It is safe to say that if you work in healthcare, you will end up using Electronic Health Record (EHR) software. It is important for current or aspiring Informatics Nurses to be familiar with their company’s EHR, as well as common EHRs used by healthcare organizations.

Which system you use depends on where you work. Hospitals use systems made by larger vendors than what you will see in physician practices. This overview provides a sense of the different systems out there right now. New vendors launch all the time, so this list may change.

What is an Electronic Health Record?

An Electronic Health Record is a collection of health information about a person. It includes medical history, allergies, medications, test results, and measurements like blood pressure, heart rate, height, and weight. You might also hear it called an Electronic Medical Record, or simply the patient’s chart.

The name is a throwback to the days when patient charts were on paper. While you might find a few doctor’s offices out there still using paper charts, most hospitals, clinics, and health systems converted to digital versions years ago.

There are a number of software vendors who make Electronic Health Records for hospitals and health systems. However, there just a few vendors used by the majority of them, which is why we are focusing on the top five.

What all Electronic Health Record systems have in common:

Given that hospitals and outpatient clinics provide similar services all over the world, it would not make sense for each EHR software vendor to make something completely different. For the most part, you will find their basic offerings are essentially the same. They all have products that support:

An Electronic Health Record for inpatient and outpatient settings

Some vendors win awards for their inpatient EHR software, whereas others are better at outpatient EHR software. But they all need to be able to capture basic clinical information wherever care is provided.

Almost all of the top vendors built in some type of clinical decision support – information, recommendations, and protocols to guide patient care. When Electronic Health Record software vendors describe supporting certain specialties, they are usually referring to clinical decision support tools specific to that specialty such as for oncology or fertility.

Revenue cycle management

Revenue cycle management refers to the process health systems use to manage their finances. This includes submitting claims for payment by insurance companies, collecting payments from patients, and capturing services of providers for billing.

This process gets complicated quickly because it requires a lot of smaller steps. Confirming a patient’s insurance is active and current before scheduling an appointment is a whole process in itself. Once a provider sees the patient, making sure an insurance claim captures their services with the right codes is another process.

Population health management

Population health involves improving the health outcomes of a group of people. In the past, health systems were paid based on how many services they gave a patient. This was called fee-for-service, and the downside is it rewarded health systems for piling on tests, procedures, specialist consultations, and anything else for which they could make money.

Fee-for-service is still around, but value-based care is quickly taking over. In this payment approach, health systems are paid based on helping people get better and live healthier. For this reason, population health is now an important part of what EHR software vendors offer.

Patient engagement

Patient engagement basically means getting patients involved in their healthcare. In the context of an EHR, this means having tools like mobile apps and portals for patients to access their records, communicate with providers, and schedule appointments.

Analytics

Even though EHRs were not initially intended for data analysis, all of the major EHR vendors now offer some type of analytics capability. The analytics tools assist health systems with better understanding their patients, finding opportunities to save money, and comparing their system’s performance to other health systems.

EHR vendors to vary in what these analytics tools can do and how they present information. Some simply display information in a dashboard, while others strategically place it in clinical workflows.

Telehealth

The pandemic added to this list the ability have virtual visits on demand so patients can skip the line at Urgent Care. A surprising number of providers did not have telehealth set up before the pandemic, and suffered financially as a result.

The top EHR vendors specifically advertise their telehealth products that are part of the EHR so providers only have one system to go to.

What makes each Electronic Health Record system different?

Even though EHR software vendors will list all of the above items in their marketing material, what really matters is what makes them different. There are five major areas where they differ.

Differentiator #1: Customers they serve. EHR vendors will advertise if they cater more to urban versus rural health systems. Several of the vendors we will go through below specialize in rural health providers. Another differentiator is different size healthcare organizations – large hospitals versus community hospitals.

Differentiator #2: Handling emerging technology trends. As technology companies, the EHR vendors have to decide how they will address things like Artificial Intelligence and interoperability – the push for EHRs to share information with each other.

Differentiator #3: Adjusting to changes in society. There is more attention now on how technology and EHRs cause clinician burnout. There is also the aging healthcare workforce that software vendors need to keep in mind.

Differentiator #4: Readiness for emerging healthcare issues. New healthcare issues crop up all the time. In 2020 it was the pandemic, but in years before there were issues like the opioid crisis, suicide rate, and obesity. Most of these vendors did do something around the COVID-19 pandemic, often sharing data to help with tracking spread and identifying treatments.

Differentiator #5: Awards and recognition. Not that winning awards means one EHR is automatically better than another. But there are organizations that rate EHR vendors on certain factors. One of the best known is KLAS – a group that interviews users of different health technologies to rate systems and vendors. They give awards called ‘Best in KLAS’ to software companies in various categories.

Differentiator #6: Market share. In this case of EHR software vendors, we will look at what percent of the acute care hospitals in the U.S. use each vendor. According to KLAS, there are 5,457 acute care hospitals making up the U.S. market.

The top 5 Hospital Electronic Health Record systems:

Now that we know what these systems have in common and what makes them different, here are the top five vendors you may hear about.

Allscripts

Allscripts’ headquarters are in Chicago, IL. While in the area where I live they are one of the two most common EHR vendors, they actually only have a market share of 6%. In 2019 they lost 29 accounts to other EHR vendors.

Their differentiators include:

Emerging technology trend: Precision medicine software. This is software that collects patient’s genetic information and translates it into recommendations that providers can use as they are treating patients.

Customers they serve: Different EHR options depending on size and budget. Allscripts has multiple versions of their EHR to cover various sizes and types of healthcare entities. For example, they have a platform that covers everything needed for ambulatory care and financial management for large hospitals and health systems, and a less expensive offering for community and critical access hospitals. They have different offerings for medium to large physician practices versus small physician practices.

Cerner

Cerner’s headquarters are in North Kansas City, Missouri. They have a pretty sizable market share of 26% even though they lost 9 accounts in 2019.

Cerner’s differentiators include:

Emerging technology trend: Voice recognition. Cerner points out their ability to integrate Dragon Voice Recognition – a software that recognizes a person’s voice and transcribes it to text. Dragon Ambient Intelligence is the latest innovation of this speech-to-text technology. It is able to listen to a patient exam, transcribe what the provider says into notes, and even create prescriptions and orders for tests and procedures.

Changes in society: Clinician burnout and health equity. Cerner is focused on addressing clinician burnout, a growing issue which many providers say is partly caused by EHRs. They see data integration as a way to save clinicians time on documentation and give better insights at the bedside. Cerner is also focusing on health equity. They are launching dashboards in 2021 centered on social inequality. These dashboards will help health systems identify where to put resources.

Customers they serve: Growth in rural markets. Cerner has seen most of their recent growth in rural markets in places like South Dakota, Louisiana, and Nebraska.

Awards and recognition: Cerner won ‘Best in KLAS’ for their behavioral health software.

CPSI

CPSI’s headquarters are in Mobile, AL, and they have a market share of 9% despite losing 5 hospitals in 2019.

Their main differentiator:

Customers they serve: Focus on rural markets. CPSI is focused on rural health systems in places like Alabama and Wyoming. What makes them different than Cerner is they were focused on rural healthcare settings since their founding in 1979.

Epic Systems

Epic’s headquarters are in Verona, WI. They have the largest market share of all EHR vendors at 29%. They gained 55 new accounts in 2019, and are one of only two EHR vendors who grew that year.

Epic’s differentiators include:

Emerging technology trends: Unique projects because of their size. It is worth noting that because of their market share, Epic is able to participate in unique projects. Some examples are:

• A COVID-19 risk model using data from all their different customers.
• Integration with Lyft to support ride scheduling.

Epic also has the most comprehensive suite of software product offerings. A few examples are:

MyChart: This is a patient portal available as a mobile app. It allows patients to message doctors, complete questionnaires ahead of appointments, and read notes from tests and exams. What is smart is it can connect any Epic patient record, even if the patient is seen at a different health system. As long as that health system uses Epic, the patient will have one record.

Cosmos: This software leverages the 250 million patients with Epic records to do things like identify best treatments for a particular patient, detect outbreaks, and find other patients with same rare symptoms. This is how Epic was able to create a risk model for COVID-19.

Epic App Orchard: This is an app store for Epic customers who create unique software to sell it to other Epic customers. This is just one example of several Epic forums for customers to collaborate.

Awards and recognition: Epic won ‘Best in KLAS’ for Overall Enterprise Software Suite and Acute Care EMR for large hospitals.

MEDITECH

MEDITECH’s headquarters are in Massachusetts with offices in Georgia and Minnesota. Their market share is 17%, and they are the other EHR vendor to gain customers in 2019 with the addition of 29 new organizations.

MEDITECH’s differentiators include:

Customers they serve: Home Care and Hospice. MEDITECH is the only EHR vendor that advertises being able to support home care and hospice as well as inpatient and outpatient care settings. Their goal is to keep these services connected to hospitals and provider practices so patients have a better experience. This is often a blind spot for EHR vendors.

Emerging technology trends: Virtual assistant. MEDITECH is embracing the trend of virtual assistants and built a virtual assistant to the EHR. This allows clinicians to speak to the EHR like they would speak to Alexa or Siri.

Awards and recognition: Black Book named MEDITECH the ‘#1 EHR in Usability for Nurses’. MEDITECH is the only EHR vendor to specifically focus on nurses – not just physicians – on their website. They have an entire booklet focused on how the EHR can help nurses focus on care, improve quality, and get time back.

MEDITECH also won ‘Best in KLAS’ for Acute Care EMR for community hospitals.

Key Takeaways:

It is helpful to know the names of the main Electronic Health Records hospitals use. While there are many different Electronic Health Records software vendors, there are several key things they all have in common. All of them can support basic clinical processes in hospitals and outpatient clinics, managing financials, and engaging patients to name a few.

It is what makes them different that is worth noting. Some focus on specific types of hospitals, like those in rural areas, while others embraced new technology to take the burden off of doctors and nurses.

If you are considering a career in health technology, or just want to be up on the latest, becoming familiar with these vendors will help you to seem knowledgeable.