The era of electronic health records has arrived and opportunities for innovative uses of data are plentiful for providers and vendors alike. Fueled by financial incentives from the government as well as meaningful use requirements, organizations that best position their data to help providers deliver patient centered care will flourish. Physician organizations are also becoming larger through growth, acquisitions, and mergers. These growth milestones provide organizations opportunities to reflect on the capabilities of their current medical record system in order to decide if their current system will keep them competitive in the future. These are the three types of organizations that will be purchasing a new Electronic Health Record (EHR) system in 2013.
The New EHR Adopter
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Buying a new EHR is not cheap which may explain why many smaller physician practices have held out on the investment as long as they could. Only around 20% of providers are attesting to Meaningful Use in the US. However, government mandates and incentives are forcing providers to overcome their resistance to EHRs. While larger practices initially lead the charge into the digital record world, SK&A has shown that small physician practices are growing their EHR adoption rates faster than larger physician organizations over the past few years. According to KLAS, many of the smaller provider organizations are using cheaper vendors such as athenahealth, eClinicalWorks, and Practice Fusion which have been enjoying their recent growth.
While there are still some larger organizations that need to adopt an electronic medical record system, the majority of the New EHR Adopters over the next year will continue to be small provider organizations.
The Acquired Converter
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While the smaller practices are still adopting EHRs for the first time, larger practices, which boast an adoption rate over 78%, are experiencing a different phenomenon. Rather than leading the pack in adoption rate growth, they have been increasingly switching vendors! One reason for this is due to consolidation that is occurring throughout the healthcare system. Federal incentives for the development of Accountable Care Organizations are driving larger physician groups and hospital systems to acquire the small practices in their local area. According to the American Family Practice Journal, the only non-government EHRs that are predominantly used by these large physician practices (>50 providers) are Allscripts Enterprise, EpicCare Ambulatory, Cerner Millenium Powerchart, and InteGreat EHR.
As acquisitions and mergers continue, organizations will have an increasing need to be able to both communicate clinical information between existing applications as well as convert data from one vendor’s EHR to another. While the messaging standards such as HL7 and CDA are easing the integration pain, conversions are becoming increasingly difficult for organizations. Many smaller vendors have data structures that are easy to understand, however they often do not store data discretely making conversions a nightmare. Larger vendors have the benefit of storing data in a more logical way, however the sheer volume of data combined with the lack of support during the conversion process makes transitioning between EHRs extremely difficult. While it is understandable for a vendor to dissuade groups from moving off their software, some providers are beginning to feel like their data is being held hostage!
The Disgruntled Replacer
The last purchaser archetype for 2013 is for the small, but growing minority of providers that are dissatisfied with their EHR system. The CDC reported that a vocal 15% of all providers reporting to them are dissatisfied with their EHR choice. Some of these providers chose a vendor based on price and have outgrown their current EHR’s capabilities, while others chose an EHR that was not a good fit for their organization. These providers often have specific needs in their organization and need extra support from the vendors in order to meet the incentive goals that drove them to purchase their EHR. They need to integrate with local Healthcare Information Exchanges, report on quality metrics, report on financial incentives, and make adjustments to the EHR to fit the way they practice medicine. Providers don’t need to know how the software works; they just need to know how to use it effectively. However, IT specialists know that the quality of the data in the EHR is only as good as the quality of the data put into it by providers. Without the proper workflow training and support from the vendors on how to make the EHR work for a provider, organizations will have a difficult time just using the EHR and never realize the benefits of electronic data management. However, according to the American Association of Family Practice Management, 56% of primary care providers are not satisfied with EHR vendor support and training. This may be why the percentage of EHR sales to physician organizations that already had some form of EHR rose from 30% in 2011 to 50% in 2012 and is showing no sign of slowing down.
A Look Ahead
KLAS recently reported that vendors such as athenahealth, eClinicalWorks, Epic, and Greenway Medical Technologies are gaining market share while the traditional ambulatory EHR vendors such as Allscripts, Cerner, GE, NextGen, and McKesson are struggling to continue the explosive growth they saw over the previous 10 years. While no one vendor is the best for every organization, it is clear that the struggling vendors need to focus on creating better products and supporting them for their customers. With Cerner and McKesson in the lead in revenue and Epic and Allscripts in lead with the most implementations in the ambulatory space, the big players have an opportunity to learn from their mistakes. However, the ambulatory market is still open for any vendor to improve the EHR data structures, design more user friendly interfaces, design products specifically for specialty practices, and utilize technologies from other tech sectors such as phone apps. EHR implementations will continue to be a significant investment for organizations and it will be exciting to see the improvements to EHRs in 2013.
Christopher holds an M.P.H. in Healthcare Policy and Management and works as a consultant with Galen Healthcare Solutions. He specializes in reporting, analytics, integrations, and custom programming for physician networks and hospital systems. He also has a particular focus on ACOs and PCMHs and has worked on ACO and HIE development projects throughout the country.
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