Enterprise EHR Vendors Consolidating Hold On Doctors

When I stumbled across a recent study naming the EHRs most widely used by physicians, I don’t know what I expected, but I did not think big-iron enterprise vendors would top the list. I was wrong.

In fact, I should have guessed that things would play out this way for giants like Epic, though not because physicians adore them. Forces bigger than the Cerners and Epics of the world, largely the ongoing trend towards buyouts of medical groups by hospitals, have forced doctors’ hand. But more on this later.

Context on physician EHR adoption
First, some stats for context.  To compile its 2016 EHR Report, Medscape surveyed 15,285 physicians across 25 specialties. Researchers asked them to name their EHR and rate their systems on several criteria, including ease of use and value as a clinical tool.

When it came to usage, Epic came in at first place in both 2012 and 2016, but climbed six percentage points to 28% of users this year. This dovetails with other data points, such that Epic leads the hospital and health system market, according to HIT Consultant, which reported on the study.

Meanwhile, Cerner climbed from third place to second place, but it only gained one percentage point in the study, hitting 10% this year. It took the place of Allscripts, which ranked second in 2012 but has since dropped out of the small practice software market.

eClinicalWorks came in third with 7% share, followed by NextGen (5%) and MEDITECH (4%). eClinicalWorks ranked in fifth place in the 2012 study, but neither NextGen nor MEDITECH were in the top five most used vendors four years ago. This shift comes in part due to the disappearance of Centricity from the list, which came in fourth in the 2012 research.

Independents want different EHRs
I was interested to note that when the researchers surveyed independent practices with their own EHRs, usage trends took a much different turn. eClinicalWorks rated first in usage among this segment, at 12% share, followed by Practice Fusion and NextGen, sharing the second place spot with 8% each.

One particularly striking data point provided by the report was that roughly one-third of these practices reported using “other systems,” notably EMA/Modernizing Medicine (1.6%), Office Practicum (1.2%) and Aprima (0.8%).

I suppose you could read this a number of ways, but my take is that physicians aren’t thrilled by the market-leading systems and are casting about for alternatives. This squares with the results of a study released by Physicians Practice earlier this year, which reported that only a quarter of so of practices felt they were getting a return on investment from their system.

Time for a modular model
So what can we take away from these numbers?  To me, a few things seem apparent:

* While this wasn’t always the case historically, hospitals are pushing out enterprise EHRs to captive physicians, probably the only defensible thing they can do at this point given interoperability concerns. This is giving these vendors more power over doctors than they’ve had in the past.

* Physicians are not incredibly fond of even the EHRs they get to choose. I imagine they’re even less thrilled by EHRs pushed out to them by hospitals and health systems.

* Ergo, if a vendor could create an Epic- or Cerner-compatible module designed specifically – and usably — for outpatient use, they’d offer the best of two worlds. And that could steal the market out from under the eClinicalWorks and NextGens of the world.

It’s possible that one of the existing ambulatory EHR leaders could re-emerge at the top if it created such a module, I imagine. But it’s hard for even middle-aged dogs to learn new tricks. My guess is that this mantle will be taken up by a company we haven’t heard of yet.

In the mean time, it’s anybody’s guess as to whether the physician-first EHR players stand a chance of keeping their market share.

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.

2 Comments

  • I enjoyed this article, thanks for sharing. My analysis is that independents cannot afford the enterprise EHR’s and are therefore going to less expensive older versions, whereas major facilities and those in the know choose larger more robust systems. Some systems can handle both IP, ambulatory, even HOD’s and therefore truly are turnkey systems (epic for example). Interoperability has been a discussion for a while now, and will continue to get better as modular components are add to systems to relieve gaps, holes, and disconnectivity. Imo, big box seems the best way to go because they can and will supply a majority of the users with the requirements that they need while still remaining profitable (and in buisness). They will be able to address the areas of concern for all such as interoperability, addition and modification of system components (modules), and cost which are factors that will improve over time.

    I enjoyed your article,

    Thanks.

  • The less expensive, “older” EHRs that you reference are actually much younger than Epic (~37 years old). We’ll see if Epic’s age catches up with it against newer systems built on newer platforms.

    I don’t think there’s anything “turnkey” about Epic either. They have an approach that seems to work relatively well, but ask a hospital system that’s paying millions of dollars in consulting fees whether it’s really a turnkey solution. It’s not.

    It will be interesting to see where Epic and all the other large EHR vendors like it take their development. Will they continue to innovate or will they do like many companies and grow stagnant with slow release cycles and upgrades that provide little value as they continue to hold their customers captive as they collect high fees for their software. We’ll see. It’s a hard trend to buck with large enterprise software systems.

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