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EHR system implementation has been on the rise over the past 10 years. This is, at least in part, attributed to the Centers for Medicare and Medicaid Services (CMS) Meaningful Use initiative that began in 2011. Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, eligible providers who demonstrated meaningful use of Electronic Health Record (EHR) technology received incentive payments. The intent was to encourage healthcare providers to utilize electronic data recording and sharing technology to improve clinical quality and care transparency.
More than 92 percent of hospitals in the U.S. use an EHR system, according to Definitive Healthcare data. The implementation rate is even higher among acute care hospitals, with over 95 percent of long- and short-term facilities using EHR systems. Vendors Epic and Cerner dominate the EHR market, holding a combined 52 percent market share. There are two varieties of EHR systems: inpatient and ambulatory. Inpatient EHR is designed for use on patients staying at a facility for at least one night and is therefore primarily used by hospitals. Ambulatory EHR is designed for outpatient facilities and small physician practices, where patient visits do not include an overnight stay.
Top 5 Ambulatory EHR System Vendors
An EHR is the digital version of a patient’s medical history. Generally, a patient’s EHR includes demographic information, diagnosis history, prescription data, laboratory results, vital signs, immunizations, progress notes, and more. Digital records allow providers to quickly and easily share patient data with providers in other facilities, regardless of whether the facility is in-network. Electronic record sharing can improve patient care and experience by allowing providers anywhere to access and understand an individual’s medical history. This is particularly useful in cases where a patient may be unconscious or unable to communicate upon arrival to a facility, when a patient is visiting a facility out-of-state, or if a patient visits a retail clinic or freestanding urgent care clinic.
Nearly 100 hospitals, or about 1.4 percent, use at least two different forms of ambulatory EHR systems. The following tables list the largest hospitals using each of the top 3 ambulatory EHR systems: Epic, Cerner, and Meditech.
Top 10 Hospitals Using Epic EHR
|Hospital||Net Patient Revenue (M)||Discharges|
|New York Presbyterian / Weill Cornell Medical Center||$4,935||102,777|
|NYU Langone Medical Center - Tisch Hospital||$3,192||48,662|
|University of Texas MD Anderson Cancer Center||$2,992||27,365|
|UCSF Medical Center at Parnassus Heights||$2,935||35,528|
|Cedars-Sinai Medical Center||$2,910||54,868|
|University of Michigan Hospital||$2,866||46,249|
|Montefiore Medical Center - Henry and Lucy Moses Hospital||$2,690||87,012|
|Massachusetts General Hospital||$2,578||49,021|
Fig 1 Data from Definitive Healthcare. For a list of the Top Hospitals Using Epic EHR, visit our blog.
Though there is high demand for EHR systems at the moment, fervor will likely die down in the coming years as the majority of facilities adopt an electronic data sharing system. This will affect sales and competition, compelling vendors to improve internal performance and customization tools and improve their products to increase contract renewals. Despite the substantial time and financial commitment that goes into EHR implementation, it’s not uncommon for hospitals and other healthcare facilities to change vendors to find the right fit for a facility’s workflow.
The cost of implementing an EHR system varies between vendors and by facility and includes many other factors than the price of the software itself. Though all implementation costs include the same basic expenditures—such as consulting fees, software licensing, training and labor costs, and predicted maintenance fees—individual facilities or health systems may choose to categorize charges like training differently, including them as part of their annual budgets instead of as part of implementation costs.
Additionally, the size of a facility or health system could impact the overall cost of EHR implementation. A facility could choose to include the utilization of new laptops or tablets with a new EHR system to increase accessibility, which would increase costs. Again, not all facilities would include device and other hardware purchases as part of the implementation, though some would. The IT infrastructure of a facility or health system would impact EHR installation costs as well. Switching EHR systems could be less expensive than implementing one for the first time, as there would be an existing cloud- or server-based storage system for software and patient data.
If hospitals are willing to test multiple EHR systems to find the one that works best, vendors must be willing to cater to client needs—especially smaller vendors with smaller market share. One of the primary issues EHR vendors face are complaints about lack of consistency between systems and inability to customize capabilities, especially in platforms by Epic and Cerner. Inconsistencies in data categorization and locations can lead to difficulties in data sharing and communication between facilities with differing platforms, compromising patient care quality and experience.
Top 10 Hospitals Using Cerner EHR
|Hospital||Net Patient Revenue (M)||Discharges|
|Florida Orlando Hospital||$3,320||136,646|
|IU Health Methodist Hospital||$2,595||47,408|
|Carolinas Medical Center||$2,199||56,896|
|Methodist University Hospital||$1,700||61,081|
|Memorial Hermann Texas Medical Center||$1,515||42,085|
|John H Stroger Hospital||$1,394||21,062|
|VCU Medical Center||$1,391||33,363|
|Milton S Hershey Medical Center||$1,376||28,469|
Fig 3 Data from Definitive Healthcare
Many of the most popular EHR systems perform similar functions; appointment management, patient portals, e-prescribing, and voice recognition are among the most common features included in EHR software. Meaningful Use attestation is also part of most EHR software, including CureMD, Practice Fusion, McKesson, and eClinicalWorks. CMS first issued Meaningful Use Stage 1 guidelines in 2011 with the goal of improving data gathering and sharing between providers. Meaningful Use Stages 2 and 3 were introduced in 2014 and 2016, respectively. Stage 2 focuses on improving clinical processes, such as engaging patients and families and increasing care coordination across the healthcare continuum. Stage 3 is more aspirational, with the aim of improving care outcomes and provider transparency through compliance with reporting and quality standards.
The CMS website provides a checklist for facilities and providers looking to install an EHR system. In order to be eligible for Meaningful Use Stage 1, providers must follow 14 core objectives regarding patient data recording and daily workflow. Examples from the list include performing drug and allergy interaction checks, providing patients with electronic versions of their health information, gathering patient demographic data, and recording changes in certain vital signs. Providers must also abide by a list of 10 menu objectives regarding proper use of data-sharing technology. This includes the incorporation of lab results into an EHR system, generation of patient lists by condition, patient-specific education resources, and more.
Top 10 Hospitals Using Meditech EHR
|Hospital||Net Patient Revenue (M)||Discharges|
|Avera McKennan Hospital & University Health Center||$928||20,676|
|Medical City Hospital||$780||25,042|
|TriStar Centennial Medical Center||$706||27,895|
|St David's Medical Center||$639||24,661|
|Henry Mayo Newhall Memorial Hospital||$635||20,932|
|CJW Medical Center||$622||28,589|
|Good Samaritan Hospital||$618||15,819|
|St. Joseph Hospital||$599||18,931|
|Wesley Medical Center||$555||29,469|
Fig 4 Data from Definitive Healthcare
Though they are often used interchangeably, EHRs are different than EMRs, or Electronic Medical Records. Both are digital records of patient data, but EHRs are generally more complete of a patient’s overall history. EMRs track a patient’s medical history, offering a narrow view of patient history. They are designed to be used in a single facility for diagnosis and treatment purposes. EHRs contain the same data, but also include patient allergies and lab results, forming a more comprehensive picture. Both EHRs and EMRs allow for data tracking over time and have the potential to improve patient care outcomes. But unlike EMRs, EHRs are designed to be shared with other providers, making it easy for authorized physicians to stay up-to-date on patient health.
In 2016, national healthcare spending reached $3.4 trillion, averaging more than $10,000 per person and making up approximately 18% of the nation’s GDP. Health spending is projected to increase to $5.5 trillion by 2025, according to a study from CMS. With healthcare expenditures increasing by about 5% every year, it is beneficial for hospitals and other healthcare facilities to improve care outcomes and reduce lost revenue to reap the most rewards from an expanding healthcare system. Effective use of EHR systems is one way to efficiently track patient data and improve clinical quality.
Correction: A previous version of this post listed Medhost as an ambulatory EHR provider. This was inaccurate, as Medhost does not offer an ambulatory EHR system, and has since been corrected. We apologize for this mistake.
Visit the Definitive Blog to read more about hospital EHR implementation.
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