Top 100 EHRs: Why understanding a company’s financial performance today may influence purchasing decisions tomorrow

This information is part of a Medical Economics exclusive ranking of the top 100 EHR companies. (medicaleconomics.com/top-100-EHRs)

The best government estimates are that 729 companies offer certified electronic health record (EHR) systems targeting medical providers.  

Software companies operating in this space range from publically-traded companies to start-up enterprises and everything in between. 

While many industry experts believe the next phase of the EHR evolution,  interoperability, will unlock communication pathways between primary care and specialists, it may also facilitate consolidation of the market simply because some companies won’t be able to clear the technological and regulatory hurdles of the government’s 2014 incentive program, conversion to the International Classification of Diseases-10th revision (ICD-10) or the development costs to make it happen.

It is clear that physicians are mostly dissatisfied with the usability and functionality of their EHR systems. In fact, a recent Black Book survey says that close to 80% of doctors surveyed say that EHR systems are not meeting their needs. Physicians are under increasing pressure to demonstrate efficiency and productivity, and therefore need these systems to offer real access to intelligence to run their medical practices, manage patient panels, and meet the economic and clinical challenges in 2014 and beyond.  Future viability of these systems has become increasingly important to physicians.

While there are key surveys in the market that gauge user experience as a basis of evaluating these systems, the editors of Medical Economics thought it necessary to take a closer look at the financial health of companies operating in this sector, especially as new hurdles and deadlines approach in 2014 for the government’s EHR Meaningful Use 2 program and even the conversion to ICD-10.

Our top 100 EHR list is sorted principally by company revenue. Industry watchers believe the next market phase will force consolidation or closure of weaker EHR companies, so monitoring the financial health of these companies takes on greater significance for physicians. Practice management experts advise that physicians should have contingency plans in place especially related to migrating patient data.

SEE THE TOP 100 EHR LIST

During the information gathering phase of this project, Medical Economics editors discovered that basic financial information about public and private HIT companies was difficult, and in some cases, impossible to obtain. Of course, our inquiries about these systems looked at many other criteria as well including Meaningful Use 2 certifications, estimates of users, system capabilities, platform, and other areas.

As part of this editorial project, we pulled together the universe of 729 complete EHR systems, using a variety of sources including  the U.S. Department of Health and Human Services. From that pool, we found great disparity in the types of systems categorized as complete EHR systems. This universe was ultimately culled to 549 companies. 

Surveys were sent to vendors offering complete EHR systems in the summer of 2013. By the close of the project, only  56 of the companies represented on this list responded to survey requests. Editors followed up with telephone calls, interviews, and Web searches, and employed data- gathering means through financial reporting services to come up with this top 100 list.

The challenges in gathering this information were very real. Moving beyond basic financial questions to get a sense of a system’s functionality, capabilities, and platforms took legwork-a lot of it.

Our inquiries demonstrated:

• There are some excellent companies operating in this space that clearly believe in the product and services they are marketing, and make a great deal of information available on their Web sites to help physicians in this evaluation. They  make it easy to find important details about the system’s functionality, target, capabilities, platforms, pricing, company history, and other criteria to help evaluate these systems. The majority of health information technology (HIT) vendors, however, make it far too difficult for physicians to evaluate their products and services.

• If an HIT vendor cannot build a useful, easy-to-navigate Web site, do you think its EHR system will be any better? We have included links to our top 100 EHR list to help you in your evaluation. 

• Size matters, especially during a period of rapid consolidation. With that said,  some excellent smaller operations are making big waves. Just look at the list of those certified for Meaningful Use 2.

And if you find yourself shopping for an EHR system for the first time, or because you are filing for an EHR divorce, be sure to ask about the financial health of the operation, number of other providers in the system, and how the system will handle Meaningful Use 2 requirements if not already certified.

Even if you don’t take advantage of the government’s incentive program to use EHR technology, operability and the ability to better monitor patient populations represent the future.

How we got our data

This Medical Economics project started in the summer of 2013 and concluded on October 10, 2013. Here is how the editorial team approached gathering accurate annual revenue and other data presented in this report:

1. Companies were given the opportunity to self-report their revenue figures and other data by filling out a survey provided by Medical Economics.

2. When EHR vendors did not fill out the survey, editors obtained revenue from interviews with company officials, annual reports, and press releases.

3. Revenue estimates were used when editors could not reach the company or if the company declined to provide information. These estimates were culled mostly from Hoovers, though some came from major business media reports. 

4. If a company provided a revenue range, editors used the low end of that range.

5. Some companies provided Medical Economics with revenue figures for our internal deliberations only. Those are marked as “embargoed” in the list.

Information on system specification, certification, and meaningful use were obtained from the Office of the National Coordinator for Health Information Technology Certified Health IT Product List, company surveys, press releases, major business publication reports, and other publicly available data.