50 Things to Know About Epic, Cerner, MEDITECH, McKesson, athenahealth and Other Major EHR Vendors

"To improve the quality of our healthcare while lowering its cost, we will make the immediate investments necessary to ensure that, within five years, all of America's medical records are computerized." — President-elect Barack Obama, Jan. 8, 2009

Five years later, billions have been poured into the transition to electronic health records. As of May, CMS has paid out a total of $14.6 billion in incentive payments to hospitals and health systems for the adoption and use of EHRs. These incentive payments, coupled with the looming threat of financial penalties for non-adopters and a need to better coordinate care have driven providers to rapidly adopt EHRs over the past few years. The EHR market is expected to reach $9.3 billion annually by the end of 2015.

As the EHR market has matured, a once-crowded field of vendors has narrowed significantly. At the end of 2013, 10 EHR vendors accounted for about 90 percent of the hospital EHR market, based on meaningful use attestation data from CMS: Epic, MEDITECH, CPSI, Cerner, McKesson, Healthland, Siemens, Healthcare Management Systems, Allscripts and NextGen Healthcare.

According to a KLAS report, just three of these vendors expanded their market share in 2013 — Epic, Cerner and MEDITECH — which together account for more than half of the acute-care EHR market.

Several of the big players in the EHR market are led by big personalities, from Judy Faulkner, who founded Epic (and wrote the software's original code) in 1979, kept the company private and is now worth an estimated $3 billion; to Cerner's Neil Patterson, known for his passionate, involved leadership style; to athenahealth's outspoken Jonathan Bush, an advocate for disruptive technologies in the healthcare industry.

Recently, the EHR market has seen an infusion of providers seeking replacements for their current systems. Surveys suggest between 12 and 30 percent of providers are dissatisfied with their EHR. Girish Navani, CEO and co-founder of eClinicalWorks, said in 2013 more than half of his company's new clients came from another vendor.

The 50 points below offer additional facts and insights into the EHR market and some of the most prominent companies. (EHR vendors below are arranged alphabetically.)

The Current EHR Market

1. At the end of 2013, 10 EHR vendors accounted for about 90 percent of the hospital EHR market, based on meaningful use attestation data from CMS. Those 10 vendors include Epic, MEDITECH, CPSI, Cerner, McKesson, Healthland, Siemens, Healthcare Management Systems, Allscripts and NextGen Healthcare.
2. According to a KLAS report, just three of these vendors expanded their market share in 2013 — Epic, Cerner and MEDITECH. The report found Epic and Cerner experienced the largest gains in both the large- and small-facility markets.
3. The EHR market is expected to reach $9.3 billion annually by the end of 2015.
4. Allscripts, Epic, Cerner, McKesson and Quadramed are the most popular EHR systems among academic medical centers, teaching facilities and hospitals with more than 300 beds, according to a report from KLAS. Among small and rural hospitals under 100 beds and critical access hospitals, the top vendors are CPSI, Cerner, Healthland, Healthcare Management Systems and RazorInsights.
5. Allscripts, MEDHOST, Cerner and CPSI all have hospital clients that have attested to meaningful use stage 2. athenahealth has the majority of physician meaningful use attesters — of the 485 eligible physicians who have attested to meaningful use stage 2 so far this reporting year, 59.2 percent use athenahealth.
6. Three of the current bids on the Department of Defenses' EHR modernization contract have been major EHR vendors partnering with companies with experience in large-scale government contracts. Epic and IBM were among the first to announce their intent to bid on the contract. Their proposal includes using Epic's electronic health record software coupled with IBM's systems integration, operations and change management expertise to replace the current DoD system. Allscripts, CSC and HP have also announced a partnership to bid on the contract. Under the bid, Allscripts' EHR technology would be coupled with CSC's and HP's large-scale health IT expertise to design and implement the system. Cerner, Accenture Federal Services and Leidos also announced a similar partnership to combine Cerner's technology with Accenture's and Leidos' expertise. 
7. HIMSS' EHR Developer Code of Conduct outlines expectations for developers in the areas of general business practices, patient safety, interoperability and data portability, clinical and billing documentation, privacy and security and patient engagement. Its 17 signatories include Allscripts, athenahealth, Cerner, CPSI, Epic, Foothold Technology, GE HealthCare, Greenway Medical, MacPractice, MEDHOST, MEDITECH, Modernizing Medicine, NextGen, Practice Fusion, Siemens, SRSsoft and Versasuite.

Allscripts

8. Allscripts' bookings during the first quarter of 2014 were $223 million, representing a 26 percent year-over-year growth for the company. Allscripts' results from the three-month period ended March 31 also show recurring revenue increased to 78 percent from 74 percent during the same period last year. Population health management solutions constituted 36 percent of first quarter bookings.
9. Allscripts is the 10th largest health IT company in terms of revenue, according to Healthcare Informatics. Allscripts solutions are currently used by about 1,300 hospitals, as well as 180,000 physicians and 13,000 post-acute organizations.
10. Allscripts clients include North Shore-LIJ in Great Neck, N.Y., Memorial Sloan Kettering in New York City, Orlando Health and Children's Hospital of Wisconsin in Milwaukee.
11. In April, Allscripts ended its relationship with its patient portal vendor, MedFusion, over a payment dispute. The terminated relationship meant 30,000 Allscripts clients that were using EHRs integrated with Medfusion's patient portal had to purchase the service directly from Medfusion or switch to Allscripts' patient portal, FollowMyHealth.
12. Allscripts is currently transitioning to focus more on population health solutions, as seen in two recent acquisitions. Both dbMotion, system interface and data analytics software that collects patient information from disparate providers into one record, and Jardogs, a patient engagement and personal health record platform, were part of a $500 million total investment in population health management solutions the company undertook in 2013.

athenahealth

13. In 2013, athenahealth's revenue grew 41 percent to $595 million. Some of the company's increased 2013 revenue is attributable to its purchase of Epocrates, a mobile health company. Although athenahealth posted earnings of $0.12 a share for the first quarter of 2014 — falling below analysts' estimates of $0.17 per share — through investments in innovation and facilities, athenahealth plans for its core revenue to grow 30 percent this year.
14. More than 50,000 medical providers have gone live using athenaClinicals — the company's cloud-based EHR — and that number is expected to grow. The company already has clients operating in all 50 states.
15. Through More Disruption Please program, athenahealth has entered into partnerships with more than 20 businesses that now offer their services through athenahealth's network. The company has entered into partnerships with 5 O'Clock Records — a venture-backed company that assists healthcare providers in getting paid for fulfilling medical record requests — and demand force, a program that attracts new patients using online marketing and appointment tools.
16. Although most of athenahealth's services are geared to support physicians and other healthcare providers, the company recently invested in Wellframe's "GPS navigation for patients" that is designed to help patients manage their health post-discharge by providing customized guidance, exercise and medication adherence trackers and symptom alerts. Wellframe received a total of $1.5 million in seed funding from athenahealth and other investors.

Cerner

17. With more than $2.67 billion in revenue in 2013, Kansas City, Mo.-based Cerner is the largest independent health IT company in the world. Revenue for 2014 is expected to reach $3.3 billion. Chairman and CEO Neal Patterson founded the company in 1979, the same year Judy Faulkner founded Cerner's main rival, Epic. Mr. Patterson is known for his passionate, involved leadership style, which led both to an infamously leaked 2001 email berating the company's managers for lack of effort as well as the development of a culture of very engaged employees who care about the company's work. With an estimated net worth of $1.5 billion, Mr. Patterson is No. 352 on Forbes' list of the richest people in America.
18. Cerner clients include Pittsburgh-based UPMC, Indiana University Health in Indianapolis, Phoenix-based Banner Health, Memorial Hermann Health System in Houston and Adventist Health System in Altamonte Springs, Fla. As of February, 532 hospitals have used a Cerner EHR to attest to meaningful use. Additionally, 37 Cerner clients have reached HIMSS Analytics stage 7.
19. Cerner consistently receives high marks in independent user satisfaction surveys. However, the company has faced a few lawsuits regarding EHR functionality. In 2013, Cerner agreed to pay $106 million to Trinity Medical Center in Minot, N.D., to resolve allegations purchased software did not function as promised. In 2012, Girard (Kan.) Medical Center sued Cerner for allegedly failing to complete the EHR implementation in time for the hospital to qualify for meaningful use incentives.
20. Cerner has acquired several companies over the past several years. In 2011, Cerner acquired workforce management software vendor Clairvia; in 2012, it acquired behavioral health technology vendor Anasazi Software; and in 2013, it acquired population health and patient engagement software vendor PureWellness.
21. Cerner has entered into several partnerships as part of its efforts to be a leader in the health IT field. In September, Cerner announced a partnership with Children's National Health System in Washington, D.C., to develop the nation's first research institute devoted to health IT, and in December, the company announced a partnership with Claritas Genomics to develop a scalable laboratory solution for molecular diagnostics designed for next-generation sequencing workflows, aiming to advance the use of personalized medicine across the healthcare industry. In October, Salt Lake City-based Intermountain Healthcare announced a partnership with Cerner to implement Cerner software in its 22 hospitals and 185 ambulatory clinics. The implementation, currently in progress, will build on Intermountain's clinical and data warehousing capabilities to build one of the most advanced EHR systems in the nation.

CPSI

22. CPSI is aimed at community, rural and critical access hospitals. The Mobile, Ala.-based company has more than 650 clients across the country.
23. CPSI clients include Henry County Health Center in Mount Pleasant, Iowa, Copley Hospital in Morrisville, Vt., Graham County Hospital in Hill City, Kan., Huron (S.D.) Regional Medical Center, Millinocket (Maine) Regional Hospital and Steele Memorial Medical Center in Salmon, Idaho.
24. Total sales revenues for CPSI increased to $52.1 million during the quarter ended March 31, 2014, up from $49.5 million during the same period last year.
25. CPSI expanded beyond EHRs in 2013 with the acquisition of TruBridge, a company specializing in the business IT needs of community healthcare providers. The acquisition allowed CPSI to offer complete solutions while focusing the core of its company on EHRs.

eClinicalWorks

26. eClinicalWorks clients include BayCare Health System in Tampa Bay, Fla., Beth Israel Deaconess Physicians Organization, Central Georgia Health Network in Macon, Ga., Summa Health System in Akron, Ohio, and St. John Providence Health System in Detroit.
27. eClinicalWorks has a majority of the federally qualified health center EHR market.
28. eClinicalWorks recently announced it will invest $50 million in the development and enhancement of patient engagement and population health products.
29. Several large accountable care organizations have recently selected eClinicalWorks, including Emerald Physicians ACO in Cape Cod, Mass., Antelope Valley ACO in Lancaster, Calif., and Physician First ACO in Deltona, Fla.
30. More than one in six providers currently using an EHR has plans to change vendors within the next year, according to a Black Book Strategies report. Girish Navani, CEO and co-founder of eClinicalWorks, said the trend of EHR replacement has benefited his company: "Approximately 60 percent of our new customers are switching to us from a previous system," he said.

Epic

31. Epic clients include Oakland, Calif.-based Kaiser Permanente, Cleveland Clinic, Johns Hopkins Medicine in Baltimore, UCLA Health in Los Angeles, Arlington-based Texas Health Resources, Massachusetts General Hospital in Boston, Mount Sinai Health System in New York City and Duke University Health System in Raleigh, N.C. In total, Epic has 315 customers, and more than 70 percent of HIMSS Analytics Stage 7 hospitals use the EpicCare inpatient EHR system.
32. In February, CVS Caremark's retail clinic chain, MinuteClinic, announced it will switch from its proprietary EHR system to Epic. When the transition is complete, about 51 percent of Americans will have an Epic record.
33. Verona, Wis.-based Epic was founded in 1979 by computer scientist Judy Faulkner, who coded the original Epic software. Ms. Faulkner remains Epic's leader, currently serving as CEO. Forbes estimates her net worth at $3 billion and put her at No. 243 on the magazine's annual list of the richest people in America.
34. Epic EHR systems are some of the most expensive on the market. Duke University Health System reportedly paid $700 million for its Epic system; Kaiser Permanente, $4 billion. Additionally, a Peer60 survey found Epic EHRs come with higher upgrade costs — Epic users spent an additional sum between 40 and 49 percent of the system's initial costs in major and minor upgrades, while Cerner users spent between 30 and 35 percent and Allscripts users spent between 20 and 22 percent.
35. Epic is not a member of CommonWell Health Alliance, an industry coalition aimed at increasing interoperability between EHR platforms. Calling the group an attempt to increase the vendors' market shares, Epic instead partnered with Kaiser Permanente, Walgreens, Surescripts and other organizations to form Carequality, which aims to increase data exchange between hospitals, physicians, payers, retail clinics and other healthcare stakeholders.
36. Because many smaller healthcare organizations may not have the resources to implement Epic, many Epic clients have begun offering their version of the EHR to local providers. In February, Chesterfield, Mo., became the first accredited provider of the Epic Connect program, and will provide consulting services and hosting of its Epic EHR in a software-as-a-service model.

Healthland

37. Like CPSI, Healthland is designed for critical access, community and rural hospitals. Healthland clients include Glacial Ridge Health System in Glenwood, Minn., Black River Falls (Wisc.) Memorial Hospital, Coryell Memorial Hospital in Gatesville, Texas and Kane (Pa.) Community Hospital.
38. Healthland recently partnered with IT integration solutions firm Iatric Systems to help rural and critical access hospitals attest to meaningful use.
39. Healthland often partners with other organizations to advocate on issues that affect its small, community and critical access hospital clients.

MEDITECH

40. Medical Information Technology, more commonly referred to as MEDITECH, was founded in 1969 by A. Neil Pappalardo. The company has an annual revenue of about $550 million.
41. MEDITECH customers include CHRISTUS Health in Dallas, Swedish Covenant Hospital in Chicago, St. Bernards Healthcare in Jonesboro, Ark., Henry Mayo Newhall Hospital in Valencia, Calif., Citizens Memorial Healthcare in Bolivar, Mo., and St. Agnes Healthcare in Baltimore.
42. As of January, more than 740 MEDITECH customers had attested to meaningful use.
43. MEDITECH is committed to being environmentally friendly, and the company supports more than 43 unaffiliated nonprofit organizations.

McKesson

44. McKesson was founded in 1833 as a botanical drug importer and seller, making it one of the oldest continually operated companies in the U.S. The company now has two main divisions, pharmaceuticals and health IT systems. In fiscal year 2013, the company reported revenue of $122.5 billion, putting it at the top of Healthcare Informatics' list of the top health IT companies by revenue.
45. McKesson clients include MedWest Health System in Clyde, N.C., Twin County Regional Healthcare in Galax, Va., St. Mark's Medical Center in LaGrange, Texas, and Oconee Medical Center in Seneca, S.C.
46. McKesson designed its EHR, Paragon, without fixed length fields, interface requirements or other set design features, helping the EHR be customized to fit a hospital or health system's needs.

NextGen Healthcare

47. NextGen clients include Cherokee Health System in Seymour, Tenn., Avita Health System in Galion, Ohio, and Tucson (Ariz.) Medical Center.
48. NextGen, like athenahealth, blasted the recent ICD-10 delay as irresponsible and unfair to vendors with ICD-10-ready products.
49. In February, NextGen and Cerner announced bi-directional data interoperability, and in June, NextGen announced it had achieved total vendor-agnostic interoperability.
50. Earlier this month, NextGen and its sister company, Mirth, announced the launch of a new interoperability platform that will allow clients to connect with external organizations and exchange patient information using Direct messaging technology.

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