The Top-5 Electronic Medical Record (EMR) Companies
In a recent article, we talked about a heavily backed startup called Practice Fusion and their cloud-based electronic medical record (EMR) system that is freely available for use. To avoid any confusion, please note that the terms “electronic health record (EHR)” and “electronic medical record (EMR)” are typically used interchangeably. While most EMR solutions cost money, Practice Fusion has an innovative business model that allows them to capture revenues through other channels than simply charging for their EMR solution. The Company claims to be the fastest growing EMR provider in the United States, and just this past week it was revealed that they have been working with JP Morgan to possibly IPO in 2017.
An article last week by the New York Times on this topic provides more insight into Practice Fusion’s revenues and forward looking projections. This article prompted us to think about who Practice Fusion’s competitors might be. What we uncovered was an extremely fragmented market for EMR which has more competitors than we would have thought, over 500 in fact. Here’s a table taken from an article published by Dark Daily on the top EMR systems for 2015 by market share:
We were amazed to see that there are over 500 competing companies in this space, and even more amazed to see that Practice Fusion has such a small estimated market share of just 6.7%. While these numbers are over a year old and Practice Fusion is said to be the fastest growing EMR provider, its still surprising to see their market share is so small. Let’s take a closer look at the top-5 players in this space which account for 42.7% of total EMR market share.
Epic Systems Corporation (Private) Epic is an employee-owned company that was founded in 1979 and is said to be profitable. The company is selective about who they “choose” as a customer. While they have just 355 customers, this list includes 69% of Stage 7 hospitals in the U.S. Over 15 million patient records were exchanged securely on their platform in June 2015 alone. According to Forbes, Epic saw 2014 revenues of $1.8 billion. With a company motto that states “Do good. Have fun. Make money.”, and a tree house to hold smaller meetings in at their headquarters, this must be one cool company to work for.
eClinicalWorks (Private) Founded in 1999, eClinicalWorks has been consistently profitable year after year with 2014 revenues of $333 million and 2015 revenues projected to reach $400 million. With 4,500 patients, the Company claims to be the largest provider of “EHR in the cloud” . If talk about “the cloud” seems vague, we demystify the term in this previous article. But aren’t all EMR providers offering solutions “in the cloud”? They actually aren’t, and for many years the number one EMR provider by market share, Epic, stayed out of the cloud until November of 2014 when they announced plans to build a massive cloud data center.
When talking about why their solution is different, eClinicalWorks cites privacy stating that they offer a “private cloud where they guarantee your data will not be co-mingled”. So does this mean a separate database for every client? A separate virtual machine? Sounds like a lot of extra work, but the customers don’t seem to mind. With 115,000 providers now, the eClinicalWorks EMR cloud platform processed over 155 million claims in 2015.
Practice Fusion (Private) is a privately held company that we detailed in a recent article. Some of the milestones realized by Practice Fusion in 2015 were year-over-year revenue growth of more than 70%, over 5 million patient visits a month, and nearly 30,000 monthly active practices using their solution. What makes the Company unique is that their cloud-based EMR system is offered free-of-charge.
NextGen Healthcare (NASDAQ:QSII) NextGen is a fully owned subsidiary of Quality Systems Inc, a publicly traded company with a market cap of nearly $1 billion. For the three months ending September 30th 2015, QSII saw revenues of $125 million, 75% of which were attributed to NextGen. With the majority of revenues coming from EMR, this becomes a decent enough play on the EMR theme in terms of exposure but not share price performance. Shares of QSII haven’t performed well at all showing investors a loss of -56% over the past 5 years while revenues have consistently grown over that same time frame:
The reason for the dismal performance appears to be in the declining profitability for QSII. With the Company doubling the size of their R&D spend to nearly $70 million in 2015, maybe they’re just investing to grow their EMR business and will get back to the juicier margins they were able to enjoy before.
Allscripts (NASDAQ:MDRX) Similar to QSII, Allscripts also receives a majority of their revenues (78%) from “the sales of EMR-related software” except that they haven’t been consistently growing revenues and they haven’t been very profitable:
With the share price losing 28% of its value over the past 5 years, it seems that investors aren’t too happy with the progress being made towards profit growth or profitability for that matter. Another interesting thing to note is that in their last 10-Q, we see that Allscripts is closely allied with highly hyped startup Nanthealth, and even purchased $200 million in shares of Nanthealth last year making them a 10% owner. If we see a successful Nanthealth IPO, this could have a meaningful impactful to shares in Allscripts given that their entire market cap is just $2.76 billion.
After taking a closer look at the top-5 companies in EMR, one key takeaway is that there is huge revenue potential for the EMR provider that can capture a majority market share. There’s no better price than free, so it’s easy to see why Practice Fusion is growing so quickly.