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Meaningful Use EHR Adoption Charts – EHR Market Analysis

Posted on June 12, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

ONC continues to push out more data when it comes to meaningful use, EHR adoption, RECs, and related areas. As a data addict, I could spend forever looking through and analyzing this data. So, I’ll probably do a series of posts across Healthcare Scene over the next couple weeks looking at the charts and data that ONC has made public about meaningful use and EHR adoption. I know some of the charts have been out for a while, but the analysis should still prove useful.

If you want to join in on the analysis of this data, I welcome you in the comments of each post. Plus, if you want to find your own nuggets to share, I’d suggest starting with their quick stats and dashboards pages.

First up in our look at the ONC EHR data is a look at the meaningful use participation chart for ambulatory EHR vendors (eligible providers if you prefer):
Ambulatory Practice EHR Adoption - Meaningful Use Participation
The most important part of this chart to me is that the two largest bars on the chart. The largest bar is the 749 “Other EHR Vendors” category at the bottom of the chart. It’s easy to miss this bar, but I believe it’s extremely important to note how big the long tail is when it comes to ambulatory EHR adoption. I’ve often said that it doesn’t take that many doctors to make yourself a decent EHR business. This chart illustrates how many EHR vendors are still in the game. There are only 3 EHR vendors that have over 40,000 providers. I know that many think that EHR vendor consolidation is bound to happen. Some certainly will, but I don’t see it happening at a massive scale in the ambulatory EHR world.

The second largest bar on the chart is the Epic EHR adoption. What’s important about this bar is that this totally represents that hospital owned ambulatory EHR adoption. Epic does not and will not sell Epic directly to a small ambulatory provider. All of these “eligible providers” for Epic are in hospital systems. I take away two important things from this. First, we see in plain sight how big the roll up of ambulatory practices is by hospitals. Second, this chart illustrates the opportunity that Cerner and Meditech have available to them. As you’ll see in the next chart, Cerner and Meditech have more hospital installs than Epic, but they’re much farther down on the ambulatory side. A look at history explains why they’ve had trouble penetrating the ambulatory market, but I believe it’s a huge opportunity for them going forward.

I’ll be interested to see how this chart continues to evolve over time. Will we doctors leaving hospitals to go back on their own shift the balance of power? Will we see massive EHR consolidation? I also can’t help but note that Mitochon Systems Inc shows up on the list and they don’t even sell an EHR to doctors directly any more. I assume this must be their white label business? I’ll have to follow up with them to get an update on their business.

Now let’s take a look at the chart for Hospital EHR vendors participating in the EHR incentive programs:
Hospital EHR Adoption - Meaningful Use Participation
This chart illustrates really well the 3 horse hospital EHR race which we’ve all known for a while. Although, given healthcare IT’s love affair with Epic (kind of like Apple in the IT world), I think some will be a bit surprised that Cerner and MEDITECH are both listed ahead of Epic. If you looked only at large hospital systems, I think the chart would look very different though.

It’s worth also mentioning the other horses in the race: McKesson, CPSI, MEDHOST, Healthland and Allscripts. They’ve all carved out their niche in the hospital space. We’ll see if they can continue to defend their territory. Hospital EHR switching is not easy.

My favorite observation from this chart versus the ambulatory chart is how well it illustrates the importance of secondary EHR vendors (the brownish gold color) in hospitals. I’ll never forget when Alan Portela of Airstrip told me that the EHR world will be a heterogenous environment. That absolutely resonated with me and this chart proves out what he said. Health systems are going to have multiple EHR vendors even if some EHR vendors would like it to be otherwise.

If you want to look at the potential disruptors in the world of EHR, I’d take a look at these secondary EHR vendors. Their foothold in hospitals provides them a really great opportunity to disrupt the status quo as we know it. Most of them won’t, but they’re all sitting on an opportunity. I’d start with the companies that make up the “Other Vendors” brownish gold bar. I bet there are some really interesting ones in that list.

I’d love to hear your observations from these charts in the comments. Anything I missed? Do you disagree with my observations? I look forward to hearing your thoughts.

An EHR Focused On Customer Requests, Not MU

Posted on February 4, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I love taking email exchanges I have with practicing doctors and making their comments into posts. This is one of those cases. The following is a quote from an email I got from a physician friend of mine about his EHR (EHR name removed):

Every time we turn around these days our EHR vendor is adding some new update. Sometimes the updates change the format of how the system appears and functions, sometimes they don’t. Unfortunately, the people who are still chasing after all the crazy government hoops to jump through and those who are not are all forced to deal with the same EHR software system. I really wish there was a separate system with no crazy upgrades that would function the same way that the system did two years ago. That was a much simpler and more commonsensical system. It’s a really sad case of the government says jump and software systems say how high?

I believe this physician has stopped taking Medicare patients and has happily avoided meaningful use. However, as the above comments illustrate, he hasn’t avoided a lot of the impact that meaningful use has had on the design of his EHR system. Plus, that doesn’t even count all the great new features that this doctor could have gotten from his EHR if they weren’t busy turning on all the MU requirements including the MU reporting and tracking.

His comments about wanting a system that isn’t influenced by MU requirements is quite interesting since Pri-Med (the company that acquired Amazing Charts) has announced an EHR product called InLight EHR that’s not certified and doesn’t do MU. The press release says the EHR is designed for Direct Primary Care. This is a really interesting move by them, and my doctor friend above illustrates why an EHR software that’s not MU certified could work.

One challenge to this idea is that a lot of doctors can’t shun Medicare and meaningful use. So, they’ll need to continue with the EHR that are still chasing the government carrot and avoiding the stick. We’ll see how these different EHR markets evolve.

Brief EHR Notes, 40% EHR Replacement, and $23 Billion EHR Market

Posted on May 4, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


It’s amazing how this has shifted. When I first started blogging about EMR, it was all about the lengthy note to justify the higher billing. We’re still dealing with the impact of that choice. I’m still not convinced that everyone believes a brief EHR note is the best. They all want to read brief EHR notes, but when they’re billing I don’t think they all agree. We need a change from the payers to solve this problem.


I have no idea how someone comes up with a percentage of EHR replacement. Although, you can be sure that there will be a bunch of EHR switching in the years to come. What is interesting is that ERP systems have been going through this process for a long time. I wonder what we could learn from the ERP switching process that will apply to EHR.


I always find the EHR market number interesting. $23 billion in EHR spending. Where are we at in EHR stimulus spending? As I recall we’re somewhere around $13 billion $22.9 billion.

The EHR Market Isn’t Like Other Markets

Posted on March 18, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today at a healthcare IT meetup I attended in Dallas I ran into a former contact at an EHR vendor. He no longer works at that EHR company and has moved on to two other companies. In our discussion we had an interesting discussion about the market. Having moved on, he’d lost touch with the EHR market. He asked me, “Are there still 700 EHR vendors?” I told him there were probably 300, but I’ve contended that their have been 300 EHR vendors for a while. I’m not counting the hundreds of ancillary companies that are “certified EHR” but only perform 1-2 EHR related functions.

Over and over again I hear people talking about consolidation of EHR vendors. They say it’s going to happen and we’re going to get down to a really small number of EHR vendors. Some go as far as saying that there will be 2-3 EHR vendors after EHR consolidation happens.

I think this idea is ridiculous. At HIMSS, I figured out why I don’t think it’s going to happen. Someone told me, “Ambulatory healthcare is fragmented. It’s second only to florists when it comes to market fragmentation.”

This to me illustrates exactly why there can and will be so many EHR vendors. The ambulatory market is completely fragmented with thousands of really small businesses (ie. solo doc) doing just fine. Think about it. There are very few businesses that could survive at the size of a solo doctor practice. In every other industry, the businesses the size of a solo doc practice get eating up as the big boy competitors kill them with their buying power. The same can’t be said in healthcare. A solo doctor practice is a very viable business. Thus we see the market fragmentation and the plethora of EHR companies.

The above analysis does make you wonder why the solo doctor practice is still a viable business and if something in the future will make that option unreasonable from a business perspective. Although, that’s a subject for a future blog post.

Of course, when you think about the hospital EMR market there’s a much different story. We’ve seen EHR consolidation. The hospital market is much less fragmented and becoming less so every day. However, I’ll still be surprised if we go below 100 ambulatory EHR vendors.

EMR Divide Remains Between Larger And Smaller Practices

Posted on January 31, 2014 I Written By

Anne Zieger 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.

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.

Epic API, EMR Market Saturation, and Faith in Clinical Decision Support

Posted on September 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


Vince asks a good question. I wrote a little bit previously about the Epic User Group Meeting where they announced the Epic API. I definitely think there’s still a lot of missed opportunity for the announced Epic API, but hopefully what they’ve released is successful so it encourages them to open up their API much more.


I’ve been writing a lot lately about the changing EMR marketplace (see Golen Age of EHR Over). This prediction offers a new insight I hadn’t covered. The market could decrease because many of the larger purchases are already done. So, that could slow the EHR spending.


I wish I could find this talk. I’m really interested in how properly implemented clinical decision support can save lives. That’s what this should be about anyway, no?

EMR Market is Growing, But It’s Not What It Was

Posted on September 11, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

The EMR market is likely to grow at more than 7 percent per year through 2016, according to a new report.

The estimate comes from London-based research and advisory firm TechNavio. The company wrote in its analysis, “Global Hospital-based EMR Market 2012-2016,” that “demand for advanced health monitoring systems” and for cloud-computing services were major contributors to demand.

On the other hand, according to the company, implementation costs could be a limiting factor.

The TechNavio figure is actually a compound annual growth rate of 7.46 percent. That means substantial opportunity for the many companies referenced in the report, including Cerner Corp., Epic Systems Corp., AmazingCharts Inc. and NextGen Healthcare, to name a few.

Another research firm, Kalorama Information, in April reported that the EMR market reached nearly $21 billion in 2012, up 15 percent from the year before, driven by hospital upgrades and government incentives.

About 44 percent of U.S. hospitals had at least a basic EHR in 2012, up from 12 percent in 2009, according to the Office of the National Coordinator for Health IT.

In the United States, at least, future growth might require more resources and creativity to achieve. You might remember the recent post “The Golden Era of EHR Adoption is Over,” by Healthcare Scene’s John Lynn, positing that the low-hanging fruit for EMR vendors, the market of early adopters and the “early majority,” is gone, leaving a pool of harder-to-convince customers.

But the TechNavio report is broader, considering not only the Americas but also Europe, the Middle East, Africa and Asia Pacific. That’s truly a mixed bag, as while health IT is at a preliminary stage in many developing markets, it’s highly advanced in countries such as Norway, Australia and the United Kingdom, where, according to the Commonwealth Fund, EMR adoption by primary-care physicians exceeds 90 percent.

When EMR initiatives get a firmer foothold in countries such as China, where cloud-based solutions could well prevail, growth rates for those areas might exceed — several times over — the overall figure predicted by TechNavio.

And in the United States, certain pockets, such as the rural hospital market, still present huge opportunity. Fewer than 35 percent of rural hospitals had at least a basic EMR in 2012, but the enthusiasm is clearly there, as that number was up from only 10 percent in 2010, according to the Robert Wood Johnson Foundation.

It looks like it’s still a great time to be an EMR vendor. But it’s not the same market that it was even a couple of years ago, and success in the new era might require looking at new markets and approaches.

EMR Market Topped $20B Last Year

Posted on May 2, 2013 I Written By

Anne Zieger 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.

As we all know, last year was a huge year for EMR adoption. How big?  Well, according to new data from research firm Kalorama Information, the EMR market hit $20 billion in 2012, driven by health IT upgrades and the desire for Meaningful Use incentive payments.

According to Kalorama, the EMR market was $20.7 billion last year, up 15 percent from the $17.9 billion it reached in 2011.  These numbers include revenue for EMR systems, CPOE systems and directly-related services such as installation, training, servicing and consulting.

Kalorama expects near year to be big as well, as providers implement EMR systems in an effort to avoid government penalties for sticking to paper charts.

More than $12.3 billion in Meaningful Use incentive payments had been doled out to 219,000 eligible hospitals and healthcare professionals as of March 1, 2013, with the incentives largely driving physician adoption of EMRs.

A recent CMS study reported that over 70 percent of physicians have used EMR systems, a huge jump from the 26 percent which had used these systems in 2006.  Hospital EMR installlations, meanwhile,  have been maturing, with 77 percent having reached Stage 3 or higher, compared  with 71 percent in 2011.

Going forward, Kalorama predicts that EMR adoption will continue to increase, that hospital adoption will be more rapid than physician adoption and that hospitals currently at adoption Stage 3 will continue to increase their engagement with their systems. The research firm also predicts that current EMR owners will be upgrading their systems.

Meanwhile, researchers say, the threat of penalties for failing to use EMRs meaningfully will force both doctors and hospitals to make upgrades over the next year or so.

While Kalorama doesn’t mention this, the next year or two is also likely to be marked by “the big switch,” with doctors in particular changing out systems that haven’t proven effective to date.  The likelihood that doctors will be buying new systems is likely to lead to a gangbuster year for ambulatory HIT vendors.

#NHITWeek Blog Carnival – How Will Health IT Make a Difference a Year from Now at the Next National Health IT Week?

Posted on September 4, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For those of you that don’t know, National Health IT Week (NHITWeek) is just around the corner (September 10-14, 2012 for those keeping track at home). As part of NHITWeek, HIMSS has put together a blog carnival where anyone who has a passion for healthcare IT can write a blog post answering the question, “How Will Health IT Make a Difference a Year from Now at the Next National Health IT Week?

EHR Market
2013 is going to be an extremely important year for healthcare IT and in particular EHR. 2013 will be final year for a whole lot of EHR companies. With meaningful use stage 2 now on the table, many EHR companies will see the writing on the wall and realize that they weren’t able to build an EHR company. Plus, another major threat to small EHR companies is the ongoing acquisition of the independent medical practice by hospitals. This will likely put many EHR companies out of business in 2013.

This move will make a huge difference in the EHR market. We currently have 600+ EHR companies vying for physicians attention. While competition can be a great thing, this much competition often leaves doctors confused and on the EHR sidelines.

HIE Market
I predict that 2013 will bring together the first active, well adopted HIE. I’m still not sure which HIE is going to be the successful one, but I believe that one of the HIE’s will get that distinction in 2013. Unfortunately, at the same time we’re going to see many other HIE’s close up shop. Hopefully this will help us draw a clear distinction about what makes a successful HIE and what doesn’t.

Mobile Health Market
In 2013 I expect we’ll see a plethora of new health monitoring devices. I don’t believe we’ll see any of these devices see mainstream adoption in 2013, but the early adopter phase for many of these devices will start in 2013 and doctors will start to run into questions about how to integrate the data these devices collect into their clinical practices.

Doctors will face a really tough challenge as none of these devices will have mainstream adoption. So, one day a patient will come in with data from one device and the next day the patient will arrive with similar data from a different device. How a physician handles this data will the challenging questions of 2013.

Outside of medical monitoring devices, we’re going to see widespread adoption of mobile health apps related to medication compliance. Much of this work will be funded on the backs of pharma, but we’ll also see related applications related to other medical compliance as well (ie. diabetes, obesity, high cholesterol, etc).

Health IT Entrepreneurship
2013 will be the year of the Health IT Entrepreneur. I expect looking back 10 years from now, we’ll see dozens of the most influential Health IT companies were started in 2013. Many parts of healthcare are ready for a change and a surprising number of investors are interested in healthcare IT. Add into that mix the large number of healthcare IT incubators and accelerator programs and it is easy to see how health IT is about to get an influx of health IT entrepreneurs.

I am interested to watch how these new to healthcare entrepreneurs adapt to many of the challenging dynamics that exist in healthcare. I’m certain that many underestimate the power of the healthcare “machine” and the challenge to change its direction. However, that might be just what healthcare IT needs.

Meaningful Use EHR Breakout by Percentage

Posted on June 20, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.