At the time of the environmental scan, we found that health centers had focused significant investment in practice management systems with some mixed, but overall positive results. Our thought leaders noted that the vast majority of medium-to-large health centers had some form of practice management software and that these applications generally improved basic administrative functions, especially billing. However, they also noted that health centers struggled with using advanced practice management functions, such as reporting, and that very few of these systems were interoperable with other systems used by the health center.
Thought leaders also described a highly fragmented market for practice management software with providers still struggling to understand their requirements and vendors challenged to differentiate themselves. At the time of the environmental scan, several health center-focused vendors were actively engaged in mergers and acquisitions and were still adjusting to clients’ functionality needs, making it difficult to accurately assess differences between products and the long-term stability of vendors. More than one health center we spoke with as part of the case studies had experienced problems when their practice management vendor was bought by another company or discontinued support for their product.
We found that EHRs were (and are) far less common than practice management systems. Thought leaders indicated that health centers were cautious about implementing EHR, due to concerns over provider comfort with the technology, the need for ongoing training, and general reluctance to invest in a technology that is still evolving. As with practice management, our findings revealed that the vendor landscape for EHR is fragmented, with the substantial majority of vendors having fewer than fifty clinic clients.
In general, the vendor landscape for the health center market was found to be still maturing, the largest category of vendors serve a small group of regionally defined customers. Increasingly, we noted that best of breed vendors packaged EHR tools or functionalities with practice management. The most mature use of EHR was found in systems such as the VA, Partners Healthcare or the Regenstrief Institute that had developed their own software for both inpatient and outpatient settings. We found that selected staff model managed care organizations such as Kaiser Permanente were able to work with best in breed vendors such as Epic to implement high end health IT systems, but that these products were out of reach financially for most health centers.