May 2010 Non-Provider Price: $14,850 CPOE: Traffic Jams on the Road to Meaningful Use

Transcription

1 May 2010 Non-Provider Price: $14,850 CPOE: Traffic Jams on the Road to Meaningful Use

2 Executive Overview CPOE: Traffic Jams on the Road to Meaningful Use T A B L E O F C O N T E N T S PAGE SECTION 4 EXECUTIVE OVERVIEW How do the vendors stack up? Worth knowing The bottom line on vendors CPOE: Traffic jams on the road to meaningful use Going the distance Community hospital CPOE entering the on-ramp or just turning the key McKesson and MEDITECH stalled by upgrades and functionality Siemens refueled and back on the road GE and QuadraMed stranded on the shoulder Cerner, Eclipsys, Epic life in the fast lane Conclusion: Life after meaningful use Vendor performance overviews 17 VENDOR BRIEFS Cerner HMS CPSI McKesson Eclipsys MEDITECH Epic QuadraMed GE Siemens Healthland 69 EXPANDED RESULTS (75+ PAGES) CPOE Digest 2010 I 1

3 HOW DO THE VENDORS STACK UP? Figure 1: Inpatient CPOE Hospital Growth 2008 to 2010 Cerner CPSI Eclipsys SCM Eclipsys TDS Epic GE Centricity GE LastWord Healthland HMS McKesson MEDITECH C/S MEDITECH MAGIC QuadraMed CPR Siemens Invision Siemens Soarian Other 2008 CPOE Hospitals Verified 2009 CPOE Hospitals Verified 2010 CPOE Hospitals Verified WORTH KNOWING Figure 1 CERNER, EPIC, ECLIPSYS CONTINUE TO LEAD. With the most hospitals live on CPOE, the highest client satisfaction, and the deepest physician adoption, these three vendors have become more successful with CPOE than has any other vendor. While Cerner has the most hospitals live, Eclipsys and Epic boast the highest percentage of their own clients live. Cerner and Epic clients are happier the more deeply they adopt CPOE. However, even these leading vendors will need to run faster than historical trends for their installation base to receive the earliest possible payments for achieving meaningful use. MEDITECH AND MCKESSON BEHIND THE EIGHT BALL. Currently, both MEDITECH and McKesson customer bases are significantly upgrading versions to improve physician adoption. However, these vendors have large customer bases and slow CPOE rollout to date. Their clients need to roll out CPOE over 31 times faster than they have in the past year if all are to achieve CPOE adoption before July 1, COMMUNITY HOSPITALS ARE CONCERNED, AND RIGHTLY SO. Of the more than 4,000 U.S. hospitals with fewer than 200 beds, 89 percent are not live on CPOE. Only MEDITECH and CPSI are making real headway. Providers commonly report difficultly using available products on a deep level. SIEMENS SOARIAN GAINING SPEED. Stuck at three since 2005, Siemens grew to ten Soarian hospitals live with CPOE this year. Providers say Soarian CPOE works but is still maturing. 2 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

4 Executive Overview THE BOTTOM LINE ON VENDORS CERNER: Among CPOE market leaders. Two-thirds of customers still need to adopt; but at Cerner s pace, adoption traffic jams are less likely. Overall product satisfaction increases with depth of CPOE usage. CPSI: One of top-two CPOE solutions in community space, but with low physician satisfaction. CPSI has shown strength in facilitating light to medium adoption, but customers working towards full CPOE are generally struggling. ECLIPSYS: Eclipsys has significant CPOE experience and the highest percentage of their own customer base live. While some customers have worries about Eclipsys ability to deliver in other areas, customers do not report worries about making CPOE adoption in time for ARRA. EPIC: Given current adoption speed, Epic is the best on track to deliver CPOE to all, or nearly all, customers by Supports widely with deep adoption; more physicians use this system than any other system. Medication administration is strong. GE: No net growth in three years. Some movement from LastWord to Centricity. Improved usability could bolster adoption. HEALTHLAND: Making some progress in community hospitals. Like most in this space, product is not yet mature. Improvements are ongoing. Many customers left to adopt a newly maturing solution. HMS: Product only out for a year, but users see progress. Functionality not conducive to physician workflow. Many customers left to adopt a relatively immature solution. MCKESSON: Huge percentage of client base still not live. Implementation of v.10.3 could increase CPOE go lives. Overall satisfaction with this product trending slightly downward. MEDITECH: Added more new CPOE-live organizations than any other vendor in Less than 10 percent of its extensive customer base live with CPOE. Customer anxiety in reaching CPOE in time for ARRA remains high. Older versions of CPOE are generally poorly adopted by physicians. QUADRAMED: CPOE base has not grown significantly in years. Difficult to retain customers; some are looking to other solutions. SIEMENS: New platform is more mature and compelling for providers, with technology now broadly adoptable. Jump from 3 to 10 CPOE-live hospitals in Of CPOE hospitals, 80 percent still entering less than half of their orders electronically. CPOE Digest 2010 I 3

5 Figure 1 2: Estimated Percent of Total Client Base Doing CPOE Eclipsys Epic QuadraMed Cerner GE 26% 31% 44% 43% 52% Currently Marketed Product Only Siemens MEDITECH 9% 13% Based on estimated market share (all hospital sizes) CPSI McKesson 8% 9% Healthland HMS 1% 2% 0% 10% 20% 30% 40% 50% 60% Figure 2 CPOE: TRAFFIC JAMS ON THE ROAD TO MEANINGFUL USE Healthcare organization s that have not yet adopted computerized physician order entry (CPOE) have plenty of company. Only 14 percent of U.S. hospitals have achieved the expected 10% CPOE level required for Stage 1 of meaningful use (MU). The other 86 percent of hospitals have just over a year until July 1, 2011, the latest date for early MU payments. (While full reimbursement is expected to be possible by as late as July 3, 2013, this research will focus on the initial July 1, 2011 date for MU payments.) Clearly, it is rush hour for hospitals trying to meet MU. For hospitals trying to maneuver through, where are the traffic jams? What is causing them? What is the likelihood that resources are available and the software mature enough to achieve sufficient CPOE use by mid-2011 with deep adoption thereafter? To answer these and other questions, KLAS gathered CPOE data from many Canadian hospitals and virtually every U.S. hospital (excluding military or VA) that were live with a commercial CPOE product through These 481 interviews represent the 804 hospitals included in this 2010 CPOE report. GOING THE DISTANCE While the introduction to this report emphasizes urgency in reaching 10 percent CPOE usage by July 1, 2011, achieving that goal represents only the beginning of a hospital s CPOE journey. Of 4 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

6 Executive Overview the hospitals in this study reporting CPOE usage, over 90 percent have already passed the 10-percent mile marker. The next and perhaps more difficult question is when each organization will be able to make CPOE an integral part of the workflow. For example, only two-thirds of organizations with CPOE are doing more than half of orders via CPOE, with notable variation between different vendor solutions. For perspective, this report represents the depth of adoption as the percentage of orders done via CPOE pilot (0 15 percent), moderate (16 50 percent), significant (51 85 percent), and deep (over 86 percent). COMMUNITY HOSPITAL CPOE ENTERING THE ON-RAMP OR JUST TURNING THE KEY Less than 12 percent of community hospitals have adopted CPOE, and those who have show generally shallow adoption. If all community hospitals were to implement CPOE in time for the earliest possible payment, more than eight community hospitals would need to go live on CPOE every day from June 1, 2010, to July 1, This statistic is even more startling considering that, of community-hospital focused CIS vendors, only CPSI and MEDITECH have more than six hospitals live. Providers in this space using HMS, Siemens MS4, McKesson Paragon, Healthland, and Keane seem restless and concerned, as their vendors have been slow to demonstrate the ability to deliver CPOE: I went to one of [my vendor s] user conferences and waited to hear that they are getting their customers to meaningful use levels. I would have liked to hear about facilities that are already successful, but instead, all I heard was While government set meaningful use dates and requirements are still subject to change, KLAS is referencing the proposed requirements and dates made public by CMS on January 13, 2010 for the analysis of this report. While a provider organization is expected to be able to receive full ARRA reimbursement if Stage 1 is met as late as July 3, 2013, the date of July 1, 2011 allows hospitals the greatest flexibility in meeting Stage 2 and 3 deadlines. their promise that their customers won't get penalized. It should be noted that more than 200 community hospitals are using Cerner Millennium, Eclipsys SCM, Epic EpicCare, or McKesson Horizon for CPOE. However, with the exception of Cerner, none of these vendors are actively selling these products to the smallest community hospitals. Entering the on-ramp. When it comes to CPOE, most vendors serving community hospitals are just ramping up: CPSI This vendor has by far the broadest reach in the community hospital space, with 59 hospitals, or up to 10 percent of its CPOE Digest 2010 I 5

7 Percent of U.S. Hospitals Under 200 Beds Doing CPOE Figure 3 Figure 3: Percent of Community Hospitals Live on CPOE vs. Percent of Community Market Share Estimated market share own client base, live on CPOE (an increase of more than one-third since 2008). Adoption at these facilities is generally shallow. Only 41 percent of CPSI hospitals are using CPOE for more than half of orders, but almost 70 percent have achieved the minimum depth required by ARRA for This success suggests that CPSI can help clients meet initial ARRA standards; however, deeper use may be hindered by missing functionality and usability. Physician satisfaction with CPSI s CPOE is significantly below the market-average satisfaction. Users frustration increases with depth of use, raising questions about whether CPSI represents a viable longterm strategy or will only satisfy Stage 1 or Stage 2 MU objectives for CPOE. Hospitals that take the time to pre-build order sets generally have more adoption success. 70% 60% 50% 40% 30% 20% 10% 0% GE Quadramed Eclipsys Siemens Soarian Epic Siemens Invision Cerner Siemens MS4 Healthland McKesson Paragon McKesson Horizon Healthland Their CPOE has rolled out slowly and is now live at five hospitals, or less than 3 percent of their clients. Adoption at these facilities is moderate to deep, with 80 percent of physicians doing at least some CPOE and three of their five organizations using CPOE for the majority of orders. With Healthland redesigning their CPOE software, some clients are interested in improved functionality but are wary of possible complications. One provider commented, Healthland is aware that their CPOE functionality has not been well received by physicians. I know Healthland is working to redesign their CPOE under a.net framework. There are a lot of possibilities for failure when keeping up with MU and CCHIT along with switching out a current platform. CPSI HMS MEDITECH 0% 5% 10% 15% 20% 25% 30% Percent of U.S. Market Share (Under 200 Beds) Average 6 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

8 Executive Overview Figure 4: Depth of Use at Average CPOE Site Maximum of 25 for each category. Average depth of use for each category was divided by 4 to give it a 100 pt scale % Doing Barcoding % MDs Entering Notes Electronically % of All Patient Orders MDs Enter % MDs Doing CPOE 0 Figure 4 Figure 4 HMS This vendor s CPOE only appeared on the scene last year and is now live at five hospitals, or less than 1 percent of HMS facilities. Providers view HMS CPOE as one more feature in a fully integrated system, but comment that usability is lacking at this point. In fact, problems with CPOE functionality have earned HMS the lowest physician satisfaction in this study. One provider commented, The medication ordering process is pretty tedious for physicians to sit down and work through. I wish we could do something to streamline the medication ordering process. The process is workable, but for a busy physician, there won t be a lot of affinity for the medication ordering. Despite these challenges, many HMS sites report interest in adopting CPOE as functionality improves. Cerner Unlike competitors who use different products to reach the smallest community hospitals (such as McKesson with Paragon and Siemens with MS4), Cerner has recently begun bringing hospitals live as part of their CommunityWorks system, a completely hosted, less customizable version of PowerChart and other Cerner applications. There are not yet enough live hospitals to measure CPOE performance. However, many customers hope Cerner will be able to leverage their clinical and CPOE strength to help struggling community hospitals come live with advanced clinicals and CPOE. In the meantime, PowerChart CPOE is live at more than 80 community hospitals in the 50 to 200 bed range. CPOE Digest 2010 I 7

9 Figure 5: Percent of all Patient Orders 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Pilot/None Moderate Significant Deep Figure 5 Starting the ignition. Several vendors that serve community hospitals don t yet have their solutions all the way out the door: Keane KLAS was unable to verify CPOElive providers on any Keane platform. Many customers are worried about Keane s ability to support CPOE and meaningful use, and more than two-thirds of Keane customers interviewed are currently planning to leave this vendor. McKesson Paragon At the time research for this study concluded, McKesson Paragon had no hospitals live with CPOE. Since then, CPOE has become generally available. Four hospitals have come live and more are expressing interest in the release. One provider said, We are excited that the McKesson Paragon CPOE software has been scheduled for general release this year. McKesson understands the heightened need for this software. We must roll out CPOE soon or risk losing the stimulus money. Siemens MS4 CPOE functionality is still in development, with a few of Siemens 120 hospitals as test sites. We are already starting testing CPOE with Siemens, even though it is just in beta form right now. We are already building the scripts for it. We are also doing bedside medication administration as we speak. We will have Siemens pharmacy, lab, radiology, EHR, and bedside medication administration shortly. As a MedSeries4 client, we see this as a big win. 8 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

10 Executive Overview Figure 6 MCKESSON AND MEDITECH STALLED BY UPGRADES AND FUNCTIONALITY For McKesson and MEDITECH, having all their customers come live with CPOE by mid-2011 is simply a numbers game. Hampered by historically immature CPOE products, both vendors have been comparatively slow in rolling out CPOE. They have recently released significant upgrades that many customers see as essential for adopting CPOE. Despite increasing CPOE adoption over the past year, some doubt that McKesson s and MEDITECH s clients will all reach MU-level CPOE before Stage 1 deadlines, since these vendors have historically slow adoption, significant upgrades, and very large customer bases. In fact, if all MEDITECH s customers were to come live by July 1, 2011, the number of go lives per year would need to be roughly 36 times higher than in 2009, or nearly 100 hospitals per month. McKesson s numbers are slightly better, but they would still need to bring customers live at least 31 times faster than last year, or about 40 per month. MEDITECH Combining MAGIC and C/S, MEDITECH has seen significant CPOE growth, almost doubling its number of CPOE hospitals since Most new adopters have been C/S rather than MAGIC users, though many MAGIC clients would like to continue with MAGIC for the time being. CPOE adoption has been moderate in both systems, with more than half of C/S and MAGIC physicians doing at least some CPOE and more than half of C/S organizations using CPOE for the majority of orders (see figure 5). MEDITECH clients report two major roadblocks. First, many clients have not Figure 6: Percent of Total Orders Entered by MD, Recently Live Hospitals 100% 90% 80% 70% 60% 50% Pilot Moderate Significant Deep 3 7 Hospitals live in last year only. Currently marketed products. Must have at least 6 new hospitals. 40% 30% 20% 10% 0% Eclipsys SCM Cerner Epic CPSI MEDITECH MAGIC MEDITECH C/S McKesson Siemens Soarian CPOE Digest 2010 I 9

11 91% Percent of live CPOE hospitals that meet the minimum requirement for meaningful use reached versions 5.6 or 6, though they view the upgraded features as critical to CPOE success as MEDITECH has publically released plans to certify both MAGIC and C/S versions and 6 for MU. Second, MEDITECH has only 12 percent of their large CIS hospitals and 8 percent of their massive community-hospital base live on CPOE. Together, vendor and provider may be challenged to marshal sufficient resources to meet the 2011 deadline. One client commented, [MEDITECH is] scrambling because so many hospitals have to get CPOE in place. Their resources are stretched thin... We are still on v.5.5, and we will not move to v.5.6 until next summer. We have been on that list to move for over a year. McKesson Horizon This vendor has achieved a modest number of hospitals live, increasing with an impressive jump from 37 to 53 hospitals in the last year. However, only a third of CPOE-live organizations are using CPOE for more than half of orders. Even hospitals that mandate CPOE use are often unable to move past moderate (51 85 percent) CPOE usage. Some clients are reluctant to adopt CPOE before implementing v.10.3, McKesson s MU-certified version, since implementing CPOE and such a substantial upgrade at the same time could be very difficult. As one provider already live on version 10.1 said, I am pretty nervous about MU. Based on McKesson's ability to deliver the v.10 platform, I am worried about making it to v I cannot move forward and implement CPOE and v.10.3 simultaneously. We thought we were in a good place before, but now we are not feeling so confident. SIEMENS REFUELED AND BACK ON THE ROAD After struggling to boost stagnating CPOE adoption for years, Siemens Soarian grew from three to ten CPOE-live hospitals this year, largely fueled by rolling out Soarian C6. CPOE organizations report that the product is usable but not fully mature. One organization noted, It was a bumpy ride to get CPOE up and live with medication orders, and there are still some feature-function challenges with regard to integration between Soarian and Siemens Pharmacy. There are some things we want Siemens to add, but we will continue rolling out CPOE. At this point, the greatest concern for current and prospective Soarian customers is whether Siemens has enough consultants to help clients come live with the product within MU timelines. GE AND QUADRAMED STRANDED ON THE SHOULDER GE Centricity and QuadraMed CPR have small CPOE installation bases, and neither is growing fast. GE has seen no net gain or loss in the number of live CPOE hospitals in the last three years. QuadraMed has achieved only one net addition since Clients of both vendors have achieved adoption depth close to the market average. 10 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

12 Executive Overview Figure 7: Organizations Doing Both BPOC and CPOE (BPOC and CPOE must be with the same vendor) Number of Organizations doing CPOE Number of Organizations doing Closed Loop Figure 7 CERNER, ECLIPSYS, EPIC LIFE IN THE FAST LANE Teamed up with the most MU-ready vendors in the market, Cerner, Eclipsys, and Epic customers express the least concern and the most confidence in meeting MU standards. Most hospitals live: Cerner Cerner boasts the most-installed CPOE solution, with continuing, rapid growth keeping this vendor in first place. Adoption is wide and deep, with 81 percent of physicians doing at least some CPOE and 85 percent of CPOE organizations using CPOE for at least half of orders. Interestingly, clients rate Cerner higher the more deeply they adopt CPOE and full closed-loop medication delivery. Around two-thirds of Cerner s client base has yet to come live on CPOE. If all of their clients were to do so by mid-2011, customers would need to go live at about 30 per month. This is an intimidating task for Cerner s customer base, though Cerner has shown strength in allocating resources and expertise to bring customers live with CPOE. Highest client satisfaction: Eclipsys At 52 percent, Eclipsys has a higher percentage of their over 200-bed customer base live on CPOE than does any other vendor. In addition to widespread adoption, Eclipsys Sunrise Clinical Manager CPOE maintains the highest physician satisfaction rating of currently marketed products in this study. One provider illustrated the appeal of this product with the following comment, Our physicians do not have to go to CPOE Digest 2010 I 11

13 multiple places in the chart to do their work. They can do it from their document and fire off orders from their document. It really streamlines the workflow and the efficiency of the clinicians using the system. Despite their strong track record, Eclipsys has slowed in their CPOE rollout, with only nine new CPOE go lives over the past year. Several factors have contributed to slower CPOE rollouts, including a smaller candidate pool with so many customers already live on CPOE, customer preoccupation with other components such as pharmacy, and few new SCM sales year over year. Deepest physician adoption: Epic This vendor has achieved some of the most dramatic growth seen in the CPOE market, jumping from 37 to 140 hospitals live in only three years. Epic now boasts the most physicians using CPOE, including the most widespread ambulatory usage. Epic hospitals also average the deepest adoption in this study, with 92 percent of organizations using CPOE for at least half of orders. Given Epic s pace, they are on track to bring all or the majority of their customers live on CPOE before mid This would require CPOE go lives to quadruple in speed over last year, increasing to about 14 per month. As one Epic client put it, when we turned on CPOE, it was a big-bang implementation and everything went live. We came out of the chute on day one at 87 percent CPOE, and now we have this thing humming. Like Cerner s clients, Epic hospitals are happier with their EMR the more deeply they adopt CPOE. CONCLUSION: LIFE AFTER MEANINGFUL USE CPOE breadth and depth are increasing across most vendors; however, despite a government push to speed things up, the road to meaningful CPOE adoption will likely be challenging and slower for many providers. Most community hospitals are currently without a viable CPOE vehicle, with MEDITECH and CPSI as the only vendors with significant success in this space. In larger hospitals, many MEDITECH and McKesson clients are awaiting version upgrades before implementing CPOE. Neither GE nor QuadraMed has made significant progress in recent years, but Siemens Soarian is finally gaining speed after years of stagnation. Cerner, Eclipsys, and Epic are giving clients the greatest reason for confidence as MU deadlines approach. With so much on providers plates just to meet the Stage 1 deadlines, it is difficult to look even further down the road. However, what happens after the first MU deadline passes, and providers want to move beyond the minimum 10 percent CPOE adoption? Most vendors are capable of meeting this initial standard with at least some clients, but some products, including CPSI, MEDITECH, and McKesson, can be so challenging that clients question their ability to achieve long-term adoption that satisfies physicians. The demands on the healthcare IT market for both providers and vendors have never 12 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

14 Executive Overview been higher. While increased pressure can mean increased finger-pointing, the need for strong collaboration among vendors, consultants, and providers has never been greater. CPOE is only one of the estimated 23 objectives to meet Stage 1 of MU, but it is a very visible and difficult-to-achieve measurement, even though the final criteria have not yet been published. The next two years will show which products upgrade to an acceptable level, which vendors can truly partner with customers, and which vendors are simply going through the motions. Vendor Performance Overviews Download additional vendor information by clicking on a vendor name. Vendor Cerner Download Vendor Detail CPSI Download Vendor Detail Eclipsys Download Vendor Detail Provider Feedback BRAVO: Has experience, with more hospitals live on CPOE than other vendors. Holding lead with strong, continuous growth. Very deep adoption. Sites newly live with CPOE report strong CPOE go-live support and focus from Cerner. OUCH: Oncology ordering usage is still lagging. Low percentage of CPOE organizations doing BPOC, despite offering a functional BPOC solution. BOTTOM LINE: Among CPOE market leaders. Two-thirds of customers still need to adopt; but at Cerner s pace, adoption traffic jams are less likely. Overall product satisfaction increases with depth of CPOE usage. BRAVO: By far the most widespread vendor for CPOE among community hospitals. Shallow and initial CPOE adopters rate CPSI high. Strides in physician documentation and BPOC are impressive for the community-hospital space. OUCH: Low CPOE physician satisfaction. Some sites have lost ground, finding it difficult to keep physicians using CPOE. Difficult to persuade physicians to adopt deeply; overall customer satisfaction decreases with depth of CPOE adoption. BOTTOM LINE: One of top-two CPOE solutions in community space, but with low physician satisfaction. CPSI has shown strength in facilitating light to medium adoption, but customers working towards full CPOE are generally struggling. BRAVO: Has highest percentage among vendors of its own customer base live and highest customer satisfaction among currently marketed products. Relatively high adoption levels. A leader in complex ordering, especially for oncology. OUCH: BPOC rollouts playing catch up due to late product introduction. Three organizations doing both BPOC and CPOE reporting early success. BOTTOM LINE: Eclipsys has significant CPOE experience and the highest percentage of their own customer base live, due in part to high physician satisfaction with the product. While some customers have worries about Eclipsys ability to deliver in other areas, customers do not report worries about making CPOE adoption in time for ARRA. CPOE Digest 2010 I 13

15 Vendor Performance Overviews Download additional vendor information by clicking on a vendor name. Vendor Epic Download Vendor Detail GE Download Vendor Detail Healthland Download Vendor Detail HMS Download Vendor Detail McKesson Download Vendor Detail Provider Feedback BRAVO: Fastest growth in this study. Second-most CPOE hospitals of any vendor. Deepest CPOE adoption. By far the widest and deepest ambulatory adoption. Strong inpatient and outpatient integration. OUCH: Not all hospitals see Epic in their price range, nor will Epic consider all hospitals as potential customers. BOTTOM LINE: Given current adoption speed, Epic is the best on track to deliver CPOE to all, or nearly all, customers by Supports widely with deep adoption; more physicians use this system than any other system. Medication administration is strong. BRAVO: Deep adoption at some facilities. Good system reliability and uptime. Some organizations using both BPOC and CPOE. OUCH: Not expanding small client base. Slower system response time. Fewer doctors using CPOE at some facilities. Low overall satisfaction with GE s development and support. BOTTOM LINE: No net growth in three years. Some movement from LastWord to Centricity. Improved usability could bolster adoption. BRAVO: More than doubled the number of CPOE-live organizations this year to a total of five. Deep physician adoption at some facilities. Some physician documentation adoption. Early data suggests good system reliability and uptime. OUCH: No organizations closing the medication administration loop. Early data suggests slower system response time. Support sometimes frustrating for clients. BOTTOM LINE: Making some progress in community hospitals. Like most in this space, product is not yet mature. Improvements are ongoing. Many customers left to adopt a newly maturing solution. BRAVO: Doing CPOE and barcoding at a few organizations. Physician documentation progressing. Labs, pharmacy, order entry, documentation, charting can be integrated. OUCH: Lowest satisfaction in this study due to immature functionality. Early data suggests very slow response time. Generally, adoption does not hit 50 percent. BOTTOM LINE: Product only out for a year, but users see progress. Functionality not conducive to physician workflow. Many customers left to adopt a relatively immature solution. BRAVO: Biggest one-year jump yet recorded for McKesson. Over 80 percent of CPOE hospitals doing both CPOE and BPOC. Executive involvement satisfies some customers. OUCH: Few hospitals doing electronic physician documentation. Significant worry among customer base concerning installing v.10.3 and coming live with CPOE in time. BOTTOM LINE: Huge percentage of client base still not live. Implementation of v.10.3 could increase CPOE go lives. Overall satisfaction with this product trending slightly downward. 14 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

16 Executive Overview Vendor Performance Overviews Download additional vendor information by clicking on a vendor name. Vendor MEDITECH Download Vendor Detail QuadraMed Download Vendor Detail Provider Feedback BRAVO: Added more CPOE hospitals this year than ever before. Added more new organizations than any other vendor. For first time in years, majority of growth with C/S clients. Stable product. Widely deployed medication-administration system. OUCH: While adoption is growing, it continues to be shallow overall, with about 1500 U.S. clients and only 130 live on CPOE. MEDITECH offers more limited clinical CPOE go-live support than the other major players. BOTTOM LINE: Added more new CPOE-live organizations than any other vendor in Less than 10 percent of its extensive customer base live with CPOE. Customer anxiety in reaching CPOE in time for ARRA remains high. Older versions of CPOE are generally poorly adopted by physicians. BRAVO: Above-average depth-of-use among clients. BPOC increasing, although still relatively rare. OUCH: Smallest CPOE installation base of all large-hospital vendors. One net addition since Barcoding used by few clients. BOTTOM LINE: CPOE base has not grown significantly in years. Difficult to retain customers; some are looking to other solutions. Siemens Download Vendor Detail BRAVO: Number of CPOE-live hospitals increased from 3 to 10 this year. Release of C6 has increased provider interest and adoption. Very strong BPOC adoption boosts closed-loop efforts. OUCH: Weakest adoption among major vendors in this study. Difficult to find experienced support; some look to third-party consulting firms. Pharmacy interfaces have caused some to struggle. Physician documentation rare. BOTTOM LINE: New platform is more mature and compelling for providers, with technology now broadly adoptable. Jump from 3 to 10 CPOE-live hospitals in Of CPOE hospitals, 80 percent still entering less than half of their orders electronically. CPOE Digest 2010 I 15

17 CPOE REPORTING TEAM Jason Hess Jason Hess REPORT AUTHOR Clinical Team Steve Van Wagenen Taylor Davis Coray Tate Mark Allphin Colin Buckley Louise Cliche Karen Ondo CHIEF EDITOR Reporting Team Sam Eaquinto Dan Czech Trina Hsieh Evan Thomas Celeste Zsembery FOR QUESTIONS OR COMMENTS ON THIS REPORT, CONTACT: KLAS 630 E Technology Ave. Orem, UT Ph: Fax: Web: TO PURCHASE THE FULL VERSION OF THIS REPORT, LOG ON TO OUR STORE READER RESPONSIBILITY: This report is a compilation of data gathered from websites, healthcare industry reports, interviews with healthcare provider executives and managers, and interviews with vendor and consultant organizations. Data gathered from these sources includes strong opinions (which should not be interpreted as actual facts) reflecting the emotion of exceptional success and, at times, failure. The information is intended solely as a catalyst for a more meaningful and effective investigation on your organization s part and is not intended, nor should it be used, to replace your organization s due diligence. KLAS data and reports represent the combined opinions of actual people from provider organizations comparing how their vendors, products, and/or services performed when measured against participants' objectives and expectations. KLAS findings are a unique compilation of candid opinions and are real measurements representing those individuals interviewed. The findings presented are not meant to be conclusive data for an entire client base. Significant variables including organization/hospital type (rural, teaching, specialty, etc.), organization size, depth/breadth of software use, software version, role in the organization, provider objectives, and system infrastructure/network impact participants opinions, precluding an exact apples-to-apples vendor/product comparison or a finely tuned statistical analysis. We encourage our clients, friends and partners using KLAS research data to take into account these variables as they include KLAS data in their other due diligence. For frequently asked questions about KLAS methodology, please refer to the KLAS FAQs. COPYRIGHT INFRINGEMENT WARNING: This report, and its contents, are copyright protected works and are intended solely for your organization. Any other organization, consultant, investment company, or vendor enabling or obtaining unauthorized access to this report will be liable for all damages associated with copyright infringement, which may include the full price of the report and/or attorney s fees. For information regarding your specific obligations, please refer to the KLAS Data Use Policy. ABOUT KLAS: For more information about KLAS, please visit our website. OUR MISSION: KLAS mission is to improve the delivery of healthcare technology by independently measuring and reporting on vendor performance. 16 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price.

18 Vendor Briefs CPOE Digest 2010 I 17

19 CERNER MILLENNIUM POWERCHART Percent of U.S. Customer Base Doing CPOE 31% # of Orgs. Doing Both Barcoding and CPOE 18 Will I be successful with Cerner CPOE? Cerner continues to lead in having the most hospitals live with CPOE. Customers coming live with CPOE generally report a strong vendor/customer partnership. As one CMIO reported, We recently brought up a hospital with CPOE. It was our first CPOE activation, and it went very smoothly; it surpassed all our expectations and was well received by the physicians. This partly reflects on Cerner and the effort that we made in building this system for the hospital. It genuinely astonished all of us how immediately CPOE was adopted by the physicians. This reflects a good tool, a good build, and a good fit for our workflow. Can Cerner help me meet Stage 1 CPOE requirements for MU? While Cerner still has two-thirds of their customer base to bring live with CPOE, they have sustained an over 30-percent growth rate in their CPOE base for three years running. With a proven product and significant experience, Cerner is as well positioned as almost any vendor to help customers come live successfully. Beyond CPOE, can Cerner get me to BPOC and physician documentation? Customers who have closed the loop are very satisfied, but more than three-quarters of CPOE organizations have not yet adopted Cerner s barcoding solution. Those who have report good success. What is the future for Cerner? Cerner s strong CPOE performance thus far suggests that these hospitals have a fighting chance of meeting CPOE deadlines for MU. Additionally, Cerner clients become more satisfied with both the vendor and product as they adopt CPOE more deeply, highlighting that Cerner adoption benefits go beyond meeting MU requirements. Cerner has made significant improvements to the quality of their code over the past year, and customers are reporting overall higher satisfaction. Physician documentation is one area where providers report immaturity. Cerner is also expanding into the community arena with Cerner CommunityWorks. KLAS has not yet validated any of the hospitals live with this product. Millennium CPOE Non-CPOE Overall Score Product Quality Ease of Use Product Works as Promoted Proactive Service I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

20 Vendor Briefs Figure 8: Cerner: Raw Hospital Count Figure 9: Cerner: In addition to CPOE, what else are you doing? 100% 90% 80% 20 No Yes Overall % Yes 70% 60% 59 50% 40% 58 30% 20% 10% 18 0% Physician Documentation Barcoding One organization doing barcoding is using a vendor other than Cerner. CPOE Digest 2010 I 19

21 Figure 10: Cerner: Breakdown of CPOE Use (inpatient n=181, ambulatory n=24) 100% 3% 4% 2% 8% 7% 90% 25% 21% 80% 38% 33% 70% 8% 51% 25% 60% 25% 33% 50% 40% 30% 20% 10% 0% 57% 67% Pilot/None Moderate Significant Deep % Deep Overall 40% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory 50% 35% 9% 18% 4% 38% Figure 11: Cerner: Physician Satisfaction, Response Time, System Reliability % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically Physician Satisfaction Response Time Reliability/Uptime I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

22 Vendor Briefs Figure 12: Cerner: Ratings vs. CPOE Vendor Average 9 8 Average Physician Satisfaction with CPOE System Response Time System Reliability & Uptime CPOE Digest 2010 I 21

23 CPSI CLINICALS Percent of U.S. Customer Base Doing CPOE 9% # of Orgs. Doing Both Barcoding and CPOE 44 Will I be successful with CPSI CPOE? While most community-focused vendors are just coming live with their first hospitals, CPSI has been doing CPOE at some of its hospitals for well over five years. With more than 50 hospitals live with CPOE today, CPSI is holding its lead in the community CPOE game. Despite this experience, many CPSI clients report frustration reaching and maintaining deep CPOE adoption with CPSI. Only six hospitals, or just over 10 percent of CPSI hospitals with CPOE, have achieved deep adoption. Some hospitals have gone backwards since last year, doing fewer orders via CPOE, or stopping CPOE altogether, often complaining that the system is difficult to use. CPSI customers also report frustration with buggy code, as CPSI works to update their platform from the older COBOL code to a Web-based product. Even with CPSI s CPOE experience, not all customers are confident that they will be able to meet all the other MU requirements. Can CPSI help me meet Stage 1 CPOE requirements for MU? Seventy percent of CPSI CPOE hospitals have achieved the 10 percent depth required for Stage 1 MU. Interestingly, a higher percentage of ambulatory than inpatient sites have accomplished deep CPOE use. While CPSI has 42 percent of their CPOE hospitals entering the majority of their orders via CPOE, many others report that they will be stuck at shallow adoption until CPSI delivers better CPOE physician functionality. Beyond CPOE, can CPSI get me to BPOC and physician documentation? Only a small group (about 20 percent) of CPOE hospitals are doing physician documentation, while about 80 percent are live with barcoding. This represents a significant achievement as many community-focused vendors still struggle to offer this functionality. What is the future for CPSI? While most CPSI customers for CPOE can reach 10 percent adoption, many report increased frustration as they attempt deeper adoption, suggesting that CPSI can satisfy the Stage 1 MU gap but may not represent a viable long-term strategy without significant product enhancements. Clinicals CPOE Non-CPOE Overall Score Product Quality Ease of Use Product Works as Promoted Proactive Service I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

24 Vendor Briefs Figure 13: CPSI: Raw Hospital Count Figure 14: CPSI: In addition to CPOE, what else are you doing? 100% 90% 80% No Yes Overall % Yes 10 70% 60% 43 50% 40% 44 30% 20% 10% 11 0% Physician Documentation Barcoding CPOE Digest 2010 I 23

25 Figure 15: CPSI: Breakdown of CPOE Use (inpatient n=59, ambulatory n=7) 100% 90% 80% 70% 60% 50% 36% 24% 14% 57% 41% 20% 57% 81% Pilot/None Moderate Significant Deep % Deep Overall 71% 40% 30% 20% 10% 0% 14% 20% 29% 14% 29% 29% 9% 20% 5% 14% 10% 5% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory Figure 16: CPSI: Physician Satisfaction, Response Time, System Reliability % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically Physician Satisfaction Response Time Reliability/Uptime I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

26 Vendor Briefs Figure 17: CPSI: Ratings vs. CPOE Vendor Average 9 8 Average Physician Satisfaction with CPOE System Response Time System Reliability & Uptime CPOE Digest 2010 I 25

27 ECLIPSYS SCM Will I be successful with Eclipsys CPOE? Percent of U.S. Customer Base Doing CPOE 52% # of Orgs. Doing Both Barcoding and CPOE 9 Of vendors, Eclipsys is able to boast the highest percentage of their own customer base live on CPOE. Eclipsys has experienced steady growth with Sunrise Clinical Manager since 2003, bringing nine new clients live over the last year. Though they were the 2007 market leader in hospitals live with CPOE, Eclipsys has since been surpassed by Cerner, Epic, and MEDITECH. Physicians continue to report high satisfaction with Eclipsys CPOE. This system is also one of the most advanced on the market when it comes to complex ordering and alerting. Can Eclipsys help me meet Stage 1 CPOE requirements for MU? Adoption levels for current customers using Eclipsys are generally high, with 79 percent of physicians across all Eclipsys CPOE hospitals doing at least some CPOE and 83 percent of organizations entering the majority of orders electronically. One provider illustrated their depth of adoption with this comment, The product is very solid. We have close to 80 percent CPOE usage. The only place we don t use CPOE is in the ICU, and that should be coming live in the next few months. The doctors have been big advocates. Beyond CPOE, can Eclipsys get me to BPOC and physician documentation? Eclipsys has made some definite strides toward closing the loop at their CPOE sites. Eclipsys boasts the third-highest number of organizations doing physician documentation, and KBMA, their BPOC offering, has rolled out to several more sites this year. Despite this growth, BPOC adoption is still lagging far behind the industry average. What is the future for Eclipsys? Eclipsys has proven that they are able to deliver when it comes to CPOE. However, many of Eclipsys more advanced customers are struggling in some areas beyond CPOE, such as vendor support or Eclipsys ambulatory offerings. The majority of Eclipsys installation base has seen great progress toward the delivery of Sunrise Emergency Care and Sunrise Pharmacy, moving the Eclipsys offering towards a more complete enterprise solution. SCM CPOE Non-CPOE Overall Score Product Quality Ease of Use Product Works as Promoted Proactive Service I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

28 Vendor Briefs Figure 18: Eclipsys: Raw Hospital Count Eclipsys TDS Eclipsys SCM Figure 19: Eclipsys SCM: In addition to CPOE, what else are you doing? 100% 90% 80% 23 No Yes Overall % Yes 70% 60% 52 50% 40% 30% 39 20% 10% 0% Physician Documentation 8 Barcoding Six organizations doing barcoding are using vendors other than Eclipsys. CPOE Digest 2010 I 27

29 Figure 20: Eclipsys SCM: Breakdown of CPOE Use (inpatient n=102, ambulatory n=15) 100% 90% 80% 70% 60% 8% 9% 13% 20% 13% 7% 7% 7% 10% 23% 20% 40% Pilot/None Moderate Significant Deep % Deep Overall 63% 47% 50% 13% 40% 30% 71% 60% 61% 14% 13% 20% 10% 0% 33% 15% 27% 8% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory Figure 21: Eclipsys SCM: Physician Satisfaction, Response Time, System Reliability % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically Physician Satisfaction Response Time Reliability/Uptime I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

30 Vendor Briefs Figure 22: Eclipsys SCM: Ratings vs. CPOE Vendor Average Average Physician Satisfaction with CPOE System Response Time System Reliability & Uptime CPOE Digest 2010 I 29

31 Figure 23: Eclipsys TDS Summary Table In addition to CPOE, what else are you doing? Breakdown of CPOE Use (n=16) 100% 90% 80% 70% 60% 50% 40% 5 No Yes Overall % Yes 7 100% 90% 80% 70% 60% 50% 40% 30% 38% 63% 25% 6% 6% 100% Pilot/None Moderate Significant Deep % Deep Overall 30% 20% 3 20% 10% 31% 31% 10% 0% Physician Documentation 1 Barcoding 0% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically Physician Satisfaction, Response Time, System Reliability Physician Satisfaction Response Time Reliability/Uptime I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

32 Vendor Briefs EPIC EPICCARE INPATIENT Will I be successful with Epic CPOE? Percent of U.S. Customer Base Doing CPOE 44% # of Orgs. Doing Both Barcoding and CPOE 24 Epic is bringing CPOE clients live faster than any other vendor, more than tripling their number of CPOE-live hospitals since Epic currently has the second-largest CPOE client base, having passed up Eclipsys this year. Throughout their explosive growth, Epic has delivered what is perceived to be a highquality experience and a quickly maturing product. Echoing many others sentiments, one provider commented, The physicians are delighted with Epic's CPOE. The system is much easier to navigate than our old CIS was. EpicCare Inpatient EMR is very robust and gives the physicians a multitude of ways to do their work. The physicians loved breaking away from an old system that forced them to follow a screen-by-screen workflow. Can Epic help me meet Stage 1 CPOE requirements for MU? Epic delivers CPOE more deeply than anyone else, with 90 percent of physicians doing at least some CPOE and 92 percent of live organizations using CPOE for the majority of orders. One provider commented, We have 100 percent CPOE. We are an academic medical center, so our EpicCare Inpatient EMR had full adoption all at once. Over 90 percent of all orders are entered by the doctors. They began entering them on day one, while we were still going live with Epic. The ER doctors think it is fine to use too. Epic has also deepened adoption in their ambulatory facilities; 93 percent of ambulatory clinics report deep CPOE with 93 percent entering notes electronically. This accomplishment reflects the strong integration between Epic s inpatient and outpatient systems. Beyond CPOE, can Epic get me to BPOC and physician documentation? In November, 2007, Epic had only seven organizations live with barcoded medication administration. That number has since grown to 24 organizations (84 hospitals the highest number of closed-loop hospitals in this study), or just under half of Epic s live organizations, doing both medication administration barcoding and CPOE. Ninety-six percent of live organizations are also doing physician documentation far above the industry average. Feedback from the sites using Epic s medication-administration system has been very positive. While Epic s product is still maturing, it is very functional. What is the future for Epic? Epic CPOE users are satisfied, deep adopters, and the more deeply they use this system, the higher they rate the product overall. In addition, Epic has more ambulatory sites using CPOE and closing the medication-administration loop than any other vendor. While CPOE Digest 2010 I 31

33 a number of Epic hospitals still need to come live with CPOE, they have reason to be confident, given Epic s track record to date. EpicCare Inpatient CPOE Non-CPOE Overall Score Product Quality Ease of Use Product Works as Promoted Proactive Service I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

34 Vendor Briefs Figure 24: Epic: Raw Hospital Count Figure 25: Epic: In addition to CPOE, what else are you doing? 100% 90% 80% 70% 2 No Yes Overall % Yes 25 60% 50% 40% 46 30% 20% 24 10% 0% Physician Documentation Barcoding One organization doing barcoding is using a vendor other than Epic. CPOE Digest 2010 I 33

35 Figure 26: Epic: Breakdown of CPOE Use (inpatient n=140, ambulatory n=40) 100% 4% 3% 1% 3% 4% 3% 3% 5% 8% 90% 13% 80% 28% 21% 70% 8% 60% 5% 5% 28% 50% 94% 93% 40% 80% 30% 20% 10% Pilot/None Moderate Significant Deep % Deep Overall 68% 62% 62% 0% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory Figure 27: Epic: Physician Satisfaction, Response Time, System Reliability % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically Physician Satisfaction Response Time Reliability/Uptime I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

36 Vendor Briefs Figure 28: Epic: Ratings vs. CPOE Vendor Average 9 8 Average Physician Satisfaction with CPOE System Response Time System Reliability & Uptime CPOE Digest 2010 I 35

37 GE CENTRICITY ENTERPRISE & LASTWORD CLINICALS Will I be successful with GE CPOE? Percent of U.S. Customer Base Doing CPOE 26% # of Orgs. Doing Both Barcoding and CPOE 9 With the second-smallest CPOE installation base among hospitals with fewer than 200 beds in this study, GE has seen no net gain or loss in the number of CPOE hospitals in three years, though there has been a slight shift to Centricity as LastWord has been replaced. Can GE help me meet Stage 1 CPOE requirements for MU? In general, Centricity hospitals have achieved moderate to deep CPOE adoption. On average, two-thirds of physicians do at least some CPOE, and just over half of organizations use CPOE for a majority of orders. Adoption depth is slightly shallower than last year, which provider commentary suggests could be due to lack of functionality. One provider said, The ordering is missing functionality in the system. Physicians still would not want to do online text documentation if it were available. However, we could be at 100 percent CPOE if the system were a bit easier to manipulate. Beyond CPOE, can GE get me to BPOC and physician documentation? About half of both Centricity and LastWord clients less than the market average are doing physician documentation. Just over 60 percent of Centricity CPOE organizations are also doing BPOC. What is the future for GE? One current GE CPOE customer reported, Several years ago, our hospital invested tens of millions of dollars in GE. Every year since then, it costs another two to three million dollars to upgrade. The problem is that we do not get two or three million dollars' worth of value, and we certainly have not seen the value of our original sum. Of currently marketed acute EMR products that KLAS tracks, GE continues to be lowest-rated overall. A number of non-cpoe GE customers and at least one GE CPOE site plan to leave GE. Centricity Enterprise CPOE Non-CPOE Overall Score Product Quality Ease of Use Product Works as Promoted Proactive Service I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

38 Vendor Briefs Figure 29: GE: Raw Hospital Count GE LastWord GE Centricity Figure 30: GE Centricity: In addition to CPOE, what else are you doing? 100% 90% 80% 5 No Yes Overall % Yes 4 70% 60% 50% 40% 30% % 10% 0% Physician Documentation Barcoding CPOE Digest 2010 I 37

39 Figure 31: GE Centricity: Breakdown of CPOE Use (inpatient n=24) 100% 90% 25% 25% 80% 70% 8% 13% 60% 8% 75% 17% 50% Pilot/None Moderate Significant Deep % Deep Overall 40% 30% 20% 10% 58% 46% 4% 21% 0% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory Figure 32: GE Centricity: Physician Satisfaction, Response Time, System Reliability % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically Physician Satisfaction Response Time Reliability/Uptime I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

40 Vendor Briefs Figure 33: GE Centricity: Ratings vs. CPOE Vendor Average 9 8 Average Physician Satisfaction with CPOE System Response Time System Reliability & Uptime CPOE Digest 2010 I 39

41 Figure 34: GE LastWord/Legacy Summary Table In addition to CPOE, what else are you doing? Breakdown of CPOE Use (n=9) 100% 90% 80% 70% 60% 4 No Yes Overall % Yes 5 100% 90% 80% 70% 60% 22% 22% 22% 56% Pilot/None Moderate Significant Deep % Deep Overall 50% 40% 30% 50% 40% 30% 20% 78% 56% 33% 20% 10% 0% 3 Physician Documentation 2 Barcoding 10% 0% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically 11% Physician Satisfaction, Response Time, System Reliability Physician Satisfaction Response Time Reliability/Uptime I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

42 Vendor Briefs HEALTHLAND CLINICALS Will I be successful with Healthland CPOE? Percent of U.S. Customer Base Doing CPOE 2% # of Orgs. Doing Both Barcoding and CPOE 0 After six years of developing CPOE, Healthland has finally achieved a substantive step forward for CPOE adoption, jumping from two to five hospitals doing CPOE. However, this represents less than 2 percent of the current Healthland customer base. Customers live with Healthland CPOE report that some significant functionality gaps have yet to be filled. One director of nursing reported, Doing CPOE with Healthland has been interesting. It is like doing half CPOE, in reality. Their pharmacy system works well, so medication orders can be done electronically. However, the Healthland lab module is a real mess, so we don't do CPOE lab orders. Can Healthland help me meet Stage 1 CPOE requirements for MU? Customers report a high level of anxiety as they work with Healthland to reach MU requirements. One CIO, not live with CPOE, recently reported to KLAS, I believe it is going to be tight for Healthland to come through with all of the clinical requirements for meaningful use. Healthland has acknowledged they have been weak on getting physicians to adopt their physician order entry. Beyond CPOE, can Healthland get me to BPOC and physician documentation? While three Healthland CPOE customers also report doing some physician documentation, no CPOE sites are doing full closed-loop medication administration. What is the future for Healthland? More than 98 percent of Healthland hospitals have yet to go live on CPOE. One CFO recently reported, I think Healthland is going to have to achieve MU or they won t be in business, but the Healthland platform is just not intuitive. It doesn t take the users where they need to go. Achieving MU is one consideration, but getting the nurses and physicians to actually embrace the technology is another issue. Clinicals CPOE Non-CPOE Overall Score NA NA Product Quality NA NA Ease of Use NA NA Product Works as Promoted NA NA Proactive Service NA NA CPOE Digest 2010 I 41

43 Figure 35: Healthland: Raw Hospital Count Figure 36: Healthland: In addition to CPOE, what else are you doing? 100% 90% 80% 1 No Yes Overall % Yes 70% 60% 50% 5 40% 3 30% 20% 10% 0% Physician Documentation Barcoding 42 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

44 Vendor Briefs Figure 37: Healthland: Breakdown of CPOE Use (n=5) 100% 90% 20% 80% 40% 70% 20% 60% 25% 25% Pilot/None Moderate Significant Deep % Deep Overall 50% 40% 25% 30% 20% 60% 60% 10% 25% 0% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically Figure 38: Healthland: Physician Satisfaction, Response Time, System Reliability Physician Satisfaction Response Time Reliability/Uptime CPOE Digest 2010 I 43

45 Figure 39: Healthland: Ratings vs. CPOE Vendor Average 9 8 Average 8.2* 7 6.8* 6.8* Physician Satisfaction with CPOE System Response Time System Reliability & Uptime 44 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

46 Vendor Briefs HMS CLINICALS Will I be successful with HMS CPOE? Percent of U.S. Customer Base Doing CPOE 1% # of Orgs. Doing Both Barcoding and CPOE 3 Appearing on the CPOE scene only a year ago, HMS CPOE has grown from three to five hospitals since Two of the five hospitals are still using CPOE for less than 10 percent of orders, blaming immature CPOE functionality for some of their problems. One CPOE hospital recently reported, There are some improvements HMS could make for CPOE. The medication-ordering process is pretty tedious for physicians to sit down and work through. I wish we could do something to streamline the medication-ordering process. The process is workable, but for a busy physician, there won t be a lot of affinity for the medication ordering. Can HMS help me meet Stage 1 CPOE requirements for MU? Providers report that Healthland s CPOE functionality isn t conducive to an easy, natural workflow. One provider related this experience, We are on a major initiative to encourage our physicians to document electronically as opposed to dictating. The majority of our physicians are now entering their notes electronically, but when it comes to entering their orders electronically, they are not very pleased with the technology. Despite HMS still-developing CPOE functionality, many HMS clients are cautiously optimistic that they will reach Stage 1 MU in time. One CIO recently reported, HMS talks a good talk regarding meaningful use, but we have not seen the end product yet. However, HMS does guarantee that they will be able to meet all of the requirements. They actually did a little presentation recently where they walked through the 23 measures and outlined how they are going to meet all of them. It all sounds good. Beyond CPOE, can HMS get me to BPOC and physician documentation? Within its very small CPOE installation base, HMS is achieving decent success closing the medication administration loop; three of their five sites are using CPOE and BPOC. Three hospitals are also documenting physician notes electronically. What is the future for HMS? While less than 1 percent of current HMS customers are doing CPOE, many non-cpoe customers report plans to adopt in the near future. Customers perceive HMS as focusing strongly on overcoming current gaps to help customers meet MU requirements. Clinicals CPOE Non-CPOE Overall Score NA NA Product Quality NA NA Ease of Use NA NA Product Works as Promoted NA NA Proactive Service NA NA CPOE Digest 2010 I 45

47 Figure 40: HMS: Raw Hospital Count Figure 41: HMS: In addition to CPOE, what else are you doing? 100% 90% 80% 1 No Yes Overall % Yes 1 70% 60% 50% 40% % 20% 10% 0% Physician Documentation Barcoding 46 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

48 Vendor Briefs Figure 42: HMS: Breakdown of CPOE Use (n=5) 100% 90% 80% 40% 70% 60% 40% Pilot/None Moderate Significant Deep % Deep Overall 60% 50% 40% 40% 30% 60% 20% 20% 10% 20% 20% 0% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically Figure 43: HMS: Physician Satisfaction, Response Time, System Reliability Physician Satisfaction Response Time Reliability/Uptime CPOE Digest 2010 I 47

49 Figure 44: HMS: Ratings vs. CPOE Vendor Average 9 8.6* 8 Average * 5.0* Physician Satisfaction with CPOE System Response Time System Reliability & Uptime 48 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

50 Vendor Briefs MCKESSON HORIZON EXPERT ORDERS Will I be successful with McKesson CPOE? Percent of U.S. Customer Base Doing CPOE 8% # of Orgs. Doing Both Barcoding and CPOE 33 This year, McKesson saw its most significant gains yet recorded by KLAS, adding 16 new CPOE hospitals over the past year. However, McKesson still needs to bring about 90 percent of its Horizon clients live on CPOE. System response and reliability scores are lower than average, and the ability to handle complex oncology ordering can be a weakness. Only a few v.10 customers are live with CPOE, but early reports are that CPOE functionality is significantly improved on this version. However, customers currently live with v.10 report that the upgrade took longer and required more effort than originally anticipated. Can McKesson help me meet Stage 1 CPOE requirements for MU? Physicians generally use Horizon CPOE shallowly, even when adoption is mandated. Only a third of CPOE-live organizations are using CPOE for a majority of orders. The more satisfied, successful McKesson clients report a high rate of involvement with McKesson executives. These high-touch clients report that it took significant investments of time and effort to make Horizon CPOE successful, due especially to the complexity of building iforms. Customers who cannot or have not made this investment relate their frustration in being left behind. One IT Director recently commented: [McKesson s] product is up there with the other market leaders. Unfortunately, there is a huge disconnect between what McKesson sells and what they deliver. McKesson sells iforms to CIOs and clinicians as the answer to CPOE, but McKesson doesn't deliver these things as advertised. We are left to build our own iforms. Beyond CPOE, can McKesson get me to BPOC and physician documentation? With the highest percentage of organizations doing BPOC (the second-highest number of organizations after CPSI), McKesson is closing the loop at a majority of their Horizon CPOE organizations. Horizon clients are behind in physician documentation, with just over 20 percent of organizations adopting. What is the future for McKesson? Horizon customers report a high degree of anxiety about their ability to reach Stage 1 CPOE for MU by mid Many potential customers say they are specifically avoiding McKesson Horizon in their CIS selection. McKesson is further expanding into the community space with the introduction of its CPOE module for Paragon, where four sites have come live since KLAS closed research CPOE Digest 2010 I 49

51 for this report. Customers waiting for Paragon s CPOE rollout are anxious, but encouraged by a strong history of on-time delivery from Paragon. Horizon CPOE Non-CPOE Overall Score Product Quality Ease of Use Product Works as Promoted Proactive Service I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

52 Vendor Briefs Figure 45: McKesson: Raw Hospital Count Figure 46: McKesson: In addition to CPOE, what else are you doing? 100% 90% 80% No Yes Overall % Yes 3 70% 60% 27 50% 40% 33 30% 20% 10% 8 0% Physician Documentation Barcoding CPOE Digest 2010 I 51

53 Figure 47: McKesson: Breakdown of CPOE Use (inpatient n=53, ambulatory n=3) 100% 90% 80% 70% 60% 50% 40% 38% 28% 33% 36% 33% 26% 33% 94% Pilot/None Moderate Significant Deep % Deep Overall 67% 30% 20% 10% 0% 67% 11% 26% 33% 33% 23% 11% 4% 2% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory Figure 48: McKesson: Physician Satisfaction, Response Time, System Reliability % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically Physician Satisfaction Response Time Reliability/Uptime I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

54 Vendor Briefs Figure 49: McKesson: Ratings vs. CPOE Vendor Average 9 8 Average Physician Satisfaction with CPOE System Response Time System Reliability & Uptime CPOE Digest 2010 I 53

55 MEDITECH C/S ENTERPRISE MEDICAL RECORD & MAGIC PATIENT CARE INQUIRY Will I be successful with MEDITECH CPOE? Percent of U.S. Customer Base Doing CPOE 9% # of Orgs. Doing Both Barcoding and CPOE 55 For the first time in six years, MEDITECH has brought more C/S than Magic sites live. These new gains have brought MEDITECH s CPOE hospital count up to around 130 hospitals, but with MEDITECH s massive client base, this represents only 12 percent of their large hospitals and 8 percent of community hospitals. Many clients are reluctant to employ CPOE until they have either v.5.6 or v.6, both of which will be MU-certified. Although recent strides give providers cause for hope, the enormity of moving MEDITECH s customer base to CPOE worries some current customers. Can MEDITECH help me meet Stage 1 CPOE requirements for MU? Adoption has been shallow to moderate, with C/S slightly exceeding Magic in the depth of adoption; 57 percent of C/S physicians over 52 percent of Magic physicians doing at least some CPOE. Fifty-three percent of C/S organizations are inputting the majority of orders electronically. If newer versions are more conducive to physician workflows, adoption could increase; for now, MEDITECH lags behind competitors. Beyond CPOE, can MEDITECH get me to BPOC and physician documentation? MEDITECH s medication administration system, BMV, remains the most widely deployed barcoding system on the market. Due to its long-standing functionality, hospitals are significantly more likely to adopt this product than MEDITECH s CPOE solution. Both Magic and C/S CPOE clients report widespread but shallow physician documentation, with around 70 percent of customers using this functionality at least sometimes. What is the future for MEDITECH? Between ARRA and the v.6 upgrade, the MEDITECH installation base is currently in a state of significant transition. The first v.6 CPOE hospital is newly live, so it is too early to measure what benefits this new upgrade will bring. While a number of hospitals (primarily MAGIC users) are currently getting off the MEDITECH bus, the majority of customers are sticking with this vendor and pushing forward to advanced clinicals, including CPOE. Getting even the majority of the MEDITECH customer base to CPOE will require previously unseen effort and focus from MEDITECH hospitals, the vendor, and consultants. C/S CPOE Non-CPOE Overall Score Product Quality Ease of Use Product Works as Promoted Proactive Service I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

56 Vendor Briefs Figure 50: MEDITECH: Raw Hospital Count MEDITECH MAGIC MEDITECH C/S Figure 51: MEDITECH C/S: In addition to CPOE, what else are you doing? 100% 90% 80% 14 No Yes Overall % Yes 21 70% 60% 50% 40% 33 30% 28 20% 10% 0% Physician Documentation Barcoding CPOE Digest 2010 I 55

57 Figure 52: MEDITECH C/S: Breakdown of CPOE Use (inpatient n=59, ambulatory n=5) 100% 90% 80% 70% 60% 22% 22% 20% 20% 25% 20% 20% 20% 45% Pilot/None Moderate Significant Deep % Deep Overall 60% 50% 19% 40% 34% 35% 30% 60% 60% 20% 20% 10% 0% 37% 11% 20% 20% 9% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory Figure 53: MEDITECH C/S: Physician Satisfaction, Response Time, System Reliability % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically Physician Satisfaction Response Time Reliability/Uptime I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

58 Vendor Briefs Figure 54: MEDITECH C/S: Ratings vs. CPOE Vendor Average 9 8 Average Physician Satisfaction with CPOE System Response Time System Reliability & Uptime CPOE Digest 2010 I 57

59 Figure 55: MEDITECH MAGIC Summary Table In addition to CPOE, what else are you doing? Breakdown of CPOE Use (inpatient n=69, ambulatory n=5) 100% 90% 80% 70% 60% 11 No Yes Overall % Yes % 90% 80% 70% 60% 23% 29% 20% 40% 19% 38% 20% 40% Pilot/None Moderate Significant Deep % Deep Overall 60% 20% 40% 50% 40% 35 50% 40% 30% 19% 16% 20% 30% 20% 10% 0% Physician Documentation 27 Barcoding 20% 10% 0% 29% 40% 28% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically 40% 10% 10% 40% Physician Satisfaction, Response Time, System Reliability Physician Satisfaction Response Time Reliability/Uptime I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

60 Vendor Briefs QUADRAMED CPR Will I be successful with QuadraMed CPOE? Percent of U.S. Customer Base Doing CPOE 43% # of Orgs. Doing Both Barcoding and CPOE 3 Of all large hospital vendors, QuadraMed CPR has the smallest CPOE installation base, with 26 hospitals and only 1 net addition since Almost two-thirds of QuadraMed s hospitals with more than 200 beds still need CPOE. Can QuadraMed help me meet Stage 1 CPOE requirements for MU? The average depth of use for CPOE at QuadraMed remains above the market average. Sixty-nine percent of physicians are doing some CPOE, and 60 percent of organizations are placing the majority of orders via CPOE. Beyond CPOE, can QuadraMed get me to BPOC and physician documentation? BPOC has progressed since last year, when no CPOE sites were using a QuadraMed or a third-party medication-administration system. Since then, QuadraMed has made progress rolling out a BPOC solution to 20 percent of their CPOE organizations. Of hospitals, 70 percent are entering documentation electronically. What is the future for QuadraMed? QuadraMed is holding steady, but it seems unlikely to see significant CPOE growth in the near future, given its small installation base. Many customers are frustrated by QuadraMed s overall lack of delivery and development. QuadraMed s most satisfied CIO recently commented to KLAS, QuadraMed is challenged by product delivery, timeline commitments, integration advancements, and overall strategy execution. They have missed so many deadlines and commitments that their credibility is nonexistent. CPR CPOE Non-CPOE Overall Score Product Quality Ease of Use Product Works as Promoted Proactive Service CPOE Digest 2010 I 59

61 Figure 56: QuadraMed: Raw Hospital Count QuadraMed Affinity QuadraMed CPR Figure 57: QuadraMed CPR: In addition to CPOE, what else are you doing? 100% 90% 80% 3 No Yes Overall % Yes 70% 60% 8 50% 40% 30% 7 20% 10% 2 0% Physician Documentation Barcoding 60 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

62 Vendor Briefs Figure 58: QuadraMed CPR: Breakdown of CPOE Use (inpatient n=26) 100% 90% 19% 15% 80% 4% 15% 70% 12% 58% 12% 60% Pilot/None Moderate Significant Deep % Deep Overall 50% 40% 30% 65% 58% 20% 10% 0% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory 42% Figure 59: QuadraMed CPR: Physician Satisfaction, Response Time, System Reliability % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically Physician Satisfaction Response Time Reliability/Uptime CPOE Digest 2010 I 61

63 Figure 60: QuadraMed CPR: Ratings vs. CPOE Vendor Average 9 8 Average Physician Satisfaction with CPOE System Response Time System Reliability & Uptime 62 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

64 Vendor Briefs SIEMENS INVISION & SOARIAN Will I be successful with Siemens CPOE? Percent of U.S. Customer Base Doing CPOE 13% # of Orgs. Doing Both Barcoding and CPOE 24 Soarian is picking up some speed after years of hovering at three hospitals live. Increased adoption is mainly due to the release of C6, a heavily anticipated upgrade. As one provider said, We came live with the first phase of our Siemens Soarian Clinicals project this past year, and we are looking forward to upgrading to C6. The quality of this version looks strong, and it will give us the underlying foundation to be able to move forward with CPOE and other initiatives. Functionality is improving but still immature in some areas, including these specified by one Soarian user, The system is missing a transfer to the level of care, which gives doctors a way to place orders when someone moves from unit to unit. We expect to get this functionality in the next couple of months. Can Siemens help me meet Stage 1 CPOE requirements for MU? Soarian has the weakest adoption in this study, with less than a third of physicians at CPOE hospitals using CPOE for at least some orders. Some sites that have recently come live say that completing the go-live process with Siemens is painful, especially noting that Siemens has not been meeting demand for experienced resources. Siemens has so many installations going on, so getting resources from them is always a challenge... It has been hard finding the right person who really understands CPOE or who has been involved in the CPOE installation. We actually hired somebody from IBM to work with us on that. Beyond CPOE, can Siemens get me to BPOC and physician documentation? BPOC is one of Soarian s brightest spots, live in nine out of ten CPOE-live hospitals. Physician documentation remains immature. Interfaces with the pharmacy have been a struggle for some sites, which could pose problems for hospitals trying to complete the closed loop. The pharmacy build [for CPOE] was huge. It was 70 percent of the build of the whole system. We had to build a second formulary for our clinical information system over and above what we had on the pharmacy information side. It had to be designed around the way the physicians order, and that was huge. It took us two and half, almost three months to do. Now I see why people say that pharmacy information systems should be integrated with hospital systems instead of interfaced. What is the future for Siemens? Soarian s development has been a bumpy road for many Siemens customers, and while the future looks promising, Siemens is not out of the woods yet. Siemens has only one CPOE Digest 2010 I 63

65 Soarian hospital currently doing nearly 100 percent of their orders via CPOE. While this is a significant achievement over last year, Siemens needs to show that they can consistently help customers reach high adoption. Soarian CPOE Non-CPOE Overall Score Product Quality Ease of Use Product Works as Promoted Proactive Service I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

66 Vendor Briefs Figure 61: Siemens: Raw Hospital Count Siemens Invision Siemens Soarian Figure 62: Siemens Invision: In addition to CPOE, what else are you doing? 100% 90% 80% No Yes Overall % Yes 10 70% 18 60% 50% 40% 30% 16 20% 9 10% 0% Physician Documentation Barcoding One organization doing barcoding is using a vendor other than Siemens. CPOE Digest 2010 I 65

67 Figure 63: Siemens Invision: Breakdown of CPOE Use (inpatient n=39) 100% 90% 80% 70% 60% 8% 5% 8% 33% 44% 74% Pilot/None Moderate Significant Deep % Deep Overall 50% 40% 30% 20% 59% 44% 15% 10% 0% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory 8% 3% Figure 64: Siemens Invision: Physician Satisfaction, Response Time, System Reliability % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically Physician Satisfaction Response Time Reliability/Uptime I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

68 Vendor Briefs Figure 65: Siemens Invision: Ratings vs. CPOE Vendor Average Average Physician Satisfaction with CPOE System Response Time System Reliability & Uptime CPOE Digest 2010 I 67

69 Figure 66: Siemens Soarian Summary Table In addition to CPOE, what else are you doing? Breakdown of CPOE Use (n=10) 100% 90% 80% 70% 8 No Yes Overall % Yes 1 100% 90% 80% 70% 50% 30% Pilot/None Moderate Significant Deep % Deep Overall 60% 60% 50% 40% 30% 20% 10% 0% 1 Physician Documentation 8 Barcoding 50% 40% 30% 20% 10% 0% 30% 50% 10% 10% 10% 10% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory 100% % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically Physician Satisfaction, Response Time, System Reliability Physician Satisfaction Response Time Reliability/Uptime I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

70 Expanded Results (75+ pages) for CPOE: Traffic Jams on the Road to Meaningful Use T A B L E O F C O N T E N T S PAGE SECTION 70 TABLE OF FIGURES 74 MARKET DETAIL 122 KLAS PERFORMANCE DATA 126 VENDOR DETAIL (COMMENTARY, OVERVIEWS, AND TECHNICAL ASSESSMENTS) Cerner CPSI Eclipsys Epic GE Healthland HMS McKesson MEDITECH QuadraMed Siemens 139 KLAS SURVEY DOCUMENTS 142 KLAS FAQS SUMMARY CPOE Digest 2010 I 69

71 TABLE OF FIGURES Figure 1: Inpatient CPOE Hospital Growth 2008 to Figure 2: Estimated Percent of Total Client Base Doing CPOE... 4 Figure 3: Percent of Community Hospitals Live on CPOE vs. Percent of Community Market Share... 6 Figure 4: Depth of Use at Average CPOE Site... 7 Figure 5: Percent of all Patient Orders... 8 Figure 6: Percent of Total Orders Entered by MD, Recently Live Hospitals... 9 Figure 7: Organizations Doing Both BPOC and CPOE Figure 8: Cerner: Raw Hospital Count Figure 9: Cerner: In addition to CPOE, what else are you doing? Figure 10: Cerner: Breakdown of CPOE Use (inpatient n=181, ambulatory n=24) Figure 11: Cerner: Physician Satisfaction, Response Time, System Reliability Figure 12: Cerner: Ratings vs. CPOE Vendor Average Figure 13: CPSI: Raw Hospital Count Figure 14: CPSI: In addition to CPOE, what else are you doing? Figure 15: CPSI: Breakdown of CPOE Use (inpatient n=59, ambulatory n=7) Figure 16: CPSI: Physician Satisfaction, Response Time, System Reliability Figure 17: CPSI: Ratings vs. CPOE Vendor Average Figure 18: Eclipsys: Raw Hospital Count Figure 19: Eclipsys SCM: In addition to CPOE, what else are you doing? Figure 20: Eclipsys SCM: Breakdown of CPOE Use (inpatient n=102, ambulatory n=15) Figure 21: Eclipsys SCM: Physician Satisfaction, Response Time, System Reliability Figure 22: Eclipsys SCM: Ratings vs. CPOE Vendor Average Figure 23: Eclipsys TDS Summary Table Figure 24: Epic: Raw Hospital Count Figure 25: Epic: In addition to CPOE, what else are you doing? Figure 26: Epic: Breakdown of CPOE Use (inpatient n=140, ambulatory n=40) Figure 27: Epic: Physician Satisfaction, Response Time, System Reliability Figure 28: Epic: Ratings vs. CPOE Vendor Average Figure 29: GE: Raw Hospital Count Figure 30: GE Centricity: In addition to CPOE, what else are you doing? Figure 31: GE Centricity: Breakdown of CPOE Use (inpatient n=24) Figure 32: GE Centricity: Physician Satisfaction, Response Time, System Reliability Figure 33: GE Centricity: Ratings vs. CPOE Vendor Average Figure 34: GE LastWord/Legacy Summary Table Figure 35: Healthland: Raw Hospital Count Figure 36: Healthland: In addition to CPOE, what else are you doing? Figure 37: Healthland: Breakdown of CPOE Use (n=5) Figure 38: Healthland: Physician Satisfaction, Response Time, System Reliability Figure 39: Healthland: Ratings vs. CPOE Vendor Average Figure 40: HMS: Raw Hospital Count Figure 41: HMS: In addition to CPOE, what else are you doing? Figure 42: HMS: Breakdown of CPOE Use (n=5) Figure 43: HMS: Physician Satisfaction, Response Time, System Reliability I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

72 Table of Figures Figure 44: HMS: Ratings vs. CPOE Vendor Average Figure 45: McKesson: Raw Hospital Count Figure 46: McKesson: In addition to CPOE, what else are you doing? Figure 47: McKesson: Breakdown of CPOE Use (inpatient n=53, ambulatory n=3) Figure 48: McKesson: Physician Satisfaction, Response Time, System Reliability Figure 49: McKesson: Ratings vs. CPOE Vendor Average Figure 50: MEDITECH: Raw Hospital Count Figure 51: MEDITECH C/S: In addition to CPOE, what else are you doing? Figure 52: MEDITECH C/S: Breakdown of CPOE Use (inpatient n=59, ambulatory n=5) Figure 53: MEDITECH C/S: Physician Satisfaction, Response Time, System Reliability Figure 54: MEDITECH C/S: Ratings vs. CPOE Vendor Average Figure 55: MEDITECH MAGIC Summary Table Figure 56: QuadraMed: Raw Hospital Count Figure 57: QuadraMed CPR: In addition to CPOE, what else are you doing? Figure 58: QuadraMed CPR: Breakdown of CPOE Use (inpatient n=26) Figure 59: QuadraMed CPR: Physician Satisfaction, Response Time, System Reliability Figure 60: QuadraMed CPR: Ratings vs. CPOE Vendor Average Figure 61: Siemens: Raw Hospital Count Figure 62: Siemens Invision: In addition to CPOE, what else are you doing? Figure 63: Siemens Invision: Breakdown of CPOE Use (inpatient n=39) Figure 64: Siemens Invision: Physician Satisfaction, Response Time, System Reliability Figure 65: Siemens Invision: Ratings vs. CPOE Vendor Average Figure 66: Siemens Soarian Summary Table Figure 67: Survey Participants by Title (n=481) Figure 68: Overall: Size of Provider Organizations (n=481) Figure 69: Summary CPOE Survey Pool Figure 70: CPOE Summary Over Time Figure 71: Most Current vs. Previous Products, Total Inpatient Organizations (IP Only + IP/Amb Combos) Figure 72: Inpatient and Ambulatory Products Figure 73: Inpatient and Ambulatory Organizations Figure 74: Number of CPOE Inpatient Hospitals Verified Live Comparison Figure 75: Number of CPOE Hospitals and Organizations Figure 76: Percent of Vendor s Own Client Base Doing CPOE (U.S., >200 Beds Only) Figure 77: Client Base Penetration vs. Percent of U.S. Market Share (<200 Beds Only) Figure 78: Inpatient CPOE Deployment Number of Live Organizations 2009 vs Figure 79: Ambulatory CPOE Deployment Number of Live Organizations 2009 vs Figure 80: Pharmacy Vendor vs. Inpatient CPOE Vendor (n=787) Figure 81: Positive Patient/Med ID Software Vendor vs. Inpatient CPOE Vendor (n=428) Figure 82: Raw Hospital Count CPOE Hospitals Cumulative Figure 83: Raw Hospital Count CPOE Hospitals Overall Figure 84: Number of CPOE Inpatient Hospitals Verified Live by Year Figure 85: Number of Live Organizations Inpatient Figure 86: Number of Live Organizations Ambulatory Figure 87: Total Number of Physicians Doing CPOE CPOE Digest 2010 I 71

73 Figure 88: Number of Physicians Doing CPOE Employed vs. Non-Employed (n=481) Figure 89: Number of Physicians Doing Inpatient CPOE Employed vs. Non-Employed by Vendor (n=481) Figure 90: Is inpatient CPOE usage mandated for non-employed physicians? (n=481) Figure 91: Is inpatient CPOE usage mandated for non-employed physicians? 2009 vs (n=481) Figure 92: Is inpatient CPOE usage mandated for non-employed physicians? by Vendor (n=481) Figure 93: CPOE Adoption Comparing Mandated vs. Not Mandated CPOE Use (n=481) Figure 94: Market Share: CPOE Live vs. Contracted CIS Clients Hospitals Over 200 Beds Figure 95: Overall Percent Teaching and Associated Teaching Hospitals versus Non-teaching Hospitals Live with CPOE (n=804) Figure 96: Inpatient Teaching and Associated Teaching Hospitals vs. Non-Teaching Hospitals Live on CPOE by Vendor/Product Figure 97: Inpatient Teaching and Associated Teaching Hospitals vs. Non-Teaching Hospitals Live on CPOE by Vendor/Product Figure 98: Raw Count Inpatient Teaching and Associated Teaching Hospitals vs. Non-Teaching Hospital CPOE Growth Figure 99: Percent of Physicians Doing Some Inpatient CPOE at live CPOE sites by Vendor Figure 100: Number of Inpatient Hospitals at the 100% Level Figure 101: CPOE Use by Physicians (Inpatient) by Number of Hospitals Figure 102: CPOE Use by Physicians (Ambulatory) by Number of Organizations Figure 103: Orders Entered by Physicians (Inpatient) by Number of Hospitals Figure 104: Orders Entered by Physicians (Ambulatory) by Number of Organizations Figure 105: Percent of All Orders Physicians Enter Inpatient Organizations (n=481) Figure 106: Percent of Organizations Not at 50% CPOE Use (n=481) Figure 107: Number of Years Doing CPOE if Not at 50% of All Orders Entered Inpatient Organizations (n=474) Figure 108: Average Number of Years Doing CPOE Inpatient (n=481) Figure 109: Overall: In addition to CPOE, what else are you doing? Figure 110: Overall: Percent of Organizations Doing any Physician Documentation (n=457) Figure 111: Overall: Percent of Organizations Doing Barcode Scanning at the Bedside (n=457) Figure 112: Summary Chart CPOE Usage Inpatient and Ambulatory (n=804) Figure 113: Physician Satisfaction, Response Time, System Reliability Figure 114: Physician Satisfaction with CPOE Inpatient (n=448) Figure 115: Physician Satisfaction Ratings Ambulatory (n=106) Figure 116: Specialty Ordering: Oncology Drugs - Inpatient Figure 117: Specialty Ordering: Oncology Drugs - Ambulatory Figure 118: Overall % of Hospitals Barcode Scanning at the Bedside (n=778) Figure 119: Hospitals/Organizations Doing Both BPOC and CPOE (with same vendor) Figure 120: Percent of CPOE Hospitals doing Bedside Barcode Scanning by Inpatient CPOE Vendor (n=778) Figure 121: Adoption (% Beds) by those Doing Bedside Barcode Scanning by Inpatient CPOE Vendor (n=403) Figure 122: System Response Time Inpatient (n=453) Figure 123: System Response Time Ambulatory (n=108) Figure 124: System Reliability and Uptime Inpatient (n=455) I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

74 Table of Figures Figure 125: System Reliability and Uptime Ambulatory (n=106) Figure 126: Response Time Ratings Legend Figure 127: Response Time Satisfaction Ratings (inpatient n=453, ambulatory n=108) Figure 128: Reliability & Uptime Ratings Legend Figure 129: Reliability & Uptime Satisfaction Ratings (inpatient n=455, ambulatory n=106) Figure 130: Response Times vs. Number of Physicians Doing CPOE per Organization (n=481) Figure 131: Side-by-Side Comparison CPOE Sites: Figure 132: Side-by-Side Comparison Non-CPOE Sites: Figure 133: CPOE vs. Non-CPOE Vendor Performance Scoring (100-point scale) CPOE Digest 2010 I 73

75 Market Detail 74 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

76 Market Detail SPECIFIC RESEARCH DATA Figure 67: Survey Participants by Title (n=481) Medical Director/ Manager 8% Pharmacy Director/ Manager 6% Administrative Director/ Manager 2% CEO/COO/CNO 2% IT Director/ Manager 30% CIO 45% CMO/CNO 7% Figure 68: Overall: Size of Provider Organizations (n=481) Over 1,000 Beds 16% Beds 33% 501-1,000 Beds 17% Beds 34% CPOE Digest 2010 I 75

77 The report hones in on the experiences of a wide variety of care delivery organizations (U.S. and Canada) and their CPOE experiences using various products from 13 different vendors, Cerner, CPSI, Eclipsys, Epic, GE, Healthland, HMS, Keane, McKesson, MEDITECH, Medsphere, QuadraMed, and Siemens. Figure 69: Summary CPOE Survey Pool 481 Interviews 370 IP Org. 111 IP + Amb. Org. 481 Org. 469 US 12 Canadian 804 Hospital Sites 785 US 19 Canadian Figure 70: CPOE Summary Over Time Year # Vendors # Products # Custom Remarkable Comments CPOE more theoretical than proven; biggest surprise, 48% of all pharmacy orders entered via CPOE are reentered in pharmacy Per-Se Patient1 acquired by Misys renamed Misys CPR First real evidence outside of teaching (employed) physicians live on CPOE; virtually all sites had at least some customers that had to reenter pharmacy orders; Siemens first Soarian site; Eclipsys first XA site Eclipsys reworks XA into a new Eclipsys SCM strategy GE acquires IDX; inpatient & ambulatory environments no longer delimiters for some vendors; first time more growth observed with non-employed physicians. Cerner first vendor to reach 100 hospitals; Consolidation is occurring w/fewer vendors, fewer products, fewer custom; Pharmacy integration still a work in progress only four vendor products report no reentry; Misys CPR acquired by QuadraMed renamed QuadraMed CPR. Good growth year, non-teaching growth doubled. More providers with more vendor products live on CPOE. Dairyland, now Healthland, acquired by Francisco Partners, a private equity firm. Siemens, HMS, and Healthland getting off the ground with multiple customer go lives. CPOE growth heating up as ARRA deadlines draw near. 76 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

78 Millennium Classic CPSI Legacy SCM TDS EpicCare Legacy Cent. Enterprise LastWord Horizon Legacy Client/Server MAGIC CPR Affinity Soarian Invision Number of Organizations Market Detail Figure 71: Most Current vs. Previous Products, Total Inpatient Organizations (IP Only + IP/Amb Combos) Cerner CPSI Eclipsys Epic GE McKesson Meditech QuadraMed Siemens Current vs. Legacy Product Description Millennium is the only product reported doing CPOE, the currently marketed Cerner product from Cerner. CPSI All sites report being on CPSI Clinicals, CPSI s currently marketed product. Sites reported two products: Sunrise Clinical Manager and TDS, although the number of TDS sites is declining. The customers previously reported on XA are Eclipsys included in with the SCM customers as the product is a single go-forward product. Epic All sites reported being on EpicCare, the currently marketed product from Epic. Sites report using three distinct products from GE, GE Centricity Enterprise, formerly Carecast, is the go forward product. GE LastWord and GE Centricity GE Acute Care are no longer being sold and are combined with LastWord for statistical purposes. The inpatient sites are doing CPOE with Horizon Expert Orders, the currently McKesson marketed product from McKesson. Sites reported using two distinct products from MEDITECH. The older product, MEDITECH MAGIC, is clearly differentiated from the newer Client/Server product. Sites report using two distinct products, CPR (which they acquired from Misys QuadraMed and is their announced go forward product) and Affinity, and provider responses have been recorded accordingly. The Siemens sites report using two distinct products from Siemens, Invision and Siemens Soarian and their responses have been recorded accordingly. CPOE Digest 2010 I 77

79 Figure 72: Inpatient and Ambulatory Products Vendor Inpatient Ambulatory Cerner Millennium PowerChart Millennium PowerWorks EMR CPSI Clinicals -- Sunrise Clinical Manager/ Sunrise Clinical Manager Eclipsys Ambulatory Care TDS Epic EpicCare Inpatient EMR EpicCare Ambulatory EMR GE Centricity Enterprise Centricity Enterprise LastWord/Legacy -- Healthland Clinicals HMS Clinicals Keane InSight Clinicals McKesson Horizon Expert Orders -- MEDITECH C/S Enterprise Medical Record C/S Enterprise Medical Record MAGIC Patient Care Inquiry LSS- Medsphere OpenVista EHR QuadraMed Affinity Clinicals -- CPR -- Siemens Invision Invision Soarian I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

80 Market Detail Figure 73: Inpatient and Ambulatory Organizations Cerner CPSI Eclipsys SCM Eclipsys TDS Epic GE Centricity GE LastWord Healthland HMS McKesson MEDITECH C/S MEDITECH MAGIC QuadraMed CPR Siemens Invision Siemens Soarian Other Inpatient Inpatient & Ambulatory Other includes Custom, Keane, Medsphere, QuadraMed Affinity, and Siemens MedSeries4 CPOE Digest 2010 I 79

81 Today s verifiable live hospitals were 804 versus last year s 623, an overall increase of 29 percent. The bottom line on U.S. hospital-based CPOE on commercial software products as validated by KLAS is: 15.7 percent of hospitals are doing some CPOE percent are actively using CPOE (active defined as physicians entering greater than 50 percent of patient orders) percent is an absolute maximum of current CPOE usage if you count the 785 U.S. KLAS validated commercial sites and the AHA reported 213 Federal Government Hospitals as all doing some CPOE. KLAS statistics do not typically include the Federal Government Hospitals (213 hospitals) as KLAS only surveys sites using commercially available products. Figure 74: Number of CPOE Inpatient Hospitals Verified Live Comparison Cerner CPSI Eclipsys SCM Eclipsys TDS Epic GE Centricity GE LastWord Healthland HMS McKesson MEDITECH C/S MEDITECH MAGIC QuadraMed CPR Siemens Invision Siemens Soarian Other 2008 CPOE Hospitals Verified 2009 CPOE Hospitals Verified 2010 CPOE Hospitals Verified Other includes Keane, Medsphere, QuadraMed Affinity, Siemens MedSeries4, and one custom site. 80 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

82 Market Detail Figure 75: Number of CPOE Hospitals and Organizations Total Hospitals Live Organizations Live CPOE Digest 2010 I 81

83 Figure 76: Percent of Vendor s Own Client Base Doing CPOE (U.S., >200 Beds Only) 70% Legacy Currently Marketed 60% 50% 52% 43% 40% 35% 34% 37% 30% 20% 25% 26% 10% 11% 12% 0% 82 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

84 Percent of U.S. Hospitals Under 200 Beds Doing CPOE Market Detail Figure 77: Client Base Penetration vs. Percent of U.S. Market Share (<200 Beds Only) 70% Quadramed 60% 50% Eclipsys Epic 40% 30% 20% Cerner Average Siemens Soarian McKesson Paragon 10% Siemens Invision CPSI McKesson Horizon MEDITECH Siemens MS4 GE Healthland 0% HMS 0% 5% 10% 15% 20% 25% 30% Percent of U.S. Market Share (Under 200 Beds) CPOE Digest 2010 I 83

85 Of all the organizations surveyed, 481 (up from 376 last year) are now live with CPOE. These 481 organizations represent 804 hospitals (up from 623 last year). Figure 78: Inpatient CPOE Deployment Number of Live Organizations 2009 vs Cerner CPSI Eclipsys SCM Eclipsys TDS Epic GE Centricity GE LastWord Healthland HMS McKesson MEDITECH C/S MEDITECH MAGIC QuadraMed CPR Siemens Invision Siemens Soarian Other Other includes Keane, Medsphere, QuadraMed Affinity, Siemens MedSeries4, and one custom site. 84 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

86 Market Detail Figure 79: Ambulatory CPOE Deployment Number of Live Organizations 2009 vs Cerner CPSI Eclipsys SCM Eclipsys TDS Epic GE Centricity GE LastWord Healthland HMS McKesson MEDITECH C/S MEDITECH MAGIC QuadraMed CPR Siemens Invision Siemens Soarian Other Other includes Keane, Medsphere, QuadraMed Affinity, Siemens MedSeries4, and one custom site. CPOE Digest 2010 I 85

87 Percent of Hospitals Figure 80: Pharmacy Vendor vs. Inpatient CPOE Vendor (n=787) 100% 90% 80% 70% 60% 50% 40% 30% 20% Pharmacy Vendor Other Siemens QuadraMed Mediware Meditech McKesson HCS GE Custom Cerner Same as CPOE Vendor 10% 0% CPOE Vendor Other CPOE vendors include Keane, Medsphere, QuadraMed Affinity, Siemens MedSeries4, and one custom site. Other pharmacy vendors include Crown and CPSI. 86 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

88 Percent of Hospitals Market Detail Figure 81: Positive Patient/Med ID Software Vendor vs. Inpatient CPOE Vendor (n=428) 100% 90% 80% 70% 60% 50% 40% 30% Custom Mediware McKesson IntelliDOT Initiate Hospira (Sculptor) GE Positive Patient/ Med ID Vendor Same as CPOE Vendor 20% 10% 0% CPOE Vendor Other CPOE vendors include Keane, Medsphere, QuadraMed Affinity, Siemens MedSeries4, and one custom site. No Healthland CPOE hospital currently has positive patient/med ID software in place. CPOE Digest 2010 I 87

89 Number of Hospitals doing CPOE Figure 82: Raw Hospital Count CPOE Hospitals Cumulative Cerner [Millennium PowerChart] CPSI [Clinicals] Eclipsys [SCM & TDS] Epic [EpicCare Inpatient] GE [Centricity & LastWord] Healthland HMS McKesson [HEO] MEDITECH [C/S & MAGIC] QuadraMed [Affinity & CPR] Siemens [Invision & Soarian] Figure 83: Raw Hospital Count CPOE Hospitals Overall I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

90 Market Detail Figure 84: Number of CPOE Inpatient Hospitals Verified Live by Year Cerner CPSI Eclipsys SCM Eclipsys TDS Epic GE Centricity GE LastWord Healthland HMS McKesson Horizon MEDITECH C/S MEDITECH MAGIC QuadraMed CPR Siemens Invision Siemens Soarian Other Overall CPOE Digest 2010 I 89

91 Figure 85: Number of Live Organizations Inpatient Cerner CPSI Eclipsys SCM Eclipsys TDS Epic GE Centricity GE LastWord Healthland HMS McKesson Horizon MEDITECH C/S MEDITECH MAGIC QuadraMed CPR Siemens Invision Siemens Soarian Other Overall Note: Other includes (for 2010) Custom, Keane, Medsphere, QuadraMed Affinity, and Siemens MedSeries4. Figure 86: Number of Live Organizations Ambulatory Cerner CPSI Eclipsys SCM Eclipsys TDS Epic GE Centricity GE LastWord Healthland HMS McKesson Horizon MEDITECH C/S MEDITECH MAGIC QuadraMed CPR Siemens Invision Siemens Soarian Other Overall I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

92 Market Detail Figure 87: Total Number of Physicians Doing CPOE # of Physicians Doing CPOE (Inpatient) 2010 # of Physicians Doing CPOE (Ambulatory) CPOE Digest 2010 I 91

93 Figure 88: Number of Physicians Doing CPOE Employed vs. Non-Employed (n=481) Number of Physicians Employed Physicians Non-Employed Physicians Figure 89: Number of Physicians Doing Inpatient CPOE Employed vs. Non-Employed by Vendor (n=481) Employed Physicians Non-Employed Physicians I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

94 Market Detail Figure 90: Is inpatient CPOE usage mandated for non-employed physicians? (n=481) Yes 40% No 60% Figure 91: Is inpatient CPOE usage mandated for non-employed physicians? 2009 vs (n=481) 70% 60% 2009 % Mandated 50% 40% 30% 20% 10% 0% Yes No CPOE Digest 2010 I 93

95 Figure 92: Is inpatient CPOE usage mandated for non-employed physicians? by Vendor (n=481) 100% 90% 80% 70% 60% 50% No Yes 6 40% 30% 20% 10% 0% Average % Mandating I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

96 Percent of Physicians Doing Some CPOE Market Detail This chart represents the percent of physicians doing CPOE split by whether or not CPOE use was mandated. Figure 93: CPOE Adoption Comparing Mandated vs. Not Mandated CPOE Use (n=481) 100% 90% Mandated CPOE Use Not Mandated CPOE Use 80% 70% 60% 50% 40% 30% 20% 10% 0% CPOE Digest 2010 I 95

97 Figure 94: Market Share: CPOE Live vs. Contracted CIS Clients Hospitals Over 200 Beds 25% 20% Market Share: CPOE Live vs. Contracted CIS Clients Percent of the Total Number of MDs Doing CPOE Percent of Live CPOE Hospitals Percent of CIS Market Share (Over 200 Beds) Through % 10% 5% 0% 96 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

98 Market Detail Figure 95: Overall Percent Teaching and Associated Teaching Hospitals versus Nonteaching Hospitals Live with CPOE (n=804) 100% 90% 80% 39% Non-Teaching Hospitals Live Teaching Hospitals Live 42% 70% 60% 50% 40% 30% 61% 58% 20% 10% 0% CPOE Digest 2010 I 97

99 Figure 96: Inpatient Teaching and Associated Teaching Hospitals vs. Non-Teaching Hospitals Live on CPOE by Vendor/Product Cerner CPSI Eclipsys SCM Eclipsys TDS Epic GE Centricity GE LastWord Healthland HMS McKesson MEDITECH C/S MEDITECH MAGIC QuadraMed CPR Siemens Invision Siemens Soarian Other Teaching Hospitals Live Non-Teaching Hospitals Live I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

100 Market Detail Figure 97: Inpatient Teaching and Associated Teaching Hospitals vs. Non-Teaching Hospitals Live on CPOE by Vendor/Product Vendor/Product Teaching Hospitals Live Non-Teaching Hospitals Live Total Hospitals Live Cerner CPSI Eclipsys SCM Eclipsys TDS Epic GE Centricity GE LastWord Healthland HMS McKesson MEDITECH C/S MEDITECH MAGIC QuadraMed CPR Siemens Invision Siemens Soarian Other Total Figure 98: Raw Count Inpatient Teaching and Associated Teaching Hospitals vs. Non- Teaching Hospital CPOE Growth Teaching Hospitals Non-Teaching Hospitals CPOE Digest 2010 I 99

101 Figure 99: Percent of Physicians Doing Some Inpatient CPOE at live CPOE sites by Vendor 100% 90% 90% 80% 70% 82% 81% 81% 80% 79% 75% 69% 67% 66% 2010 Average = 67% 60% 50% 57% 52% 48% 46% 44% 40% 30% 29% 20% 10% 0% 100 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

102 Market Detail Figure 100: Number of Inpatient Hospitals at the 100% Level Number of Inpatient Hospitals at the 100% level for: Physicians Doing CPOE Orders Entered There is more aggressive CPOE use. Of the 785 US hospitals live with CPOE, 565 had over 50 percent of potential orders entered by physicians and KLAS considers this group as aggressive CPOE users. Based on the AHA s count of 5,010 U.S. hospitals this translates into 11.3 percent of U.S. hospitals aggressively doing CPOE. Actual physician usage is described in this chart as deep ( percent), significant (51-85 percent), moderate (16-50 percent) or pilot (1-15 percent). Pilot Moderate Significant Deep Overall Figure 101: CPOE Use by Physicians (Inpatient) by Number of Hospitals Cerner CPSI Eclipsys SCM Eclipsys TDS Epic GE Centricity GE LastWord Healthland HMS McKesson MEDITECH C/S MEDITECH MAGIC QuadraMed CPR Siemens Invision Siemens Soarian Other Deep Significant Moderate Pilot CPOE Digest 2010 I 101

103 Figure 102: CPOE Use by Physicians (Ambulatory) by Number of Organizations Cerner CPSI Eclipsys SCM Eclipsys TDS Epic GE Centricity GE LastWord Healthland HMS McKesson Deep Significant Moderate Pilot MEDITECH C/S MEDITECH MAGIC QuadraMed CPR Siemens Invision Number of Organizations Figure 103: Orders Entered by Physicians (Inpatient) by Number of Hospitals Cerner CPSI Eclipsys SCM Eclipsys TDS Epic GE Centricity GE LastWord Healthland HMS McKesson MEDITECH C/S MEDITECH MAGIC QuadraMed CPR Siemens Invision Siemens Soarian Other Deep Significant Moderate Pilot I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

104 Percent of Organizations 50% All Orders Entered Market Detail Figure 104: Orders Entered by Physicians (Ambulatory) by Number of Organizations Cerner CPSI Eclipsys SCM Eclipsys TDS Epic GE Centricity GE LastWord Healthland HMS McKesson Deep Significant Moderate Pilot MEDITECH C/S MEDITECH MAGIC QuadraMed CPR Siemens Invision Number of Organizations Figure 105: Percent of All Orders Physicians Enter Inpatient Organizations (n=481) 100% 90% % 70% 60% 50% 40% 30% 20% 10% 0% CPOE Digest 2010 I 103

105 Percent of Organizations Not at 50% CPOE Use Average Years Live if Not at 50% CPOE Use Figure 106: Percent of Organizations Not at 50% CPOE Use (n=481) 80% 78% % 66% % 50% Average Years Live if Not at 50% CPOE Use 45% 47% 58% 60% % 40% 40% % % 15% 17% % 8% 1.0 0% I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

106 Market Detail Figure 107: Number of Years Doing CPOE if Not at 50% of All Orders Entered Inpatient Organizations (n=474) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% Over 3 Years 2-3 Years <2 Years At 50% 0% CPOE Digest 2010 I 105

107 Figure 108: Average Number of Years Doing CPOE Inpatient (n=481) I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

108 Market Detail Figure 109: Overall: In addition to CPOE, what else are you doing? 100% 90% No Yes 80% 70% % 50% 40% 30% 20% % 0% Physician Documentation Barcoding CPOE Digest 2010 I 107

109 Figure 110: Overall: Percent of Organizations Doing any Physician Documentation (n=457) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% CPOE Vendor Average = 59% No Yes 4 2 Figure 111: Overall: Percent of Organizations Doing Barcode Scanning at the Bedside (n=457) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% CPOE Vendor Average = 49% No Yes I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

110 Market Detail Figure 112: Summary Chart CPOE Usage Inpatient and Ambulatory (n=804) 100% 90% 80% 70% 60% Pilot/None Moderate Significant Deep % 18 40% 30% 20% % 147 0% Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory % MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically CPOE Digest 2010 I 109

111 Figure 113: Physician Satisfaction, Response Time, System Reliability Physician Satisfaction Response Time Reliability/Uptime I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

112 Market Detail Figure 114: Physician Satisfaction with CPOE Inpatient (n=448) * 4.6* Average = Figure 115: Physician Satisfaction Ratings Ambulatory (n=106) Average = * 7.0* * Cerner CPSI Eclipsys SCM Epic McKesson MEDITECH C/S MEDITECH MAGIC CPOE Digest 2010 I 111

113 Figure 116: Specialty Ordering: Oncology Drugs - Inpatient 100% 90% 80% 70% 60% None Some Nearly All % 40% 30% 20% 10% 0% Figure 117: Specialty Ordering: Oncology Drugs - Ambulatory 100% 90% 80% 70% 60% None Some Nearly All % % 30% 20% 10% % 112 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

114 Market Detail Figure 118: Overall % of Hospitals Barcode Scanning at the Bedside (n=778) 60% 50% 52% 40% 38% 30% 20% 10% 0% CPOE Digest 2010 I 113

115 Figure 119: Hospitals/Organizations Doing Both BPOC and CPOE (with same vendor) Number of Organizations doing CPOE Number of Organizations doing Closed Loop Number of Hospitals doing Closed Loop Note: Data displayed assumes all hospitals are doing BPOC in each closed loop organization. 114 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

116 Market Detail Figure 120: Percent of CPOE Hospitals doing Bedside Barcode Scanning by Inpatient CPOE Vendor (n=778) 100% 90% 80% 70% 60% Average = 52% 50% 40% 30% 20% 10% 0% Note: Data displayed assumes all hospitals are doing BPOC in each closed loop organization. Hospitals using a different vendor for BPOC: Cerner 3 Eclipsys SCM 11 Eclipsys TDS 6 Siemens Invision 4 CPOE Digest 2010 I 115

117 This chart displays the percent of beds with barcode scanning capability for only the 403 hospitals that are doing barcode scanning at the bedside. Figure 121: Adoption (% Beds) by those Doing Bedside Barcode Scanning by Inpatient CPOE Vendor (n=403) 100% 90% 80% 70% Average = 83% 60% 50% 40% 30% 20% 10% 0% Note: Data displayed assumes all hospitals are doing BPOC in each closed loop organization. No Healthland hospitals are doing BPOC. Hospitals using a different vendor for BPOC: Cerner 3 Eclipsys SCM 11 Eclipsys TDS 6 Siemens Invision I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

118 Market Detail Figure 122: System Response Time Inpatient (n=453) * * 6.0 Average = * Figure 123: System Response Time Ambulatory (n=108) * * 6.4* 6.0 Average = Cerner CPSI Eclipsys SCM Epic McKesson MEDITECH C/S MEDITECH MAGIC CPOE Digest 2010 I 117

119 Figure 124: System Reliability and Uptime Inpatient (n=455) * 8.6* * 6.0 Average = Figure 125: System Reliability and Uptime Ambulatory (n=106) * 7.0* 7.0 Average = * Cerner CPSI Eclipsys SCM Epic McKesson MEDITECH C/S MEDITECH MAGIC 118 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

120 Market Detail Figure 126: Response Time Ratings Legend Score Definition Score Definition 9 Always immediate (< 1 second) 4 Delays common with complaints (> 5 seconds) 8 Very slight delays at times (1 2 seconds) 3 Continuous complaints, still livable 7 Slight delay routine, no inconvenience (2 3 seconds) 2 Very difficult, impacts everyone 6 Slight delay, inconvenient (3 4 seconds) 1 Unacceptable, must be fixed 5 Okay with busy time delay, inconvenient (4 5 seconds) Figure 127: Response Time Satisfaction Ratings (inpatient n=453, ambulatory n=108) Inpatient Ambulatory Inpatient Average = Ambulatory Average = CPOE Digest 2010 I 119

121 Figure 128: Reliability & Uptime Ratings Legend Score Definition 9 Never down (99.9% uptime or less than ½ hour per month) 7 Rarely down + short scheduled down time (99% uptime or less than 7 hours per month) 5 Unscheduled down time four or more times per year plus some scheduled down time 3 Unscheduled down time almost monthly and/or significant scheduled down time 1 Unscheduled or scheduled down time almost weekly Figure 129: Reliability & Uptime Satisfaction Ratings (inpatient n=455, ambulatory n=106) Ambulatory Average = 7.9 Inpatient Ambulatory Inpatient Average = I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.