Special Topics in Vendor-Specific Systems: Common Commercial Electronic Health Record

Special Topics in Vendor-Specific Systems: Common Commercial Electronic Health Record (EHR) Systems Used in Ambulatory and Inpatient Care Settings

Audio Transcript

Slide 1: Common Commercial Electronic Health Record (EHR) Systems Used in Ambulatory and Inpatient Care Settings

Today we'll be talking about common commercial electronic health record systems (EHR) used in ambulatory and inpatient care settings.

Slide 2: Learning Objectives

At the end of this lecture, you will be able to:

1.Describe the mission and vision of HIMSS and KLAS and how their respective resources can be used to research EHR systems.

2. Describe common and distinguishing features of common EHR systems.

Slide 3: HIMSS

The HIMSS vision is, to advance the best use of information management systems for the betterment of healthcare, and its mission is to lead healthcare transformation to the effective use of health information technology. I'd like to point out the use of the term Transformation. HIMSS's mission is not to automate healthcare, but rather to transform healthcare through the effective use of information technology. This is a very important concept. HIMSS is a membership organization; it provides global leadership for optimal use of information technology (IT) & management systems for healthcare.

Slide 4: HIMSS (cont.)

HIMSS was founded in 1961, has offices worldwide, and it represents more than 23,000 members. It has 380 corporate members, and nearly 30 not-for-profit organizations.

Slide 5: HIMSS (cont.)

So not surprisingly, HIMSS takes a lead role in framing healthcare policy and industry practice through its educational, professional development, and its many advocacy initiatives, trying to promote quality healthcare for patients.

Slide 6: HIMSS: Member Demographics

HIMSS has over 23,000 individual members. Over 19,000 of these members provide a demographic data in their membership profile. Over thirteen thousand members work in healthcare provider settings, which means, they are involved in direct patient care.

Slide 7: HIMSS “Products”

HIMSS produces many products. There's an extensive collection of industry research reports, it produces daily IT news, and there's an extensive collection of topics and tools. For example, there are tools for EHR professionals, which are materials that can be used to supplement knowledge, factors, and trends, in the use of electronic health records. These are just few dimensions. Please note that given the mixed membership, which includes vendors, HIMSS does not contain vendor comparisons and product reviews.

Slide 8: KLAS: Quick Facts

KLAS, on the other hand, does deliver product reviews and vendor comparisons. KLAS is independently owned and operated, and was founded by Kent Gale. The name KLAS comes from the first initial of its founders; Kent Gale, Leonard Black, Adam Gale, and Scott Holbrook. The name is a play on words similar to class, as best in class. Its headquarters are in Utah, and it is staffed by independent researchers working throughout the country. Its business focuses solely on healthcare technology.

Slide 9: KLAS (cont.)

KLAS’ mission is to improve healthcare technology delivery by honestly, accurately, and impartially measuring vendor performance. One of its main functions is to help providers make informed decisions about vendor performance.

Slide 10: KLAS: How They Do It

They produce a performance database, which does real-time performance rating on all of the market, vendors, and products, and it's freely accessible to healthcare providers. In addition, KLAS develop reports based on performance or perception of specific healthcare technology segments, and reports on performance advisory services, along with custom research for customers. Vendors purchase costly reports and use them to track their own performance in

the market. These reports permit vendors to monitor how they are rated by their own customers.

Slide 11: How Providers Use KLAS Findings

Providers use KLAS reports and findings to understand products and vendor strengths and weaknesses. They can screen perspective vendors, for narrowing their search. KLAS reports can be used to research and produce influential proposals. They can be used to manage risk and exposure, being informed on price, contract issues, and very importantly, common complaints from peer providers. In addition, after purchasing products from a vendor, the provider organization could set realistic expectations for their organization based on experiences of others, and probably more importantly, it can save time on

performing research.

Slide 12: KLAS Research Focus

While KLAS does focus solely on healthcare technology, its range of services and scope has expanded over the years. In 1997, when the company was founded, the main focus was solely on healthcare technology softwares and vendors. Now providers can use the services for various aspects such as purchasing and negotiating decisions. In 2004, KLAS expanded its portfolio to rate service firms. Service firms are those that do implementation, consulting, planning, assessments, assistance with vendor selection, and other business process outsourcing. In 2005, KLAS further expanded to review medical equipment companies selling products such as MRI scanners.

Slide 13: KLAS Methodology

Let's review how KLAS produces its ratings for a software. It uses twenty five questions, and each question is rated based on a scale of one to nine, where one is poor and nine is excellent, and when applicable, a yes or a no response. Questions involve sales and contracting, implementation and training, functionality and upgrades, service and support, and other general questions. Each question is weighted equally and the rating is a total score based on a hundred point scale.

Slide 14: KLAS Methodology (cont.); Criteria in Evaluations

Some of the criteria used in software evaluation includes contract and experience, money's worth, avoids nickel-and-diming, quality of training, ease of use, product response time, supports integration goals, quality of phone and web support, importantly, executive involvement, keeps promises, overall communication, overall satisfaction, and the extremely important question, "Would you buy it again?" Moreover, is it ranked as the client's best vendors? The responses to these questions form the basis of a KLAS rating score.

Slide 15: KLAS Ratings

Let's review KLAS ratings for acute care electronic health records systems.

These are software products that provide core inpatient functionality, such as

Clinical Data Repository (CDR), order entry including CPOE, results reporting,

clinical charting, and documentation. KLAS divides this type of software into two groups: larger inpatient facilities, over 200 beds, and small inpatient facilities, 200 beds or less.

Slide 16: Top 10 Acute Care EHR: Over 200 Beds

Here, are the top 10 acute care EHR vendors and their overall score in the category of inpatient facilities over 200 beds. In the top five, are Epic, Cerner, McKesson, Meditech, and Siemens. Notice that Cerner and Meditech and McKesson appear multiple times in the top ten. That is because they sell different product suites. Cerner, in second place, is rated based on its CareNet clients. Whereas Cerner in the seventh position are clients reviewing Cerner where they have Power Chart, Power Orders, and CareNet; PowerChart being the charting component, PowerOrders being the order entry module, and CareNet being nurse charting. Some interesting findings can be seen in the overall scores. There's quite a large spread between the first and second position where Epic has a nearly 88 score, followed in second place by Cerner with 78, whereas afterwards, Cerner compared to McKesson and others very rapidly start to hover around the same numbers. This indicates a rather large spread between the first, second and third place vendors.

Slide 17: Top 10 Acute Care EHR: Under 200 Beds

Let's now review the top ten acute care EHR vendors and their products in the area of inpatient facilities under 200 beds. Notice on this screen that Epic doesn't even show up. Cerner drops to fifth place, and other vendors move in to first, second, third, fourth position. In addition, the top score is not nearly as high as it was in the over 200 bed, where Epic had nearly a score of 88. Here, McKesson scores 81. But once again, after 10 points from the third position down, you'll notice that most of the vendors score around the same score.

Slide 18: KLAS Ratings

Let's now look at KLAS ratings for ambulatory EHR's. These are software solutions for clinic and practice management that provide charting, orders, prescriptions, and other EHR functionality. Here, the divisions are a little more complicated because of the way physicians organize themselves.

First, the large groups are over 100 physicians, followed by 26 to 100, then 6 to 25, 2 to 5 physicians, and finally, solo physicians. So let's now look at top ten ambulatory.

Slide 19: Top 10 Ambulatory EHR: Over 100 Physicians

EHR's in the over 100 physician category. You'll notice several similar vendors, Epic, GE, Cerner, Eclipsys, McKesson are on the list, and in the second and the ninth place are two vendors that didn't appear in the inpatient EHR listings, NextGen and eClinicalWorks. That's because these companies only sell ambulatory EHR products. Epic once again has a very high score compared to the second place position. In fact, even higher--it's greater than 10 points, higher than the second place vendor, NextGen. There's a rather quick drop off by the fourth position, and then all of the vendors are in the 60's.

Slide 20: Top 10 Ambulatory EHR: 26 - 100 Physicians

Let's look now at the 26 to 100 physician group. Epic still holds first place. Another vendor comes into second place that hasn't appeared before and several others. New vendors are on the list, and many disappeared. As you can determine, vendors sell to different size physician practice groups.

Slide 21: Top 10 Ambulatory EHR: 6 - 26 Physicians

And now, looking at the 6 to 26 physician groups, there are even bigger changes. Epic and others are all gone, and many other companies are now selling into this sector. There’s an overall higher satisfaction in these groups, where the top four all score in the 80's, probably reflecting that it is easier to implement systems in smaller businesses than it is in very large businesses, increasing customer satisfaction.

Slide 22: Summary of Inpatient Vendors

At this point, let’s turn our attention to five of the top vendors in the lists that we've reviewed. These are not the top five vendors. They just appear regularly in the top ten in the different categories, therefore we will review them. We will now review each of these companies based on publicly available information found on their websites.

Slide 23: Epic

Epic makes software for midsize and large medical groups, hospitals, and integrated healthcare organizations.

Slide 24: Epic

It brags that its on-time, on-budget track record is one of the best. As we reviewed before, KLAS rates them very highly. Differently from other vendors, Epic develops, installs, and supports all their applications in-house, with very little use of third party consultants or implementation specialists.

Slide 25: Epic

Epic was founded in 1979. It's private and employee-owned, with only a hundred and ninety customers. On their website, they claim to support 150,000 physicians. That would be one in four US physicians are currently using Epic systems.

Slide 26: Cerner

Cerner on the other hand, is a much larger company with eight thousand clients worldwide. Founded in the same year, 1979, the three founders, Neil Patterson, Cliff Illig, and Paul Gorup continue to lead the company. In 2000, Cerner bet the company’s future on a person-centric architecture called Cerner Millennium.

Slide 27: Cerner

Cerner has 7500 associates worldwide, 4800 of which are staffed in Kansas City with 8,000 clients, hospital physician, practice ambulatory facilities, home health facilities, and retail pharmacies. Its 2009 revenues were 1.67 billion, with a net earning of nearly 200 million dollars. Cerner is traded on NASDAQ.

Slide 28: McKesson’s Vision

Even more different is McKesson. McKesson is a leading healthcare services company providing pharmaceuticals, medical supplies, and healthcare information technologies. In fact, it's the largest pharmaceutical distributor in North America. It's also a leading healthcare IT company, with its software and hardware installed in more than 70 percent of the nation's hospitals. In addition, it develops and installs electronic systems, and helps prevent medication errors through the deployment of its medication bar code scanning technology.

Slide 29: McKesson

McKesson is ranked fourteenth in the Fortune 500 with over 100 billion in annual revenues. It claims customers including 200,000 physicians, 26,000 retail pharmacies, 10,000 long- term care sites, and 5,000 hospitals, not to mention 450 pharmaceutical manufacturers.

Slide 30: Meditech

Meditech, again, is a very different company from the first three. Its mission is to provide software that enables physicians, nurses, and other clinicians to orchestrate and deliver patient care in a safe, effective, and efficient manner. It's an integrated software solutions suite.

Slide 31: Meditech

Meditech is another longstanding company with over forty years developing, installing, and supporting its information systems. It was founded in 1969 by the developers of MUMPS, a language used in healthcare information technology. Neil Pappalardo and Curt Marble developed MUMPS on a DEC PDP-11 at Mass General Hospital. It has worldwide markets with over 2200 customers with more than 3000 staff members. Its revenues in 2008 were nearly 400 million and it's a privately held company.

Slide 32: Eclipsys

Eclipsys is another company with a 40-year history of developing advanced healthcare solutions. It's been long recognized as a leader in CPOE solutions, but it also includes revenue cycle management solutions and other new Electronic Health Record (EHR) systems solutions.

Slide 33: Eclipsys

Eclipse Systems, incorporated in 1995 has a long history of IT solution experience. It's headquartered in Atlanta, Georgia with nearly 3,000 employees worldwide. It claims 6,000 hospitals, healthcare systems, and physician practices as clients. It is publicly traded on the NASDAQ with revenues of nearly half a billion dollars. On June 9th, 2010, Allscripts announced that it would buy Eclipsys for 1.35 billion dollars.

Slide 34: Summary

This concludes the lecture on commercial EHR. We've reviewed how to use HIMSS, its treasure trove of resources, how to use KLAS and rate vendors and compare products, and finally, we reviewed five of the top companies in the industry showing information that's publicly available that can help you understand the origin of the companies, their mission, the size of the companies, who their clients are, and some of the products that they sell.

Slide 37: References

No Audio

end

Health IT Workforce Curriculum Special Topics in Vendor-Specific Systems1

Version 3.0 / Spring 2012 Common Commercial Electronic Health Record (EHR) Systems Used in Ambulatory and Inpatient Care Settings

This material (Comp14_Unit1) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003.