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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.

EMR and EHR Whitepapers

Posted on April 23, 2013 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.

For a while I’ve been considering how the Healthcare Scene network of blogs can provide an EMR, EHR and healthcare IT whitepaper service. Over the many years I’ve been blogging about EMR and EHR, I’ve seen a lot of really valuable whitepapers created by the various EHR vendors. The time required to create a whitepaper is lengthy and for someone looking for an in depth look at a subject, a whitepaper is a nice option.

With that in mind I recently launched a new EMR, EHR and Healthcare IT whitepaper portal. We’re just getting started with the healthcare whitepaper portal, but we’ll be growing the content that’s available there over time. We’ll also be including a nice sidebar widget for those interested in the latest whitepapers we have to offer and we’ll embed a list of whitepapers in the email subscription as well.

We already have a number of great whitepapers available. For example, athenahealth created this whitepaper on Making the Switch: Replacing Your EHR for More Money and More Control. We’ve often talked about EMR switching becoming a very popular and important topic. This whitepaper helps a practice considering the EMR switch to go through an analysis of why to switch EMR or not.

Another whitepaper by NextGen is called The tips and tools to help you on the path to MU (Meaningful Use) and beyond. Considering less than 50% of providers have attested to meaningful use, this could be useful to many. It contains a lot of great resource links and some tips on how to approach meaningful use. If you’re looking at meaningful use stage 2, check out this one from AdvancedMD called Achieving Stage 2 Meaningful Use in Private Practice.

Those are just a few examples. You can find many more of them on this EMR and EHR whitepaper library page. I look forward to adding a lot more interesting whitepapers in the future. Hopefully you’ll find the content valuable.

Farzhad Uses Twitter to Call Out EHR Vendors

Posted on September 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.

When it comes to ONC, I think a few things have always been clear:
1. ONC has its heart in the right place.
2. ONC hates the government restrictions that have to work within as much as the rest of us.

If you’ve ever had a chance to meet with someone from ONC in person, then you know the first item to be true. They really do have a sincere desire to improve healthcare in America through the implementation of IT. Not only do you see that in person, but their actions compliment this as well. In fact, I’d say that they’re some of the most sincere parts of Washington DC that I’ve ever met.

The challenge comes with the second point. ONC has to work within the legislation and government regulations that they’re given. I once posted about Blumenthal’s HIMSS adress as being meaningless. Someone at ONC found it and asked what they could do to make his address more meaningful. I told them nothing, because he was subject to the government muzzle. I think they’re reply was something like, “Many of us here don’t like the government muzzle either.” Another simple example of how they are very sincere people at ONC. I wonder if Blumenthal could offer a non-muzzled speech now.

I say all of this as background for a tweet that Farzad Mostashari sent out to EHR vendors. The thing I love most about this tweet is that Farzad is using the farthest extent of his power possible to push forward health IT within the government framework. This is no easy task, but I think Farzad’s tweet is brilliant:

I think the ONC pledge is still being considered by many EHR vendors. I know how EHR companies make decisions and so this won’t be any different. However, Farzad already posted this tweet with EHR companies that have made the pledge:

I’ve also seen tweets from NextGen and Azzly. We’ll see if others pop up on the #ONCPledge hashtag.

Oh the power of a tweet! Can you imagine how simple, but powerful Farzad’s request could be? No complicated legislation. No expensive stimulus. No mind numbing regulation. Just good old fashioned public pledge to do what’s right. I wonder how else this could be used.

Some Interesting Thoughts from the EHR Summit

Posted on November 17, 2011 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 enjoyed all day at the EHR Summit that’s being held by HBMA in Phoenix. It’s been a really interesting event for me. I had some sound bites from the Ron Sterling keynote queued up, but it’s not connecting to Twitter. So, I’ll see if I can post those tomorrow. Today, I thought I’d post some of my other tweets from the other session. I think you’ll find them interesting, enlightening, thought provoking or some other adjective. I really look forward to the discussion on this post.

EMR software has many versions of the same data. #interesting #EHRSummit11 Think about an HIE as well. They have a version of the data too

HIE’s aren’t good at getting the receiving doctor the second version of a clinical document. #interesting #EHRSummit11

Think about the records retention issues when you switch EHR software companies. Good thought. #EHRSummit11

If you haven’t lost a client to a hospital this year….you will next year. #EHRSummit11 #HBMA

How many EHR companies are billing companies? They have 7 listed on screen. Do you know of others? #EHRSummit11
They have MED3000, Allscripts, Greenway, NextGen, Athena, GE Centricity, Ingenix. Any other EHR companies do billing as well? #EHRSummit11

Shame on you if you hire an EHR Company and don’t check the references. Ask for a list of 10 in that specialty and size. #EHRSummit11

Pre-existing conditions, No lifetime maximum and kids on parents plan for longer are going to increase our insurance costs. #EHRSummit11

Definitely interesting to consider how the healthcare billing industry will be affected by things like ACO’s and concierge. #EHRSummit11

Super bills are going to go away once we get ICD-10. #EHRSummit11 #HBMA

The healthcare billing sales cycle is 12-18 months. #EHRSummit11

Since I’m putting some of my tweets. I also enjoyed a number of the tweets coming out of the ONC Meeting today. Here’s one that really hit me:

RT @INHSbeacon If you’ve seen one CCD, you’ve seen one CCD. Everyone interprets different, we need to find a standard to succeed #ONCMeeting

A Couple Initial NextGen User Group Meeting Observations #NextGenUGM

Posted on November 14, 2011 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 I’ve had the opportunity to come and check out the NextGen user group meeting. It was conveniently located in Las Vegas and the PR people at NextGen were generous enough to let me come by and get to learn more about NextGen from their actual users. I’ve gone to a lot of healthcare IT conferences (too many recently), but I love to be at user group meetings since you actually get to meet doctors, practice managers, etc that are working on EMR day in and day out. They provide a much different perspective than the health IT industry people that you often meet. Events like this give me a much better perspective of what’s happening in doctors’ offices with EMR.

NextGen announced 4200 in attendance at the user group meeting and I can attest that it’s a very large crowd. It’s quite interesting that the opening keynote was held in the same arena that Pacquiao vs Marquez was fought in a couple nights ago. Yep, that’s a pretty big crowd. Turns out, this big of crowd has its challenges. Not the least of which is having a bunch of the sessions that were completely full and didn’t allow people in. I heard at least one person tell me how frustrated they were that they’d spent a lot of money to attend and couldn’t go to the session they wanted. NextGen is working to offer a repeat of the session, so hopefully that will work out for people that are upset. A part of me wonders why they don’t record all the sessions, but when you read their social media policy for attendees (Something about not revealing NextGen’s proprietary info) you get a better idea of why they wouldn’t probably like that idea.

I could go on about the particulars of the conference, but so far it’s been a well organized and well attended event.

One quick thought I had during the Scott Decker keynote was about NextGen’s focus on SaaS based solutions. Here’s what I tweeted:

Those are just a few examples, but it seemed very clear to me that NextGen sees SaaS as the future and they’re working hard to make that a reality. I’ll write about this in a future post when I talk about some of the things Scott Decker mentioned that can really only be done in the SaaS environment.

In some of my talks with NextGen users, I asked them about the theme of web based EHR software. One in particular has 30 Citrix servers serving all of their clients. You can imagine that they don’t have any plans to move to a web based environment in the near future with such a large investment in Citrix. So, it will be interesting to see how these two forces play out.

I also saw this tweet coming out of the conference which I found really interesting:

It’s an interesting way to look at EHR adoption. Little insights like this are a really great part of a conference like this. The nice thing is that with the power of Twitter, you can get a number of the insights from the user group yourself. Just follow the hashtag #NextGenUGM.

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.

CALLING ALL DOCTORS! EMR Software Opinions Wanted

Posted on July 24, 2009 I Written By

This is a SHOUT OUT to all doctors who use EMRs. Which EMRs do you use and how do you like them. Do you love them or hate them? Are you luke warm in your like or dislike? Tell us which EMR you have and how you feel about it. Also tell us what you would do (the mistakes and the good moves) if you were looking into getting an EMR at this time.

I have personally looked at Greenway PrimeSuite, SOAPware, SRSsoft, e-MDs, AmazingCharts, NextGen, Centricity and others.

Can you comment on the cost and the usability?. Let’s share information so we can help other doctors choose systems that are usable, simple to learn, effective and efficient.

If you don’t have an EMR and are looking into one, what questions would you have for those “who have gone before you”? What advice would you be interested in receiving?