James Sorace1, Hui-Hsing Wong2, Thomas DeLeire3, Dashi Xu4, Sheila Handler4, Bruno Garcia4, Thomas MaCurdy5. 1. Retired from Division of Data Policy, Office of Science and Data Policy, Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, 8620 Valleyfield Road Lutherville, MD 21093, USA. Electronic address: jamessorace1@gmail.com. 2. Division of Science Policy, Office of Science and Data Policy, Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington DC, USA. 3. Georgetown University and at Acumen, LLC, Washington DC, USA. 4. Acumen, LLC, Washington DC, USA. 5. Stanford University at Acumen, LLC, Burlingame, CA, USA.
Abstract
OBJECTIVE: The objective of this study was to quantify both the competitiveness of the EHR vendor market in the United States of America (US) and the degree of fragmentation of individual Medicare beneficiaries' medical records across the differing EHR vendors found in the US healthcare system. METHODS AND MATERIALS: We determined the Part A and Part B Medicare-expenditure weighted market shares of EHR vendors and estimated the rate of attestation of meaningful use (MU) for EHRs among Medicare Part A & B providers from 2011 to 2016. Based on these data we calculated the annual Herfindahl-Hirschman Index to quantify the competitiveness of the EHR market as well as the number of vendors individual Medicare beneficiaries' medical records were stored in for the period 2014-2016. RESULTS: We find that as of 2016 the EHR vendor environment was competitive but trending towards becoming highly concentrated soon. We also found that patient medical records were highly fragmented as only 4.5 % of expenditure-weighted individual Medicare beneficiaries had their MU medical records associated with a single vendor, while 19.8 % of expenditure-weighted beneficiaries had their MU medical records stored in 8 or more vendors. DISCUSSION: These results indicate that there are tradeoffs between EHR market competition, and the challenges associated with achieving interoperability across numerous competing vendors. CONCLUSION: Uncertainty of interoperability among different EHR vendors may make transmission of medical records among different providers challenging, mitigating the benefit of vendor competition. This highlights the critical importance of current interoperability efforts moving forward. Published by Elsevier B.V.
OBJECTIVE: The objective of this study was to quantify both the competitiveness of the EHR vendor market in the United States of America (US) and the degree of fragmentation of individual Medicare beneficiaries' medical records across the differing EHR vendors found in the US healthcare system. METHODS AND MATERIALS: We determined the Part A and Part B Medicare-expenditure weighted market shares of EHR vendors and estimated the rate of attestation of meaningful use (MU) for EHRs among Medicare Part A & B providers from 2011 to 2016. Based on these data we calculated the annual Herfindahl-Hirschman Index to quantify the competitiveness of the EHR market as well as the number of vendors individual Medicare beneficiaries' medical records were stored in for the period 2014-2016. RESULTS: We find that as of 2016 the EHR vendor environment was competitive but trending towards becoming highly concentrated soon. We also found that patient medical records were highly fragmented as only 4.5 % of expenditure-weighted individual Medicare beneficiaries had their MU medical records associated with a single vendor, while 19.8 % of expenditure-weighted beneficiaries had their MU medical records stored in 8 or more vendors. DISCUSSION: These results indicate that there are tradeoffs between EHR market competition, and the challenges associated with achieving interoperability across numerous competing vendors. CONCLUSION: Uncertainty of interoperability among different EHR vendors may make transmission of medical records among different providers challenging, mitigating the benefit of vendor competition. This highlights the critical importance of current interoperability efforts moving forward. Published by Elsevier B.V.
Entities:
Keywords:
EHR Market competitiveness; Electronic medical records; Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH); Interoperability; Meaningful use
Authors: Elmer V Bernstam; Jeremy L Warner; John C Krauss; Edward Ambinder; Wendy S Rubinstein; George Komatsoulis; Robert S Miller; James L Chen Journal: J Am Med Inform Assoc Date: 2022-04-13 Impact factor: 4.497