The Ambulatory EHR Market

Presented by: Elise Ames

HIS Professionals Buyers Seminar

October 14, 2010
Speaker Bio Ambulatory EMR

• 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
 Compelling Reasons to Address Ambulatory EHR Ambulatory EMR

• 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
Interoperability is the key Ambulatory EMR

• 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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A Bewildering Array of Choices… Ambulatory EMR

• 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
Market Share 2010 Ambulatory EMR

Source: CapSite 2010 Ambulatory EHR Market Share Analysis Report

HIS Vendor PM/EHR Strategies Ambulatory EMR

• 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”
HIS Vendor “Integrated” PM & EHR Systems Ambulatory EMR

• 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.
HIS Vendors Ambulatory EHR Offerings Ambulatory EMR

• 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 ??????
Vendors Selling to Independent Practices Ambulatory EMR

• Large number of vendors and products

• Many products sold through resellers

• Markets tend to be local for smaller vendors

 Ambulatory EMR
Allscripts

• 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?

 eClinicalWorks Ambulatory EMR

• 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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eCW Revenue Growth Ambulatory EMR

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Sage Software Ambulatory EMR

• 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?
eMds Ambulatory EMR

• 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
GE Healthcare Ambulatory EMR

• 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
NextGen Healthcare Information Systems, Inc Ambulatory EMR

• 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
AthenaHealth Ambulatory EMR

• 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
 Other players… Ambulatory EMR

 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 Medium Large

(<10 Providers) (10-50 Providers) (50+ Providers)
Allscripts Professional Professional Allscripts Enterprise
MyWay
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 eClinicalWorks

PM/EMR PM/EMR

Sage Intergy PM/EMR Intergy PM/EMR Intergy PM/EMR

Considerations for Hospitals Ambulatory EMR

• 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?

HIS Professionals, LLC 25