Friday, August 2, 2013

So Many EHR Vendors, So Little Time

Summary: In the US, >=442 vendors need to interface to imaging systems. Good thing we have IID.

Long Version.

A report on US Physician Office EHR adoption from SK&A that Brian Ahier described in a recent post, contains some interesting numbers of relevance to imaging folks. Overall adoption hovers around 50%, but what really intrigued me was the list of vendors with market share ... Allscripts, eClinicalWorks and Epic had about 10% each, another 17 vendors split about half the market (45%), then there were 422 more (!!!) splitting the remaining 25% or so.

That seemed like an awful lot, and I was wondering if perhaps the "other" category confused different versions or something, or was just an error. So I went to the ONC's Certified Heath IT Products List, and in the combination of 2011 and 2014 editions, elected to browse all Ambulatory Products, and was rewarded with 3470 products found! That list includes lots of different bits and pieces and versions, but it does confirm the presence of a large number of choices.

That is a very large number of EHR vendors and systems for PACS and VNA and Imaging Sharing system producers to interface with, in order to View (or Download or Transmit) images.

It certainly is a very large "n" for the "n:m" combinations of individually customized interfaces, if one goes that route. It is a good thing perhaps that we just finished the IID profile in IHE, to potential make it "n+m" instead.

It is hard to believe that there won't be some very dramatic consolidation some time soon, but no matter how rapidly that occurs, being able to satisfy the menu option for stage 2 that includes image viewing, would seem to be a potential discriminator and a competitive advantage.

This may be particularly true for the smaller players, who clearly seem to be satisfying some customers (judging by the stratification in the SK&A report by practice size). Perhaps the big players are too expensive or too complicated, or too busy to bother with small accounts, as MU obsession consumes all their available resources.

Imaging vendors that make it easy for small EHR players to access images by implementing the Image Display actor of IID might help imaging facilities that purchase their products to remain competitive in this age of reimbursement reduction. If their referring providers' insist on integration with whichever one of the 442 to 3470 EHR products they happen to have, if not satisfied, they can easily switch to another imaging provider.

Small EHR players that don't take advantage of standards like IID, and succumb to pressure from even a modest number of PACS vendors to customize to an existing proprietary interface, may run out of resources pretty quickly. Our other imaging standards like WADO and XDS-I are good as far as they go, and very important for imaging vendors to support. But they require a level of sophistication on the client side that may be beyond most small EHR vendors, particularly if interactive viewing is required by the referring providers. WADO and XDS-I might be the means used to support IID on the imaging side, but the EHR doesn't need to sweat the details.


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