The Ambulatory EHR Market

Presented by: Elise Ames

HIS Professionals Buyers Seminar

October 14, 2010

Ambulatory EMRSpeaker Bio

• Software Development– Programmer, Systems Analyst

• Healthcare IT Management– IT Director & CIO

• Healthcare IT Consulting– Ambulatory PM/EHR, HIE & RHIOS, Implementation

Assistance , Hospital Systems, Meaningful Use• PMI Certified Project Manager

Ambulatory EMRCompelling Reasons to Address Ambulatory EHR

• Many hospitals own physician practices

• These physicians qualify for ARRA stimulus incentives from Medicaid or Medicare

• Desire for seamless electronic data exchange between hospital and physicians and for communication between physicians (e.g. primary care and specialty physicians)

• Physician recruitment

• Both employed and community physicians look to the hospital for guidance - believing easy integration with hospital systems (as well as hospital support) will be the key to their success.

HUGE Growth Projections for Ambulatory EHR*

• 2010 EHR sales are expected to double 2009’s sales

• Over the next 24 months, the projected EHR/PM market opportunity will exceed $3 billion (currently $1.6 billion)

• Market saturation predicted by 2016

* September 2010 Frost and Sullivan Ambulatory EHR Market Survey Report

Estimates of EHR Adoption Vary Widely

• Approximately 600,000 practicing physicians in the US

• 2008 Harvard Medical School Study estimated 17% of physicians using EHR

• 2008 National Center for Health Statistics estimated 38% of physicians using EHR

Ambulatory EMRInteroperability is the key

• Community-wide patient record is the goal • One view of patients record incorporating all settings of

care• Bi-directional data exchange – beyond pushing lab

results via an HL7 interface from a hospital or lab system to a providers EHR system.

• New “Holy Grail” is the CCR/CCD transaction– “Published” and “Consumed” by providers in varying

care settings– Contains basic demographics, problem list, med list,

allergies, visit summaries, results, etc

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Ambulatory EMRA Bewildering Array of Choices…

• More than 300 ambulatory EHR products are currently being marketed

• The market will consolidate

• Ambulatory EHR products are rapidly being certified under ONC temporary certification program

• http://onc-chpl.force.com/ehrcert

2010 Mergers and Acquisitions

• GE acquires MedPlexus – SaaS offering rebranded Centricity Centricity Advance

• Allscripts acquires Eclipsys

• NextGen acquires Opus and Sphere

Ambulatory EMRMarket Share 2010

Source: CapSite 2010 Ambulatory EHR Market Share Analysis Report

Ambulatory EMRHIS Vendor PM/EHR Strategies

• Either single database (inpatient and outpatient)– Epic, Cerner, Eclipsys, CPSI, Healthland

• Or “seamlessly” integrated (interfaced)– Meditech & LSS

– McKesson Paragon and Practice Partner

– HMS

• Or “Partner” vendor– QuadraMed and e-Mds

• Or use inpatient EHR in ambulatory environment– Keane, QuadraMed, Prognosis

• … Or “We can integrate with anyone”

Ambulatory EMRHIS Vendor “Integrated” PM & EHR Systems

• Marketed by HIS Vendors to support the continuum of care provided by hospitals and their owned or affiliated physician practices.

• Generally not sold to independent physician practices.• Level of integration ranges from “hidden” interfaces to true

single database solutions• Pricing claimed to be competitive with products marketed to

independent practices. • Systems hosted by hospitals who provide IT support.• Acceptance by physicians is variable depending on quality

of product, value of hospital support, and perceived control.

Ambulatory EMRHIS Vendors Ambulatory EHR Offerings

• Cerner – PowerWorks

• CPSI – MPM/EHR

• Allscripts (Eclipsys) – MyWay, Professional, Enterprise, Sunrise Ambulatory Care, Medinotes, Misys EMR

• Epic – EpicCare Ambulatory

• GE – Centricity EMR, Centricity Advance

• Healthland – Physician Practice Documentation

• HMS – HMS Ambulatory EHR

• Meditech - LSS MPM Suite

• McKesson – Practice Partners, Lytec, Horizon Ambulatory Care, Practice Point Plus

• QuadraMed – Partnership with eMDs

• Siemens – Partnership with NextGen ??????

Ambulatory EMRVendors Selling to Independent Practices

• Large number of vendors and products

• Many products sold through resellers

• Markets tend to be local for smaller vendors

Ambulatory EMRAllscripts

• Founded in 1986 as medication dispensing company, brought standalone e-prescribing to market in 1994

• 2001 acquired Channel Health from IDX and the TouchWorks system

• 2006 acquired A4 Health Systems and the Healthmatics HER• 2008 merged with Misys, acquiring MyWay and Misys EMR• 2010 acquired Eclipsys and the Sunrise Ambulatory and Peak

Practice (Medinotes) EMR• 2008 revenue - $383.7M• 2009 revenue - $591M

• Which products will survive?

Ambulatory EMReClinicalWorks

• Founded in 1999 - Privately held• One product

• EHR very slick, some weakness in PM• Company has grown very quickly – over 1000 employees• Claims 40,000+ physicians using system• Pros – product is integrated, intuitive, has been on short

lists for several RHIOs.• Cons – implementation and support issues• 2008 Revenue - $86M• 2009 Revenue = $113M

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Ambulatory EMReCW Revenue Growth

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Ambulatory EMRSage Software

• Large software company headquartered in Great Britain– traded on the London stock exchange

• 13,900 employees worldwide• Founded 1982• 2006 Acquisition of Intergy PM/EHR from Emdeon

– In 2000 Healtheon/WebMD purchased Medical Manager, Inc

– May possibly sell off HIT division?

Ambulatory EMReMds

• Founded in 1996 - Privately held• One product• Claims 2,000 installed licenses sites as of

Nov 2008• Pros - physicians like the product,

reasonable pricing, good support• Cons – proprietary drug database, weaker

PM module• Possible acquisition target

Ambulatory EMRGE Healthcare

• Current “Centricity” product is a descendant of:

• Logician EHR, purchased by GE in March 2002 and

• Millbrook PM, acquired by GE in 2003.

• GE purchased IDX Corporation in 2005

• Also acquiring their GroupCast and FlowCast PM products

• GE acquired MedPlexus in 2010 – rebranded “Centricity Advance”

• Pros – flexibility good support, the financial stability and size of GE, product recently rewritten with integrated database

• Cons – client server product still looks dated, slow to incorporate e-prescribing…

• GE does not disclose HIT revenue separately

Ambulatory EMRNextGen Healthcare Information Systems, Inc

• Wholly owned subsidiary of Quality Systems, Inc. (NASDAQ: QSII)

• In 2010 NextGen purchased Sphere and Opus, adding inpatient systems to their portfolio

• Pros – very sophisticated and customizable, stable and profitable

• Cons – highest cost in this market for an EHR sold by a niche vendor

• 2009 Revenue - $269M – up nearly 30% from 2008

Ambulatory EMRAthenaHealth

• Founded 1997• 1026 employees• 2009 HIT Revenues $188.5M• Web based EHR • Price determined by volume of collections• Also offer scanning and order routing as part of

AthenaClinicals offering• Possible acquisition candidate

Ambulatory EMROther players…

Greenway Medical Technologies – Founded 1998, 3000 physician clients – good specialty EHR

iMedica – Patient Relationship Manager product, company founded 1998, claims 800 physician clients

Community Computer Service- founded 1992, Medent product, 2000 physician clients

JMJ Technologies - “Encounter Pro” product, founded 1994, specialty Pediatric and OB/Gyn, “several hundred implementations”.

And many more…

Product Positioning By Practice Size

Small

(<10 Providers)

Medium

(10-50 Providers)

Large

(50+ Providers)

Allscripts ProfessionalMyWay

Professional Allscripts Enterprise

McKesson Practice Partner Practice Partner

Practice Point Plus& Horizon EMR

GE Centricity PM/EMR

Centricity PM/EMR Centricity PM/EMR

NextGen NextGen EMR NextGen EMR

eClinicalWorks eClinicalWorks PM/EMR

eClinicalWorks PM/EMR

Sage Intergy PM/EMR Intergy PM/EMR

Intergy PM/EMR

Ambulatory EMRConsiderations for Hospitals

• Buy ambulatory PM/EHR from your HIS vendor?• Consider…

– Integration with inpatient record– Price – no charge for interfaces!!– Vendor strategy– Physician acceptance– ONC certification roadmap

• HIS Pros selection and contracting methodologies apply to ambulatory systems as well.

QUESTIONS?

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