No enterprise revenue cycle product, 50 million for Bond and Medinotes? Now the investment goes towards 5 plus ambulatory and HIE products? Merger has WAY too many products for the same markets- Ambulatory alone has Mysis, allscripts touchworks, allscripts professional, Eclipsys sunrise amb, Eclipsys peak (bond clinician), and Medinotes.”. Forest Gump take away- RUN, RUN, RUN

From Lazlo Holyfeld:
Smorgasbord. My bet is that Sunset Ambulatory and MyWay get sunsetted in the end. Allscripts has Peak Practice for the small practices while keeping Professional & Enterprise for the big clients. Allscripts did waste some R&D funds on trying to update the source from Aprima to bring MyWay up-to-speed this year especially on the coding/billing side. In the end, it is still a pig with lipstick on it. If you really want MyWay, you are better off with Aprima (iMedica).

As for the HIE aspect, that is the harder part of this to guess what plays ot. Allscripts has several parternships with various HIE vendors but dbMotion is their contracted partner. If a client doesn’t want dbMotion, they have to have a seperate agreement.

More interesting to see what happens with the Eclipsys relationships with Medicity & Microsoft. Less clear on what happens there.