A new report from KLAS, a market research firm that measures vendor performance based on feedback from the user community, shows while the market for hospital EHR systems nearly doubled in 2009, only two vendors, Epic and Cerner, appeared to benefit from this market growth. According to an article summarizing major findings from the KLAS report, hospitals “want a vendor that can be a consistent and reliable partner in their efforts to reach meaningful use”. Jason Hess, author of the KLAS report, suggests that “Changes in the CIS (clinical information system the marketplace as a result of ARRA seem to have blindsided some vendors and left them struggling to stay afloat in the hospital market”.
While the US has chosen to let the market decide the vendors with whom they prefer to work, the introduction of “meaningful use” regulations is nonetheless having an impact on the US market. Vendors such as Eclipsys, GE, McKesson, and Quadramed lost more hospitals than they gained, according to KLAS and are “struggling to regain lost ground”. While Siemens and MEDITECH did not lose ground in the same as some other vendors, their growth was much more limited than either EPIC or Cerner.
I have written several articles in Healthcare Information Management & Communications Canada (on my own and co-authored with Bill Pascal, CTO for the Canadian Medical Association) regarding the need for a more “bottom approach” to integrating health IT systems across the continuum of care. The crux of my argument is that the health sector is more an “ecosystem” and less an “enterprise”. Hence, top down approaches are less likely to deliver tangible results in reasonable periods of time and are have a higher probability of failure.
Given my perspective on the need for more bottom initiatives, I was very interested to hear about a local integration project led by OntarioMD with funding from eHealth Ontario. Physicians at the Barrie and Community Family Health Team are now electronically receiving patient reports from the Royal Victoria Hospital in Barrie. These reports are transferred directly into the family health team’s EMR and include:
- Medical reports including discharge, consult, oncology, and surgery
- Diagnostic imaging reports (text only)
A key feature of the newly developed electronic Hospital Report Manager is that works with any EMR subsidized by Ontario’s EMR Adoption Program and can be used by any Ontario hospital. EMR vendors need only develop a single interface to the Hospital Report Manager while each Hospital need only develop a single interface to the Hospital Report Manager.
Vendors involved in developing the Hospital Report Manager include:
- Orion Health whose Rhapsody integration engine is at the heart of the Hospital Report Manager
- Clinicare whose EMR product is used by the Barrie and Community Family Health Team.
- MyDDS and Graphically Speaking who developed the underlying database for routing reports
- Praxia which is conducting project evaluations
- Trusted by Design which performed the Privacy Impact Assessment
- Healthvision who developed the interface to the hospital’s Meditech hospital information system
Phase 2 is currently underway which will extend the scope of the project to additional participants including four new family health teams and three new hospitals. Phase 3 and beyond depends upon availability of additional funding from eHealth Ontario.
An interesting study from KLAS regarding criteria that small US hospitals apply when selection an HIT system.
Some noteworthy points from this study:
- “in light of new meaningful use requirements, many community hospital executives are now considering more complex – and often more costly – IT solutions, which many providers perceive as supporting greater clinician adoption.”
- “Meaningful use requirements are forcing buyers to focus on this issue rather than cost and infrastructure, which were the much more significant criteria in the past”
- “Meditech still dominates provider mindshare for health information systems, with McKesson also gaining significant traction recently. Meditech continues to leverage its reputation as a low-cost, integrated solution, with 70 percent of providers including the vendor in their selection process”
- “Cerner, Eclipsys, Epic and Siemens Soarian are at the table more frequently due to a perceived higher potential for clinician adoption.”
- “The consideration of these traditional large hospital solutions in community hospitals has also been spurred by the shrinking opportunity for new sales among large organizations.”
A group of US and UK software vendors have launched a “one-size fits all” consortium of healthcare IT solutions aimed at the EMEA market. It appears to be aimed at acute care facilities and operates under the principle of a CIO being able to go to the Alliance for all of their IT needs. I’m not sure this would work under the current public buy RFP process in the Canadian market, but the idea is interesting. Vendors in the alliance claim to support interop standards, making it easy to buy an integrated stack from them. Vendor include:
- Lawson Software, which provides enterprise resource planning and business software applications;
- Perceptive Software, based in Shawnee, Kan., which develops enterprise document management, imaging and workflow software under the ImageNow brand;
- Perot Systems, a Plano, Texas-based provider of IT solutions and services;
- Sun Microsystems, a Santa Clara, Calif.-based provider of interoperable, secure and scalable network computing hardware and software infrastructure and solutions;
- SciQuest, a Cary, N.C.-based developer of procurement automation and supplier enablement solutions;
- Ardentia, based in Stafford in the United Kingdom, which provides business intelligence and Web-based information management solutions;
- Clinical Solutions, a global company with headquarters in Basingstoke, Hampshire, in the United Kingdom, which offers evidence-based decision support and clinical software solutions; and
- System C. Healthcare, based in Kent in the United Kingdom, which offers healthcare information systems and implementation and consulting services.
What is striking about this is not the vendors involved, who with the exception of SUN and maybe Lawson have little footprint in Canada, it is the model. The Canadian market (for Admin and Clinicals in Acute Care) is dominated by Meditech, Cerner and McKesson. Is their a place in the Canadian market for other vendors adopting a similar model, or is the market too small? If so who would those vendors be and would they be acute or primary care focused?
An interesting idea nonetheless.