Settle - EHR Vendor

EHR Vendor Marketplace: Which Stars
Are Rising—And Which Are Falling
Robin Settle
Partner
Introduction
1
Presentation Overview
The state of the industry Goals
› How have these developments impacted › Identify the big players in the EHR
the marketplace? marketplace
› What are the new tools? › Gain objective understanding of their
› How can we support existing systems? customers, reputations and what makes
them different
› Name new vendors, their offerings and
what to ask them in a selection process
› Ask informed IT vendor evaluation
questions (e.g., function, response to
changing dynamics and technologies)
We’ll provide an unbiased look at who the big players are now, the differentiated
disruptors and who plays well with others—or doesn’t
2016 | © Kurt Salmon | 3
Essential Elements of a Fully Integrated EHR
The fully integrated EHR needs to support the continuum of care …
MANAGING FOR CLINICAL
EFFECTIVENESS
Traditional focus of
Extension of capabilities hospitals within the
“care continuum” Extension of capabilities
to community, teaching,
to ACO, partnerships
research
PATIENT CARE
CONTINUUM
Primary Care Specialist Surgical Inpatient Long‐Term Home
Care Care Care
Prevention Urgent Diagnostic Emergency Rehab Skilled End‐of‐
Care Ancillaries Care Care Nursing Life Care
e.g., imaging
2
A Deeper Dive into the Vendor Marketplace
Focus is on patient‐centric, enterprise solutions for clinicals, access and revenue cycle,
population health, and analytics
Scope tends toward clinical enterprise/health system, affiliated physicians and
patients/families
Delivered through unified/single database platform or interoperable solutions; in‐house or
remote hosted solutions
Small group of dominant commercial vendors; new cloud‐based solutions emerging but
immature
A Deeper Dive into the Vendor Marketplace (cont’d)
Major functional emphasis on:
 Process/workflow automation to improve quality/efficiency/effectiveness
 Automated information capture and delivery
 Clinical activity based on evidence‐based protocols
 Proactive, “intelligent” alerts to improve patient care
 Analytics to support outcomes management, performance improvement, quality,
population health, etc.
 Personalization (not customization) based on user needs/practice
 Integration of multimedia, biomedical devices, wearables, emerging technologies
Robust “starter” systems, prepackaged content and more streamlined implementation
methodologies
3
Enterprise EMR Marketplace: Industry Inpatient
Adoption
Stage Cumulative Capabilities 2006 2010 2012 2014 2015

Stage 7 Complete EMR; CCD transactions to share
data; data warehousing; data continuity with 0.0% 1.0% 1.8% 3.6% 4.1%
ED, ambulatory, OP
Stage 6 Physician documentation (structured
templates), full CDSS (variance & 0.1% 3.2% 7.3% 17.9% 25.4%
compliance), full R‐PACS
Stage 5 Closed‐loop medication administration 0.5% 4.5% 11.5% 32.8% 34.6%
Stage 4 CPOE, clinical decision support (clinical
3.1% 10.5% 14.0% 14.0% 10.3%
protocols)
Stage 3 Nursing/clinical documentation (flow sheets),
CDSS (error checking), PACS available outside 18.7% 49.0% 41.7% 21.0% 17.3%
Rad
Stage 2 CDR, controlled medical vocabulary, CDS, may
40.0% 14.6% 11.4% 5.1% 3.4%
have document imaging; HIE capable
Stage 1 Ancillaries—Lab, Rad, Pharmacy—all installed 17.4% 7.1% 4.8% 2.0% 1.8%
Stage 0 All three ancillaries not installed 20.4% 10.1% 7.5% 3.7% 3.1%
Source: HIMSS Analytics Database
# Hospitals 4,237 5,281 5,310 5,467 5454
EHR Marketplace
The Big Players
4
Competitive Marketplace
Gartner Magic Quadrant for Global Enterprise EHR Systems
CHALLENGERS LEADERS
Epic
Cerner
(Millennium)
InterSystems
MEDITECH
ABILITY TO EXECUTE
Cerner (i.s.h.med) Cerner (Soarian)
Allscripts
NICHE PLAYERS VISIONARIES
COMPLETENESS OF VISION
As of March 2015 2016 | © Kurt Salmon | 9

McKesson Paragon product is not marketed outside the US
User Feedback
2015 EHR Satisfaction Survey
Healthcare IT News’
2015 EHR Satisfaction
Survey is based on
ratings, feedback and
insight of nearly 400
active EHR users & IT
professionals in hospitals
& physician practices
across the U.S. Users
rated their EHR vendors
across nine different
metrics. The highest
possible score is a 10.
Healthcare IT News
http://www.healthcareitnews.com/news/2015‐ehr‐satisfaction‐survey 2016 | © Kurt Salmon | 10
5
Total Market Share by Hospital Size
1,000
800 OVER 600 BEDS 101–200 BEDS

401–600 BEDS 26–100 BEDS
201–400 BEDS 1–25 BEDS
600
400
200
© 2014 KLAS Enterprises LLC. All Rights Reserved. www.klasresearch.com 2016 | © Kurt Salmon | 11
2014 Market Wins and Losses
Losses, Over 200 Beds Losses, 1–200 Beds Wins, 1–200 Beds Wins, Over 200 Beds Net
EPIC +101
CERNER +79
MEDITECH* +12
MCKESSON* ‐32
SIEMENS* ‐5
CPSI ‐2
HEALTHLAND ‐17
MEDHOST (HMS) ‐2
ALLSCRIPTS ‐10
QUADRAMED ‐14
GE HEALTHCARE ‐29
‐80 ‐60 ‐40 ‐20 0 20 40 60 80 100
* Legacy to current product migrations are counted in both win and loss columns
6
Why Vendors Gained or Lost Hospitals
Competitive Wins (N = 304) Competitive Losses (N = 225)
LEGACY MIGRATION
(stayed with vendor)
ADD‐ONS MIGRATIONS CHANGE OF 14%
25% 11% LEADERSHIP
17%
NEW IDN NEW VOLUNTARY

(Hospitals) STANDALONE DEPARTURES
32% 32% 69%
Vendor Viability
Marketplace observations
Market Factor Vendors at Risk
Losing market share Allscripts, McKesson
Financial viability concerns Allscripts
Product sunsets McKesson, Siemens
Incomplete product suite Allscripts
Products in transition McKesson, MEDITECH
Emerging vendors (e.g., Athena) McKesson, MEDITECH
Marketplace observations 2016 | © Kurt Salmon | 14
7
KLAS Enterprise EHR Vendors Ratings
HOW THE SUITES PERFORM AGAINST ALL OTHER ENTERPRISE SUITES
Rank
Summary Score 86.8 74.4 72.3 71.0 66.3 65.6 64.0 60.9
Sales & Contracting
Implementation & Training
Functionality & Upgrades
Service & Support
Overall Satisfaction
Would You Buy Again?
Recommend to Peer/Friend?
Part of Long‐Term Plans
Well Above Average/ Below Average/
Average
Above Average Well Below Average
iCare not rated by KLAS
© 2015/2016 KLAS Enterprises, LLC. All Rights Reserved. www.klasresearch.com. 2016 | © Kurt Salmon | 15
Key Aspects of Usability
PHYSICIAN LEADERSHIP WEIGHS IN ON ACUTE EMR USABILITY PROGRESS OVER THE PAST TWO
YEARS, April 2015
© 2015 KLAS Enterprises, LLC. All Rights Reserved. www.klasresearch.com 2016 | © Kurt Salmon | 16
8
Vendor Improvement and Contribution
PHYSICIAN LEADERSHIP WEIGHS IN ON ACUTE EMR USABILITY PROGRESS OVER THE PAST TWO
YEARS, April 2015
© 2015 KLAS Enterprises, LLC. All Rights Reserved. www.klasresearch.com 2016 | © Kurt Salmon | 17
Two Market Leaders: Cerner and Epic
2015 KLAS Rankings ‐ Enterprise EHR Vendors
Hospitals Over 200 Beds
Acute Care EMR Patient Accounting and Patient Management
9
Two Market Leaders: Cerner and Epic
2015 KLAS Rankings ‐ Enterprise EHR Vendors
Community
Acute Care EMR Patient Accounting and Patient Management
Current U.S. HIMSS Stage 7 Hospitals by EMR Vendor*
For the purposes of this research, a hospital’s CDR vendor was assumed to be the
core clinical information system vendor at that site.
100% Market Share
Epic EpicCare 69.9%
Cerner Millennium 19.4%
MEDITECH Client Server 7.3%
GE/Self‐Developed 3.9%
Allscripts Sunrise 1.0%
MEDITECH 6.X 1.0%
MEDITECH MAGIC 0.5%
HIMMS Analytics, 7/2015 – Reported Clinical Data Repository Vendor –
Live & Operational/Vendor Websites & Kurt Salmon Research
10
Current U.S. EMR Market Share (Live, Installed Systems*)
For the purposes of this research, a hospital’s CDR vendor was assumed to be the
core clinical information system vendor at that site.
100% Market Share
Misc. Vendors/Systems 30.5%
Epic EpicCare 18.3%
Cerner Millennium 17.0%
CPSI System 2000 8.3%
MedHost HMS 7.3%
MEDITECH 6.X 4.1%
McKesson Paragon 3.9%
Self‐Developed 3.9%
Siemens Soarian (Now 3.4% HIMSS Analytics, 7/2015 – Clinical Data Repository Vendor – Live & Operational
Cerner) Does not include new contracts or current system implementations
Allscripts Sunrise 3.3% Misc. Vendors/Systems includes legacy systems that are currently supported but no
longer offered (e.g., Siemens Invision, MEDITECH MAGIC/Client Server, McKesson
Horizon)
Looking Ahead with Legacy Players
› Cerner’s acquisition of › MEDITECH 6.x offers › Epic is beginning to offer

Siemens has accelerated ambulatory and new look solutions for smaller
selections and feel customers
› Recent DoD contract › MEDITECH slows › Now offers hosting at their
award to Cerner has investment in MAGIC data center in Wisconsin
increased market platform
speculation
11
Emerging Vendors Are Making Waves
In‐house‒developed
Development
Few new market entrants solutions are largely being
partnerships with vendors
have been successful replaced with commercial
have largely failed
solutions
BUT … the market is ripe for disruption with cloud‐based, leading‐edge technology
Product Availability and
Integration
12
Vendors Are Moving Toward Fully Unified Platforms
But no vendor yet offers a completely self‐contained solution that provides every IT module
Inpatient Specialty
Clinicals Clinicals
Home
Critical Care Care
Care Management Radiation
Oncology
Pharmacy Patient
(Inpatient) Portal
Enterprise
Resource
Radiology) Planning
Blood
Emergency Bank
Department
Provider
Portal
Tangible Benefits of an Integrated EHR
PATIENT BENEFITS
Single patient portal to retrieve Clinical and financial processes
test results; pay bills integrated
No need to repeat information
Providing patients with a single bill between physician office and
hospital encounters
Safer, as all information in the
Online scheduling available for
same system; may avoid duplicate
both physician and hospital
tests
13
CLINICIAN BENEFITS
Patient data available across Promotes Centers of Excellence for
continuum of care specialties
Streamlined work processes, e.g., Efficient access; reduces phone
surgical scheduling calls, faxing and copying
Improved patient safety, e.g.,
Enhanced communication with
medication reconciliation; problem
staff and patients
list
Improved patient safety, e.g.,
Pertinent decision support medication reconciliation; problem
list
Patient data recorded by all
Easier and more accurate reporting
disciplines in one system
OPERATIONAL BENEFITS
Single eMPI; single medication list;
Potential for direct cost savings single problem list minimizes
reconciliation across systems
HIM function streamlined into one
Reduced IT maintenance
location; minimal paper records;
requirements
potential FTE reduction
Simplification of referrals from the
Customer service and business
hospital to ambulatory and
office consolidation potential
ambulatory to the hospital
Eliminate or reduce records faxing
or copying on transition of care
14
Attributes: EHR Integration vs. Interoperability
Integration Attributes Interoperability Attributes
› Single vendor, single contract › Limited number of vendors, multiple contracts
› More interfaces/complexity; error queues;
› Few(er) interfaces; interfaces still required
customized
› Integration over department function › Some department function over integration
› Mostly shared information; interoperability › Shared information is incomplete, but adequate
required with affiliated providers on other EHR for many needs
› Single patient experience, single patient portal › Multiple portals
› Provides population health and analytics within › Often required for population health
the organization management across different organizations
› Single sign‐on for the user › Single sign‐on requires additional software
› Single eMPI, master files (provider, charges, etc.) › Incomplete eMPI, multiple set of master files
› Some niche vendors still required (radiation › “Best of breed” orientation with niche vendors
oncology, device integration, etc.) still required and many interfaces
› HIE and data warehouse products often included › HIE and data warehouse at additional costs
› Attestation for meaningful use is simpler › Attestation for meaningful use is more complex
Vendor Interoperability vs. Integration Conclusions
› Cerner, Epic and MEDITECH are moving to integrated solutions vs. interoperability across
the continuum of care
› McKesson Paragon is still missing many modules requiring interfaced solutions
› Health information exchange is here to stay
 Hospitals will continue to have partnerships with organizations with different EHR
vendors
 Meaningful use regulations require the exchange of clinical data with HER
 FHIR, CommonWell, and Sequoia projects will drive more standardization
› Future technologies
15
IT Vendor Evaluation Questions
Questions to Ask When Issuing an RFI/RFP
Implementation,
General Technical Strategic
Training and Support
› Costs › Hosting vs. on‐ › Vendor’s long‐ › Implementation

› Capital premises? term growth strategy
› Operating › Hardware and strategy › Training program
› Vendor’s financial network › Development › On‐call support
stability? requirements? roadmap › Your IT support
› Application/modu › Which end‐user › New staff structure
le information? devices are technologies
› Client wins and supported? › Payment
losses over the › What interfaces models?
last three years? are supported?
16
Appendix
Allscripts (Sunrise)
Company Overview
› Public HIT company (NASDAQ: MDRX) based in Chicago, Ill.; founded in 1986
› $1.4B 2014 revenue; flat growth 2012–2014
› ~6,000 employees; operating in 11 countries and in over 60,000 facilities worldwide
› Key acquisitions: 2008—Misys; 2010—Eclipsys; 2013—dbMotion
Product Overview
› Fully integrated EMR, Revenue Cycle & Ambulatory; some additional products available (e.g., population health)
› 162 U.S. hospital live installs; 6 additional hospitals contracted/installation in progress (HIMSS database 7/2015)
› 1% of HIMSS Stage 7 U.S. hospitals use Allscripts (2 of 206)
› Ranked #3 of 6 in 2014 KLAS Acute Care EMR (75.4)
› Not ranked in 2014 KLAS Acute Care EMR—Community (68.9)
› Ranked as Visionary in Gartner’s 2015 Magic Quadrant for Enterprise EHR Systems
› Ranked #1 out of 5 in 2014 Black Book EHR Rankings for Academic, Teaching & 300+ Bed Hospitals
Commentary
› Continued focus on turnaround following leadership change in late 2012
› Customers report improved quality, service and implementation
› Strategy focused on interoperability, but has not been fully realized
› Sales challenges due to issues delivering on plans and organizational instability; flat EHR market share
17
Cerner (Millennium)
Company Overview
› Public HIT company (NASDAQ: CERN) based in Kansas City, Mo.; founded in 1979
› $3.4B 2014 revenue; 27% revenue growth 2012–2014
› ~15,800 employees; 14,000+ facilities worldwide
› Key acquisitions: 2010—IMC Health Care; 2011—Clairvia; 2015—Siemens Health Services
Product Overview
› Fully integrated EMR, Revenue Cycle & Ambulatory Solution; wide array of additional solutions
› 19% of HIMSS Stage 7 U.S. hospitals use Cerner (40 of 206); also 1 Stage 7 hospital in Spain
› Ranked #1 of 7 in 2014 KLAS Acute Care EMR—Community (74.9) (CommunityWorks Clinical Suite)
› Ranked as Leader in Gartner’s 2015 Magic Quadrant for Enterprise EHR Systems
Commentary
› Market leader with significant growth in market share
› Fully integrated solution; historical weaknesses in revenue cycle and ambulatory EMR have been focus of
development and have improved significantly
› Major improvements in delivery and execution overall
Epic (EpicCare)
Company Overview
› Private HIT company based in Verona, Wis.; founded in 1979
› $1.8B projected 2014 revenue; 16% growth 2012–2014
› Key acquisitions: None
Product Overview
› Fully integrated EMR, Revenue Cycle & Ambulatory Solution
› 70% of HIMSS Stage 7 U.S. hospitals use Epic (144 of 206) (1 Stage 7 hospital in the Netherlands)
› Ranked as Leader in Gartner’s 2015 Magic Quadrant for Enterprise EHR Systems
› 100% of HIMSS Enterprise Davies Awards past 5 years
Commentary
› Market leader with significant growth in market share
› Fully integrated solution; historical weaknesses in analytics/reporting have been focus of development and have
improved significantly
› Historical concerns about eventual leadership transition and technology platform
18
McKesson (Paragon)
Company Overview
› Public health care company (NYSE: MCK), Technology Solutions division based in Alpharetta, Ga.; founded in 1833
› $179B 2015 revenue ($3.1B for Technology Solutions); flat Technology Solutions growth 2012–2014
Product Overview
› EMR, Revenue Cycle, Ambulatory & ERP available, though some products are very immature or come from Horizon
or other legacy platforms
› No HIMSS Stage 7 U.S. hospitals using McKesson Paragon
› Ranked #4 of 7 in 2014 KLAS Acute Care EMR—Community (69.2)
› Not Ranked in Gartner’s 2015 Magic Quadrant for Enterprise EHR Systems
Commentary
› Significant concern among customers regarding future; some success moving customers from Horizon to Paragon
› Paragon is primarily focused on smaller standalone community hospitals; development is planned to build out
functionality required for larger (400+ beds) enterprises
› Not all products yet available on Paragon (e.g., ambulatory)—significant development underway/planned; requires
other McKesson solutions
MEDITECH (6.X)
Company Overview
› Private HIT company based in Westwood, Mass.; founded in 1969
› $517M 2014 revenue; 13.5% revenue decline 2012–2014
› Key acquisitions: 2011—LSS
Product Overview
› Fully integrated EMR, Revenue Cycle & ERP Solution; Ambulatory Solution not fully integrated
› 424 and 394 U.S. hospitals still on legacy MAGIC & Client Server platforms, respectively (HIMSS database 7/2015)
› 9% of HIMMS Stage 7 U.S. hospitals using MEDITECH (18 of 206), 2 are 6.0, as is 1 Canadian Stage 7 hospital
› Ranked #2 of 7 in 2014 KLAS Acute Care EMR—Community (71.6)
› Ranked as Visionary in Gartner’s 2015 Magic Quadrant for Enterprise EHR Systems
› Not Ranked in 2014 Black Book EHR Rankings for Academic, Teaching & 300+ Bed Hospitals
Commentary
› Highly successful, but generally with smaller organizations (e.g., < 200 beds)
› Some attrition due to small hospitals becoming part of large IDNs, as well as need to migrate from legacy platforms
› Ambulatory EMR not fully integrated and perceived as having limited functionality and clinical content to date; new
integrated Web‐based module in development
19
Questions to Ask When Issuing an RFI/RFP—General Questions
› What are the key costs of the system—one time and ongoing?
 Application and system software
 Third‐party software
 Hardware
 Implementation and other consulting fees
 Interfaces
 Training
 Other
› What is the vendor’s financial stability?
 What are the vendor’s key financial metrics?
› What should I know about the application/module information?
 What is the current installed base of each application/module?
 When was each application/module developed?
 Is each application/module fully integrated into the product suite?
› How many clients has the vendor won/lost during the last three years?
Questions to Ask When Issuing an RFI/RFP—Strategic Questions
› What is the vendor’s long‐term growth strategy for their products?
 What is their 10‐year roadmap?
 Ask questions specifically surrounding new acquisitions and/or mergers (e.g., Cerner’s acquisition of
Siemens Soarian).
› What is the vendor’s long‐term strategy for emerging trends in health care?
 What is the vendor’s strategy for population health and how does that enable your organization to
pursue your goals?
 What is their strategy for health exchanges and, specifically, within your organization’s region?
 What is their big data/analytics strategy, and how does that align with your organization’s goals and
go‐forward strategy?
› What is the vendor’s strategy surrounding emerging technologies and payment models?
 What is their go‐forward strategy with mobile and tablet integration?
 How do they integrate with wearables (e.g., Apple WatchKit, Fitbit)?
 What are they doing with new patient payment models such as Apple Pay?
 What is the vendor’s strategy with payment reform, bundled and capitated payments?
20
Questions to Ask When Issuing an RFI/RFP—Technical
› What is the vendor’s strategy for hosting vs. on‐premises?
 Is the vendor already cloud‐based, or are they moving to the cloud? How does this impact pricing?
 Does the vendor host the system themselves, or are third‐party vendors used?
› What are the vendor’s hardware and network requirements?
 Which server and database software packages are supported by the vendor?
 Does the vendor support virtualization?
 What other key technologies are supported (e.g., single sign‐on, Citrix)?
 What are the vendor’s storage requirements?
 What are the vendor’s network requirements?
› Which end‐user devices are supported by the vendor?
 Computers/all‐in‐ones/WoWs?
 Mobile devices—tablets, phones?
 Printers—network and label, barcode scanners, other?
› With which of your other vendors has the vendor successfully integrated?
 Third‐party systems (e.g., key applications such as ERP; bolt‐on/niche applications, content
providers)?
 Medical equipment (e.g., infusion pumps, point‐of‐care devices, bedside monitoring devices)?
Questions to Ask When Issuing an RFI/RFP—
Implementation, Training & Support
› What is the vendor’s implementation strategy?
 What method does the vendor recommend (i.e., staged vs. big bang)?
 What is the specific plan for your organization (i.e., duration, multiple facility)?
 What is the vendor’s recommended staffing for the implementation team?
› What is the vendor’s training strategy?
 What is the training approach for the project team and end‐users?
 How and where is training conducted?
› What is the vendor’s support strategy?
 What are the basic included services (availability and location of support resources)?
 What are the costs for additional support?
› What is the vendor’s recommendation for your IT support staff structure?
1. 2015. Partners’ $1.2B patient data system seen as key to future. The Boston Globe.
http://www.bostonglobe.com/business/2015/05/31/partners‐launches‐billion‐electronic‐
health‐records‐system/oo4nJJW2rQyfWUWQlvydkK/story.html 2016 | © Kurt Salmon | 42
21

Settle - EHR Vendor

Caricato da

Informazioni sul documento

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

Settle - EHR Vendor

Caricato da

Copyright:

Formati disponibili

EHR Vendor Marketplace: Which Stars

Stage Cumulative Capabilities 2006 2010 2012 2014 2015

As of March 2015 2016 | © Kurt Salmon | 9

800 OVER 600 BEDS 101–200 BEDS

© 2014 KLAS Enterprises LLC. All Rights Reserved. www.klasresearch.com 2016 | © Kurt Salmon | 11

Losses, Over 200 Beds Losses, 1–200 Beds Wins, 1–200 Beds Wins, Over 200 Beds Net

© 2014 KLAS Enterprises LLC. All Rights Reserved. www.klasresearch.com 2016 | © Kurt Salmon | 12

NEW IDN NEW VOLUNTARY

© 2014 KLAS Enterprises LLC. All Rights Reserved. www.klasresearch.com 2016 | © Kurt Salmon | 13

Marketplace observations 2016 | © Kurt Salmon | 14

© 2015/2016 KLAS Enterprises, LLC. All Rights Reserved. www.klasresearch.com. 2016 | © Kurt Salmon | 18

© 2015/2016 KLAS Enterprises, LLC. All Rights Reserved. www.klasresearch.com. 2016 | © Kurt Salmon | 19

› Cerner’s acquisition of › MEDITECH 6.x offers › Epic is beginning to offer

› Costs › Hosting vs. on‐ › Vendor’s long‐ › Implementation

Potrebbero piacerti anche