Ambulatory EHR (11+ Physicians) 2018
Decision Insights Report

The A-List: Really, Only Epic?

The EHR market A-list is Epic; Epic is the only EHR vendor in the large ambulatory practice space to have an overall satisfaction score above 85 (out of 100). Additionally, 99% of current Epic customers report that Epic is part of their long-term plans. Epic leads EHR-vendor considerations among large ambulatory practices by a wide margin. Enterprise-wide software decisions, hospital affiliations, data sharing with other clinics in the local area, and integration with practice management software are the reasons most often listed for why an organization chooses Epic. When Epic is not chosen, the clinic often feels like they are too small to be an Epic customer. Vendors who are not considering Epic look at Cerner, athenahealth, and eClinicalWorks most often.

What Is the A-List?

To qualify for the A-List, a vendor/product must demonstrate a track record of high market energy (considerations), high overall customer satisfaction (overall performance score of 85 or better), and high customer retention (no more than 10% of customers planning to replace).

Performance Trends and Vendors Driving New Energy

Epic Does Not Work for Everyone

While Epic does many things right, some potential customers would like a non-Epic option. Epic’s lack of flexibility and high cost are the two main concerns provider organizations report when they don’t select Epic. What other vendor options exist? Are these vendors trending toward increased consideration by potential customers? Are they satisfying and retaining their current customers?

Given Allscripts’ multiple product offerings, customers are confused as to which one is the fully integrated, go-forward option for larger clinics. Many clinics who have made the decision to move away from Allscripts mention lack of integration between the EHR and PM products as a significant factor in their frustration. With overall satisfaction scores between 63 and 69, all of the Allscripts options score below the market segment average. Taken in aggregate, Allscripts products are considered in more than 10% of KLAS’ Decision Insights conversations. However, Allscripts replacements are almost double Allscripts considerations, leading to overall negative market energy. 35% of existing customers report that Allscripts is not part of their long-term plans.

“There is more flexibility with the vendor we switched to. We were getting to be a bigger system, and we just needed everything to be integrated in one place. Allscripts just couldn’t provide that for us.” —Physician, 75+ physician organization

With an overall satisfaction score of 79.1, Aprima customers are happier than those of all other vendors except Epic and athenahealth. Boasting a strong retention rate of 91%, Aprima should be a stronger contender in the midsized to large ambulatory EHR space. However, Aprima is almost never mentioned by current EHR decision-makers that KLAS speaks to. Aprima is seen as a regional player and tends to work with customers who have fewer doctors. Aprima has only one KLAS-verified very large ambulatory customer. Some organizations have reported that Aprima’s EHR can be very click heavy compared to competitors’ EHRs.

“[The system] is just not user friendly. There are way too many clicks, so the physicians can’t access data in a timely fashion. Using the tool is time consuming.” —Manager, 11–75 physician organization

athenahealth has the third-highest number of considerations, but over the last 12 months, KLAS has observed a sharp drop in considerations and an increase in replacement vulnerability. athenahealth has a current overall satisfaction score of 79.6, second highest in the segment. 83% of their customers are planning to stay with the vendor long term. athenahealth’s aligned incentives business model is polarizing—those that engage with and choose athenahealth praise the model as a partnership, while clinics who choose another vendor over athenahealth decry the model as seeming too expensive in the long run. When athenahealth is replaced, healthcare providers cite unkept promises as reasons for their dissatisfaction.

“We are trying to decide which vendor to get our EHR from. athenahealth is an enigma because they have a very different business model. I like that things with athenahealth are aligned so that athenahealth does well when the provider does well, but what our respective responsibilities would be is still a mystery to me. I have seen really strong pros and really strong cons about athenaClinicals, so we are struggling with whether it is really the right fit for us. It sounds as though everyone either loves athenaClinicals or hates it. I have not heard a lot of opinions in between.” —COO, 11–75 physician organization

With a solid inpatient clinical solution, Cerner has significant industry momentum and retains most customers. The thing holding Cerner back in the ambulatory space is lower customer satisfaction, driven by Cerner’s lack of EHR and PM integration; potential customers look at Cerner for the promise of integrated modules, but existing customers express frustration with integration. Customers report that they are not seeing Cerner develop promised functionality fast enough. When customers have challenges, support is sluggish. Cerner is also being held back by revenue cycle challenges, both on the acute care and ambulatory side. Some potential customers view Cerner as an expensive option. Customer satisfaction with Cerner will likely increase as they close their functionality gaps and better support their clients.

“Cerner struggles a bit with interoperability. The vendor we went with does interfaces, and we can have 1,000 of them with no extra cost. Cerner charges for interfaces. The interfaces are part of Cerner’s original deal with an organization, but the interfaces aren’t part of the service. Cerner’s tool is still a little clunky and not intuitive. There is a lot of clicking and scrolling. I want a more intuitive interface. Cerner is not yet where they should be. They have leaped ahead with some of the interoperability work but haven’t thought it all the way through.” —VP of IT, 75+ physician organization

Considerations for eClinicalWorks are surprisingly high considering their very low overall satisfaction score. Mentioned by potential customers in over 20% of conversations, eClinicalWorks has seen their customers’ overall satisfaction drop 17% over the past 12 months to 57.3, far below the A-List average of 85.0. 47% of eClinicalWorks’ customers report they are looking for a replacement EHR. Several organizations mentioned the DOJ settlement and class-action lawsuit as factors in their decision to replace or not consider eClinicalWorks. It is notable that with such weak overall performance and almost half of their existing customers looking to make a change, eClinicalWorks is still receiving so much consideration. Providers are often looking at any possible viable option other than the traditional acute care EHR vendors.

“We are moving away from NextGen Healthcare and going with eClinicalWorks for our EHR. What drove that change is mainly the cost; for what we receive, eClinicalWorks is cheaper for all the pieces. We are a clinically integrated network, so we have to be integrated. There are some EHRs that the hospital won’t integrate with, but eCW is one vendor that every single hospital chain I talked to integrates with.” —IT Manager, 11–75 physician organization

Satisfaction with GE Healthcare’s solution has improved slightly since last year, but consideration for the vendor is low. Replacement vulnerability for both Centricity products is high; over 30% of responding customers indicate GE Healthcare is not part of their long-term plans. athenahealth and Epic are most often considered by GE Healthcare customers thinking about switching vendors. GE Healthcare’s new cloud product (Project Northstar) has not been delivered as quickly as customers anticipated.

“We went with GE mostly because their support was better than our previous vendor’s and because GE’s product was more open ended and integrated. The one thing that I am not sure about with GE is their process of gradually moving parts of the product to the cloud.” —IT Manager, 11–75 physician organization

Both Prime Suite and Intergy clients report declining satisfaction since last year. One-third of Greenway Health respondents say they are looking for a new solution. Prime Suite is especially vulnerable; requests for improvements, including external integration, have not been fulfilled quickly enough.

“I don’t like Intergy EHR because it doesn’t have good usability. Trying to get interfaces has been a nightmare. We can get customer service pretty quickly, but it takes the resources a long time to resolve issues, and Greenway never reaches out proactively. . . . Greenway has issues with some of their other systems, but it is hard to know which product Greenway is working on. We don’t get the feeling that Intergy EHR is their main focus.” —COO, 11–75 physician organization

Selected most often by clinics affiliated with MEDITECH hospitals, Web Ambulatory EHR has an overall satisfaction score of 70.4 and above-average considerations. Provider enthusiasm about the new integrated ambulatory and acute care platform has created a feeling that MEDITECH is becoming a more innovative company. A few clinics report that with Web Ambulatory, MEDITECH is finally a viable competitor to Cerner and Epic, with the perception that Web Ambulatory is a less-expensive and fully integrated option. MEDITECH is trending upward with improvements in both satisfaction (almost 8 points) and retention (12 percentage points) over the last year.

“We had not looked at the latest product from MEDITECH, and we had a good relationship with them, so we asked for a demo. They only showed us things that were already available or that would be available by the time we implemented. Our end users preferred the MEDITECH system. MEDITECH’s new product competes with Epic’s product and surpasses Cerner’s product. Cerner has a big market share, and people really seem to like their system. MEDITECH was late to the game, but their product is very, very good. I think that is because of how they conduct business. They aren’t willing to rush something out to market that doesn’t work quite right. I think MEDITECH has followed that model with 6.0 and 6.1. I feel very strongly that MEDITECH is far superior to Cerner in that sense.” —Director of Support Services, 11–75 physician organization

NextGen Healthcare has a lower-than-average consideration rate, although existing customers are reporting strong signs of a significant positive shift in satisfaction. NextGen Healthcare’s overall satisfaction scores have risen 10% over the past 12 months, to 73. The largest gains have been seen in metrics related to relationship and support, such as keeping promises, would you buy again, and executive involvement. Both existing and potential customers are hopeful that NextGen Healthcare is heading in the right direction and will become a viable competitor in the large ambulatory EHR space.

“Over half of our users are on NextGen Healthcare’s technology, mainly on the practice management side. Either way, NextGen Healthcare is one of the two vendors used most across our organization. NextGen Healthcare also provides the entire PM side of our ancillary division that involves the majority of our existing users. . . . We had a bunch of people go to the NextGen Healthcare UGM, and they were really impressed with what is about to come in our upgrade. NextGen Healthcare was originally considered because we felt obligated to include them, but now, there might be some excitement around them again.” —CEO, 11–75 physician organization

Decision Insights help provider organizations understand which vendors have market energy and why organizations are considering these vendors. Decision Insights are not designed to be a comprehensive census or win/loss market share study.

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