Pathologists and clinical lab managers will not be surprised to learn that Epic leads the competitive electronic health record system market, as ranked by SK&A

No one will be surprised that, in one company’s rankings of the top electronic health record (EHR) systems for 2015, the number one position is held by Epic Systems Corporation. More broadly, about half the market share of EHR systems is concentrated among just five EHR vendors.

Overall Ranking of Top 10 EHR Vendors in 2015

The report from SK&A outlines the top 10 EHR vendors by overall market share during 2015 as follows:

EHR Vendor and Market Share %

1) Epic Systems Corporation  11.6%
2) eClinicalWorks   10.2%
3) Allscripts   8.7%
4) Practice Fusion   6.7%
5) NextGen Healthcare  5.5%
6) General Electric Healthcare IT  3.6%
7) Cerner Corporation   3.5%
8) Athenahealth, Inc.   3.3%
9) McKesson Provider Technologies  3.2%
10) Amazing Charts Inc.   2.3%

In its assessment of the EHR market, Becker’s Hospital Review reported that, at the start of 2014, roughly 90% of the hospital EHR market was dominated by the top 10 providers. SK&A’s newest EHR report for 2015 suggests that this hold is loosening. However, collectively, the top 10 EHR vendors still hold well over 50% of the market share.

As Dark Daily reported in 2014, the majority of the market share belongs to just a handful of EHR vendors. Many of these companies were in the top 10 ranking for 2015 as well.

In its recent report of EHR market share for 2015, SK&A, a healthcare information solutions and research company based in Irvine, Calif., noted that, as the 2016 deadline for Meaningful Use Stage 2 attestation looms, adoption and use of EHR systems has increased by multiple percentage points.

Medical Labs and Pathology Groups Must Interface to the EHRs of Physicians

Since the federal government initiated its program to increase use of EHR systems by hospitals and physicians in 2011, clinical laboratories and anatomic pathology groups have needed to devote substantial resources to developing the laboratory information system (LIS)-to-EHR interfaces needed to enable electronic lab test ordering and lab result reporting.

A further challenge has come in recent years from two developments. First, some hospitals and physicians switched their EHR systems because of the need to qualify for Meaningful Use Stage 2. Second, hospitals continue to consolidate and health systems continue to acquire physicians groups. In all of these situations, their medical labs and pathology groups had to develop a new LIS-to-EHR interface to continue delivering lab testing services to these providers.

Combine this with facilities switching EHR vendors as solutions mature, or as healthcare systems consolidate and many clinical labs face the potential for additional substantial investment requirements to maintain interoperability and provide services.

SK&A Report_Page_4 revised

This chart was compiled by SK&A in January, 2015, so the figures are about 12 months old. Two notable insights: 1) Epic Systems Corporation holds a market share of 41.8% and 53.7% of physician groups of 26 to 40 and 40+ physicians respectively; and 2) the overall market share by practice size is dominated by the five largest EHR vendors, which collectively control more than 40% of this market segment. (Chart copyright: SK&A.)

Clinical Laboratories Caught in the Middle

According to a recent study in Health Affairs, attestation rates for meaningful use stage 2 rose nearly 35% between 2013 and 2014. However, interoperability concerns among popular EHR systems still remain.

Implementation of EHR systems is complex, even within a single care network or local system. Add in communications needs, such as ordering tests from pathology labs, receiving diagnostic results from clinical laboratories, or retrieving medical records from other facilities, and this complexity grows almost exponentially.

Even as the EHR market continues to expand and mature, 100% interoperability appears to be a distant goal. Until this goal is achieved, medical professionals, clinical laboratories, and patients will remain caught in the middle of this complicated web of interfaces and information systems.

EHR Systems and Interoperability Concerns

One point of concern for medical laboratories and anatomic pathology groups is that despite the majority market share of only a few providers, there are more than 550 vendors with EHR solutions on the market. Each system has the potential to add unique requirements involving the interface, data structure, and communications to maintain workflows, and to operate accurately and efficiently.

Jon Christensen, Strategic Operations Director at KLAS, believes “marketing dynamics” have made this year’s SK&A report one of the most “unique” in years. (Photo copyright: LinkedIn.)

Jon Christensen, Strategic Operations Director at KLAS, believes “marketing dynamics” have made this year’s SK&A report one of the most “unique” in years. (Photo copyright: LinkedIn.)

While laboratory information systems might get updated to account for changes in major EHR platforms, lesser-known or lesser-used systems might be overlooked. This further complicates achieving true interoperability.

Each of these studies highlight the fact that the potential for major shifts in the market still exists. “There are a lot of interesting market dynamics that have made this year’s market share report one of the most unique in recent years,” noted KLAS Strategic Operations Director Jon Christensen.

Until the market stabilizes, interoperability standards mature, and definitive vendors emerge, clinical laboratories and anatomic pathology group practices will need to remain vigilant for changes and take a proactive approach to interfacing and communications.

—Jon Stone

Related Information:

Physician Office Usage of Electronic Health Records Software (PDF) 

50 Things to Know About Epic, Cerner, MEDITECH, McKesson, athenahealth and Other Major EHR Vendors

CPSI acquires Healthland in $250M EHR deal

Mayo chooses Epic EHR, Revenue Cycle Management System 

Healthcare Vendors Agree to Interoperability Metric During KLAS Keystone Summit

KLAS Ranks Top 10 EHR Vendors by Interoperability 

Top 10 Rankings of EHR Market Share Put Epic First as Hospitals, Physicians, and Clinical Laboratories Make Progress on Interoperability