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Providers Seek Options In EMR Vendors

Although three vendors now dominate the ambulatory electronic medical record market, a KLAS report finds that other firms are picking up speed.

Though three established vendors continue to dominate mindshare, a larger pool of companies is being considered by hospitals and physician practices looking to purchase ambulatory electronic medical records, according to a new report by Orem, Utah-based KLAS.

Allscripts, NextGen, and eClinicalWorks constitute what report author Mark Wagner, KLAS general manager of ambulatory research, calls "the Big Three" in his report, Ambulatory EMR Buying: A Roller Coaster Ride in 2010. For the study, KLAS interviewed more than 370 healthcare providers who plan to choose an EMR solution in the next two years.

"What's interesting to note in this year's report was that while the Big Three continue to dominate mindshare and consideration -- they are in just a high percentage of deals -- you are seeing other vendors that you didn't see previously be pulled into those deals at a higher frequency," said Wagner. "So if you look at vendors like Greenway Medical Technologies and e-MDs, which have traditionally performed well in smaller practices, they are being considered more in larger deals where they didn't show up on that radar at all previously."

The report investigated both ambulatory practices planning to buy EHRs for themselves and hospitals looking to leverage relaxations in the anti-kickback Stark provisions to underwrite EMRs for independent physicians.

Which ambulatory EMR providers are in consideration varies significantly depending on practice size.

Allscripts EMR products (including Enterprise, Professional, Misys, and MyWay) are being collectively considered in 35% of purchase decisions, more often than any other vendor's products. This was followed by NextGen (considered in 32% of planned purchases) and eClinicalWorks (29%). Other vendors highlighted in the report include athenahealth, Cerner, e-MDs, Eclipsys, Epic, GE, Greenway, McKesson, and Sage.

Half of the providers planning a switch are doing so because their current EMR lacks functionality or certification -- in short, because they are not viable go-forward strategies in today's American Recovery and Reinvestment Act-focused healthcare environment.

Though the government is currently focused on building out a certification program to replace the one established by the Certification Commission for Health Information Technology, Wagner said buyers should not see a Department of Health and Human Services stamp of approval as indicating nothing can go wrong with the implementation.

"It's important for us to have certification and a threshold of functionality -- I don't question that one bit. The danger is in providers looking at that certification as guaranteeing they will be successful. If they do that, they are short-selling some of the challenges we see in this space," explained Wagner. "One-third of the people we talked to... are actually replacing one EMR with another. And 62% of those are replacing a certified EMR. That tells us there are no guarantees, especially from a productivity perspective, from a physician satisfaction perspective. Having a certified product is not going to guarantee success."

What may guarantee success, adds Wagner, is a solid system-selection process, mixed with a willingness to redesign workflow.

"Some practices understand that when you make this sort of a change, the way business gets done needs to adjust as well. Some feel the system should comply to how they do business -- that the way they learned on paper should be how systems work. There is no question that practices which look at how they do business, as well as the system, will have more success than those who remain rigid and expect the vendor or product to make all adjustments."

Anthony Guerra is the founder and editor of, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at

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