I love fall! Not only for the changing colours and cool, crisp days but also for the many conferences and trade shows that take place this time of year. At the recent HealthAchieve conference, organized by the Ontario Hospital Association, for example, I learned that there is a growing trend in Canadian hospitals towards a single, enterprise-wide electronic medical record system. Experience elsewhere in the world suggests that this preference for single vendor systems over best of breed environments is fraught with challenges and runs counter to the trend in other industries.
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A new report from KLAS, a market research firm that measures vendor performance based on feedback from the user community, shows while the market for hospital EHR systems nearly doubled in 2009, only two vendors, Epic and Cerner, appeared to benefit from this market growth. According to an article summarizing major findings from the KLAS report, hospitals “want a vendor that can be a consistent and reliable partner in their efforts to reach meaningful use”. Jason Hess, author of the KLAS report, suggests that “Changes in the CIS (clinical information system the marketplace as a result of ARRA seem to have blindsided some vendors and left them struggling to stay afloat in the hospital market”.
While the US has chosen to let the market decide the vendors with whom they prefer to work, the introduction of “meaningful use” regulations is nonetheless having an impact on the US market. Vendors such as Eclipsys, GE, McKesson, and Quadramed lost more hospitals than they gained, according to KLAS and are “struggling to regain lost ground”. While Siemens and MEDITECH did not lose ground in the same as some other vendors, their growth was much more limited than either EPIC or Cerner.
Further to an earlier blog post regarding a drop in user satisfaction among ambulatory EHR (what are known as EMR systems in Canada) users reported by KLAS, data from a survey conducted by the American Academy of Family Physicians (AAFP) suggests vendor support may be a major contributor to the drop in user satisfaction.
While previous AAFP surveys have generated responses from less the 500 physicians, the most current survey elicited responses from more than 2,500 AAFP members. Some interesting results from the survey include:
- Respondents identified 142 different EHRs
- 20 EHRs identified in the survey were named by 84% of the respondents.
- 120 of the EHRs identified in the survey were named by 12 or fewer respondents
- More than 60% of respondents agreed with the statement, “This EHR enables me to practice higher-quality medicine than I could with paper charts,”
- Less than 40% agreed with the statement, “Our EHR vendor provides excellent training and support.”
So, good news is that more than half of the physicians responding to the survey felt that EHRs has a positive impact on their practice of medicine. Unfortunately, more than half of the respondents seemed to be neutral or unhappy with the support they received from their vendor. What would be interesting to know is how the 20 vendors with significant market share fared compare to those vendors with minor market share.
While the survey results do offer cause for concern, I suggest that it is likely easier to fix the support problem than it would be rework software to have a more positive impact on the practice of medicine.
An interesting study from KLAS regarding criteria that small US hospitals apply when selection an HIT system.
Some noteworthy points from this study:
- “in light of new meaningful use requirements, many community hospital executives are now considering more complex – and often more costly – IT solutions, which many providers perceive as supporting greater clinician adoption.”
- “Meaningful use requirements are forcing buyers to focus on this issue rather than cost and infrastructure, which were the much more significant criteria in the past”
- “Meditech still dominates provider mindshare for health information systems, with McKesson also gaining significant traction recently. Meditech continues to leverage its reputation as a low-cost, integrated solution, with 70 percent of providers including the vendor in their selection process”
- “Cerner, Eclipsys, Epic and Siemens Soarian are at the table more frequently due to a perceived higher potential for clinician adoption.”
- “The consideration of these traditional large hospital solutions in community hospitals has also been spurred by the shrinking opportunity for new sales among large organizations.”