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Top Takeaways from the 2017 Healthcare Informatics 100

June 6, 2017
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As always, The 100 gives us plenty of angles to dive into

Every year when Healthcare Informatics officially releases its rankings of the top 100 vendors by revenue in the healthcare IT market, I like to give the list a few days to breathe, review it, and then take a deeper dive into the nuances of it that may not be so apparent at first glance.

Indeed, there is a lot that goes into this list—which has been published for more than 20 years—especially in the last two years when we have added lots of enhanced features to make for a better viewing experience, digitally. For instance, once again vendors were asked to estimate the percentage of revenue earned in all of their product segments. Coming later this month we will showcase the top five vendors by revenue in each of the seven breakout product categories. What’s more, the Healthcare Informatics 100 complete vendor listings also include: year-over-year revenue comparison charts; key thought leader executives; markets served; major revenue sources; M&A activity from the previous year; and brief descriptions of the companies.

Before I get into my takeaways from the 2017 list—which is of course based on 2016 vendor financial data—I’d like to point readers to a few pieces of content that surrounds The 100. Last week, we released our two Most Interesting Vendor stories on Epic and Optum, obviously both very high health IT revenue earners, and who were picked as “most interesting” by our editorial staff for a variety of reasons. I highly encourage you to read both of these vendor profiles. Also, strategic and financial advisory firm ST Advisors, which helped us compile the list, penned a terrific piece on all of the M&A activity that took place last year in the health IT market. With that, let’s get to the odds and ends of the 2017 Healthcare Informatics 100.

The top 10 holds steadyThe 2016 list and the 2017 list had the same four companies at the top, in the same order—Optum, Cerner, Cognizant and McKesson. While there was some moving around in the bottom half of the first 10 vendors, one company that jumped 12 spots, from #21 to #9 was Leidos, reporting an HIT revenue of nearly $1.7 billion, up significantly from $593 million the year prior. In fact, Leidos was named one of our Most Interesting Vendors in 2016 after snaring the Defense Department’s EHR (electronic health record) implementation contract, in partnership with Cerner, the year prior. But the main takeaway here is that the big health IT players are continuing to prove their worth at the top of the market.  

Optum #1 yet again—Two years ago, our team changed the submission process for The 100, allowing for health IT revenue that was derived from the payer market to be counted towards the total. What that did is allow Optum, the Eden Prairie, Minn.-based consulting and analytics division of the country's largest health insurer, UnitedHealth Group, to turbocharge to the top of the list. This is the third consecutive year in which Optum topped the list, reporting a health IT revenue of $7.3 billion in 2016. What are the keys to Optum continuing to grow and prosper within The 100? For that answer you’ll have to read my just-published vender profile of them!

Risers and fallers—Who were the vendors that made the biggest jumps and the ones that witnessed the steepest drops? Not counting any new companies to this year’s list (more on those below), the biggest list climbers year-over-year were: Harris Healthcare, which moved up 29 spots (#87 to #58); Sharecare, moving up 20 spots (#73 to #53); Orion, moving up 19 spots (#74 to #55); Softheon, moving up 16 spots (#34 to #18); and the aforementioned Leidos, which moved up 12 spots (#21 to #9).

As far as the companies who fell the most on the list from 2016 to 2017, Medecision fell 12 spots; NEC Corporation of America dropped 11 spots; and MEDHOST and Brightree both fell nine slots on the list. It should be noted that just because a vendor ranked lower on this year’s list than last year’s, that doesn’t necessarily mean that their revenue fell. For example, Medecision was the biggest faller this year, but their revenue actually held fairly steady year-over-year. This is due to the companies on the 2017 edition having higher revenues overall. Indeed, the 100th company on the 2016 list had a revenue of $55 million; this year’s final company had a revenue of $65 million.

Welcome, new participants!—We always welcome new health IT firms to the list, as it adds a layer of freshness to lists’ prior. This year, we saw 15 new companies make The 100, ranging from the 100th company all the way up to the 27th. This is up from eight new vendor firms on last year’s list. There are various reasons as to why a company might be new to the list, such as not submitting their data in prior years, not having a high enough revenue in prior years, or perhaps being a new company that didn’t exist in prior years. Whatever the reason, we’re happy to have them!

Oldest and youngest—While not every single company on this year’s list denoted which year they were founded, plenty did. And once again, Elseiver, a 127-year-old company, and Philips, a 126-year-old company, easily take the case for oldest companies on the list. Other than those two, Wipro Limited, established in 1945 is the next oldest. There were plenty of newly-founded companies in this year’s edition, with more than one-fourth being established in 2000 or later. Cotiviti, one of the 15 new companies this year that were mentioned above, is the newest of the new, founded in 2014.

Health IT regional hubs—I also always like to look at which regions of the U.S. are the biggest hotbeds for healthcare technology. While there is a variety of geographic representation, a few states stuck out as having the most vendors on this year’s list: Massachusetts (8), California (8), Georgia (8), Texas (7), Florida (7), and Tennessee (6). Combined, these six states represent almost half the 2017 list.

Have any other comments or takeaways on The 100 list? Feel free to tweet at @RajivLeventhal or comment in the section below. And be sure to check out our product breakout lists later this month!

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Allscripts Sells its Netsmart Stake to GI Partners, TA Associates

December 10, 2018
by Rajiv Leventhal, Managing Editor
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Just a few months after Allscripts said it would be selling its majority stake in Netsmart, the health IT company announced today that private equity firm GI Partners, along with TA Associates, will be acquiring the stake held in Netsmart.

In 2016 Allscripts acquired Kansas City-based Netsmart for $950 million in a joint venture with middle-market private equity firm GI Partners, with Allscripts controlling 51 percent of the company. With that deal, Allscripts contributed its homecare business to Netsmart, in exchange for the largest ownership stake in the company which has now become the largest technology company exclusively dedicated to behavioral health, human services and post-acute care, officials have noted.

Now, this transaction represents an additional investment for GI Partners over its initial stake acquired in April 2016, and results in majority ownership of Netsmart by GI Partners.

According to reports, it is expected that this sale transaction will yield Allscripts net after-tax proceeds of approximately $525 million or approximately $3 per fully diluted share.

Founded 50 years ago, Netsmart is a provider of software and technology solutions designed especially for the health and human services and post-acute sectors, enabling mission-critical clinical and business processes including electronic health records (EHRs), population health, billing, analytics and health information exchange, its officials say.

According to the company’s executives, “Since GI Partners' investment in 2016, Netsmart has experienced considerable growth through product innovation and multiple strategic acquisitions. During this time, Netsmart launched myUnity, [a] multi-tenant SaaS platform serving the entire post-acute care continuum, and successfully completed strategic acquisitions in human services and post-acute care technology. Over the same period, Netsmart has added 150,000 users and over 5,000 organizations to its platform.”

On the 2018 Healthcare Informatics 100, a list of the top 100 health IT vendors in the U.S. by revenue, Allscripts ranked 10th with a self-reported health IT revenue of $1.8 billion. Netsmart, meanwhile, ranked 44th with a self-reported revenue of $319 million.

According to reports, Allscripts plans to use the net after-tax proceeds to repay long-term debt, invest in other growing areas of its business, and to opportunistically repurchase its outstanding common stock.

The transaction is expected to be completed this month.

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Study Links Stress from Using EHRs to Physician Burnout

December 7, 2018
by Heather Landi, Associate Editor
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More than a third of primary care physicians reported all three measures of EHR-related stress
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Physician burnout continues to be a significant issue in the healthcare and healthcare IT industries, and at the same time, electronic health records (EHRs) are consistently cited as a top burnout factor for physicians.

A commonly referenced study published in the Annals of Internal Medicine in 2016 found that for every hour physicians provide direct clinical face time to patients, nearly two additional hours are spent on EHR and desk work within the clinic day.

Findings from a new study published this week in the Journal of the American Medical Informatics Association indicates that stress from using EHRs is associated with burnout, particularly for primary care doctors, such as pediatricians, family medicine physicians and general internists.

Common causes of EHR-related stress include too little time for documentation, time spent at home managing records and EHR user interfaces that are not intuitive to the physicians who use them, according to the study, based on responses from 4,200 practicing physicians.

“You don't want your doctor to be burned out or frustrated by the technology that stands between you and them,” Rebekah Gardner, M.D., an associate professor of medicine at Brown University's Warren Alpert Medical School, and lead author of the study, said in a statement. “In this paper, we show that EHR stress is associated with burnout, even after controlling for a lot of different demographic and practice characteristics. Quantitatively, physicians who have identified these stressors are more likely to be burned out than physicians who haven't."

The Rhode Island Department of Health surveys practicing physicians in Rhode Island every two years about how they use health information technology, as part of a legislative mandate to publicly report health care quality data. In 2017, the research team included questions about health information technology-related stress and specifically EHR-related stress.

Of the almost 4,200 practicing physicians in the state, 43 percent responded, and the respondents were representative of the overall population. Almost all of the doctors used EHRs (91 percent) and of these, 70 percent reported at least one measure of EHR-related stress.

Measures included agreeing that EHRs add to the frustration of their day, spending moderate to excessive amounts of time on EHRs while they were at home and reporting insufficient time for documentation while at work.

Many prior studies have looked into the factors that contribute to burnout in health care, Gardner said. Besides health information technology, these factors include chaotic work environments, productivity pressures, lack of autonomy and a misalignment between the doctors' values and the values they perceive the leaders of their organizations hold.

Prior research has shown that patients of burned-out physicians experience more errors and unnecessary tests, said Gardner, who also is a senior medical scientist at Healthcentric Advisors.

In this latest study, researchers found that doctors with insufficient time for documentation while at work had 2.8 times the odds of burnout symptoms compared to doctors without that pressure. The other two measures had roughly twice the odds of burnout symptoms.

The researchers also found that EHR-related stress is dependent on the physician's specialty.

More than a third of primary care physicians reported all three measures of EHR-related stress -- including general internists (39.5 percent), family medicine physicians (37 percent) and pediatricians (33.6 percent). Many dermatologists (36.4 percent) also reported all three measures of EHR-related stress.

On the other hand, less than 10 percent of anesthesiologists, radiologists and hospital medicine specialists reported all three measures of EHR-related stress.

While family medicine physicians (35.7 percent) and dermatologists (34.6 percent) reported the highest levels of burnout, in keeping with their high levels of EHR-related stress, hospital medicine specialists came in third at 30.8 percent. Gardner suspects that other factors, such as a chaotic work environment, contribute to their rates of burnout.

"To me, it's a signal to health care organizations that if they're going to 'fix' burnout, one solution is not going to work for all physicians in their organization," Gardner said. "They need to look at the physicians by specialty and make sure that if they are looking for a technology-related solution, then that's really the problem in their group."

However, for those doctors who do have a lot of EHR-related stress, health care administrators could work to streamline the documentation expectations or adopt policies where work-related email and EHR access is discouraged during vacation, Gardner said.

Making the user interface for EHRs more intuitive could address some stress, Gardner noted; however, when the research team analyzed the results by the three most common EHR systems in the state, none of them were associated with increased burnout.

Earlier research found that using medical scribes was associated with lower rates of burnout, but this study did not confirm that association. In the paper, the study authors suggest that perhaps medical scribes address the burden of documentation, but not other time-consuming EHR tasks such as inbox management.


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HHS Studying Modernization of Indian Health Services’ IT Platform

November 29, 2018
by David Raths, Contributing Editor
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Options include updating the Resource and Patient Management System technology stack or acquiring commercial solutions

With so much focus on the modernization of health IT systems at the Veteran’s Administration and Department of Defense, there has been less attention paid to decisions that have to be made about IT systems in the Indian Health Service. But now the HHS Office of the Chief Technology Officer has funded a one-year project to study IHS’ options.

The study will explore options for modernizing IHS’ solutions, either by updating the Resource and Patient Management System (RPMS) technology stack, acquiring commercial off-the-shelf (COTS) solutions, or a combination of the two. One of the people involved in the analysis is Theresa Cullen, M.D., M.S., associate director of global health informatics at the Regenstrief Institute. Perhaps no one has more experience or a better perspective on RPMS than Dr. Cullen, who served as the CIO for Indian Health Service and as the Chief Medical Information Officer for the Veterans Health Administration

During a webinar put on by the Open Source Electronic Health Record Alliance (OSEHERA), Dr. Cullen described the scope of the project. “The goal is to look at the current state of RPMS EHR and other components with an eye to modernization. Can it be modernized to meet the near term and future needs of communities served by IHS? We are engaged with tribally operated and urban sites. Whatever decisions or recommendations are made will include their voice.”

The size and complexity of the IHS highlights the importance of the technology decision. It provides direct and purchased care to American Indian and Alaska Native people (2.2 million lives) from 573 federally recognized tribes in 37 states. Its budget was $5.5 billion for fiscal 2018 appropriations, plus third-party collections of $1.02 billion at IHS sites in fiscal 2017. The IHS also faces considerable cost constraints, Dr. Cullen noted, adding that by comparison that the VA’s population is four times greater but its budget is 15 times greater.

RPMS, created in 1984, is in use at all of IHS’ federally operated facilities, as well as most tribally operated and urban Indian health programs. It has more than 100 components, including clinical, practice management and administrative applications.


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About 20 to 30 percent of RPMS code originates in the VA’s VistA. Many VA applications (Laboratory, Pharmacy) have been extensively modified to meet IHS requirements. But Dr. Cullen mentioned that IHS has developed numerous applications independently of VA to address IHS-specific mission and business needs (child health, public/population health, revenue cycle).

Because the VA announced in 2017 it would sundown VistA and transition to Cerner, the assessment team is working under the assumption that the IHS has only about 10 years to figure out what it will do about the parts of RPMS that still derive from VistA. And RPMS, like VistA, resides in an architecture that is growing outdated.

The committee is setting up a community of practice to allow stakeholders to share technology needs, best practices and ways forward. One question is how to define modernization and how IHS can get there. The idea is to assess the potential for the existing capabilities developed for the needs of Indian country over the past few decades to be brought into a modern technology architecture. The technology assessment limited to RPMS, Dr. Cullen noted. “We are not looking at COTS [commercial off the shelf] products or open source. We are assessing the potential for existing capabilities to be brought into “a modern technology architecture.”

Part of the webinar involved asking attendees for their ideas for what a modernized technology stack for RPMS would look like, what development and transitional challenges could be expected, and any comparable efforts that could inform the work of the technical assessment team.




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