FORT WAYNE, IN –

Medical Informatics Engineering, which has carved out a healthy niche for itself as a regional EHR player in the Midwest, has about 68 employees. Cerner, by comparison, has nearly 8,000.

But CEO Bruce Lisanti likes it that way. Being a small firm is not a hindrance, he said, but a help. And MIE's agile size has helped set the company apart from the competition in a crowded market, over which a handful of big "brand-name" vendors loom.

Even as a recent KLAS survey found smaller community hospitals gravitating toward MEDITECH, McKesson and Epic, Lisanti is satisfied with his firm's place in the market.

"This marketplace has probably hundreds of EMR vendors," he said. "So a lot of what we're doing is differentiation. Helping people understand how you select this EMR over that one."

It's working, he says. "Were really starting to see a good uptick in activity."

One recent big score was MIE's selection by outsourcing giant Affiliated Computer Services to do Medicare and Medicaid processing in 28 states. "What ACS looked at was not just the technology, not just a list of 100 or 200 features," said Lisanti. "What they were looking for was flexibility and adaptability. We were never designed to run in a pure server environment. We're 100 percent web-based. And that gives us a lot of flexibility."

Many big vendors, siloed and proprietary, can't claim that.

"Our real strength is the whole ability to interact with the rest of the world easily," said Lisanti.

Provider frustration

A recent Black Book Rankings survey found widespread frustration from providers with their vendors, with 90 percent of them not ready to meet meaningful use. Ninety-three percent of respondents griped about a lack of substantive support from their vendor; 89 percent reported implementation delays due to the cost of additional support from EHR vendor/consultants; and 77 percent complained of a lack of available and/or trained staff to properly support implementation.

Smaller firms are well positioned to offer a more personal touch, said Jack Smyth, President and CEO of Houston-based Spring Medical Systems. "Smaller firms are always able to move more quickly and to be more personal than larger firms,” he said. “Spring Medical customers can usually get me, the CEO, on the phone to discuss any issues they have. That's much appreciated."

In addition, he said, "our products are designed for smaller practices so our customers, one- to 10-doctor practices, are small businesses just like us. That creates a bond that won’t happen with larger vendors."

Added Jay Volk, president of Westlake, Ohio-based Workflow.com: "As president, I have personally done several of our installs."

In a market so crowded, many customers, overwhelmed by the purchasing process, gravitate to the larger names. That presents big challenges to smaller vendors. Smyth said it's "difficult to get our message out about how much easier SpringCharts EHR is to use and how the lower cost does not mean less functionality."

Still, said Catherine Huddle, vice president of sales and marketing of San Antonio-based Sevocity, providers who "ask their peers and trust their own judgment will still often consider vendors that aren't big names."

And while those "making their decisions based upon advertising" go with a big player, it's also true that "they may change their mind later," she said. "We are seeing more and more practices that originally bought another system."

Haste makes waste

Indeed, that Black Book survey found 82 percent of providers reporting that a hurried vendor selection has resulted in negative consequences.

"I believe those providers that are unhappy with their initial decisions will be back in the market for the right product within the next few years," said Volk. "If we take care of our existing customers and continue to develop our software, we will be one of the products that will catch a provider’s eye once they have a better idea of the market."

John Moore of Chilmark Research agreed. "It's an incredibly fragmented market," he said. As such, in the year ahead he expects that "also-rans will continue to lose deals to larger companies that are more politically savvy, à la getting onto RECs and striking deals in various states."

At the same time, he said, "I think you'll see niche vendors addressing very specific requirements and specialties. And I believe they could potentially do well."

No question, there are challenges. But they're ones these pug-sized players have outsized confidence in besting. And by offering try-before-you-buy programs, specializing in ease of use and simplified training and speedy troubleshooting and running in mixed environments, they're sure more and more customers will come around to their way of thinking.

After all, money talks. MIE recently announced that its client, the Fort Wayne Neurological Center, had received a $104,600 check as part of the Centers for Medicare and Medicaid Services’ e-Prescribing Incentive Program.

"We'll guarantee reimbursement because we know exactly what it's going take to get 'em there," said Lisanti. "We've been spending a lot of time just making sure they're hitting all the benchmarks they need to get their checks in May."