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KLAS: Epic Losing Ground To Cerner

At this point in the EMR buying cycle, one would figure that the market for new hospital EMR purchases is pretty saturated, especially among larger hospitals with the capital to invest in big health IT projects. But according to a recent blog entry from KLAS, that’s not exactly the case.

In his blog item, KLAS researcher Colin Buckley notes that his firm has been watching clinical IT vendor wins and losses at 200+ bed hospitals for 10 years.  During that period — and especially post- Meaningful Use — KLAS has seen a growing number of new hospital EMR contracts.

By this point, after lots of EMR buying, and some switching out technology for second and third-choice EMRs, one might think that over-200-bed hospitals had settled on a platform that they could live with through Meaningful  Use Stage 3. Actually, not quite, Buckley says.

In fact, KLAS data shows that there are more hospitals running legacy EMRs, homegrown EMRs or no EMR at all than those who have bought a currently-marketed solution sometime in the past four years. And it’s likely these hospitals will be choosing a new EMR from the current vendor marketplace within the new few years, KLAS projects.

As sales increase in the 200+ bed hospital segment, market forces are shifting to favor new vendors. What’s particularly noteworthy about this is that the research firm has seen the ratio of Epic-to-Cerner wins shrink from 5-to-1 in 2010 to 2-to-1 in 2012.

According to KLAS, the hospitals that are likely to be out buying new EMRs look different than those which have already bought and implemented the EMR they’ll use for the next several years. “They are smaller and more cost conscious than the large hospital IDNs that have given Epic a lion’s share of wins year after year,” Buckley writes.

With Cerner and Epic busy eating each other’s lunch, Allscripts, MEDITECH, McKesson and Siemens are moving ahead as quickly as possible to roll out integrated ancillary and ambulatory solutions, Buckley notes. In other words, the competition for both ambulatory and hospital EMRs is far from played out.

Despite all of this activity, we are clearly in a late stage of the EMR market as a whole, or as my colleague John Lynn puts it, “the Golden Age of EHR adoption is over.” But if KLAS is right, there’s still some very healthy bucks to be made selling to laggard mid-sized hospitals. Let’s see if vendors used to serving hospital giants can adapt in time.

September 6, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

EMR Vendors Need To Get Their Act Together

For quite some time now, EMR vendors have gotten away with selling products that aren’t very usable and may even pose safety risks. But that’s the price enterprise EMR buyers have been willing to pay to jump in and automate. Very soon, though, vendors may be held to a higher standard, a new report from KLAS.

KLAS recently held a bake-off comparing Allscripts, Cerner, Epic, McKesson’s Paragon, Meditech 6 and Siemens’ Soarian EMRs head to head where it comes to usability and efficiency, SearchHealthIT reports. The study looked at how the products worked for individual users, and then looked at how they meet organizational quality of care demands.

Some of the EMRs  – and I wish SearchHealthIT had told us which ones — took a full month for physicians to learn. In some cases, physicians who were willing to take that month ended up with a richer experience than those which were easy and quick to learn, while in other cases, the darned thing still wasn’t usable.  Of course, those with long learning curves and unimpressive features suffered from low physician adoption, the  publication notes.

This is all interesting enough, but what grabbed me about the story was a provider quote from an end user, supplied by KLAS:

“As suggested by the new 2014 certification standards, vendors should take more responsibility for both the usability and safety of their products. These responsibilities shouldn’t be the sole purview of healthcare organizations and providers like they have been until now.”

Could it be that providers have finally gotten to the point where they’re no longer going to put up with unusable products and bring the hammer down even on giants like the big-shouldered group listed above?  After all, so far providers have swallowed hard and accepted a lot of ugly technology.

Maybe Meaningful Use demands are finally giving health organizations the backbone they need to stand up to Jabba the Hutt vendors?

March 22, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Top Inpatient EHR Vendors – 2013 Black Book Rankings

I think that most of you know how I feel about the various EHR ranking systems. They all have their issues, but they are another interesting data point in the search for the right EHR. Plus, the EHR ranking trends over time can be interesting. Not to mention, it’s hard not to look at a post that has rankings. It’s almost un-American not to look.

So, I figured I’d post some of the Black Book Rankings over the next week. The following are the Top Ranked EHR Vendors for Inpatient Hospital Systems, Chains and IDN (in alphabetical order).

4MEDICA
ALLSCRIPTS
CPSI
EPIC
GE HEALTHCARE
HCS EMR
HEALTH MANAGEMENT SYSTEMS
HEALTHLAND
INFOMEDIKA
KEANE
MCKESSON
MEDITECH
NEXTGEN
PROGNOSIS HIT
QUADRAMED
SEQUEL
SIEMENS
UNI/CARE
VERSASUITE

Not too many surprises on the list. Was their any Hospital EHR vendor that you think should have made it on this list? I think this list would be more interesting if it just ranked the top 5 Hospital EHR vendors.

February 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

How Danish Leaders Are Choosing Their EMR

This is something you don’t see every day. Courtesy of my always-on-top-of-things colleague John, here’s a look at the process by which Danish government authorities are selecting an EMR for the Capital Region of Denmark.

As the TBKConsult blog notes, this is a big decision. The authorities expect to spend 135 million euros on the EMR, which will have 40,000 IT users and need to support up to 12,000 clinical and administrative users at 17 hospitals and 54 other healthcare institutions simultaneously. Once installed, the system will support a region serving 2.5 million patients.

Once chosen, the EMR will be implemented with a pilot in the Capital region and eventually, by the end of 2016, rolled out throughout Eastern Denmark.

The selection process has already narrowed down the list of possibilities to five prequalified vendors: Systematic, Epic, Cerner, Cambio and Siemens.  None of the vendors have submitted official proposals yet.

What’s interesting about this isn’t the shortlist, but the means by which the authorities have decided to narrow the list down. Here’s their list of fourteen criteria by which TBKConsult expects them to do so:

  • Installed base and references
  • Clinical reputation
  • HIMSS/EMRAM level 6/7 certifications (Electronic Medical Record Adoption Model)
  • Fit for purpose – clinical processes
  • Fit for purpose – PAS
  • Fit for purpose – external integration
  • Software scalability – current installed base
  • Software scalability (SIG test)
  • Software maintainability (SIG test)
  • Price/Performance
  • Implementation capability
  • Product strategy and influence
  • Political preference
  • Staff perks and community participation

TBK Consult has also ranked the importance of each of these criteria, assigning the most weight to “Fit for purpose-clinical processes” (25 percent), “Fit for purpose-PAS” (15 percent) and “Fit for purpose-external integration” (15 percent). They rated “Implementation capability” at 10 percent and most of the rest of the criteria at 5 percent.

By their weights and ranking, vendor Cambio comes in first, Systematic second, Epic third, Cerner fourth and Siemens fifth. Intriguing. I wonder how close TBK will be when the actual results are announced?

February 19, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Other EHR Options When Epic Denies You

I got the following email from the CIO of a hospital.

They’ve [Quadramed] got the whole ONC-ATCB certified EHR for Phase 1 MU (although the point in your post is valid about that certification being fairly general anymore). They are working on obtaining and integrating/interfacing ambulatory functionality for physician practices, but for hospitals they have some pretty good sized hospitals running their QCPR product. KLAS includes them in their evaluation of EHR vendors (along with the likes of Allscripts, Cerner, Epic, GE, McKesson, Meditech, and Siemens) although they clearly don’t have as many installed hospitals that most of that list has. They also need to develop some real patient portal type of functionality to stay certified for future MU Phases. Not a market leader, but they are a market player. In spirit of full disclosure, we are almost live with Quadramed product, and we will be using it as a full EHR for both inpatient and outpatient care settings. We could not afford the bigger vendor solutions, and Epic wouldn’t even talk with us because we are below their minimum size to qualify for their sales efforts….only vendor I’ve seen that has that luxury of flat out ignoring possible business. We didn’t like the inflexibility of the lower end EHR vendors, and Quadramed provided a lot of the flexibility of bigger vendors for the price of the smaller vendors.

I’d love to learn where other hospital CIOs turn when Epic won’t give them the time of day. Considering Epic’s hospital size requirements and who they will work with, this is more hospitals than not. I started a list of hospital EMR and EHR vendors that might help. Where do hospital CIOs go when Epic isn’t an option? Is there a Denied by Epic support group somewhere online where hospital CIOs can commiserate?

January 18, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Sometimes Epic Doesn’t Win: Public Hospital Goes Open Source

Most of the hospitals I write about go with big, expensive commercial EMR packages and suffer through upgrades and code fix schedules imposed by the vendor.  The process seems pretty miserable, and rather inefficient, but IT departments are stuck with it.

That being said, at least some hospitals take advantage of the open source paradigm, including the following midwestern facility.

Oklahoma-based Stilwell Memorial Hospital, a 50-bed public facility, has decided to install Medsphere Systems Corp.’s OpenVista EHR.  The Medsphere product is an open source derivative of the Department of Defense’s widely praised VistA system.  Rather than millions of upfront bucks, Medsphere charges a subscription fee for OpenVista use.

As part of choosing OpenVista, Stilwell Memorial becomes part of Medsphere’s “Healthcare Open Source Ecosystem,” in which various users share code, system upgrades and tips for managing the system.

The question that pops into my head, as I read the background on this install, is why we’re hearing about a 50-bed hospital making this selection, but few if any medium-sized or large community hospitals.

After all, given its history as a massive DoD implementation, I don’t think there’s any question that VistA scales up well. And we are all over the taint open source once had as too casual a community for hard-core enterprise use, right?  By at least a decade?

The truth, however, is that we probably all know the answer. The reason open source EMR installations are still in the minority is that CEOs and board members like the sound of having a giant, sprawling corporate partner better than working with a community.   Meditech, Epic, Cerner and Siemens are more or less automatically shortlisted.

Sigh. Wouldn’t it be nice if hospital C-suite folks and boards were more flexible?  Great things could happen.

June 18, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Top HIS Vendors By 2011 Revenue: Siemens (SI)

As some of you may recall, a few months ago we took a look at Soarian’s prospects for taking some of Epic’s ever-growing EMR marketing share.  At the time, we noted that Soarian’s  customer satisfaction ratings were climbing and its list of big deals was growing.  In the wake of our story a few readers chimed in to slam Sorian, hard — one dubbed it “the most asinine and ridiculously slow system. Ever.” — but with Siemens’ $85 billion behind it, it’s not going anywhere soon.

So,  here’s some stats on Siemens’ position on the HIS market, courtesy of HealthDataManagement magazine.  As previously noted, HDM defines HIS as the complete package of hardware, software and implementation needed to manage and support a hospital.

HDM has ranked Siemens as third in volume, behind McKesson (#1) and Cerner (#2). HDM estimates that Siemens has 14 percent of the HIS market.

All that being said, bear in mind that we’re  not suggesting the order in which their revenue streams are ranked implies that, say, McKesson offers better products then Cerner. But numbers like these are interesting anyway, aren’t they?  At least in that rubbernecking-can’t-turn-away-from-that-car-crash way…

-Anne Zieger
anne@healthcarescene.com 

 

Siemens AG (SI)
Wittelsbacherplatz 2
MUENCHEN, 80333
Germany
(Phone) +49-89-63600

CEO: Peter Loescher

CEO of Healthcare Sector: Hermann Requardt


2011 HIS Revenue:
$1.7 billion

2010 HIS Revenue: $1.6 billion

Clearly, Siemens wouldn’t go out of business any time soon if it dropped the entire HIS business into a black hole.  $1.7 billion isn’t chump change but it’s a tiny part of the 85 billion Euro company’s overall revenues.

Ah, but for readers of this publication, there’s a catch. Soarian seems to be set up for growth, if the consultants behind HDM’s research are right. According to them, Soarian continues to sell well, and what’s more, with many clients still using Siemens’ older Invision and MedSeries4 systems, Siemens has many prospects that could be sold on a Soarian upgrade.  If so, we could see some real rumbling in the power structure of the EMR business overall.

Interesting fact:  While most of its competitors are firmly rooted in the healthcare business, Siemens is as much (if not more) an electronics and electrical engineering company with very large stakes in power generation, renewable energy, oil and gas, power transmission and distribution.

April 30, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Differences Between ROI, Ease of Meaningful Use Vary Between Vendors

New research by KLAS seems to have uncovered important differences between the way EMR vendors perform when organizations are mounting them for Meaningful Use compliance.

According to the research firm, which interviewed 104 MU-compliant providers, both large and small hospitals successfully passed through Meaningful Use attestation.  However, the choice of vendor did seem to make a difference — one which, if KLAS is right, hospitals would be ill-advised to ignore.

KLAS concluded that hospitals using Allscripts, Healthland, HMS, McKesson had a harder time moving ahead on MU than organizations that went with MEDITECH, Cerner, CPSI and Epic. (It should be noted that while MEDITECH had the highest number of successful attesters, most of those came from a single large IDN, which makes it a bit hard to tell whether the IDN’s execution strategy or the product deserves the credit.)

One surprising bit of data, for me at least, that community hospitals were having an easier time covering their costs than larger IDNs.  KLAS notes that this varied from vendor to vendor, but didn’t name which were the higher performers.

Why the difference? My guess is that the bigger IDNs bought “Extormity” software (such as Epic and Cerner) and are having a hard time paying for it; that they have higher integration costs; and that they’re dealing with larger piles of smoking heaps of machinery (oh, excuse me, I meant very outdated mainframes and what have you).

As for problems, providers obviously had plenty to share.  Reporting and problem list functions were the most commonly reported challenges, KLAS said. In these areas, it seems, all vendors performed poorly, including the ever-popular Epic Systems.

March 21, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Which Hospital Vendor Solutions Are a Fit for the Community and Mid-Size Hospital Space?

The following are some of the vendors often under consideration:

  • Allscripts: The Eclipsys Sunrise platform has proven clinical functionality. Strong outpatient strategy via Allscripts.
  • Cerner: Has been among the most aggressive in adapting a large hospital solution for the community space. A proven clinical platform which is made more consumable by the introduction of the remote-hosted version.
  • Epic: Has dominated the large hospital market. Not accustomed to selling to hospitals with less than 300 beds (unless it is a children’s hospital). Some community hospitals are piggybacking on a larger organization’s investment in Epic, making these larger hospitals act as solutions providers to other hospitals – i.e. acting as vendors.
  • McKesson: Paragon has a lot of momentum in the community and mid-size hospital space. They are rolling out CPOE functionality.
  • Meditech: The most successful (and affordable) integrated platform in the community hospital market. Huge number of legacy installs. The go-forward is Version 6.
  • QuadraMed: Has a sizable client base in the middle of the market. Proven clinical adoption. Clients wonder where the core clinical product is going in terms of development.
  • Siemens: Soarian has several installs in community and mid-size hospitals. Has gained CPOE adoption. Little clinical enhancement with MedSeries4 and still working out which is the preferred solution for this market – Soarian or MS4.

CPSI, Healthland, HMS, and NextGen are pushing up into the small end.

What is on the horizon?

Large hospital vendors are redoubling their efforts to win business in the community hospital space, which, in turn, causes vendors with small hospital solutions to reinvest in their products in order to prove clinical functionality and adoption. These two groups of vendors are coming at the market from different places, but providers benefit all the same.


Guest Post: Jeremy Bikman is Chairman at KATALUS Advisors, a strategic consulting firm focused on the healthcare vertical. We help vendors grow, guide hospitals into the future, and advise private equity groups on their investments. Our clients are found in North America, Europe, and Asia. www.KATALUSadvisors.com

The principals of KATALUS Advisors have worked with hundreds of healthcare organizations, vendors, and other consulting firms across the globe. The opinions expressed here are our own and are not intended to promote any specific vendor and do not reflect those of any other organization or individual.

December 29, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

The Argument for Meditech


Guest Post: Jeremy Bikman is Chairman at KATALUS Advisors, a strategic consulting firm focused on the healthcare vertical. We help vendors grow, guide hospitals into the future, and advise private equity groups on their investments. Our clients are found in North America, Europe, and Asia. www.KATALUSadvisors.com

Why Meditech Continues to Be a Force in HIT
Meaningful Use is a load of white noise, and it could be argued has become a load of something else.
While it is true that certain mandates associated with HITECH are meant to help hospitals achieve real and significant milestones, these mandates also tend to skew and confine the scope of conversation to within narrow clinical parameters. Press releases also reflect this, whether it be Epic’s latest win or the newest Siemens Soarian or McKesson Horizon site to turn on CPOE. What seems to get lost in the noise are the thousands of small and mid-size hospitals and the vendors which serve them. These hospitals provide care for a substantial percentage of the population. This post focuses on one such vendor, Meditech, and the reasons behind its strong position in the industry.

Meditech: By the Numbers
Number of Hospital Clients (U.S.): approximately 2,000
Market Share Position by Total HIS/Core Clinical Installs: 1st
HIS/Core Clinical Offerings: MAGIC, C/S, and 6.0 (with 6.0 as the new standard and go-forward platform)

Serving the Underserved
Small and community hospitals typically have had the fewest choices when selecting a HIS or core clinical vendor. This has always been a function of limited hospital budget, limited IT staff, and the limited number of vendors serving the community and critical access hospital space. Meditech radically changed the paradigm by successfully targeting cash-strapped hospitals and delivering a solution which was both capable and affordable. Specifically, Meditech was able to gain a huge client base by delivering the following:
1. An integrated, comprehensive HIT platform
2. Low upfront and maintenance costs; historically lower priced than any comparable competitor
3. Utilized a proven database technology
Until now, no other vendor has been able to match this value proposition for community hospitals, and without the recent influx of billions of dollars of government funding for HIT spending, it’s unlikely almost any other major vendor could match Meditech’s value proposition today.

What Detractors Say
The following are a series of arguments typically levied against Meditech. Also included are responses which illuminate alternative points of view to these arguments and provide balance to the overall discussion:
Argument: Meditech utilizes old technology.
Response: Meditech’s core technology is really no older than that of the hottest vendor on the market right now – Epic. In fact, they use much of the same technology, with both vendors utilizing a MUMPS database, which is proven as an extremely reliable, fast system.

Argument: Meditech doesn’t support its customers.
Response: No vendor is perfect in customer service and support, and all have room for improvement. That being said, most Meditech customers believe they receive support which meets their expectations. A much higher level of support would require Meditech to hire additional staff and raise its maintenance fees, which would directly hurt their smaller hospital clients.

Argument: Meditech is just about the money.
Response: Let’s set the record straight – every vendor is in business to make money and there is nothing wrong with it. Meditech was certainly late to the game with V6 but so have most of the other major EHR/HIS vendors in the releases of their go-forward “Meaningful Use” compliant solutions. Furthermore, extremely large portions of their customer base are very small hospitals with very small IT budgets that almost no other vendor could afford to support.

Argument: Ok, Meditech might work for smaller hospitals but definitely isn’t suited for larger, more sophisticated ones.
Response: Tell that to Centura Health in Colorado, CHRISTUS Health in San Antonio, Methodist Health System in Dallas, Hospital Sisters Health System in Springfield, IL, or St. Joseph’s Health System out of Orange County, CA. These major organizations are just an example out of a much larger pool of healthcare organizations that are having demonstrable success utilizing Meditech’s core clinical offerings.

Simply put, Meditech is not for everybody, and frankly neither is Cerner, Allscripts, Siemens, McKesson, or Epic. Organizations that go in with their eyes wide open, have committed IT staffs (lead by tough and independent minded executives) and involved physician and nurse leadership can have success with Meditech on par with competing clinical IT solutions.

In summary, Meditech remains a competitive and viable enterprise vendor for hospitals of all sizes. If there is one area where Meditech truly lags behind its competitors it is in the area of trumpeting their every success across the industry. Negative spin has filled this information void. It’s time for Meditech to come back to the HIMSS conference and start making noise on influential HIT websites and blogs to share their clients’ successes and promote its hard-won reputation for value to the industry.

Disclaimer: Meditech is not a client of KATALUS Advisors.

October 12, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.