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Clinical Laboratories and Pathology Groups

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Clinical Laboratories and Pathology Groups

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EHR Sales Reached $31.5 Billion in 2018 Despite Concerns over Usability, Interoperability, and Ties to Medical Errors

Cerner and Epic are the industry’s revenue leaders, though smaller vendors remain popular with physician groups

Sales of electronic health record (EHR) systems and related hardware and services reached $31.5 billion in 2018. And those sales will increase, according to a 2019 market analysis from Kalorama Information. This is important information for clinical laboratories and anatomic pathology groups that must interface with the EHRs of their physician clients to enable electronic transmission of lab orders and test results between doctor and lab.

The Kalorama report, titled, “EMR 2019: The Market for Electronic Medical Records,” ranks EHR companies based on revenue rather than market penetration. Kansas City-based Cerner holds the No.1 spot on the list. That may be due to Cerner’s securing one of the largest IT contracts in the federal government—a potential $10 billion deal over 10 years with the U.S. Department of Veterans Affairs (VA) to replace the VA’s VistA medical record system.

Is Bigger Better?

Kalorama’s ranking includes familiar big EHR manufacturer names—Cerner (NASDAQ:CERN) and Epic—and includes a new name, Change Healthcare, which was born out of Change Healthcare Holding’s merger with McKesson. However, smaller EHR vendors remain popular with many independent physicians.

“We estimate that 40% of the market is not in the top 15 [in total revenue rankings],” said Bruce Carlson, Kalorama’s publisher, in an exclusive interview with Dark Daily. “There’s a lot of room. There are small vendors out there—Amazing Charts, e-MDs, Greenway, NextGen, Athena Health—that show up on a lot of physician surveys.”

“The EHR is really important,” noted Bruce Carlson (above), Publisher at Kalorama. “Since there are a variety of systems—sometimes different from the LIS [laboratory information management system]—you want to make sure you know the vendors and the space.” Carlson says opportunities remain for new entrants in the 700-plus competitor space, which is expected to see continued mergers and acquisitions that will affect clinical laboratories and their client physicians. (Photo copyright: Twitter.)

Interoperability a Key Challenge, as Most Medical Laboratories Know

Interoperability—or the lack thereof—remains one of the industry’s biggest challenges. For pathologists, that means seamless electronic communication between medical laboratories and provider hospitals can be elusive and can create a backlash against EHR vendors.

Kalorama notes a joint investigation by Fortune and Kaiser Health News (KHN), titled, “Death by a Thousand Clicks: Where Electronic Health Records Went Wrong.” The report details the growing number of medical errors tied to EHRs. One instance involved a California lawyer with herpes encephalitis who allegedly suffered irreversible brain damage due to a treatment delay caused by the failure of a critical lab test order to reach the hospital laboratory. The order was typed into the EHR, but the hospital’s software did not fully interface with the clinical laboratory’s software, so the lab did not receive the order.

“Many software vendors and LIS systems were in use prior to the real launching of EHRs—the [federal government] stimulus programs,” Carlson told Dark Daily. “There are a lot of legacy systems that aren’t compatible and don’t feed right into the EHR. It’s a work in progress.”

Though true interoperability isn’t on the immediate horizon, Carlson expects its arrival within the next five years as the U.S. Department of Health and Human Services ramps up pressure on vendors.

“I think it is going to be a simple matter eventually,” he said. “There’s going to be much more pressure from the federal government on this. They want patients to have access to their medical records. They want one record. That’s not going to happen without interoperability.”

Other common criticisms of EHRs include:

  • Wasted provider time: a recent study published in JAMA Internal Medicine notes providers now spend more time in indirect patient care than interacting with patients.
  • Physician burnout: EHRs have been shown to increase physician stress and burnout.
  • Not worth the trouble: The debate continues over whether EHRs are improving the quality of care.
  • Negative patient outcomes: Fortune’s investigation outlines patient safety risks tied to software glitches, user errors, or other flaws.

There’s No Going Back

Regardless of the challenges—and potential dangers—it appears EHRs are here to stay. “Any vendor resistance of a spirited nature is gone. Everyone is part of the CommonWell Health Alliance now,” noted Carlson.

Clinical laboratories and pathology groups should expect hospitals and health networks to continue moving forward with expansion of their EHRs and LIS integrations.

“Despite the intensity of attacks on EHRs, very few health systems are going back to paper,” Carlson said in a news release. “Hospital EHR systems are largely in place, and upgrades, consulting, and vendor switches will fuel the market.”

Thus, it behooves clinical laboratory managers and stakeholders to anticipate increased demand for interfaces to hospital-based healthcare providers, and even off-site medical settings, such as urgent care centers and retail health clinics.

—Andrea Downing Peck

Related Information:

EMR 2019

EMR Market Tops $30 Billion, Despite Intensifying Criticism and Challenges

VA-Cerner $10B EHR Control Finally Gets Signed

McKesson and Change Healthcare Announce New Company Will be Named Change Healthcare

Assessment of Inpatient Time Allocation among First-Year Internal Medicine Students Using Time-Motion Observation

Kalorama Report Analyzes Global EMR/EHR Market as Tech Giants Apple, Google, and Microsoft Prepare to Launch Their Own Offerings. Will This Alter Current Conditions for Clinical Laboratories and Pathologists?

Kalorama Report Analyzes Global EMR/EHR Market as Tech Giants Apple, Google, and Microsoft Prepare to Launch Their Own Offerings. Will This Alter Current Conditions for Clinical Laboratories and Pathologists?

While approaches differ between the three companies, heavy investment in EMR/EHR and other HIT solutions could signal significant changes ahead for a market currently dominated by only a few major developers

If healthcare big data is truly a disruptive force in healthcare’s transformation, then a big battle looms for control of that data. Some experts say that the companies now dominating the electronic health record (EHR) market will soon face tough competition from the world’s biggest tech companies.

Until recently, most clinical laboratories, anatomic pathology groups, hospitals, and other healthcare providers have depended on EHR systems from just a handful of health information technology (HIT) developers. But tech giants Google, Apple, and Microsoft have been filing hundreds of HIT related patents since 2013 and appear poised to compete on a large scale for a chunk of the EMR/EHR/HIT market, according to coverage in EHR Intelligence of Kalorama Information’sEMR 2018: The Market for Electronic Medical Records” report.

How this will impact medical laboratories and pathology practices remains to be seen. Labs are sure to be influenced by coming events, since clinical laboratory test data represents the largest proportion of an individual patient’s permanent medical record. It’s important to note, though, that while most EHR/HIT developers have been motivated by federal incentives, Google (NASDAQ:GOOG), Apple (NASDAQ:AAPL), and Microsoft (NASDAQ:MSFT) are motivated by consumer demand, which increasingly dictates the direction of health technology development.

Thus, they may be better positioned to compete moving forward, as patients, physicians, and hospitals turn to precision medicine and value-based care for improved outcomes and increased revenues.

“The EMR efforts have moved hospitals from paper to digital records,” Bruce Carlson (above), Publisher of Kalorama Information, told HIT Infrastructure. “The next step is for tech giants to glean the data and improve upon that infrastructure. We’ll be talking about EHR in different ways in the next ten years.” (Photo copyright: Twitter.)

EMR/EHR Market Poised for Disruption

According EHR Intelligence, as of 2017, 97% of all US non-federal acute care hospitals and 84% of US hospitals had adopted an EHR system. Of these hospitals, more than half (50.5%) use products from just two developers—Cerner or Epic. That’s according to Health Data Management’s coverage of the KLAS report “US Hospital EMR Market Share 2017.”

However, recent interest in HIT and EHR systems by major Silicon Valley tech companies could lead to potential disruptions in the current state of the market. According to The New York Times, in the first 11 months of 2017, 10 of the largest US technology companies were involved in healthcare equity deals worth $2.7-billion. This marks a drastic increase over the 2012 figure of $277-million.

Though each company is approaching the market differently, Google, Microsoft, and Apple are all working on projects that could influence how both consumers and healthcare professionals interact with and utilize medical record data.

Of the three, Apple is the most consumer-centric with their Apple Health personal health record (PHR) integration into Apple iOS for iPhones and iPads. Microsoft, however, is working on developing analytics tools and storage solutions aimed at healthcare providers in general. And Google, through its parent company Alphabet, is focusing on data processing and storage.

Amazon also is working on its own HIT project which it calls 1492. While details are scant, HIT Infrastructure reports that the project is focused on interoperability among disparate EHR systems to improve sharing of protected health information (PHI) between providers, patients, and other healthcare providers, such as clinical labs and pathology groups. HIT Infrastructure also reported on rumors of Amazon branching into telemedicine using their Amazon Echo and Alexa platforms.

Security Concerns and Opportunities for Clinical Laboratories

According to Computerworld’s coverage of IDC research, by 2020, 25% of patients are expected to be taking part in ‘bring your own data” healthcare scenarios. Tech-savvy medical laboratories could find opportunities to interact directly with patients and encourage follow-through on test orders or follow-up on routine testing.

However, shifting protected health information to devices carried by consumers is not without risks.

“How do I know the data won’t make its way to some cloud somewhere to be shared, sold, etc.” Jack Gold, Principal Analyst with J. Gold Associates, told Computerworld. “And if I rely on an app to tell me what to do—say, take my meds—and it somehow gets hacked, can it make me sick, or worse?”

These are important questions and developments, which Dark Daily has covered in other recent e-briefings. (See, “Apple Updates Its Mobile Health Apps, While Microsoft Shifts Its Focus to Artificial Intelligence. Both Will Transform Healthcare, But Which Will Impact Clinical Laboratories the Most?” July 25, 2018.)

Nevertheless, with tech giants already developing products for the consumer market and healthcare provider industry, it’s a given consumers will soon gain greater access to their own healthcare information. Whether patients will ultimately embrace it, how they will use it, and how developers will interact with the data, is still undefined. But it’s coming and clinical laboratories should be prepared.

—Jon Stone

Related Information:

Apple to Launch Health Records App with HL7’s FHIR Specifications at 12 Hospitals

How Google, Microsoft, Apple Are Impacting EHR Use in Healthcare

Microsoft, Apple, Google Secure HIT Infrastructure Patents

How Big Tech Is Going after Your Health Care

Amazon Secret Healthcare IT Tech Team Focuses on EHRs, Alexa

Apple’s Health Record API Released to Third-Party Developers; Is It Safe?

Apple, Cerner and Microsoft Are Interested in Buying AthenaHealth: Here’s Why This CEO Says They Won’t

Apple Says iOS Health Records Has over 75 Backers, Uses Open Standards

Report: Health Systems Share Apple Health Records Feedback

Apple Is Officially in the EHR Business. Now What?

Why Apple’s Move on Medical Records Marks a Tectonic Shift

Slideshow Where the Top 8 EMRs Are Deployed

Apple Updates Its Mobile Health Apps, While Microsoft Shifts Its Focus to Artificial Intelligence. Both Will Transform Healthcare, but Which Will Impact Clinical Laboratories the Most?

Apple’s Update of Its Mobile Health App Consolidates Data from Multiple EHRs and Makes It Easier to Push Clinical Laboratory Data to Patients

Zooming Sales of Defibrillators for Home Use Signal More In-Home Medical Laboratory Testing

Informed consumers fuel double digit increases in sales of defibrillators specifically manufactured for home use

One of the fastest-growing markets in healthcare is the sale of defibrillators to consumers for home use. In fact, independent market research publisher Kalorama Information expects defibrillators for home use to be the number one growth item in the home care products industry through 2014!

Dark Daily believes the rapid growth in defibrillators for home use is an auspicious sign for the clinical laboratory testing industry. It demonstrates the willingness of consumers to take on the responsibilities for sophisticated medical procedures performed at home. That will include a wide range of medical laboratory tests, designed specifically to be used by consumers in their homes.

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