– MEDITECH launches a web-based Quick Vaccination solution enabling healthcare organizations to efficiently administer the vaccine to their patients from multiple care venues, including through tablet devices.
– With Quick Vaccination, healthcare organizations have
the speed and mobility to distribute the vaccine at high-volume locations,
including pop-up inoculation sites.
healthcare organizations’ administration of the COVID-19
vaccine, MEDITECH is extending its
capabilities to include a complimentary, short-form Quick Vaccination solution.
This web-based solution streamlines vaccine administration, enabling healthcare
organizations to efficiently administer the vaccine to their patients from
multiple care venues, including through tablet devices.
Quick Vaccination Overview
Vaccination, healthcare organizations have the speed and mobility to distribute
the vaccine at high-volume locations, including pop-up inoculation sites. And,
since the solution leverages integration within the MEDITECH Immunization
Interface, it automatically transmits vital vaccine data to state immunization
Quick Vaccination is a stand-alone solution that can also be
added to any menu within the EHR. The solution allows for automatic defaults of
key vaccine and administration data using flexible parameters. This
significantly shortens the amount of time it takes to document vaccine
administration, so sites can vaccinate more patients in less time.
How It Works
Per CDC guidelines, Quick Vaccination automatically generates a
certificate of COVID-19 vaccination, which is also accessible from the
patient’s portal. The certificate includes administration details such as the
vaccine’s manufacturer, the date the patient received the vaccine, and the care
setting in which it was administered.
Patients will bring the certificate with them to their
appointment for the second dose to ensure the proper next dose is given. The
next certificate will show validation of receipt of both doses within the
appropriate time frame.
MEDITECH provides guidance and scenarios for vaccine administration
across all integrated care areas, and the EHR has the flexibility for sites to
easily add new vaccine codes. Additionally, MEDITECH’s Scheduling solution
enables customers to schedule vaccine administrations as part of an appointment
set, which means the first and second doses can be scheduled at the same time
with the appropriate eligibility interval between doses. Appointments are
integrated with the patient portal, so the patient is reminded of the second
Furthermore, patient registries can identify eligible patients
and vaccine distribution by phase ― such as residents of long-term-care
facilities or those with specific preexisting conditions. Eligible employees
can also be identified and registered as patients. In addition, registries keep
track of patients who have not received a full course of the vaccine, and may
also be used to alert staff of high-risk patients who may require follow-up
“Time is essential in fighting COVID-19, and we recognize that immunizing as many people as possible is imperative,” said MEDITECH Vice President of Client Services Leah Farina. “We developed the Quick Vaccination solution to streamline the process and enable care providers to efficiently administer the COVID-19 vaccine to their patients while meeting CDC guidelines.”
Meditech continues to hold the largest EMR market share in Canada, but it is losing customers — mostly to Epic, which has seen a rapid rise in popularity, a new KLAS report shows. The report delves into market share data and customer satisfaction insights to assess EMR vendors’ positions in the Canadian market.
– Today, MEDITECH announced MEDITECH Cloud Platform—a
suite of solutions available to healthcare organizations of all sizes that
further extend the possibilities of the Expanse EHR.
– This offering includes: Expanse NOW, High Availability
SnapShot, and Virtual Care solutions, all created to work naturally in the
cloud, and available through a subscription model.
introduced MEDITECH Cloud Platform—a suite of solutions available to healthcare
organizations of all sizes that further extend the possibilities of the Expanse Electronic Health Record
(EHR). Multiple MEDITECH Cloud
Platform solutions are built on Google Cloud, enabling healthcare organizations
to further personalize their EHR in a way that is secure, reliable, and easy to
Subscription-Based Cloud Model
Healthcare organizations can select one or a combination of
the solutions from MEDITECH Cloud Platform. The flexibility of the subscription
model enables a quick setup as well as the ability to add solutions as needed.
Additionally, the cloud combined with the subscription model provides
opportunities to add solutions in the future.
Expanse NOW is a mobility app that empowers
physicians to manage everyday tasks and coordinate care on their smartphone
device. Integrated with Expanse, tasks and messages can flow between workload
and the app in real time.
High Availability SnapShot provides healthcare
organizations with immediate access to key patient data in the event of
unexpected or planned downtime. Patient information such as medications,
allergies, orders, and more is backed up securely and accessible via
Virtual Care gives new and existing patients access
to urgent virtual care on demand through the healthcare organization’s website,
as well as the ability to schedule virtual visit appointments. New patients who
request Virtual Care are automatically enrolled in the Patient Portal,
connecting them to the organization and in turn, enabling organizations to grow
Leveraging Google Cloud’s Capabilities
The Expanse NOW and High Availability SnapShot solutions
leverage Google Cloud’s core capabilities including compute and storage (as
well as their healthcare-specific data, analytics, security, and identity
management solutions) alongside existing on-prem solutions to provide high
availability and continuity of care in a secure and scalable service. They can
be easily accessible to critical care staff to improve healthcare continuity
across MEDITECH-powered healthcare organizations.
For more information about the MEDITECH Cloud platform,
Razor-thin operational margins coupled with substantial and ongoing losses related to COVID-19 are culminating in a perfect storm of bottom-line issues for U.S. hospitals and health systems. A study commissioned by the American Hospital Association (AHA) found that the median hospital margin overall was just 3.5% pre-pandemic, and projected margins will stay in the red for at least half of the nation’s hospitals for the remainder of 2020.
The reality is that an increase in COVID-19 cases will not overcome the pandemic’s devasting financial impact. An internal analysis found that, in the first half of 2020, client organizations documented more than 1.2 million COVID-19 related cases. At least one study suggests that $2,500 will be lost per case–despite a 20% Medicare payment increase. And notably, a positive test result is now required for the increased inpatient payment.
The healthcare industry must face its own “new normal” as the current path is unsustainable, and the future stability of hospitals in communities across the nations is uncertain. If financial leaders do not act now to implement systems and embrace sound revenue integrity practices, they will face unavoidable revenue cycle bottlenecks and limit their ability to capitalize on all appropriate reimbursement opportunities.
The COVID-19 Effect: A Bird’s Eye View
The financial impact of COVID-19 is far-reaching, impacting multiple angles of operations from supply chain costs to lost billing opportunities and compliance issues. Findings from a Physician’s Foundation report released in August suggest that U.S. healthcare spending dropped by 18% during the first quarter of 2020, the steepest decline since 1959.
Already vulnerable 2020 Q1 budgets were met with substantial losses when elective procedures—a sizeable part of income for most health systems—were halted for more than a month in many cases. Many hospitals continue to lose notable revenue associated with emergency care and ancillary testing as patients choose to avoid public settings amid ongoing public safety efforts.
Outpatient visits also dropped a whopping 60% in the wake of the pandemic. While a recent Harvard report suggests that numbers are back on track, the reality is that a resurgence of cases could make consumers wary of both doctor visits and elective procedures again.
In addition, the supply chain quickly became a cost risk for health systems by Q2 2020 as the ability to acquire drugs and medical supplies came at a premium. Meeting cost-containment goals flew out the window as did the ability to create value in purchasing power.
Further exacerbating the situation is an expected increase in denials as healthcare organizations navigate a fluid regulatory environment and learn how to interpret new guidance around coding and billing for COVID-19 related care. For example, while telehealth has proved a game-changer for care continuity across the U.S., reimbursement for these visits remains largely untested. History confirms that in times of rapid change, billing errors increase—and so do claims denials.
While there is little that can be done to minimize the impact of revenue losses and supply chain challenges, healthcare organizations can take proactive steps to identify all revenue opportunities and minimize compliance issues that will undoubtedly surface when auditors come knocking to ensure the appropriate use of COVID-19 stimulus dollars.
Holistically Addressing Revenue
Getting ahead of the current and evolving revenue storm will require healthcare organizations to elevate revenue integrity strategies. Hospitals and health systems should take four steps to get their billing and compliance house in order by addressing:
1. People: Build a cross-functional steering committee that will drive revenue integrity goals through better collaboration between billing and compliance teams.
2. Processes: Strategies that combine the strengths of both retrospective and prospective auditing will identify the root cause of errors and educate stakeholders to ensure clean, timely filed claims from the start.
3. Metrics: Best practice key performance indexes are available and should be used. Clean claim submission, denial rate, bad debt reduction and days in AR are a few to consider.
4. Technology: The role of emerging technologies that use artificial intelligence cannot be understated. Their ability to speed identification of risks, perform targeted audits, identify and address root causes and most importantly, monitor the impact of process improvements is changing current dynamics. For one large pediatric health system in the Southwest, technology-enabled coding and compliance processes resulted in $230 million in reduced COVID-related denials and a financial impact of $2.3 million.
Current manual processes used by many healthcare organizations to assess denials and manage revenue cycle will not provide the transparency needed to both get ahead of problems and identify areas for process improvement and corrective action in today’s complex environment.
About Vasilios Nassiopoulos
Vasilios Nassiopoulosis the Vice President of Platform Strategy and Innovation at Hayes, a healthcare technology provider that partners with the nation’s premier healthcare organizations to improve revenue, mitigate risk and streamline operations to succeed in an evolving healthcare landscape. Vasilios has over 25 years of healthcare experience with extensive knowledge of EHR systems and PMS software from Epic, Cerner, GE Centricity and Meditech. Prior to joining Hayes, Vasilios served Associate Principal at The Chartis Group.
– New KLAS report finds acute and ambulatory care EMR
vendors Cerner, Epic and NextGen are best at making outside patient data usable
for clinicians (data from outside the clinician’s health system).
– KLAS report examines adoption and usability among advanced
users of the main acute and ambulatory care EMR vendors.
The national interoperability networks of Carequality and CommonWell Health Alliance have become some of the primary means by which patient records are shared between healthcare organizations in the US. Despite progress in delivering interoperability, the number of providers connected to these plug-and-play networks, and the usability of the shared data varies significantly depending on the EMR in use. The KLAS report, Interoperability 2020 (Acute/Ambulatory) examines adoption and usability among advanced users of the main acute and ambulatory care EMR vendors.
Epic, NextGen, Cerner Best at Making Outside Patient Data
The report reveals Cerner, Epic and NextGen are the best
acute/ambulatory EMR vendors at making outside patient data
usable for clinicians (data from outside the clinician’s health system). Epic
continued to enhance the end-user experience with its Happy Together solution delivering
the most natural integration of outside data into the clinician workflow,
including the recent addition of basic lab trending.
KLAS named NextGen as the only ambulatory specific EMR vendor
to provide a strong usability experience for all interoperability workflows,
while Cerner customers validated its strong capabilities for accessing and
incorporating a wide variety of outside data into the patient record.
Duplicate PAMI Data a Growing Problem
Customers of both Cerner and Epic say the next step is for
the vendors to reduce the duplication of problems, allergies, medications, and
NextGen Healthcare is the only vendor whose customers report
significant improvement in this area. The NextGen EMR is able to filter out duplicate
medications, even for inexact matches (e.g., Tylenol vs. acetaminophen). While
other solutions may be capable of flagging duplicate information and removing
some of it, customers say the process is often still very manual.
Other key findings of the report include:
– athenahealth and Epic continue to lead in overall
adoption, with nearly all customers connected to CommonWell Health Alliance
– Cerner has been encouraging customers to adopt the
CommonWell connection for some time, and over the past 18 months, the number of
customers live has doubled, meaning a majority of clients are now connected.
– NextGen Healthcare has also continued to advocate for the adoption of Carequality among its customer base.
– eClinicalWorks customers have been actively connecting;
their usability experience remains similar to what it was in the past.
– Since early 2019, many organizations have implemented Expanse, but the adoption of CommonWell among MEDITECH customers has increased only slightly (from two customers to eleven).
– Allscripts was a founding member of CommonWell in 2013 but
never connected. After multiple delays and a shift to Carequality, they
connected their first customer (via dbMotion) in the second half of 2020.
– How the top US acute EHR vendors, namely Cerner, Epic, Allscripts, and MEDITECH (+85% share of US acute market in terms of revenues), have progressed on international expansion.
As highlighted below, there is a significant variance amongst the big four in terms of revenue and share of business outside the US. Cerner has by far the highest revenue at more than $650M in 2019, representing 12% of its business. Whilst MEDITECH has considerably lower revenue than Cerner, its international revenue is broadly similar to a share of its total revenue.
By contrast, Allscripts and MEDITECH each has international business that is comparable in terms of revenues, but as a share of overall revenues, international is much less important for Allscripts.
Allscripts’ international revenue was lower than Epic, Cerner, and Meditech in 2018, however, its growth in 2019 enabled it to overtake MEDITECH and become the third largest of the four vendors in 2019.
Cerner’s international revenues fell marginally as a proportion of its total business in 2019 (11.5%, down from 11.9% in 2018), although revenues grew in absolute terms by 3%. This growth was aided by success in Europe, particularly in the UK and Nordics where it won new contracts. Cerner’s overall revenue suffered a 3% decline in 1H 2020 (versus 1H 2019). Despite the impact of COVID-19, its international business witnessed marginal revenue growth (+1%) and rose as a share of its overall business (11.9%) during this period.
Cerner received a significant boost to its international business in 2015 when it acquired Siemens’ EHR business. This provided it with a broad footprint of deployments in DACH (Germany, Austria, Switzerland), Benelux, France, Norway, and Spain. Since this acquisition, the challenge for Cerner had been to migrate the customer base to Millennium. However, this has not happened to date, particularly in Germany and Spain.
Tough market conditions, especially in Germany which already had a highly competitive acute EHR market, was another factor impacting the market growth. The above challenges faced by Cerner were key drivers behind the deal to sell parts of Cerner’s Healthcare IT portfolio in Germany and Spain to CompuGroup Medical (CGM). Cerner will continue to maintain a presence in Spain and German acute markets via its i.s.h.med solution (originally contracted to SAP/Siemens), which was not included in the CGM agreement. i.s.h.med has also provided Cerner a footprint in several other European, African, and Asian countries such as Russia and South Africa.
In other European countries where Cerner has a Millennium footprint it has had more success, and the additional product support and development costs have been less.
Cerner has a substantial UK presence, in part owing to its legacy relationship with BT and the subsequent contracts given out under the largely failed NPfIT program. These customers do use Millennium and the company has grown this business in recent years. To date, Cerner has an installed base of 26 trusts in the UK, up from 22 in 2019, and has had success upscaling these contracts to include products such as HealtheIntent. It has also grown the number of acute trusts served. For example, in 2018 it won contracts with The Countess of Chester Hospital National Health Service Foundation Trust, previously using MEDITECH, and Sandwell and West Birmingham Hospitals. In 1Q 2020, Cerner was selected by two NHS Foundations Trusts (Ashford and St Peter’s Hospital and Royal Surrey) to implement a shared Millennium EHR system, which should support a more coordinated care approach between the two organizations.
Elsewhere in Europe, Cerner expanded its Nordic business recently with large contracts in Region Skäne and Västra Götalandsregionen (both in Sweden) during 2018 and 2019. Cerner was chosen as the preferred EMR supplier for Central Finland (four of 19 sote-areas) and will have the opportunity to expand the contract to other surrounding regions in the mid-long term. However, it lost its Norwegian footprint to Epic when it chose not to bid when the Helse Midt-Norge (Central region) contract was renewed in 2019.
The company has also seen success in the Middle East, particularly in the UAE, Qatar, and Saudi Arabia. However, growth has been more subdued over recent years. In the UAE, it has large contracts with the Ministry of Health and Prevention (MOHAP) and Abu Dhabi department of health (HAAD). Whilst Cerner already has a significant footprint in Saudi, e.g. King Faisal Hospital, the country is still relatively untapped in terms of deployment of digital solutions and offers Cerner a good future growth opportunity.
In Asia Cerner has been successful in Australia, winning state/territory-wide EHR contracts in both Queensland and New South Wales (the only vendor to win two state/territory-wide contracts), and also had success in other states/territories where procurement is decentralized. Cerner was aiming to add a third centralized Australian contract to its customer base, namely ACT Health (Capital Territory), but was unsuccessful in a head-to-head with Epic, which was selected as the chosen partner in July 2020. Cerner aims to push its PHM solution (HealtheIntent) through its existing state-level contracts where it already has a presence with Millennium.
Most of Cerner’s non-US business in the Americas is in Canada where approximately 100 hospitals are estimated to be using its solution. Here it faces competition from the other leading US vendors such as MEDITECH, Epic, Allscripts, and also local vendor Telus.
In summary, Cerner has broadly made a success of its international business. It tops the market share table in several of its international geographies and it has done this while broadly maintaining the margins achieved with its US business. However, Cerner’s divestiture of the legacy Siemens business in Germany/Spain, and withdrawal from Norway (Central region), will reduce the size of its European business. Cerner also faces an increasing threat from EMEA competitor Dedalus, whose recent acquisitions of Agfa Health’s EHR and integrated care business, and DXC’s healthcare provider business (deal to close in March 2021), could impact Cerner’s position as acute EHR market leader in EMEA moving forwards.
Allscripts’ international revenues witnessed a substantial rise in real terms (up by 34% versus 2018) and as a share of overall business in 2019. This was partly due to a strong performance in the UK with existing customer sales, and new contract wins in New Zealand, Qatar, Philippines, and Saudi Arabia. The impact of COVID-19 on Allscripts’ total revenues was comparatively significant (versus Cerner and MEDITECH), with declines of 9% and 6% respectively in 2Q 2020 and 1H 2020. It is estimated that these declines predominantly impacted North American revenues, whereas international revenues suffered to a lesser extent.
Canada had historically been its largest market outside the US accounting for just under a third of its non-US business, however, its share fell by six percentage points from 2018 to 23% in 2019, largely owing to the growth of its business in the UK and Australia, which are estimated to now be broadly similar in size to Canada.
In Canada, it is a top-five player, but lagging someway behind MEDITECH, Cerner, and Epic in terms of hospital installations. Allscripts continues to steadily grow its Canadian business with a focus on selling added functionality/upgrades to long-standing customers in three provinces (Manitoba, Saskatchewan, and New Brunswick). It aims to expand its Canadian coverage by securing the contract with Nova Scotia province in 2H 2020.
Success in EMEA was mainly driven by wins in the UK, which included two Sunrise clinical wrap contracts along with several added-value solutions for existing client systems. In May 2019, Gloucestershire Hospitals NHS Foundation Trust selected Allscripts to provide a clinical wrap around InterSystems’ PAS. This was rolled out to the entire Trusts’ inpatient wards in March 2020 and represented the fifth clinical wrap around another vendor’s PAS in the UK. In the UK it serves 18 acute trusts (only Cerner, DXC, and SystemC are estimated to serve more).
Much of the company’s UK footprint was built from its acquisition of Oasis Medical Solutions six years ago. However, it has slowly built on this foundation adding new acute trust customers and upgrading many from the legacy Oasis PAS solution to Sunrise and other Allscripts’ solutions such as dbMotion – although perhaps at a slower rate than hoped. Besides the UK and Italy (where it has one Sunrise contract) Allscripts does not have immediate plans for Sunrise expansion in mainland Europe. However, countries that are attempting to implement integrated data-sharing programs (e.g. France, Germany, and Italy), offer Allscripts potential markets for its dbMotion solution.
Allscripts also achieved growth in the Middle East, fuelled by a contract win in March 2020 with Qatar’s Alfardan Medical / Northwestern Medicine for Sunrise. Allscripts has been working on opportunities across Saudi Arabia, UAE, Oman, Qatar, and Kuwait, with different strategies for each country. For example, Oman has a relatively low level of digital healthcare maturity and is being targeted with EMR solutions, whereas relatively mature health markets (e.g. UAE and Qatar) are being targeted with PHM/dbMotion.
Its entry into the Oceania market was also largely via acquisition (Core Medical Solutions in 2016). Core Medical Solutions was a leading player in the smaller hospital and private hospital markets in Australia. Allscripts has added to this legacy with a state-wide Sunrise EHR contract in South Australia (although deployment has not been without its challenges). Sunrise has been implemented in Royal Adelaide Hospital, South Australia Health and Medical Research Center, University of Adelaide, and the University of South Australia.
In 4Q 2019 Allscripts added South Australia’s largest regional hospital network, Mt Gambier, to its coverage. It also had success selling its Sunrise solution outside of this state-wide contract (e.g. Gippsland Health Alliance in Victoria in 2018) and in 2019 its footprint expanded into New Zealand.
In terms of its broader Asian strategy, the company recently split its Asian business into two sub-businesses, ASEAN and ANZ, indicating it sees opportunities beyond its existing Singapore footprint in South East Asia. This has been supported by 2019 wins in the Philippines. In less digitally mature countries, the BOSSNet EHR solution it obtained via the Core Medical Solutions acquisition offers a potential route to offering a more entry-level EHR solution compared to Sunrise.
At just 4.0% of revenues in 2019, international remains a relatively niche business for Allscripts. To some extent the company needs to decide where it wants to take this business. Relying on organic growth in the regions it currently serves is unlikely to move the dial far from this 4.0% figure over the next five years. A significant change is likely only via acquisition, something the company has not shied from in the past. However, should it focus on cementing its position in existing markets or expansion into new? Given it is not a top-two vendor in any of its current geographies outside the US, acquisition to cement its position in existing markets would make more sense than further expansion into new geographies.
Historically, there have been two major points of entry into new geography for EHR vendors; either through a partnership to gain expertise and ‘localize’ a solution or through the acquisition of a local vendor (as with Cerner and Allscripts earlier). Both have their challenges, with partnerships often being slow to progress and acquisition resulting in the long-term support, and in some instances a significant burden of a legacy solution (e.g. Cerner is still supporting several legacy Siemens EHR solutions nearly six years after announcing its acquisition plans and most of Allscripts’ UK customers are not using Sunrise).
Examples where vendors have taken on large regional projects without sufficient ‘localization’, have often resulted in projects not meeting expectations and negatively affecting both vendors and providers alike. To some extent, Epic has suffered from this with several of its non-US deployments, in particular in the UK (e.g. Cambridge University Hospitals in 2015) and more recently in Denmark (regional contracts in the Zealand region and Capital Region) and Finland (regional contract in the Apotti Region).
Epic has not made acquisitions to enter its international markets and in all these examples EHR implementations have not met expectations and have either had to be scaled back, delayed, or required a significant amount of remedial action. The main criticism is often not enough ‘localization’ before deployment. That said Epic has had success elsewhere internationally, with less controversy surrounding its deployments in DACH, Netherlands, Middle East, and Singapore. In Canada, it is estimated to be the market leader in terms of revenues and second only to MEDITECH in terms of hospital deployments.
Epic has increased its focus on international expansion in recent years with incremental increases in revenue. However, it needs to improve on implementation/execution or future opportunities may be limited. The fact it was the only vendor to hit the preselection criteria in Norway for the Helse Midt-Norge contract which it won in 1Q 2019 (replacing Cerner) suggests that progress has perhaps been made on this front.
Historically Epic has struggled to win any Australian state/territory-wide deployments where Cerner, Allscripts, and InterSystems have been successful. However, Epic strengthened its position by winning its first state contract in July 2020 – a $151m deal for the Australian Capital Territory (ACT Health). This was also significant due to it being the first time the Capital Territory had centralized contracting.
At 12% of 2019 revenue, MEDITECH had the highest proportion of non-US sales of all the vendors analyzed in this insight. However, the overwhelming majority of this was from Canada, where it is estimated to be the market leader in terms of the number of hospital installations (although in terms of revenues it is smaller than Epic, Cerner, and Allscripts). Of approximately $60M in non-US sales in 2019, nearly $50M is estimated to have been from Canada. Non-US revenue share was down marginally from 13% in 2018 and in absolute revenues (-7%) due to a fall in Canadian revenues (-8%), whereas revenue from other international markets was marginally up (+1%).
In early 2018 MEDITECH announced the release of its cloud-based EHR, Expanse. MEDITECH has since been rolling out its cloud-based EHR to new customers and replacing its legacy hosted Magic solution for existing customers. This will ease some of the costs and time associated with implementing the solution, which should make it more competitive. In addition, the data hosted on the cloud will make it easier to drive interoperability through a Health Information Exchange, further increasing its attractiveness for provider networks.
Implementation delays caused by COVID-19 contributed toward MEDITECH’s total revenue declining by 3% in 2Q 2020 (versus 2Q 2019). However, a strong international performance in 1Q 2020 (estimated revenue up by c.25%) was driven by new Expanse installations in Canada (including Ontario Mental Health Hospital), leading to 1H 2020 revenues rising by almost 10% (versus 1H 2019).
Approximately 2% of MEDITECH’s business comes from outside North America, a trend that has remained relatively unchanged for several years. As with Epic, Cerner and Allscripts, a significant proportion of its non-American business is in other English-speaking countries, such as the UK/Ireland (22 customers in the UK and 3 in Ireland – mainly public/private sector hospitals), South Africa (24 hospitals) and Australia (72 private hospitals). In the UK it is a second-tier vendor providing EHR solutions to a small number of NHS trusts (low double-digit). Despite a concerted push into the UK, with the acquisition of Centennial (its UK distributor and system integrator) and the official formation of MEDITECH UK in 2018, the number of trusts served decreased with Cerner taking Chester NHS Trust from MEDITECH in 2018.
The company has had considerable success in Africa, selling solutions in 12 countries including Botswana, Namibia, South Africa, Kenya, Nigeria, and Uganda. In September 2019, it partnered with Aga Khan University for a new 2020 deployment of Expanse in South African and Kenya, and subsequent deployment in Pakistan. Contracts in Kuwait and the UAE result in the whole MEA region accounting for a sizable share of its non-North American business.
MEDITECH’s international business mirrors its US business to some extent. It has one of the largest installed bases of hospitals worldwide, but predominantly small hospitals, and often in countries where spend per bed is low; it is also typically not upselling beyond core EHR, meaning that its international revenues, particularly when Canada is excluded, remain small.
In Signify Research’s latest global EHR analysis, it was estimated that the US accounted for nearly two-thirds of global EHR sales in 2019, so for these four vendors it must remain the key priority. However, the US is forecast to be one of the slowest growing EHR markets over the next five years as it approaches saturation, particularly for core-EHR products in the acute market. Further, the acute market in the US has now broadly consolidated around these four vendors meaning opportunities for gains in share through replacement is increasingly rare – the long tail has gone.
The geographic expansion offers a potential avenue to drive growth. However, it is not easy and there are plenty of pitfalls. Localizing solutions, acquiring local vendors, displacing local incumbents, aligning products to match government requirements and projects, and putting in place local implementation, project management, and support teams all require significant time and investment. Because of this, the global market remains highly fragmented and market share change is slow. However, for the big four discussed in this insight, ignoring the international opportunity will significantly limit long-term growth; so despite slow and sometimes painful progress, we expect it to remain a priority.
About Arun Gill, Senior Analyst at Signify View
Arun Gil is a Senior Market Analyst at Signify Research, a UK-based market research firm focusing on health IT, digital health, and medical imaging. Arun joined Signify Research in 2019 as part of the Digital Health team focusing on EHR/EMR, integrated care technology, and telehealth. He brings with him 10 years’ experience as a Senior Market Analyst covering the consumer tech and imaging industry with Futuresource Consulting and NetGrowth Consultants.
– The latest Chilmark Research report examines how data-oriented APIs are contributing to development and integration efforts across healthcare from the perspective of the developer.
– Reeling from the impact of the COVID-19 pandemic and
seeking more effective ways to implement new functionality, healthcare
enterprises of all kinds are looking to alternatives for prevailing development
and integration practices.
Outside healthcare, the ascendance of
data access and integration facilitated by application programming interfaces
(APIs) is the culmination of decades of technology evolution and implementation
lessons with distributed applications. Across the SaaS landscape in particular,
APIs have become the preferred method for accessing data and conducting
transactions across applications and organizations. Developers recognize and
appreciate the value of loosely coupling their applications and data, wherever
each is located.
Inside healthcare, many enterprises are
hesitant on the topic of APIs, seeing them as too big a leap from established,
successful software practices. But they also recognize that eliminating the
need for hard-coded interfaces that must be re-implemented every time an
application or its underlying data changes will deliver higher programmer
productivity and more-responsive applications.
Traditional Integration Methods Fall
Conventional development and
integration approaches proved cumbersome and slow in efforts to contribute to
understanding or responding to the current health crisis. Unlocking more value
from the data scattered across healthcare communities is — post-COVID-19 —
a critical element in clinical and
“Enterprises across healthcare were already wrestling with challenging market forces and government mandates,” says Brian Murphy, the report’s lead author and analyst. “Open APIs will play a central role for providers, payers, or any healthcare enterprises that intend to better utilize their data and pursue development efforts that make them — and the broader healthcare community — more responsive and adaptable to the demands of a post-pandemic healthcare system.”
Developers Require Accessible Data
Developers find data wherever they can from among a large
and confusing mix of data holders and associated vendors. This report
identifies the sources where different kinds of health-related data are most
likely to be API-accessible. It shows how APIs are already contributing to
development and integration efforts across healthcare and estimates the much
larger potential of widespread adoption.
This report includes detailed profiles on 20 public and
private organizations and their offerings, including 1upHealth, 4Medica,
Allscripts, Apple, Athenahealth, Availity, Blue Button 2.0, Cerner, Change
Healthcare, Datica, Epic, Human API, Meditech, NextGen, NCPDP, Particle Health,
The Sequoia Project, Redox, Surescripts, and Validic.