Which Acute EMR Vendors Have the Strongest Ambulatory Products?

A Reader Asks: Dear HIS Pros, I recently read Anthony Guerra’s article on Meditech’s ambulatory EHR situation and wanted to know your assessment of the other major inpatient vendors when it comes to their ambulatory offerings. Thanks!

Good question: Anthony’s blog on Meditech and LSS makes one wonder about the other big boys offerings in these two market niches, so here goes, in order of size (annual revenue):

McKesson – they’re so darned big with so many products, this will be tricky, so bear with me. They have at least 5 discrete HIS offerings:

• Paragon – red-hot true C/S HIS, selling like hot cakes in the small and medium markets (up to 250 beds)
• Horizon – new name for the former “Pathways” series of standalone clinical systems for nursing, lab, RX, RIS, etc, etc, etc.
• HERM – just announced, high-end (250+ beds) Soarian-fighter
• Star – their old DG-based HIS with a few hundred stalwart users
• Series – iSeries-base RPG dinosaur, also with hundreds of users

On the ambulatory side, they also acquired a bunch, with the major ones being:

• Practice Partners – a leading ambulatory system acquired a few years ago with a medium-strength EMR and good 1500 billing; support seems to have suffered during the takeover however…
• Practice Point Plus – their re-write of the old CyCare system, strong in 1500 billing, registration and scheduling, but weak (non-existent?) clinical EMR.
• Plus a bunch of stuff they bought from Per Se, and supposedly a new product (“Fusion”) they’ve been working on…

In the same boat as Meditech, whatever combination you try.

Cerner – wonderfully functional high-end “Millennium” acute-care EMR – can answer yes to any RFP question you can dream up! Probably, the best hospital clinical system, bar none (including Epic), provided you have the large IT and Informatics staff to build it, and a strong CFO to pay for it. Definitely targeted to large AMCs and IDNs. On the revenue cycle side, their “ProFit” offering has had a checkered past, but slowly improving; no ERP, they punt to Oracle. They claim the same PowerChart and ProFit apps will work in MD practices, but they don’t have near the acclaim in physician offices as they have in hospitals. Integrated, yes; equally functional, no.

Siemens – like McKesson, a number of discrete HIS offerings:

• Soarian – finally overcoming a decade of growing pains to be a true high-end competitor in the 250+ bed market.
• Invision – old COBOL-based mainframe with 600+ users
• MedSeries 4 – iSeries-based RPG mid-range with 400+ users

On the ambulatory side, they have had a strong 1500 billing system for years named Signature, but with little or no clinical functionality. They used to “partner” with either NextGen for ambulatory EMR systems while they were supposedly working on a Soarian offering, but when NextGen bought an HIS (see below), that deal ended, so ambulatory is definitely an Achilles heel in Malvern right now.

GE – bought IDX years ago to get a top-notch, high-end clinical system called CareCast, which they’re renamed Centricity. Superb clinical functionality even before their deal with IHC to improve medical alerts. So-so in revenue cycle and no ERP. On the ambulatory side, they acquired Logician from MedicaLogic, a world-beater at the time in ambulatory EMRs and 1500 billing. Challenge is to integrate the two, which hasn’t happened. Their interfaces are good, but what an MD sees in her office bears little resemblance to what she sees in the hospital… just like every other vendor except:

Epic – need one say more? The only system where a doc sees the same screen, edits, passwords, etc, in both settings. Period. True and total integration, not lame interfacing. What Epic bigots won’t admit is its acute-care functionality is weaker than Cerner, GE, Soarian, and Horizon. Especially in hospital specialty areas like ED, OR, etc. But, when the physicians line up outside the CEOs office demanding to have the same system as in their practice, what’s a CIO to do?

AllScripts (Eclipsys) – Sunrise is another world-beater on the acute-care side, with superb clinical functionality for nursing and hospital MDs. Even their revenue-cycle offering (formerly SDK) is super, so they have done well in the AMC and IDN world for years. On the practice side, AllScripts has been a leader in both practice EMRs and 1500s, so a match made in heaven, right? Wrong: it’s interfaced, not integrated. A doc sees one set of screens, reports and prompts in his office, and enters another world at the hospital.

Meditech – Anthony summed it up well: whether Magic, C/S or Release 6, Boston’s acute-care offerings are great for small to mid-size hospitals. LSS started as small firm in Wisconsin who programmed a practice system in Magic, and sold into Meditech’s client base. Meditech bought an interest at first, then the whole thing, but only their balance sheet is integrated today: different screens, reports, etc.

Other Mid-Size Vendors – what about Meditech’s competition in the mid-size market?

• QuadraMed – Affinity has always shown in the revenue cycle space, and QCPR gives them a world-class inpatient EMR. But no MD practice offering.
• Keane – fascinating new Optimum combination of PatCom revenue cycle and i-Med EMR, but no MD practice offering.
• IntraNexus – wonderful Sapphire hospital clinical and financial system, with great price/performance, but no MD office offering.

Small-hospital Vendors – what about Meditech’s competition in the under 100-bed market?

• CPSI – Amazingly integrated HIS (even has T&A and PACS!), but little or no ambulatory EMR functionality.
• HMS – another solid HIS offering, just added MedHost as a leading ER specialty system. It’s interfaced, not integrated.
• Healthland – leader in the CAH market, the old Dairyland HIS offers super price/performance, but little MD office functionality.

So is it hopeless? Read on:

NextGen – A leader in the practice EMR and 1500 world, NextGen scooped up Opus, a superb acute care EMR last year, and added Sphere, a fine old financial suite. So they have it in theory, except they’re interfaced, not integrated…

So there you have it: the whole industry at a glance, and a telling explanation of why Epic dominates the AMC and IDN world. For everyone else, it’s time to build an inhouse HIE!