by Houston Neal
Director of Marketing, Software Advice
April 19, 2012

Last updated on April 19, 2012 - There are several hundred electronic medical record (EMR) and electronic health record (EHR) systems available for just about every medical specialty and clinic size. EMR vendors have customized systems for outpatient care, inpatient care, solo practices, enterprise groups, primary care, therapy, mental health, eye care, chiropractic and so on. Furthermore, various systems span the full range of pricing, from free to several hundred thousand dollars.

With so many EMR companies catering to so many specialties, physicians face a big challenge as they determine which medical software is right for their needs. We put together this buyer's guide--and list of top 10 EMR software programs--to help physicians understand the market and know where to start.

Here’s what we’ll cover:

What is EMR Software?
Deployment Strategies
The EMR Vendor Landscape
What Type of EMR Buyer Are You?

Market Trends You Should Understand
Recent Events
Benefits & Potential Issues
Costs & Return on Investment

What is EMR Software?

Electronic medical records manage the clinical operations of healthcare providers. They provide digital storage of patient charts, and include functionality to track patient demographics, histories, SOAP notes, medications, and test results. Buyers should note that electronic medical records systems are also often called electronic health records systems. They may also be referred to as digital or computerized medical records.

While there is a technical distinction between EMRs and EHRs, almost all buyers and vendors will use the terms interchangeably. By definition, an EMR is a record of a patient’s medical history created and stored at a single location, while an EHR is a comprehensive collection of patient medical records created and stored at multiple locations. Visitors may review our article EHR vs. EMR - What's the Difference? for a more in-depth look at the differences (and for additional examples of EHR systems). For the purposes of this guide, we will use the terms interchangeably.

Deployment Strategies

The decision most doctors will need to face is whether to implement a standalone electronic medical records system or a single, integrated suite with billing and scheduling modules. Buyers who implement standalone EMRs often do so if: they have unique needs their vendor cannot address; outsource billing with no plans to bring billing back in house; or made a large upfront investment in a billing and scheduling system they do not wish to replace.

Buyers who implement integrated tools typically see the value in having one centralized system to manage all clinical, administrative and financial information. Many popular vendors such as Allscripts, eClinicalWorks, and GE Centricity can sell EMRs by themselves or complete EMR and medical billing and scheduling systems.

What Type of EMR Buyer Are You?

Before you dig in to EMR vendors and go through a formal feature or EMR cost comparison, you’ll need to assess what type of buyer you are. We believe more than 90% of buyers fall into one of these categories:

• Primary care MDs/DOs and related specialists. These buyers work at private practices that provide internal medicine, family medicine, pediatrics, Ob/Gyn, cardiology, oncology, orthopedics, urology, etc. These buyers’ various needs are addressed by broad systems with specialty-specific templates. 
• Specialists with other designations (DC, OD, PT, PhD, LCSW, etc.). These buyers include chiropractors, psychologists, therapists, counselors, and optometrists. They typically have straightforward needs that are met by affordable, specialty-specific systems. 
• Small practices. These buyers work at practices with one or two providers. They are usually moving away from paper charts and want to prescribe electronically and integrate with labs. 
• Mid-sized to large practices. With anywhere from a handful to 100+ physicians, these buyers are often looking to eliminate paperwork and improve efficiency. They may also want to integrate with other healthcare networks’ systems, track information across several locations, and provide consistency of care across providers. 
• Inpatient care organizations. These buyers work for hospitals and acute care centers that need to manage patient rooms/beds, assigned nurses, and physician rounds. They usually require robust, emr systems for hospitals that can integrate with a variety of other applications.

The EMR Vendor Landscape

While the vendor landscape is highly fragmented, the available solutions are differentiated by their appeal to the different buyer types.

Recent Events

We’re in the middle of one of the most active and innovative times in the history of the medical charting software market. Spurred by certification requirements outlined in the HITECH Act, electronic medical records companies are rolling out new capabilities on a regular basis. These features will help physicians meet stage 1 and stage 2 meaningful use requirements.

At the same time, the market is becoming increasingly competitive. This is good news for doctors. Top EMR vendors are rolling out new innovations on a regular basis. Here are a few trends playing out:

• Support for Mobile Devices. A growing number of EHR software vendors are releasing mobile apps for both Apple devices--the iPad and iPhone--as well as Android phones and tablets. For example, in March 2012, Greenway Medical announced the availability of PrimeMOBILE for Android phones and tablets. PrimeMOBILE integrates with Greenway’s core EMR and practice management system, PrimeSUITE, a top rated EMR. Mobile app development is driven in large part by demand from physicians who want to access patient data remotely.
• Mergers and Acquisitions. There are over 300 hundred electronic medical record systems on the market. We expect to see some of the top medical software companies make strategic purchases in the coming years to quicken growth and ownership of market share. To cite a fairly recent example, AdvancedMD was acquired by ADP, a leading provider of payroll, benefits administration and human resources services.

Market Trends you Should Understand

These electronic medical record market trends should be considered as you select a product and vendor.

• ONC-ATCB Certification. In 2009, President Obama signed into law the American Recovery and Reinvestment Act. 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 health records. Providers that make “meaningful use” of “certified” electronic health records 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 the department responsible for heading up this initiative. They have selected six organizations to certify electronic health records from medical vendors. These organizations (e.g. CCHIT) have been titled “ONC-Authorized Testing and Certification Bodies,” or ONC-ATCB. To see a list of certified products, visit our ONC-ATCB EHR buyer’s guide. We also have a list of CCHIT-certified EMRs, one of the ONC certification bodies.
• Mobile device support. Mobile devices are growing 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 tablet PC EMRs. For example, MediTouch is a leading company in mobile healthcare IT.
• Software as a Service (SaaS). We have found that roughly 25% of buyers are interested only in web-based systems, while another 50% of buyers 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. 

Benefits & Potential Issues

EMRs are designed to benefit both healthcare providers and administrative staff. The following are the minimum benefits of electronic medical records 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 and faxes electronically, and prescribe electronically. 
• Increase in patient visits. 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 medical 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 properly and upcode when necessary. Of course, seeing more patients should naturally increase collections as well.  
• 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.

These are just a few of the advantages of electronic medical records. But, as with all healthcare technology, there are potential advantages and disadvantages of electronic medical records to consider as well. The most common concern we hear is in regards to 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. Most 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 so familiar with 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. The final consideration is vendor viability. Such a fragmented market is bound to undergo consolidation as vendors get acquired or go out of business. As a result, buyers will want to make sure they select a viable vendor whose products will not be discontinued.

Costs & Return on Investment

The goals for any electronic health record system are to increase revenue, lower administrative costs, and improve the quality of care. The primary measures of effectiveness are the claims collection rate, the number of patient visits per day, the amount of time spent managing faxes and paper charts, and the direct costs of paper charts (cost of materials, storage, destruction, etc.). 

EMR systems have traditionally been very expensive, often beyond the budgets of most small practices. However, increased competition among vendors has applied downward pricing pressure on the market. Furthermore, technology developments such as SaaS have led to alternative, more budget-friendly pricing models. Government stimulus programs such as ARRA will likely make EMR investments even more feasible for small and large practices. 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 will typically require costs for licenses, servers, implementation, training, and ongoing technical support. Support costs typically range 15%-20% of the upfront licensing cost per year. Implementation and training costs also 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. In both cases, buyers need to be aware that integrating a standalone EMR system with an existing billing and scheduling system can often be equal to or more than the cost of implementing one system for both electronic medical records and practice management.

Have an opinion on this guide? Email the authors. We appreciate the feedback.