Ambulatory practices both large and small say they're thinking hard about replacing their EMR, according to a new KLAS report. Hospitals, too, are in for disruption.

[See also: Cerner, Siemens and the future of EHRs]

More than 25 percent of physician practices are considering yanking their existing system, according to KLAS' study, "Ambulatory EMR Perception 2014: New Leaders Emerging as Market Shifts."

This group of dissatisfied customers are arriving at these decisions from different strategic vantage points, however, depending their size, financial wherewithal and need to integrate with area hospitals.

[See also: Ambulatory EMR sales shoot up again]

"There are different reasons for this shift," says KLAS analyst Jared Dowland, who authored the report, in a press statement. "Larger practices are seeking to consolidate from multiple EMRs and tighten their relationships with nearby hospitals, while smaller practices are seeking to resolve functionality, support and cost concerns."


KLAS – which based its report on interviews with more than 400 large and small practices nationwide – also finds that a further 12 percent of respondents would prefer to replace their system, but are prevented from doing so for financial or organizational reasons.

On the topic of system replacements, another new study from KLAS takes a broader look at the hospital EMR landscape, and its subtitle  – "Competition Mounts as Markets Collide" – suggests the marketplace is in for even bigger disruption.

Just look at the lingering fallout from Cerner's $1.3 billion acquisition of Siemens Health Services on Aug. 5.

"(I)t represents a major shift in the hospital EMR market place," writes KLAS analyst Colin Buckley in the first of a two-part blog post exploring what the "new Cerner" will mean for providers.

"Siemens has experienced their share of ups and downs over the last 20 years, but there is no arguing that they have been a major market player," he writes. "Unfortunately, since unveiling their next-generation Soarian EMR in 2002, Siemens has had a few more downs than ups ... Over the years, providers have indicated that Siemens is too slow to achieve reliable go lives at customer sites, too slow delivering code fixes and upgrades, and too slow evolving their portfolio – most notably in producing an integrated Soarian ambulatory EMR."

Even as it pledges to continue to support Soarian customers, Cerner is clearly hoping its acquisition will lead to a healthy expansion of its customer base. But Buckley points out that it may have some stiff competition coming out of Verona, Wis.: Of the 16 hospitals that decided to replace Siemens systems this past year, a dozen switched over to Epic.