Vendor market sees an 'Epic' takeover

$19B in incentives spurred a vendor horserace
By Erin McCann
12:00 AM
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It’s hard to get nostalgic about the olden days of health IT. Over the past decade, the vendor product landscape has seen much-needed progress, and although status quo is far from ideal, clinical systems back in 2004 were, many say, in pretty rough shape.

We’re talking five- to 15-second system response times, regular one- to two-day outages at hospitals and paltry clinician adoption. All of which contributed to big vendor market share changes over time. 

“It’s fascinating to see what’s transpired in the past 10 years because I don’t think anyone would have expected how this turned out,” said Kent Gale, founder of healthcare research firm KLAS. “In 2004, I can’t imagine any executive of any of the major EHR companies saying, ‘This is where it would be in 2013.’”

Gale, who has been in the health IT industry for more than 40 years now, said back that in 2004, MEDITECH had the largest share of hospitals with more than 200 beds. Back then, though, primarily financial buyers were purchasing their products, not clinical buyers.

“MEDITECH was, at that point, struggling to have any satisfaction with physicians using their systems,” said Gale.

Today, the company still struggles with ambulatory systems and lacks a fully integrated platform.

Siemens took the No. 2 place in 2004, but didn’t stay there for long.

Two of their big products were Invision and MedSeries4, both of which boasted a fairly large number of customers.

However, a couple years earlier, Siemens announced Soarian would be their go-forward strategy. But, when 2004 came along, the product had stumbled and had poor adoption rates.

“Siemens customers were continuing to live on their older products and were not moving to the new products at this point,” said Gale. “This new EHR was sitting there.”

McKesson was next up. But their big problem – not unlike Allscripts’ recent woes – was integration. Their signature product, Horizon, focused on the clinical side and enjoyed significant adoption rates. “But the satisfaction with the product wasn’t what they anticipated,” said Gale.

Back in 1998, McKesson had purchased health IT systems provider HBO & Co. and subsequently acquired several other companies. Resultantly, Horizon was an “eclectic mix of five or six other vendors’ products,” Gale explained.

Then stood Cerner and Eclipsys in a tie, both of who were new entrants to the acute care space for docs and nurses.

Eclipsys leveraged their acquisition of the Technicon System, which was billed as the very first clinically oriented system, used by the Mountain View Calif.-based El Camino Hospital.

Eclipsys’ Sunrise inpatient product also enjoyed significant adoption by physicians in the beginning, but when the company tried to develop an ambulatory and ED product, it didn’t fare well, and they started to lose their footing.

Cerner, who had started in the laboratories back in the ‘70s and ‘80s, had recently launched its Millennium product and was seeing early success.

Epic everywhere

“2004 was the beginning of a shift in the market,” Gale said. That year finally made it apparent that physicians and nurses were really going to use these systems.

He cited the landmark 1999 Institute of Medicine report, “To Err is Human,” which had estimated that as many as 98,000 Americans were killed each year from medical errors.

“Medication errors now occur frequently in hospitals, yet many hospitals are not making use of known systems for improving safety,” the IOM report concluded.
These findings, Gale said, finally got the ball rolling on better technology.

As vendors rushed to develop and tweak their systems, CPOE initially, many claimed to have hundreds of customers. But much of this, Gale explained, citing a 2003 KLAS study that analyzed CPOE in hospitals, was marketing hype. The numbers weren’t matching up.

That is until Epic entered the scene.

At Evanston Northwestern in Chicago, Epic was the first company not only to install CPOE across three hospitals that became virtually paperless, but also for 500-600 physicians in the ambulatory space, also paperless.  What’s more, these two systems were integrated.

“It broke a barrier,” said Gale. “No one had ever seen this … and that’s when Epic took off, when people could fly to Chicago and see.”

Rumors began to move through the industry – rumors about which systems weren’t producing and which systems were.

“Can you imagine a CEO buys this expensive system,” Gale said, “But nobody uses it because it’s too slow?”

So what are hospitals looking for? They’re looking for a system with decent response time and one docs and nurses will actually use.

“And so Epic does it,” Gale added. “Once Epic signed Kaiser, (the other vendors) are dead.”

Fast-forward to today and Epic still holds the lion’s share of the market, with Cerner close behind.

Some, however, say the success of both companies is far from overwhelming.

“Nothing that these companies did in my eyes was spectacular,” John Gomez, Allscripts’ former head of technology, told The New York Times back in February. “They grew as a result of government incentives.”

The $19 billion federal incentive to spur meaningful use certainly didn’t hurt their fates.

Overall, however, Gale said he’s a bit disappointed at where things stand now. “I think all of us would have expected that the vendors would have had a more robust and mature suite of products that are integrated and ready for use,” he said. “It’s more challenging than anyone expected. It’s tough to deliver.”