When I was much younger, one of my favorite treats was a family trip to the local ice cream parlor. There was a Baskin-Robbins in the neighborhood and I still remember the excitement and amazement surrounding all of the available choices. How could there possibly be 31 flavors of ice cream? I’d stand on my toes and peer through the glass at all the buckets, trying to decide what flavor to choose. Fast forward more years than I care to admit. I still like ice cream and for some reason the 31 flavors image came roaring back when I was exploring meaningful use data from 2011. I know it’s a reach but bear with me.
Our Federal government maintains a very handy website that contains all sorts of interesting information. If you dig deep enough you will find a compilation of meaningful use related data, including information from the ONC, CMS and the CHPL (Certified Health IT Products List) rendered in a useful spreadsheet format. Using some Excel magic, one can find interesting tidbits buried in this sea of data. For example, almost 700 nephrologists successfully attested to meaningful use in 2011. Depending on whose figures you choose to use, that’s roughly ten percent of the nephrologists in this country.
Of further interest, those nephrologists used 35 different EHRs to accomplish this task. (Okay, it’s not 31 flavors but its darn close.) Similar to the ice cream parlor experience, some EHRs were consumed frequently, others only rarely so. There are several EHRs on this list that were used by a single nephrologist and others that were used by only a handful of docs. Check out the pie chart below which displays the EHRs most commonly used by nephrologists who demonstrated meaningful use in 2011:
I learned a couple of things during this exercise worth noting. First, the three most commonly used applications accounted for over half of the meaningful use attestations by nephrologists in 2011. Second, in spite of spending the past four years in this industry, there are many EHRs on this list of 35 that I have never heard of. Finally, I was a little surprised by the size of Epic’s slice of the nephrology pie.
Epic is the premier hospital-based EHR in the land these days. In communities where an EHR has been installed within a hospital, the vast majority of employed physicians are compelled to use the ambulatory version of the vendor’s EHR. This is particularly true in areas of the country where vertically integrated health systems exist; Kaiser is perhaps the best example. Some community physicians have also felt the pull towards utilizing an EHR chosen by a regional hospital. However, as the nation’s infrastructure for data sharing matures over the next few years, I think we will see fewer providers selecting EHRs based upon a local hospital’s decision.
As I was putting together this information, I came across this related graphic compiled by an anonymous commenter on the HISTalk site:
The table displays data from the same source I cite above but examines the entire universe of eligible professionals who demonstrated meaningful use last year. Epic dominates this list, again likely representing a large contingent of employed physicians across the country. I think the large Epic presence here may also be explained by the large number of primary care providers who qualify for this program via the Medicaid. Those providers will receive their year 1 incentive simply by attesting to the fact that they are implementing a certified EHR. Within this context, Epic’s position in the general market is not surprising, but I would have guessed their slice of the nephrology pie would have been smaller.
As 2012 progresses, the slices of the nephrology pie are bound to change. The number of flavors will likely increase in the short term before ultimately declining. Food for thought the next time you find yourself contemplating a scoop of black walnut vs. chocolate chip. Bon appetit!