Our methodology was simple. We sifted through all 1,200 apps in the Health category and pulled out the highest rated, most relevant apps for doctors, nurses and students in the respective categories. Each category is sorted by most popular app, as determined by the ratings in the Android Marketplace. You’ll probably see a lot of the same brand name apps that were listed in our best medical iPhone apps list.

Before You Start
One thing to note before you dive into this list is that each app listed below is linked to its profile on Androlib.com, the definitive database for Android Marketplace apps. That profile contains pricing information, ratings, version number and download size.

Each app profile on Androlib.com also contains an image of a QR code, which looks like a UPC code. Once you download the Barcode Scanner app from the Android Marketplace, you’ll have a couple of new options for downloading apps. Here are two ways to download apps via QR code on Androlib.com:

1. Scan your monitor. Launch the Bar Scanner app and scan your actual monitor (the QR code image itself) with your Android phone. Tap “Open in Market” button that pops up and you will be directed to that app, in the Android Marketplace.
2. Tap the image. If you’re viewing an app’s QR code on your Android phone, you can simply tap the image of the code and you will be directed to the Android Marketplace where you can download the app.

Leave any suggestions in the comment section and we’ll update the list if we see a good app we missed.

Note: Descriptions were written by the app’s developer.

All-in-One

SkyScape Medical Resources – Free – Skyscape Medical Resources is a collection of medical information and decision support resources for healthcare professionals such as physicians, nurses, PAs, NPs, medical students, nursing students and more. When you install the App, it will download your free resources which include RxDrugs, OCM & Archimedes.

Lexi-Comp – Free – Keep updated with Lexi-Comp’s trusted clinical knowledge, now at the touch of a button. This application includes 30-days of access to all databases Lexi-Comp offers for your Android phone. Plus hundreds of images, calculations, and tables available with a cell or wifi connection, so you’re never without answers again.

Anatomy

Netter’s Atlas of Human Anatomy – $76.95 – Netter’s Atlas of Human Anatomy is the most loved and best selling anatomy atlas in the English language. Based on the phenomenal medical artwork of Dr. Frank H. Netter, full-color anatomic illustrations allow users to test themselves on key anatomic structures and relationships.

999 Medical Anatomy Terms Quiz – $2.29 – Learn hundreds of anatomy and physiology definitions through multiple choice quizzes, flashcards and dictionaries.

Anatomy of the Brain – $1.99 – Anatomy of the Brain is a fully-featured flash card app that helps you learn the names, locations, and functions of over 125 parts of the brain. Perfect for doctors, nurses, medical students or anyone interested in medicine.

Calculators

Mediquations Med Calculator – $4.99 – The most comprehensive medical calculator on Android. With 223 formulas and scoring tools and an intuitive interface, Mediquations makes getting the answers you need quick and painless.

MediCalc – $.99 – MediCalc contains over 70 of the most commonly used medical equations and scoring tools. It has a very simple UI with formulas broken down by specialty and systems.

Medical Calculator – $2.99 – MedCalc includes 58 of the most important medical calculators and scoring tools for the G1 android phone. It incorporates a simple and fast interface and provides comprehensive results maximizing your time caring for patients.

InfusionCalc – $.99 – Great tool for paramedics and nurses. Enter the dosage ordered (mcg/kg/mind), drug on hand (mg or mcg), fluid volume (ml), drop factor, and patient’s weight (kg or lbs).

Cardiology

Cardio Calc – Free – This app contains cardiology clinical calculators and decision support tools, Framingham & Reynolds risk score, CHADS2 and much more. It is designed for anyone managing patients with heart disease disease or lipid disorders.

Cardiovascular Pharmacology – $1.99 – This is a fully-featured flash card app that helps you learn about cardiovascular pharmacology.

EKGdroid – $3.99 – This is a simple arrhythmia guide for Android devices. Each component of the EKG is explained.

Dentists

Dentistry Terms – $1.25 – This Dentist Glossary application is a dictionary of all things having to do with Dentistry. They have included abbreviations, definitions, a glossary of terms, and many more Dentistry Terms.

Clinical Decision Support

Medicine Central – $159.95 – Medicine Central is an integrated mobile and web reference built specifically for physicians, students, residents, and nurse practitioners. Medicine Central brings you comprehensive point-of-care content on the essentials of diagnosis, treatment, and follow-up for over 700 diseases and disorders in a quick-read format.

Merck Manual Suite – $79.95 – The Merck Manual Suite plus Davis’s Drug Guide combines three references to create a complete point-of-care solution for clinicians. This package integrates expert descriptions of diagnosis and management of diseases with an A to Z symptoms guide and an award-winning drug guide.

Drug Facts Platinum – $149.95 – This app combines the most comprehensive drug database (A to Z Drug Facts) with a powerful interactions product (Drug Interaction Facts) and over 300 natural product monographs (The Review of Natural Products) for complete point-of-care drug coverage.

Diagnosaurus DDx – $.99 – Quickly search over 1,000 differential diagnoses by organ system, symptom, disease, or browse all entries to help you reach an accurate diagnosis.

Dictionaries

Concise Oxford Medical Dictionary – $14.99 – An Oxford Medical dictionary with over 10,000 terms used in modern medicine.

BKS Medical Dictionary – $19.95 – The Medical Dictionary for Android, contains easy-to-understand explanations of over 38,000 medical terms.

Medical Terminology – $.75 – A dictionary with over 500 medical words.

Drug Reference

Epocrates – Free – Quickly and easily access reliable drug information with Epocrates Rx beta. It provides multiple clinical tools in one easy-to-use application. Join more than 950,000 healthcare professionals who rely on Epocrates’ innovative clinical products to make more confident decisions at the point of care. (SD card is required)

SkyScape RXDrugs – Free – Skyscape’s RxDrugs Dosing Companion provides dosing guidelines on thousands of commonly used brand and generic drugs and now includes nearly 400 integrated weight-based drug dosing calculators. Continuously updated dosing guidelines on a variety of medications, including antimicrobial, cardiovascular and many more.

Davis’s Drug Guide – $49.95 – Davis’s Drug Guide delivers up-to-date, comprehensive, and practical information on over 5,000 trade name and generic drugs. Look up information on dosing and administration, safety, interactions, and patient teaching.

A2ZDrugs – $49.95 – A2ZDrugs is the handheld version of A To Z Drug Facts, the easy-to-use drug guide with the latest FDA approvals, indications, dosages, side effects, and patient care considerations.

Eyecare

Ophthalmology Glossary – $1.25 – Ophthalmology is a branch of medicine which deals with the diseases and surgery of the visual pathways, including the eye, hairs, and areas surrounding the eye, such as the lacrimal system and eyelids. To help you navigate this special issue on Ophthalmology, we have created a comprehensive Glossary on the subject.

Ophthalmology – $2.99 – Ophthalmology is a fully-featured flash card app that helps you learn about ophthalmology.

Games

Speed Anatomy – Free – How fast can you point to your liver, gall bladder or incisor? Speed Anatomy is an addictive game that tests your speed and challenges your knowledge of human anatomy.

450 Medical Slang Terms Quiz – $.99 – Includes 450 slang terms. Nurses, Doctors, and medical professionals use humorous euphemisms and slang to deal with serious situations. Review flash cards, online dictionary, and glossary.

General Reference

5-Minute Clinical Consult – $79.95 – The 5-Minute Clinical Consult, 5MCC, delivers to-the-point guidance on diagnosis and treatment of 700+ medical conditions seen in everyday practice. These include diagnosis, treatment, medications, follow-up, ICD-9 coding, and patient teaching.

PubMed Mobile – Free – Search the PubMed database with over 19 million citations for biomedical articles and life science journals.

Medical Glossary – $1.25 – This app is a comprehensive A to Z listing of medical terminology. The glossary contains thousands of terms, acronyms, institutions, lingo, descriptions, and definitions all about medicine, and practicing medicine.

Medical Abbreviations – $2.99 – Medical Abbreviations provides simple, fast and convenient access to more than 1,800 medical abbreviations at your fingertips. Easily search the abbreviations and definitions and see the search results as you type.

ICD Code Look Up

ICD-10 – $2.99 – Now you can see the new ICD-10 codes that will replace the current ICD-9. Works off-line and it contains more than 32,500 searchable codes.

ICD-9 – $2.99 – ICD-9 application gives you the latest ICD9-CM diagnosis codes on your mobile. If you need to quickly and easily find a code from the International Statistical Classification of Diseases and Related Health Problems (ICD), get it now onto your mobile.

Lab Tests

Davis’s Lab & Diagnostic Tests – $49.95 – Davis’s Labratory and Diagnostic Tests is a nursing reference that puts hundreds of laboratory and diagnostic test monographs at your fingertips. Each entry delivers information on how the test works, how to accurately interpret results, and how to provide the best care to your patients before, during and after a test.

Labs 360 – $49.95 – Labs 360° is a clinically oriented laboratory guide written for the healthcare provider who wants to understand what a given test is, its clinical significance, and how the test can aide in patient diagnosis and treatment.

Normal Lab Values – $4.99 – Lab Values helps you in accessing the quick information to the common laboratory values. Around 150 common laboratory values are compiled in this application. You even have an option of adding a new category and a new lab value.

Mental Health

Psychiatry Q&A – $9.99 – Prepare for your certification, re-certification, USMLE, shelf exams, or rotations with Psychiatry Q&A. The app has 100 questions designed for students, residents, fellows, attendings, nurses, and physician assistants.

Psych Drugs – Free – Learn important and useful information (drug names, indications, etc) for psychotropic medications such as antidepressants (depression), antipsychotics (psychosis), mood stabilizers (bipolar), and anti-anxiety (OCD, panic, PTSD) medications.

Psych Facts – Free – Learn about mental health topics such as depression, anxiety, bipolar, OCD, ADHD, drugs, eating disorders and schizophrenia. This app contains hundreds of facts.

Nursing

Nursing Central – $159.95 – Nursing Central is the complete mobile solution for nursing that includes Davis’s Drug Guide, Taber’s Medical Dictionary, Diseases and Disorders, Davis’s Laboratory and Diagnostic Tests, and Unbound MEDLINE. Look up information on diseases, tests, and procedures.

RNotes – $29.95 – RNotes is a quick-reference application that puts the latest clinically-focused nursing information at your fingertips, helping you improve patient care. Find answers fast with conveniently organized content. The new third edition also helps you prepare for the NCLEX examinations by noting topics covered on the exam.

Handbook of Nursing Diagnosis – $39.95 – Handbook of Nursing Diagnosis helps nurses reach an accurate diagnosis with speed and confidence by identifying collaborative problems, addressing the special needs of specific populations, and linking clinical situations to a specific diagnosis using the latest NANDA-approved list. Also includes NIC and NOC lists.

Nursing Pharmacology – $2.99 – Nursing Pharmacology application helps you learn all about the nursing pharmacology. It contains over 140 flash cards.

Mini-Nurse – Free – An app made for student nurses and those who wish to know a little more about nursing. Contains dosage calculations, med abbreviations, and more.

Pediatrics

Pediatrics Central – $179.95 – Pediatrics Central Dx + ID + Rx is the complete solution for pediatric information at the point-of-care. Look up detailed disease and drug information in 5-Minute Pediatric Consult, Red Book, A to Z Drug Facts, Drug Interaction Facts, and MEDLINE Journals.

Pediatrics Q&A – $9.95 – Prepare for your certification, recertification, USMLE, shelf exams, or rotations with Pediatrics: PhysicianBoardReview Q&A. The app has 100 questions designed for students, residents, fellows, attendings, nurses, and physician assistants.

PALS – $2.99 – Pediatric Advanced Life Support (PALS) is a fully-featured flash card app that helps you learn how to effectively respond to a pediatric emergency. Perfect for doctors, nurses, paramedics, pediatricians, medical students or anyone interested in medicine.

Pronunciations/Translations

Taber’s Medical Dictionary – $49.95 – Taber’s Medical Dictionary is the most complete medical dictionary with over 60,000 entries, 9,000 new and revised terms, 1,000 illustrations, and 30,000 audio pronunciations.

Merriam-Webster Medical – Free – A concise guide to the essential language of medicine with more than 39,000 entries, including English audio pronunciations.

Medical Spanish – $6.99 – The Emergency Medical Spanish Guide (EMSG) is a tool designed for non-Spanish speaking health care professionals to quickly ascertain vital medical information from their patients.

Study Guides

Medical Mnemonics – $1.99 – Medical Mnemonics puts 1500+ clever acronyms, rhymes, and memory tricks on your Android, on topics ranging from Anatomy and Biochemistry to Pharmacology and Surgery.

MCAT Prep Chem – $2.99 – The MCAT Prep Chem app covers all of the aspects of MCAT prep; general & organic chemistry. All the content is arranged by topic and category for easy navigation.

MCAT Prep Bio – $2.99 – The MCAT Prep Bio app covers all the aspects of MCAT prep: molecular bio, genetics, etc. All the content is arranged by topic and category for easy navigation.

999 Medical Anatomy Terms – $1.29 – Multiple choice quiz, flashcards, and dictionary. Post your score online for global ranking. Record and review correct and incorrect answers with email. Text message quizzes to friends. Recent upgrades include hundreds of new heart, muscle, blood, CNS, and skeletal terms.

For a full list of medical apps for the Android operating system, check out the Android Marketplace on your smartphone or head over to the Android Library.

Federal qualified health centers (FQHCs) are certainly not exempt from this predicament. They too will be required to use electronic medical records by 2015. Since most are using paper charts, the transition to electronic can be especially challenging for them.

The advantages of going electronic will become critical – increased information mining; quicker access to patient information; more security; and less storage space are just a few of the benefits of switching from paper charts to EMR software.

When beginning the search for an EMR, we recommend that buyers assemble a list of their key requirements. Specialty-specific templates, lab integration, e-prescribing, and device integration are commonly required features. FQHCs, however, need to consider additional functionality due to their unique offering.

These requirements include:

• The ability to serve a wide range of specialties. Most FQHCs will need a system that supports a broad range of care – primary care, pediatrics, women’s health, behavioral health, physical therapy, dental, etc. While many vendors can address primary care and related specialties, very few can also address mental/behavioral health, therapy, and dental care in a single system.
• FQHC reports. As you know, FQHCs are required to track detailed patient information and provide Universal Services Data (USD) reports on patient demographics, statistics, and trends. Most software vendors on the market will have basic reports for patient demographics and sometimes PQRI, but most will not offer specific FQHC reports out of the box.
• Support for sliding fee scale adjustments. Systems built for FQHCs will allow administrators to apply discounts based on family size and income. Most vendors will not offer this functionality, requiring users to complete adjustments manually. This process can become very labor-intensive and increase the room for human error.
• Efficient workflows for high-volume centers. FQHCs are notoriously busy, with many providers seeing 30-40 patients per day. This large patient load will require a system that allows users to complete notes quickly, calculate charges efficiently, and generate claims automatically. Wasting time with redundant tasks can quickly lower an FQHC’s ability to support high patient volumes.

Although the EMR software market is large and complex, FQHCs can begin their EMR search processes effectively by focusing on software vendors that offer these four features. They will further benefit from the simple fact that fewer software vendors can serve their specialized needs. This smaller universe of potential vendors will help them quickly identify potential options and make the research process that much easier.

To learn more about EMR software for FQHCs, take a look at our FQHC EMR Buyer’s Guide. We’ve listed a handful of options below to get you started.

However, CCHIT’s role in the EHR market is changing. The Office of the National Coordinator of Health IT (ONC) and the Center for Medicare & Medicaid Services (CMS) announced in early March 2010 that they would name more than one organization to certify EHR software, countering previous claims that CCHIT would become the sole certifying body. The certification requirements are in accordance with 2009′s Health Information Technology for Economic and Clinical Health (HITECH) Act.

As this news swirled around, one doctor called Software Advice and asked: “Is CCHIT dead?“

Dead? No. But it appears that the organization’s influence is waning.

In the spirit of point counterpoint, here are three reasons why CCHIT could become less relevant in the EHR industry:

1. Competition with other certifying entities;
2. Influence of regional extension centers; and,
3. Diminishing need for certification.

And here are three reasons why CCHIT could continue to remain relevant:

1. Institutional knowledge;
2. CCHIT products are a bridge to HITECH incentives; and,
3. Need for alternatives to government certification.

Let’s take a look at these reasons in detail. Make sure you vote in our poll and leave us your thoughts in the comment section.

Why CCHIT Will Become Less Relevant
CCHIT became a recognized certifying body (RCB) in 2006 so that hospitals could donate IT systems, equipment and training to physicians and other healthcare providers without fear of violating anti-kickback laws. If the equipment donated by the hospitals was approved by an RCB, then it was perfectly legal. CCHIT was the only organization, and still is, to earn the RCB designation.

Fast forward to 2010 and you’ll see how CCHIT has outgrown this role. Even though we think that CCHIT has considerable staying power in the EHR software market, the organization’s fight to remain relevant includes numerous obstacles as the U.S. healthcare system enters the “HITECH era.”

1. Competition with other certifying bodies. In a recommendation released in August 2009, the Health IT Policy Committee, an advisory group to the National Coordinator for Health IT, said that it would be in the best interest of the healthcare industry to have multiple entities certifying EHR software.

This recommendation by the Health IT Policy Committee effectively ends CCHIT’s “monopoly” on certifying EHR software. Other groups, such as The Drummond Group, are beginning to step into the certification space. This company “has tested over a thousand international software products used in vertical industries such as automotive, consumer product goods, healthcare, energy, financial services, government, petroleum, pharmaceutical and retail.” While The Drummond Group hasn’t specifically certified EHR software before, they obviously feel comfortable enough with the government’s certification requirements to move forward with their application.

Private entitites aren’t the only groups involved in certifying EHRs. The National Institute of Standards and Technology, a government entity, is collaborating “with health IT stakeholders such as vendors, implementers, standards organizations and certification bodies to establish a testing infrastructure.” Essentially, the institute will monitor the organizations that become official certifying bodies and ensure they’re held to national data standards.

In short, there is now competition and oversight in a space where previously there was none. This alone reduces CCHIT’s influence and relevance. Organizations that become RCBs will have the opportunity to attack CCHIT’s perceived weak spots, such as evaluating more specialty-specific EHR software and offering certification programs with less stringent requirements.

2. RECs may not choose CCHIT-certified products. The HITECH Act established approximately 60 regional education centers (REC) whose goal is to “offer technical assistance, guidance, and information to support and accelerate health care providers’ efforts to become meaningful users of Electronic Health Records.” Spread throughout the country, RECs are tasked with getting approximately 100,000 physicians up to speed as meaningful users of EHR software over the next two years.

The RECs not only will help physicians implement EHR software but also will choose “preferred” EHR vendors to work with. For example, the NYEC Regional Extension Center, which serves New York state except for New York City, recently chose eClinicalWorks, Eclipsys, Greenway, NextGen and Sage as “preferred vendors.”

How does this affect CCHIT? Each REC can choose their own preferred EHR software vendors, CCHIT-certified or not. If RECs choose to promote vendors that don’t offer CCHIT-certified EHR software, then CCHIT is effectively cut out of that region’s REC physician pool. The more software vendors RECs choose that are not CCHIT-certified, the less influence the commission will have. Conversely, if RECs choose CCHIT-certified software or make CCHIT certification part of their preferred vendor selection process, the commission stands to actually increase their influence in the EHR arena.

3. Certification may become less important to new vendors. The list of EHR software providers that are currently CCHIT-certified leans heavily towards larger, more established software vendors. While some may take this as an indication of CCHIT bias towards larger vendors, others may argue that smaller or less established vendors may not choose to have their products CCHIT-certified because of the cost involved.

Whether or not new competition drives down CCHIT’s certification fees remains to be seen. If their certification costs remain high, it’s plausible that more EHR vendors without interest in CCHIT certification will emerge. The emergence of cloud computing and Software as a Service (SaaS) applications is bringing software development and maintenance costs down. A lower barrier of entry to the market means more niche vendors will emerge, filling in gaps that CCHIT-certified software doesn’t fill.

Why CCHIT Will Become More Relevant
CCHIT has been entrenched in the EHR certification game for too long to just disappear. In fact, there’s an argument that CCHIT stands a good chance of becoming a permanent certifying body in the EHR software industry. Here are a few reasons why CCHIT will continue to remain relevant to providers searching for EHR software.

1. Experience counts. In the world of EHR certification, CCHIT is currently “it.” They’ve been carrying the torch of EHR certification since the organization was created in 2004. No other U.S. organization has been more thoroughly involved in testing and certifying EHR software than CCHIT. They’ve certified nearly 200 products since 2006.

With experience like that, it’s unlikely that CCHIT will be left out in the cold once Health & Human Services chooses certification bodies. CCHIT already has applied to become an official certification body under the program and created a preliminary EHR certification program designed to meet the proposed HITECH standards. Even if CCHIT isn’t the best choice to become an official certifying body, it’s tough to argue against including them as at least one of the options.

The bottom line: No other organization is as prepared as CCHIT is to begin certifying EHR software for the government.

2. CCHIT products are the “best bet.” Many providers and hospitals are waiting on the certification requirements of the HITECH Act to become final before they choose an EHR software system. At the same time, a provider needs to demonstrate meaningful use for 90 consecutive business days in the year 2011 to earn up to $18,000 in incentive payments for the 2011 calendar year.

So, providers need to have an EHR up and running relatively quickly but they’re still not sure what EHR systems are going to be certified. What can they do? Currently, CCHIT offers a Preliminary 2011 ARRA certification in addition to its it’s full 2011 EHR certification. CCHIT’s ARRA certification is “simpler and more flexible” than the normal CCHIT certification and is “designed to demonstrate that a developer’s technology is well-prepared to be certified once ONC-accredited testing and certification becomes available.”

It’s likely that in this time of uncertainty, many providers and even RECs are turning to CCHIT-certified products to guide them.

3. Alternatives to government certification are needed. The HITECH Act’s success is not guaranteed. And in the event that the government-sponsored EHR certification program doesn’t succeed or loses relevance, the market will need to fill a void. Some authority on EHR software will be needed and CCHIT is one of the best positioned organizations to become that authority.

Even if the HITECH Act is a rousing success, the EHR market will still have a need for an organization akin to what CCHIT and others do now – evaluate the functionality of EHR systems.

Vote In The Poll and Let Us Hear Your Thoughts
Make sure you cast your vote in our poll above on whether or not CCHIT will remain relevant during the HITECH years. Please chime in with your thoughts, as well, using the comments section.

We’re hearing more and more questions about Mac compatibility from physicians interested in electronic medical records (EMR systems). Many providers, notably smaller offices, are choosing Apple computers over PC-based systems to run their practice. Their reasons are the same reasons consumers choose Mac products: stability, simplicity and “coolness.”

On the surface, it appears that Apple’s popularity in the consumer market is starting to creep into the medical practice market. Physicians like their home Macs and their iPhones, so they want the same hardware in the office.

A Limited Selection of Mac EMRs
Unfortunately, a physician wanting to run EMR software on a Mac is going to find a limited number of choices. Over 95% of the EHR software on the market won’t run natively on a Mac.

Most EMR software vendors haven’t developed a Mac OS-specific version of their software. On top of that, many of the web-based EMR vendors don’t provide support for the the most popular Mac web-browsers such as Safari, Firefox and Chrome. And if a physician wants to run EMR software from any of the top ten most popular EMR vendors, they’re out of luck. None of those vendors support Macintosh computers.

However, for the Mac diehard, there are a number of solutions. Here are three ways that a physician can start running EMR software on their Macintosh computer:

EMRs Built for the Mac
Relative to Windows-based systems, EMRs designed to run on Mac OS represent a fraction of the overall EMR software market. Only a handful of the over 300 EMRs available are designed exclusively for Mac OS.

If a physician wants a truly Mac-based EMR, built for Mac OS, this is the direction they want to go in. Here is a list of the native Mac EMRs we found in our research, along with the size and types of practices they are designed for:

Since these systems are designed specifically for Mac OS, that means they’re going to have a Mac look and feel to them. They’re installed either through a download or from a disc, meaning they are on-premise software systems. The install exists on a doctor’s physical machine, and not “in the cloud.”

Advantages of using on-premise EMR software for Macs include:

• The same familiar Mac look and feel;
• Less risk of performance degradation from “Windows emulator” software; and,
• Easy integration with other Apple software products.

The downsides of these products largely result from the fact that the Mac-based products are developed by smaller companies (largely because they service a smaller market – Mac users). These downsides might include:

• Smaller software companies may be less viable in the long term;
• They may have limited R&D budgets; and,
• They may get left behind as “the big names” race to meet new EHR requirements.

Web-based EMRs – A Great Alternative
Web-based EMR software is a growing segment of the market and one that is appealing to physicians in a wide range of specialties. Because web-based EMRs don’t depend on a specific operating system, a physician needs to only have a compatible web browser (Safari or Firefox for example) on their Mac to access the software online. There’s no installation of software on a physical machine; all data is hosted in the “cloud.”

The number of web-based EMR vendors is rising but unfortunately only a handful have optimized their software to run on a Mac-based web-browser. Here are the web-based EMR products that will run on a Mac:

Also known as Software-as-a-Service (SaaS), the web-based model of software offers a number of advantages over on-premise systems:

• No physical install of the software on a machine;
• System can be accessed from any computer with a web browser; and,
• Upgrades are pushed out automatically by the software vendor.

Another quasi-web-based option is to remotely access another machine running EMR software. This has potential security concerns, as well as possible performance issues, but some physicians are doing this. They’ll access a Windows-based EMR through their Mac web browser or Mac-based remote software.

Run Windows-Based EMRs, On Windows, On a Mac
The final way that a doctor can run EMR software on their Macintosh computer is through a virtual machine. This involves running a separate program (Parallels, VMWare, BootCamp) that mimics a Windows operating system on a Mac machine. This process is simpler than it sounds, with today’s virtual machine software being relatively easy to install and set up.

Advantages of going the virtual machine route include:

• Being able to run any Windows-based programs on a Mac;
• Seamless transition between Mac and Windows programs on one machine; and,
• Elimination of compatibility issues between Mac and Windows files.

The downside of this approach is that you will have to buy licenses of Microsoft Windows and you will have to run the EMR on the Windows OS. You won’t be using a native Mac OS application. However, as we said, it is fairly easy to toggle back and forth between the Windows EMR and your other Mac applications.

This option is appealing for practices that don’t want to give up their Windows EMR, but want to move to Apple computers.

An Eager Market Awaits
We’re a Mac office if you will here at Software Advice. Each employee has a iMac and we purchase Apple or SaaS software whenever possible. Actually, we use a lot more SaaS systems than on-premise Mac software. That’s why we hope that the leading EMR software vendors, both on-premise and web-based, can open up the market to those who want to use Apple hardware in their practices.

Nevertheless, the team at Software Advice set out to see what numbers we could pull together. We limited our analysis to the outpatient EHR software market. Moreover, we decided to measure market share based on the number of physicians users, rather than vendor revenue or other metrics. We tried to keep it simple. It’s not.

Number of Doctors Using EHR Software
First, let’s define the total size of the market we are analyzing. Of the approximately 788,000 physicians in the United States, 65% of them work in an outpatient facility or physician’s practice, according to the Bureau of Labor & Statistics. That’s 512,000 possible physicians who are in the outpatient EHR software market.

According to a recent study of office-based physicians released by the Center for Disease Control and Prevention (CDC), 44% of those of 512,000 office-based doctors had adopted either a partial, basic, or fully functional EHR system. That’s 225,000 outpatient doctors using an EHR to some extent. Here’s how EHR adoption breaks down among the total number (512,000) of outpatient physicians in the United States:

Outpatient EHR software adoption, 2009

The CDC defines “partial” EHR systems as those not exclusively used for billing. “Basic” systems include the following functionalities: patient demographic information, patient problem lists, clinical notes, orders for prescriptions, and viewing laboratory and imaging results.

Systems defined by the CDC as “fully functional” include all functionalities of a basic system plus these functionalities: medical history and follow-up, orders for tests, prescription and test orders sent electronically, warnings of drug interactions or contraindications, highlighting of out-of-range test levels, electronic images returned, and reminders for guideline-based interventions.

Outpatient EHR Market Share
So, what EHR software are the 225,000 physicians using? Based on number of physician users, here’s how the market breaks down:

Outpatient EHR software market share by vendor, 2010

Software Advice’s analysis showed that a handful of vendors – Allscripts, Epic, eClinicalWorks, NextGen, and GE Centricity – own more than three-quarters of the ambulatory EHR software market. This is a similar trend that other EHR market reports and analysis have noted.

Here is the data Software Advice was able to gather on the top EHR vendors, based on volume of physician users:

Vendor	Physician Users	Practices Served
Epic	45,000	N.A.
Allscripts	40,000	N.A.
eClinicalWorks	40,000	6,500
GE Centricity	35,000	2,500
NextGen	35,000	2,000
SOAPWare	30,000	8,000
Practice Fusion	18,500	10,000
Eclipsys	11,000	N.A.
Sage Health	10,000	N.A.
Greenway Medical	6,000	1,400

Clarifications, Disclaimers, Footnotes, Contradictions, etc.
As mentioned in the introduction, the EHR software market has many “fuzzy” sources of data. In fact, when all of the physician users are calculated in the table above, the number of physicians using EHRs in the United States is more than 40,000 over what the CDC reported. Clearly, we need to dig into these numbers a bit more.

In most cases, the information was gathered directly from the EHR software vendors. For those vendors that weren’t able to be contacted, publicly reported information was used. In some cases, exact numbers of physicians and practices were available. In some cases, approximations were used by Software Advice and the software vendors (In the case of a discrepancy, please contact us).

Here are a few questions that came up during the research process whose answers would help refine our market share numbers:

• Sage Health. How many of Sage Health’s users are using their Intergy EHR product in conjunction with their practice management software versus those using just Sage’s practice management software, in particular, Medical Manager?
• Allscripts. How many of Allscripts users are still using Misys practice management systems? Like Sage, they have a huge practice management installed base, but not all of those customers are using their advanced EHR systems.
• Epic and NextGen. How many of their users are exclusively outpatient customers? Both of these EHR vendors are meaningful players in the inpatient EHR market. We need to exclude those physicians from our analysis.
• GE Centricity. General Electric didn’t distinguish between physician (MD) users and mid-level providers in their count of users. This would be a helpful distinction to have in this analysis.
• Practice Fusion. Being a free EHR system, it would be important to see how many of Practice Fusion’s EHR users are actively using their software, instead of just kicking the tires on a cool new web-based EHR and “freemium” business model.

Feedback (We Need Your Help)
Software Advice knows many of you are just as, if not more, intimately plugged into the EHR software market than we are. That’s why we’d like your feedback to help figure out these numbers.

Which vendors’ numbers are higher? Lower? Who are the up and coming players that will earn significant market share in the coming years?

How can a provider tell the difference between a fly-by-night medical billing company and one to which they can hand overtheir patient’s medical information with confidence? If a physician knows what criteria by which to judge a medical billing service, they’ll be able to select a company that will significantly decrease their time spent on billing issues and increase their time spent on patient care.

To choose correctly, a provider will need to evaluate these five key criteria when choosing a medical billing company:

• Level of service;
• Industry experience;
• Use of technology;
• Pricing model; and,
• Capacity to take on new clients.

What Functions Will a Billing Service Perform?
Before getting into the selection details, let’s quickly review how a billing service fits into the medical billing process. A medical billing company will be able to take over most billing functions in a provider’s office.

The medical billing process

To see a substantial benefit, a provider needs to select a medical billing service that performs at least these functions:

1. Claim generation and submission;
2. Carrier follow-up;
3. Payment posting and processing;
4. Patient invoicing and support; and,
5. Collection agency transfer services.

These functions are the “guts” of medical billing. Following up with insurance carriers and pursuing denied claims are two areas where medical billing services typically excel versus a provider’s in-house staff.

Other services that may be offered include credentialing, medical coding, transcription, insurance eligibility verification and appointment scheduling.

Naturally, as the number of services increases, fees will increase. A provider will want to strike the proper balance between cost and service by honestly evaluating their own capacity to perform these functions.

Criteria #1: Level of Service
In addition to the basics of medical billing mentioned above, there are more details a provider will want to be clear on before choosing a medical billing service. Here are some important functions that a provider and billing service should delineate before they enter into a partnership:

It’s important that a provider and a billing service agree on the level of service before they get started. If the right level of service isn’t chosen, a provider won’t reap the full benefits of outsourcing their medical billing.

Criteria #2: Industry Experience
When a provider evaluates a medical billing service’s experience, they need to look beyond the number of years the company has been in business. Experience includes not only time but also familiarity with certain specialities. Billing certification plays a key role here as well.

Billing procedures will vary by medical speciality, so a provider will want to choose a billing service that is familiar with their specialty. Experience with billing to Medicare and Medicaid will be a huge plus, in any speciality.

Choosing a service with staff members that are certified by the American Medical Billing Association (AMBA) is important as well. The AMBA offers a Medical Reimbursement Specialist certification designed to promote professional medical billing.

The certification implies that the recipient is knowledgeable in the areas of:

• ICD9, CPT4 and HCPCS Coding;
• Medical Terminology;
• Insurance claims and billing, appeals and denials, fraud and abuse;
• HIPAA and Office of Inspector General (OIG) Compliance;
• Information and web technology; and,
• Reimbursement.

Even with a certified staff, the proper procedures and technology will need to be employed to maximize benefits of the provider/billing service relationship.

Criteria #3: Use of Technology
Software for medical billing is allowing billing services to accomplish more with less. However, just because a company is using sophisticated billing software doesn’t necessarily mean they’re going to do an efficient job. They need to have the proper procedures in place to take advantage of everything the billing company software offers.

Most importantly when it comes to technology, a provider will want to know about a company’s information sharing, data security, recovery procedures, data backup procedures.

Here are some potential technology issues in those realms that will need to be addressed:

• How will superbills and claims be shared?
• How does billing service fit with the provider’s electronic health record (EHR) strategy?
• Does the service have an integrated EHR?
• How does the service ensure data security?
• What are the disaster recovery procedures?
• Where and how is backup data stored?
• Will a provider need to install and maintain software or access the system online?
• Is the technology HIPAA compliant?

Choosing a medical billing service company that employs technology in a way that effortlessly bridges the gap between provider and biller can mean the difference between profit and loss. By choosing a medical billing service that integrates with a provider’s EHR (or provides their own EHR), that gap can be closed even more.

Criteria #4: Pricing Options
When dealing with practices whose revenue is in the millions of dollars, the cost savings between pricing models can be in the hundreds of thousands of dollars.

There are three pricing options offered by medical billing companies and we’ve broken them down in the table below:

	Description	Pros	Cons
Percentage-based	The service will charge a percentage of collections or they will charge a percentage of gross claims submitted or total collections.	The success of the billing company is tied to the success of the practice.	Small claims may not be pursued as aggressively due to lower payoff.
Fee-based	With this model, the billing services charges a fixed dollar rate per claim submitted.	This model is potentially more cost effective.	Less incentive for the billing service to follow-up on denied claims.
Hybrid	With this model, the billing service charges on a percentage basis for certain carriers or balances and charges a flat fee for others.	This model is potentially more cost effective.	Less incentive for the service to follow-up on certain claims.

Percentage-based models are most common on the market today. Fee-based models are the next most common option with the hybrid option appearing with less frequency. Many billing companies offer two or three of these options.

Criteria #5: Capacity to Take on New Clients
Finally, a provider will want to get into the nitty gritty of a medical billing company’s performance to evaluate whether the company has the capacity to take them on as a client. Remember, much of the payoff in hiring a billing service comes from the pursuit of denied claims and fee collection. A billing service that doesn’t have the capacity to effectively follow up with outstanding bills will provide minimal benefit.

Determining capacity involves collecting a number of metrics about the company’s performance, including:

• Years in the business;
• Number of employees and reporting structure;
• Number of clients by specialty;
• Gross number of billings; and,
• Number of claims processed annually.

Knowing this information will help a provider determine the level of service a billing company will be able to provide to their practice. Getting even more detailed, a provider will also want to delve into a number of “quality” metrics about billing companies. These include:

• Average number of days in A/R by specialty;
• Coding, submission and follow-up delay metrics;
• By what percentage they’ve been able to increase revenues for existing clients; and,
• By what percentage they’ve been able to reduce payment delays.

How a medical billing service performs on each of these metrics will significantly affect a provider’s bottom line.

Need a Cheat Sheet?
Download our free guide (PDF) to evaluating medical billing services and keep it handy during your search.

Medical Billing Services Selection Guide

Our Best Practices Guide to selecting medical billing services will help you stay organized and make the right choice for your revenue cycle management.

( 11 Page PDF)

Software Advice’s Director of Business Development Samarra Davis contributed to this article.

What is remarkable is how closely the SaaS market’s evolution matches the definition of a disruptive technology that was described by Harvard Business School professor Clayton Christensen in The Innovator’s Dilemma (he later replaced the term with “disruptive innovation” in his subsequent book, The Innovator’s Solution). In fact, the SaaS dilemma that incumbent software vendors currently face is playing out almost page-for-page from Christensen’s books. As a result, we can use the disruptive innovation framework to gain insight into what’s to come in enterprise software.

After a decade of deriding SaaS technology as too simple, functionally incomplete and insecure, vendors such as Microsoft, Oracle, SAP and thousands of incumbent “on-premise” software vendors are now embracing SaaS. It’s an awkward embrace – one that threatens to cannibalize existing revenue steams, divert resources and eat up profits.

Of course, the innovator’s dilemma doesn’t destroy every incumbent. These incumbent market leaders are powerful, resilient innovators themselves. But for armchair quarterbacks like us, this the next five years will present a fascinating game to watch.

What is a Disruptive Innovation?
Disruptive innovation refers to new solutions – often technologies – that through a new delivery model, alternate pricing model or target market segment are able to disrupt existing competitive dynamics dramatically. For example, SaaS offers a new delivery model (i.e. hosted “in the cloud”), a new pricing model (i.e. subscription) and initially targeted smaller customers.

Initially, these disruptors target the least profitable customer segments – typically smaller or unsophisticated buyers. These are the only customers whose requirements are limited enough to accept the bare bones feature-set of the new system. Meanwhile, they appreciate the new model (i.e. it’s cheap and easy to get started). We certainly saw this in SaaS as small businesses or autonomous departments adopted customer relationship management (CRM) systems like Salesforce.com as early as 1999. For them, SaaS CRM was “good enough.”

The disruptive innovation cycle applied to SaaS.

Over time, however, disruptive innovators improve their performance and feature-set and can meet the needs of more sophisticated customers. Combine that with a little buzz around their new model (e.g. everybody’s talking about cloud computing these days), and the incumbent vendors start to take note. Of course, the incumbent still has plenty of ammunition to dismiss the new technology, since it remains functionally deficient relative to incumbent products and the most demanding customer segments (e.g. SaaS penetration into the ERP market remains limited).

I’ll posit that SaaS is now entering the penultimate – and most contentious – stage of disruption. At this point, the innovators start to gain serious momentum. Their products approach functional parity and they begin to steal substantial market share. The incumbents finally get serious about defending their traditional markets by releasing their own version of the innovation (in the case of SaaS, that means true web-based, on-demand, cloud computing, not just hosted client/server software). Unfortunately, it is often too late. Incumbents remain apprehensive about cannibalizing existing revenue and they face challenges replicating the innovation. Typically, most incumbents stagnate, decline and fade into obscurity. Only a few nimbly transition to the new model.

The innovator now becomes the incumbent and new innovators emerge. The cycle repeats.

SaaS Disruption Battles are Well Underway
Christensen mentions Salesforce.com in his second book, The Innovator’s Solution:

This company, with its inexpensive, simple, Internet-based system, is disrupting the leading providers of customer relationship management software, such as Siebel Systems.

I worked at another leading CRM vendor back when Salesforce.com was just a start-up. I remember meetings where executives derided the system as a toy. Most Salesforce.com implementations were just a half dozen users and most customers paid their subscription fees with a credit card (Gasp!). Since then, Salesforce.com has exceeded $1 billion in revenue and incumbent market-leader Siebel Systems sold out to Oracle after hitting tough times.

While Salesforce.com in the CRM market is the best example, the SaaS dilemma is playing out in numerous software markets. Gmail and Google Apps are nascent yet serious threats to Microsoft’s Outlook/Exchange and Office cash cows. We use both of the Google services extensively. NetSuite is a contender in enterprise resource planning (ERP), but hasn’t dented SAP or Oracle too badly as of yet.

Most interesting, however, is how this same battle is being waged by innovators in so many lesser followed market segments: SaaS construction project management, SaaS electronic medical records, SaaS property management, SaaS retail point of sale. The list goes on…

Most SaaS Shortcomings are Addressed
As I mentioned earlier, I believe we are entering the final stages of SaaS disruption. The SaaS model and its proponents have not defeated the incumbents, but SaaS solutions have reached functional parity to the point where incumbent derisions are starting to fall on deaf ears.

Let’s examine each of the top five objections to SaaS:

1. Web browsers are not interactive enough. This was true when web applications required a full page refresh to complete a transaction, but the maturation of JavaScript, AJAX, Adobe Flex and other web user interface technologies addressed this. HTML 5 will put this one to rest for good. I find my SaaS apps faster and more dependable than any on-premise app.
2. Hosted data is not secure enough. This one always perplexed me, since so many of us were comfortable with web banking as early as ten years ago. Few systems could be more valuable than financial transactions. Moreover, very few software buyers can afford to implement the same security infrastructure as a professional SaaS data center.
3. It’s not possible to integrate SaaS. This was true when few SaaS vendors had built APIs and there was no middleware for SaaS. Nowadays, API integration to SaaS applications is non-trivial, but not any more difficult than on-premise integration. I should know; we just finished a successful integration to Marketo, a SaaS marketing vendor.
4. You can’t customize SaaS systems. Again, this is changing. Many SaaS applications remain fairly “packaged,” but many vendors have successfully positioned this as a benefit (i.e. “adopt our best practices”). At the same time, SaaS customization tools are maturing. Salesforce.com has built an entire development environment, force.com.
5. Big companies want to own the software, not rent. This may be still be true in some cases, but in this economy the recurring nature of subscription payments is attractive. It also puts more of an onus on the vendor to earn their future subscription payments. I’m not convinced that this presents a concrete competitive advantage for incumbents.

Incumbents are Now Challenged to Counter SaaS
Now that SaaS vendors and incumbents are locked in a real battle – the gloves are off and incumbents are releasing their own SaaS systems – our analysis turns to the big challenges that incumbents will face. Let’s examine the five most significant characteristics of SaaS systems, and then explore why they are great for SaaS purists and a real challenge for incumbent on-premise vendors.

	Great for SaaS companies	Tough for incumbents
Browser-based	They can promote the benefits of not installing and maintaining client-side software. Plus anyone can use a web browser!	Moving to a web-based architecture is a near-complete rewrite. "Web-enabled" options are temporary, at best.
Subscription pricing	Not needing to justify a big purchase up front means fewer approvals and fewer risk-averse buyers to assuage. Also, great recurring revenue.	This is the core cannibalization issue: moving to subscription pricing will stall growth and maybe lead to revenue declines for some time.
Multi-tenant architecture	With all users on one codebase and database, changes are made in one location, but roll out globally. Also, computing resources are shared.	With thousands of installs, it's impossible to consolidate. There are incremental benefits to multi-tenancy, but the legacy customers remain.
Rapid release cycles	With changes being made to one codebase/database, releases can be rolled out weekly, even nightly. More releases = better products.	The quarterly, bi-yearly or annual release cycle is deeply ingrained in the DNA of an on-premise development organization.
Bought by business, not IT	It's far easier to sell to business units with their own budget, without the need for IT approval or budget. Faster sales cycles = growth.	IT relationships are a core advantage of incumbents. With SaaS, those relationships are less relevant - a competitive barrier is lifted.

It’s Not Over Yet – Not Even Close
Microsoft, Oracle and SAP still own the large enterprise market and the SME market. In hundreds of niche software markets, on-premise incumbents dominate. Even ten to fifteen years into the evolution of SaaS, SaaS vendors still possess minimal market share relative to incumbent vendors. While still powerful and often growing, all of these incumbents face the daunting challenge of SaaS disruption. Moreover, each of the major incumbents has started in earnest on credible SaaS offerings.

Microsoft has released Microsoft Dynamics CRM Online – the first Dynamics family application to be offered in a SaaS model. Microsoft has also released Microsoft Office Online as a counter to Google Docs.

Oracle, meanwhile, continues to grow its Oracle OnDemand solution set. While much of Oracle OnDemand consists of managed services for traditional on-premise solutions, their SaaS CRM offering (acquired through the Siebel deal) is true SaaS. So too are other solutions they acquired in recent years.

Finally, SAP’s Business ByDesign appears to be a pure SaaS, on-demand offering that is operating independently from the SAP mothership. Our own conversations with SAP employees have shown that the company is maintaining an arms-length relationship with the Business ByDesign team so that this in-house “start-up” can truly function as a nimble SaaS entity, unconstrained by SAP’s on-premise legacy.

If the disruption examples and case studies in Christensen’s book are a guide, we can expect to see a massive number of incumbent vendors stall, fade and become irrelevant over the next decade. Others will deftly navigate the transition.

In our comments section below, I’d like to start a conversation about which incumbent vendors will fade and which will transition. Please share your opinion.

You would think Microsoft would be in such a promising industry, but you won’t find a Microsoft EHR available. The primary reason why is that EHRs are highly specialized, and Microsoft’s main products (Dynamics, CRM, and SharePoint) don’t come anywhere near the needs of physician practices. It would be very difficult for Microsoft to build an EHR from scratch and introduce it to the market. So what should Microsoft do to enter the industry? Acquire a current player.

Such an entry into the medical market would mimic the acquisition spree that Microsoft conducted between 2000 and 2002, when it acquired Great Plains, Navision, Damgaard, and several related vendors. These systems were re-branded and offered as Microsoft Dynamics. Before these acquisitions, Microsoft was not present in the enterprise resource planning (ERP) application market. Its only ERP presence was as an infrastructure vendor, licensing SQL Server databases and related platforms to support application rollouts. However, this lack of application presence gave competitors such as Oracle and SAP the opportunity to squeeze Microsoft out of the ERP infrastructure market by pushing Unix, Oracle databases and IBM DB2. By acquiring several applications, Microsoft was able to drive sales of its SQL Server and Windows Servers directly, in addition to the Dynamics applications themselves. This strategy proved effective in giving Microsoft a multi-billion dollar share of the lucrative ERP market.

Setting its sights on the medical market, Microsoft is starting to squeeze its way in with a few smaller acquisitions and developments of its own, mainly Amalga and HealthVault. However, these current medical offerings are on the periphery of the market and do not really target the sweet spot: electronic health records for physician practices. An intelligent acquisition of a large EHR player would provide a key piece of the puzzle for Microsoft’s entry into the medical market.

Acquired by Microsoft in 2006, the Amalga family of products (Hospital Information Systems, Life Sciences, and Unified Intelligence System) addresses hospital administration, data aggregation for biotechnology firms, and information connectivity to large enterprises. Microsoft may be planning to expand Almaga’s presence or may be looking to acquire another vendor to complement it. Regardless of Microsoft’s strategy, Amalga still would not address the physician practice EHR market.

On the other end of the spectrum, HealthVault is a patient-managed, centralized health records solution. It is essentially designed to be a reference point for consumers, not a substitute for medical records. If Microsoft were able to introduce an EHR to the market and enable its users to make records accessible to patients, labs, specialists and pharmacies via HealthVault, then they would really be on to something. This synergy with its other products would just be an added bonus to having its own EHR.

So what would Microsoft prioritize as its key acquisition criteria when evaluating EHR targets? They would certainly want target vendors who possess the following:

1. Large market share and name brand recognition. Microsoft usually likes to be the largest name in the business, so they would definitely want to sell a “big-name” system with which most buyers are already familiar.
2. A scalable product for small and large practices. Microsoft would need to be able to cover a wide range of medical customers. While its bread and butter is always in the small and mid-size market, they would want scalability into the largest organizations.
3. A .Net architecture to drag along infrastructure sales. Reinforcing the position of .Net in the medical software marketplace would be important because it would drive further sales of Microsoft infrastructure while squeezing out Unix, Oracle and IBM.
4. An established, indirect sales channel. Microsoft historically favors selling through partners, including the existing Dynamics dealer network. An EHR vendor with a large dealer network would provide Microsoft an easily transferable sales channel and process.

So which EHR vendor should Microsoft acquire? This is where it starts to get interesting. We decided to examine Microsoft’s ten most logical targets in detail. Two very popular products, GE Healthcare’s Centricity and McKesson’s Practice Partner, did not make the top ten list. While these systems meet many criteria, the parent companies – General Electric and McKesson – are not really acquirable by Microsoft. The remaining ten are outlined below.

	MARKET SHARE	SCALABLE PRODUCT	.NET ARCHITECTURE	INDIRECT CHANNEL
NextGen
Greenway
Pulse
Aprima
Allscripts/Misys
eClinicalWorks
Eclipsys
athenaHealth
Epic
Cerner

• NextGen – One of the “biggest names” in EHRs, NextGen focuses on medium to large enterprises. However, its system is certainly able to scale down to smaller practices. While it is often too expensive for groups with less than ten physicians, it has a strong position in the sweet spot of the market. Its .Net-based system is sold both directly and through a channel network, so NextGen is a good fit for Microsoft.
• GreenWay – GreenWay has a nice product, but is toward the smaller end of the companies on this list. It sells primarily directly and has some channel partners. PrimeSuite 2008, its EHR and practice management sytem, is .Net-based and is popular among small and mid-sized groups. Microsoft could leverage its resources and Greenway’s technology to become a major force in the industry. Moreover, Greenway doesn’t come with any legacy of old architecture or acquired customers.
• Pulse – Pulse has quickly climbed its way into the ranks of bigger EHR vendors and will likely stay here for some time. They were one of the first vendors to achieve 2011 CCHIT certification and are receiving a lot of buzz as a result. While the system is scalable and .Net based, Microsoft would likely want to pursue bigger fish for now.
• Aprima – Aprima (formerly known as iMedica) has focused on its .Net framework and N-tier architecture from the beginning. As a result, its modern platform and interface make it widely received among physicians across a broad range of specialties. While Microsoft would likely focus on larger companies first, Aprima could be a nice additional partner to champion .Net.
• AllScripts/Misys – A large brand and a publicly-traded company, it is a logical first place to look. After all, the company claims to have 160,000 physicians using its products. However, the 2008 merger between AllScripts and Misys presents the usual integration challenge, which might keep this firm busy for quite a while. Although we think the future of AllScripts/Misys is very promising, Microsoft probably wouldn’t get involved at this point.
• eClinicalWorks – This system is probably the most ubiquitous of the list, especially among smaller practices. The recent deal to sell eClinicalWorks through WalMart will definitely increase its brand recognition and share of the market. However, the system is built in Java, an open programming language that is the traditional enterprise alternative to Microsoft .Net. Microsoft would most likely rather acquire a pure .Net system or one that is at least close to it, especially with Oracle, IBM and SAP all embracing Java.
• Eclipsys – Eclipsys acquired MediNotes in 2009 in an attempt to move users to its Peak Practice EHR. While Eclipsys is fairly popular among hospitals, Peak Practice has not achieved similar success among small to mid-size outpatient practices. Existing MediNotes users are not thrilled about being forced to purchase Peak Practice and we’ve seen quite a few seeking a new solution from a new vendor. We think the success of the MediNotes deal is unclear and Microsoft would steer clear for now.
• Athena – The youngest company on this list, Athena’s product offering is slightly different from the others. Its system is offered via software as a service (SaaS) and is combined with outsourced billing and revenue cycle management services. This offering is indeed unique, but not a suitable target for Microsoft due to its SaaS offering and labor-intensive service component.
• Epic – This company possesses an interesting niche in the market. It has only 190 clients, but 150,000 physicians using its products. This is due to its focus on only the largest healthcare organizations in the United States. While this focus is great for Epic, it wouldn’t be effective for Microsoft. Epic will never be able to achieve the ubiquity in the small to mid-sized market where Microsoft dominates. It also sells direct, contrary to Microsoft’s traditional indirect sales mode.
• Cerner – Cerner’s cash cow is Millenium, a product designed primarily for hospitals. PowerWorks, its outpatient EHR, does not possess the market share among physician practices that Millenium enjoys among hospitals. While Cerner is a recognized name, few practices consider PowerWorks. It is also an older system. Cerner would need to improve its PowerWorks offering before becoming a suitable target for Microsoft.

Although NextGen is not currently dominant amongst small practices, Microsoft could bring them downmarket. NextGen is unable to serve these smaller buyers for two reasons: 1) small practices cannot afford an enterprise expenditure; and, 2) NextGen does not want to (and maybe cannot) devote resources to chasing smaller deals. If Microsoft owned NextGen, they could double down on pursuing smaller practices, perhaps through their channel partners. They may even lower prices to buy market share and make up the difference with revenue from services, SQL licenses, and maintenance.

Cost Analysis
For many practices, the outsourcing decision boils down to one factor: cost.

To help compare the costs of in-house billing versus outsourced billing, we’ve created a hypothetical, three-physician practice. To arrive at these numbers, we’ve used what we believe to be industry averages. Here are the characteristics of this practice:

• Three primary care physicians;
• Two medical billing specialists;
• 80 insurance claims filed per day (~20,000 per year);
• $125 billed per claim on average (~$2,500,000 per year); and,
• We assume that the billing service has a high collection rate on claims.

So, how much does each billing approach cost? Take a look at the annual costs:

	In-House	Outsourced
Billing department costs	$118,000	$4,000
Software and hardware costs	$7,500	$500
Direct claim processing costs	$3,600	$122,500
Software and hardware costs	$5,500	$2,000
% of billings collected	60%	70%
Collections	$1,370,900	$1,623,000
Collections costs	$129,100	$127,000
Collections, net of costs	$1,241,800	$1,496,000

But there are other factors – beyond costs – that a provider must consider in its decision making. Let’s examine the two approaches to compare advantages and disadvantages.

In-House Process
The in-house procedure for processing insurance claims involves a number of steps that are universal to every practice. First, employees enter information into the medical billing software program from a “superbill,” which is gathered during a patient’s visit. The superbill contains particular diagnosis and treatment codes, among other patient information, which the insurance company uses to determine if the claim is legitimate.

Via the practice’s billing software, the provider then submits the claim to a medical billing clearing house, which verifies the claim and sends it to the payer. The clearing house scrubs the claim for the errors (for a fee) before passing it on to the payer. By not submitting claims directly to a payer, the provider saves time, money and lowers rejection rates. The clearing house also has the ability to format and submit claim data en masse in the various insurance company formats.

Once the claim is rejected/accepted by the payer, notification of the claim’s status is sent to the clearinghouse, which updates the provider on the status of a claim. If a claim is rejected, the provider’s staff resubmits the claim once additional information has been gathered. The practice will be charge for each claim submission, even if it’s a correction.

EHR software – especially those EHRs with a integrated practice management system – has the potential to make in-house billing easier for a practice. EHR software, when integrated with a practice management system, will populate both system’s data fields. Diagnosis codes and other information needed for billing doesn’t need to be keyed into another system. This eliminates a second round of data entry. This tighter integration may be one factor that helps keep billing in-house.

Outsourced Process
The process for outsourcing billing is more straightforward for practice staff. Superbills and other documents are scanned and electronically sent or mailed to the medical billing service. The medical billing service takes care of the data entry and claim submission on behalf of the provider. Most billing services charge a percentage of the collected claim amount. The industry average is approximately a 7% charge for processing claims through a medical billing service.

The medical billing service takes care of much of the “dirty work” associated with the billing process. It will also follow up on rejected claims, pursues delinquent accounts, and even send invoices directly to patients. The convenience factor is a major reason that providers choose to outsource.

If a practice is using EHR software, then the process is even easier. Information from a patient’s superbill is stored in the EHR and electronically transmitted to the billing service. This eliminates the need to send paper records to the billing service. And because the EHR software eliminates an extra round of data entry, accuracy is also improved.

One possible issue here is data integration between the EHR software and the billing service. The type of data being exchanged between the provider and the billing service will need to match, or else the data will need to be converted to a different format. Depending on the billing service, data conversion may be an option.

• Your billing process is inefficient. If you’ve been watching your collections drop while the time to collect increases, you may have issues in your billing department. Outsourcing to a third-party billing service typically decreases the number of rejected claims and decreases the time it takes to receive payment from a payer.
• You have high staff turnover. Turnover is an issue in any industry but turnover in a provider’s billing department is especially damaging. Claim processing is the economic life blood of a practice and a new addition or replacement in the billing department will inevitably lead to slowdown in the processing of claims.
• You’re not tech savvy. Keeping your billing in-house will require an investment in practice management software. Add in training for your staff and the significance of this investment becomes clearer. If you don’t want to deal with software upgrades and occasional technical issues, outsourcing is probably a good choice.
• You’re a new provider. New providers have plenty to learn and worry about aside from their billing. Outsourcing their billing right off the bat can give them much needed relief from the day-to-day stress of launching a new practice, without a trial by fire in hiring, training and managing employees.
• You have different priorities. Many doctors are not strong on the business side of running a practice. They became doctors to help patients – not worry about the administrative/clerical side of the business.  Outsourcing the billing process eliminates the hassle and frees doctors to concentrate on patients.

It’s important to note that a medical billing service isn’t a silver bullet for in-house billing issues. Billing services can vary widely in their efficiency and accuracy when processing claims. If a provider chooses a billing service that is lax and prone to errors, the headaches surrounding billing issues won’t get better – they’ll get worse.

Which Approach Should I Choose?
It’s important for a practice to factor in their individual costs and preferences when deciding whether or not to outsource their medical billing. In an apples-to-apples comparison, we found that outsourcing had the higher net income. However, cost isn’t the only issue practices should consider.  There are plenty of other factors involved in this business decision that may be as – if not more – important than costs.

Do you want to learn more about outsourcing your medical billing? Download our free guide to selecting a medical billing service:

Medical Billing Services Selection Guide

Our Best Practices Guide to selecting medical billing services will help you stay organized and make the right choice for your revenue cycle management.

( 11 Page PDF)

A topic that hasn’t been as hotly discussed is using information gleaned from EHR software to participate in clinical trials. We think this should play a larger role in deciding whether or not a practice should purchase EHR software. Why? Participation in clinical trials has the potential to net a profit of hundreds of thousands of dollars per year. Now that’s an incentive to purchase an EHR.

While there are many factors that go into an EHR software purchase, we think clinical trial participation should get more consideration because:

• Participating in these trials is easier through an EHR than through traditional paper means;
• Using EHR data solves many of the major problems that clinical trials face; and,
• Purchasing an EHR creates a big ROI for physicians who decide to participate in clinical trials.

Using EHR data in clinical trials is a win for physicians, patients, the companies conducting clinical trials and the entire healthcare system.

Here’s why clinical trials should be a factor in purchasing EHR software.

EHR Software Facilitates Clinical Trial Participation
According to Synergyst Research, only 10% of licensed physicians participate in clinical trials. Why is participation so low?

Major reasons include the extra burden that research and information collection place on a practice’s time, staff and resources. Extra paperwork and onerous regulations are involved, not to mention training staff on how to properly complete forms and follow protocol. The average practice would find it difficult to find the time and resources to create a new department devoted to clinical trial participation.

Those using EHRs, however, stand a better chance of being able to adapt to the needs of a study. In the table below, we’ve identified ways that EHR software can make the clinical trial process faster, more efficient and more accurate.

By using an EHR to do much of the patient identification and information collection, many of the previously mentioned obstacles no longer exist. If a practice purchases EHR software that doubles as an electronic data capture (EDC) system for clinical trials, as we’ve described in the table above, then it’s way ahead of the curve in terms of efficiency and accuracy.

For years, there has been a growing push for EMR software to integrate with EDC systems. Greenway Medical Technologies is one company doing this through their PrimeResearch solution. In addition to designing their EHR software to natively submit data to EDC systems, Greenway is providing access to “a vast network of clinical studies, quality/safety initiatives, composite (clinical and financial) analytics that lead to more efficient processes, improved patient care and increased practice revenue.” Essentially, Greenway has created a turnkey solution to help practices participate in clinical trials.

Participating in a program like Greenway’s allows a practice to:

• Easily identify clinical trials that the practice may be eligible to participate in;
• Quickly query their database to identify patients who meet certain conditions for participating in particular clinical trials;
• Submit information from their EHR directly to EDC systems; and,
• Reduce overall data entry time and costs associated with clinical trials.

By digitizing what used to be paper records, a practice can lower the number of patient rejections from a trial, decrease time spent doing data entry, reduce transcription costs and reduce staff time related to clinical trial participation.

Clinical Trials Are Important to the Future of Healthcare
Most drugs and treatments on the market today originated from some form of a clinical trial. These tests are extremely important to the health of virtually every person in the world. But unfortunately, getting a new drug to market costs more than $1 billion dollars; takes approximately 10 years; and has upwards of a 75% failure rate. This leads to increased healthcare costs and more patient suffering as drugs wait to get on the market.

If the clinical trials could be completed more quickly by using EHR software, it wouldn’t just be the drug companies that would benefit. Sick patients waiting on essential treatment would be cured more quickly; overall healthcare costs would be reduced; and the conclusions reached from the data gathered would be more solid.

As we said before, improving clinical trials by using EHR software is a win for everyone.