Why “Top 10” Hospital EMR Lists Are Bad News

Everyone likes the comfort of choosing a product from a pre-approved list of some kind, especially a “top 10” list ranked by a credible source.  And if you’re a hospital IT leader, it’s certainly reassuring if your vendor has the KLAS or HIMSS seal of approval stamped on it.

But do those lists really help you select the right system for your hospital? Or are they high school popularity contests?

I’d argue that while some lists are better than others — particularly if someone has actually tested the systems themselves! — most stifle innovation and push hospitals into deals they regret later.

Sure, I understand why hospital leaders want the reassurance of choosing from a “best of” or “most installed” list when they’re buying an EMR. Not only are they making a huge investment of time and capital, they’re also making some critical bets on where the industry is headed. And the stakes are remarkably high. Of course, CIOs in any industry take big risks and spend big bucks when buying mission-critical software, but few face an industry as volatile as healthcare when they spend their money.

That being said, these lists aren’t great for the hospital industry, for a number of reasons:

* What, me innovate?  Top 10 lists tend to end up selecting for big, established vendors — either because they pay for the privilege or because they’re well-known — and those players usually aren’t cutting-edge types. Then, once you buy from them, they have even less reason to make risky, potentially valuable changes.

* Setting standards artificially:  Another effect of Top 10s is that they tend to reward certain types of products, say, those who fit some set of HIMSS criteria, while ignoring other models.  (After all, they’ve got to select their winners somehow.) It’s easy to get caught up in the hype and forget that their selection criteria may not be the best ones.

*Discouraging new vendors: Because the Top 10 lists select for giant vendors meeting certain criteria, they discourage vendors from spending much on alternative models that might have great promise. For example, why aren’t commercial open source EMRs or cloud-based EMRs getting more attention?

Take it from me, boys and girls, as an editor who’s created more than one of these lists in her day. Yes, they’re worth reading to gather a bit of industry intelligence, and certainly to understand the trends.  And it doesn’t hurt to know what your peers are buying.  But don’t make them a key part of your buying cycle; they’re best used, ultimately, for their entertainment value.

About the author

Anne Zieger

Anne Zieger

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.


  • The biggest problem of any ranking system is in providing a transparent methodology. Let’s face it, the three most important decision making methods are and have always been the same: recommendations/feedback from trusted colleagues and friends, hands-on interaction with the prospective solutions (site visits, live demos), and the buyer’s past experiences. While analyst firms can provide a certain perspective, their information needs to be taken in context of a provider’s larger due diligence initiative.

  • Black Book’s 3rd annual EMR/EHR users survey recently closed for 2012 ballots. Over 10,000 responses are validated through Q3. Results will be released on Nov 9. Our methodology is posted on our website as are the survey results before any data sets can be purchased by a vendor or potential EMR user. We do this to maintain unbiased objectivity. One of the 18 polled KPIs is on vendor innovation/cutting edge research and development. Also, web/cloud based EMRs and open source were always part of the user evaluation process and well represented in last years results. Although we always look for process improvement suggestions for our survey users, our original 18 Key Performance Indicators were recommended by a consortium of business school acedemics as most practical and valuable to Supplement a software/service purchasing evaluation.

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