Press releases from software vendors announcing contract wins often describe their customer as a new “partner.” More than ever before, that description is proving accurate as providers of acute-care electronic medical record systems and their customers work closely to meet meaningful use requirements and help hospitals qualify for federal incentive funds under the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act. For many, millions of dollars are riding on the success or failure of their meaningful use efforts.
“We definitely are seeing fewer customers considering switching vendors, specifically in the larger hospitals and health systems,” says Jason Hess, general manager of clinical research at KLAS. “We're still seeing buying decisions take place in the smaller community hospitals, but for those larger hospitals and health systems, their beds are made.” The electronic medical records (EMRs) are now firmly implanted, and in most cases, it is too late to swap out systems.
So does that mean there's less activity on the software front in this year's “Top 20 Best in KLAS Awards: Software & Professional Services” report? On the contrary: the HITECH Act and the Patient Protection and Affordable Care Act (PPACA), the federal healthcare reform law, are like two tectonic plates pushing on each other and forcing the healthcare sector in several new directions at once.
The rush to get systems and features in place to earn 2011 meaningful-use dollars has been a boon to some vendors, and has exposed the Achilles' heels of others, leading to some dramatic shifts in customer perceptions of EMRs, as well as of several related modules.
Acute Care EMR
Companies seeing upticks in their scores include Epic (+2 percent) and Cerner (+3 percent), which have earned reputations for strong computerized physician order entry (CPOE) implementations, Hess notes. “Even Meditech, which has traditionally been a little challenged on CPOE, has been getting early strong marks for physician friendliness in the 6.0 version.”
Bobbie Byrne, M.D., vice president for health information technology at the 309-bed Edward Hospital, in Naperville, Ill., says those early reports of satisfied customers with 6.0 make her cautiously optimistic about her organization's plans to go live on that platform in May. “The challenges I foresee with Meditech are not those bread-and-butter applications, but new features being driven by meaningful use, such as public health reporting, patient portals, and health information exchange,” she says. Those were on her list of things to do, but not necessarily in 2011, she adds.
Although Meditech does remain the most-considered vendor in community hospitals, Hess notes, Cerner's hosted offering is making in-roads, and McKesson's Paragon continues to lead the customer rankings.
Perhaps the biggest surprise in this year's “Top 20 Best in KLAS Awards” report is the score for Siemens' Soarian Clinicals, which saw a 9 percent ratings jump, moving it from the No. 7 spot in the rankings to No. 2. “That uptick is real,” says Hess, who notes that more Siemens Invision customers, who have been patiently waiting for Soarian to evolve, are now adopting it. In an in-depth study of Siemens last November, customers told KLAS that Soarian Version C6 enables stronger, easier clinical adoption of CPOE and nursing documentation. “They are seeing a deeper clinical adoption by physicians and nurses, and better interfacing with Siemens' pharmacy system,” he says.
“We like that Siemens periodically brings in customers to help their development group understand the real-world implications of what they are doing,” says Mike Mistretta, vice president of information systems and CIO at the two-hospital MedCentral Health System in Mansfield, Ohio. “That has made a world of difference in the quality of the product as it is rolled out.”
MedCentral started working on its Soarian implementation very gradually several years ago, as it transitioned from a McKesson order entry system. Mistretta says it is now at 50 percent CPOE usage, and Soarian has been well received by the physicians. Pamela Crawford, RN, MSN, PhD, vice president of nursing and social services, adds that Soarian now matches nursing work flow with seamless processes for accessing data and medication administration.
Ambulatory EMR (Over 100 Physicians)
On the other hand, McKesson's Horizon (-4 percent), Quadramed CPR (-6 percent), and GE Healthcare Centricity (-17 percent), have all faced CPOE challenges and have seen scores fall off - dramatically in GE's case.
“We are hearing that GE has basically put a hold on the CPOE in Centricity for a year to get it fixed,” Hess says. “They need to right the ship.”
As it has for several years running, Epic Systems earned the Best in KLAS designation, by far outpacing its competitors in customer satisfaction rankings, with its 89.2 score. Almost inevitably, companies that lead in the rankings for several years eventually slip, but KLAS analysts haven't yet seen any signs of dissension among the Epic customer ranks. “The company has a very interesting business model,” Hess explains. “Some customers we've spoken to have described it as almost a cult mentality. They run a very tight ship. They pick and choose whom they will work with. We hear that they tell their customers that it will take lots of training to get up to speed, and if the customers aren't willing to do it, they walk away from those deals.”
By avoiding those relationships, Epic manages to keep its ranking score so high. Some in the industry say Epic really only looks so good by comparison. “I have a lot of respect for Epic, but it may be that their scores are not so much because what they do is so spectacular, but because some of their competitors have really fallen down on the job,” says Todd Cozzens, CEO of Picis, a provider of emergency department and operating room solutions that is now part of Ingenix. “But health IT is really still in its infancy, and the No. 1 criteria is: Does this system actually work? And Epic actually works. Is it the optimal system with a rich user interface? I would say no.”
Cozzens sees Meditech in the same light in the community hospital space. “It is a bare-bones system, but it does work, and relative to its competitors it looks good,” he says, but Cozzens adds that there is a real opportunity for improvement. “There is still room for disruptive new technology to be introduced in the next five years.”
In the ambulatory setting, different vendors continue to lead the various market segments KLAS tracks based on physician group size. Epic continues to lead in the group with more than 100 physicians, with 100 percent of respondents saying they would buy the software again. Cerner moved up from the No. 6 position to No. 3 with a 25 percent ratings improvement. “Cerner did a fantastic thing for its clients by creating one interface for hospital and office settings, so there is a unified view and the work flow is identical,” says Mark Wagner, KLAS's director of ambulatory research.
Allscripts continues to struggle with version 11 implementations, with its overall score falling 5 percent. It won Best in KLAS several years running, Wagner notes, but now has fallen to the back of the pack. “It may be that we have seen the worst and it is on the way back up,” he adds.
After Allscripts announced its merger with Eclipsys in 2010, Eclipsys customers were enthusiastic about the potential of a more viable ambulatory solution, Wagner notes. “But many Allscripts Enterprise customers, who have been struggling with version 11, were less enthusiastic about the union and possibility of increased distractions that would delay the vendor from resolving existing problems.”
In the 26- to 100-physician market space, eClinicalWorks continues to lead, while Greenway and e-MDs win Best in KLAS in the smaller physician group markets. “Greenway has done a great job of taking care of customers,” Wagner notes, and has drawn interest from hospital CIOs as a community physician offering by way of Stark-exception EHR subsidies.
Looking ahead, Frost & Sullivan senior industry analyst Nancy Fabozzi expects to see a market consolidation, especially among vendors that serve small physician groups, to match the consolidation taking place in the provider market. “I am not bullish on very small EHR [electronic health record] vendors,” she says. “There are way too many of them, and the market is crowded. Solo practitioners are being bought out by hospitals or large physician groups. The solutions customers are looking for have to be scalable. Just catering to small offices is not going to fly much longer.”
On the imaging front, there's less movement in the market for hospital PACS than in the ambulatory EMR space, partly because the field is pretty much saturated. “Ninety-five percent of larger hospitals and integrated delivery networks have a PACS system,” notes Ben Brown, KLAS research director for medical imaging and medical equipment. “It is some of the smaller hospitals that have yet to adopt.”
Earning the PACS Best in KLAS is DR Systems Unity. Because the company grew quite fast, it had some support issues and its ranking fell for a couple of years, Brown says. “Their additional customer focus and effort is apparent, and we are seeing nice trends in customer reaction. Customers love that it was founded by a radiologist for radiologists.” DR Systems gets customers involved in deciding which next-generation tools to work on each year, he adds.
For GE Healthcare, the IW product it acquired with Dynamic Imaging saw its rating drop off by 11 percent. GE has been very successful in selling it, but some of the implementations and support resources fell short of customer expectations, influencing this drop, Brown says.
Larger, multi-site organizations still tend to look more often at offerings from McKesson, Philips, and Fuji, while DR Systems tends to interest the 200- to 500-bed hospital market.
From the radiology information systems (RIS) standpoint, there is a much stronger drive toward integration, so hospitals tend to use the RIS offering from their EMR vendor. “If you look at who's winning most deals, it is Cerner and Epic in the EMR replacement market,” Brown says, “and for those customers, integration trumps bells and whistles.”
The fact that KLAS is giving a Best in KLAS award in the business intelligence (BI) category for the first time reflects its increasing importance in the era of meaningful use and health reform. The push for EHR adoption and meaningful use can be a catalyst to get people thinking about how they are going to use all this data they now have in transactional systems, notes KLAS research director Lorin Bird. He adds that BI is moving from academic medical centers to midsized hospitals that are realizing the power of analytics.
Among the core hospital vendors, the only company to be ranked in the KLAS report was McKesson, with its Horizon Business Insight product. The others are vendors that focus on BI and cater to several vertical markets. The Best in KLAS goes to Dimensional Insight's Diver Solution. Paul Alcala, vice president and CIO of NorthBay Healthcare, a two-hospital system with fewer than 200 beds based in Fairfield, Calif., is using Dimensional Insight's software to create data marts, starting with revenue analysis and with plans to move on to clinicals. Alcala believes he can accomplish about 85 percent of what a larger data warehouse project could do for about 50 percent of the cost. “We can see with the direction of the meaningful-use requirements that these tools are going to be important to us,” he recently told Healthcare Informatics.
In the emergency department space, several best-of-breed vendors jockey with Epic to top the rankings, with Wellsoft winning Best in KLAS again. “At hospitals that have best-of-breed systems such as Wellsoft or Picis, usually the physicians are quite happy, and the EMR vendor's offering isn't as full featured, so they look at it, but probably won't immediately switch even though integration is such a key goal,” Hess notes. But the exception is Epic, because of the satisfaction ratings with its emergency department module.
All of the pressure to adopt CPOE has boosted hospitals' needs for outside consulting help. Deloitte Consulting took Best in KLAS in the Clinical Implementation Principal category, with Accenture's ranking jumping 11 percent to claim the No. 2 spot. Both have experience with very large, complex clinical projects. Hess cautions that the rankings for services are based on smaller customer samplings, so a few disgruntled customers can alter the ranking places significantly.
Another trend gaining strength among community hospitals is software vendors hosting applications, Hess says, with Cerner and Siemens leading the pack. “As vendors increasingly go after the small-hospital market, this is a very attractive option. Every year the vendors are getting better at this.”
Because the CPOE requirement in Stage 1 of meaningful use was softened a little between the proposed and final rulemaking, there's generally more confidence about success, Hess says, and hospital IT executives are focusing their attention on other issues.
“Customers ask about health information exchange and ambulatory integration,” Hess adds, and the new buzzwords are accountable care organization and patient-centered medical home. “Everyone wants to know how vendors are going to provide the interoperability required to make those things happen.”
Healthcare Informatics 2011 March;28(3):S2