“This is just the beginning of the shakeout,” said Dr. David Brailer, founder and CEO of Health Evolution Partners, a San Francisco-based private equity firm and former head of the Office of the National Coordinator for Health Information Technology at HHS. “There is an asset bubble in electronic health records and health IT” from the massive stimulus in ARRA.
Federal officials are expecting many vendors to drop out of the program. In a lengthy post Sept. 13 on the ONC's blog, Steven Posnack, director of federal policy, and Dustin Charles, a public health analyst, noted that while “an impressive number of different EHR vendor products” have been used by providers to meet their meaningful-use targets in Stage 1, “the data suggests that it is likely we'll see a sizable reduction in the number of EHR vendors listed for 2014 Edition certification.” Close to half the products certified for Stage 1 have never been used.
Even those vendors with customers are challenged to keep up. There were 3,343 “complete” in-patient hospital EHR systems built by 38 different developers and deployed by Medicare meaningful users, but 92% of those are from just the top 10 vendors. Two of them have nothing certified for 2014. Of the next 10 on the list, only two have an updated product ready to go.
The situation is even more tenuous in ambulatory care. Three of the top 10 vendors of complete EHRs for physicians (the top 10 account for 65% of the ambulatory-care market) do not yet have a 2014 certified product, potentially leaving their 31,240 physicians with noncompliant systems next year. Another 30,500 physicians purchased EHR systems from more than 400 vendors certified for Stage 1, most of which have not yet come up with a certified product for meaningful use Stage 2.
Lobbying groups for hospitals and physicians, including the American Hospital Association, the American Medical Association and the MGMA-ACMPE, have urged HHS Secretary Kathleen Sebelius not to impose penalties or deny incentive payments to providers for a situation not of their making. Last week, 17 Senate Republicans wrote Sebelius asking HHS to delay implementing Stage 2 for those providers that are not ready. Vendors “are under tremendous time pressures to ensure their products are certified for the 2014 criteria and have sufficient time to upgrade their products for each hospital or physician client(s),” the senators said.