Digitized Medicine

Snapshot of EHRs Used in Texas to Achieve Meaningful Use Gives Glimpse of Regional EHR Market Consolidation

Over 400 electronic health record (EHR) vendor products are certified by the Office of the National Coordinator of Health IT (ONC), but only a handful of them are used by a majority of the physicians in Texas who have been awarded EHR incentive payments by the Centers for Medicare and Medicaid Services (CMS) according to an ONC database released last week.

Physicians who successfully meet CMS criteria that demonstrate their “meaningful use” of an ONC-certified EHR become eligible for incentive payments up to $44,000 over 5 years under the Medicare program or $21,500 over 6 years under the Medicaid program. The ONC database includes the records of 21,697 physicians who have received EHR incentive payments so far, de-identified by physician but including the physician’s EHR product name, the physician’s state and whether payment was received through the Medicare or Medicaid programs. There are 217 EHR vendors listed as having products that had been used successfully by at least one eligible physician.

In Texas 1,585 physicians have received EHR incentive payments according to the database. Although 75 different ambulatory EHRs were used by at least one physician, only six of them were used by more than 100 physicians. These six EHRs account for 69% of the EHRs used in Texas to achieve meaningful use.    They are listed here with the number and percent of physicians using each to achieve meaningful use:

• Epic 277 (17%)
• eClinicalWorks 249 (15%)
• e-MDs 177 (11%)
• Allscripts 170 (11%)
• Athenahealth 128 (8%)
• NextGen 114 (7%)

The following graph displays the 25 EHRs that at least 10 Texas physicians have used to achieve meaningful use payments (click to enlarge):

There are 50 other EHRs used by less than 10 physicians in Texas who have successfully attested for meaningful use incentive payments.   These are listed at the end of this blog.

Across the nation Epic is the early leader with over 25% of physicians using it to achieve meaningful use. The top five EHRs nationally–Epic, eClinicalWorks, Allscripts, athenahealth and Community Computer Services–are used by nearly 49% of the physicians.    The top 13 EHR vendors nationally are used by more than 75% (see list below).   There are variations in regions across the nation, though, as seen with the Texas data.

It is interesting to note in Texas that the first three of the top six EHRs used to achieve meaningful use–Epic, eClinicalWorks and e-MDs–are all private companies.   The other three are public companies–Allscripts, NextGen and athenahealth.  They all all generally have positive reputations and perennially receive a variety of “Best in KLAS” rankings.    Epic’s ambulatory EHR is used primarily by physicians affiliated with large health centers and is not currently a feasible option for many small practices in rural Texas.    Athenahealth is marketed as a web-based EHR, but the others can be web-based as well.   Although e-MDs is popular nationally, their market share in Texas benefits from their headquarters being located locally in Austin.    

In the past decade many speculated that CCHIT certification of EHRs, which is more comprehensive than the ONC-certification for meaningful use, would spur a consolidation of what is currently a disperse EHR market with hundreds of vendors supplying products.  Others felt that free market forces, with physicians in the center creating demand for EHRs that worked well, would eventually swing the pendulum toward consolidation.   It is still early, but the data set in the ONC database gives a provocative glimpse at the EHR market forces in play today.  There is clearly some consolidation around a small number of EHR products after the first year of the CMS EHR Incentive Program.    I suspect physician demand for EHRs that simplify their ability to receive incentive payments will continue to play a significant role in swinging the EHR market pendulum towards consolidation over the next decade. 

 

Additional data:

The top 13 EHRs used by physicians nationally for EHR incentive payments were:

#Providers         Vendor Name

6330                     Epic Systems Corporation

1847                    eClinicalWorks LLC

1502                    Allscripts

1158                    athenahealth, Inc

999                      Community Computer Service, Inc.

921                       GE Healthcare

899                      NextGen Healthcare

770                      e-MDs, Inc.

712                     Greenway Medical Technologies, Inc.

567                     Cerner Corporation

565                     Sage

397                     BioMedix Vascular Solutions

252                     AmazingCharts.com, Inc.

 

The following 50 vendors had less than ten physicians in Texas using them to achieve meaningful use incentive payments:

Meditab Software, Inc.

HealthFusion

Pulse Systems

Altos Solutions, Inc.

Integrated Health Care Solutions

MED3000, Inc

Waiting Room Solutions

BizMatics Inc

Compulink

Crystal Practice Management

digiChart, Inc.

NexTech Systems Inc.

American Medical Software

ICANotes, LLC

MicroFour, Inc.

Prime Clinical Systems, Inc.

ADP AdvancedMD

Altapoint Data Systems, LLC

Ingenix

Intivia, Inc.

MedPlus, A Quest Diagnostics Company

MTBC (Medical Transcription Billing Corporation)

Nuesoft Technologies, Inc.

Spring Medical Systems, Inc.

SuiteMed

UnisonCare Corporation

AllegianceMD Software, Inc.

Cerner Corporation

CodoniX

CureMD Corporation

Data Strategies, Inc.

DoctorsPartner, LLC.

DrChrono.com Inc.

DrFirst

EMRlogic Systems

Encite, Inc.

Exemplo Medical LLC

E-Z BIS, Inc.

gMed, Inc.

Health IT Services Group

Insight Software, LLC

Medical Office Online, Inc.

MedInformatix, Inc

MedLink International, Inc

Medrium Inc.

Midwest Software, LLC

MPN Software Systems, Inc.

Net Health Systems, Inc.

Sammy Systems

WellCentive

Bipartisan Health IT Support and ARRA Insulate EHR Incentive Funds From Budget Cuts

A physician colleague recently asked me why I am confident that CMS will not cut off EHR incentive funding in the future.   This question is important to him and other physicians who plan to qualify for up to $44,000 in CMS incentive payments by achieving the meaningful use of EHRs.   They fear that the dragging economy and political discord will result in budget reductions that will cut this and other important health IT funding programs.    What I see, though, is a decade-long track record of bipartisan support for health IT initiatives and a 2009 federal law that requires CMS to provide funding for the EHR incentives and other health IT programs.

In his 2004 State of the Union speech President Bush envisioned the adoption of EHRs for all Americans by 2014.   Since then bipartisan support at both the state and federal levels for health IT initiatives toward the achievement of that vision has held strong.   At the federal level CMS  not only established a new office in 2004 to support health IT, the Office of the National Coordinator of Health IT (ONC) but has also increased funds to support ONC initiatives which promote the adoption and use of EHRs.  CMS works collaboratively with ONC and has consistently shown an understanding that the broad adoption and effective use of EHRs are necessary to better manage spiraling healthcare costs.   CMS understands that the data captured by EHRs is superior to claims-based data when attempting to analyze quality and establish benchmarks.    Physicians have long complained that claims-based data is incomplete and does not fairly demonstrate the quality of care they provide.     EHRs must be broadly adopted in order to capture accurate and meaningful data that can then be used to improve quality or save costs.  

It is important to recognize that CMS is required to provide EHR incentives to physicians by law.   Specifically, the $800 billion American Recovery and Reinvestment Act (ARRA) of 2009, commonly refered to as the Stimulus Bill, allocates over $36 billion to health IT programs through the Health Information Technology for Economic and Clinical Health (HITECH) Act.   This funding includes an estimated $34 billion for the Medicare and Medicaid EHR Incentive Program and over $300 million to support state-wide health information exchange efforts.

In order to cut funding for EHR incentives, this means that bipartisan support would have to be garnered in the House and Senate to rescind ARRA or part of ARRA.   The intent of ARRA  initiatives is to stimulate economic activity and produce jobs.   In the current economic environment it would seem very risky, perhaps even foolish, for a politician to drum up support for new legislation that eliminates economic stimulus activity, especially if that activity is already producing jobs.

So, is the EHR Incentive Program stimulating the economy and producing good jobs?   I am not an economic expert, but from what I see around me the answer is clearly, "yes".    I see job openings in the local paper for healthcare system IT analysts and other staff, I speak with IT consultants most of whom are actively seeking personnel, I hear about physician offices investing into the economy $10,000-$70,000/doctor to implement EHRs or upgrade other office technologies, I read about physicians receiving $44,000 federal incentive payments and about hospitals receiving larger amounts, some of which is surely returned into local economies.  The graph below is a composite view of the 3-year stock performance of the health IT sector since 2009.   EHR vendors and other health IT companies appear to be thriving well since ARRA was passed despite the depressed economy.

I suspect that several years from now when experts analyze the impact of the $800 billion stimulus package, the puny $36 billion provided to health IT initiatives through the HITECH portion of ARRA will go down as perhaps the most bang for the buck in terms of stimulating the economy.  

The EHR incentive funds appeared to be well insultated from budget cuts for these same reasons. 

Texas Medical Association video provides in-depth look at meaningful use, how RECs can help physicians

This video does a good job of describing Meaningful Use, the electronic health record (EHR) incentive program and how the four regional extension centers (RECs) in Texas leverage federal grants to subsidize services for physicians that help them select/implement or upgrade an EHR, and then use their EHR to improve quality of care and meet the Meaningful Use requirements.  

The four RECs in Texas currently charge primary care physicians only $300 for consulting services valued at $5,000.  These services include:

o    Select and implement a certified EHR (or upgrade your current EHR to a certified version)

o    Optimize your practice workflow,

o    Achieve meaningful use,

o    Qualify for EHR incentives, and

o    Obtain CME credit hours