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Report: EHR Market Share Shifting, Cerner Continues to Lead Global Market

May 16, 2018
by Heather Landi
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The electronic health record (EHR) vendor market share has changed as players have dropped out, and Cerner continues to lead the global EHR market, with 17 percent of the market, more than double the market share of its rival, Epic, according to a recent report from market researcher Kalorama Information.

According to Kalorama’s annual report, “EMR 2018: The Market for Electronic Medical Records,” Epic, the Verona, Wis.-based EHR vendor, holds the Number 2 spot in the global market with 8.8 percent market share. Allscripts and GE Healthcare were third and fourth, respectively.  

However, the report notes that when the overall EMR market is segmented into big healthcare systems and smaller hospitals and large physician practices, Epic leads there. No one company has majority share and there are scores of competitors, the report states.

As noted in Kalorama’s annual report last year, while a few companies own more than half the market, no one EHR vendor, not even the largest healthcare IT firms, have even a fifth of the market. Kalorama’s report authors credit this lack of dominant market share to ongoing issues around “usability, vendor-switching, lack of mindshare in the market" and also note that “customers are aching for better.”

In last year’s report, the market research firm estimated the size of the EHR market at $28 billion. And, the market is expected to rise quickly and is forecasted to hit $36.6 billion by 2021.

Kansas City, Mo-based Cerner garnered the top position with 17 percent market share reaching revenues of $5.1 billion in 2017. As noted in Kalorama’s report, the company's acquisition of Siemens IT in 2015 was a major move that influenced advancement of Cerner's market share. Its success securing of the U.S. Department of Defense contract, announced in July 2015, also helped to move Cerner forward.

Cerner is continuing to add new business and add to its services by adding CernerITWorks, a suite of services that improve the ability of hospital IT departments to meet their organization's needs. A second example is Cerner RevWorks, which includes solutions and services to help healthcare organizations with their revenue cycle functions. According to Kalorama, the company is very strong in the hospital IT market.

“Healthcare still involves a lot of local markets and then with this type of software there is a web opportunity to sell direct to smaller hospitals and physicians.  EHR companies that have earned market share include large and small companies,” the 2017 report stated.

According to the firm’s 2017 report, McKesson secured the second position, yet the company’s market share dropped to third this year.

Epic currently is the second largest EHR vendor, by global market share, with 8.8 percent of the global market, according to the 2018 report, and the company is building on its market position. “The company is the vendor for Kaiser Permanente and many other large healthcare companies and has many new innovative solutions that are of interest to large hospitals, capturing a greater share of the new business in the EMR market than rivals,” the report states.

Further, it is anticipated that Epic will continue to gather market share attempting to add to its ambulatory market share as well. “The company has one of the most complete enterprise EHRs with an excellent record of accomplishment. The company has a strong customer service record and a consistent record for making realistic promises and being able to deliver on them,” the market report states.

“There are many EMR providers, so it's important to look at where they operate,” Mary Anne Crandall, the report's author, said in a statement. “In the competition for large healthcare systems, it's the top four EMR companies mainly participating with some exceptions. If you focus on small hospitals, you've got Cerner and Epic but also Meditech is a factor. When it's physician practices, you see Epic and Allscripts but also NextGen, athenahealth, eClinicalWorks, NueMD – a lot of competitors.”

Crandall added, “In the physician office arena, competition is fierce but the leader in this arena seems to be Epic. The company is aggressively filling the gaps in their program by either acquiring technology or developing it to meet the needs.”

According to this latest report, Allscripts Healthcare Solutions secured 6.1 percent market share, climbing the ladder after its merger with Misys and acquisition of Eclipsys. In 2017, Allscripts bought McKesson's EHR technology, part of the Enterprise Information Solutions business unit that includes the Paragon EHR system. The report authors contend that this will allow Allscripts to offer a stronger hospital offering, especially among smaller hospitals and health systems.


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Report: athenahealth Has Multiple Bidders for Sale of the Company

October 15, 2018
by Heather Landi, Associate Editor
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Watertown, Mass.-based health IT company athenahealth has attracted interest from at least five potential bidders for a possible sale of the company, people familiar with the matter told Bloomberg.

In an article posted Friday, Bloomberg reports that private equity players including Bain Capital, Hellman & Friedman, Clayton, Dubiliar & Rice and TPG are considering bids for athenahealth, the people said, asking not to be identified because the matter is private. Elliott Management Corp., the sometimes-activist fund run by billionaire Paul Singer, is also weighing a bid, people familiar with the matter told Bloomberg.

Elliott, which owns 9 percent of athenahealth, may keep that stake if it is unsuccessful in acquiring the company, the people said.

“athenahealth has received indications of interest above $135 a share, the people said, with final bids due by the end of the month,” Bloomberg reported.

As previously reported by Healthcare Informatics, in May, Elliott Management made an all-cash takeover offer to buy athenahealth, at a valuation of $6.9 billion. The investors sent a letter to athenahealth’s board proposing to acquire the company for $160 per share. In the letter, the investors criticized leadership at the electronic health record (EHR) vendor for failing to make the changes necessary “to enable it to grow as it should and to create the kind of value its shareholders deserve.”

The story continued to take turns throughout the summer, particularly following the resignation of CEO and President Jonathan Bush in June. Bush’s resignation came just a few weeks after Elliott Management’s takeover bid, and just a few days after reports surfaced that the athenahealth chief had allegedly assaulted his ex-wife more than a decade ago, and also created a “sexually hostile environment” at the company.   

Following the news, various companies, both inside and outside of healthcare, were brought up as possibilities to buy athenahealth, including the Kansas City-based EHR giant Cerner Corp.

According to a report in the New York Post published in early September, Elliott Management was cited as the favorite to win the athenahealth takeover bid, reporting that Cerner and UnitedHealth declined an opportunity to acquire the health IT company.

The Sept. 6 report noted that “The healthcare companies that would most logically be interested in athenahealth, including Cerner Corp. and UnitedHealthcare, have taken a pass…” As such, Elliott has now teamed up with investment firm Bain Capital on its bid, the New York Post noted at the time.

Bain Capital owns Waystar, a healthcare technology company that was recently formed by combining Navicure and ZirMed, two revenue cycle management vendors. Waystar may benefit if Bain buys athenahealth, an industry banker told the New York Post.

However, almost two weeks later, another report in the New York Post indicated that Elliott Management had backed away from its $160-a-share bid for athenahealth. “As a result of Singer’s retreat and the lack of robust interest from others, athena has extended a final bid deadline by 10 days — to Sept. 27, sources said. Singer backing off the promised bid is a stark turnaround in the battle for the health care tech company,” the New York Post article stated.

According to an October 11 article in the New York Post, suitors whose offers were deemed too low months ago are being invited to take a second look, according to sources. Bids are now believed to value the company at no greater than $135 a share.

“athena first sought final bids by a Sept. 17 deadline. Then, it extended that deadline by 10 days. Now, the company will likely not make a decision until next week at the earliest on how to proceed, two sources said,” according to the article.

“The seller is deciding between a full sale, a merger with Pamplona Capital’s NThrive or to continue as a listed company,” the New York Post article reported.

The New York Post article also reports that if the company decides not to sell or merge, it will have to find a new CEO to replace Bush, sources said. Former GE chief Jeff Immelt has been running Athena as its executive chairman since the summer.

“They definitely need a CEO that is not Jeff Immelt,” the analyst said in the article. “If I’m the candidate, I would want to know what Elliott’s perspective is going forward.”

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KLAS Report: Behavioral Health EHR Vendors Demonstrate Poor Performance

October 10, 2018
by Heather Landi, Associate Editor
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The behavioral health electronic health record (EHR) vendor market has shown poor performance, to date, according to customers, who cite slow development, implementation challenges and lackluster customer support, according to a KLAS Research report.

A recent KLAS report examines behavioral health EHR performance, based on interviews with 149 unique organizations to get their perspective on the performance of these solutions. According to the organizations interviewed, the settings in which behavioral health EHRs are used are primarily outpatient/private practice (78 percent); intensive outpatient/residential day program (64 percent); inpatient residential treatment center (42 percent) and acute psychiatric services (22 percent).

The report, KLAS’ first on behavioral health EHRs, is intended to give executives at behavioral health organizations a high-level overview of the market and to shine a spotlight on where vendors can improve. Specifically, the report dives into the behavioral health vendors used most frequently (in both inpatient and outpatient settings) and their performance in product quality, development, and service and support. 

Organizations who offer behavioral health services need robust IT solutions that can support their efforts, however, on average, the overall performance of behavioral health vendors is very low. According to KLAS, the average overall score for behavioral health vendors is 70.8 (out of 100), putting behavior al health in the second percentile of all software market segments that KLAS measures (about 100 total).

Several factors contribute to this low performance, KLAS researchers note in the report. Organizations’ needs vary greatly based on the types of services they offer and the states they operate in, and this latter factor specifically impacts reporting. What’s more, a one-size-fits-all solution isn’t adequate for most organizations. Also, behavioral health vendors often overcommit on what they can deliver and are slow to develop the functionality organizations need and request.

According to KLAS “While vendor performance is low across the board, most frustrated customers plan to stay with their behavioral health vendor due to limited resources and a lack of compelling alternatives,” the researchers wrote.

Among the vendor solutions covered in the report are Cerner’s Community Behavioral Health solution, Cerner’s Millennium Behavioral Health, Core Solutions, Credible, Harris Healthcare, Netsmart, Qualifacts, Valant and Welligent.

Credible, a Rockville, Md.-based vendor that provides web-based EHR software for behavioral health providers, is leading what, so far, is an underperforming segment with wide variation, according to the report. KLAS researchers also note that Valant, a Seattle-based company that behavioral health HER software, is strong among private practices.

“Credible and Valant manage to give their customers a more consistent experience,” the report authors wrote. “Of the vendors used broadly in both outpatient and inpatient settings, Credible is most consistent thanks to their stronger implementation and training process, which has helped most customers find success with the easy-to-use, cloud-based system. Valant, whose customers are mostly private practices, also has an easy-to-use product, which was designed by a licensed psychiatrist. Valant’s multi-pronged approach to training (which includes a train-the-trainer program as well as online tools, such as webinars and blogs) helps private practices feel they get good value for their money.”

Despite the challenges, few are planning to replace, KLAS notes. One CIO interviewed for the report said, “Our CEO was considering other options a while ago. That person spends every spare minute trying to figure out what is best for us, and the CEO's research suggested that there really isn't anything better than [our current EHR] on the market.”

KLAS researchers also found that most behavioral health vendors have been slower to develop than customers would like or have failed to keep development promises. “Missed development timelines are referenced by almost all customers who say their vendor hasn’t kept promises,” the report authors wrote. “Even Credible, the overall top-performing behavioral health vendor, has overcommitted on timelines, specifically for new treatment-planning and state-reporting functionality.”

Cerner is the most mature of the enterprise health system EHR vendors when it comes to behavioral health, according to the report. Cerner has been developing their go-forward Millennium platform and incorporating learnings and content from their acquired Anasazi product (renamed Community Behavioral Health).

KLAS researchers found that overall customer satisfaction with the two products is comparable. In regard to Millennium, health system clients report higher satisfaction; relatively strong support and previously unattainable benefits, like integration across service lines, make up for product inadequacies mentioned by some behavioral health–specific Millennium customers.

Looking at other health system EHR vendors, Meditech has customers live with their integrated behavioral health solution, though adoption is light to date. Epic recently released a behavioral health–specific module, but no customers were yet live at the time of this research. Several of Epic’s inpatient EHR customers say they would have to pay an additional fee for the behavioral health module, according to the report.

Allscripts has no specific platform for behavioral health and recently sold their stake in Netsmart, making them the only EHR vendor—among those in use at large health systems—with no behavioral health–specific solution, the report authors state.

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Survey: Half of Providers Use Multiple CDS Solutions, Use Varies by Provider

October 9, 2018
by Heather Landi, Associate Editor
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While three-fourths of providers currently use some sort of clinical decision support (CDS) solution, more than half are using multiple solutions, which indicates there is still not one solution that is meeting all of providers’ needs, according to a Reaction Data survey.

Reaction Data, a market research firm focused on the healthcare and life sciences industries, surveyed 180 healthcare physicians to gauge adoption of clinical decision support systems. Thirty-one percent of respondents hold the title of chief medical officer and 13 percent are chief medical information officers (CMIO) and another 13 percent are quality directors. The remaining respondents were chief nursing officers (CNOs), clinical informatics directors, health information management directors and IT directors. The majority of participants (91 percent) come from acute facilities with just 9 percent from ambulatory facilities.

The survey examines the main use cases for clinical decision support and the major vendors in the space, both as a full functioning system, and those who contribute to the early stages of a full CDS strategy. Three-fourths of respondents (74 percent) reported that they currently use a clinical decision support system.

On the clinical side, the number one use case for clinical decision support is medication orders, with 30 percent of respondents reporting CDS for this purpose, followed by lab orders (24 percent) and medical imaging orders (20 percent).

Cerner currently holds about 25 percent of the CDS market, according to the report. EPSi (Allscripts) has a 14 percent market share, Epic has an 11 percent market share and Stanson Health has six percent of the market. Many other vendors holding about five percent market share, including Nuance, Premier, Truven (IBM), Elsevier, Zynx Health and NDSC (Change).

These survey results on the clinical side of CDS indicate that the majority of people turn to their EHR vendor to provide the support they need. “After moving past the larger EHR providers in the market, you see companies like Stanson Health who offer a full CDS start to show up.

The report findings also illustrate that most vendors are in the early stages of their CDS strategy, as only 12 percent of the vendors listed by respondents offer a full CDS solution. About half of respondents offer an electronic health record (EHR) solution and 37 percent offer CDS as a secondary component.

Just slightly more than half (55 percent) of respondents said they currently use multiple solutions or components for their CDS needs rather than one system. For example, a provider might use one solution for aiding in drug ordering, and another solution for their clinical needs.

Of those currently using multiple solutions about half of that group said they plan to continue using multiple solutions moving forward, which indicates that there still is not one solution that meets all of respondents’ CDS needs. Looking at future plans, about a quarter of respondents plan to standardize on one platform and another quarter of respondents said they are unsure what their organization’s plans are.

“With only a 9 percent replacement rate everyone seems to be staying put for the most part. From our commentary, it appears clinicians are either satisfied with their current vendor, or are just holding out until they find a solution that meets all (or close to all) of their needs,” the report authors wrote.

The report authors also note there is room for growth in the clinical CDS market. “Things like real-time data mining in connection with decision support can improve clinicians’ views of the usefulness of the product. Others feel it’s helpful, but only for training purposes, the idea being that as time goes on you start to derive the same conclusions as your CDS solution,” the report authors wrote.

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