EHR Vendor Marketplace: Which Stars Are Rising And Which Are Falling. Robin Settle Partner. Introduction

Transcription

1 EHR Vendor Marketplace: Which Stars Are Rising And Which Are Falling Robin Settle Partner Introduction 1

2 Presentation Overview The state of the industry How have these developments impacted the marketplace? What are the new tools? How can we support existing systems? Goals Identify the big players in the EHR marketplace Gain objective understanding of their 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 Extension of capabilities to community, teaching, research PATIENT CARE CONTINUUM Primary Care Prevention Urgent Care Specialist Traditional focus of hospitals within the care continuum Surgical Diagnostic Ancillaries e.g., imaging Emergency Care Inpatient Care Extension of capabilities to ACO, partnerships Rehab Care Long Term Care Skilled Nursing Home Care End of Life Care 2016 Kurt Salmon 4 2

3 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 2016 Kurt Salmon 5 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 2016 Kurt Salmon 6 3

4 Enterprise EMR Marketplace: Industry Inpatient Adoption Stage Cumulative Capabilities 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 protocols) 3.1% 10.5% 14.0% 14.0% 10.3% 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 have document imaging; HIE capable 40.0% 14.6% 11.4% 5.1% 3.4% 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% # Hospitals 4,237 5,281 5,310 5, Source: HIMSS Analytics Database 2016 Kurt Salmon 7 EHR Marketplace The Big Players 4

5 Competitive Marketplace Gartner Magic Quadrant for Global Enterprise EHR Systems CHALLENGERS LEADERS Epic Cerner (Millennium) ABILITY TO EXECUTE InterSystems MEDITECH Cerner (i.s.h.med) Cerner (Soarian) Allscripts NICHE PLAYERS VISIONARIES COMPLETENESS OF VISION As of March 2015 McKesson Paragon product is not marketed outside the US 2016 Kurt Salmon 9 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 ehr satisfaction survey 2016 Kurt Salmon 10 5

6 Total Market Share by Hospital Size 1, OVER 600 BEDS BEDS BEDS BEDS BEDS 1 25 BEDS KLAS Enterprises LLC. All Rights Reserved Kurt Salmon Market Wins and Losses Losses, Over 200 Beds Losses, Beds Wins, Beds Wins, Over 200 Beds EPIC CERNER MEDITECH* MCKESSON* SIEMENS* CPSI HEALTHLAND MEDHOST (HMS) ALLSCRIPTS QUADRAMED GE HEALTHCARE Net *Legacy to current product migrations are counted in both win and loss columns 2014 KLAS Enterprises LLC. All Rights Reserved Kurt Salmon 12 6

7 Why Vendors Gained or Lost Hospitals Competitive Wins (N = 304) Competitive Losses (N = 225) ADD ONS 25% MIGRATIONS 11% CHANGE OF LEADERSHIP 17% LEGACY MIGRATION (stayed with vendor) 14% NEW IDN (Hospitals) 32% NEW STANDALONE 32% VOLUNTARY DEPARTURES 69% 2014 KLAS Enterprises LLC. All Rights Reserved Kurt Salmon 13 Vendor Viability Marketplace observations Market Factor Losing market share Financial viability concerns Product sunsets Incomplete product suite Products in transition Emerging vendors (e.g., Athena) Vendors at Risk Allscripts, McKesson Allscripts McKesson, Siemens Allscripts McKesson, MEDITECH McKesson, MEDITECH Marketplace observations 2016 Kurt Salmon 14 7

8 KLAS Enterprise EHR Vendors Ratings HOW THE SUITES PERFORM AGAINST ALL OTHER ENTERPRISE SUITES Rank Summary Score 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/ Above Average Average Below Average/ Well Below Average icare not rated by KLAS 2015/2016 KLAS Enterprises, LLC. All Rights Reserved Kurt Salmon 15 Key Aspects of Usability PHYSICIAN LEADERSHIP WEIGHS IN ON ACUTE EMR USABILITY PROGRESS OVER THE PAST TWO YEARS, April KLAS Enterprises, LLC. All Rights Reserved Kurt Salmon 16 8

9 Vendor Improvement and Contribution PHYSICIAN LEADERSHIP WEIGHS IN ON ACUTE EMR USABILITY PROGRESS OVER THE PAST TWO YEARS, April KLAS Enterprises, LLC. All Rights Reserved Kurt Salmon 17 Two Market Leaders: Cerner and Epic Acute Care EMR 2015 KLAS Rankings Enterprise EHR Vendors Hospitals Over 200 Beds Patient Accounting and Patient Management 2015/2016 KLAS Enterprises, LLC. All Rights Reserved Kurt Salmon 18 9

10 Two Market Leaders: Cerner and Epic Acute Care EMR 2015 KLAS Rankings Enterprise EHR Vendors Community Patient Accounting and Patient Management 2015/2016 KLAS Enterprises, LLC. All Rights Reserved Kurt Salmon 19 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 2016 Kurt Salmon 20 10

11 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 Epic EpicCare Cerner Millennium CPSI System 2000 MedHost HMS MEDITECH 6.X McKesson Paragon Self Developed Siemens Soarian (Now Cerner) Allscripts Sunrise 4.1% 3.9% 3.9% 3.4% 3.3% 8.3% 7.3% 18.3% 17.0% 30.5% HIMSS Analytics, 7/2015 Clinical Data Repository Vendor Live & Operational Does not include new contracts or current system implementations Misc. Vendors/Systems includes legacy systems that are currently supported but no longer offered (e.g., Siemens Invision, MEDITECH MAGIC/Client Server, McKesson Horizon) 2016 Kurt Salmon 21 Looking Ahead with Legacy Players Cerner s acquisition of Siemens has accelerated selections Recent DoD contract award to Cerner has increased market speculation MEDITECH 6.x offers ambulatory and new look and feel MEDITECH slows investment in MAGIC platform Epic is beginning to offer solutions for smaller customers Now offers hosting at their data center in Wisconsin 2016 Kurt Salmon 22 11

12 Emerging Vendors Are Making Waves Few new market entrants have been successful Development partnerships with vendors have largely failed In house developed solutions are largely being replaced with commercial solutions BUT the market is ripe for disruption with cloud based, leading edge technology 2016 Kurt Salmon 23 Product Availability and Integration 12

13 Vendors Are Moving Toward Fully Unified Platforms But no vendor yet offers a completely self contained solution that provides every IT module Inpatient Clinicals Pharmacy (Inpatient) Critical Care Radiology) Specialty Clinicals Patient Portal Emergency Department Care Management Blood Bank Home Care Enterprise Resource Planning Radiation Oncology Provider Portal 2016 Kurt Salmon 25 Tangible Benefits of an Integrated EHR PATIENT BENEFITS Single patient portal to retrieve test results; pay bills Providing patients with a single bill Online scheduling available for both physician and hospital Clinical and financial processes integrated No need to repeat information between physician office and hospital encounters Safer, as all information in the same system; may avoid duplicate tests 2016 Kurt Salmon 26 13

14 Tangible Benefits of an Integrated EHR CLINICIAN BENEFITS Patient data available across continuum of care Streamlined work processes, e.g., surgical scheduling Improved patient safety, e.g., medication reconciliation; problem list Pertinent decision support Patient data recorded by all disciplines in one system Promotes Centers of Excellence for specialties Efficient access; reduces phone calls, faxing and copying Enhanced communication with staff and patients Improved patient safety, e.g., medication reconciliation; problem list Easier and more accurate reporting 2016 Kurt Salmon 27 Tangible Benefits of an Integrated EHR OPERATIONAL BENEFITS Potential for direct cost savings HIM function streamlined into one location; minimal paper records; potential FTE reduction Simplification of referrals from the hospital to ambulatory and ambulatory to the hospital Single empi; single medication list; single problem list minimizes reconciliation across systems Reduced IT maintenance requirements Customer service and business office consolidation potential Eliminate or reduce records faxing or copying on transition of care 2016 Kurt Salmon 28 14

15 Attributes: EHR Integration vs. Interoperability Integration Attributes Interoperability Attributes Single vendor, single contract Limited number of vendors, multiple contracts Few(er) interfaces; interfaces still required More interfaces/complexity; error queues; customized Integration over department function Some department function over integration Mostly shared information; interoperability required with affiliated providers on other EHR Single patient experience, single patient portal Multiple portals Provides population health and analytics within the organization Shared information is incomplete, but adequate for many needs Often required for population health 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 oncology, device integration, etc.) Best of breed orientation with niche vendors 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 2016 Kurt Salmon 29 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 2016 Kurt Salmon 30 15

16 IT Vendor Evaluation Questions Questions to Ask When Issuing an RFI/RFP General Technical Strategic Implementation, Training and Support Costs Capital Operating Vendor s financial stability? Application/modu le information? Client wins and losses over the last three years? Hosting vs. onpremises? Hardware and network requirements? Which end user devices are supported? What interfaces are supported? Vendor s longterm growth strategy Development roadmap New technologies Payment models? Implementation strategy Training program On call support Your IT support staff structure 2016 Kurt Salmon 32 16

17 Appendix Allscripts (Sunrise) Company Overview Public HIT company (NASDAQ: MDRX) based in Chicago, Ill.; founded in 1986 $1.4B 2014 revenue; flat growth ~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 2016 Kurt Salmon 34 17

18 Cerner (Millennium) Company Overview Public HIT company (NASDAQ: CERN) based in Kansas City, Mo.; founded in 1979 $3.4B 2014 revenue; 27% revenue growth ~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 840 U.S. hospital live installs; 117 additional hospitals contracted/installation in progress (HIMSS database 7/2015) 19% of HIMSS Stage 7 U.S. hospitals use Cerner (40 of 206); also 1 Stage 7 hospital in Spain Ranked #2 of 6 in 2014 KLAS Acute Care EMR (79.1) 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 Ranked #3 out of 5 in 2014 Black Book EHR Rankings for Academic, Teaching & 300+ Bed Hospitals 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 2016 Kurt Salmon 35 Epic (EpicCare) Company Overview Private HIT company based in Verona, Wis.; founded in 1979 $1.8B projected 2014 revenue; 16% growth ~7,000 employees; 13,000+ facilities worldwide Key acquisitions: None Product Overview Fully integrated EMR, Revenue Cycle & Ambulatory Solution 904 U.S. hospital live installs; 193 additional hospitals contracted/installation in progress (HIMSS database 7/2015) 70% of HIMSS Stage 7 U.S. hospitals use Epic (144 of 206) (1 Stage 7 hospital in the Netherlands) Ranked #1 of 6 in 2014 KLAS Acute Care EMR (89.3) Ranked as Leader in Gartner s 2015 Magic Quadrant for Enterprise EHR Systems 100% of HIMSS Enterprise Davies Awards past 5 years Ranked #2 out of 5 in 2014 Black Book EHR Rankings for Academic, Teaching & 300+ Bed Hospitals 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 2016 Kurt Salmon 36 18

19 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 ~43,500 employees; 3,100+ facilities worldwide Product Overview EMR, Revenue Cycle, Ambulatory & ERP available, though some products are very immature or come from Horizon or other legacy platforms 195 U.S. hospital live installs; 5 additional hospitals contracted/installation in progress (HIMSS database 7/2015) No HIMSS Stage 7 U.S. hospitals using McKesson Paragon Ranked #6 of 6 in 2014 KLAS Acute Care EMR (59.2) 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 Ranked #4 out of 5 in 2014 Black Book EHR Rankings for Academic, Teaching & 300+ Bed Hospitals 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 2016 Kurt Salmon 37 MEDITECH (6.X) Company Overview Private HIT company based in Westwood, Mass.; founded in 1969 $517M 2014 revenue; 13.5% revenue decline ~4,000 employees; 2,400+ facilities worldwide Key acquisitions: 2011 LSS Product Overview Fully integrated EMR, Revenue Cycle & ERP Solution; Ambulatory Solution not fully integrated 233 U.S. hospital live installs; 28 additional hospitals contracted/installation in progress (HIMSS database 7/2015) 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 #4 of 6 in 2014 KLAS Acute Care EMR (67.2) 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 2016 Kurt Salmon 38 19

20 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? 2016 Kurt Salmon 39 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? 2016 Kurt Salmon 40 20

21 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)? 2016 Kurt Salmon 41 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? Partners $1.2B patient data system seen as key to future. The Boston Globe. launches billion electronichealth records system/oo4njjw2rqyfwuwqlvydkk/story.html 2016 Kurt Salmon 42 21