Table of Contents
ONE:EXECUTIVE SUMMARY
INTRODUCTION
INDUSTRY AT A GLANCE
SCOPE AND METHODOLOGY
USE OF EMR
Percentage and Increase of Physician Usage of EMR
HOSPITAL USE OF EMR
SIZE AND GROWTH OF THE MARKET
KEY ISSUES AND TRENDS AFFECTING THE MARKET
LEADING MARKET PARTICIPANTS
Conclusions/Highlights
TWO: INDUSTRY OVERVIEW
Introduction
The Medical Record
The Electronic Medical Record
Industry Terminology
Industry Structure
Physician-based/Ambulatory EMR Services
Age-based and Practice Distribution of Office-based Physician EMR
Adoption
Physician EMR Adoption by Region (US)
Hospital-based EMR Services
Advantages
Increased Access and Efficiency
Improved Documentation
Quality of Care
Increased Resources
Quality Assurance
Eliminates Costs
Disadvantages
Reliability
Accountability
Patient Privacy
EMR Software
Components of an EMR
Administrative System Components
Laboratory System Components
Radiology System Components
Pharmacy System Components
Computerized Physician Order Entry
Clinical Documentation
Flow of Patient Data across Various Components
Pricing of EMRs
US EMR Adoption Model
Hospitals
United States
Canada
Ambulatory
THREE: EMERGING TRENDS
Meaningful Use
Modified Stage 2
Economic Stimulus Package
Stimulus Guarantee
Information Overload
Patient Access – Blue Button Technology
Vendor Switches
Merit Based Incentive Payment System
Virtualization Technology
Storage Area Networks
Interoperability
Types of Interoperability
Dimensions of Interoperability
Benefits
CommonWell Alliance
Sequoia Project
Argonaut Project
The InteroperabilityPledge
Cloud Computing
Hybrid Healthcare Clouds
Interoperable Devices
BYOD
Accelerates
Dashboard modules
Big Data
Rise of Epic
ONC Interoperability Guidelines Draft
Mergers and Acquisitions
Professional Sports Organizations Using EMRs
Stark Law
Discreet Recordable Transcription
Health Information Exchange Update
Regional Extension Centers
Personnel Issues
Healthcare Cybersecurity
Security Breaches/Portable Devices
Ransomware
Fraud and Security Surveillance Increases
Mobile Adoption
Network for Doctors
National Physician Education Program
ICD-10 Controversy
Physician Position and Usability
Accountable Care Organizations
The Personal Health Record System
Differences in Access to PHR
Industry Survey Results
Medscape
Black Book Ratings
KLAS Survey
Captera Survey
SK&A Survey
Smart Cards Technology
Wireless Technologies
Open Source EMR Applications
Benefits of Open Source EMR Applications
Adoption Issues
Usability And Adoption
Quality of Care/Malpractice
Cost-Benefit Analysis
ROI for a Typical Physician Practice
EHR Incentive Program
Implementation Costs and ROI for Hospitals
Summary
Privacy Issues
Technology Limitations
Social and Organizational Barriers
E-Prescribing
CCHIT
Certifications 2006
Certifications 2007
Certifications 2008
Certifications 2010
Certifications in 2011
Certifications in 2012
Certifications in 2013
Certifications in 2014
Certifications in 2015
NHIN (eHealth Exchange)
Direct Pay-Per-Click (PPC) Offerings
Global Healthcare Spending Trends
Europe
Asia Pacific
The US Market
FOUR: MARKET PARTICIPANTS
4Medica
Company Overview
AdvancedMD
Company Overview
ALERT LIFE SCIENCES COMPUTING S.A
Company Overview
Products and Services
Allmeds
Company Overview
Allscripts Healthcare Solutions
Company Overview
Performance Review
Key Acquisitions, Alliances, and Partnerships
Products and Services
Key Competitors
Growth Strategy
Amazing Charts LLC
Company Overview
Aprima Medical Software, Inc
Company Overview
Key Acquisitions, Alliances and Partnerships
Products and Services
Key Competitors
Growth Strategy
athenahealth, Inc.
Company Overview
Performance Review
Key Acquisitions, Alliances and Partnerships
Products and Services
Key Competitors
Growth Strategy
BizMatics, Inc.
Company Overview
Cambio Healthcare Systems
Company Overview
Products and Services
Growth Strategy
CARECLOUD
Company Overview
Cerner Corporation
Company Overview
Performance Review
Key Acquisitions, Alliances, and Partnerships
Products and Services
Key Competitors
Growth Strategy
ChartLogic
Company Overview
COMPUGROUP MEDICAL AG
Company Overview
Performance Review
Key Acquisitions, Alliances, and Partnerships
Products and Service
Growth Strategy
Computer Programs and Systems, Inc.
Company Overview
Performance Review
Products and Services
Key Competitors
Growth Strategy
CSC
Company Overview
CureMD
Company Overview
Dr First/Rcop
Company Overview
eClinicalWorks
Company Overview
Performance Review
Products and Services
Key Competitors
Growth Strategy
EGTON MEDICAL INFORMATION SYSTEMS LIMITED (NOW EMIS HEALTH)
Company Overview
Performance Review
Key Acquisitions, Alliances, and Partnerships
Products and Service
Growth Strategy
e-MDs
Company Overview
Epic Systems Corporation
Company Overview
Performance Review
Key Acquisitions, Alliances, and Partnerships
Products and Services
Key Competitors
Growth Strategy
GE Healthcare
Company Overview
Performance Review
Key Acquisitions, Alliances, and Partnerships
Products and Services
Key Competitors
Growth Strategy
Greenway Health, LLC
Company Overview
Performance Review
Key Acquisitions, Alliances, and Partnerships
Products and Services
Key Competitors
HealthFusion, Inc
Company Overview
Healthland
Company Overview
Henry Schein
Company Overview
IMS MAXIMS
Company Overview
Products and Services
INTERSYSTEMS CORPORATION
Company Overview
KAREO
Company Overview
McKesson Corporation
Company Overview
Performance Review
Key Acquisitions, Alliances, and Partnerships
Products and Service
Key Competitors
Growth Strategy
Medent Community Computer Service, Inc
Company Overview
MEDHOST
Company Overview
Meditab Software Inc
Company Overview
MEDITECH, Inc. (Medical Information Technology, Inc.)
Company Overview
Performance Review
Key Acquisitions, Alliances, and Partnerships
Products and Services
Key Competitors
Growth Strategy
Medsphere Systems Corporation
Company Overview
Microtest Ltd.
Company Overview
Products and Services
Nextech
Company Overview
NextGen Healthcare Information Systems /Quality Systems Inc
Company Overview
Performance Review
Key Acquisitions, Alliances and Partnerships
Products and Services
Key Competitors
Growth Strategy
Nightingale Infomatix Corporation
Company Overview
Performance Review
Key Acquisitions, Alliances and Partnerships
Products and Services
Key Competitors
Growth Strategy
NOEMALIFE S.P. A.
Company Overview
Performance Review
Key Acquisitions, Alliances, and Partnerships
Products and Services
Growth Strategy
Nuesoft Technologies Inc
Company Overview
Practice Fusion
Company Overview
Key Acquisitions, Alliances and Partnerships
Products and Services
Key Competitors
Growth Strategy
PRAXIS
Company Overview
Quadramed Corporation
Company Overview
Key Acquisitions, Alliances and Partnerships
Products and Services
Key Competitors
Growth Strategy
Quality Systems, Inc.
Company Overview
Performance Review
Key Acquisitions, Alliances and Partnerships
Products and Services
Key Competitors
Growth Strategy
Quest Diagnostics, Inc
Company Overview
Performance Review
Key Acquisitions, Alliances, and Partnerships
Products and Services
Key Competitors
Growth Strategy
SAP AG
Company Overview
Performance Review
Key Acquisitions, Alliances, and Partnerships
Products and Services
Growth Strategy
Sequel Systems, Inc
Company Overview
Streamline MD
Company Overview
Tieto
Company Overview
Performance Review
Products and Services
Growth Strategy
WebPT
Company Overview
WRS Health (Waiting Room Solutions)
Company Overview
FIVE: MARKET ANALYSIS
Market Overview
Market by Region
United States
EMEA
United Kingdom
Germany
France
Spain
Nordic Countries
Middle East
Africa
Others
APAC
Japan
China
India
Australia
Others
Rest of World
Brazil
Canada
Others
Market by Segment
Hospital
Physician/Web-based
Market Segment by Type
Competitive Analysis
Hospitals and Health System Technology Providers
Practice Management System (PMS) Acquirers
Pharmacy Services Providers
Other Entities
Large Practices (20+ Practitioners)
Small Practitioners (1-20 Practitioners)
Web-based Users
Meaningful Use Attestations
Inpatient
Ambulatory
Market Leaders
Hospital
Physician Office
SIX: CONCLUSIONS
Overview
One: Physician Practices Still High Growth Area
Two: Role of Meaningful Use
Three: No Clear Market Leadership
Four: Mergers and Acquisitions
Five: Interoperability A Major Hurdle
Six: PR Effect of Breaches Downside for Industry
Seven: Usability and Data Entry an Under the Radar Issue
Eight: Opportunity for Telecoms
Nine: Moving Beyond the “Stick”
Ten: Role of CPOE and Other Features
Eleven: Hospital EMR Incentives Factor in Growing Market
Twelve: Technology Moving Faster than EMR Technology Providers
Thirteen: Data Storage Concerns- Top Focus
Fourteen: User Satisfaction On Decline
Fifteen: Specialists See Gains
Sixteen: EHRs More Personalized
Seventeen: Move by ONC for more Transparency and Accountability
Eighteen: Paradigm Shift in Expectations
Nineteen: Mobile Health Systems
APPENDIX I: DEFINITION OF INDUSTRY PRODUCTS
APPENDIX II: LIST OF SELECT MAJOR COMPANIES
Table of Figures
CHAPTER ONE: EXECUTIVE SUMMARY
Figure 1-1: Percentage Physician EMR Usage, 2006-2015
Figure 1-2: EMR Market Analysis, 2013-2020
Figure 1-3: Market Share (%) of EMR Providers, 2015
CHAPTER TWO: INDUSTRY OVERVIEW
Table 2-1: Terminology Comparison Matrix (Electronic Medical Record, Electronic
Health Record, Personal Health Record)
Table 2-2: Physician Adoption of EMRs, 2006-2015 (Basic System and Fully
Functional System)
Figure 2-1: Overall Physician Adoption of EMRs, 2007-2015
Table 2-3: State Percentage Distribution of Office-based Physicians Using EMR (US)
by State, 2013-2015 (# In EMR Incentive Program, Any Use of EMR, Basic System,
Fully Functional EMR)
Table 2-4: Percentage Distribution of Office-based Physicians Using EMR by Age and Practice Characteristics (US, 2012) (Physician Specialty Type, Practice Ownership, Physician Age)
Table 2-5: Physician Usage by US Region (2012-2015) (North, South, West, East)
Table 2-6: Percentage of Office-based Physicians with Certified EMR by State,2014
Table 2-7: State Percentage Distribution of Non-federal Acute Care Hospitals Using EMR (US) by State, 2015
Table 2-8: Average Total Cost for a Three-Physician Practice for EMR/PMS Installations (2013-2014)
Table 2-9: Total Cost Range for EMR/PMS Installations (2013-2014)
Table 2-10: Estimated Two-Year Total Cost for EMR/PMS Installations/Subscriptions, 2010-2015, Selected Products
Table 2-11: US EMR Hospital Adoption Model, 2015
Table 2-12: Canada EMR Hospital Adoption Model, 2015
Table 2-13: US Ambulatory EMR Adoption Model, 2015
Table 2-14: Ownership vs. Non-ownership Adoption Rates, 2012-2015
Table 2-15: Doctors Office Adoption Rates, 2011-2015 (1 physician, 2 physicians, 3-5 physicians, 6-10 physicians, 11-25 physicians, 26 or more)
CHAPTER THREE: EMERGING TRENDS
Table 3-1: Attestation Details through November, 2015
Table 3-2: Modified Stage of Meaningful Use, 2015-2017
Table 3-3: Medicare EHR Incentive Payment Schedule
Table 3-4: Medicaid EHR Incentive Payment Schedule
Table 3-5: Three Types of Interoperability
Figure 3-1: Global Healthcare Cloud Market, 2010-2020
Table 3-6: Mergers and Acquisitions
Table 3-7: Number of Health Information Exchanges (HIEs) in 2011 and 2012 by Top States
Table 3-8: HIE Grants by State
Table 3-9: 2015 Listing of Regional Extension Centers
Table 3-10: 2015 Data Breaches
Table 3-11: Cost of Implementing ICD-10, 2008 and 2014 (Typical Small Practice,Typical Medium Practice, Typical Large Practice)
Table 3-12: Top Accountable Care Organizations, 2015
Table 3-13: Top 5 Most Widely Used Physician EHRs, 2012, 2014
Table 3-14: Top Rated Physician EHRs Overall 2012, 2014
Table 3-15: Physician Satisfaction with EHR Vendor
Table 3-16: Switch or Keep EHR, 2014
Table 3-17: Privacy Concerns, 2014
Table 3-18: Meaningful Use Survey, 2014
Figure 3-2: Type of EHR System by Practice Size, 1-9 Physicians (Web-based,Installed, Don’t Know)
Figure 3-3: Type of EHR System by Practice Size, 10-24 Physicians (Web-based,Installed, Don’t Know)
Figure 3-4: Type of EHR System by Practice Size, 25+ Physicians (Web-based,Installed, Don’t Know)
Table 3-19: Cost per Physician to Purchase and Install EMR, 2014 (Under $10,000;$10,000-$34,999; $35,000-$49,999; Over $50,000; Don’t Know)
Table 3-20: Monthly Fees per Physician Web-based System (Under $300, $300-$499,
$500-$700, Over $700, Don’t Know)
Table 3-21: 2013 Black Book Ratings for Ambulatory Care Practices (Solo Practice,2-5 Group, 6-10 Group, 11-25 Group)
Table 3-22: 2014 Best in KLAS Award Ambulatory EMR (1-10 Physicians)
Table 3-23: Top 20 Vendors by Popularity
Table 3-24: EHR Vendor Market Share by Practice Size, 2015 (1-3, 4- 10, 11- 25, 26-40, 41+, Overall)
Table 3-25: Adoption by Selected Practice Specialties, 2015
Table 3-26: Top Free or Open Source EMR Products, 2014
Table 3-27: Physician Office National Level Adoption by Vendor
Table 3-28: Regional Adoption by Vendor (East, New England, Midwest, South,West)
Table 3-29: Cost Break-up for a Typical One-Physician Practice (5-year period)
Figure 3-5: Distribution of Cumulative Savings
Table 3-30: EHR Incentive Select Program Payments, 2012-2015
Table 3-31: Percent of Physicians e-Prescribing Using HER, December 2008 and April 2014
Table 3-32: Vendor Product Certifications, 2006
Table 3-33: CCHIT 2007 Vendor Certifications
Table 3-34: CCHIT 2008 Vendor Certifications
Table 3-35: EMR/EHR Certifications, 2010
Table 3-36: Modular System Certifications, 2010
Table 3-37: System Certification in 2011
Table 3-38: System Certification in 2012
Table 3-39: Select Ambulatory EMR Certified Products, 2013
Table 3-40: Select Ambulatory EMR Certified Products, 2014
Table 3-41: Select Ambulatory EMR Certified Products, 2015
Table 3-42: EU Healthcare Expenditure as % of GDP by Top Countries (Norway,Switzerland, Netherlands, Austria, Belgium, Luxembourg, Denmark, Germany)
Figure 3-6: By Sector Contribution to the US GDP (2012) (Energy, Clothing,Automotive, Defense, Food, Housing, Medical care)
Figure 3-7: The US Healthcare Spending (2009-2020)
CHAPTER FOUR: MARKET PARTICIPANTS
Table 4-1: EMR Mergers and Acquisitions, 2010-2015
Table 4-2: Selected Black Book Ratings
Figure 4-1: Allscripts Healthcare Solutions Revenues, 2013-2015
Figure 4-2: athenahealth Revenues, 2013-2015
Figure 4-3: Cerner Revenues, 2013-2015
Figure 4-4: CompuGroup Revenues, 2013-2015
Figure 4-5: CPSI Revenues, 2013-2015
Figure 4-6: eClinicalWorks Estimated Revenues, 2013-2015
Figure 4-7: EMIS Group Revenues, 2013-2015
Figure 4-8: Epic (estimated) Revenues, 2013-2015
Figure 4-9: GE Healthcare IT Applications Revenues, 2013-2015
Figure 4-10: Greenway Revenues, 2013-2015
Figure 4-11: McKesson Revenues, 2013-2015
Figure 4-12: MEDITECH Revenues, 2013-2015
Figure 4-13: NextGen Revenues, 2013-2015
Figure 4-14: Nightingale Infomatix Revenues, 2013-2015
Figure 4-15: NoemaLife Revenues, 2013-2015
Figure 4-16: QSI Revenues, 2013-2015
Figure 4-17: Quest Diagnostics Revenues, 2013-2015
Figure 4-18: SAP Revenues, 2013-2015
Figure 4-19: Tieto Revenues, 2013-2015
CHAPTER FIVE: MARKET ANALYSIS
Table 5-1: EMR Market Analysis, 2013-2015
Table 5-2: Forecasted EMR Market Analysis: 2016-2020
Figure 5-1: EMR Market Analysis, 2013-2020
Table 5-3: United States EMR Market Analysis, 2015-2020
Table 5-4: EMEA EMR Market Analysis, 2015-2020
Table 5-5: United Kingdom EMR Market Analysis, 2015-2020
Table 5-6: Germany EMR Market Analysis, 2015-2020
Table 5-7: France EMR Market Analysis, 2015-2020
Table 5-8: Spain EMR Market Analysis, 2015-2020
Table 5-9: Nordic Countries EMR Market Analysis, 2015-2020
Table 5-10: Middle East EMR Market Analysis, 2015-2020
Table 5-11: Africa EMR Market Analysis, 2015-2020
Table 5-12: Other EMEA EMR Market Analysis, 2015-2020
Table 5-13: APAC EMR Market Analysis, 2015-2020
Table 5-14: Japan EMR Market Analysis, 2015-2020
Table 5-15: China EMR Market Analysis, 2015-2020
Table 5-16: India EMR Market Analysis, 2015-2020
Table 5-17: Australia EMR Market Analysis, 2015-2020
Table 5-18: Other APAC EMR Market Analysis, 2015-2020
Table 5-19: Rest of World EMR Market Analysis, 2015-2020
Table 5-20: Brazil EMR Market Analysis, 2015-2020
Table 5-21: Canada EMR Market Analysis, 2015-2020
Table 5-22: Other Rest of World EMR Market Analysis, 2015-2020
Table 5-23: Hospital EMR Market Analysis, 2013-2015
Table 5-24: Forecasted Hospital EMR Market Analysis: 2016-2020
Figure 5-2: Hospital EMR Market Analysis: 2013-2020
Table 5-25: Physician/Web-based EMR Market Analysis, 2013-2015
Table 5-26: Forecasted Physician/Web-based EMR Market Analysis: 2016-2020
Figure 5-3: Physician/Web-based EMR Market Analysis: 2013-2020
Figure 5-4: EMR Market Breakdown, Physician/Web vs. Hospital, 2015
Figure 5-5: EMR Market Breakdown, Physician/Web vs. Hospital, 2020
Figure 5-6: EMR Breakdown by Type, 2015 (Services, Hardware, Software)
Table 5-27: Notable Companies by Healthcare Specialty Area, 2015
Table 5-28: 20 Top Vendor by State’s Meaningful Use Attestations
Table 5-29: Revenues and Market Share of EMR Providers, 2015
Figure 5-7: Percent Market Share of EMR Providers, 2015
