Cerner tops Medical Economics' list of key EHR systems

EHR systems are all the rage among physician practices and healthcare networks; incentives built into the HITECH Act and the 2009 economic recovery act reward practices that install the software, and these incentives will turn into penalties in coming years if healthcare records are not digitized. As EHR use among physicians now reaches approximately 70%, a new communication channel is being created for the pharma industry to interact with physicians. The catch is, some systems expressly prohibit a pharma promotional presence, while others (especially ones that are free to physicians) depend on it.

The field is relatively chaotic, still, as systems originally devised as practice-management tools are revamped; other systems are built geared toward large healthcare networks, and still others enter the arena. According to Medical Economics, some 729 IT systems can be characterized as “EHR” in some fashion; but for its survey, only 549 of those qualify by its definition. From that list, the top 100 were selected based on a combination of usage, the financial health of the developer, and the systems’ maturity in meeting the “meaningful use” criteria that HHS uses to justify financial incentives to offices installing the systems.

The top 10 in Medical Economics’ list are:

• Cerner Corporation
• Epic Systems Corporation
• Allscripts
• NextGen Healthcare Information Systems, Inc.
• athenahealth
• GE Healthcare
• eClinicalWorks
• McKesson
• Abraxas Medical Solutions (Merge Healthcare)
• Vitara Healthcare Solutions

The financial might of these firms varies widely. Cerner, Epic and Allscripts each generate revenue of over $1 billion; then the revenue drops to about $400 million for NextGen, and the others tail off into the $100-200-million range.

Pharma’s perspective

Many of the systems on the top 10 list do not expressly prevent pharma industry input, but frequently that input needs to enter by way of engagement with other companies that do interact directly with pharma marketers. For example, athenahealth (No. 5 on Medical Economics’ list) acquired Epocrates, the online drug-information service, this year. In another case, PDR Network (which has just announced “PDR+ for Patients,” a service that provides patient-education content within the workflow of a physician’s EHR system, so that the physician could choose to deliver or link that content to a patient at the point of care) now has a “PDR Certified” network of 28 leading EHR vendors (representing over 200 EHR platforms). By contrast, Practice Fusion, an up-and-coming EHR vendor, is targeting individual physician practices with a free, advertiser-supported EHR system. (The company recently won $70 million from private-equity investors in its latest round of financing; it is No. 12 on Medical Economics’ list.)

EHR systems are being driven from Meaningful Use I to Meaningful Use II over the next year, which will entail more support of e-prescribing, patient contact and, most significantly, some evidence of interoperability between separate EHR systems. That, combined with the increasingly competitive marketplace, is driving some consolidation of vendors. Greenway Medical Technologies is merging with Vitara Health Solutions (Nos. 13 and 10, respectively, on the list), in a $644-million deal announced last month. Quality Systems, the owner of Nextgen Healthcare (No. 4) is acquiring Mirth Corp. which specializes in healthcare-IT integration.

Besides being a marketing communications channel, EHRs will represent a dramatically higher potential for understanding patient journeys, noted Patrick Howie, manager of data integration and analytics at Merck, at the Commercial Data Congress this week (CBI Events, Oct. 28-30). “There are numerous compilations of patient records available now, but EHR systems will provide richer data about patient lives, and will bring together patient therapies with the labs and test results that determined those therapies,” he said. But the fulfillment of this potential will be years in the making.