Besides reflecting customers’ experience with so many aspects of healthcare-focused software systems, the annual “Best in KLAS Awards: Software & Services” report offers a fascinating snapshot of an industry in flux. Thousands of healthcare providers share their candid feedback about the reality of healthcare technology solutions with KLAS, which uses that input to paint a picture of how well the technology suppliers are responding to their needs. Stacked side by side, the 15 annual Best in KLAS reports tell a story of the growth of the health information technology industry.
In fact, just looking over the list of market segments that are new to the report in 2012 gives us an idea of how the market is changing. They include clinical decision support, point-of-use inventory management, and vendor-neutral archives, as well as health information exchange consulting.
This year, impatience may be the word that best sums up the mood of many providers who are feeling pressure from meaningful use deadlines. As an August 2012 KLAS study entitled “Clinical Market Share 2012: Meaningful Use Momentum Continues” noted, providers who might normally be patient with their vendors feel they can’t afford to wait.
“They want an integrated platform with stable meaningful use functionality that their physicians won’t fight them over,” notes KLAS report author Colin Buckley. Additionally, meaningful use deadlines are forcing some providers back to the market sooner than expected.”
What follows is an analysis of the report, with comments from KLAS researchers, other analysts and consultants, and some customers, turning the numbers in the charts back into personal observations.
Acute Care EMR
In the acute care EMR market, all the vendors and their customers have been incredibly busy retooling their functions and features to chase meaningful use deadlines. But the real story has been that Epic and Cerner have separated themselves from the pack largely due to how tightly integrated their systems are. And Epic’s EpicCare Inpatient EMR continues to lead the rest of the companies in this segment in terms of Overall Score by more than 12 points. One hundred percent of its customers said they would buy the product again.
“It’s true that Epic is winning a lot of the new business,” says Coray Tate, KLAS research director. “You continue to hear from customers that the staff they bring in are young and smart and well trained. If you run into problems, they rally the troops and are right there with you. You don’t hear about perfection, but the customer satisfaction is still there.
Cerner has its pieces put together well and has grown much more consistent in terms of supporting its customers, Tate says. “Some customers find Cerner appealing because it works hard at being innovative—for instance, connecting smart pumps to the EMR,” he adds. Yet Cerner has been hampered because its accounting module is not seen as strong.
Other vendors such as Allscripts, McKesson, MEDITECH, and Siemens are signing new customers too, yet CIOs of larger hospitals are drawn toward higher levels of integration and clinical functionality—and they want them now.
Those competitors see the success Epic is having, Tate says, and are trying to work through issues or build out a similar approach of a tightly integrated platform. For instance, some customers are very excited about Siemens’ Soarian architecture, but were concerned about the lack of an ambulatory or emergency department module. Siemens has tried to fill those holes in its portfolio with partnerships, Tate adds.
In late 2011, McKesson announced that although it would not “sunset” its Horizon product, its Paragon Clinicals would be its main product line going forward. Paragon has been successful in the community hospital space, and although it is just starting to penetrate the larger hospital space, it did quite well in terms of rating in this Best of KLAS, at No. 3, so it merits close attention, Tate says.
The report suggests that MEDITECH’s Version 6 has not been as well received by customers as the company would have liked. “It is a new product and still maturing,” Tate explains. Their customers have been very loyal over the years, and the product has been stable even if it didn’t have all the bells and whistles. But as EHRs have begun to move from a data repository to more of a clinical tool, customers’ expectations have risen, and CIOs are saying this has not been as smooth a transition as they would have liked. “It is not just an upgrade; it is a new platform,” Tate says. “So some customers are saying, since I have to move to a whole new platform from Magic, maybe it is time to look at my other options.”
Customers of Allscripts’ Sunrise Clinical Manager are concerned about the turmoil the company has seen recently, including the departure of CEO Glen Tullman. But they don’t seem to be panicking, Tate says. “They have a product they like and they want to see the company succeed. But now is the time for the company to put up or shut up.”
Tate notes that GE Healthcare, whose overall score fell another 15 percent, has been up front with its customers that Centricity had some problems that the company needs to fix. “They lost a large portion of their customer base,” he says. They have worked with Intermountain and Microsoft on some innovations, but it remains to be seen when those might come to market.”
Seeing Epic’s success, some in the industry question whether its growth is sustainable. Yet one Epic customer, Dan Kinsella, CIO of Cadence Health, a two-hospital system in the suburbs of Chicago, believes that the company simply made a bet about the way the market would develop and “built a better mousetrap.” Other vendors tried the acquisition and roll-up strategy, he says. “I joke that some of these systems are integrated at the invoice level, but when you look underneath the covers, they aren’t really integrated.”
The Ambulatory Market
KLAS has noted that the ambulatory EMR market expansion brought about by the Health Information Technology for Economic and Clinical Health (HITECH) Act has found the top vendors racing to keep current clients on board while also engaging new ones. The expansion also has opened up opportunities to a wider range of vendors.
More large physician practices are making the decision about their ambulatory EMR based on the acute care EMR in use in their network or affiliated hospital because they want interoperability across those settings. This is especially true for the Epic and Cerner acute-care EMR customers. Yet some innovative vendors continue to pick up new customers. NextGen has managed to move up in the rankings from fifth to third place in the rankings, Tate notes, and eClinicalWorks is very physician friendly and they are a nimble company, he adds. (eClinicalWorks ranks No. 2 in the ambulatory market for physician groups with more than 75 physicians.)
Allscripts’ ratings have continued to slide a bit. Following its merger with Misys a few years ago, the company lost a little bit of focus, Tate says. “They still have a huge client base and those customers are still hopeful they can turn it around.”
A few vendors, such as Greenway and LSS, have shown the potential to move up to the niche serving larger physician practices. “Greenway already has some larger customers who report having a good experience,” Tate says.
As provider organizations continue to consolidate, the ambulatory vendors will be forced to chase fewer larger customer, notes Judy Hanover, research director for IDC Health Insights in Framingham, Mass. “We haven’t seen too many consolidations on the vendor side yet, but I think we will see more over the next few years,” she adds. In the ambulatory setting, the smaller players have been buoyed somewhat by the meaningful use financial infusion, she adds. But when it comes time to for customers to renew their technology, some of those players may not survive.
As providers continue to seek ways to do more with fewer resources, software as a service (SaaS) solutions are appealing to more of them. For instance, athenahealth has made a real splash in the smaller-office market, Tate says. “Their SaaS model has been disruptive,” he adds. “It is lightweight, and they have been taking good care of their customers.”
One of those customers is seven-physician Pioneer Valley Pediatrics in Longmeadow, Mass. It has been using athenahealth’s practice management system for seven years and has been on the clinical system for three years.
“This was a fairly new product, so in a way we were taking a chance,” says Sally Ginsburg, M.D., of Pioneer Valley. “But we already knew the company well. All we had to do was buy laptops and install wi-fi. It really limited the amount we had to spend up front. We did not have to hire an IT person.” She says that so far the practice’s experience with the solution has been great. “We attested to meaningful use Stage 1,” Ginsburg adds, “and are in good shape to do Stage 2.”
In the Emergency Department software space, the tension still exists between going with the module of the core EMR or using a best-of-breed solution such as Wellsoft EDIS, which moved into the No. 1 ranking spot. “In Cerner and Epic shops, there is pressure to use all of their pieces,” Tate says. “When we survey CIOs, there is a strong preference for that. But when we talk just to the ED doctors, the ranking is quite different. They feel they are giving up a lot by going with the EMR’s module. That battle has also been fought in surgery and pharmacy, and is largely over. For the most part, no one goes with a best of breed in those.”
Cardiology and Oncology
The tradition in cardiology is that there is a hodge-podge of multiple systems to handle separate aspects, but providers really would like to go to one vendor, and the top-tier vendors, such as McKesson, Philips and Siemens, are getting closer to making that a reality, says KLAS Research Director Monique Rasband. Digisonics, which is the highest rated in terms of overall score, “is a great little performer. But despite their great customer service, they are still not deep on functionality.”
Two vendors, Elekta and Varian, also make equipment in oncology, and they are the only ones who offer solutions in radiation oncology and medical oncology, explains Rasband. Now IntrinsiQ is offering a deep, robust oncology IT system you could overlay on an EMR in a multispecialty practice for medical oncology, she adds. “Both Varian and Elekta have work to do because now all of a sudden with meaningful use and enterprise solutions, other vendors such as Epic are targeting oncology. “Epic has started slow, but their offering is integrated from the start. Cerner is starting in on this market now, too.”
Looking at the picture archiving and communication system (PACS) market, there is not a hard line between vendors considered in the top tier and the second tier, in terms of being invited to bid on the replacement systems in large health systems. Philips, McKesson, Fuji and GE and Agfa are in the top tier. DR Systems, which tops the ranking again this year, may not play in that larger tier as often, but it has been consistently leading in ratings, notes Ben Brown, general manager for imaging, informatics and medical equipment for KLAS Enterprises. “DR Systems’ business is imaging; it is a single database. Its founder is a radiologist. And we hear each year that the customers really have a say in new features and functions and the product direction. They have a vested ownership in it. That is part of their success.”
PACS is becoming a commodity, so vendors are digging deep to add features to help them be seen as an innovative player, Brown says. For instance, most have added a speech engine, and there are efforts in the vendor-neutral archive space.
Choices in radiology information systems (RIS) tend to be driven by the choice of EMR vendor. Most EMR vendors have a RIS module and hospitals are deciding they want the interoperability and they want to work with fewer vendors. Initially Epic’s Radiant didn’t meet customer expectations on some things such as workflow, Brown says. “Based on customer feedback, they improved the tools on the RIS side and that is why we see a 10 percent jump in ranking in 2012.”