The electronic medical record market is poised for a competitive shakeup. As Stage 2 meaningful use demands more from hospitals, many current EMR platforms just aren't cutting it, and up to half of large hospitals are ditching their old systems for new, interoperable platforms with population health capabilities. 

Two new reports, conducted by Black Book and KLAS Research, underscore the EMR market trends at hospitals with more than 200 beds. And the once ill-fated Allscripts has made a huge comeback this year, edging out a slight lead for top-ranked EMR inpatient vendor over three-time annual champion Epic Systems, according to Black Book researchers. 

[See also: EHR users unhappy, many switching.]

The reports find that from one-third to half of all large hospitals are looking to trade out their old EMRs by 2016, but, according to KLAS data, only 22 percent of those buying decisions may be up for grabs, as 34 percent of them have already officially selected a vendor, and the lion's share, 44 percent, are already strongly leading toward a certain vendor. 

"Where the last round of EMR purchases was fueled by meaningful use requirements and enticing reimbursements, this next round is being fueled by concerns about outdated technology and health system consolidation," said report author Colin Buckley in a press statement. "This shift in focus will play a major factor in which EMRs are being considered." 

Black Book data, which includes responses from 163 large hospitals -- which it defines as hospitals having more than 300 beds, highlights a growing percentage of provider dissatisfaction with current EMR systems, as some 32 percent of them are reevaluating their vendor's products and services, with 20 percent saying the reevaluation will likely lead to a replacement system. Vendors that have advanced population health capabilities are likely to come out on top, hospital officials point out.

[See also: The great EHR switch.]

"Top scoring (EMR) vendors that are attracting the available market share are looking for patient engagement tools, clinical decision support, quality measurement solutions, mobile capabilities, intelligent interoperability and financial analytics as part of their (EMR) compendium," said Doug Brown, managing partner of Black Book, in a March 10 press release. "This large hospital market segment has progressed beyond meaningful use driving purchasing decisions but is aggravated with the extraordinary delays, cost run-ups, extended implementations and glitches interrupting operations from first-choice EHRs."

Large hospitals are not the only ones considering making an EMR change. Medical practices are also updating and trading up their systems. Last year, some 23 percent of them said they would be switching out their current platform by the year's end, according to a winter 2013 Black Book report. 

Stage 2 meaningful use requires that eligible hospitals meet 16 core objectives and three menu objectives -- up from 14 core and five menu objectives in Stage 1 -- many of which are still not fully understood by hospital officials. 

"There's certainly a number of people who know what the requirements for Stage 2 are, but it's probably not as widespread as you might think," said Robert Anthony, deputy director of the health IT initiatives group at CMS' Office of E-Health Standards and Services, in an interview with Healthcare IT News earlier this year. "As we have gotten into Stage 2 and we've really gotten into implementation, as people are actually starting to do it or starting to think about doing it and planning for their workflow, it's like anything else: you read about it, and you think about it, but once you're actually putting it into practice, it's a different beast altogether." 

There are six completely new core objectives in Stage 2, including recording electronic notes in patient records; test imaging results must be available through the EMR; record family health history as structured data; generate and transmit more than 10 percent of permissible discharge prescriptions electronically; provide structured electronic lab results to ambulatory providers.

[See also: EHR users unhappy, many switching]