2016 Physician Practice Vendors

• Top 10 physician practice vendors- Ranked by # of EHR attestations per 2015 ONC reports- Leaders in both PM and EHR

• For each vendor:- H.I.S.-tory- Products - # of FTEs- Client base- Annual revenue- Rating by application- Future Prospects

© 2016 HIS Professionals, LLC

Vince Ciotti&

Elise AmesHIS Professionals, L.L.C.

• Overview - In 1st place is Judy’s incredible machine with no national sales & marketing force, that sold almost every large AMC & IDN for years.– Epic dominates in both the large hospital and large MD practice niches.– Their annual revenue topped $2B in 2015, making them the 3rd largest HIS

vendor, trailing only Cerner ($4B) & McKesson ($3B).– Epic’s major products “EpicCare” EHR and “Resolute” RCM are installed

primarily at hospital-owned or very large (50+ MD) physician practices.– Physician satisfaction with Epic is high per most ranking services, but they

are a captive audience of the practice, IDN or AMC that owns them.– “Interoperability” = seamless, if Epic is used on both ends! Interfaces with

foreign systems are as costly and difficult as with every HIS vendor.• Cerner recently launched “CommonWell” as a

counter to Epic’s proprietary cache files, but almost all vendors have proprietary data base structures so CommonWell is much more of a marketing gimmick than technical breakthrough – after all, we have had HL7 standards and Interface Engines for decades…

#1 =

• HIS-tory – founded by CEO Judy Faulkner in 1979 in Madison, as HRC (Human Resources Computing). Initially wrote systems for diverse industries, but soon specialized in healthcare, first MD practices then hospitals, with the first truly integrated HIS/MD system, written in InterSystems’ “Cache” db/language.

• Product Lines – only one product: “EpicCare,” with a wide array of applications and modules to meet almost every dept’s needs in hospitals & practices.

• Stats – 9,400 employees as of 2015, mostly young, bright, recent college graduates well trained in the “Epic Way.” Only a handful in sales & marketing.

• Client base – about 380 contracts representing mostly large IDNs and AMCs, with a total of 835 hospital and 109,000 physician ONC EHR attestations.

• Rating by application – strong on both sides of the equations: hospital and practices, clinical and financial, with a wide array of ancillary systems too.- Only gap: no ERP system, either self-developed or through partners.

• Future Prospects – as solid as Wisconsin’s frozen lakes! They won almost every large AMC and IDN selection (outside of Siemens’ clients), with but a few exceptions: the DoD (Leidos/Cerner) and Intermountain Healthcare (Cerner).

Details

• Allscripts retains it’s #2 slot in the physician practice marketplace (# 4 in the HIS market), despite recent turmoil due to C-suite upheavals, lawsuits, layoffs, mixed stock performance, and seemingly non-stop mergers and acquisitions, eg: 2001 = Channel Health, 2006 = A4, 2008 = Misys, 2010 = Eclipsys, 2013 = dbMotion, 2016 = Netsmart...

• Allscripts sunset several of these acquired products (eg: Misys’ MyWay and Eclipsys’ Medinotes), leading to litigation by upset users.

• In 2015 Allscripts settled a $9M+ class actions suit due to it’s failure to deliver promised integration of its standalone physician practice systems with Eclipsys’ “Sunrise” suite (their one integrated MD/HIS system).

• Sales growth has been relatively flat over the past several years, nonetheless today Allscripts retains a huge customer base and solid revenue stream from selling support and services to existing clients.

• However, with many physician practices looking to replace their current EHR and PM systems (many with Allscripts products), it is unclear how Allscripts will fare competing against giants like Epic & Cerner, as well as the many smaller companies offering far newer products...

#2 =

• HIS-tory –. Founded in 1986 as a medication dispensing company, Allscripts brought one of the first e-prescribing products to market in 1994. Current products in the hospital, physician, and post-acute care marketplaces were all obtained through many acquisitions – no products are self-developed. • Product Lines – Numerous MD offerings: “Enterprise” for large practices,

“Professional” for medium and small practices, and “Sunrise Ambulatory Care” for practices affiliated with hospitals running the Eclipsys HIS.

• Stats – approximately 7,000 FTEs, with ≈$1.4B annual revenue in 2015• Client base – Allscripts claims 45,000 practices and 180,000 physician users

across all of its many products; 49K MD attestations per ONC data.• Rating by application – According to a 2015 Black Book survey, Allscripts

was rated highest in customer satisfaction in medium (26-50 physician) and large (100+ physician) practices; however, anecdotally, users complain their products are somewhat dated and overly complex...

• Future Prospects – Mixed: Allscripts is not bringing new products to market, sales in the US are slow (only one recent 80-bed HIS sale through their “Community Pricing” model), with a few large international sales.

Details

• HIS-tory – Privately held, eCW was founded in 1999 in Westborough, Mass., by CEO Garish Narvani and CMO Raj Dharampuriya (hope we spelled ‘em right!)

• Product Lines – eCW sells a single, integrated, self-developed PM/EHR product for physician practices, both through themselves and re-sellers. eCW recently revealed the system also runs in 80 hospitals in India & Africa, and is currently developing a US hospital system with Tidelands Health in SC & 8 other pilots.

• Stats – Claims 4,500 employees and ≈$400M in revenue (excluding resellers). • Client base – Claim 75K providers (42K ONC attests) in mostly small practices

due to low startup costs (per-provider, per-month fees), but now in several

large organizations through deals with NYCHHC, the NFL, and Walmart. • Rating by application – EHR highly usable with strong ratings among physicians,

although some have struggled with the billing system. On-going buzz of complaints about lack of in-depth training and poor response from support.

• Future Prospects – Bright and shining based on past performance. eCW’s entrée into the HIS market in the US may offer hospitals a low-cost alternative and help them keep up with athenahealth’s acquisition of RazorInsights…

# 3 = (eCW)

#4 =

• HIS-tory – Founded as Quality Systems Inc. (NASDQ: QSII) in 1994 as a dental software company. Through a series of mergers and acquisitions (Clinitec, Micromed…), re-branded as NextGen in 2001. In 2009 they purchased Opus & Sphere, adding small hospital (mostly CAH) clinical and financial systems respectively to their portfolio – but couldn’t sell them well and sold both to QuadraMed in 2015, leaving the HIS market. In 2013 NextGen acquired the interface engine formerly known as Mirth. The recent purchase of HealthFusion and it’s cloud-based, mobile-device-enabled “Medi-Touch” system provides NextGen with a simpler offering for small practices. • Products – Prior to the acquisition of Medi-Touch, NextGen focused on a single physician product, an integrated PM and EHR system. NextGen also offers business analytics and “integration” tools (Mirth interfaces) as well as RCM outsourcing. • Stats – Claim ≈3,000 FTEs, generating $490M in annual revenue for 2015. • Client base – 38K ONC attestations from 7K practices, mostly medium and large size,

due to relatively high cost and complexity of the systems; 3K Medi-Touch attests.• Rating by application: Mature products, highly configurable, good specialists content. • Future Prospects: NextGen continues to be financially strong and will continue to be

a leader, especially if Medi-Touch helps them expand into small practices…

• HIS-tory: Formed in 1892 (older than Invision!), GE has been in Healthcare forever too through devices like patient monitors. Their “Centricity” physician practice products descended from the Logician EHR (purchased 2002) and Millbrook PM (acquired 2003). In 2005 GE purchased IDX, acquiring their leading GroupCast and FlowCast PM systems. In 2010, GE acquired MedPlexus – rebranded “Centricity Advance,” but since sunset.

• Products: Centricity EMR & Practice Solutions for midsize & large practices.• Stats: GE = $142B in 2015, GE Healthcare = $14B (devices), 28K MD attests• Client Base: large/mid-size independent practices (not IDNs), FQHCs. • Rating by App: Pros = flexible, good reporting, strong support, corporate

stability, integrated financial/clinical database, integration with GE medical devices. Cons = the relatively expensive EHR is complex to configure.

• Future Prospects: Thanks to its large MD client base, GE Healthcare will probably not sunset the current physician products, however the company is about out of the acute care EHR business as of 2015 (only 11 hospital attestations) and does not seem to be aggressively promoting Centricity.

# 5 =

#6 = • HIS-tory – Complicated: Greenway Medical Technologies was founded in 1998, and was a publically traded company until 2013, when Greenway Health was formed as a private company uniting Vitera Healthcare Solutions, SuccessEHS, and Greenway Medical Technologies. Capisce?• Products – PrimeSuite PM/EHR (targeted primarily at small specialty clinics), SucessEHS PM/EHR (for community health centers and FQHCs), Vitera Intergy EHR, EDR (dental EHR), as well as RCM outsourcing services.• Stats – 1,700 FTEs as of 2015, 21K MD attestations, $378M in 2014. • Client base –2,200 practices; however in 2014 announced implementation

of Walgreen’s “Cloud EHR” at 8,200 pharmacies (on sunny days…).• Rating by application – Their “PrimeSuite” PM/EHR is highly usable and has

strong ratings among specialists; Intergy is somewhat dated.• Future Prospects –Greenway stresses interoperability and has partnered

with Orion Health for integration service. Interesting departures from the bread and butter physician practice systems includes a partnership with Vanderbilt University to create a clinical research network.

#7 =• HIS-tory - Founded as “PGI” by Neal & Co. in 1979, Cerner was originally a

Laboratory (LIS) specialty vendor, competing so well in that niche they expanded into hospital clinical systems in the 90s, and then entered the Revenue Cycle Management (RCM) markets with their “ProFit” system in the 2000s.

• Products - Like Epic, Cerner’s “PowerChart Ambulatory” EHR is installed mainly in large hospital-owned physician practices that run Cerner’s total HIS systems.– Cerner ranked 7th in ONC physician EHR attestations in 2015 with 20,465.– They offer two practice management systems depending on MD staff size:

• “Specialty Practice Management” for practices of 10 or less physicians• “PowerWorks Practice Management” for practices with 10 or more MDs

• Revenue - They led the pack of all HIS vendors in 2015 with over $4B in revenue, including $1B added through their acquisition of Siemens HIS division, whose interfaced “Signature” physician billing system was growing rather outdated.

• Stats – 22K FTEs as of 2015, serving 18,000 “facilities” worldwide (restrooms?).• Prospects - Although technically integrated via their Oracle data base, they have far

less physicians using their EHR and RCM system than leaders like Epic and Allscripts. They will add MDs through hospital-owned practices in the hundreds of Siemens clients they are converting from Soarian, Invision and MedSeries4.

#8 =• HIS-story: Practice Fusion was founded in 2005 by Ryan Howard and Jonathan Malek. They are very unique in offering an ad-based version of software at no charge to providers! Revenue is generated primarily from ads, and Practice Fusion also has numerous private investors. • Product Lines – A cloud-based EHR (there’s ads up there too…) and practice management, along with e-prescribing, mobile device connectivity, and business analytics. FusionConnect is their HIE offering that connect practices with labs, hospitals and other data sources.• Stats – 300+ FTEs, with ≈16K ONC attestations in 2015.• Client base – claim 35,000 facilities, mainly small and mid-size practices• Rating by application – System is simple and intuitive, gaining popularity. Providers don’t seem turned off by the ads, which are relatively unobtrusive.• Future Prospects – recent 2016 layoff raises some questions, but based on

the companies’ growth since 2007, the business model is working for now.

#9 = • HIS-tory – Founded in 1997 by Jonathon Bush (yes, he’s related to them…)

and Todd Park as a medical practice, today athenahealth is a highly-successful, publicly traded company (NASDAQ: ATHN).

• Product Lines – RCM services, document management services and AthenaOne cloud based PM/EHR, which is priced as a % of a practice’s revenue collections. In 2015 bought HIS vendor RazorInsights whose EHR and RCM runs in 25 Critical Access Hospitals, and also rights to Beth Israel Deaconess Medical Center’s in-house “webOMR” solution, to be branded as “Athena Clinicals for Hospitals” and marketed to large (non-CAH) hospitals.

• Stats – claim 4,619 FTEs, with14K ONC attestations, and $752M revenue• Client base –claims 75K providers, mostly midsize & large practices; hospitals

are currently all CAH (<25 beds) on RazorInsights, but Toledo Medical Center, a 250-bed AMC, is piloting their “integrated” (via API?) HIS/MD system…

• Rating by application – Very tight integration between MD EHR and PM. Challenge will be to “integrate” the HIS and MD systems without re-writing.

• Future Prospects – A huge potential! Athena’s entry into the hospital market is an exciting addition to the growing # of vendors with both HIS & MD systems.

#10 =• HIS-tory – Founded in 1974 by Walt Huff & Co as HBO, a minicomputer

pioneer, they grew through countless acquisitions to be the #1 HIS vendor by 2000, when HBOC was acquired by the pharmaceutical giant McKesson.

• Products – Just as with HIS products, HBO/McKesson acquired numerous physician PM and EHR systems over the years, with a total of 10K providers attesting with them as the primary EHR in 2015 on 9 product offerings:

– 3 for Small (<10 MDs): Practice Choice (cloud-based), Medisoft, and LytecMD

– 4 for Medium (10-25 MDs): Medisoft, LytecMD, PracticePartner, & Integreat

– 2 for Large (25+ MDs): PracticePartner and Integreat (sic)• Paragon – During VP Jim Pesce’s reign, which sadly ended last year, they had

admirable plans to add a fully integrated RCM and EHR written in Microsoft’s Windows & SQL data base to this “go-forward” HIS system.– They completed the integrated RCM module last year, but the

integrated EHR system has been pushed back to mid-year 2017.• Prospects - In 2016, McKesson sold most of the above MD systems to

eMDs, a leading physician practice vendor, with 55K physician clients. Rumors afloat that McKesson may be selling their HIS product line as well…

Next Week In our final episode, we’ll wrap up our review of MD vendors with:• - Overview of the top 10, next 40, and other 735 vendors • - HIS vendor “crossover” products• - Product positioning by practice size• - MD replacement market• - Various rating sources• Direct your attorneys to:

- Vince Ciotti - 505.466.4958- vciotti@hispros.com

Please send any questions or comments to:- Elise Ames

- 413.329.6925- eames@hispros.com