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EMR Divide Remains Between Larger And Smaller Practices

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A new study finds that while physicians’ adoption of EMRs has grown substantially between 2009 and 2012, there’s still a big “digital divide” between large and small medical practices, according to a Commonwealth Fund study reported by iHealthBeat.  But it also concluded that there are ways to close the gap, largely through cash incentives and tech help.

According to the study, EMR adoption by primary care physicians increased from 46 percent in 2009 to 69 percent in 2000.  What’s more, Commonwealth Fund found that most doctors are using core health IT functions, including clinical decision support, e-prescribing and electronic ordering of lab tests.  This is clearly a sign that Meaningful Use Stage 1 has had a large impact. (We’re still waiting to see whether doctors continue to drop out and avoid Stage 2′s tougher criteria.)

The study also found that as of 2012, 33 percent of doctors could electronically exchange clinical summaries, and 35 percent could share lab or diagnostic tests with physicians outside their practices electronically.

But these results were not distributed evenly.  Specifically, researchers found that practice size substantially affected EMR adoption.

For example, the research found that 90 percent practices with 20 or more doctors had adopted EMRs, but that just 50 percent of solo physician practices were on board. That being said, the study found higher rates of EMR adoption among small practices that were sharing resources or that took advantage of Meaningful Use incentives.

All told, researchers concluded that technical assistance programs that incentives close the digital divide regarding EMRs between large and small practices.  This just makes sense. If such programs can make it easy and even lucrative to adopt EMRs, we could see the digital gap close soon.

January 31, 2014 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Meaningful Use EHR Breakout by Percentage

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I’ve seen a bunch of different websites listing the top 10 EHR vendors based on physicians who attested to meaningful use using their EHR software. This list is certainly interesting and worthy of a discussion. However, I think it’s also important to put these numbers in some context. Remember that these numbers are just for the ambulatory EHR space. The Hospital EHR numbers are a different story which I’ll probably cover on Hospital EMR and EHR.

Here are the EHR incentive numbers by EHR vendor and also the percentage of meaningful use attestations they had (Thanks to Dr. Rowley for the numbers):

EHR Vendor MU Attestations Percentage
Epic 11075 23%
Allscripts 5743 12%
eCW 4057 8%
NextGen 2237 5%
GE 2002 4%
Athena 1733 4%
Greenway 1650 3%
Cerner 1375 3%
MEDENT (Previously Community Computer Service) 1264 3%
e-MDs 1235 3%
Practice Fusion 1156 2%
Sage 1140 2%
Other EHRs (272) 14358 29%

As Dr. Rowley points out in his post, Epic is the largest vendor on the list, but they don’t market or sale their product to independent clinics or even independent physician groups. Epic’s ambulatory EHR is found in owned or affiliated clinics who use the ambulatory piece of the EHR an Epic hospital buys. So, the above Epic number actually provides an insight into how many ambulatory practices are associated with Epic using hospitals.

The numbers tell an interesting story if you take Epic out of the mix:

EHR Vendor MU Attestations Percentage
Allscripts 5743 15%
eCW 4057 11%
NextGen 2237 6%
GE 2002 5%
Athena 1733 5%
Greenway 1650 4%
Cerner 1375 4%
MEDENT (Previously Community Computer Service) 1264 3%
e-MDs 1235 3%
Practice Fusion 1156 3%
Sage 1140 3%
Other EHRs (272) 14358 38%

Once you take out the hospital dominance in the ambulatory market, the EHR market share for any one EHR vendor is quite small. In fact, the other EHR vendor category has 38% of the EHR market. The long tail of EHR software is definitely at play right now.

Plus, we have to be really careful using meaningful use attestation as a proxy for the EHR market. I recently saw a figure that only 20% of the ambulatory EHR market had attested to meaningful use. That’s right, the above numbers only represent 20% of the ambulatory market.

If my math is correct, that still leaves almost 200,000 providers that aren’t represented in the above analysis of 50k providers. Imagine an EHR vendor comes along that’s so great that they quickly capture only 20% of the 200,000 uncounted providers (no small feat). That would give them about 40,000 providers and using the above numbers they would have 45% of the EHR market (including Epic).

Of course, the current EHR vendors will continue to sale EHR software and many will switch EHR software vendors during that time as well. Plus, no doubt many of those who haven’t attested to meaningful use already have an EHR, but aren’t represented in the numbers above. They just either don’t care about meaningful use and EHR incentive money or they’re still working to get to the point where they can attest to meaningful use. However, I still think the above numbers illustrate that there’s plenty of opportunity available for an upstart EHR company to get plenty of EHR market share.

It’s going to be an exciting next couple years as we watch all of this shake out. We’ll take a look back at this post in a few years to see how far we’ve come.

June 20, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

EMR Vanity Metrics

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I’m still mulling over my post on EMR and EHR about EMR market share. Add in my mulling over my post about creating an EMR pricing comparison website and my mind is kind of overwhelmed with ways to try and get providers better information.

One of my hobbies is learning about internet startup companies. In fact, I’m starting one of my own. In my reading about internet startup companies I found this really provocative post by Eric Ries about entrepreneur speakers lying on stage. Here’s the money quote for me:

This is the same issue we see with vanity metrics: companies are giving the appearance of sharing information while actually engaging in spin or outright deception.

I call this the vanity ratio: the amount of apparently interesting information given divided by the amount of useful information contained therein. The higher the vanity ratio, the more effective the PR. Unfortunately – also – the more misleading the story is as a help to others.

Of course, since I’d just recently written the post I linked above about EMR market share, I quickly drew the line to EMR vanity metrics. Or as Eric Ries might say it, EMR vendors lying about their market share.

I really don’t know any way to solve this problem since Eric is right that the vanity ratio applies. The higher the vanity ratio, the more effective the PR. I guess the key is to educate providers about the skewed numbers that EMR vendors like to provide. These posts are my effort.

October 13, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

AllScripts Market Share and HITECH

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I recently found an interesting post about AllScripts market share after the acquisition of Misys last year.

Based on recent research, Allscripts is estimated to own about 21% of market share for the practice management system space. Further, of the 18% or so of medical providers who have adopted electronic health records, Allscripts has around 17% of that market.

17% of the EHR market is pretty huge. Congratulations AllScripts. I previously posted a really cool viral EHR video by AllScripts. I really like things like this that AllScripts is doing. It’s nice that a technology company is using technology to encourage EHR adoption.

I have been a little soured towards AllScripts after I posted about AllScripts CEO being a HIT advisor to Obama. I just can’t comprehend how an EHR vendor can think that’s not a conflict of interest. I don’t know how Obama can’t understand what that looks like from the outside looking in.

Today I got on the AllScripts conference call to hear AllScripts take on HITECH. I won’t post all my thoughts on the experience (too many to list here), but myself (@techguy) and John Moore (also check out John’s blog) were both twittering during the call and the following are some of the tweets we made as we listened to the Allscripts CEO address HITECH and CCHIT:

@techguy tweeted: AllScripts: [HITECH] Huge win for EHR industry…I agree that the EHR vendors are going to profit greatly from this $18 billion

@john_chilmark tweeted: Tullman now giving High Praise to CCHIT – logical, in his interests, not necessarily the mkt. CCHIT cert doesn’t equate to data liquidity

@techguy tweeted: @john_chilmark You like how he said that CCHIT would probably be the certification criteria. Of course AllScripts wants that to happen.

@john_chilmark tweeted: AllScripts now stating that CCHIT cert will help winnowing out the mkt – Yes, leaving mostly legacy stuff behind

@techguy tweeted: Man, the AllScripts discussion on CCHIT is just killing me. Full of misinformation about CCHIT EHR certification benefits.

@john_chilmark tweeted: @techguy CCHIT/AllScripts conv driving me nuts as well, loads of mis-information

@john_chilmark tweeted: AllScripts: Nutty, not like docs won’t use tech if there is a true value in adoption- to date, EMR vendors have not demonstrated such value

@john_chilmark tweeted: AllScripts claims that $$$ is now available is disingenuous. True, prob need to make decision soon to demonstrate meaningful use of EMR

@john_chilmark tweeted: With so many questions left unanswered, eg, what is certified, what is meaningful, will wise docs sit back and wait to see? Could stall mkt

February 19, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.