EHR Replacement Trends Reveal Winners and Losers

August 28, 2014

Twenty-seven percent of medical practices are looking to replace their current electronic health record (EHR) system, according to a new survey suggesting that some well-known programs are fading in the marketplace.

In addition, another 12% of practices polled by KLAS, a healthcare information technology research firm, said they would like to replace their EHR but can't because of financial or organizational constraints.

These findings speak to more than the animus that many physicians feel toward digital charts, which are criticized for being too click-intensive and time-consuming. Forty-four percent of the 406 practices in the KLAS survey are owned by or tightly affiliated with a hospital. Such groups have little or no choice but to give up their EHR system, even if they like it, for the one deployed by the "Big House" to achieve standardization and integration, said study author Jared Dowland.

In their search for a replacement program, these captive medical practices are giving the most consideration to Epic and Cerner, 2 giants in the inpatient EHR market. KLAS ranks them among the top programs in terms of functionality, training, and customer support. These and other systems in the KLAS survey are referred to as electronic medical records (EMRs), an older term for EHRs.

The same kind of software hegemony occurs in independent medical practices, Dowland told Medscape Medical News. "In the past, if a group of 25 physicians joined a group of 150, and they used 2 different EMRs, it wasn't uncommon for the smaller group to keep its program," he said. "In some organizations, there might be 5 or 6 different EHRs in use. Now these groups are looking at one EHR for everyone."

There is another category of involuntary EHR replacement, noted Barbara Drury, a healthcare information technology consultant in Tucson, Arizona. "Some practices have to change products because their vendor went out of business, or they were acquired by another company, and the program was discontinued," Drury told Medscape Medical News.

Cloud-Based EHRs Getting Looks From Replacement Shoppers

The replacement market for ambulatory EHRs also builds on physicians disliking the systems they use now on account of poor usability, poor technical support, and cost, according to the KLAS report, titled Ambulatory EMR (Electronic Medical Record) Perception 2014. Among independent medical practices, the chief beneficiary of this discontent is EHR vendor Athenahealth, named by 34% as a possible replacement, followed by eClinicalWorks (25%). Similar to Epic and Cerner, these programs are near the top of the KLAS charts when it comes to overall value.

Athenahealth, said Dowland, first transformed the practice management software market by essentially operating as a medical office's billing and collection department. It then branched out to an EHR product that, similar to its practice management program, is cloud-based. "Their pitch is, 'If you have an Internet connection, you can turn on our EHR in minutes,' " said Dowland. He credits the company's EHR with having an up-to-date user interface.

The number 2 replacement candidate, eClinicalWorks, "has been a great success over the last 4 years," said Dowland. "They have a lot of market share." Physicians can choose a cloud version of the program or have it installed on an office server, he said.

As Web-based programs, Athenahealth and eClinicalWorks attract EHR replacement shoppers who do not want to make a big, long-term investment in the technology, perhaps because they anticipate eventually working for a hospital and using its system, noted Barbara Drury. Physicians merely pay a monthly subscription fee to access Athenahealth and eClinicalWorks in the cloud.

Industry Shakeout?

So which EHRs are getting replaced by the likes of Athenahealth and eClinicalWorks? The KLAS study points to some vendors and their products that once were market mainstays: GE Healthcare, Allscripts, NextGen Healthcare, and McKesson.

"Of respondents who recently switched to EMRs, more moved away from GE Healthcare and NextGen than any other vendors," according to KLAS. In the future, these 2 vendors, along with Allscripts and McKesson, "stand to lose more customers than other vendors, as 40% to 50% of their responding customers reported potential plans to move." The report described customer satisfaction with all 4 vendors as "relatively low."

In his interview with Medscape Medical News, Dowland noted that some of these vendors, such as Allscripts, sell several lines of EHRs systems. That approach, he said, tends to scatter corporate resources and leave customers wondering whether the company will ditch their particular product. At the same time, some of these customers are replacing their EHR with another line from the same vendor, said Drury. So these companies are still in the game.

But for how long? "There appears to be some [industry] shakeout happening," said Dowland. As further proof, he points to the drop-off in EHR vendors with systems that satisfy the ever-more-rigorous requirements of the federal meaningful use incentive program. The US Department of Health and Human Services stated on its Web site in September 2013 that 861 vendors had complete ambulatory EHR systems or EHR modules that were certified as meeting stage 1 requirements introduced in 2011. However, only 512 companies so far have had EHR products certified under stiffer stage 2 criteria (they are called 2014 edition products), although more and more vendors are making the grade, a US Department of Health and Human Services spokesperson told Medscape Medical News.

In the eyes of physicians, the 2014 edition EHRs out there are not created equal. When KLAS asked medical groups whether they are confident that their current EHR vendor will enable them to meet meaningful use requirements that go beyond having certified technology, the research firm uncovered substantial variation. Meaningful use confidence is sky high among customers of Epic (98%) and Athenahealth (94%) and very strong among eClinicalWorks customers (86%), but it falls off significantly for systems with the highest percentage of replacement-minded customers: Allscripts (76%), McKesson (71%), NextGen (71%), and GE Healthcare (68%).

The KLAS report on EHR replacement trends can be purchased on the company's Web site. Physicians who complete an online survey about the medical software, equipment, or computer services that they use can look up survey data about individual vendors free of charge.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.