KLAS: Growing number of ambulatory EMR vendors creating competitive market

Although the relaxation of the Stark Law and the passage of the economic stimulus package have motivated hospitals to subsidize ambulatory EMR adoption for affiliated physician practices, it is challenging for EMR vendors in the small physician group practice space to translate their success to hospitals or large physician groups, according to a new report from health IT research firm KLAS.

Despite predictions of mass consolidation in the market, new ambulatory EMR vendors have proliferated, according to KLAS. There has been some consolidation, as in the case of Misys and Allscripts, but a tremendous number of EMR options remain on the market today, with new vendors frequently entering the market. The unique needs of various clinical specialties and the capability of physician groups to commercialize their home-grown products continue to fuel the market's growth.

Also adding to the market, the report said that the stimulus package has motivated physician groups that have been hesitant before to seriously consider the financial incentives now tied to EMR adoption.

The report found that the same group of vendors dominates provider mindshare. Though there are many options for providers to choose from, there are a group of vendors that shows up consistently in ambulatory EMR discussions, regardless of the size of the physician group, including Allscripts, eClinicalWorks, GE Healthcare and NextGen Healthcare.

Although vendors rarely take an EMR that is proven in the small physician practice space and successfully adapt it for large physician groups, eClinicalWorks is the latest in a short line of vendors to have started in the small physician practice market and make significant headway in the large physician group market, KLAS said. NextGen has made this transition, as has GE. Greenway is starting to gain more consideration in the larger end of the market, but has yet to gain significant mindshare there.

In this report, 197 respondents were asked what steps their organizations were taking to leverage the Stark changes--54 percent of respondents were doing something in relation to Stark, 28 percent had hospital commitments to fund an EMR and 26 percent were exploring or discussing Stark-related options. (All of the data collected for this research were gathered before the stimulus package was signed into law.)

For practices in the 100-physician member segment, the respondents revealed that Epic continues to dominate the large ambulatory organization market, where integration is the key consideration. Of respondents interviewed, 42 percent would put Epic on their short list, which is a wide margin over the next most considered vendor, Allscripts, at 25 percent.

For this same market, Allscripts and NextGen are mentioned by one out of every four respondents in the large end of the market with their products defined as "scalable solutions that are flexible and robust." Their downside is the lack of an integrated inpatient EMR and for Allscripts, an unproven practice management (PM) solution for this space, according to respondents. GE also makes the list, mentioned 23 percent of the time. GE's solution scales across the entire market and is user friendly, the report noted. KLAS also said that GE is replaced most often among large physician groups in this study sample, in part because they were one of the first vendors to market with MedicaLogic's Logician many years ago.

For organizations with 26-100 physicians, Integration to an inpatient solution becomes somewhat less important, and functionality trumps integration, according to KLAS. In this context, NextGen leaps to the head of the pack with 41 percent mindshare. NextGen's integrated EMR/PM allows a large physician group to customize the solution to suit a variety of specialties, while also handling the billing and other operational needs of the organization. NextGen was also most frequently mentioned as "the vendor to avoid in this space due to the complexity and cost of their product."

For practices with six to 25 physicians, NextGen asserts itself with a mindshare lead yet again, at 32 percent. KLAS noted that in their research NextGen was mentioned more than any other single solution for consideration, which is "quite a feat considering that NextGen has no legacy client base to leverage." Second to NextGen is GE, which also received a large mindshare percentage in this physician space (25 percent) and throughout this research.

Additionally, KLAS pointed out that more vendors are now offering more ASP model solutions than before. The provider market is responding favorably to vendor-hosted solutions--42 percent of respondents said they would definitely consider an ASP or remote-hosted EMR, and a further 22 percent might consider such an arrangement. Many of the large clinical vendors, such as Cerner and Siemens Healthcare, already offer ASP solutions on the inpatient side.