2015 Edition Market Readiness for Hospitals and Clinicians

These graphics visualize the proportion of developers, by market share, that have certified 2015 edition health IT modules. Market share approximations are determined through an analysis of the certified health IT products reported by participants in the Medicare EHR Incentive Program from 2011 to 2016. Approximations use the most recently reported data for each unique clinician and hospital participant.

It is important to understand how to interpret these approximations. Some clinicians and hospitals report certified software from more than one unique developer. The market share percentages in the graphics and tables, therefore, include some double counting (the percentages will, if summed together, add up above 100 percent.) The approximations convey the percent of hospitals and clinicians who use a developer's technology, and are not to be interpreted in aggregate as the percent of all hospitals and clinicians who have access to 2015 edition certified technology.

Click here to see hospital graphic
Click here to see clinician graphic

Eligible Hospitals

Chart: Eligible Hospital Developer Market Share and Certification of 2015 Edition Health IT Modules

This chart is an approximation of the health IT market for eligible hospitals. Approximations are based on hospitals who had previously attested to meaningful use through the Medicare Program, and closely reflect market share estimations from other sources.

Overall, as of August 2018, over 9 in 10 hospitals have 2015 Edition certified technology available from their most recently reported EHR developer.

Chart Legend
Developer names are as they appear in the Certified Health IT Product List (CHPL).
Tooltip: the tooltip (which appears when you hover or click on a box) provides a percentage - it is the % of all hospitals who report a certified product from this developer.
Box size: the proportion of hospitals who reported a developer's certified product through the Medicare EHR Incentive Program.
Box color: developer's progress to certification of a 2015 edition module. See key, below, for color range.

Developer does not have any products with at least one 2015 edition certified capability

Developer has product(s) with some 2015 Edition certified capabilities.

Developer has product(s) certified which meet the 2015 Edition "base"1 requirements.

Loading Chart...This may take a few seconds.

This chart is a tree map data visualization. It includes a box for each health IT developer with at least one hospital using its certified software. The box is shaded by the percent of 2015 edition base criteria the developer has certified across all its listings. Data shown in the graphic is reproduced in the table below.

Source: Certified Health IT Product List (CHPL), August 2018; Medicare EHR Incentive Program data, 2016

Notes:
1: The 2015 Edition Certification Final Rule includes a definition for the term "2015 Edition Base EHR," which references a defined set of 2015 Edition certification criteria that all health care providers must have as part of their overall Certified EHR Technology. See note for more details.
2: (%) = percent of hospitals that reported the developer's certified product(s) to the Medicare EHR Incentive Program, 2011-2016. See data sources and notes at the end of the page for citation and calculation methodology.
3: Allscripts acquired McKesson's health information technology products in 2017. The certification status of McKesson in the table and graphic, above, reflect Allscripts' certification of these McKesson products to the 2015 Edition.

Table: Eligible Hospital Developers with 2015 Edition Health IT Modules

The table only reflects developers who have a certified 2015 health IT module and at least one Medicare Meaningful Use (2011-2016) attestation from an eligible hospital. The table is ordered in descending order by the percentage of base criteria certified by the developer.

Source: Certified Health IT Product List (CHPL); Medicare EHR Incentive Program data;

Notes:
1a: The 2015 Edition Certification Final Rule includes a definition for the term "2015 Edition Base EHR," which references a defined set of 2015 Edition certification criteria that all health care providers must have as part of their overall Certified EHR Technology. See note for more details.
1b: 100% = developer has a module(s) that meets the full set of base criteria; 0% = developer has certified a 2015 edition module, but the module meets none of the base criteria. See notes at the end of the page for more information on this calculation.
2: (%) = percent of hospitals that reported the developer's certified product(s) to the Medicare EHR Incentive Program, 2011-2016. See data sources and notes at the end of the page for citation and calculation methodology.


Eligible Clinicians

Chart: Eligible Clinician Developer Market Share and Certification of 2015 Edition Health IT Modules

This chart is an approximation of the health IT market for MIPS eligible clinicians. Approximations are based on clinicians who had previously attested to meaningful use through the Medicare Program, and closely reflect market share estimations from other sources.

Overall, as of August 2018, over 4 in 5 clinicians have 2015 Edition certified technology available from their most recently reported EHR developer.

Chart Legend
Developer names are as they appear in the Certified Health IT Product List (CHPL).
Tooltip: the tooltip (which appears when you hover or click on a box) provides two percentages. The first is the % of all clinicians who report a certified product from this developer, and the second is the approximate % of those clinicians who are not exempt from 2018 MIPS reporting.
Box size: the proportion of clinicians who reported a developer's certified product through the Medicare EHR Incentive Program.
Box color: developer's progress to certification of a 2015 edition module. See key, below, for color range.

Developer does not have any products with at least one 2015 edition certified capability

Developer has product(s) with some 2015 Edition certified capabilities.

Developer has product(s) certified which meet the 2015 Edition "base"1 requirements.

Loading Chart...This may take a few seconds.

This chart is a tree map data visualization. It includes a box for each health IT developer with at least one clinician using its certified software. The box is shaded by the percent of 2015 edition base criteria the developer has certified across all its listings. Data shown in the graphic is reproduced in the table below.

Source: Certified Health IT Product List (CHPL), August 2018; Medicare EHR Incentive Program data, 2016; Medicare Physician Utilization and Payment Data

Notes:
1: The 2015 Edition Certification Final Rule includes a definition for the term "2015 Edition Base EHR," which references a defined set of 2015 Edition certification criteria that all health care providers must have as part of their overall Certified EHR Technology. See note for more details.
2: (%) = percent of clinicians that reported the developer's certified product(s) to the Medicare EHR Incentive Program, 2011-2016. See data sources and notes at the end of the page for citation and calculation methodology.
3: % = approximate percentage of clinicians who report the developer's certified products and are not exempt from reporting for 2018 MIPS. See notes at the end of the page for more information on this calculation.

Table: Eligible Clinician Developers with 2015 Edition Health IT Modules

The table only reflects developers who have a certified 2015 health IT module and at least one Medicare Meaningful Use (2011-2016) attestation from an eligible clinician. The table is ordered in descending order by the percentage of base criteria certified by the developer.

Source: Certified Health IT Product List (CHPL); Medicare EHR Incentive Program data; Medicare Physician Utilization and Payment Data

Notes:
1a: The 2015 Edition Certification Final Rule includes a definition for the term "2015 Edition Base EHR," which references a defined set of 2015 Edition certification criteria that all health care providers must have as part of their overall Certified EHR Technology. See note for more details.
1b: 100% = developer has a module(s) that meets the full set of base criteria; 0% = developer has certified a 2015 edition module, but the module meets none of the base criteria. See notes at the end of the page for more information on this calculation.
2: (%) = percent of clinicians that reported the developer's certified product(s) to the Medicare EHR Incentive Program, 2011-2016. See data sources and notes at the end of the page for citation and calculation methodology.
3: % = approximate percentage of clinicians who report the developer's certified products and are not exempt from reporting for 2018 MIPS. See notes at the end of the page for more information on this calculation.


Data Sources

Certified Health IT Product List (CHPL): The Certified Health IT Product List (CHPL) is a comprehensive and authoritative listing of all certified Health Information Technology which has been successfully tested and certified by the ONC Health IT Certification program. All products listed on the CHPL have been tested by an ONC-Authorized Testing Laboratory (ONC-ATL) and certified by an ONC-Authorized Certification Body (ONC-ACB) to meet criteria adopted by the Secretary of the Department of Health and Human Services (HHS). This analysis used the data available in the downloadable XML file of the CHPL and through the CHPL open API.

Medicare EHR Incentive Program Data: ONC makes certain program data publicly available through the EHR Products Used for Meaningful Use Attestation public dataset. This data includes the certified health IT products reported by eligible professionals and eligible hospitals to the Medicare EHR Incentive Program. Market share estimations in this analysis are based off the reported certified products in this dataset. This analysis uses the product(s) most recently reported by eligible professionals and eligible hospitals, i.e. the most current attestation made by each unique provider. Unique providers are designated by NPI (eligible professionals) and CCN (eligible hospitals).

Medicare Physician Utilization and Payment Data: the CY 2015 Physician and Other Supplier Data provides information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals for 2015. The PUF contains information on utilization, payment, and submitted charges organized by NPI. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program, and contains 100% final-action Part B non-institutional line items for the Medicare fee-for-service population. This analysis used payment data for the 2015 calendar year only.

You can access the full dataset that's used to create these graphics and tables here.

Notes

(1) % 2015 Base Criteria Certified is determined through an analysis of 2015 edition certified health IT modules documented in the CHPL. The percentage of certified 2015 base criteria is calculated by dividing the number of base criteria certified by a developer across all its listings by the total number of base criteria. The 2015 Edition Certification Final Rule includes a definition for the term "2015 Edition Base EHR," which references a defined set of 2015 Edition certification criteria that all health care providers must have as part of their overall Certified EHR Technology. In some cases, to provide flexibility to its customers, a health IT developer may not certify its product to a particular Base EHR definition listed criterion. As a result, developer's with products listed near 90% may have completed all of the certification they intended to complete. See this fact sheet for more information: https://www.healthit.gov/sites/default/files/2015edition_base_ehr_definition_ml_11-4-15.pdf.

(2) % of Providers (Hospitals/Clinicians) with Developer's Health IT Products: in the charts and tables above, a percentage is provided for each developer of the share of eligible hospitals and clinicians that reported a developer's certified health IT product through meaningful use attestation to Medicare (i.e. developer market share). Please note that some providers report products from more than one unique developer (this is more predominant among hospitals). Therefore, the sum of these hospital and clinician percentages for all developers may exceed 100%. See methodology (1) below for more information on this calculation.

(3) Approximate % ECs Required to Report to 2018 MIPS: See methodology (2) below for more information on this calculation.

Methodology:

(1) % of Providers (Hospitals/Clinicians) with Developer's Health IT Products or developer market share is approximated using public Medicare meaningful use attestation data. Counts of how many providers reported at least one health IT product certified by a developer was done separately for eligible clinicians and eligible hospitals in the same manner as similar ONC analyses and visualizations of this data for eligible professionals and hospitals. These counts only include the most recent attestation by each unique provider to avoid duplication and to consider the most recent reported data for each unique provider. Unique providers are designated by NPI (eligible professionals) and CCN (eligible hospitals) in the dataset. Market share percentages are estimated by dividing each developer's de-duplicated count of unique provider reports by the total number of active eligible professionals (NPI is listed as active in NPPES) and hospitals (CCN is listed as active in Provider of Services (POS) file) who ever attested to meaningful through the Medicare Program.

The dataset includes reports from over 95% of all active non-federal acute care hospitals, and thus reflects a nearly comprehensive view of the hospital certified health IT market. However, less than 360K eligible professionals ever attested to meaningful use through the Medicare program. These represent roughly half of all office-based physicians nationwide, and do not include non-physician professionals, such as physician assistants and advanced practice registered nurses (APRN). The MIPS eligible clinician population includes more than just physicians. It also includes APRNs and physician assistants, who were not eligible to participate in the Medicare Meaningful Use Program, and were only eligible to participate in state Medicaid Meaningful Use Programs, for which we lack certified health IT product data. Because we lack health IT market data on these non-physician clinician populations, market share rates are biased toward those software chosen by physicians and physician-led practices. Therefore, the market share percentages for eligible clinicians should be treated as approximations. Though they do closely mirror those approximated by other sources.

(2) Approximate % ECs Required to Report to 2018 MIPS are approximated using publicly available Medicare Part B physician payment data. In 2018, clinicians eligible to participate in MIPS, based on their specialty, are exempt from reporting, as an individual, if they meet one of two thresholds: (i) if the clinician did not have allowable Medicare charges greater than $90K at any practice to which she is a member, and/or (ii) if the clinician did not treat more than 200 unique Medicare beneficiaries at any practice to which she is a member (https://qpp.cms.gov/).

ONC's approximations use the payment data from the 2015 Medicare Physician Utilization and Payment Aggregate Dataset to estimate those eligible clinicians, who have previously attested to meaningful use through Medicare, that are exempt from reporting for 2018 MIPS. For this approximation, we used (i) the payment data in data field, "total_medicare_allowed_amt", to determine if a clinician made less than $90K in allowable charges to Medicare, and (ii) "total_unique_benes" to determine if a clinician treated less than 200 unique Medicare beneficiaries. If an individual clinician met either of these criteria, she was considered exempt for 2018 MIPS. This method, however, does limit the accuracy of the approximation:

(a) CMS' MIPS low-volume exemption policy makes determinations based off allowable charges and unique beneficiaries by a unique NPI at a unique TIN (tax identification number associated with a unique practice location). Our approximation uses for a unique NPI the sum of all allowed charges and sum of all unique beneficiaries, as provided in the referenced dataset. Because a clinician may have more than $90K total allowed charges (or more than 200 unique beneficiaries) across all practices, but still not have more than $90K allowed charges (or more than 200 unique beneficiaries) at any individual practice, this approximation may underestimate the number of exempt clinicians.
(b) These approximations use 2015 Medicare claims data. 2018 MIPS exemption determinations use claims data from September 1, 2016 through August 31, 2017. Therefore, these approximations may misestimate total exemptions if eligible clinicians' allowable charges differ between 2015 and 2017.

(c) MIPS allows individual clinicians the option to report as an individual or as part of a group or virtual group. These percentages reflect only individual eligible clinicians and do not reflect group or virtual group eligibility. For clinicians in groups with more than one clinician, their individual charges and unique beneficiaries may exempt them from reporting as an individual, but allow them to report as part of a group or virtual group if their group exceeds the exemption thresholds.


Given these limitations, the approximate percentage of clinicians (by developer) not exempt (required to report) for 2018 MIPS may differ from percentages based off actual eligibility determinations. Though the estimated percentages may vary from the actual percentages, these approximations do allow for comparisons of percentages across developers, as we assume any differences carry across all developers.

Suggested Citation:

Office of the National Coordinator for Health Information Technology. '2015 Edition Market Readiness for Hospitals and Clinicians,' Health IT Quick-Stat #55. dashboard.healthit.gov/quickstats/pages/2015-edition-market-readiness-hospitals-clinicians.php. August 2018.