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Electronic medical records (EMRs) automate the clinical operations of healthcare providers. They provide digital storage of patient charts, and include functionality to track patient demographics, histories, SOAP notes, medications, test results and more.
Electronic medical records are also referred to as electronic health records (EHRs), digital medical records or computerized medical records. By generally accepted definition, an EMR is an electronic record of patients’ medical histories, created and stored at a single location. Meanwhile, an EHR is the comprehensive collection of patient medical records created and stored at multiple locations.
While there is a technical distinction between the two, buyers and vendors use the terms interchangeably. Review our article "EHR vs. EMR - What's the Difference?" for an in-depth look at the differences. Or, for more information about important events, people and milestones in the history of EHRs, visit our historical timeline.
This guide will cover:
Which EHR systems are practices using? What are their benefits and challenges? Take our survey and view the results in real-time. Click here to take the survey.
Our research regarding the impact of the HITECH Act on EHR purchases draws from primary data collected from 2010 through 2013. You can access the report at its new location here.
In January 2013, we published an EHR market share report based on CMS data from medical providers attesting to meaningful use (MU). That report contained data through October 2012. Since then, CMS has updated the data through January 2013, so we wanted to update this report accordingly.
Medical providers made quite a bit of ground in three months: As of October 2012, 110,230 medical providers had attested to meaningful use, but by the end of January that number had jumped by over 55% to 171,226. When looking just at eligible professionals (EPs), there were 176,965 who attested to meaningful use, compared to 350,844 actively registered. So although the number of EPs attesting has grown significantly, about half of them still haven’t attested at all.
Looking at the vendors themselves, that number has grown, too. In total, we identified 560 vendors receiving at least one attestation for meaningful use—a 19.4% growth from two months earlier, when 469 vendors had received a mention. Four hundred thirty-six of those were for complete EHRs for EPs, compared to 361 back in October.
In terms of market share, it appears that the smaller vendors have benefited the most from these last three months. The market share owned by the top ten vendors dropped to 64.8%, compared to 67.4% just three months earlier. Epic Systems Corp lost quite a bit of their lead in the process, though they still have a commanding advantage, maintaining almost 9 percentage points more than their nearest competitor, Allscripts.
Among modular EHRs, Allscripts, Cerner Corporation, and Jardogs are the three biggest players, combining for almost half the market. And for hospitals, MEDITECH owns 15.9%. They’re followed by Cerner, Epic, and then CPSI.
We’ve compiled the above data in a single spreadsheet, which identifies MU attestations by vendor, product classification, and setting.
We understand the above information is based on a limited dataset. However, this may be the best representation of market share available. Why?
Now that this data is being published by CMS on an ongoing basis, we will be able to provide updates to this report on a regular basis.
It’s worth noting that the new data has created and/or brought to light some challenges with regard to methodology and accuracy. First, since many providers are now in their second year of participation with the HITECH incentive program, they have now attested multiple times and therefore have multiple entries in the MU data. These duplicates were filtered out in this report.
Through creating this filter, however, we noticed some additional challenges. Some medical providers are using multiple EHR products, or are using a single product that attests separately for separate elements, and these, too, would appear multiple times. (As an example: Cerner Corporation sells its solutions under separate banners, primarily PowerChart and HealthSentry. There are hundreds of providers using both of these as a single products, but the data reports them separately, giving us the illusion that Cerner Corporation has received two sales, when in fact they received only one.) To correct this, we’ve filtered such that a single vendor is counted only once per provider, though two distinct vendors associated with a single provider will each be counted.
The following are the minimum benefits that should be realized with a successful implementation:
Improved Efficiency. Physician practices should find themselves with more time to focus on patient care as they eliminate paperwork, speed up medical charting, receive lab test results electronically, and prescribe electronically.
More Time for More Patients. As physicians and support staff spend less time tracking paperwork, they should be able to see more patients. EMRs should also allow physicians to complete and document patient encounters more quickly, further increasing their ability to see more patients.
Increased Collections. Electronic patient records provide physicians with the necessary documentation to support claims sent to insurance companies, Medicare, and Medicaid. Integrated features for E&M coding also help providers code visits appropriately and confidently. Of course, seeing more patients should naturally increase collections as well. This is one of the top benefits of electronic health records.
Improved Quality of Care. Features such as integrated drug databases, symptom checks, and drug interaction verification help physicians prescribe the correct medications and dosages. EMRs can also provide prompts to physicians based on inputs of patient chief complaints and/or risky demographic factors. This is another one of the many advantages of electronic health records systems.
There are several hundred electronic medical record / electronic health record systems that collectively address the needs of just about every medical specialty and clinic size. For example, EMR vendors have customized systems for outpatient care, inpatient care, solo practices, enterprise groups, primary care, therapy, mental health, ophthalmology, chiropractic and so on.
With so many medical EMR companies catering to so many specialties, physicians face a big challenge as they determine which medical software is right for their needs. However, we find the majority of practices we speak with fall under one of these common categories:
The expected benefits of any electronic health record system are to improve patient care, lower administrative costs, and improve billings and collections. The primary measures of effectiveness are:
EMR system costs will vary widely and depend primarily on the size of the practice and the deployment model preferred (on-premise vs. Web-based). On-premise systems typically require costs for licenses, servers, implementation, training and ongoing technical support. Support costs are typically 15-20 percent of the upfront licensing cost per year. Implementation and training costs vary widely, but are often as high as the licensing costs.
Web-based systems typically have lower upfront costs that cover training and implementation. Ongoing fees paid on a monthly basis cover licensing, technical support and upgrades.
Today, increased competition among vendors has applied downward pricing pressure on the market. Furthermore, technology developments such as Software as a Service (SaaS) have led to alternative, budget-friendly pricing models. There are even free EMR software systems that are supported by alternative revenue streams like advertising. And finally, government stimulus programs such as the American Recovery and Reinvestment Act (ARRA) make EMR investments even more feasible for small and large practices.
In 2009, President Obama signed ARRA into law. A major component of this bill is the Health Information Technology for Economic and Clinical Health (HITECH) Act, which includes $19 billion to incentivize medical offices to adopt electronic healthcare records. Providers that make “meaningful use” of “certified” electronic health record systems are eligible to receive $44,000 in reimbursements in the form of increased Medicare and Medicaid premiums. Physicians have a mandate to become meaningful users by 2015. Those that fail to qualify will face decreased Medicare and Medicaid payments.
The Office of the National Coordinator (ONC) for Health Information Technology, part of the Department of Health and Human Services (HHS), is responsible for heading up this initiative. They have selected organizations to certify electronic health records from medical vendors. These organizations have been titled “ONC-Authorized Testing and Certification Bodies,” or ONC-ATCBs. To see a list of certified products, visit our ONC-ATCB EHR buyer’s guide. We also have a list of CCHIT-certified EMRs. (Until January 2014, CCHIT was perhaps the foremost ONC-ATCB. They are no longer certifying new products, but previous certifications are still valid.)
Mobile Device Support
Mobile devices are proliferating quickly and health care providers are eagerly adopting them. As physicians aim to accomplish more from outside the office and improve mobility within the office, iPhones, iPads and Android devices are becoming increasingly prevalent in the workplace. Some of the top EMR vendors are catching on to this increased demand and we expect to see more iOS and Android-compatible systems coming to market. Several vendors already offer iPad EMRs. For example, MediTouch is a leading electronic medical record company in mobile healthcare IT.
Software as a Service (SaaS)
We find roughly 25 percent of medical practices are interested only in Web-based systems, while another 50 percent of are open to the model during early stages of their research. As cloud computing catches on in other industries, it is emerging quickly in health care as well. Developments in HIPAA compliance, data security and encryption, server reliability, and data backup make Web-based EMRs viable alternatives in medicine. Furthermore, many healthcare providers are avoiding large upfront costs required for client-server systems and preferring monthly payments for hosted systems.
The most common concern we hear regards data security. Patient privacy and HIPAA compliance are typically on the front of providers’ minds, so buyers will want to make sure that the EMR is implemented properly and that standard security measures are in place. Vendors are well aware of this concern and have proper data encryption technology for both on-premise and Web-based systems.
A second consideration is user adoption, primarily among providers. Some providers find EMRs difficult to use, often because they are accustomed to working with paper charts. Most user adoption issues can be solved with adequate training. The amount necessary typically depends on the user’s level of tech savviness.
Integrated Software Suites vs. Best-of-Breed Solutions.
The decision most doctors will need to face is whether to implement a standalone electronic medical records system or an integrated suite with billing and scheduling applications. Buyers who implement standalone computerized medical records often do so if: they have unique needs their vendor cannot address; outsource billing with no plans to bring billing back in house; or, they have made a large upfront investment in a billing and scheduling system they do not wish to replace.