EHR Rankings Suggest 'Epic' Shakeout

December 17, 2012

Hundreds of companies sell electronic health record (EHR) systems, but just 2 of them dominated the annual year-end rankings published by research firm KLAS, suggesting the tremors of a long-awaited industry shakeout.

The KLAS findings partly reflect the accelerating shift of physicians from independent practice to hospital employment, experts told Medscape Medical News.

Epic received the company's Best of KLAS Award for EHRs for medical practices with from 11 to 75 physicians and those with more than 75 physicians. It also took top honors in the category of inpatient EHRs. Meanwhile, Athenahealth had the number 1 EHR for practices with 1 to 10 physicians.

Further indications of industry consolidation are the KLAS awards for practice management software that automates scheduling, billing, and collections. Athenahealth topped the list for medical practices with 1 to 10 physicians and for practices with 11 to 75 physicians. Epic had the number 1 practice management system for groups with more than 75 physicians and the highest-rated program for patient accounting and management in hospitals.

KLAS named Epic the number 1 overall software vendor and the number 1 overall physician practice vendor.

Based in Orem, Utah, KLAS surveys medical software customers about not only the quality of the product but also the quality of implementation, training, and support. It segments the market for ambulatory EHRs and practice management systems because vendors design and price their programs for various practice sizes. In 2011, KLAS reduced the number of categories for ambulatory EHRs based on size from 4 to 3, which limited the diversity of the winners' circle.

Epic has long dominated the EHR market for jumbo group practices. The smaller practice categories over the years have been captured by vendors such as eClinicalWorks, Greenway Medical Technologies, Amazing Charts (which won the 1- to 10-physician category in 2011), and Athenahealth, the number 1 vendor in the 11- to 75-physician category last year.

Epic Noted for Excellence in Implementation

Epic's haul of so many KLAS awards does not surprise Jeffery Daigrepont, senior vice president of the Coker Group, a consulting firm in Alpharetta, Georgia. Epic dominates the inpatient EHR market among large hospitals and health systems, and they have been binge-buying physician practices, according to Daigrepont.

"Even if physicians prefer another vendor, they're forced to go on the hospital's system," Daigrepont told Medscape Medical News.

The big institutions that invest hundreds of millions of dollars in Epic inpatient and ambulatory programs have the kind of information technology (IT) staffs and other resources to successfully switch from paper to digital charts, boosting customer satisfaction, he said. In addition, executives are reluctant to criticize expensive systems that represent "an absolute commitment."

One of Epic's strengths is helping providers implement the software, said Rosemarie Nelson, a healthcare IT consultant in Jamestown, New York, who is affiliated with the Medical Group Management Association. "Hospitals need that assistance when they integrate physician groups," said Nelson.

Epic's KLAS awards are "a sign of the impact of integrated delivery systems on the healthcare IT world," she noted. "It's clearly a sign of trying to simplify connectivity among all the entities."

Nelson attributes Athenahealth's strong showing in the Best of KLAS Awards to how the company delivers its EHR and practice management software to physicians through cloud computing. The software and patient data reside on Athenahealth's computers, not the practice's, reducing hardware and network administration costs. Customers can access the program online for a monthly subscription, which is more affordable for small practices than a 1-year license.

Athenahealth, added Nelson, also brings extra value to medical practices by performing billing and collection chores that were once done in-house. "It's hard to find billing people," she said. In addition, the company mines its vast trove of billing data to analyze how third-party payers are processing claims and then shares that information with clients. "That gives Athenahealth an edge," said Nelson.

DigiView Tops in Cardiology Software

Vendors of more specialized medical software also vie for KLAS awards, and here again, Epic stands out on the leader board. The categories and winners include:

  • cardiovascular image management and reporting: DigiView from Digisonics;

  • speech recognition: Dolbey Fusion Expert/SpeechEMR;

  • radiology: Epic Radiant from Epic;

  • emergency department: Wellsoft EDIS; and

  • surgery management: Epic OpTime.

KLAS also surveys providers about healthcare IT service firms. Navicure ranked first this year for claims and clearinghouse services, and Precyse was number 1 in transcription services.

The KLAS report can be purchased on the company's Web site. Survey data on individual vendors are free if physicians complete an online survey about the medical software, equipment, or computer services they use.