More than 300 vendors share ambulatory-care EHR market

Remember those old sword-and-sandal historical epics, with their "cast of thousands" hacking and clubbing at each other in hand-to-hand combat?

To the hordes of vendors of electronic health-record systems designed for office-based physicians, those struggles may seem like halcyon days.

Three-hundred-and-thirty-three vendors of complete EHRs for ambulatory care have battled for market share and had at least one customer attest to having met the meaningful-use criteria under the Medicare EHR incentive payment program, according to a federal database.

Such a wide variety of choices makes the task of finding and selecting the right system a struggle for the practitioners, too.

"Really, what I need is just somebody to tell me what I need to get," said Dr. Terri Strassburger, who is retired from her own practice but manages a two-physician pulmonary and critical-care office-based practice in Alexandria, Va., for her husband and his partner. Her duties include helping them pick an EHR system.

By waiting a bit to enter the fray, Strassburger and her husband can avail themselves to data on what has worked for others. Some of that is data about their peers who have used various EHR systems to meet the meaningful-use goals established through the Medicare EHR incentive payment program. The information can be gleaned from a database that is a mix of CMS statistics on attested meaningful users and the Office of the National Coordinator for Health Information official list of certified EHR systems.

According to the federal data, from April 2011 through August of this year, 90,295 physicians and other eligible professionals working in ambulatory care have used complete EHRs to attest to having met the Medicare meaningful-use criteria. (Data from the Medicaid EHR incentive programs is not yet available from the states.)

The top 10 vendors in the CMS/ONC database account for 68% of attestations in the physician and EP/ambulatory/compete EHR market niche, but that leaves the remaining 323 vendors sharing nearly one-third of the attesting providers.

Picking an EHR system has "always been on the back burner since the government talked about conversion," Strassburger said. The CMS began receiving attestations under the Medicare EHR incentive payment program in April 2011.

Now, Strassburger said, with some fellow physicians in the region talking about their systems and incentives, EHR adoption seems to have "taken on a movement of its own. We feel like we kind of need to catch up."

But finding an EHR that's the right fit, can integrate with the practice's management system, is not controlled by the hospital and won't require a lot of hardware and network expertise, and fit within the practice's budget is a challenge.

"We've only just started looking into everything, and we're trying to talk to as many people as possible," Strassburger said. So far, word of mouth hasn't been very helpful.

"People have been pretty unhappy," she said, adding, "the amount of money that people are asking for is more than we can manage."

According to a Modern Healthcare analysis of the CMS/ONC database, Epic Systems, based in Verona, Wis., leads the pack among vendors of complete EHR systems designed for physicians/EPs in ambulatory care, with 22% of that market niche. Others in the top five in that niche, along with their market percentage, are Allscripts, 12%; eClinicalWorks, 9%; NextGen Healthcare, 7%; and GE Healthcare, 6%.

Remaining vendors in the top 10 are Greenway Medical Technologies, 3%; athenahealth, 3%; Practice Fusion, 3%; e-MDs, 2%; and Community Computer Service, 2%.

More than a few physicians and eligible professionals in ambulatory care—6,682 to be precise—have pieced together an EHR and achieved meaningful use. Cerner Corp. is the dominant player with 36% market share. It is followed by Allscripts, 19%; Jardogs, 8%; MedCPU, 6%; and Dr. First, 5%.

Also, 1,325 physicians and other eligible professionals have met meaningful-use targets using complete or modular systems in the inpatient environment. Within that specific market for complete or modular inpatient EHRs used by individual doctors and EPs, Cerner has a 31% share and is followed by Epic, 25%; Allscripts, 20%; Meditech, 13%; and McKesson, 3%.