"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
President Obama made this statement about six weeks before the Health Information Technology for Economic and Clinical Health Act was signed into law. Under the HITECH ACT, CMS began its EHR Incentive Program. Although that five-year benchmark has been surpassed, of April 2015, CMS paid out more than $30 billion in incentive payments to hospitals and health systems for the adoption and use of electronic health records. 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 $8.3 billion by 2016.
As the EHR market matured, a once-crowded field of vendors narrowed significantly. In March of 2015, 10 EHR vendors accounted for about 90 percent of the hospital EHR market, based on meaningful use attestation data from CMS: Cerner, MEDITECH, Epic, McKesson, CPSI, MEDHOST, Healthland, Allscripts, NextGen Healthcare and Indian Health Service.
According to the government's Health IT Dashboard, three of those companies — Epic, Cerner and MEDITECH — corner nearly 60 percent of the market share combined.
Several of the big players in the EHR market are led by big personalities, from Judy Faulkner, CEO and founder of Epic, who kept the company private and is now worth an estimated $2.6 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 at least one-third of physicians are dissatisfied with their current EHR, and more than half would not recommend their current EHR to colleagues. Tied with financial issues, 37 percent of physicians reported the EHR as their number one challenge.
With meaningful use stage 3 delayed until 2017, and a chorus of voices calling for an extended moratorium on the policy, the need for EHR vendors to offer providers systems capable of efficient data use and exchange has never been more pressing. The ONC has outlined the minimum criteria EHR vendors need to meet in order to achieve Health IT Certification, which ensures that that the system providers choose to adopt offers the necessary capabilities and functionalities to enable them to achieve meaningful use. To qualify to receive incentive payments, providers must successfully attest to MU by both adopting and demonstrating their meaningful use of certified health IT.
Here are 50 additional facts and insights into the EHR market and some of the most prominent players. (EHR vendors below are arranged alphabetically.)
The current EHR market
1. In March of 2015, Cerner, MEDITECH and Epic Systems comprised nearly 60 percent of the market share of primary certified EHRs for participating hospitals. Furthermore, the top 10 of 169 total EHR vendors — MEDITECH, Cerner, Epic, McKesson, CPSI, MEDHOST, Healthland, Allscripts, NextGen and Indian Health Service — provided the primary EHR for over nine out of 10 hospitals. For the remaining 169 hospital EHR vendors, 9 out of 10 of all hospitals report the vendor's product as their secondary EHR. A secondary EHR is any additional modular EHR used within the hospital's system.
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. 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 2014 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.
4. The following is a list of the top 10 vendors associated with the most providers who attested to meaningful use as of May 2015.
1. Epic — 185,997
2. Cerner — 120,331
3. Allscripts — 99,091
4. GE Healthcare — 55,681
5. eClinicalWorks — 52,565
6. NextGen — 50,771
7. Greenway — 30,588
8. Intermountain — 30,330
9. McKesson — 22,878
10. athenahealth — 21,442
11. Practice Fusion — 18,701
12. MEDITECH — 10,746
Here are the top seven vendors broken down by hospital attestations only.
1. Cerner — 10,044
2. MEDITECH — 5,374
3. Epic — 2,307
4. McKesson — 1,930
5. MEDHOST — 1,840
6. CPSI — 1,261
7. HCA I&T —1,223
5. Just a handful of EHR vendors dominate the market share for physician practices. Here are the top 10 vendors for those practices broken down by market share, as of February 2015, according to an SK&A report.
1. Epic — 11.6 percent
2. eClinicalWorks — 10.2 percent
3. Allscripts — 8.7 percent
4. Practice Fusion — 6.7 percent
5. NextGen Healthcare — 5.5 percent
6. GE Healthcare — 3.6 percent
7. Cerner — 3.5 percent
8. athenahealth — 3.3 percent
9. McKesson — 3.2 percent
10. Amazing Charts — 2.3 percent
6. After a months-long bidding war among finalists for the Department of Defense's $11 billion-EHR modernization contract, three teams led by Epic, Cerner and Allscripts, respectively, remain in the running for the history-making deal. The Pentagon wants seamlessly interoperable health data exchange for its nearly 10 million employees, service members, retirees and their families. The transition to the new system will be the largest of the decade and the winning team is expected to be awarded the contract in fall 2015.
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 32 signatories include:
· AllMeds
· Allscripts
· Amazing Charts
· Aprima
· Cerner
· CureMD
· e-MDs
· EndoSoft
· Epic
· Evident
· Falcon EHR
· Foothold Technology
· GE HealthCare
· Greenway Medical
· Healthland
· MacPractice
· McKesson
· MEDHOST
· MEDITECH
· Modernizing Medicine
· NexTech
· NextGen
· NTT Data
· Office Practicum
· Practice Fusion
· PrognoCIS
· QuadraMed
· Sevocity
· SRSsoft
· STI Computer Services
· Valant
· Wellsoft
8. CommonWell Health Alliance is a coalition of founding and contributing members who seek to create and execute a vendor-neutal platform that breaks down the barriers inhibiting interoperability and effective health data exchange. CommonWell's mission also includes the promotion of a national infrastructure with common standards and policies. Its 29 members include:
· Allscripts
· Aprima
· athenahealth
· Brightree
· CareCloud
· CareMerge
· Cerner
· CitiusTech
· CVS Caremark
· Evident
· Greenway Health
· HIE Texas
· Influence Health
· Kareo
· MacPractice
· McKesson
· MEDHOST
· MEDITECH
· Merge
· MiHIN
· MTBC
· Obix
· OmniSYS
· PeriGen
· PointClickCare
· Sunquest
· Surgical Information Systems
· T-System
· Wellcentive
Allscripts
9. Allscripts' bookings during the first quarter of 2015 were $236 million, up from $223 million from the same quarter last year, representing a 6 percent year-over-year growth for the company. Allscripts' results from the three-month period also show recurring revenue increases to 77 percent from 73 percent total revenue year-over-year. Cash flow from operations totaled $59 million in the same quarter.
10. 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. The company employs more than 6,000 people in 20 locations across the U.S., Asia, Canada, Australia and the U.K.
11. Allscripts clients include North Shore-LIJ Health System in Great Neck, N.Y., Memorial Sloan Kettering Cancer Center in New York City, Orlando (Fla.) Health and Children's Hospital of Wisconsin in Milwaukee.
12. Allscripts is currently transitioning to focus more on population health solutions, as seen in two recent acquisitions. Both dbMotion, a 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 the first quarter of 2015, athenahealth reported revenues of $206.4 million, up 27 percent from $163 million in the same quarter for 2014. For fiscal year 2015, the company expects total revenues between $905 million and $925 million.
14. More than 64,000 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 the More Disruption Please program, athenahealth has entered into partnerships with more than 30 businesses that now offer their services through athenahealth's network.
16. Two major acquisitions in early 2015 — Atlanta-based hospital EHR provider Razor Insights and the EHR developed by Boston-based Beth Israel Deaconess Medical Center — position athenahealth for expansion in the EHR market.
Cerner
17. With a 2014 revenue of $3.4 billion, Kansas City, Mo.-based Cerner is the largest publicly traded health IT company in the world. The company reported bookings of $1.20 billion for the first quarter of 2015. This was an all-time high and an increase of 32 percent from $910.2 million in the same quarter of 2014. First quarter revenue was $996.1 million, up 27 percent from the same quarter of 2014.
18. 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 $1.8 billion, Mr. Patterson is No. 351 on Forbes' list of the richest people in America.
19. Cerner clients include Pittsburgh-based UPMC, Indiana University Health in Indianapolis, Phoenix-based Banner Health, Memorial Hermann in Houston and Adventist Health System in Altamonte Springs, Fla. As of March 2015, 931 hospitals participating in the CMS EHR incentive program used Cerner for their primary EHR.
20. Cerner completed acquisition of Siemens' Health Services, a unit of Siemens AG, for $1.3 billion in February 2015. A company statement following the acquisition said Cerner will use Siemens' expertise to boost the creation of its next generation of health IT solutions. Other recent acquisitions include PureWellness, a population health and patient engagement software vendor, in 2013; Anasazi software, a behavioral health technology vendor, in 2012; and Clairvia, a workforce management software vendor, in 2011.
21. Cerner has entered into several partnerships as part of its effort to lead the health IT field. These include an interoperability certification program, which features companies like athenahealth and NextGen as partners, and a medical device certification program. In September, Cerner will celebrate the second anniversary of a seven-year partnership with Children's National Health System in Washington, D.C.. The goal of the partnership is to utilize innovation in electronic health technology to advance evidence-based pediatric care, research and education. In December 2013, 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 the company's software in its 22 hospitals and 185 ambulatory clinics. The implementation, currently in progress, has already led to dozens of go-lives.
CPSI
22. CPSI is aimed at community, rural and critical access hospitals. The Mobile, Ala.-based company has more than 650 clients representing more than 12,000 providers 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. CPSI reported first quarter revenues for 2015 of $46.2 million, down from $52.1 million from the same quarter last year.
25. In March 2015, CPSI was ranked the top inpatient EHR vendor for hospitals under 100 beds for the fifth consecutive year by Black Book Rankings.
eClinicalWorks
26. eClinicalWorks clients include BayCare Health System in Tampa Bay, Fla., Beth Israel Deaconess Physicians Organization in Boston, Central Georgia Health Network in Macon, Summa Health System in Akron, Ohio, and St. John Providence Health System in Detroit. Several large accountable care organizations have selected eClinicalWorks, including Emerald Physicians ACO in Cape Cod, Mass., Antelope Valley ACO in Lancaster, Calif., and Physician First ACO in Deltona, Fla.
27. In January 2015, HIMSS named eClinicalWorks a certified educator of its EHR Adoption Model, an eight-step process that allows providers to analyze their level of EHR adoption and benchmark progress against others.
28. eClinicalWorks' user base is comprised of more than 100,000 physicians and 600,000 healthcare professionals across all 50 states with 2014 revenues exceeding $320 million.
29. In April 2015, eClinicalWorks announced interoperability with Epic's EHR through the Carequality framework. Together, the two companies represent more than 1,000 hospitals and 40,000 clinics.
30. In March 2015, eClinicalWorks announced integration between leading wearable devices, fitness trackers and the company's Healow platform, an app that enables patients to link health information across multiple accounts and access it through one portal.
Epic
31. Epic has approximately 315 customers. Some big-name clients include Oakland, Calif.-based Kaiser Permanente, Rochester, Minn.-based Mayo Clinic and Boston-based Partners HealthCare.
32. Additionally, CVS Health, the largest retail health clinic in the country, uses EpicCare at its CVS MinuteClinic locations.
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 CEO. Forbes estimates her net worth at $2.6 billion and previously ranked her No. 6 on its "America's Self-Made Women List."
34. As of March 2015, Epic was the most commonly selected EHR by eligible professionals participating in meaningful use. CMS reported more than 109,000 eligible professionals attested to meaningful use on Epic's platform, followed by approximately 49,000 eligible professionals attesting on Allscripts.
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. Additionally, Epic joined forces with key health IT players to form the Argonaut Project, an initiative formed by Health Level Seven International to accelerate development and adoption of HL7's Fast Healthcare Interoperability Resources. Epic joins competitors athenahealth, Cerner, MEDITECH and McKesson, along with key systems like Boston-based Beth Israel Deaconess Medical Center, Boston-based Partners HealthCare, Salt Lake City-based Intermountain Healthcare and Rochester, Minn.-based Mayo Clinic.
36. The EpicCare EMR platform consistently receives top marks from KLAS Research. Epic was named the best overall physician practice vendor in 2014 by KLAS. It was also named the best overall software suite of 2014 by KLAS for the fifth year in a row. Additionally, the inpatient EMR was named the best acute-care EMR, and the ambulatory EMR was named the best for practices with over 11 physicians.
Healthland
37. Like CPSI, Minneapolis-based 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 acquired Marshall, Minn.-based Rycan Technologies, a healthcare revenue cycle solutions firm, to broaden its revenue cycle management offerings. Healthland often partners with other organizations like Make a Wish Foundation and the YMCA to advocate issues affecting its small, community and critical access hospital clients.
39. Chris Bauleke has served as the company's CEO since 2013. Prior to joining Healthland, Mr. Bauleke worked with McKesson for nearly 20 years. Todd Laddusaw, Healthland's CFO, began his career at KPMG and PricewaterhouseCoopers and held a number of other administrative healthcare positions before joining the company in 2014.
MEDITECH
40. Medical Information Technology, more commonly referred to as MEDITECH, was founded in 1969 by A. Neil Pappalardo. The Westwood, Mass.-based company's annual combined revenue for 2014 was $517 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 March 2015, more than 940 MEDITECH customers had attested to meaningful use.
43. In February 2011, MEDITECH acquired Eden Praire, Minn.-based LSS Systems, a health IT company specializing in ambulatory care. MEDITECH had been partnered with the company for nearly thirty years prior to purchasing it.
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 2014, the company reported revenue of $137.6 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, letting 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. The company has more than 4,000 clients, which have attested for approximately $220 million in meaningful use incentives.
49. NextGen places a heavy emphasis on health information exchange and interoperability, and it offers software that is able to integrate and report real-time information from a variety of sources.
50. In 2013, NextGen acquired Mirth, a provider of interoperability tools that aim to move data quickly across different systems. In July 2014, the two companies launched NextGen Share, a national health information service provider that enables clients to connect with external providers using direct messaging capabilities.