The Bigger Picture: Battle Royale in EMR Market

“Our aim is to create the Microsoft Office for healthcare,” Allscripts CEO Glen Tullman told Time, “to develop a standard all doctors can rely on.”

Allscripts and companies like it are not out to sell a few more software licenses. They want to replace today’s patchwork of proprietary systems with one standard: theirs.

The upside for you? Real-time data on every patient, anywhere. If there were only a single dominant player, sharing information between hospitals and clinics or among offices would be as easy as document-sharing has become in the age of Microsoft Word.

The upside for the vendors? Total market domination. The Allscripts-Misys operation begins life with 150,000 physicians in its network, nearly a third of all practicing physicians in the US.

Others are itching to catch up; more consolidations are imminent. With some 300-plus vendors out there, it’s inevitable. “There’s going to be a tremendous amount of consolidation, and there’s going to be a lot of guys left by the wayside, too,” forecasts Practice Fusion CEO Ryan Howard, whose company has already had multiple purchase offers. “Virtually everyone out there is for sale,” says Tullman.

“There is no doubt that about five years from now the landscape is going to look a lot less confusing and more bloody. The only ones that [will] survive are big corporations with deep pockets or ones that are differentiated - which are not many,” observes Joe Rubinsztain, CEO of gMed.

It’s too early to assume that proprietary software vendors like Allscripts will dominate. Smaller, faster companies, including Practice Fusion and gMed, think licensed-based systems are too complex and inflexible to take over the world. “Complexity is associated with immature product,” says Rubinsztain. The future, he thinks, lies in revenue from subscriptions or even revenue-sharing from nearly effortless, open systems. Smaller practices simply won’t be able to get on board a platform that is expensive and complicated.

Powerful outsiders lurk, too. Microsoft and Google are entering the healthcare IT space. While their initial forays are designed for consumers, physicians are willing to jump ship to Microsoft if it offers a free product, according to one recent survey. Microsoft can play its standard role as the safe, dominating player and sweep physicians off their feet.

If you’re like most physicians, you’re largely unaware of this battle, but you won’t be for long. The handful of winners will dominate the way that electronic medical records evolve - and are paid for - over the next five years. Vendors are looking way past simply digitizing charts.

“In the future,” says Rubinsztain, “you wonder if license as a source of revenue will become less important, and the processing of the information will become more important. Can [physicians] compare best practices to their peers? Can we [help them] identify patients at certain risk, identify them for payers to do proactive measures? The service model is about taking data to help physicians take better care of patients while also helping payers control costs.”

Does all this mean that you should hold off on that EMR purchase until the dust clears? Not necessarily. If an EMR makes sense for your practice now, go ahead and get one. Just make sure you understand what will happen to your data should the vendor close shop or get bought.

Pamela Moore is editorial director for Physicians Practice. She can be reached at pmoore@physicianspractice.com.

This article originally appeared in the July/August 2008 issue of Physicians Practice.