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Small Practice Ambulatory EMR/PM (10 or Fewer Physicians) 2018
Decision Insights Report
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Small ambulatory practices have been increasingly ignored by some EMR/PM vendors, and their overall satisfaction has decreased steadily—over the past six and half years, the average overall score for vendors in the small practice ambulatory EMR market has dropped from 81.6 to 74.2 (out of 100). Small practices today are looking for more than just a minimally viable EMR—they want to invest in an asset that improves their bottom line, facilitates patient-centric care, and increases clinician job satisfaction. And they want their EMR vendor to be a strategic partner that provides great support. The introduction of meaningful use created a flood of EMR vendors, most of whom were unable to sustain viable long-term business models. Today, KLAS tracks less than 20 vendors in the small practice market segment. None meet all the needs of small practices today.Healthcare Providers,
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The A-List: No Vendors Meet the Criteria
There are no A-list vendors in the small practice ambulatory EMR/PM market segment. Inclusion in the A-list requires above average market consideration, excellent customer retention (90%+), and high customer satisfaction (>85.0, top quartile of all software products KLAS rates). Many small practices KLAS has interviewed cite less-than-acceptable support and a lack of vendor executive involvement as significant factors in their overall dissatisfaction. These two metrics are key bellwethers of the provider-vendor relationship, so it is not surprising that small practices also report poor overall relationships.
Where Are the Vendors with the Most Considerations Falling Short?
In 2012, athenahealth was a strong small practice player, with a satisfaction score of 87.0 and 94% customer retention. Today, athenahealth has slipped in both areas. Executive turnover has led to a change in culture, which some organizations compare to a ship losing its rudder. athenahealth still has strong consideration energy—almost half of practices looking to switch EMR vendors are considering athenahealth.
athenahealth’s reputation and name recognition are the most often mentioned reasons for consideration. The vendor’s aligned-incentives business model is polarizing; it is mentioned by provider organizations as a positive and a negative factor in almost equal frequency. Robust functionality is also mentioned as a consideration factor, but some potential customers believe athenahealth has weak support for small practices.
“The Client Support Center is marginal. We can get somebody who knows what he or she is doing, but athenahealth is expanding so quickly that the probability is that most people we talk to won't know what they are talking about . . . In reality, we usually get put on hold and have to go through two or three people before finding someone who can actually help. We often call athena multiple times to ask them to do something for us and get told ‘We can't’ the first five times but ‘We can’ the sixth. That wastes our time. athena's help system certainly needs work.” —VP/COO
AdvancedMD is considered in 10% of small practice EMR purchases and has the highest customer retention in the market. AdvancedMD customers report higher-than-average overall satisfaction, but the vendor’s score doesn’t meet the A-list criteria. Current and potential customers note concern with AdvancedMD’s ability to integrate with other systems. Current customers also report issues with implementations, training, and follow-through on commitments.
“The salespeople promised us unlimited storage, and the implementation people didn't make good on that. Apparently, the salespeople didn't have the authority to make that promise.” —System Administrator
CureMD is considered in just over 10% of small practice EMR buying decisions. Customer satisfaction is fair, coming in just above the market average. Three-fourths of current customers report that the product is part of their long-term plans. Organizations considering CureMD say that good support, a good sales process, and the vendor’s reputation are reasons they consider CureMD. Others report that development is stagnant and would like to see enhanced browser options and upgraded functionality.
“I like that with the CureMD tool, we can almost go completely paperless. We are able to set up a lot of electronic documents that we would normally fill out manually . . . That is definitely a plus and is something that attracted me to CureMD. Also, their customer service is very good.” —Practice Manager
drchrono is considered in about 8% of decisions tracked by KLAS. drchrono’s customer satisfaction is below the market average, but nearly 90% of existing users report that they are likely to stay with the vendor. Potential customers mention value and mobile functionality as reasons they considered drchrono. Existing and potential customers have concerns about the user experience, a lack of responsiveness from the support team, and the quality of the training. Less than 50% of clients say drchrono keeps all their promises.
“The tool might work for people who are good and fast with computers, but the tool is a little clunky. Considering how many patients we see and how much billing work we have to do, the drchrono tool isn't efficient enough.” —Practice Manager
eClinicalWorks has the second highest number of considerations among small practices, but overall satisfaction among current customers is weak—while 86% say eClinicalWorks is part of their long-term plans, only 62% would buy the EMR again (the lowest percentage among small practice vendors). Positive consideration factors include an overall good user experience, good external integration, and good value. Concerns among potential customers include eClinicalWorks’ legal issues, poor support, and perceptions that the software is click heavy in places.
“The customer service people are not easy to access and are not always very helpful. The degree to which the customer service people address flaws is very slow or nonexistent. If we say there is a flaw, they tell us there is a workaround we can use. There is not a serious attempt on their end to address the flaws. We have difficulties talking to people and then resolving the issues. eCW needs to improve their customer service responsiveness.” —CMO
Small Practices Struggle to See Value in Their Ambulatory Vendors
When considering a product’s value, small practices factor in price as well as the product quality and vendor relationship. Small practices feel mostly ignored by vendors, as evidenced by the fact that vendors in this market receive very low relationship scores and poor product scores compared to other software offerings. The solutions used by small practices are often the same as those sold to larger clinics, but small practices report a worse product and vendor experience.
What Factors Do Potential Buyers Mention Most Often?
Product features such as quality, functionality, and integration are the factors most often mentioned as influencing buying decisions. Market forces—such as consolidation and local peer pressure to be on a common platform—also strongly influence new purchase decisions. When vendors are not selected, a lack of perceived value is often a key factor.
What About the Other Competitors?
Aprima currently has the highest overall performance score in the small practice ambulatory EMR market and was Best in KLAS for Small Practices in KLAS’ January 2017 Best in KLAS report. Potential customers say the demo process is good, and existing customers report that the product works as promoted. While the product is easy to use, some needed functionality is missing, and current customers would like the service to be more proactive.
“The service people from Aprima are friendly on the phone, but only a few people are knowledgeable. If Aprima were more proactive, we wouldn't have half of the problems that we currently have.” —Office Manager
CareCloud is reported by both current and potential customers to have an easy-to-use product. Support is a weakness, with customers reporting declining support quality. Additionally, potential customers indicate that support issues are one reason they remove CareCloud from their consideration list. Support problems, unkept promises, and the product not working as promoted contribute to CareCloud’s overall performance score being lower than those of the market leaders.
“When we first began with CareCloud, their support was phenomenal. I don't know what happened, but probably in the last year or so, the support has not been so great.” —Practice Administrator
NextGen Healthcare is one of the few vendors in the small practice space whose support is mentioned as a strength by current and potential customers. Product functionality and delivery of new technology are trending upward as well. Over the past year, there has been a severe drop-off in the quality of NextGen Healthcare’s training and implementations, and this has led to poor overall satisfaction with the Enterprise solution. NextGen customers report higher satisfaction with Office, the go-forward product for small practices.
“NextGen Healthcare has been doing a great job, and that has a lot to do with them keeping us up to date on our training and all of the new government standards and regulations. NextGen Healthcare is sending out constant webinars and reminders about all of the new updates that are coming out. NextGen Healthcare is keeping us up to date and keeping their product up to date.” —IT Manager
Greenway Health’s relationships with Intergy customers are improving, with customers reporting solid year-over-year gains in support and executive involvement. Unlike most products in this segment, overall satisfaction has improved over the past 6 years. Potential customers also report support as a positive consideration factor. The vendor has historically been cited for nickel-and-diming; while they continue to improve in this area, there is still a long way to go. Current customers want Greenway Health to put more energy and development into the Intergy platform, and this should be a focus now that Intergy is the clear go-forward product.
“We considered Greenway Health because their support staff was so easy to work with, and we had already used Greenway Health's system before.” —Practice Administrator
Although acute care enterprise EMR vendors do not actively target small ambulatory practices, they are still considered by these organizations. Potential customers mention the value of having a single patient record shared between clinics and hospitals as a major reason. Though enterprise vendors are seen as an expensive option for small clinics, organizations who go this route feel the interoperability advantages outweigh the cost disadvantages.
Decision Insights help provider organizations understand which vendors have market energy and why organizations are considering these vendors. Decision Insights are not designed to be a comprehensive census or win/loss market share study.
Aprima currently has the highest overall performance score in the small practice ambulatory EMR market and was Best in KLAS for Small Practices in KLAS’ January 2017 Best in KLAS report. Potential customers say the demo process is good, and existing customers report that the product works as promoted. While the product is easy to use, some needed functionality is missing, and current customers would like the service to be more proactive.
“The service people from Aprima are friendly on the phone, but only a few people are knowledgeable. If Aprima were more proactive, we wouldn't have half of the problems that we currently have.” —Office Manager
CareCloud is reported by both current and potential customers to have an easy-to-use product. Support is a weakness, with customers reporting declining support quality. Additionally, potential customers indicate that support issues are one reason they remove CareCloud from their consideration list. Support problems, unkept promises, and the product not working as promoted contribute to CareCloud’s overall performance score being lower than those of the market leaders.
“When we first began with CareCloud, their support was phenomenal. I don't know what happened, but probably in the last year or so, the support has not been so great.” —Practice Administrator
NextGen Healthcare is one of the few vendors in the small practice space whose support is mentioned as a strength by current and potential customers. Product functionality and delivery of new technology are trending upward as well. Over the past year, there has been a severe drop-off in the quality of NextGen Healthcare’s training and implementations, and this has led to poor overall satisfaction with the Enterprise solution. NextGen customers report higher satisfaction with Office, the go-forward product for small practices.
“NextGen Healthcare has been doing a great job, and that has a lot to do with them keeping us up to date on our training and all of the new government standards and regulations. NextGen Healthcare is sending out constant webinars and reminders about all of the new updates that are coming out. NextGen Healthcare is keeping us up to date and keeping their product up to date.” —IT Manager
Greenway Health’s relationships with Intergy customers are improving, with customers reporting solid year-over-year gains in support and executive involvement. Unlike most products in this segment, overall satisfaction has improved over the past 6 years. Potential customers also report support as a positive consideration factor. The vendor has historically been cited for nickel-and-diming; while they continue to improve in this area, there is still a long way to go. Current customers want Greenway Health to put more energy and development into the Intergy platform, and this should be a focus now that Intergy is the clear go-forward product.
“We considered Greenway Health because their support staff was so easy to work with, and we had already used Greenway Health's system before.” —Practice Administrator
Although acute care enterprise EMR vendors do not actively target small ambulatory practices, they are still considered by these organizations. Potential customers mention the value of having a single patient record shared between clinics and hospitals as a major reason. Though enterprise vendors are seen as an expensive option for small clinics, organizations who go this route feel the interoperability advantages outweigh the cost disadvantages.
Decision Insights help provider organizations understand which vendors have market energy and why organizations are considering these vendors. Decision Insights are not designed to be a comprehensive census or win/loss market share study.
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2021 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.