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Top 100 EHRs by Revenue – Who Cares?

Posted on November 8, 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.

Medical Economics put out a list that it’s just irresistible to those of us in healthcare IT. It’s a list of the Top 100 EHR vendors by revenue. I know that this is irresistible, because I did a post on EMR Thoughts back in 2011 listing the Top 100 Healthcare IT Companies by Revenue and still today it’s the top visited post on that site. Plus, when I saw the headline I couldn’t resist checking out the list myself.

While we all have to look when we see something like it, I think we need to be careful looking at these lists. They are filled with errors since the sources for such information aren’t that reliable. Not to mention there are a lot of ways to count revenue when you’re as large as these organizations. So, they can mislead you as much as lead you.

In fact, I know of a number of errors myself in the list. Although, the one that made me laugh the most was when I saw Meditech listed at 55. I literally openly laughed out loud that whoever created the list didn’t have enough common sense to know that it couldn’t be the case. Then, I took a second look at Meditech at 55 and realized that even the data in the chart shows that it shouldn’t be 55th on the list, but should be 4th on the list. They have them ranked based on $4.9 million in revenue instead of the $490 million which is listed. Those pesky decimals. I’ll have to give them my son’s 4th grade homework on decimals.

Of course, any of us could make that type of mistake. Stuff happens when you’re compiling a lot of data. Considering the way the page seems to be coded (manually I believe), I feel bad for whoever will have to adjust the list.

Another change they need to make is the acquisition of Greenway by Vitera. It looks like the combined entities would move them to 6th on the list and possibly higher.

Of course, the real question is whether any of this really matters. It’s great fodder for discussion. I have made the argument in the past that it’s important to understand the long term financial viability of the EHR organization you choose. However, revenue is just one of the measures of a company’s long term viability. There have been plenty of hundred million dollar companies who have failed. It’s about costs and revenue, not just revenues. Not to mention as the EHR industry consolidates, many of these companies are going to sunset their EHR product after they merge. So, is buying from a large EHR vendor any less risky than buying from a smaller EHR vendor?

As someone who lives, eats, and breathes EHR every day, this is fun for me to look at, but I don’t think it has much impact.

CommonWell Health Alliance – The Healthcare Interoperability Enabler?

Posted on March 4, 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 biggest news that will likely come out of HIMSS was the big announcement that was made about the newly formed CommonWell Health Alliance. They’ve also rolled out a website for the new organization.

This was originally billed as a Cerner and McKesson announcement and would be a unique announcement from both the CEO of Cerner and McKesson. Of course, the news of what would be announced was leaked well before the press briefing, so we basically already knew that these two EHR companies were working on interoperability.

In what seemed like some final, last minute deals for some of the companies, 5 different software products were represented on stage at the press event announcement for CommonWell Health Alliance. The press event was quite entertaining as each of the various CEOs took some friendly jabs at each other.

Of course, Jonathan Bush stole the show (which is guaranteed to happen if he’s on stage). I think it was Neal Patterson who called Jonathan Bush the most articulate CEO in healthcare and possibly in any industry. Jonathan does definitely have a way with words.

One of Jonathan’s best quote was in response to a question of whether the CommonWell Health Alliance would just be open to any health IT software system, or whether it was just creating another closed garden. Jonathan replied that “even a vendor of epic proportions” would be welcome in the organization. Don Fluckinger from Search Health IT News, decided to ask directly if Judy from Epic had been asked about the alliance and what she said. They adeptly avoided answering the question specifically and instead said that they’d talked to a lot of EHR vendors and were happy to talk to any and all.

Although, this is still the core question that has yet to be answered by the CommonWell Health Alliance. Will it just be another closed garden (albeit with a few more vendors inside the closed garden)? From what I could gather from the press conference, their intent is to make it available to anyone and everyone. This would even include vendors that don’t do EHR. I think their intent is good.

What I’m not so sure about is whether they’ll put up artificial barriers to entry that stop an innovative startup company from participating. This is what was done with EHR certification when it was started. The price was so high that it made no sense for a small EHR vendor to participate. They could have certified as well, but the cost to become certified was so high that it created an artificial barrier to participation for many EHR vendors. Will similar barriers be put up in the CommonWell Health Alliance? Time will tell.

With this said, I think it is a step forward. The direction of working to share data is the right one. I hope the details don’t ruin the intent and direction they’re heading. Plus, the website even says they’re going to do a pretty lengthy pilot period to implement the interoperability. Let’s hope that pilot period doesn’t keep getting extended and extended.

Finally, I loved when Jonathan Bush explained that there were plenty of other points of competition that he was glad that creating a closed garden won’t be one of them. I hope that vision is really achieved. If so, then it will be a real healthcare interoperability enabler. Although, artificially shutting out innovative healthcare IT companies would make it a healthcare interoperability killer.

Meaningful Use Infographic – Meaningful Use Monday

Posted on August 13, 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.

It seems that everyone (including myself) love infographics. So, I was really glad to see that Greenway (Full Disclosure: They advertise on the site, but they didn’t ask me to post this. I found it on my own.) put together an Infographic with the Meaningful Use stats. They offer the following important details on the data for the meaningful use infographic:

  • Payment and registration statistics as of May 2012
  • Top Specialties participating in Medicare MU 2011
  • Meaningful Use attestations by Region 2011
  • Money available for Eligible Providers
  • Who is eligible to participate
  • Necessary steps to achieve Meaningful Use

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.

Great Period for EMR and HIPAA

Posted on March 14, 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 use to do this a lot more when I started blogging, but I’m so busy with all the Healthcare Scene blogs that I don’t do it nearly as much. Although, I think it’s interesting to take a quick look at some of the stats for EMR and HIPAA and also take a minute to recognize the new and renewing advertisers on the site. I hope you’ll indulge me for a minute and you’ll take a look at those companies that support the work I do here on EMR and HIPAA. Most of them are not only sponsors of the site, but also readers. That means a lot to me.

First, let’s take a look at some stats for EMR and HIPAA. This will be the 1,318th post and there have been 6417 comments on those posts. That’s about 5 comments a post which is pretty incredible. According to WP.com stats, we’ve had 5,920,478 pageviews since I started using that stats program in July 2007. Since my first blog post was back in December 2005, that puts us well over 6 million pageviews.

This is astounding to me. I remember when I thought that maybe 1000 pageviews a day was the entire EHR market online. I’m glad I was wrong. Thanks for everyone that’s been reading. In fact, in another milestone, the EMR and HIPAA email subscription just blew by 4000 subscribers (now at 4,079). Considering I mistakenly didn’t start this email list until 2009, I’m happy that 4000 people want a daily email from EMR and HIPAA. Add in the 15,538 twitter followers on @ehrandhit and I’m humbled beyond belief.

Speaking of humbling experiences, this list of new and renewing EMR and HIPAA sponsors is really humbling as well. I’m very appreciative of their support.

New EMR and HIPAA Advertisers
Greenway – I’d been talking with Greenway for about a year about advertising on my network of websites. They might have been a little busy with something called an IPO (GWAY) that slowed the discussion. Now that the IPO is out of the way, we were able to finally finish up the details of Greenway advertising. For those who don’t know Greenway, they provide an integrated EHR and clinical research solution to more than 40,0000 providers in 30 specialties. Greenway has a single-database EHR, PM and interoperability solution called PrimeSUITE®. As one Greenway partner said to me at HIMSS, “Greenway is a good company with good people trying to do good for healthcare.” I can’t say I’ve seen anything to say otherwise.

NoMoreClipboard – The President of NoMoreClipboard, Jeff Donnell, was my first ever meeting at HIMSS. NoMoreClipboard has been doing some really interesting things since then including it’s most recent partnership with iMPak (see my interview with NoMoreClipboard and iMPak). I’d label iMPak as the most creative technology that I found at HIMSS 2012. Once I get a good demo video of the product, I’ll be doing a full post about it. It makes a lot of sense for the iMPak technology to be put together with the NoMoreClipboard technology. I’m looking forward to see what else they do together as well.

Online Tech – I think this is the first time I’ve had a web hosting company advertise on my site. After talking with Online Tech, I think I know why they want to advertise on EMR and HIPAA. Most hosting companies pay lip service to HIPAA, but Online Tech takes it very seriously. While I haven’t done a really deep dive into all the details of their hosting and HIPAA compliance, I could quickly tell how much HIPAA privacy and security was part of their culture. I believe HIPAA compliance is less about perfection and more about intent and effort. I think those who work with Online Tech won’t have to worry as much about being a “Covered Entity with Egg on Their Face.”

Renewing EMR and HIPAA Advertisers
Now to those companies that have renewed their ads on EMR and HIPAA since my last update:
Sequelmed (Advertising Since November 2009)
Ambir (Advertising Since January 2010)
Mitochon (Advertising Since December 2010)
Amazing Charts (Advertising Since May 2011)
Elsevier (Advertising Since September 2011)

As you can see, a number of them have been supporting EMR and HIPAA for a lot of years. I look forward to many more years working together with them.

No doubt this list and the numbers above set a high bar for me which I don’t take lightly. I’m sure I often don’t measure up, but I’ll keep doing what I can to provide value to people. Thanks for reading.

Meaningful Use Stage 2 Commentary and Resources – Meaningful Use Monday

Posted on March 5, 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 this week’s Meaningful Use Monday, I decided I’d go through the large list of meaningful use stage 2 commentary that’s been put out over the past week. I’ll do my best to link to some of the most interesting commentary, summaries, etc of meaningful use stage 2 and point out some resources that I’ve found useful.

John Halamka on Meaningful Use Stage 2
First up is the blog post by John Halamka about MU stage 2. I really like his recommendation to read pages 156-163 of the MU rule (PDF here). Sure, the rule is 455 pages, but many of those pages are a recap of things we already know or legalese that is required in a government document. Halamka also created a meaningful use stage 2 powerpoint that people can reuse without attribution. Worth looking at if you’re not familiar with MU stage 2 or if you have to make a presentation on it.

Health Affairs on MU Stage 2
Health Affairs has a nice blog post covering meaningful use stage 2. They offer “3 highlights that seem particularly important:”

  1. The bar for meeting use requirements for computerized provider order entry (CPOE), arguably the most difficult but potentially the most important EHR functionality, has been raised: now a majority of the orders that providers write will have to be done electronically.
  2. There is a major move to tie quality reporting to Meaningful Use. We knew this was coming, but CMS has laid out a host of quality measures that may become requirements for reporting through the EHR.
  3. Health Information Exchange moves from the “can do it” to the “did do it” phase. In Stage 1, providers had to show that they were capable of electronically exchanging clinical data. As expected, in Stage 2, providers have to demonstrate that they have done it.

Health Affairs also talks about the timeline for this rule and the feedback that CMS is likely to get on MU stage 2. I’m sure they’re going to get a lot of feedback and while they suggest that the rule will look quite similar to the proposed rule, I expect CMS will make a couple strong changes to the rule. If nothing else to show that they listened (and I think they really do listen).

Stage 2 Meaningful Use by The Advisory Board Company
The Advisory Board Company has a good blog post listing the 10 key takeaways on stage 2 of meaningful use. Below you’ll find the 10 points, but it’s worth visiting the link to read their descriptions as well.
1. Centers for Medicare & Medicaid Services (CMS) affirms a delay for 2011 attesters.
2. Stage 1 requirements will be updated come 2013.
3. Medicaid definitions are loosened; more providers are eligible.
4. While the total number of objectives does not grow, Stage 2 measure complexity increases significantly.
5. Information exchange will be key, but a health information exchange (HIE) will not be necessary.
6. Patients will need to act for providers to succeed.
7. Sharing of health data will force real-time, high-quality data capture.
8. More quality measures; CMS’ long term goals—electronic reporting and alignment with other reporting programs—remain intact.
9. The Office of the National Coordinator’s (ONC) sister rule proposes a more flexible certification process and greater utilization of standards.
10. Payment adjustments begin in 2015.

AMA MU Stage 2
The American Medical News (done by the AMA) has a blog post up which does a good job doing an overall summary of where meaningful use is at today (post MU stage 2). Meaningful Use experts will be bored, but many doctors will appreciate it.

Justin Barnes on Meaningful Use Stage 2
Justin Barnes provides his view on meaningful use stage 2 in this HealthData Magement article. It seems that Justin (and a few other of his colleagues at other EHR vendors) have made DC their second home as they’ve been intimately involved in everything meaningful use. I found his prediction that the meaningful use stage 2 “thresholds and percentages will remain largely in place come the Final Rule targeted for August, and should not be decreased via the broader public comment phase next underway like we saw with Stage 1.” Plus, he adds that the 10 percent of patients accessing their health information online will be a widely discussed topic. Many don’t feel that a physician’s EHR incentive shouldn’t be tied to patients’ actions. Add this to the electronic exchange of care summaries for more than 10 percent of patients and the healthcare data is slowly starting flow.

Meaningful Use Stage 2 and Release of Information
Steve Emery from HealthPort has a guest post on HIT Consultant that talks about how meaningful use stage 2 affects ROI. This paragraph summarizes the changes really well:

The bottom line for providers is that Stage 2 MU changes with regards to these specific criteria will drive organizations to implement a patient portal or personal health record application; and connect their EHR systems to these systems. Through these efforts it is expected that patient requests to the HIM department for medical records will decrease; as patients will be able to obtain records themselves, online and at any time.

e-Patients and Meaningful Use Stage 2
e-Patient Dave got together with Adrian Gropper MD, to put together a post on meaningful use stage 2 from an e-Patient perspective. This line sums up Adrian Gropper MD’s perspective, “My preliminary conclusion is that Stage 2 is a huge leap toward coordinated, patient-centered care and makes unprecedented efforts toward patient engagement.”

Meaningful Use Stage 2 Standards
Those standards geeks out there will love Keith Boone’s initial review and crosswalks from this rule to the Incentives rule here.

Shahid Shah on Meaningful Use Stage 2
I like Shahid Shah’s (the Healthcare IT Guy) overview and impressions as well. He’s always great at giving a high level view of what’s happening in healthcare IT.

Are there any other meaningful use stage 2 resources out there that you’ve found particularly useful or interesting?

DrFirst Shifts to EHR Platform Company

Posted on February 8, 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.

If you haven’t yet seen this video that DrFirst created for HIMSS 2012 and the HIMSS Healthcare Hero, then you need to watch it now. It’s a really beautiful video: http://bit.ly/AnNvzU

After seeing such a well made video, I definitely wondered what was up DrFirst’s sleeve at HIMSS 2012. So, I reached out and today I had the chance to talk with Cam Deemer President of DrFirst about the transition that’s happening at DrFirst.

I think that most of us have known DrFirst as an ePrescribing company. Since about 2004 they have been extremely focused on the ePrescribing area and that shows in the fact that DrFirst is the “ePrescribing Inside” 230 EHR companies. That’s a really impressive number and includes a client list with such names as GE and Greenway.

DrFirst is ready to make a shift which they’ll be talking about at HIMSS in Las Vegas. What I think makes DrFirst’s ePrescribing platform really interesting is that they can provide it using the DrFirst interface or an EHR vendor can customize it to their liking using a series of API calls. It takes a unique company and a unique set of skills to be able to do this effectively. Now imagine they provide these same functions and features across a whole array of EHR related products and services. By doing so, DrFirst becomes a really interesting EHR Platform.

You can find DrFirst at HIMSS to get the entire list of the products and services that they’ll be offering to EHR software vendors beyond just ePrescribing. However, I was really intrigued when they talked about their EHR platform providing compliance programs, patient education, and even co-pay discounts which help with medication compliance. I wouldn’t say that any of these things on their own are all that interesting. They are however things that a small EHR vendor wouldn’t have the time or the resources to be able to execute properly. For those EHR vendors who use the DrFirst interface, they can be turned on with the flip of an online switch.

Now just imagine a whole suite of other EHR services that DrFirst could provide EHR vendors as well. It becomes a really interesting value proposition. Plus, DrFirst also has a number of interesting solutions in the hospital market that also leverages this platform. Things like medication history for hospitals and a lab platform.

At the end of the day, EHR vendors are going to decide if this is a value added service or not. Many larger EHR vendors are going to develop a number of these features themselves and that should be expected. I just see it as a really healthy thing to have these type of EHR platform services available. Many EHR vendors have been so swamped with meaningful use and EHR certification, it’s great that a third party integration could continue to add real value to an EHR software.

The real challenge for DrFirst is going to be around how well they integrate these new EHR service offerings into the various EHR software vendors. If the integration is clean and adds value, they’re going to do very well. If it’s kludgy (a software term for messy) and doesn’t integrate well, then we won’t see much adoption. I think their current 230 EHR integrations are one sign that it will go smooth, but we’ll see.

My next question to consider is how DrFirst could extend their platform next. I can think of a number of mobile health companies that could benefit from the right connection to prescription data or to doctors. I’ll be pressing them at HIMSS to find out what’s next. I hope you will too and come back and share what you find out.

On a side note, I just got the list of things DrFirst is doing at their HIMSS 12 booth. It’s extensive and will be a can’t miss booth. Watch for the details in my upcoming HIMSS 12 exhibitor post.

Full Disclosure: DrFirst is an advertiser on EMRandHIPAA.com.

HIMSS11 EMR Company and EMR Market Wrap Up

Posted on February 25, 2011 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 going to take a couple weeks to really process all that I saw and heard at HIMSS 2011. In fact, there’s no doubt that much of the content I publish over the next month or two will be things I learned from the people I learned from at HIMSS or influenced by what I saw and heard. However, after a good night’s sleep in my own bed I’m really happy with my experience at HIMSS. The energy and passion for healthcare IT that was found at HIMSS was really powerful and wonderful to be apart of.

I think those people out there that are asking if we’re in a healthcare IT bubble right now are on the mark. There’s very little doubt in my mind that we’re in a healthcare IT bubble. It’s a feature of $36+ billion in EHR incentive money being given out by the government. I can’t remember the size of the EMR market numbers off the top of my head, but $36 billion in money coming into what is a relatively small market is going to change things dramatically. So, it makes sense that this type of infusion of money would create a bubble of sorts.

One person in their comments that we’re in a healthcare IT bubble asked if the bubble would pop before HIMSS 12 in Las Vegas. I believe we have at least one or two more years before the healthcare IT bubble pops. In fact, if you thought that HIMSS 11 in Orlando was big, I predict that HIMSS 2012 in Las Vegas will be even bigger. The EHR incentive money will have started flowing and the trench battles will be in full swing as the 300+ EMR vendors battle each other for customers.

EMR software was obviously my focus at the conference and despite my comments about the lack of innovation by EMR vendors and the future of EMR, I think there are a ton of really interesting EMR approaches that in aggregate are going to impact the EMR world in really dramatic ways. Here’s some examples:

  • Azzly described a meeting of EHR vendors they attended with ONC. The question was asked which EHR vendors in the room started development after the HITECH act was announced. Azzly was the only one to raise their hand. I’m sure there’s other EHR vendors in that same boat, but it will be interesting to see an Azzly EHR that was built post incentive go up against the legacy EHR software.
  • ClearPractice was the first native iPad EMR (called Nimble) that I’d seen and there’s no doubt they’ve made a big play in that space. Will that combined with the backing of John Doerr and their internet driven sales change EMR as we know it?
  • Will larger companies like Greenway and Sage continue to gain market share as they go after the EMR market while maintaining their customer experience? Or will they head the way of the Misys of the world and be bought up by other EMR vendors?
  • What about NaviNet‘s entrance into the EMR world? Can they leverage their existing connections with so many providers to be a major player in not just interoperability but in EMR as well?
  • Even the big behemoth of a company, GE surprised me when I visited with them. There was a polish and a professionalism that I loved about my visit with GE and GE’s Centricity Advance people. I think there’s a fair comparison with Microsoft. Something about the nature of the US loves the underdog and hates the big name player. Yet, the big company just keeps executing their vision and many doctors are going to happily buy and use their products.
  • What about Ingenix‘s multiple EMR offering strategy? Will it just be confusing to clinicians or will they effectively differentiate their various offerings while providing a backbone for interoperability as well? Is the future large EMR vendor one that aggregates a bunch of niche specific EMR companies?
  • What impact will the transcription based EMR vendors have on the market? I wrote about the change from transcription company to EMR vendor earlier this week. Watch for the names MD-IT, FutureNet, Intivia, and MxSecure.
  • Many people probably don’t recognize the name MedPlus. However, everyone knows the company behind the MedPlus Care360 EMR: Quest Diagnostics. There’s something powerful about being able to turn on an EMR in a medical practice with basically the flip of an electronic switch. That’s what MedPlus can do since Care360 is already being used in so many clinics that use Quest for their lab work. Add in their existing lab sales staff that already have relationships with large numbers of clinics and they’re going to be a very interesting player in the EMR space.
  • Free EMR is a really compelling marketing tool. There’s a reason that Practice Fusion and Mitochon Systems free EMR offerings get so much press and so many doctors evaluating their EMR offerings. While many might disagree with their model or even believe that it will fail, these companies have and will have an interesting impact on the EMR landscape.
  • MicroMD offers an interesting approach. First, because of their existing LONG term practice management clients. Second, because of the interesting integration with the supply side of their company. Not to mention, the executives that I met with were some of the most realistic people and well thought out people I met at HIMSS.
  • Props to EMR company MIE that could use a fake EMR company (Extormity) to launch themselves into the EMR discussion while also helping to open up the discussion as well.  If I were a doctor, I’d want to demo their EMR just so I could see if I could find any Extormity features in their EMR.  Although, maybe that’s just the blogger in me.

I could keep going on, but that gives you a bit of flavor of some interesting EMR vendors and their market approaches. Plus, this is just 16 of the 300+ EMR companies that are working in this space. Each one with their own interesting story.

The most exciting thing for an EMR nerd like myself is that we’re really only at the beginning. Wait until we get beyond 15-25% adoption and reach 50% adoption. Then, the fun really begins.

Full Disclosure: Practice Fusion, MD-IT, MxSecure, and Mitochon Systems are all advertisers on this site. EMRandHIPAA.com’s HIMSS11 coverage was also sponsored by Practice Fusion, provider of the free, web-based Electronic Medical Records (EMR) system used by over 70,000 healthcare providers in the US.

CPA Comment on EMR Pricing

Posted on October 10, 2010 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 response to my previous post about possibly creating an EMR pricing comparison website, I got a really interesting set of comments from a CPA who’s been assisting their clients in their EMR selection process. You might laugh at the idea of a CPA participating in the EMR selection process. Interestingly, the CPA that I use has also been asked by their clients about the EMR stimulus money and so they were grateful they could ask me some questions.

This aside, I found this person’s comments interesting. I think they also illustrate some of the challenges in EMR pricing and some of the thirst for EMR pricing also. I removed some identifying information and some other comments about EMR and HIPAA. Otherwise, the comments are in tact.

I have been pondering trying to do some sort of price comparison myself, and you’re right, they all differ so it’s tough to just do one basic comparison chart. I’ve seen already how some have things all bundled (ie.Athena, and others do it in separate modules can add on – ie. Greenway)

I have featured remote demo’s for clients to listen/view through our firm so they can avoid the vendor pressure… I thought I would try to get info on others for comparison purposes, but in keeping with the theme… it is just not that easy.

There are a few challenging items for comparison purposes, one of them being support and related costs.
The support/training is many times where the wheels fall off the well-intentioned EMR wagons.
You just don’t seem to get an answer or know the true support/training costs until you have already tied the knot with your new EMR system. If you could get more comparative info on that aspect, that would be very helpful – or better yet, come up with an EMR Pre-Nup.

Another toughy is the interfacing costs
From what I hear a [EMR Vendor] system may charge $30k to interface with another EMR vendor.
The vendors call that “not playing nicely”.
So tack on another layer of subjective complexity to your pricing project.

And yet another cost factor I’ve noticed is what EMR system an affiliated hospital is getting preferred pricing on. There is a hospital by us in an arrangement with [EMR Vendor], and of course advising the outside practice physicians to use the same. I am not to thrilled with this idea, I think there are better products that are not spread so thin in so many markets.

I mention the patient portal separately below as some of my clients don’t seem quite ready for that yet.
They view it as another task and feel could attack it once get the EMR running smoothly.
I know they need it for MU [Stage 1 doesn’t require this, but future stages probably will], but they seem to want that a little later than sooner.

In any case, I think some possible approaches for a comparative pricing schematic would be to have different scenarios:
a) 1-5 Docs & Midlevel providers /Web Hosted/ EMR only/ PM Interface/ No Patient Portal
b) 1-5 Docs & Midlevel providers /Web Hosted/ EMR only/ PM Interface/ With Patient Portal
c) 1-5 Docs & Midlevel providers /Web Hosted/ EMR & PM Bundled/ No Patient Portal
d) 1-5 Docs & Midlevel providers /Web Hosted/ EMR & PM Bundled/ With Patient Portal
e) 1-5 Docs & Midlevel providers /Web Hosted/ EMR & PM Bundled/ With Revenue Cycle Mgt/ With Patient Portal

Greenway EMR Resource List

Posted on February 2, 2010 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 few days ago, I took a few moments and attended a Greenway presentation on the EMR stimulus money. They did a pretty good job on most aspects of the EMR stimulus money. For someone who didn’t know anything about ARRA, it would have been a decent start. Only a few comments that had a nice EMR vendor bias.

One thing that did kind of bother me was the list of EMR resources that they listed to help people searching for an EMR. Here’s the list of sites they suggested:
cchit.org
klasresearch.com
ihe.net
mgma.com
himssehra.org
ehrdecisions.com

Interestingly, I don’t think any of the above sites would make my list of great EMR resources. I think I might have to do a future post with my list of resources. Sure, I know that Greenway is a large EMR vendor with a certain agenda. Maybe I’m just offended since I wasn’t on the list (my own personal agenda). It’s just unfortunate with so many good EMR resources out there that the above websites were the ones listed. I mention Greenway, since they provided this list. No doubt many other of the large EMR vendors would have provided a similar biased list.

Feel free to provide your list of great EMR resources in the comments.