The market for electronic medical records (EMRs) topped $30 billion in 2018 and continues to grow, according to a new report on the industry by market research firm Kalorama Information. The report, “EMR 2019: The Market for Electronic Medical Records,” states that the market for EMR was $31.5 billion in 2018. The Kalorama report includes revenues for EMR systems, computerized provider order entry (CPOE) systems, and directly related services, such as installation, training, servicing, and consulting, which are key profit areas for companies. It does not include picture archiving and communication systems (PACS) or hardware.

This growth comes in a time when EMRs are portrayed as time wasters, stress causers, and, even according to one major media account, killers, Kalorama noted. The market research firm has conducted a dozen studies on the market since 2007, and it has seen the industry reckon and sometimes fail to reckon with issues of usability and interoperability.

“Years ago, there were warning signs that usability — especially the drop-down menu problem — was an issue and that EMR systems weren’t as popular with users as with institutional buyers,” said Bruce Carlson, publisher of Kalorama Information. “Those have accumulated, so a few drop-down menu complaints have surged to the point where now news accounts are linking it to larger issues, such as physician burnout.”

The EMR is a computer-based patient medical record. Over the last 30 years, medical institutions have encouraged the shift toward computerization to help manage patient information. Adoption surged after government incentives encouraged hospitals and physicians to purchase and use EMR systems.

Now the EMR industry is facing criticism:

  •   Wasted provider time? First-year internal medicine residents spend 43 percent of their day on average on EHR use and ultimately spend more time in indirect patient care than interacting with patients. This finding comes from a recent JAMA Internal Medicine study by Chaiyachati, MD, et al. Chaiyachati and her team of researchers from the University of Pennsylvania and Johns Hopkins University conducted a direct observational secondary analysis of internal medicine interns at six university-affiliated and community-based internal medicine programs. The researchers completed a cluster randomized trial comparing the activities of 80 interns across 194 shifts for a total of 2,173 hours. The team observed and collected time motion data across daytime, nighttime, and call shifts from March 10 to May 31, 2016. Numerous other studies, including a study published in the Annuals of Internal Medicine in 2016, have identified that for every hour physicians interfaced with patients, it took two additional hours to interface with the EHR and perform desk work.
  • Physician burnout? Physician burnout continues to be a significant issue facing the healthcare community and healthcare IT participants. EHRs are constantly implicated as a top burnout factor. Additionally, a new study published in the Journal of the American Medical Informatics Association indicated that the stress from using EHRs is associated with physician burnout, specifically for general practitioners, primary care doctors, and pediatricians.
  • Worth the Trouble? A study conducted by researchers at Stanford University found that EMRs did little to improve the quality of care. Although they seem on the surface to have the ability to improve quality of care by coordinating care and not duplicating some aspects of care, these systems are complicated and are being used by individuals with little formal training and, consequently, might not have made full use of the system.
  • Negative patient outcomes? A recent article in Forbes, titled “Death by a Thousand Clicks: Where Electronic Health Records Went Wrong” (http://fortune.com/longform/medical-records/), cited patient safety risks tied to software glitches, user errors, or other flaws.

Articles that criticize the EHR tend to avoid a historical comparison to the days of paper-based records, and that’s partially because it’s hard to document those errors. EHRs in an odd way provide their own spotlight on their failures, whereas paper record errors would require extensive manual review to find — the very type of work EHRs sought to replace.

Paper records required lots of storage and real estate costs, labor costs in retrieving, and opportunity costs in not being available when needed for care, Kalorama noted. While they could not be hacked per se, paper records could be stolen, lost, ruined by leaking water, or improperly disposed of. But in most parts, it was the lack of accessibility that made them less than useful, even if they were safe.

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

The EMR market is competitive, with over 700 providers; however, increasing mergers and acquisitions in the industry will result in reducing the number of competitors. Local and country-specific vendors were counted in the total number of EMR providers but were not considered as major players participating in the worldwide market. Companies remain competitive by offering high-quality solution packages to private practices and hospitals.

 Still, EMR systems need to show long-term productivity results, and vendors need to be more aware of their public image, according to Kalorama.

Other findings in the EMR market report:

  • The market for EMR systems continues to grow but at a slower rate, as more physicians and hospitals use EMRs and acquire EMR systems and as hospitals and physician groups upgrade existing systems.
  • Mergers and acquisitions are impacting industry in a big way. According to industry experts, the number of mergers and acquisitions has increased 15 percent over the past year with private equity firms gathering the lion’s share of deals.
  • Artificial intelligence in healthcare is an exciting new prospect gaining attention, and many feel that it is the future of healthcare. Future prospects include health assistance and medication management, precision medicine applications, drug creation, and helping people make healthier choices and decisions.
  • Cerner has the largest share of the EMR market; however, many opportunities remain for other companies and new entrants. There is still not a single system that is complete with true interoperability. The main drawback for smaller companies is the cost to enter the market with a certified product.

For more information, the Kalorama Information report – EMR 2019: The Market for Electronic Medical Records is available.