Basic Economics – EHR Market Share

EHR Market Share – When Enough is Enough

At what point should capitalism allow itself to run rampant? My thoughts on the EHR market share

Disclaimer: I am not versed in economics at ALL. So please take everything in this post with a grain of salt, it’s only based on my observations and what I have read from various articles. I am not saying that these articles are 100% correct and unbiased either, but these are just my OWN thoughts. I don’t intend to use names but only statistics but if for some reason, a representative of an EHR company parses through Google search results and happens to stumble upon this post,  feel free to comment or contact me through the form if you have any qualms and want to discuss.

We’ve got a badass over here

Source: Becker’s Hospital Review

It’s basic economics and capitalistic to allow companies to dominate and fight for market share right? But at what point is it no longer acceptable when only a small handful of companies are dominating a majority, no 90% of the market? At what point can we allow companies undercutting others, especially when these other alternatives are actually providing better solutions but lack the visibility? I understand that it is about private market and private competition, but in all honesty, it seems to be more about “socialized production with privatized appropriation” … in that production can be done by a large number of people collectively, but whose value is appropriated as though it were done by one person. Now, don’t get me wrong, capitalism is a great economic system as it can really provide more benefits than disadvantages, however in this healthcare industry, it has been manipulated and perverted into becoming a loophole to abuse market share. Capitalism is meant to maximize production and encourage development and innovation in order to strengthen society and the country but it is controlled by private parties. Now, enough of my economics 101. There’s literally a blog called “Medical Economics. In general in order to understand a little bit more about the beneficial/original aspects of implementing EHR, let’s take a little trip back to 2005. WOOOSH. There. Rand researchers had predicted in 2005 that HIT could save U.S. healthcare more than $81 billion per year. Fast forward 7 years, 2012. WOOSH. Nope, not yet. Where is it? I want muh moneh. Oh but look, spending has grown by $800 billion due to EHR implementation. It failed.

Due to HITECH, it led to an AMAZINGLY crapton of EHR software that was meant to fulfill Meaningful Use, but not necessarily take into account its users. In a sense, it’s led to an unsurprising amount of fragmentation. The faster a company could push out a complete suite that fulfilled Meaningful Use, meant the faster hospitals and providers could gain the stimulus incentives. As a result, as the early bird got the worm, the bird kept going back to that same hole where the early worm came out, and GOBBLED it down. However, as more birds learned, they realized they couldn’t compete over the same hole so they picked the best holes, and they ended up getting 90% of the worms each morning. These incentives (worms) ended up creating an brawl for dozens of immature EHR products (birds), and only the fattest could dominate because they took up all the space at the wormhole.

EHR Market Share Distribution

Although the graph above shows the dominating EHR companies in the market, it’s still very difficult to pin down the exact market share because metrics are very difficult to aggregate and the current measure, Meaningful Use Attestations, has its limitations. Any other metric is either not available, like sales data, or vendors use different methods of calculating their customer bases: users? providers? practices? etc.

Does this mean that these companies are providing the best solutions? Nope. In fact, they’ve be likened to “Microsoft Office” in that the only reason it’s so popular is because of the range of services that are provided. By providing a wide array of software, there is a huge flexibility and availability for these health systems instead of having to pick and choose from a variety of vendors for different specializations and uses, the larger companies provide 100+ kinds of software that are connected with each other and do not require a separate learning curve. However, most of the time it is a “copy+pasta” technique, and these “specialized” software packages don’t really improve efficiency at all, and if anything can even detract from the purpose. Pediatrics is a hugely affected area because EHR did not account for weight-based dosing, which is vital for kids to aid with calculating medicine dosages. In fact, another study found that pediatricians are typically one to two years behind other providers in terms of adoption rates because the systems did not accommodate these specialists with the needed functionality.

Out of those EHR users considering a system switch, 80 percent said the solution does not meet the practices’ individual needs; 79 percent indicated that the medical practice had not adequately assessed the group’s needs before choosing the EHR; 77 percent of respondents cited solution design as ill-fitted for their medical practice or specialty; and 44 percent said vendors have been unresponsive to requests.

Damn. That's disappointing. EHR Market Share

Fortunately, consumers have indicated that they are starting to be dissatisfied with products as there has been an increasing percentage of replacing existing software. EHR replacements are on the rise, which has also spurned an ever-growing number of vendors and substitute options into the market. Although it is great that part of the market is dictating certain trends and alternatives, it is the stabilized percentage that must be shifted for a greater impact to be had. Even over the years, there has been very little shifting in the ranks and the Top 10 from 2012 are still the Top 10 today in 2016. However, back in 2013 was a year of the great EHR vendor shift, 31% of the active EHR adopters had said they were dissatisfied and considered making a change, and 17% of those active EHR adopters said they would be switching it within the first year. Since then, there has been a growth of vendors that have been known to be dedicated to addressing customers’ current demands and rather quick on fixing issues and improving usability.

Most concerning to current EHR users are unmet needs for sophisticated interfaces with other practice programs, complex connectivity and networking schemes, pacing with accountable care progresses and the rapid EHR adoption of mobile devices, the report finds.

For the top EHR vendor currently, in both inpatient and ambulatory markets, that vendor holds the market plurality. However, when a vendor is able to assert such market dominance, it could possibly stifle EHR and Health IT innovation. Having such big name contracts under its name, it’s not surprising that such a high-profile company has attracted several notable critics. As I mentioned earlier, when does capitalism become unregulated? And when should interventions happen? Now people believe it is the way of the market, free range of competition, and alternative solutions. However, what happens when such a big company begins to use its influence to limit consumer options and hold back technological advancement? The reason for that is because these vendors do not necessarily play with a “LET’S GO TEAM” attitude and is typically using its own proprietary software, framework, and technologies which unfortunately only drive internal innovation. This can limit the development of new ideas as well as becomes an innate road block to interoperability (more on that later on). Thus, these vendors could actually end up setting the new standards for EHR systems instead of Meaningful Use and other government mandated requirements.

Source: EHR Users Unhappy – Many Switching and Source2 (Title Omitted For Anonymity Click At Your Own Risk)

I truly believe that in order to see progress, increased efficiency, happiness, and better health outcomes ALONG with reduced cost expenditures, there has to be a revamp in the EHR implementation and standards to create more standardized systems that are easier to use, interoperable, patient-centered with physician use in mind, and allow the patients access to their health data. However it is not just a vendor responsibility, but all of healthcare, and primarily the providers because they have to continue to voice their outrage in order to pressure the vendors to implement changes that actually help with workflow. Nevertheless, EHR’s purpose has been corrupted. It is now a glorified POS system (Point of Sales… I know what you’re thinking) for billing, insurance reimbursements, and administrative oversight. Heck, look at this chart:

Market Share

Now, no one can deny that healthcare is an industry, a service, and a business. There are so many steps in revenue billing and management. But is that all EHR and Health IT Is today? Is that the result and culmination of all the efforts put into improving healthcare outcomes and services? Is this really now a glorified POS system (this time, I mean the original Urban Dictionary meaning)?


Article by Sir. Lappleton III

I'm a happy-go-lucky recent graduate that started a blog as a way to not only document my education and my experiences, but also to share it with whoever stumbles upon my site! Hopefully I can keep you guys entertained as well as learn about a few things from IT as well as from my time and experiences as I plunge deeper and deeper into healthcare! A couple of my areas of focus is data management, system security (cyber security), as well as information technology policy.