Project Overview. Source: AC Group, Inc. 1

Transcription

1 Project Overview Joint CCMS & SWFPA Sponsorship Conducted by Nationally Recognized Consultant Mark R. Anderson, CPHIMS, FHIMSS Member Survey Assessing EHRs and Practice Management Systems Currently in Use Assessment of Integration with Cerner (NCH) and Medicity (HMA) Health Information Exchanges (HIE) Comparative Analysis of Predominant Systems in Use Locally and Top Rated Nationally Source: AC Group, Inc. 1

2 Questions Targeted What are considered the best practice management/ EMR systems on the market today? How does my current system compare to the others in cost, function and ability to integrate? What are the systems' ability to meet future reporting requirements of healthcare (PQRI, meaningful use, managed care/aco reporting)? What are the major systems currently in use in the community? How well and at what cost will my system integrate with the Health Information Exchanges (HIEs) currently available in the community? National EHR Trends Source: AC Group, Inc. 2

3 Why are Practices not using what they Purchased? Adoption of EMR/EHR systems by office based physicians has continued to increase 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% MU Basic System Any EHR 20.0% 10.0% 0.0% Percentage of office-based physicians with EMR/EHR systems: United States, and preliminary NOTES: EMR/EHR is electronic medical record/electronic health record. Any EMR/EHR system is a medical or health record system that is all or partially electronic (excluding systems solely for billing). Data for are from in-person National Ambulatory Medical Care Survey (NAMCS) interviews. Data for are from combined files (in-person NAMCS and mail survey). Data for are preliminary estimates (dashed lines) based on the mail survey only. Estimates of basic systems prior to 2006 could not be computed because some items were not collected in the survey. Data include nonfederal office-based physicians and exclude radiologists, anesthesiologists, and pathologists. SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, Source: AC Group, Inc. 3

4 Percent of Physicians that have Attested 50% 40% 30% 20% 10% 0% April 2011 April 2013 Source: July 2013 CMS Report on EHRs 7 Total Attestation by Vendor 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 Source: AC Group, Inc. 4

5 Total Attestation by Vendor without EPIC 30,000 25,000 20,000 15,000 10,000 5,000 0 Number of EHR Products by Number of Physicians Products Source: AC Group, Inc. 5

6 Practice Survey Naples, FL Results Overview 75 different practices responded representing 400 providers There were 36 practice management products and 29 different EHR products reported No one vendor dominates Naples, FL. The community has too many vendors to create a consolidated clinical record that a ACO would require Of those that responded to the survey, 75% of the practices have an EHR and > 95% of the physicians are using for full encounter documentation. This is twice as high as the national average 87% have stated that they have already attested for Meaningful Use Stage 1 The national average is only 35% Source: AC Group, Inc. 6

7 % of Practices by # of Physicians Physicians 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Solo 2 to 5 6 to over 30 Local System Adoption Definitions: Practice Management (PM) Appointment Scheduling Billing & Accounts Receivable Electronic Health Record (EHR) Source: AC Group, Inc. 7

8 Survey Findings Vast majority of respondents in Private Practice Representation across many specialties with 45% Primary Care Most (~80%) have both PM and EHR Over 1/3 use Data center hosted solutions. Majority run software on their own servers ~25% had no EHR Most kept staffing levels the same after EHR implementation Survey Findings Continued Most believe the EHR had made the Practice s workflow more efficient Most unlikely to change their EHR vendor over the next two years Most able to access their EHR from a mobile device ~87% have successfully attested to Stage 1 Meaningful Use Most have started preparing for Stage 2 Meaningful Use ~80% reported not close to ready for ICD 10 Source: AC Group, Inc. 8

9 There are 36 different PM products in 75 Practices athenahealth 9.3% None 8.0% Sage/Vitera/Medical Manager 8.0% NextGen 6.7% Cerner 5.3% McKesson Medisoft 5.3% Advance MD 4.0% Aprima 4.0% eclinicalworks 4.0% NexTech 4.0% Allscripts Professional 2.7% e-mds 2.7% MediSoft 2.7% MedWare 2.7% Practice Fusion and Kareo 2.7% TheraOffice by Hands On Technology 2.7% Vendors with just 1 practice acumen Allscripts Others Allscripts Misys Vision CollaborateMD GE Centricity Greycat Software GSR Helper ICS Kareo MacPractice McKesson Lytec Medics (ADS) Plan to change to Quest Care360 soon Presently switching from EHS PTOS QuickEMR SAMMY USA TIMS There are 29 different EHR products in 60 Practices AthenaHealth 10.0% Vendors with just 1 practice NextGen 8.3% Acom Solutions, RAPID Documentation Practice Fusion 8.3% acumen Advance MD Amazing Charts 6.7% Allscripts - MyWay Vitera/Sage 6.7% e scripts MDIntellesys (Ophthalmology specific Allscripts - Professional 5.0% program) MIE Aprima/iMedica 5.0% modernizing medicine ema Cerner 5.0% none-retired Physician's Solution eclinicalworks 5.0% Prognocis e-mds 3.3% PTOS Soapware NexTech 3.3% SuccessEHS Quest Care % TheraOffice by Hands On Technology SAMMY USA 3.3% TIMS Source: AC Group, Inc. 9

10 Products Certified for MU Stage 2 as of February 7, 2014 Acumen Physician Solutions/Acumen EHR ( v7 ) Advanced Data Systems Corporation/MedicsDocAssistant ( v7 ) Allscripts/Sunrise Ambulatory Care ( v6.1 ) AmkaiSolutions LLC/AmkaiCharts ( v3.3 ) Aprima Medical Software, Inc./PRM 2014 ( v14 ) athenahealth, Inc/athenaClinicals ( v14.1 ) BizMatics Inc/ PrognoCIS ( v3 ) CorrecTek/CorrecTek 2014 ( ) CPSI/ CPSI Medical Practice EMR ( v19 ) DrMHope Softwares Pvt. Ltd./Dr.M ( v1 ) e MDs, Inc./e MDs Solution Series ( v8 ) Family Health Centers of San Diego, Inc./ CMIS Medical EHR ( v2 ) GE Healthcare/Centricity EMR( v9.8 ) GE Healthcare/Centricity Practice Solution( v12 ) Glenwood Systems LLC/GlaceEMR( v5 ) glostream, Inc./gloSuite( v8 ) HealthFusion/MediTouch( v4 ) Henry Schein Medical Systems, Inc./MicroMD( v9 ) Insight Software, LLC/My Vision Express( v2014 ) isalus Healthcare/OfficeEMR( v2014 ) LSS Data Systems/Medical and Practice Management (MPM)( v6.08 ) MagView/MagView Radiology EHR( v6.7 ) McKesson/Horizon Ambulatory Care ( v12.1 ) MTBC/MTBC WebEHR( v2 ) Netsmart Technologies, Inc./Avatar( v2014 ) Office Ally, LLC/EHR 24/7( v3.7 ) Plexus Information Systems, Inc./Anesthesia Touch( v4 ) Practice Fusion, Inc./Practice Fusion EHR( v3 ) Pulse Systems/Pulse Complete EHR( v4.2 ) Sevocity/Sevocity( v11.4 ) Stratus EMR, Inc./Stratus EMR( v2 ) SuccessEHS, Inc., a Division of Vitera Healthcare Solutions/SuccessEHS( v7 ) TriMed Technologies, Corp./e Medsys EHR( v7.9 ) Ulrich Medical Concepts, Inc./TCC 2014( v ) Western Dental Services, Inc./WDS echart( v2 ) HIE Capability Source: AC Group, Inc. 10

11 Practices by size and HIE capability Vendor Solo 2 to 4 5 to > 20 Total Cerner Medicity Cerner Medicity Practices AthenaHealth NO Pending 0 6 NextGen Yes Yes 5 5 Vitera No No 0 0 Practice Fusion No No 0 0 Amazing Charts 4 4 No No 0 0 Aprima Yes Yes 3 3 Cerner Yes No 3 0 ecw Yes Yes 3 3 Allscripts Pro 3 3 No No 0 0 e-mds 2 2 Yes Yes 2 2 Quest No No 0 0 Sammy 2 2 No No 0 0 Practice Software Capable of HIE Integration 22% Cerner 52% 26% Medicity None Source: AC Group, Inc. 11

12 PM/EHR Vendor Ratings PM/EHR Vendor Rankings Completed on 10/01/2013 Included over 80 PM/EHR vendors Ranked the top 30 vendors based on the number of Physician users Included rankings on: EHR Functionality PM Functionality End User Satisfaction Company Viability Implementation and Support Pricing HIE Integration Source: AC Group, Inc. 12

13 Top Practice Management Products NextGen AthenaHealth eclinicalworks Allscripts Enterprise Vitera Greenway Vitera SuccessEHS Aprima Vitera Intergy EHR Caretracker Allscripts Prof. Top EHR Products NextGen eclinicalworks Webchart e MDs Vitera Intergy EHR GE Centricity Aprima Cerner Allscripts Enterprise McKesson Practice Partner Vitera Greenway Vitera SuccessEHS Caretracker Allscripts Prof. AthenaHealth Amazing Charts GE Practice Solution Quest Care 360 PracticeFusion SoapWare Source: AC Group, Inc. 13

14 Top Products Practice Management & EHR NextGen eclinicalworks Vitera Intergy EHR Vitera Greenway Aprima e MDs Vitera SuccessEHS Webchart Allscripts Enterprise AthenaHealth GE Centricity Allscripts Prof. Amazing Charts Caretracker McKesson Practice Partner Quest Care 360 PracticeFusion Cerner AdvancedMD SoapWare Vitera Stat Praxis EMR Top Products for Company Implementation and Support 5.90 Vitera Greenway e MDs Vitera Intergy EHR eclinicalworks NextGen Aprima eclinicalworks Quest Care 360 Vitera SuccessEHS Source: AC Group, Inc. 14

15 Summary Six Star Rating Summary NextGen ecw Vitera Intergy Vitera Greenway Aprima e-mds Success EHS Webchart Athena GE Allscripts Prof. Amazing Charts Top overall Company for PM/EHR Top EHR products Top PMS Products Top Company's for Implementation and Support Price (6 low, 1 High) Medicity HIE Yes Yes NO Yes Yes Yes Yes Yes NO NO NO NO Cerner HIE Yes Yes NO Yes Yes Yes Yes NO NO NO NO NO 6 Star End User Rating by Practice Size Company Over Allscripts Enterprise Allscripts Professional Aprima 4.6 athenahealth Cerner ecw e-mds 4.7 EPIC GE Vitera Greenway McKesson NextGen PracticeFusion 4.8 Vitera Intergy Source: AC Group, Inc. 15

16 Small Practice EMR (1 10 physicians) Money s Worth vs. Product Performance Practice Fusion M o n e y s W o r t h McKesson G.E. Athena Health Cerner Greenway eclinicalworks Allscripts NextGen Product Works as Promised Small Practice PM/EMR (10 to 50 physicians) Money s Worth vs. Product Performance M o n e y s W o r t h ecw Athena Health Greenway NextGen Vitera Intergy Cerner E MDs Aprima Allscripts Enterprise GE Medical Allscripts Professional McKesson Product Works as Promised Source: AC Group, Inc. 16

17 Final Comments Consolidation of Vendors already taking place as a result of Meaningful Use certification requirements It is in the best interest of the Medical Community to consolidate onto a handful of the top rated systems Top vendors have a higher likelihood of market viability Your practice size, budget and specialty will influence the optimal system for you HIE connectivity and will likely be very important to future success Contact CCMS or SWFPA for Detailed Survey Results Survey Findings Source: AC Group, Inc. 17

18 Which is the nature of your practice? 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Source: AC Group, Inc. 18

19 Which software products do you have in your practice? 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Practice Management only (Registration, Scheduling, and Billing) Only Practice Management and EHR EHR Only What is the delivery model of your current Practice Management (PM) software for Registration, Scheduling, and Billing? Software installed on your practice s hardware/servers Software hosted at a local hospital or community (IPA, MSO, PHO) Software hosted elsewhere (ASP, SaaS, on-demand or online model) I don't know Source: AC Group, Inc. 19

20 How would you rate your satisfaction with your current Practice Management (PM) vendor on the following criteria, where 1 is very dissatisfied and 5 is very satisfied? Product Enhancements Ongoing support if there are problems/questions with the system Functionality Ease of use Overall satisfaction with your PM vendor Do you have an EMR product today in your practice for Charting all of your clinical encounters? Yes No Unknown Source: AC Group, Inc. 20

21 EMR Implementation Process Our EMR implementation is complete and all of our software is installed, but physicians are not using the EMR product yet. Our EMR implementation is complete and all of our software is installed, and some of the providers are using the system as needed. Our EMR implementation is complete and all of our software is installed, and all of our providers are using the system as needed. Our EMR implementation is still in transition. We're still in the process of implementing our EMR. How would you characterize your EMR transition Process? A little bumpy but it could have been worse. We got through it, but it was more painful than it needed to be. Smooth sailing. Couldn't have asked for a much easier process, given the nature of the change. Traumatizing. I wouldn't have wished it on my worst enemy Source: AC Group, Inc. 21

22 How did the EMR affect total staffing? We kept staffing levels the same. We added staff to manage the EMR. It's not clear yet how the EMR will affect staffing We've had an EHR so long that I'm not sure how it affected staffing We laid off staff Are all providers and staff who should be using the EMR doing so? 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Yes, everyone is using the EMR who should be No, some of our providers have simply refused to switch to the new system. Not Yet. Some Providers are still struggling with it, but they're trying Source: AC Group, Inc. 22

23 Would you say your EMR has made your practice's work flow more efficient overall? Yes No, it's worse It's about the same as it was Do you own or lease your EHR software? 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% We own our EMR software, and it's hosted on our own servers. We lease access to a cloud-based EMR that is owned by the software vendor Source: AC Group, Inc. 23

24 How likely are you to change your current EMR vendor over the next two years, where 1 is very unlikely and 5 is very likely? Very unlikely Very likely 0 Likelihood to switch EMR vendor N/A Can you access your EMR with a mobile device like ipad, Tablet, or Smart Phone? Yes No Source: AC Group, Inc. 24

25 Have you successfully attested to Stage 1 of the government's meaningful use rules for EMR adoption? Yes, we received our government stimulus money, or have been notified that we soon will. No, we went through the government's meaningful use attestation requirements, but we failed to meet them. I don't think we'll ever get our stimulus money. Not yet. We failed to meet the meaningful use requirements, but we're making adjustments and expect, eventually, to receive the stimulus dollars. Have you started preparing for the Stage 2 rules to meet meaningful use? No. We don't plan on attesting for Stage 2 Not Yet. We are still focused on Stage 1 A bit. We have begun familiarizing ourselves with the requirements but have not done much beyond that. Yes. We have reviewed the requirements and are making some changes so that we can more easily attest. Source: AC Group, Inc. 25

26 Other Use of PM/EHR 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Use social media to communicate with your patients? Use a smartphone to do your job? Use a mobile tablet to do your job? Conduct e-visits? Use mobile health-monitoring devices? How would up describe your practice's readiness for the coming transition to the ICD-10 code set? Not at all ready. We're not very close, but we've begun making preparations. We've gotten reasonably far in getting our system ready to code under ICD-10. We've just about ready right now. Source: AC Group, Inc. 26

27 Why have you not purchased EHR 60% 50% 40% 30% 20% 10% 0% % We are planning on purchasing one in the next 12 months. They're too expensive We've heard too many honor stories We couldn't find a product that met our needs, and have indefinitely suspended our search We don't have full buy in from all of our physicians. Are you interested in sharing Patient Data with the Local Hospital's HIE program? Cerner's HIE offered by NCH Medicity's HIE offered by HMA/PRMC 5 0 Yes No Maybe Need More Information Source: AC Group, Inc. 27

28 Additional Vendor Information Allscripts Professional Allscripts Enterprise Amazing Charts Aprima AthenaHealth Cerner eclinicalworks e MDS EPIC GE Medical NextGen Practice Fusion Allscripts Professional Strengths One of the 9 EHR products that Allscripts sold Weak EMR Functionality Strong PMS Functionality Designed for 5 to 15 providers Over 8,200 Providers attested TCO is around $43,000 for five years Good for Primary Care and Internal Medicine PHR is new to the product Product is Stage 2 MU Certified already Weaknesses Weak Marketing West of Mississippi River Non Integrated PMS/EMR Product looks older Replacement for Allscripts MyWay Not strong for most specialists HIE integration is questionable Tied to Payer Path for EDI which means practices are required to switch causing delays in payments Source: AC Group, Inc. 28

29 Allscripts Professional Implementation Average of 40 hours per site plus 4 hours for practices with more than 5 physicians On-site team has experience within practices. Usually one person understands both PM and EHR side One of the lowest end-user satisfaction levels regarding implementation Support Weak Marketing West of Mississippi River Non Integrated PMS/EMR Product looks older Replacement for Allscripts MyWay Not strong for most specialists One of the lowest end-user satisfaction levels regarding support. Allscripts Enterprise $1.45B Strengths One of the 9 EHR products that Allscripts sold Strong EMR Functionality Strong PMS Functionality Designed for large multi-specialty practices with over 75 providers Over 15,000 Providers attested TCO is around $65,000 for five years Good for Primary Care and Internal Medicine Modular Approach PHR is new to the product Weaknesses Non Integrated PMS/EMR Product looks older Not strong for most specialists HIE integration is questionable Tied to Payer Path for EDI which means practices are required to switch causing delays in payments Major Management Turnover Major integration issues with the Eclipsys Hospital System Lost trust of the larger physician community Try to hold on to clients vs. selling new Source: AC Group, Inc. 29

30 Allscripts Enterprise $1.45B Implementation Average of 400 hours per site plus 4 hours for practices with more than 80 physicians On-site team has experience within practices large practices Usually one person understands PM and a different person for the EHR side Went from the Highest end-user satisfaction rating in 2009 to one of the lowest end-user satisfaction levels regarding implementation Incremental approach towards implementation which is preferred Support Non Integrated PMS/EMR Product looks older Not strong for most specialists One of the lowest end-user satisfaction levels regarding support. Good call center Fast support calls End user satisfaction has fallen since change over in Management Amazing Charts $7.2 M Strengths Very Low Costs - $1,995 Very easy to use No onsite support EHR product that meets Stage 1 MU needs and is very easy to use Great at helping clients get MU dollars Over 6,000 physicians Over 2,000 Providers attested Great DEMOs they make the EHR look easy because functionality is weak Strong showing in KLAS reports Number 1 in AAFP reports All Web Hosted Weaknesses EHR might be weak for Stage 3 needs No integrated PM product Designed for Primary Care only No onsite support HIE integration is questionable Mostly 1 to 5 provider practices Limited ability to add new clients because of staff Limited financials Proprietary Clinical Knowledge base Limited VARs - limited Sales team One office one support No Speaking Invites and not much visibility anymore Not MU Stage 2 Certified yet Top Management just changed over Company might be primed to be sold Source: AC Group, Inc. 30

31 Amazing Charts $7.2 M Implementation No on-site support, but a practice can hire outside firm to help AC teams does not know PM functions Most have PM product working from a separate vendor first Practice specific primary care database makes implementation easier Assumes all practices have the same workflow not good Sign up today and start using tomorrow Minimal functionality so easy to learn Support End-user satisfaction levels regarding support is strong, top 5 Good call center but it s taking longer to get responses Fast support calls but it s taking longer to get responses Concern with long-term viability Product is not Stage 2 MU Certified already yet Not sure how support will improve or become an issue with Stage 2 Aprima $39 Million Strengths Top 10 EMR Functionality Top 10 PMS Functionality Very easy to use They took over most of the Allscripts MyWay clients Over 5,500 physicians Over 1,200 Providers attested TCO is around $42,000 for five years Great DEMOs they make it look easy Integrated PMS/EMR Great Looking PMS that is fully integrated with EHR Strong showing in KLAS reports Web Hosted for practices less than 3 Very smart staff with strong workflow knowledge Weaknesses HIE integration is questionable Mostly 1 to 5 provider practices Limited ability to add new clients because of staffing Limited financials Proprietary Clinical Knowledge base Limited VARs - limited Sales team One office one support No Speaking Invites Source: AC Group, Inc. 31

32 Aprima $39 Million Implementation Average of 20 hours per site plus 5 hours for practices with more than 3 physicians On-site team has strong practical experience within actual practices Usually one person understands both the PM and the EHR side Incremental approach towards implementation which is preferred but they push for Big Bang Practice specific database makes implementation easier Support End-user satisfaction levels regarding support is decreasing, but still in the top 10 Good call center but it s taking longer to get responses Fast support calls but it s taking longer to get responses Product is Stage 2 MU Certified already athenahealth $422.3 M Strengths Weak EMR Functionality Top Ranked PMS Functionality Designed for 1 to 15 providers Top Ranked KLAS Over 10,000 Physicians Over 4,500 Providers attested RCM offering only not selling software Billing RCM at 3.2% and full PM/EHR/PHR at 5.3% Good for Primary Care and Internal Medicine Product is Stage 2 MU Certified already Great Visibility top 5 list Integrated PMS/EMR Remotely Hosted Weaknesses Not strong for most specialists EHR is weaker than the majority of the big vendors HIE integration is questionable Most outsource your billing which limits marker share Very little on-site support One database for all clients Large % of RCM work is outsourced to India Most clients not using EHR, only RCM process for PM Source: AC Group, Inc. 32

33 athenahealth $422.3 M Implementation Average of 10 hours per site plus 2 hours for practices with more than 3 physicians On-site team has PM experience within practices but limited EHR expertise Usually one person understands both PM and EHR side One of the highest end-user satisfaction levels regarding implementation Majority of time is spent in PM implementation Support EHR is not strong for most specialists One of the lowest end-user satisfaction levels regarding support. Demo s are PM oriented Great support on PM Great support for RCM Weak support for EHR since they are not EHR experts Cerner $2.67B Strengths Middle valued EMR Functionality Weak PMS Functionality Designed for large multi-specialty practices with over 75 providers Over 6,900 Providers attested TCO is around $45,000 for five years Large HIT Company Massive Marketing Associated w/ 1000 Hospitals Best Hospital Clinical Strong Hospital designed EMR Product is Stage 2 MU Certified already Weaknesses Non Integrated PMS/EMR Product looks older Not strong for most specialists HIE integration is questionable Sell to hospital CIOs Sell to Hospital Execs Lost trust of the larger physician community Major lawsuit outstanding that could hurt the company Large % of Patient Accounting products have been deinstalled prior to 2010 Source: AC Group, Inc. 33

34 Cerner $2.67B Implementation Average of 200 hours per site plus 4 hours for practices with more than 80 physicians On-site team has experience within large practices Usually one person understands PM and a different person for the EHR side Big Bang approach towards implementation which is not preferred Support Non Integrated PMS/EMR Product looks very older Not strong for most specialists Mid level end-user satisfaction levels regarding support. Good call center Fast support calls Powerworks for small practices PowerChart for Large groups with Hospital affiliation eclinicalworks $293M Strengths Top 5 EMR Functionality Top 10 PMS Functionality Very easy to use Large practice base for small, mid, and large practices Over 60,000 physicians Over 15,500 Providers attested TCO is around $38000 for five years Massive Marketing Associated w/ 100 Hospitals Large support team Great DEMOs Offering PM/EHR and RCM at 2.9% Integrated PMS/EMR Very happy client base but most between 2 and 15 providers Weaknesses Delivered with one multi-specialty database which means each client must set up their database based on their specialty HIE integration is questionable Sell to hospital CIOs Lost trust of the larger physician community Major issues with foreign languages and accent It appears that > 70% of the staff have never worked in a US physician Office Very smart staff but not workflow smart Appears like an Indian-Based company No real sales team Source: AC Group, Inc. 34

35 eclinicalworks $293M Implementation Average of 40 hours per site plus 4 hours for practices with more than 3 physicians Average of 200 hours per site plus 4 hours for practices with more than 10 physicians On-site team has very little practical experience within actual practices Usually one person understands PM and a different person for the EHR side Big Bang approach towards implementation which is not preferred Support Mid level end-user satisfaction levels regarding support. Good call center Fast support calls 50% of cost of Stronger Vendors Revenue growth of 300% per year Product is Stage 2 MU Certified already e MDS $30 Million Strengths Top 10 EMR Functionality Top 10 PMS Functionality Very easy to use Over 5,500 physicians Over 2,800 Providers attested TCO is around $44,000 for five years Great DEMOs they make it look easy Integrated PMS/EMR Great Looking PMS that is fully integrated with EHR Strong showing in KLAS reports Highest Rating with AAFP for years Web Hosted for practices less than 3 Very smart staff with strong workflow knowledge Weaknesses HIE integration is questionable Mostly 1 to 5 provider practices Limited ability to add new clients because of staffing Limited financials Proprietary Clinical Knowledge base Limited VARs - limited Sales team One office one support No Speaking Invites and not much visibility anymore They have lost their market share visibility with most practices Company is believed to be up for sale for years Not MU Stage 2 Certified yet Source: AC Group, Inc. 35

36 e MDS $30 Million Implementation Average of 30 hours per site plus 5 hours for practices with more than 3 physicians On-site team has strong practical experience within actual practices Usually one person understands both the PM and the EHR side Incremental approach towards implementation which is preferred but they push for Big Bang Practice specific database makes implementation easier Assumes all practices have the same workflow not good Support End-user satisfaction levels regarding support is decreasing, but still in the top 5 Good call center but it s taking longer to get responses Fast support calls but it s taking longer to get responses Product is not Stage 2 MU Certified already yet EPIC Healthcare $1.5 Billion Strengths Typically sold to 250 Providers practices and larger They own the IDN Marketplace They own the University Marketplace Only competition is Cerner Top EMR Functionality for clinics and Hospitals Very easy to learn and is taught in 70% of the medical schools Over 74,000 physicians Over 41,700 Providers attested TCO is around $70,000 for five years Massive Marketing Associated w/ 100 Hospitals Weaknesses Delivered with one multi-specialty database which means each client must set up their database based on their specialty HIE integration is questionable Sell to hospital CIOs No real sales team High Price Limited Availability All or nothing MUMPS database No Speaking Invites > 250 Physicians Open database everyone sees all data Source: AC Group, Inc. 36

37 EPIC Healthcare $1.5 Billion Implementation Average of 800 hours per site plus 4 hours for practices with more than 250 physicians On-site team has very strong practical experience within actual practices Usually one person understands PM and a different person for the EHR side Big Bang approach towards implementation which is not preferred Product is Stage 2 MU Certified already Support Highest support ranking every year Good call center Fast support calls Revenue growth of 30% per year Judy s way: or no way Strong model for support GE Medical $293 M Strengths Top 5 EMR Functionality Top 10 PMS Functionality Very easy to use Large practice base for small, mid size Over 60,000 physicians Over 7,900 Providers attested TCO is around $58,000 for five years Losing Association w/hospitals Lost Providence Hospitals and Intermountain healthcare Large support team via VARS Great DEMOs Integrated PMS/EMR Mid level happy customers Weaknesses HIE integration is questionable Lost trust of the larger physician community No real sales team left within GE - Mostly VARS Inconsistent support and implementation approaches Not selling to small practices anymore GE appears to have left the ambulatory market even though they have a number of practices using the software GE owns the data and sells practice data to Pharma Source: AC Group, Inc. 37

38 GE Medical $293 M Implementation On-site team has very little practical experience within actual practices Usually one person understands PM and a different person for the EHR side Big Bang approach towards implementation which is not preferred Product is Stage 2 MU Certified already Support Mid level end-user satisfaction levels regarding support. Good call center Fast support calls Long term vision and support is questionable Greenway Medical $124 Million Strengths Top 5 EMR Functionality Top 5 PMS Functionality Very easy to use Over 10,000 physicians Over 4,800 Providers attested TCO is around $65,000 for five years Great DEMOs they make it look easy Integrated PMS/EMR Great Looking PMS that is fully integrated with EHR Large OB/GYN client base Entering Neurology Specialty Very smart staff with strong workflow knowledge Weaknesses with one multi-specialty database which means each client must set up their database based on their specialty HIE integration is questionable Lost trust of the larger physician community Sales have slowed in the past 6 months Questions on financial viability RCM offering does not seem to be taking off costs to high Source: AC Group, Inc. 38

39 Greenway Medical $124 Million Implementation Average of 80 hours per site plus 5 hours for practices with more than 5 physicians On-site team has strong practical experience within actual practices Usually one person understands both the PM and the EHR side Incremental approach towards implementation which is preferred Practice specific database makes implementation easier Support End-user satisfaction levels regarding support is decreasing, but still in the top 5 Good call center Fast support calls Product is Stage 2 MU Certified already NextGen $429.8 Million Strengths Top 3 EMR Functionality Top 7 PMS Functionality Over 60,000 physicians Over 14,750 Providers attested TCO is around $70,000 for five years Integrated PMS/EMR Great Looking PMS that is fully integrated with EHR Strong showing in KLAS reports Great 3 rd party validated case studies Strong Technology Strong Financials Numerous Speaking Invites Sales Team of 38 Over 1,000 clinical templates Very smart staff with strong workflow knowledge They have a new GUI coming out in 2014 Weaknesses HIE integration is questionable Limited ability to add new clients because of staffing Financials are not looking good Proprietary Clinical Knowledge base One office one support Very poor DEMOs they want to show everything and they confuse the end users High cost for implementation and very few hours on site Major issues with actual implementations Major complaints with add on costs PM product GUI is very old RCM offering to costing Source: AC Group, Inc. 39

40 NextGen $429.8 Million Implementation Average of 150 hours per site plus 5 hours for practices with more than 5 physicians However, only about 20% is on site Average 20 physician practice will be charged over $40,000 just for off-site project manager support On-site team has strong practical experience within actual practices Usually one person understands PM and another on the EHR side Big Bang approach towards implementation which is not preferred Practice specific database makes implementation easier Support End-user satisfaction levels regarding support is decreasing, and is in the bottom 10 Good call center but it s taking longer to get responses Fast support calls but it s taking longer to get actual corrected responses Product is Stage 2 MU Certified already Major issue for 20013/14 that NextGen is working on Practice Fusion $134 M Strengths Free Product Revenue comes from sell data and advertising Very easy to use NO onsite support EHR light product that meets Stage 1 MU needs but not much more Great at helping clients get MU dollars Over 9,000 physicians Over 5,500 Providers attested Great DEMOs they make the EHR look easy because functionality is weak Strong showing in KLAS reports All Web Hosted Weaknesses EHR is very weak for Stage 2 and Stage 3 needs No integrated PM product No onsite support HIE integration is questionable Mostly 1 to 5 provider practices Limited ability to add new clients because EHR is weak Limited financials Proprietary Clinical Knowledge base Limited VARs - limited Sales team One office one support No Speaking Invites and not much visibility anymore Not MU Stage 2 Certified yet Source: AC Group, Inc. 40

41 Practice Fusion $134 M Implementation No on-site support, but a practice can hire outside firm to help Practice Fusion teams does not know PM functions Most have PM product working from a separate vendor first Practice specific database makes implementation easier Assumes all practices have the same workflow not good Designed for Internal Medicine not good for specialists Sign up today and start using tomorrow Minimal functionality so easy to learn Support End-user satisfaction levels regarding support is strong, top 5 Good call center but it s taking longer to get responses Fast support calls but it s taking longer to get responses Concern with long-term viability Product is not Stage 2 MU Certified already yet Not sure how support will improve or become an issue with Stage 2 Source: AC Group, Inc. 41