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Table of Contents
ii
T A B L E O F C O N T E N T S
Table of Contents
iii
Computerized Physician Order Entry ............................................................................. 48
Clinical Documentation................................................................................................... 48
Flow of Patient Data across Various Components .......................................................... 49
Pricing of EMRs ................................................................................................................ 50
US EMR Adoption Model............................................................................................... 56
EMR Adoption Rates ...................................................................................................... 59
Table of Contents
iv
Wireless Technologies ....................................................................................................... 96
Open Source EMR Applications ...................................................................................... 98
Benefits of Open Source EMR Applications .................................................................. 99
Adoption Issues .................................................................................................................. 99
Usability And Adoption .................................................................................................. 102
Physician Group Practices And the Recession.............................................................. 103
Quality of Care/Malpractice/Security ........................................................................... 104
Cost-Benefit Analysis ...................................................................................................... 104
ROI for a Typical Physician Practice ............................................................................ 105
EHR Incentive Program ................................................................................................ 107
Implementation Costs and ROI for Hospitals ............................................................... 108
Summary ....................................................................................................................... 108
Privacy Issues ................................................................................................................... 109
Technology Limitations................................................................................................... 109
Social and Organizational Barriers ............................................................................... 110
E-Prescribing ................................................................................................................... 110
CCHIT .............................................................................................................................. 111
NHIN................................................................................................................................. 126
Results of Wal-Mart and DELL Launches ................................................................... 129
Direct PPC Offerings ...................................................................................................... 130
Healthcare Spending US and International .................................................................. 131
Europe Asia, and Other EMR Markets ......................................................................... 131
The US Market .............................................................................................................. 132
Table of Contents
v
Practice fusion.................................................................................................................. 186
Quadramed Corporation ................................................................................................ 188
Siemens Medical Solutions.............................................................................................. 191
Table of Contents
vi
Market by Segment ......................................................................................................... 226
Competitive Analysis .................................................................................................... 235
Hospital Market Leaders ............................................................................................... 249
Physician Office EMR Market Leaders ........................................................................ 249
Table of Contents
vii
Table of Contents
viii
Table 3-3 AAFP Most Commonly Cited EMR Companies Results 2011 ..................... 89
Table 3-4 ACP /American EHR Partners Cited Companies List ................................. 90
Table 3-5: Cost Break-up for a Typical One-Physician Practice (5-year period) ..... 106
Figure 3-1: Distribution of Cumulative Savings ........................................................... 107
Table 3-6: EHR Incentive Program Payments 2011 .................................................... 108
Table 3-7: Vendor Product Certifications 2006 ............................................................ 113
Table 3-8: CCHIT 2007 Vendor Certifications ............................................................ 116
Table 3-9: CCHIT 2008 Vendor Certifications ............................................................ 118
Table 3-10: EMR/EHR Certifications 2010 .................................................................. 121
Table 3-11: Modular System Certifications 2010 ......................................................... 122
Table 3-12: System Certification in 2011 ...................................................................... 123
Figure 3-2: By Sector Contribution to the US GDP (2009) ......................................... 133
Figure 3-3: The US Healthcare Spending (2009-2020)................................................. 135
Table of Contents
ix
Table 6-4: Forecasted Hospital EMR Market Analysis: 2012-2016............................ 228
Figure 6-2: Hospital EMR Market Analysis: 2009-2016.............................................. 229
Table 6-5: Physician/Web-based EMR Market Analysis 2009-2011 .......................... 230
Table 6-6: Forecasted Physician/Web-based EMR Market Analysis: 2012-2016 ..... 231
Figure 6-3: Physician/Web-based EMR Market Analysis: 2009-2016 ....................... 232
Figure 6-4: EMR Market Breakdown, Physician/Web vs. Hospital 2011 .................. 233
Figure 6-5: EMR Market Breakdown, Physician/Web vs. Hospital 2016 .................. 234
Table 6-7 Notable Companies....................................................................................... 236
Two: Introduction
50
If the clinician can access the patient data stored in a semantic form, he or she
will be able to obtain a list of patients diagnosed with a specific condition linked to
another list of patients diagnosed with a similar condition. This is possible due to
developments in the semantic web technologies, which can link medical conditions
that are coded as synonymous terms. This type of data may be useful for research.
An integrated architecture is created to facilitate the sharing of data across
systems. The systems can store their data locally. A system (or system user) must be
accessible to another system in order to share patient information. It can also transmit
a copy of the file to the other system. As the file is identified for sharing, it can be
integrated with other files, but it depends upon the interoperability level between the
integrating systems.
Data may be entered in the following three forms:
Even if the system collects data via drop-down pick lists, there is no assurance
that the values in the lists will be compatible with those of other systems used at the
healthcare facility. This demands that the data coding for the system should be highly
structured. This also necessitates the provider to be more knowledgeable and
disciplined while entering data. The organization also needs to increase efforts to
manage the structure and code vocabulary or nomenclature that it uses.
PRICING OF EMRS
EMR pricing is an intangible concept, as several categories of products and
services need to be taken into account. The pricing structure is complex as it includes
prices of subscriptions, per-seat licensing, concurrent user licensing, installation of
additional modules, interfaces, consultation, etc. This explains the reason for the
difficulty in obtaining average price for an EMR. Additionally, the total cost for an
EMR includes more than the initial price of the software. The costs for hardware,
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Two: Introduction
60
Table 2-10
Size of Practice
Adoption as of
January 2010
Adoption as of
October 2010
1 physician
2 physicians
3 -5 physicians
6-10 physicians
11-25 physicians
26 or more
physicians
Source: Physician Office Usage of EHR Software
Adoption
as of
October
2011
Web-based Users
The companies catering to Web-based users were formed to leverage the cost
and service aspects of the Internet. Besides, the vendor offerings are estimated to be
more competitive in terms of functionality and product maturity. These offerings are
based on the one-size-fits-one philosophy and ensure better balancing of efficiency
and customer relationships. Further, these companies are in their nascent stages with
limited distribution capabilities, and hence become attractive acquisition or
collaboration targets of larger players.
Some companies in this domain are as follows:
e-ClinicalWorks
Practice Fusion
ADP Advanced MD
NueMD
MediTouch
Leaders in the market of EMR providers include large and small companies.
The market leader in 2011 was again McKesson who secured XX% market share.
McKesson is a large player the healthcare market and therefore is well-positioned to
expand its offerings. The company offers a full range of solutions to meet both
clinical and business performance needs ranging from medication safety and
information access to revenue cycle management, resource utilization and physician
adoption of EMRs.
Cerner garnered the second position with XX% market share reaching
revenues of $XXX in 2011. The company is continuing to add to its services by
adding CernerITWorks, a suite of services that improve the ability of hospital IT
departments to meet their organizations needs. A second example is Cerner