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Did We Miss the Patient Engagement Opportunity with Meaningful Use?

Posted on May 2, 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.

One of the most controversial parts of meaningful use is the requirement that a certain percentage of patients engage with the office. The argument goes that the doctor shouldn’t be rewarded or punished based on the actions of someone (the patients) they don’t control. Regardless of the controversy, the requirement remains that doctors have to engage with a certain number of patients if they want to get the meaningful use money.

I’m personally a fan of patient engagement and think there’s a lot of value that will come from more engagement with patients. This reminds me of Dr. CT Lin’s presentation and research on patient engagement. We need to find more ways to make patient engagement an easy reality in healthcare.

The problem I keep running into with the meaningful use patient engagement requirement is that meaningful use requires a certified EHR to meet that requirement. There are a whole suite of patient engagement apps that provide a useful and logical engagement between doctor and patient. However, none of them can be used to meet the meaningful use patient engagement criteria. Yes, I know the patient engagement app could become modularly certified, but that’s really overkill for many of these apps. It really doesn’t make any sense for them to be certified. The software doesn’t get better (and an argument can be made that the software becomes worse) if they become modularly certified as an EHR.

Because of this issue, the requirement basically relegates EHR vendors to implement some sort of after thought (usually) patient portal. Then, the doctors have to try and force patients to use a patient portal just to meet a requirement. Plus, many are “gaming” this patient engagement number in the way a patient signs up and engages in the portal.

Wouldn’t it be so much better to allow the patient engagement to happen on a non-certified EHR? Why does this need to happen on a certified EHR? EHR vendors aren’t focused on patient engagement, and so it shouldn’t be a surprise that they’re not creating amazing patient engagement tools. Think about how much more effective the patient engagement would be if it happened on a software that was working and thinking every day about how they can make that engagement work for the patient and the provider.

I’d love to see ONC make an exception on this requirement that would allow patient engagement to occur on something other than the certified EHR. I imagine if they did this, they could even raise the bar when it comes to what percentage of patients they should engage with electronically. If they don’t, we’ll have a bunch of lame duck patient portals that are really only used to meet the MU requirement. What a terrible missed opportunity that would be.

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.

The EMRs You Don’t Hear About

Posted on September 4, 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 best-known EMRs got that way because they target the masses. About a third of the country’s physicians focus on primary care, with the remainder fragmented across dozens of specialties and subspecialties. It’s easy to see, then, why the major EMRs are primary-care centric.

For specialists, the solution is often to use a general EMR and tailor it, with templates and other features, for the field’s common diagnoses and treatments, as well as its workflow. The question is whether the customization is enough. After all, the practice of, say, a nephrologist, who focuses on kidney ailments, doesn’t look much like that of the average family practitioner. And that’s not even considering other health care providers, such as optometrists, who aren’t MDs but who are eligible for meaningful use incentives all the same.

Some providers, then, choose a single-specialty EMR. Sometimes it’s a specific product from a larger health IT company. In other cases, it’s software from a vendor operating in but one niche.

Here are a few specialties with very specific practice patterns and the vendors who serve them with EMRs and practice-management software.

  • Nephrology. Physicians in this specialty deal with conditions and treatments such as kidney stones, hypertension, renal biopsy and transplant. A major part of the workflow is dialysis. One vendor catering to this specialty is Denver-based Falcon, which claims that its electronic notes transfer feature can “bridge the gap between your office EMR and dialysis centers.”
  • Eye care. Care in this field is provided by ophthalmologists, optometrists and opticians. Diagnosis and treatment rely on equipment and techniques unlike those found anywhere else in medicine. If you’ve ever had your eyes dilated, you know this is true. Hillsboro, Ore.-based First Insight created MaximEyes with eye care’s peculiar workflows in mind.
  • Gastroenterology. More commonly referred to as Gastro or GI. Florida based gMed (Full Disclosure: gMed advertises on this site) focuses on GI practices with GI specific problem forms, order sets, history forms, and Endoscopy reports to name a few. Plus, they are the only EHR which reports directly to the AGA registry.
  • Podiatry. These specialists of the foot train in their own schools. Bunions, gout and diabetic complications are among the problems they treat with therapies ranging from shoe inserts to surgery. DOX Podiatry, based in Arizona, concentrates on this field, providing clinical, scheduling and billing and collections modules. Its clinical component starts with a graphic of a foot, allowing the podiatrist to specify the problem area and tissue type. DOX claims that the software can eliminate the need to type reports.
  • Addiction. Chemical dependency and behavioral health providers include a variety of specialists, including psychiatrists, psychologists and counselors. Documentation in the field must account for outpatient, inpatient and residential services and for individual and group counseling sessions. Buffalo, N.Y.-based Celerity addresses the heavily regulated industry with its CAM solution, developed by a clinical director in the field.
  • Oral Surgery. This field is a dental specialty focused on problems of the hard and soft tissues of the mouth, jaws, face and neck. As such, an oral-surgery EMR needs heavy-duty support for the anatomy in play. DSN Software, based in Centralia, Wash., sells Oral Surgery-Exec for this group of providers. You might actually have heard about this one, because I interviewed its creator, Dr. Terry Ellis, in July for a post called “Develop Your Own EMR Crazy, But This Guy Did It Anyway.” In fact, there’s nothing crazy about using an EMR custom-designed for the work you do.

What a Real Open EHR API Should Accomplish

Posted on June 17, 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.

There’s been a lot of talk in the EHR world about APIs and most of the time they talk about it as an open API. The problem is that there’s been a lot of talk about EHR APIs and not a lot of action. Having an open API is more than just giving a couple people access to some really small subset of your EHR. We need truly open EHR APIs that are more than just a nice press release.

A successful EHR API requires two core elements: Access to EHR Data and a User Base.

The first element is the obvious one and the one that everyone focuses on. An API needs to have access to the data in the EHR. This includes accessing that data for display in an outside application. Plus, it requires that an EHR accept data from an outside application. EHR APIs seem to fall short on both of these areas. Most only give you access to some really small portion of the EHR data. Even fewer let you write any sort of data to the EHR.

If you don’t give an outside application the ability to access the EHR data and write data to the EHR, there are very few applications you can build on top of it. Is it any wonder that the third party EHR developer community isn’t doing more things with EHR software? If they had these two things, EHR vendors would be amazed at what they’d build. I love Jonathan Bush’s idea of “every surface area” of athenahealth being available in an API. If he achieves this vision, third party developers will flock to that EHR and enhance it in ways that would have never been possible for athenahealth to do on their own.

The second piece is just as important to an API. EHR API developers need to get access to your existing EHR user base. This doesn’t mean you have to give them a list of all your clients. It does mean you need to feature the work of these third party developers to your existing user base. This can be in your application, in an email list, at your user conference, etc.

Think about the message you’re sending to your developer community and your existing user base when you do this. The developer community wants to build even more functionality into your product. Your EHR users get more value out of your EHR application thanks to the development efforts of an outside party. Plus, ambitious EHR users can even create their own functionality using the EHR API.

I can’t wait for the day that EHR vendors fully embrace the idea of a third party EHR API. There are so many outside companies that would benefit from an EHR API, but the EHR vendor will benefit just as much. Plus, the real winners will be the EHR users and patients who get the functionality they’ve been wanting from their EHR that the EHR vendor couldn’t deliver.

EHR Backlash, Patient Interaction, Smart Phone Use, and Dell Think Tank

Posted on March 17, 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.


I realize this first tweet might be controversial for many. Any time you bring a bit of politics (Obamacare in this tweet), there’s a risk of bringing out the crazies. Hopefully we can avoid that, but I was intrigued by this tweet also because it had 17 Retweets by other people. That’s a crazy number of retweets for healthcare IT. I think this view is also part of the EHR backlash that we’ve written about before. Whether you agree with the tweet or not, there are a lot of doctors that feel similar to Dr. Kris Held and they’re starting to make their voice heard.


I love how many people have a focus on increasing patient interaction. An EMR can get you away from it if you’re not careful. The article in this link has some decent suggestions to consider. The most important advice is to be aware of it. Awareness does a lot to improve it.


The killer mobile app in healthcare has been Epocrates and largely is today. A well done EHR mobile app could see similar adoption. Although, there are 300 EHR vendors that aren’t focused on mobile (many of them at least), and so that’s why we don’t hear as much about it.


I’m going to be part of the Dell Healthcare Think Tank that’s mentioned in this tweet. They are doing a live online stream of the event and are even opening it up for questions from Twitter I believe. So, it should be a great opportunity to hear from a lot of smart people on the subject of healthcare IT and to participate online as well. Check it out Tuesday if you want to participate.

An Interview with Mitochon About Their Recently Launched EMO (Electronic Medical Office)

Posted on February 27, 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.

The following is an interview with Mitochon about their newly launched EMO (Electronic medical Office) and a discussion of some of the various trends happening in healthcare IT like: ACOs, Meaningful Use, and HIEs.

Q: Tell us about your recently launched EMO (Electronic Medical Office) product.

A: Our Electronic Medical Office product is a complete end-to-end solution for the modern day medical practice. Allowing the practice to accomplish all their daily task in one solution. One application, one vendor, one solution….. EMO.

Q: When did you start thinking about a suite of applications beyond just EHR?

A: We have seen for years the issues the practice has had to endure when dealing with multiple vendors, products and interfaces. The finger pointing and passing the buck when many different vendors are involved. Its the old right hand left hand issue. Just over two years ago as a team we knew we had to step forward and develop an end-to-end solution and give the practice the continuity and consistency of dealing with one vendor and one solution to take care of all the practice needs from the Patient accessing their medical records and financial data from their own PC to the tracking of insurance claims and collections.

Q: Will EMO (Electronic Medical Office) be free like your past Free EHR offering?

A: Yes EMO will be a FREE offering. In addition to our FREE EMO we are offering a plus package, with EMO+ you get all the features of EMO and back office Revenue Cycle Management. With EMO plus the practice pays only 2.85% of their monthly collections and we handle all the billing and collections from a back office perspective.

Q: In this world of EHR consolidation, EHR’s closing down, etc, why should a doctor feel comfortable choosing Mitochon?

A: We started Mitochon with the belief that Health IT services are too expensive and too complex! We wanted to take away the cost barrier that many independent physicians couldn’t previously overcome, enabling them to provide better patient care while qualifying for Meaningful Use incentives. Our advertising business model is proven, sustainable and successful and is a similar model that works for TV, radio, newspaper and the web. We’re here to stay!

The Mitochon application is used in other markets on a paid basis. We are saddened by the fact that companies still pay to use systems that were closed down such as Kareo and Epocrates recent announcement, they are late and trying to resurrect a system that was closed down. We understand other free vendors have over spent on promotion and the day of reckoning is coming closer, we gain 30% of our new users from other free systems that offer poor support, when the investors get sick of running a business with scant regard to profits they will go the way of MySpace, remember them?

Q: Do you think that most of the doctors using your EHR will becoming “meaningful users”?

A: The question should really be if the physicians believe the meaningful useage criteria, as defined, really add to their patient care or do they see it more of a hassle or prying eyes of payers. The vast majority of our users have achieved Meaningful Use. We are a conservative company owned by physicians, we build a real base of users, no hype. We believe we likely have the highest percentage of users achieve MU versus any other EHR.

Q: The claims clearinghouse is a new Mitochon feature. Tell us more about that part of the product.

A: EMO would not be an end-to-end solution if we did not include medical claims clearing. There are no gimmicks or gotchya’s with our clearinghouse. The sending of medical claims as well as status updates of those claims is FREE as well! We are redefining the end the end solution

Q: What other applications aren’t part of EMO (Electronic Medical Office) that you’ll look at incorporating in the future?

A: We have appointment reminders, Statement printing, fully integrated credit card processing that is linked to a users account. We have the in built HIE that allows Physician to Physician referral as well as the soon to be launched Patient Health Record. As the market demands we will continue to add features and functionality. In office dispensing solutions can bring Physicians significant revenue, up to $7,000 per month profit depending on sub-speciality. We are also working to bring an integrated sample closet so physicians can add further value to their patient interaction. Also remember we also have free mobile access to our EHR.

Q: How do you think what you’re doing fits in with other trends like ACOs (Accountable Care Organizations)?

A: In an ACO the goal is population management, better outcomes with lower cost. As such you have to manage the 30% of chronically ill patients who are utilizing 60-70% of the health care dollars. To do so, every provider needs to be engaged, integrated and connected. So our free solution has a role to complement the other solutions so that an ACO can gather information from all their providers. The risk is very high for an ACO that has a leaky infrastructure because the management of risk will be exposed and the cost curve will not be bending, hence no savings will be generated. Our EMO solution is created for instant collaboration and coordination because of the built in HIE function. In our network physicians who care for the same patients instantly are connected and can share medication list, problem list, labs, radiology and progress notes without the additional cost of integrating. We have contracts with 3 ACO’s.

Q: What’s your take on mobile adoption by doctors, particularly when it comes to products like EHR?

A: Mobile phones are ubiquitous in the medical community. We see Physicians and Nurse Practitioners adopting our mobile solution. It is unlikely they will undertake a full clinical interaction on an iPhone but they do use our native iPad App. The key here is it is a tool for the Doc on the run. The office based PC will always be the tool of choice in the foreseeable future, many have just purchased them recently!

Q: What’s something that doctors aren’t paying enough attention to right now?

A: Connectivity. They have just paid for a stand alone EHR, now they need to coordinate care with other providers/hospitals/labs etc. These other entities are cherry picking and paying certain providers who have enough volume or contribution to the hospital or system. It is a cost that may be just as expensive as the EHR in the long term for the physician. This is a crucial part of the solution and why we have an inbuilt HIE functionality allowing physicians to immediately refer patients across our system. This is particularly attractive to the ACO market.

Also, the meaningful use subsidy will end in a few years, if a provider is using an expensive system, how will that affect the ability for the provider to sell their practice to a new physician who is already in debt from med school. We have many fat cat EHR vendors just milking the Physician who they see as an equal opportunity victim. How many EHR’s are showing 60% revenue growth since 2009? This will come to a end soon and the physician will be leveraged again unless they are using a system with an alternate revenue model. Thats where our Mitochon Patent comes in, introducing contextual clinical content into the workflow and subsidize the Physician’s cost.

Full Disclosure: Mitochon is an advertiser on EMR and HIPAA.

$5k Per EHR Lab Interface

Posted on February 1, 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.

A provider organization recently reached out to me to discuss the issues they were having trying to get their EHR vendor to do a lab interface with their lab. It was a pretty standard large EHR vendor document where they nickle and dime you for little things like a lab interface. Looking at it always reminds me of when I’ve seen the $5 aspirin charge in the hospital.

The problem with the lab interface charge is that it’s usually $5000 instead of $5. When an organization is choosing to implement an EHR, they often forget about many of the future hidden costs associated with an EHR vendor like the EHR lab interface. Plus, they also forget that the EHR vendor will often charge them $5k for the interface and then the lab will charge them another $5k for that interface. This is often true even when an EHR vendor has created many interfaces with a particular lab vendor before.

In fact, the organization that I mentioned above brought a new light to the cost of lab interface. It turns out that this organization was on its third lab and thus its third lab interface with their EHR. I don’t expect clinics change labs this often, but it is very common for a medical organization to switch from one lab to another. Plus, let’s not even get started on the challenge of getting a hospital lab to integrate with your EHR.

Not all EHR vendors are like those I mention above. In fact, a number of EHR vendors have seen this as a great way to differentiate their EHR from other competing EHR vendors. I know of at least one EHR vendor that’s done a few hundred lab interfaces (all at no cost to the doctor). The large number of labs partially illustrates the challenge associated with lab interfaces. There are just so many of them that need to be done. It’s not like there’s 1 or 2 labs that dominate the market. However, many EHR vendors are offering a free lab interface as part of the EHR purchase. Be sure to ask before you buy.

The sad part of the lab interface story is that because of the items mentioned above, many doctors just end up scrapping a lab interface. They can’t justify a $10k expense to integrate their EHR with the lab. This is unfortunate, because it’s amazing how much benefit can come from a well integrated EHR Lab interface.

Meaningful Use the Commodity – Meaningful Use Monday

Posted on October 15, 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 decided to take a step back this week for Meaningful Use Monday to look at where we are in the new world of health IT which includes the commonplace terms of EHR incentive money and meaningful use. Plus, I’m probably waxing a bit nostalgic today as I think about the David Brailer keynote at the Digital Health Conference today (follow my tweets on @ehrandhit for more coverage) where he spoke a bit about the origins of healthcare IT.

At this point it seems that meaningful use has become basically a commodity. There are very few EHR vendors out there now that aren’t certified EHR that can help a physician get to meaningful use (Although there are some non-certified EHR still). Basically, if you are doing EHR, then more than likely you are doing meaningful use. Or at least you’ll have that opportunity if you want. Some would argue that means that this result is a function of the meaningful use bar being set too low.

In fact, that is largely what the congressmen’s argument was in their letter to HHS about halting meaningful use. The real question is whether this is a problem. I personally don’t mind all the EHR competition. I think it would have been worse if the government incentive, meaningful use, and the RECs essentially narrowed the field of EHR vendors down to only a few.

The argument on the other side is around the “paradox of choice.” There’s little doubt that many practices are in a situation where there are so many EHR choices that they make the decision not to choose. However, I see this more as an excuse not to do EHR from people who didn’t really want to do EHR in the first place. I’m not sure these people would have been doing EHR even if there were only a few choices.

This does leave us with a challenging problem going forward. The EHR churn rate is going to go through the roof. David Brailer pointed this out today in his keynote and he’s right that it’s already happening today. Although, the majority of the EHR churn that’s happening now is from those organizations that are going after meaningful use. The major EHR churn rate of the future is going to come from EHR consolidation.

What does this all mean? Now more than ever, an organization needs to do good due diligence on the stability of the EHR software. Notice that I didn’t say EHR vendor. Just because you’re a large EHR vendor that’s financially stable doesn’t mean that the EHR software is safe (see Exhibit A and Exhibit B).

One thing is clear though, meaningful use and EHR are here to stay. There’s no escaping EHR. We’re finally back to the point where doctors are no longer asking if they should do EHR. Instead, they’re asking how, when and which EHR they should do. This is a very good industry trend.

EHR Incentive Inflates EHR Pricing

Posted on July 25, 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.

In a recent conversation I had, the question of EHR pricing came up. It was suggested in the conversation that EHR incentive money was inflating EHR pricing.

I wish that I had harder data on the price of EHR software. Unfortunately, there’s no really good source of EHR pricing across all the 600+ EHR comanies. At one point I considered the idea of creating such a resource, but the challenge of getting that type of information is ominous and might be impossible since many EHR vendors keep that information very close to the chest.

Since we don’t have the quantitative data that we’d love to have in this situation, instead let me offer some observational data on EMR pricing.

In my first couple years blogging about EMR software (I started EMR blogging 6+ years ago), I was able to witness a dramatic shift in the price of EHR software. The norm 6+ years ago was for an EMR for a small clinical practice to cost somewhere in the $30,000 range. For a larger group practice they were easily paying $100,000-200,000 for their EHR software. In almost every case this was a huge up front lump sum payment for the EHR software. Although, many of them conveniently offered financing for your purchase. These EHR were almost always an in house EMR software that needed a lot of up front costs for things like a server.

In those early years, we started to see a wave of mostly SaaS EHR software enter the market at a much lower price point. In most cases they were offering their EHR software for a small monthly fee (usually around $350-500/doctor). Of course at this same time a number of Free EHR software entered the market as well. Both of these entrances forced the price of EMR software to decrease dramatically. Sure, a few EMR software vendors pillaged a practice for an ourtrageous price, but for the most part the price of EMR software came down. Plus, the movement to the monthly charge pricing model for EMR software took hold. In most cases, EMR software vendors would offer a one time fee EMR pricing model along side a monthly per doctor EMR pricing model.

Over the past couple years I think we generally saw a leveling off of EMR pricing. However, I have seen one major thing happen with EMR pricing since the EHR stimulus money was introduced. The new bar for EMR pricing was set at $44k over 5 years. You can be certain that every EHR vendor has looked at their EHR pricing and compared it to the $44k over 5 years.

While I can’t say I’ve seen long time EHR vendors increase the price of their EHR to match the $44k of EHR incentive money, what I have seen is new EHR vendors pricing their EHR software accordingly. Instead of pricing their EHR according to market pricing, they’re generally inflating their EHR price to match the EHR incentive money. I believe this has driven the overall cost of EHR software up thanks to the EHR incentive money. Plus, it has held the EHR pricing of some EHR vendors higher than it would have been if the EHR incentive money weren’t there.

One other thing worth considering is the long term effect on EHR pricing because of the EHR incentive money. EHR incentive is creating an artificial pricing bubble, but eventually the incentive money will run out and I expect a number of EHR vendors to drop their price when that happens. However, what might have an even longer term impact on EHR pricing is the increased number of EHR vendors thanks to the EHR incentive money. Standard economics says more EHR competition leads to lower EHR prices.

What have you seen related to EMR pricing? I’d love to hear your thoughts and experience.

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.