1. 2016 md vendor overview

Physician Practice Vendor Review

• Leading physician practice vendors- Market overview- Types & sizes of practices- Terminology & applications

• Rank by # of EHR attestations- Per 2015 ONC reports- Leaders vs. “other” vendors

• Vendor review- Founders, products, - FTEs, client base, revenue

• HIS versus Practice vendors- Rating by application- Latest developments

© 2016 HIS Professionals, LLC

Elise Ames&

Vince CiottiHIS Professionals, L.L.C.


A Bewildering Array of Vendors…

• As of 2015, 785 Physician Practice Systems are listed on ONC’s Certified HIT Product List as having “Complete” EHRs!

• This huge number will probably consolidate soon. The number of vendors with certified EHRs has steadily increased since 2010 when the HITECH Act was passed. However, the rush to attest for Meaningful Use is about over, so sales will slow.

- Physician markets are much more local than the hospital (HIS) market. Much more like the “Mom & Pop” shops that most of today’s large vendors started out as…

- There is an opportunity for venture capitalists purchasing several small to midsize vendors, retaining existing customers, the most talented developers, and leveraging the best products through strong sales.

- Physicians are independent and entrepreneurial thinkers – less inclined to buy mainstream costly products.

Elise Ames

Need fact checking for dates - not sure


Equally Bewildering Array of Terms…

Even the words used to describe this complex market are diverse:• What does one call these systems:

- “Ambulatory” – the most common term, but it also applies to a large segment of hospital business – outpatient surgery and the many patients who walk in for lab tests, radiology procedures, etc.- “Physician” systems – but don’t all hospitals have a large number of physicians too: salaried, hospitalists and admitting physicians?

• To avoid any confusion, here’s how we define the terms we use:- “Hospital Information System” (HIS) – comprised of two components:

• Financial systems for revenue cycle (RCM) and accounting (ERP)

• Clinical systems for MDs & RNs (EMR) and ancillaries (Lab, RX, etc.) - “Physician Practice Systems” – also with two key parts:

• Practice Management (PM) – registration, scheduling, billing, AR, etc.

• Physician EHR – CPOE, alerts, test results, H & Ps, notes, etc.

• Since many physician practice vendors are privately held and do not release their revenue, we ranked them by the # of EHR attestations:


Leading Physician Practice Vendors – EMR Attestations*

Ranking Vendor# of 2014 Attesters

% of 2014 Attesters

1 Epic 109,310 22.0%

2 Allscripts 50,232 9.8%

3 eClinicalWorks 42,615 8.4%

4 NextGen 38,125 7.6%

5 GE Healthcare 28,344 5.6%

6 Greenway Health 21,881 4.3%

7 Cerner 21,823 4.1%

8 Practice Fusion 15,941 3.2%

9 athenahealth 14,770 2.9%

10 McKesson 11,829 2.1%

* Based on data published by ONC in October 2015


Breakdown of EP Attestations by Primary Vendor 2014

Note: “Other” = the 775 vendors besides the top 10, showing the diversity of this market!


2014 EP Attestations by Primary EHR Vendor

Other

Epic S

ystem

s Corp

oratio

n

Allscri

pts

eClin

icalW

orks L

LC

NextG

en H

ealth

care

GE Hea

lthca

re

Greenw

ay H

ealth

LLC

Cerner

Corpora

tion

Practic

e Fus

ion

athen

ahea

lth In

c

McKes

son

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

30.00%

22.00%

9.80%8.40% 7.60%

5.60%4.30% 4.10% 3.20% 2.90% 2.10%


Who are these “other” vendors?

• With 30% of the physician practice EHR market, these “other” 775 vendors comprise the largest slice of the pie:– They are much smaller vendors in terms of annual revenue, # of

FTEs, size of client base, length of PowerPoint presentations, commission % for sales reps, etc.

– And dominant in the smaller physician practices, which are commonly broken down into three segments:• Small = 10 or less physicians• Medium = 10 to 50 physicians• Large = 50 or more physicians

– Needless to say, the larger vendors tend to sell to larger sized practices to maximize their revenue.

– The largest of these “other” vendors are listed on the next slide, which is also based on ONC data from October, 2015:


“Other” physician practice EHR vendors

• After the “Big 10,” here are the next 40 leading vendors of physician practice EHRs:


Hospital Owned vs. Independent Practices

• One more layer in this complex market is the type of practice ownership:– Practices owned by hospitals – an increasing trend for population health, which

tend to purchase vendors with an integrated HIS as well, such as Epic & Cerner.– Independent practices - owned by physicians – more likely to acquire systems

from vendors without an HIS, such as eClinicalWorks, athenahealth (both about to enter the HIS market in 2016), NextGen, Greenway, Practice Fusion, etc.

• Epic is seen predominantly in large hospital-owned practices, where the hospital and practices share a single HIS/EHR database. – Many HIS vendors now allow hospitals to extend licenses to community

physicians. This facilitates transitions of care and makes the plan of care available to all providers that need it. Physicians that use Epic in large hospital-owned practices seem happy with this approach, but they have no choice…

• Large independent practices lean towards MD specialists like Allscripts and NextGen. – For EPs attesting in 2014, an Allscripts product was the 2nd most frequently

reported as the certified EHR installed. • Note that Cerner – the leading HIS vendor in terms of annual revenue, that also offers

an integrated PM/EHR system – came in only 7th for physician attestations– 22% of EPs attesting for MU in 2014 reported using Epic, vs. only 4.1% reporting

Cerner’s Power Chart as their EHR.


“Integrated” HIS & Physician Practice Systems

Developed by HIS Vendors to support the continuum of care.- These systems are not just “interfaced,” but truly integrated

in the same hardware, data base & programming language.- Unlike early interfaced systems such as Siemens’ (SMS)

Signature, McKesson’s Practice Partner, & Meditech’s LSS. The pioneering integrated vendor was Epic, strong in both PM

and EHR for physician practices - Followed by Cerner, not as popular in physician practices- And recent integrated entrants by Meditech & McKesson…

Such systems are generally not sold to independent practices.- Rather they are hosted by the sponsoring hospitals who also

provide implementation and ongoing IT support. Acceptance by physicians is variable depending on quality of

product, value of hospital support, and perceived control.


“Crossover” HIS vs. MD Systems

Only Epic rates highly on both sides of the EHR market:


Next Week

In our next episode, we’ll review each of these top 10 physician practice vendors in depth:- Founding and history- Merger & acquisitions- Product lines- Annual revenue- Client base

Please send any questions, comments or threats to:- Elise Ames

- 413.329.6925- [email protected]

- Vince Ciotti - 505.466.4958- [email protected]