This document summarizes a vendor review of electronic health record (EHR) systems for physician practices. It provides an overview of the market, including the types of practices and applications available. It then ranks the top 10 vendors by the number of EHR attestations reported to ONC, with Epic having the largest market share. The document also examines "other" smaller vendors, hospital-owned practices versus independent practices, and integrated hospital/physician systems offered by various vendors like Epic, Allscripts, and Cerner.

1. Physician Practice Vendor Review
This year’s review of physician practice
vendors has three episodes:
1. Market overview
- Types & sizes of practices
- Terminology & applications
- Market share per ONC EP attestations
- “Crossover” HIS/MD vendors
2. Top 10 Vendor review
- Founders & products,
- Target market by practice size
- # of FTEs, client base, revenue
3. “Other” vendors
- Highlights of remaining vendors
© 2017 HIS Professionals, LLC
Vince Ciotti
&
Elise Ames
HIS Professionals, L.L.C.

2. © 2017 HIS Professionals, LLC
A Bewildering Array of Vendors…
• As of July 2016 data, “only” 632 ambulatory EHR vendors are listed on
ONC’s Health IT Dashboard as providing certified EHR technology to
physicians attesting for Meaningful Use.
• This is down from the 785 listed by ONC last year. Market trends:
- Larger vendors and venture capitalists have been purchasing
small to midsize vendors, acquiring their existing customers,
letting go the most experienced (and expensive) personnel,
and then selling the acquired client base their replacement
products through strong sales & marketing.
-- Small and solo medical practices are being acquired by hospitals
and larger physician groups who mandate use of their EHR
(… usually Epic or Cerner).
- As the bar for Meaningful Use is raised, more practices are
opting not to attest for the program.
• Since many physician practice vendors are privately held and do not
release their revenue, we ranked them by the # of EHR attestations as
reported by ONC (as of July 2016):

3. © 2017 HIS Professionals, LLC
Leading Physician Practice Vendors – EMR Attestations*
Rank Vendor
# of 2016
Attestations
% of ≈366K
Total
1 Epic 83,674 22.8%
2 Allscripts 33,123 9%
3 eClinicalWorks 25,521 7%
4 NextGen 19,674 5.4%
5 GE Healthcare 17,703 4.8%
6 Cerner 15,100 4.1%
7 athenahealth 14,570 4%
8 Greenway 12,707 3.5%
9 Practice Fusion 8,522 2.3%
10 McKesson 7,346 2%
* Based on ONC’s latest “Health IT Dashboard,” with data as of July 2016.

4. © 2017 HIS Professionals, LLC
Market Share of Leading Vendors
• “Other” comprises 122K attests by 622 vendors besides the
top 10, showing the wide diversity of the MD practice market!
• This pie
chart nicely
illustrates
the leading
vendors’
market
share,
• And Epic’s
enormous
lead over
the other
competitors.

5. © 2017 HIS Professionals, LLC
Changes from Last Year
The tables below show vendor attestation ranking changes from 2015 to 2016
In upcoming episodes in this series, we speculate on causes of
these changes for each vendor…

6. © 2017 HIS Professionals, LLC
Who are the “Other” vendors?
• With 35% of the physician practice EHR attestation total, the “other”
622 vendors comprise the largest slice of the pie:
– They are much smaller vendors in terms of annual revenue, # of
FTEs, # of clients, size of client practices, length of PowerPoint
presentations, commission % for sales reps, HIMSS booth, etc.
– They dominate the smaller physician practice market, which us
commonly broken down into three rough segments:
• Small = 10 or less physicians
• Medium = 10 to 50 physicians
• Large = 50 or more physicians
– Bigger vendors tend to sell to larger sized practices to maximize
their revenue, just as large HIS vendors sell to IDNs & AMCs.
– The largest of these “other” vendors are listed on the next slide,
which is also based on ONC attestations from July, 2016:

7. © 2017 HIS Professionals, LLC
“Other” physician practice EHR vendors
• After the “Top 10,” here are the next 40 leading vendors of physician practice EHRs:

8. © 2017 HIS Professionals, LLC
Hospital Owned vs. Independent Practices
• One more layer in this complex physician market is the type of practice ownership:
– Hospital-owned practices – an increasing trend for population health, which tend
toward vendors with an integrated HIS, the leaders being Epic, Allscripts, &
Cerner, which have been joined by athenahealth and eClinicalWorks in 2016.
– Independent practices - owned by physicians – more likely to acquire systems
from vendors without an HIS, like NextGen, Greenway, Practice Fusion, etc.
• Epic is seen predominantly in large hospital-owned practices in multi-hospital IDNs
and AMCs, where the hospitals and practices share a single HIS/EHR database.
– Many HIS vendors allow hospitals to extend licenses to community physicians,
which facilitates transitions of care and makes the plan of care available to all
providers. Physicians that use vendors like Epic in large hospital-owned
practices seem happy with this approach, but they have no choice…
• Large independent practices lean towards MD specialists like Allscripts and NextGen.
– For eligible providers (EPs) attesting in 2016, Allscripts Enterprise or
Professional was the 2nd most frequently reported as the certified EHR installed.
• Cerner – the leading HIS vendor in terms of annual revenue, that also offers an
integrated PM/EHR system – came in only 6th for physician attestations
– 22% of EPs attesting for MU in 2016 reported using Epic’s EpicCare, vs. only 4%
reporting Cerner’s PowerChart as their primary EHR.

9. © 2017 HIS Professionals, LLC
“Integrated” HIS & Physician Practice Systems
 Pioneered by Epic several decades ago, integrated hospital/physician
systems are now offered by a growing number of HIS Vendors.
- Not just interfaced through IEs (Interface Engines) or APIs, but running in
the same programming language, data base, servers and OS
- Unlike early (& poorly) interfaced systems such as Siemens’ (SMS)
Signature, McKesson’s Practice Partner, and Meditech’s LSS
 Epic has been joined by a number of vendors, in rough chronological order:
- Allscripts acquired Eclipsys’ “Sunrise” integrated system in 2009, (not to
be confused with their standalone “Enterprise” & “Professional” systems).
- Cerner, the HIS giant, uses the same Oracle data base for its HIS & MD
systems, but is not quite as popular in physician practices as in hospitals.
- athenahealth’s “One” was acquired from RazorInsights in 2015 and
since re-written as part of their totally integrated cloud-based system.
- Meditech’s Release 6 integrated MD system released in 2016, and now
running in scores of pilot hospitals and their physician practices.
- eClinicalWorks – claims to have their 10i “in the works” with 4 pilot
hospitals due to come live by year-end 2017 or early in 2018…

10. © 2017 HIS Professionals, LLC
“Crossover” HIS and MD System Vendors
Only Epic scored high on both sides of the HIS and MD markets:

11. © 2017 HIS Professionals, LLC
Next Week
 In our next episode, we’ll review each of these top 10 physician
practice vendors in depth:
- Founding and history
- Merger & acquisitions
- Product lines & target size practices
- Annual revenue (if available)
- Client base & # of FTEs
 Please send any questions or comments to:
- Elise Ames
- 413.329.6925
- eames@hispros.com
• Send any complaints or threats to:
- Vince Ciotti
- 505.466.4958
- vciotti@hispros.com