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Ways to Not Rank EHR Vendors

Posted on September 16, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of my pet peeves is organizations that put out rankings for EHR vendors that are based on really low quality factors and metrics. I’ve put a graphic I recently found at the bottom of this post. The graphic uses user adoption level, search traffic, and social media presence to rank “The 10 Most Popular EHR Products.” Yes, the image is at the bottom of the post, because I don’t think you should pay much attention to the ranking. Let’s talk about why.

First, I’ll give credit to them for putting their factors in the graphic itself. Many organizations that put out these rankings don’t even share their methodology for ranking EHR vendors. Although, this compliment falls flat on the first factor: user adoption level.

EHR User Adoption Level
They obtained this ranking and score from a survey of software users. Of course, they don’t say anything about how this survey sample was collected, how they selected who participated in the survey, etc. Long story short, I can think of probably 1000 ways that this sample is going to be biased. There are literally 300 EHR vendors out there. I need to consult my statistician friends, but I can’t imagine the random sample you’d need to get in order to estimate the users of 300 EHR vendors. Plus, there are so many ways to bias this sample based on region, hospital EHR or ambulatory EHR, hospital size, practice size, specialty, etc etc etc.

I also am not sure what they consider “regular users” of the system. Does that mean my 5 front desk staff count as well or is it just providers? Plus, if you look at the scores for the vendors taht are listed, Cerner and Meditech should be much higher when it comes to user adoption level. In fact, it’s possible they have more users than Epic which has the highest ranking possible for user adoption level.

I do think that user adoption level is an ok way to rank EHR vendors. The fact that many healthcare organizations have spent a bunch of money on an EHR vendor is one sign of an EHR vendors popularity and it’s worth considering what’s popular when evaluating software of any kind (including EHR software). However, does anyone have a really good way of analyzing how many users an EHR vendor has? The closest I’ve seen is meaningful use attestation data and it has its weaknesses. Long story short, I’m not buying the user adoption level rankings below.

EHR Search Traffic
Google has a great tool where you can compare search traffic for various keywords. I’ve used it before to compare the popularity of terms like EMR and EHR (They’re about even with EMR still ahead). While this tool is cool and very interesting, is that how you determine how popular an EHR vendor is? What if that EHR vendor has had some major security breaches and everyone is searching their name to find out about the breaches? That seems to be a sign that the EHR vendor is popular, but not for good reasons. Plus, how do you know when someone is searching for the Epic EHR versus Epic the movie and a few million variations of the word epic? Not to mention, if you have Jonathan Bush as your CEO, you’re going to get more searches than other EHR vendors just because of his vibrant personality (was that the politically correct way to describe it?).

Long story short, search traffic is an awful measure to use when ranking EHR vendors. I know some really amazing EHR software that have very little search traffic. I don’t think that’s a bad thing. They’ve focused on creating great software, partnering with doctors, and creating direct relationships with their users. Their search traffic certainly won’t reflect that piece of the puzzle.

EHR Social Media Presence
What’s in a like or follow? Yes, those are the factors the graphic below used to evaluate EHR vendors social media presence. They do weigh this factor less than the others. Does a like or follow on Twitter, LinkedIn or Facebook mean you’re popular? Do you know how easy it is to buy followers if you want to look like you have a lot of followers? $5 per 1000 followers is easy to get. Plus, these counts don’t matter as much as which people are following you and how engaged they are with you on social media. That matters a lot more than follower counts.

I don’t want to totally discredit an EHR vendors involvement in social media. That might be a sign that the company stays up to date and involved with the latest technology changes. It might mean that they’re engaged with and interested in their customers. Then again, it might not. Many EHR vendors just use it as a way to broadcast their company and not actually engage with people. Some EHR vendors don’t even participate in social media at all. That’s not an evil thing, but it might be worth investigating more and seeing if their lack of involvement in technology is seen in other aspects of their product offering.

So while I see value in evaluating an EHR vendor’s social presence, you can’t evaluate and rank it based on likes and followers. A much more complicated assessment is needed.

I understand that many organizations are grabbing hold of any means to differentiate the 300+ EHR vendors out there. It’s certainly a challenge I know first hand. However, I hope that healthcare organizations don’t get led astray by poorly done rankings like the graphic below. There’s always more to the story. If EHR rankings were easy, I would have done them myself a long time ago.

Top 10 Most Popular EHR Vendor Infographic

EHR Product Market Shares Rankings: The Envelope Please!

Posted on May 27, 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 the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manager 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, a role he recently repeated for a Council member.

In politics, it’s the horse race, that is, who’s in front and where’s the rest of the pack. We have our own EHR version, who’s got the biggest market share and where’s everyone else.

In politics, there’s no end of polling by candidates, parties, media and all stops in between. We aren’t so lucky. You can count the reliable EHR market share estimates on one hand and not need your thumb. Of those available, I’ve found SK&A’s to be the most comprehensive and reliable free option, though they do require a registration.

Leaders of the Pack

Table I shows the top 20 EHR vendors’ installed base for all US practitioners. Not surprisingly, Epic leads with about 11 percent. Table II shows the market’s concentration: the top seven have almost half the market.

Table I All practioners

The remaining 13 vendors have about a 20 percent market share. The remaining vendors, about 470 companies, have the remaining 30 percent. But don’t go away just yet. There’s more to the story.

Table II All Shares

Market Share by Practice Size

Market share by practice size refines the picture a bit more. For their analysis, SK&A divided practices into five classes shown in Table III. Each of these is examined in turn.

Table III Group Size

As you’ll see, the larger the number of practitioners in a class, the more concentrated the market becomes. However, the greatest number of practices is in the smaller classes. For example, SK&A reports that 80 percent of practices have 10 or less practitioners.

For example, both EPIC and eClinicalWorks have a ten percent market share. EPIC does this by having a large percent of practices with the highest number of practitioners.

 eClinicalWorks, on the other hand, achieves its share by selling to a many, smaller practices. As a result, you’ll see ECW’s market share drop as the numbers in a class increases, while EPIC’s share will go up.

Class 1 – 1 to 3 Practitioners

Table IV shows the top twenty vendors and again shows a heavy concentration in a few vendors. eClinicalWorks is the leading small practice EHR vendor with a 10 market share. The eight top vendors have half the market in this class.

Table IV 1 to 3 Practitioners

The other 12 top vendors have a 20 percent market share. The remaining 470 vendors split the remaining 30 percent.

Two EHR cloud vendors, Practice Fusion and athenahealth, have an 11 percent market share. While others offer hosted or private cloud products, these two are the sole cloud only solutions in the top 20.

This market segment shows less diversity than those before it. In this case, four vendors have almost half the market, Epic, Allscripts, eClinicalWorks and NextGen.

Class 2 – 4 to 10 Practitioners

The remaining 52 percent, Table V,  is spread among 16 vendors. Notably, athenahealth and Practice Fusion drop in this class to about 3 percent.

Table V 4 to 10 Practitioners

As the next classes show, the market tightens up considerably with a few vendors having greater and greater shares.After NextGen, the other 16 vendors have 30 percent of the market. This leaves all the remaining vendors with 23 percent of the market.

Class 3 – 11 to 25 Practitioners

In this class, Tables VI and VII, three vendors have a market majority: Epic, Allscripts and NextGen. The top seven vendors have over three-quarters of it. The concentration among is so great that three top 20 vendors, AdvancedMD, AmazingCharts and Office Ally are no shows.

Table VI 11 to 25 Practioners

Table VII 26 to 40 Practioner

Class 4 – 26 – 40 Practitioners

Table VIII shows the bunching of vendors in this practitioner class. Only about half of the major vendors had any significant share. All the remaining top 20 vendors lack any significant shares.

Table VIII 26 to 40 Practitioners

Epic’s dominance is even more pronounced in this final class as shown in Table IX. EPIC’s share 47.7 percent and GE has 11.9. Together, they have market share of about 70 percent.

Class 5 – 41 Practitioners and More

Epic’s dominance is even more pronounced in this final class as shown in Table IX. EPIC’s share 47.7 percent and GE has 11.9. Together, they have market share of about 70 percent.

Table IX 40 Plus Practioners

The remaining five vendors have a 20 percent market share: Allscripts, Cerner, NextGen, McKesson. The other 400 plus vendors divide the remaining 10 percent.

There are some interesting changes in this class’ shares, Table X, compared to the previous classes. Cerner drops from second place with 12.5 percent to fourth place with 9.2 percent.

Table X 40+ Practitioners

MEDICTECH all but disappears dropping from 4.7 percent to 0.9. On the other hand, EPIC, GE, Allscripts, NextGen and Greenway increased their shares.

Source and Other Boring Details

The net has many EHR market share analyses, however SK&A’s stands out for several reasons. Most importantly is the active way they gather their statistics. They call every medical practice in the US every six months. This includes all hospitals, private or affiliated practices and urgent care clinics, etc. This approach means that few practices are left out and the answers gathered are on the same basis.

This differs substantially from studies that hang a question out and scoop in whatever they get. They don’t give all practices an equal chance to answer. They are flawed compared to those that actively contact practices or based on statistical samples.

Many other studies base their estimates on ONC’s MU attestations. In fact, most market studies I’ve seen cite ONC. The problem with ONC’s count is that it only includes those in the MU program. Those who don’t, perhaps 40 percent, are left out.

SK&A is not the only company that uses an active approach to determining market share. However, it is the only one I know of that actively surveys the market using that approach and publishes the results free. This is unusual.

I also want thank them for briefing me on their methodology. They did this with only the barest of descriptions of what I was up to.

Future Posts – Hospital and MU v Market Share

There are two other, related topics I’ll cover in future posts.

Hospital Practices

The first is a look at hospital based EHRs. Definitive Healthcare, similar to SK&A, actively surveys the in-patient market by calling practices. They have generously furnished their analysis to Where SK&A breaks down its findings by class size, Dimension looks at hospitals by factors such as:

  • Bed size
  • Independent v affiliated hospitals, and
  • In-patient v ambulatory systems used in hospitals.

MU EHRs v Market Share

The last issue I want to look at is how the vendor rankings in MU’s attestations actually compare to those in this analysis. A preliminary look shows many differences.

KLAS Names Top EMR Vendors For Mid-Sized Practices

Posted on January 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 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.

A new report by KLAS has designated Epic, athenahealth and Greenway as the top three EMR vendors among mid-sized healthcare practices.  The report, which also identified unpopular EMRs in the space, drew its conclusions based on analysis of ability, workflow and integration capabilities, according to iHealthBeat.

To do the study, KLAS interviewed clinicians and IT personnel at practices with 11 to 75 doctors.

Researchers named the top three mid-sized EMR vendors as Epic Systems, which scored a 85.3 points out of 100; athenahealth, which scored 83.5 points; and Greenway, which scored 81.3 points.

Each of the top three vendors distinguished themselves in unique ways.  For example, researchers found that practices liked Epic’s consistent delivery in large hospital-based practices, athenahealth’s “nimble deployment” and system updates, and Greenway’s exceptional service to smaller, independent practices.

Meanwhile, KLAS noted that Allscripts, McKesson and Vitera had the highest percentage of dissatisfied customers, practices which felt stuck with their current EMR system but would not purchase it again.  Reasons for their dissatisfaction included upgrade issues, lack of support, and a perceived lack of vendor partnership, iHealthBeat said.

When it comes down to it, it’s pretty clear when these practices need from their vendors, and a feeling of partnership and mutual support seems to top the list of matter which researchers is doing the study.  But it’s clear that these characteristics can be pretty hard to come by, even from companies you’d think had plenty of resources to deliver a sense of support and availability to their customers.  Allscripts, McKesson and Vitera (although it is Greenway now) had better get their act together quickly, as mid-sized medical practices are a major market, even if they don’t spend quite as much as hospitals.