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Acute Care EMR Decision Insights 2019
Buyers Unwilling to Settle
Author
Coray Tate
Author
Sam Eaquinto
A seamless patient record across the healthcare organization has become a universal expectation. Having integrated acute care and ambulatory records is the most-often-cited reason for a hospital of any size to look at a new EMR system. EMR systems without proven integration are rarely considered and even more rarely selected. Buyers know what is possible from an EMR, and most are now unwilling to settle for less.
Cerner, Epic, and MEDITECH are most likely to be considered for large hospitals (500+ beds) and midsize hospitals (201–500 beds). The competition for hospitals with fewer than 200 beds is much more crowded, with MEDITECH Expanse, athenahealth, Allscripts (both Sunrise™ and Paragon), CPSI, eClinicalWorks, and MEDHOST battling alongside Cerner CommunityWorks and Epic Community Connect.
The A-List
To qualify for the A-list, a vendor product must demonstrate a track record of high market energy (purchasing considerations), high overall customer satisfaction (overall performance score of 85 out of 100 or higher), and high customer retention (no more than 10% of customers planning to replace the product).
Epic EpicCare Inpatient EMR
Having an integrated record across the continuum of care and being able to share data between hospitals continue to be strong drivers of Epic consideration energy. Pressure from physicians and other clinical users who have used Epic at other locations or know of its capabilities is pushing vendor selection in ever-increasing measure—this factor was the second-most-cited reason for Epic purchase decisions. Epic is still considered expensive by some hospitals, and a few facilities feel they are too small to be a viable Epic customer.
A-List Honorable Mention:Â MEDITECH Expanse
MEDITECH Expanse garners praise from existing customers, who often cite the usability of the system, improved workflows, and mobility options as satisfaction drivers. Potential Expanse buyers report they consider the system for the integrated acute care and ambulatory record, the responsiveness of the MEDITECH team, and the perception that Expanse is innovative while also providing strong value. A few hospitals considering Expanse are not sure the product is mature enough to meet all their needs, but existing and potential buyers are generally optimistic about the direction MEDITECH is taking.
For more information, see KLAS’ 2019 Emerging Acute Care EMRs report.
Users Exerting Greater Influence in Considerations
As mentioned above, an integrated acute care and ambulatory record is the most common reason why a vendor is considered. The lack of an integrated record is also the most common reason a vendor is replaced and the second-most-common reason why a vendor is not selected. Increasingly, pressure from physicians looking for an integrated view of clinical data across all care settings is influencing buying decisions.
Price and product maturity round out the top three reasons why vendors are not selected. Value-conscious buyers in the smaller hospital space are always concerned about the total cost but still expect integration, a mature product, and modern technology.
Frustrated organizations replacing an EMR know they want an integrated patient record, and they cite lack of development on legacy products and lack of quality support as factors in their dissatisfaction with their current vendor. Vendors who share a strong product road map and vision, stabilize and update their products, and provide strong support could win back some customer loyalty.
Users Exerting Greater Influence in Considerations
Replacement energy is most prevalent at hospitals running outdated technologies. Some of these systems are not the vendor’s go-forward products, such as MEDITECH versions older than Expanse, while others are products that have stagnated in development, like Allscripts Paragon, CPSI, and MEDHOST platforms.
Older technologies not only have trouble integrating acute care and ambulatory records, but they are often difficult to integrate with newer outside technologies like population health solutions. Because hospitals feel the pressure to manage populations and provide value-based care, legacy EMR technologies are no longer viable. This leads to a poor EMR experience, unmet promises, missed expectations, and overall dissatisfaction.
Small-Hospital Case Study: One Organization’s Mind-Set
"[Vendor A's] platform didn't seem as innovative as another vendor's app approach. We briefly looked at [Vendor B], but the cost removed them from the running fairly quickly. [Vendor C] isn't a vendor we can count on to develop and deliver. They had the right price, but there was no reason to select them when another vendor was an option. A couple of things in [Vendor D’s] product looked interesting to us. Based on the product demonstration and [the Vendor D] product's ability to meet all our needs as an organization from a clinical and revenue cycle perspective, [Vendor D] had what we were looking for. The price was right for us." —Director of Quality, less than 50-bed hospital
Vendors That Didn’t Make the A-List
Cerner is the second-most-considered vendor in the acute care EMR market. Potential Cerner buyers report good acute care and ambulatory integration. Revenue cycle issues are cited as a reason some possible buyers stay away. Cerner buyers like the fact that the product is very flexible, though a few potential buyers report the system is too complex and is difficult to fully implement. Some positive pressure from clinician users is influencing C-suites in their buying considerations.
Cerner Soarian users expect the product will be discontinued in the future, and these organizations are not necessarily choosing Cerner Millennium as an obvious replacement.
Allscripts Paragon users are particularly dissatisfied with their current experience and complain about outdated technology and the lack of acute care and ambulatory integration; it should be noted that an ambulatory Paragon solution was recently announced by Allscripts. 16 Paragon customers left the platform in 2018, moving to Cerner (6), Epic (6), MEDITECH (3), and CPSI (1). About 46% of the current Paragon customers interviewed by KLAS report that they are looking to move to another solution.
While Sunrise™ is Allscripts’ flagship platform, it receives few considerations and when considered is rarely selected. Several organizations are replacing Sunrise™, and the majority of those are strongly considering moving to Epic.
athenahealth inpatient customers report a good experience with the product, and athenahealth was considered in 14% of the purchase decisions in this report. Potential customers are very polarized on the business model—small hospitals with few capital expenditure dollars appreciate the low price of entry and the aligned-incentives model. A few potential buyers did not think the product was mature enough to consider, most often mentioning gaps in ED and laboratory functionality. 96% of current customers say the system is part of their long-term plans. The average hospital that considers athenahealth has 30 beds, but a few larger hospitals (150, 205, and 350 beds respectively) report considering athenahealth. Currently contracted implementations are moving forward, but new sales are on hold as athenahealth regroups after their acquisition by Veritas Capital; for more information, see KLAS’ 2019 Emerging Acute Care EMRs report.
CPSI is seen by small hospital buyers as an affordable option. However, CPSI currently has more replacements than new considerations; almost 40% of customers say CPSI is not part of their long-term plans, and only 47% would buy again. One small hospital customer reports recent positive changes in the development process amid pressure from competing vendors and is looking forward to promised updates.
eClinicalWorks has promised a live acute care product soon, and a few potential buyers, particularly critical access hospitals, are anxious to see the product. These buyers are looking for a viable solution at a very competitive price and think eClinicalWorks might be the answer. KLAS looks forward to validating the experience of eClinicalWorks acute care customers once there are live sites.
MEDITECH Gaining Traction outside of Legacy Base
MEDITECH MAGIC, C/S, and 6.x users are looking closely at the Expanse platform and are optimistic. Expanse is seen as an integrated option that is more affordable than Cerner or Epic, especially for current MEDITECH customers. However, when a legacy MEDITECH hospital considers moving to Expanse, the lift of this system change is large enough that other vendors are often also considered. In 2018, hospitals leaving MEDITECH most often chose Epic, followed by Cerner.
Acute Care EMR Buyer's Guide
Designer
Natalie Jamison
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.