Large EHR Vendor Recommendation

One of the more interesting dynamics in the EMR and EHR world has to do with large versus small EHR companies. I guess we’ve always loved a big versus small story ever since David slew the Giant Goliath. Plus, there’s something American that causes most of us to really root for the underdog. I don’t know what it is, but unless my team is playing I’m most often hoping that the underdog spoils the party and does something surprising. Maybe this is why so many of us love to pit the big EHR vendors against the small EHR vendors.

Personally I don’t have any particular preference for or against larger or small EHR vendors. I care more about choosing the right EHR vendor for the right situation. In some cases those are small EHR vendors and in some cases those are large EHR vendors. I only discriminate against EHR vendors who don’t perform. Many of those that don’t perform I call Jabba the Hutt EHRs. If you haven’t read my Jabba the Hutt EHR posts, you should.

Although, what prompted this post was a comment I read recently from a doctor who uses a large EHR vendor. I won’t say which EHR or who made this comment since it doesn’t matter to learn from the comment. They basically made this suggestion:I recommended a large EHR so that it can connect everything. Then he said that the large EHR vendor decreased productivity.

Certainly I realize this is only one person discussing why doctors should go with a large EHR vendor, but if I’m a large EHR vendor I’d be really upset if this is my message. And while this is one example, I’ve certainly heard it other times before.

Think about this message from a physician’s perspective. I can either go with an EHR product that decreases my productivity (Translation: I make less money) or with an EHR product that can connect everything (Translation: That’s nice, but does it save me time or make me more money?)

All the connections in the world are great, but if you hurt a clinical processes business in the process then that’s going to be a real problem. I’m a huge EHR software advocate. I think every doctor should use EHR. However, if EHR vendors continue to do EHR implementations that have a long term negative impact on EHR productivity, then physicians will continue to resist EHR software in their offices.

The good news is that I’m seeing more and more EHR vendors focused on maintaining and improving the productivity of an office during and after an EHR implementation. I hope that trend continues and that all EHR vendors become fanatical at maximizing the efficiency of a practice during and post EHR implementation.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • In my experience, the larger the EHR vendor, the less likely it is that they’ll connect with others. I don’t know where the view of large EHR == interoperability comes from.

  • Large vs. Small (that’s what she said)

    @Chip – what I’ve seen “proving” this is: large vendor creates proprietary way of doing things, but since they are large, and have the most people dealing with them, the vendors who create the connection capability build for them the most.
    What connectivity are we talking about here??
    Medical devices?
    A PM?

    EHR’s these days seem to meld the PM into the EHR confusing things even further.

    What I see that favors the big vendors is the same reason why people (used to??) choose IBM:
    -They’ll be here tomorrow
    -It is a “safe” choice
    -more devices connect

    None of these reasons are the “right” reason, but they are reality.

  • In the world I work in, the connections are to labs, hospitals, portals, registries, electronic claims options, and, most importantly, other EHR and PM vendors.

    The larger the vendor, the less likely it is that they will make themselves available to a smaller vendor. It’s not only a matter of proprietary connections, it’s literally a matter of “We won’t work with you.” It’s a business decision, as it’s all politics and territory, not technical limitations. The large vendors have the leverage, as you note, so they have a lot less interest in doing the right thing.

    A classic example I run into every day is when a local health system (IPA, hospital, etc.) turns to its members and says, “Here’s your EHR, take or leave it.” Will they allow practices who love their existing EHRs to submit data? No. Can a practice keep its PM? No.

    Or, you’re on a billing service using Big Vendor A. Can you go pick your own EHR? Nope, you have to use the one Big Vendor A locks you into (i.e., their own).

    But most importantly can the practice on new Vendor A transfer a record to another practice with Vendor A? Almost never…and only with the small vendors that I know.

    So, I agree with you: the larger vendors use their leverage to push out the smaller ones, all the time. Happens in every business. But the smaller vendors are more nimble and interested in building these connections.

    Let’s put it this way: can you name a large vendor that is known for its interoperability across the board and its clients? I can’t. Meanwhile, I can think of a handful of small companies who have all kinds of cool and unique interfaces that the big fish would never have the time or interest to complete.

    Put it one other way: do a survey of the average costs to transfer your patient or billing records off of the vendor systems. The larger the vendor, the larger the costs, no?

    Just my perspective.

  • Great discussion all around. You make a good point Chip that many of the large EHR vendors “can” connect to everything, but many of them don’t. One challenge in this discussion is that no EHR software is really connecting to other EHR software right now. Ok, there might be a few edge cases, but it’s just not happening on a large scale despite a whole section of HIMSS on Interoperability.

    However, many of the larger EHR Vendors have made a big play in connecting with other sources. This post I did a while back about Emdeon on my EMR and EHR blog is an example:

    As I think through the discussion, a lot of this really points to the value of the middle EHR. Not too big. Not too small. Just right.

  • What I think it boils down to is that the vendors who benefit from being interoperable try to be and those who benefit from being exclusive generally are.

    We worked with some small EHR companies for a while, all of whom jumped at the chance to interact with our PM. Some of them boast(ed) dozens of working integrations. The larger EHR companies don’t think twice about saying no.

    The point I was making about vendor-to-vendor is that even the big vendors *don’t integrate with themselves*.

    Meanwhile, I call yours the Goldilocks Theorem. Not too big, not too small 🙂

  • I should add: I see the HIEs playing a role in this environment soon and I suspect that the vendors aren’t going to like it. They couldn’t play well together, the states and Feds are going to do it for them.

    I’m already working with some state HIEs who want, essentially, copies of the entire medical record uploaded to their registries where, ultimately, it can be pushed out to people who need it. There are some massive implications (safety and privacy, data ownership, etc.), but one plus is that you can then really chose the EHR of your liking as long as it works with the HIE.

  • @Chip – I completely agree.

    I thought I had nothing else to say, but…

    There are a few companies who all they do is build “connectors”. I’ve dealt with them in the past, but they are expensive.

    I’m guessing that being able to import data from another EHR will become a selling point for any EHR. This is an expense the EHR vendors will have to pick up in order to make moving to their EHR as pain-free as possible.

    With that, the big players will continue to tweak things to make this painful.

    I will say, many of the big players do use “major” databases & do a good job of documentation which does make custom work easier – with the caveat that you don’t tell the vendor you are touching their database.

  • Chip,
    I almost said my quote was from Goldilocks. Maybe I should make a post to officially start the Goldilocks EMR branding.

    I think we’re a long ways from when an HIE will have the full EHR data so that a clinician can switch EHR software with ease.

  • I agree that we’re a long way off, especially in EHR years. But once the first piece crumbles off, the rest will follow quickly I bet.

    Well, OK, except in those states that still can’t process ARRA yet (what are there, 9? 12?).

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