Out with old, in with new
Many providers switching vendors, EHR systems
Billions of dollars of federal stimulus money and a once-derided program of testing and certification of electronic health records systems have combined to produce a plethora of health IT choices for hospitals and officebased physicians.
Pressed to participate in the federal programs to subsidize the cost of health IT and to meet their meaningful- use targets, providers are buying EHRs for the first time, trading up their current EHRs for newer versions, and, increasingly, are dumping their existing systems for EHRs from different vendors.
The latter was the case for tiny Blue Mountain Hospital in the four-corners region of southeastern Utah.
When the 16-bed, critical-access hospital opened in Blanding in July 2009, it had an EHR from a small developer, said Jeremy Lyman, the hospital’s chief financial officer.
Now, three years later, Blue Mountain’s initial EHR system is gone, replaced by an EHR from another small company. “What prompted us to really evaluate our options was the meaningful-use incentive program,” Lyman said.
Four recently released data sets add perspective to this still- expanding and fast- changing health IT market, fueled to date by $ 6.2 billion in federal EHR incentive payments to providers under the American Recovery and Reinvestment Act, with an estimated $ 27 billion in incentive payments expected throughout the life of the program.
In a report based on interviews with 318 buyers of EHRs designed for use in ambulatory care, market researcher KLAS Enterprises, Orem, Utah, found that 50% of experienced EHR users want to replace their systems, up from the 33% churn rate a year ago.
More than half of the ambulatory EHR buyers interviewed by KLAS—about 64%— were considering EHR systems other than those from the top 11 most-often appearing vendors’ names on these buyers’ shopping lists. These “other” developers were closing deals with interviewees 31% of the time, according to KLAS.
The National Center for Health Statistics, meanwhile, issued a report based on a much larger survey sample (3,180 office-based physicians) finding that 38% were “very satis-
fied” with their systems, but 47% were only “somewhat satisfied.”
And while seven out of 10 physicians in the EHR survey indicated they were happy enough with their current systems that they would buy them again, one in 20 current EHR users surveyed (5%) told the NCHS they were “dissatisfied” with their EHRs, and another 10% reported they were somewhat dissatisfied.
Dr. Farzad Mostashari, who heads the Office of the National Coordinator for Health Information Technology at HHS, wrote in blog posts that the numbers suggest a high level of satisfaction with the systems “in spite of the fact that I often hear from providers who are dissatisfied with their EHR systems” and who grumble that their EHRs “don’t work correctly and present significant workflow challenges with little potential to improve patient care.”
Earlier this month, Jodi Daniel, director of the ONC’s office of policy and planning, presented the July numbers from its official Certified Health IT Product List. According to Daniel, there are 1,477 “unique” EHR products that have been tested and certified for use in the Medicare and Medicaid incentive payment programs under ARRA, including 613 “complete” EHRs for use in ambulatory care, and another 87 complete EHRs for inpatient use.
In addition, the certified list offers 777 pieces of EHR system technology that can be stitched together with computer interfaces to create a “modular” EHR for ambulatory or inpatient care. All totaled, 816 vendors have products on the ONC list.
Not all of these vendors have been successful in attracting actual customers that have used an EHR to meet their meaningful-use criteria and get paid their share of federal incentive money, according to the CMS, which periodically releases a mashup of data from the ONC”s certified list and its own database of paid providers under the Medicare portion of the program.
Well-known EHR vendors in the hospital and ambulatory markets are grabbing shares of these federally incentivized installations, as expected, but the CMS data also show the game is still very much afoot for many lesserknown firms, particularly those selling to office-based physicians.
According to a Modern Healthcare analysis of the CMS data, through May 31 this year, 27 vendors have shared in the sale of 1,027 complete EHR systems to hospitals that have used those systems to receive Medicare EHR incentive payments. Almost a quarter of those hospital installations used EHRs from those 22 developers of complete EHRs not in the top five on the CMS list.
Meanwhile, in ambulatory care, 319 vendors have provided 71,183 complete EHRs to eligible professionals paid under the Medicare incentive program. Nearly a quarter (24%) used one of the 304 vendors’ systems not in the top 15, according to CMS data.
The size and diversity of the EHR market might come as a shock to even many veteran
“Those of us who were around 20 years ago couldn’t imagine this industry (would grow) in the way it has.”
—Dr. Jacob Reider, ONC
health IT market watchers, and to critics of federal efforts to test and certify EHR systems. A program of voluntary testing and certification began at the urging of the first ONC chief, Dr. David Brailer, back in 2004.
“We’re all surprised by the large number of options that could be certified,” said Dr. Jacob Reider, acting chief medical officer at ONC. “Those of us who were around 20 years ago couldn’t imagine this industry (would grow) in the way it has.”
Reider said simply having a testing and certification program has helped define as well as shape the market. “Nobody was tracking the breadth of this market in the way that a certification program would track it,” he said. “Unless there is a funnel though which all must pass, there isn’t any way to know.”
In 2010, the year after Blue Mountain Hospital opened, the federal government published its first set of meaningful-use criteria under which EHRs would need to be tested and certified to qualify for use by providers in the stimulus incentive payment programs.
To qualify for those incentive payments, Blue Mountain’s EHR either had to be upgraded or replaced, Lyman said, and “in our experience, it was an older, antiquated platform and not user friendly. To go with an upgrade was going to cost as much as a new system.”
Blue Mountain officials decided instead to shop around. They also collaborated with several other hospitals in compiling a list of needs and evaluating vendors, taking serious looks at about 10 systems, Lyman said.
Several potential vendors were large companies that historically had been focused on much larger hospitals but are now branching out into the small hospital market. Big- ness was no asset to Lyman and his colleagues at Blue Mountain.
“They have people who are paying them 10 times what we ever will,” Lyman said. “They could decide to turn on a dime and not need us any more.”
Instead, Blue Mountain officials chose an EHR and a financial system from Prognosis Health Information Systems, a privately held Houston-based company founded in 2006. It has 17 complete EHR installations that have been subsidized with federal payments, CMS data show, representing a 2% market share.
“We found that Prognosis is focused on our size,” Lyman said. “We investigated their financial position and met with their key executives, all of that stuff, so we felt comfortable going with a lesser-known company.”
The new EHR is installed, and the hospital is a month into its 90-day period to meet Stage 1 meaningful-use criteria to qualify for a payment, Lyman said. “We’re confident we’ll be able to meet that.”