EHR Software Market Share Analysis

Excellent piece, and worthy of participation.

This is an exceptionally challenging space for technology. At it’s simplest, information technology is competing with a pen and a piece of paper, in regard to cost, portability and ease-of-use, it’s hard to beat.

In addition, the costs, both explicit (cost of the system) and implicit (training and adoption) are incurred by the practice, but not always the benefits, they fall to insurance companies and patients.

Add to this that medical practices are professional corporations who can not keep retained earnings. This means that funds remaining at the end of the year have to be distributed as ordinary income. The cost of an information system comes directly out of the income of the practitioner. Ouch!

Everyone believes that there are benefits to the process of care and to the patient, but those benefits lie well beyond the cost of bringing on the system, often in the future.

To understand the strategy going forward consider this: the future of healthcare medical practice will look a lot more like the 1950′s than the 1990′s. That is an increasing amount of income will be coming from patients paying cash. With that in mind, what should a practice do?

As a trained economist, my bias is that it changes the nature of the relationship between practice and patient to where the patient is also a customer. This means that practices need to work on building close relationships with their patients, develop communication strategies to share information with them, and provide them the ability to create their own appointments at their convenience.

All the sophistication of an EHR is irrelevant until the patient shows up, and the longer they stay around, the more valuable the information in that system is to the practice. This is why I’ve focused on tools for practices to better communicate with their patient/customers along with the ability for those patient/customers to create their own appointments when it is convenient to them. It wasn’t easy, but it’s done. And better yet, it’s a revenue story, not just an expense reduction story.

Good luck,
Tom

Chris,

Great job conducting research and aggregating and presenting data. An interesting notion is that of Microsoft entering the market – perhaps by buying a major EMR vendor. The following article speculates just that, suggests it’s just a matter of time before that occurs and highlights which EMR vendors are likely acquisition targets: http://www.softwareadvice.com/articles/medical/microsoft-emr-it%E2%80%99s-not-just-a-matter-of-when-it%E2%80%99s-a-matter-of-who-1040510/

That said, one of my colleagues recently did her own research and published an article outlining the typical costs of implementing an ambulatory EHR. Take a look: http://blog.galenhealthcare.com/2010/05/18/how-do-i-budget-for-my-ehr-implementation-project/

-Justin

@ Justin

Thanks for the link. Figuring out how to budget for an EMR implementation is probably just as difficult as figuring out the market share. Lots of different numbers out there.

Are we using EMR & EHR interchangeably here?
In http://www.softwareadvice.com/articles/medical/ehr-vs-emr-whats-the-difference/ the author described EHR as integrated across providers while EMRs are for single organization.

Was the CDC survey using another definition?

@ Michael

Yes we are. I listed the CDC’s definitions in the post, after the first chart.

Chris,

Great study. Is there a way that you might have published the complete study for publication somewhere? I’d love to study your research design. I’m finishing my MPA and love studying research methodologies.

Regards

This is a very proprietary biased view as it excludes an enormous segment: Veterans Affairs VistA, its close cousin IHS RPMS and its increasing number of private sector deployments. There are approximately 1,000 VA outpatient clinics and many more Indian Health Service outpatient clinics. Pretending that they don’t exist gives an inaccurate view.

– IV

@IV

We’d love to include them if we can get accurate numbers on them. Do you know how many physicians are using that EHR software?

This is a nice attempt to get an idea of the EMR market. We at Medical Records Institute (MRI) have been trying to come up with good estimates for some time. Although I have moved on to mHealth, here is my input:
1. The CDC definition is a compromise but it does not cover the range of EMRs. EMR definitions are more complex. At a minimum, please recognize that there is a difference between EMRs which are enterprise-based (providing interoperability for all who are linked to a clinic or have ties to a hospital) and EHRs providing interoperability between any provider in the US. The difference is not in name, these are very different systems. Your survey covers only EMRs.
2. Your numbers are way off. More detail is needed as to practicing physicians in ambulatory care.
3. You seem to assume that those 10 vendors represent the market. What percentage has the rest of vendors, some of which have good market share in a number of specialties?

I would offer the advice that between items 2 and 3, your numbers should be considered as “not final”.

@ Peter

Thanks for the comment. This is indeed a work in progress, as we noted in the post. Out of curiosity, why do you say the numbers are “way off?” We’re trying to arrive at the best possible answers as well so I’d love your input.

Some recent EMR adoption studies show the US at about 1.5% — if you include the VA, it doubles.

The government agencies make a ton of data available — here’s a few pointers.

VA Care Utilization Stats (as of 4/2010):
http://www1.va.gov/VETDATA/Pocket-Card/4X6_spring10_sharepoint.pdf

Tons of IHS statistics:
http://info.ihs.gov/

There is no centralized means to track deployments in the private sector or internationally. There are certainly ‘tens’ of deployments (small and large) w/in the US. Mexico has publicized an installation several years back. The country of Jordan is deploying. There is a recent contract to deploy 8 hospitals in India.

@ Ben

I didn’t see anything in those links about physician EHR/EMR adoption, just patients in the VA. Am I missing something?

Hello Chris,
Thanks for contacting me about this particular post. I’m away soon on holiday and have a couple of deadlines to meet before departure (volcano permitting). This work even if ‘in progress’ does look very interesting and stimulates some initial thoughts that I’m sure I can expand upon. I do feel disadvantaged given my UK – NHS location and perspective – but we’ll see.
In the meantime your readers may find the informatics links of interest at:
http://www.p-jones.demon.co.uk/linksTwo.htm
Best regards,
Peter Jones
Community Mental Health Nurse Older Adults, Independent Scholar & Informatics Specialist
Lancashire
UK
–
http://hodges-model.blogspot.com/
Hodges Health Career – Care Domains – Model
http://www.p-jones.demon.co.uk/
h2cm: help 2C more – help 2 listen – help 2 care
http://twitter.com/h2cm

Good first cut. Doing a little more research and adding in the public sector data will further enhance your report. I know in our state of West Virginia, we have 70 hospitals, with 11-12 running the VistA system. It’s the most widely deployed hospital EMR in the state. There are also over 40 rural clinic sites running RPMS, the Indian Health variant of VistA. Throw in the 1000+ hospitals, nursing homes and clinics in the VA running VistA, he undreds of Indian ealth facilities running RPMS, the growing number of state facilities runnin VstA/RPMS in Oklahoma, West Viginia, Texas, Hawaii, etc. and we’ll see the open source VistA/RPMS solution is probably the major player out here. I’m not sure of the exact numbers, but there are over 180,000 users of VistA in the VA alone of which there are about 20,000 physicians and maybe another 50,000 nurses. Again, a little more research and the next version of your report will be great. Looking forward to it.

Not sure how these numbers were obtained, but it speaks volumes as to the lack of scientific validity in many studies being touted to the press.

For example, Amazing Charts EHR, has a documented unique practice base of over 3,500 and a physician user count double this. How many other EHRs with similar numbers were excluded, and why?

@ Jonathan

We only chose the top ten for space/time reasons. We did our best to get in contact with as many vendors has possible. Your comment will be left here for the record.

Excellent work – thank you!

Do you have a similar study for the general market? How many software vendors are there in all?

@ James

What do you mean by general market? There are 300+ EMR/EHR software vendors out there.

Great post and research Chris…I think our HITECH Answers readers would be interested in this information.

Thanks Chris, really appreciate your efforts in this. Are you able to provide any state based analysis for Outpatient EHR software market share by vendor. I would be particularly interested in NY

Can you give it another try,
this time with VA data and open source programs included??

Thanks

@ Susan

We discussed listing the open source EHR programs out there but it is very difficult to find data on the number of users and practices served. That may be another blog post entirely.

Nice work —

We recently unveiled our semantic health care platform
http://www.businesswire.com/news/home/20100527006003/en/Kyield-Unveils-Semantic-Health-Care-Platform

This companion use case on diabetes might be of interest — story telling format; light on marketing and heavy on substance:
http://www.kyield.com/images/Kyield_Diabetes_Use_Case_Scenario.pdf

Increasingly it will not be the EHR component that matters so much, but rather what can be done with it on a continuous basis for analytics– diagnosis, therapy, predictive, and research.

Thanks

Hi Chris,

Just goes to show that no good deed goes unpunished. I thank you for your good work.

Peter W. is right.

Other than the very valid Vista issue, A lot of the questions go back to the original question of a standardized definition of what a “certifiable” EMR is, what constitutes meaningful use etc. Thanks to early champions (P.W.& Blair-TEPR)and thought leaders (Dr. Brailer)at least in a few years we will be able to discuss our market in terms that we can all agree on as to the meaning.

Really nice piece of information and I really commend the kind of research that has gone behind this piece of work.
I also feel that some of the numbers on this might be a bit less if you start to consider the smaller and mid-size ehr vendors.
I think today medical practitioners are looking to avail of this federal incentive by trying to comply with the definition of meaningful use but at the same time EHR providers are looking at their own set of profits.
This misunderstanding is mostly I believe as a result of wrong interpretation of the federal guidelines. The EHR providers need to look at these guidelines from the prospective of the practitioners who deal with different specialties.
Each specialty EHR has its own set of challenges or requirements which I believe is overlooked by in most EHR vendors in a effort to merely follows federal guidelines. This is resulting in low usability to the practitioners, thus less ROI, finally redundancy of the EHR solution in place.
I think ROI is very important factor that should be duly considered when look achieve a ‘meaning use’ out of a EHR solution. Though one may get vendors providing ‘meaning use’ at a lower cost, their ROI / savings through the use of their EHR might be pretty low when compared to costlier initial investment. Found a pretty useful ROI tool that is pretty customizable and easy to use. It also accounts for the different specialty EHR’s too.

Some of the other useful resources on this topic:
REC’s putting EHR’s to meaningful use
Certification criteria for EHR

Also the introduction of REC’s through the HITECH act. is a great way to avail of quality EHR solutions at competitive prices. The stiff competition among not only these REC’s but also among EHR vendors ( to become a preferred vendor of a given REC) will result in lot of positives to medical practioners.
Looking the funding provided to the REC’s, the staggered grant allocation system also promises to be an unbiased way of allocating funds. It will also help in the concept of REC’s helping out each with their own unique business models. It can be one of the possible answers to the
’safe vendor challenge’ as discussed by many critics.

These new acts and growing urgency for EHR evolving out of this federal push is bound to put the numbers on the higher side.
Do you all agree with me ?

Allscripts has more than 1,60,000 physician user base. With Eclipsys they go to 1,80,0000.
Please look at this link and lot of other statutory documents by these two companies to get correct picture of number users they have.

http://www.businessweek.com/news/2010-06-09/allscripts-to-buy-eclipsys-expand-in-health-software-update2-.html

My apologies for typo, with eclipsys they go to 1,80,000 and not 1,80,0000

@ Akash

I didn’t see in that link where it said Allscripts had 160,000 users. Can you help us out?

i think the 180,000 physicians in the business week article includes docs at Eclipsys inpatient sites as well (greatly increasing the # of docs and likely validating Chris’ Allscripts #’s)

Great post and research! I was surprised by Sage’s numbers, thought they were a bigger player.

I came across an updated member count for Practice Fusion: 40,000 expected to reach 100,000 by end of 2010 ( According to CEO /Founder Ryan Howard).

Article:
http://www.massdevice.com/features/massdevice-qa-practice-fusion-founder-and-ceo-ryan-howard

It seems unusual that Practice Fusion appears in some market share analyses, but not others.

What has been done to validate the user data provided by Practice Fusion? Is there a danger that many of the users they report are not active users… just curios physicians who wanted to try a free product?

@ DJ

That’s one of the questions we asked in the post and I don’t have a clear answer for you right now.

Hello Again Chris,

Just went through the numbers again.

Strange that EHS, Companion,Pulse, Shared Health and e-MD could even remotely fit into others %.

Your premise only stated non-federal physicians so we don’t need to get into VISTA and Integic users. There still are not enough interfaces with the VISTA program to even count it yetfor outpatient usage. (VBECS etc)

Good shot.
Chris

Regards,

Chris

There are a couple factors to keep in mind with Allscripts (beyond the recent merger with Eclipsys). Allscripts has achieved its growth via acquisition. “Allscripts users” in the survey could be using any one of a number of products:
* the former Allscripts Touchworks
* the former A4 / Healthmatics
* Mysis EMR
* Mysis MyWay (formerly iMedica/Aprima)

There may be more, but that’s all that I can think of off the top of my head.

I appreciate your work. I think this is usefull for lot of physicians like me. I am in a 2 provider internist practice completely on paper chart. Our practice is 4 year old. I did register to the REC. We plan on going electronic in the near future. I welcome any advice.

Thanks for the attempt to uncover the EHR market Share. How many vendors did you include in the data for Market Share? Since there are over 300 vendors, I find it hard to believe that the “other vendors” market share was only 10 percent of the market. Did the EHR adoption information come from the CDC?

The reason for the inconsistent market share data is likely because you gathered the information on number of physicians from the vendors and not from the physicians themselves. Most of the vendors are private companies that don’t have to prove their revenues or physician base numbers. I also question if the numbers provided by vendors were in fact total number of physicians and not actually the number of EHR customers. Not all EHR customers are just physicians. It would be great if you could do a survey of these physicians directly to uncover what they are truly using.

I am looking for solutions that Occupational Medicine practices as part of a group practice who have gone on Epic have implemented with success for the employer services. Thanks