. VENDOR BRIEFS
AXOLOTL (OPTUMINSIGHT) DATA
CERNER DATA
ECLINICALWORKS DATA
EPIC DATA
GE HEALTHCARE DATA
MEDICITY DATA
MOBILEMD DATA
NEXTGEN DATA
ORION HEALTH DATA
RELAYHEALTH DATA
Vendor Briefs
22 I HIE Study 2011 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.
. Vendor Briefs
. AXOLOTL (OPTUMINSIGHT) ELYSIUM EXCHANGE
Number of With 14 live public HIEs (more than any other vendor) and 8 live private HIEs validated, Live HIEs Axolotl is one of the few vendors that can boast substantial penetration in both the Claimed by public and private markets. They have been working in the HIE market since 1995, and Vendor when it comes to mindshare in the current HIE market, Axolotl is on the short list of vendors that providers consistently mention. In addition, Axolotl is one of the few HIE vendors actively pursuing opportunities in the public HIE market. NA Axolotl customers at public HIEs tend to be more satisfied than customers at private Number of HIEs, as evidenced by the disparity in KLAS performance scores between the two Live Public groups—public HIEs give Axolotl an average score of 83.8, while private HIEs give them HIEs Validated an average score of 76.4.
Providers at public HIEs generally feel like they get what they expect from Axolotl and 14 appreciate how engaged they are as a vendor. One CIO at a public HIE commented, “I worked with Axolotl to get everything up and running. I worked with their sales manager. He spent a lot of time going over what they could and, more importantly, what they Public HIEs couldn’t do by way of an HIE. I was very impressed and very comfortable with his honesty in Overall Score telling me areas where they couldn’t help us. Axolotl worked very closely with us. As a vendor, they have my complete respect.”
83.8* Some providers at private HIEs, meanwhile, feel like Axolotl hasn’t been able to deliver exactly what they need. One CIO commented, “I was very positive about Axolotl in its Number of early years with us. . . . But we are seeing the product cracking at the seams because Axolotl Live Private has not been invested in getting things fixed or in hiring the staff that some of their HIEs Validated competitors have.”
In 2010, Axolotl was acquired by UnitedHealth Group/Ingenix. The acquisition so far has 8 provoked mixed responses from Axolotl’s client base and providers in general. Some feel that the acquisition will give Axolotl badly needed resources to be able to address Private HIEs challenges with product development and expansion. Others are worried that so much Overall Score patient data in the hands of a company that also owns a payer will lead to abuse of the data.
76.4*
HIE Study 2011 I 23
Figure 6: Axolotl (OptumInsight): What information is currently being exchanged? (n=17)
100% 100% 100% 100% 94% 94%
80% 71% 65%
60% Average HIE Vendor
41% 40%
29% 29%
20%
0%
Figure 7: Axolotl (OptumInsight): Which vendors provide the various components of your HIE? 100% 1 1 90% 1 2 3 1 1 4 80% 2 1 70% 10 60%
50% WellCentive 7 Siemens 40% 13 Multiple Vendors 12 9 Mirth 30% 7 Initiate 1 20% Healthbridge Cerner 10% Same as HIE 0%
24 I HIE Study 2011 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.
. Vendor Briefs
Figure 8: Axolotl (OptumInsight): In which areas is your HIE providing reports to Regulatory Agencies? (n=17) 100%
90%
80%
70%
60%
50% 41% 40% 35% 29% 30%
20%
10%
0% Immunization Registry Disease Registry/Population Health Bio Surveillance
HIE Study 2011 I 25
. CERNER HUB
Number of Cerner has made significant progress in the HIE market as of late, growing from 1 live Live HIEs public HIE validated by KLAS in 2009 to 2 live public HIEs and 21 live private HIEs validated Claimed by in 2010. Although Cerner’s Hub solution works best when exchanging data between sites Vendor using Cerner EMRs, KLAS was able to validate that a handful of customers are using Hub, with technology provided by Certify Data Systems, to exchange data with non-Cerner EMR solutions. 36 Providers report that Cerner provides knowledgeable implementation teams with deep Number of clinical industry experience. One CIO commented, “We have the leadership from Cerner Live Public involved, and we are getting a lot of attention. We keep confusing ourselves on what HIEs Validated connects where, and how quickly those connections are going to be up and running, and how to manage some of that, but Cerner has been great at thinking through some of those things with us.” 2 However, a number of customers also report that the system has some reliability issues that need to be worked out and that they aren’t getting the help they need from Cerner Public HIEs to fix them. “We had some issues with information not going through the interface from Overall Score PowerChart to Cerner Hub to PowerWorks. Cerner tested the problem out but didn't fix it. Now, several weeks later, we are talking to them about it and they are acting like they have never heard of the issue, even though it is all documented in the system. I think their NA resources must be stretched very thin.” Some providers also complain about nickel-and- diming and the cost of maintaining the system. Number of Live Private HIEs Validated
21
Private HIEs Overall Score 70.8
26 I HIE Study 2011 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.
. Vendor Briefs
Figure 9: Cerner: What information is currently being exchanged? (n=17)
100% 88%
80%
59% 60% Average HIE Vendor 47% 41% 41% 41% 40%
20% 12% 12% 12%
0%
Figure 10: Cerner: Which vendors provide the various components of your HIE? 100% 1 1 90% McKesson 1 Certified Data Systems 80% Same as HIE 3 70%
60%
50% 8 6 2 12 40% 10
30%
20% 10% 0%
HIE Study 2011 I 27
Figure 11: Cerner: In which areas is your HIE providing reports to Regulatory Agencies? (n=18) 100%
90%
80%
70%
60%
50%
40%
30%
20% 17%
11% 11% 10%
0% Immunization Registry Disease Registry/Population Health Bio Surveillance
28 I HIE Study 2011 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.
. Vendor Briefs
. ECLINICALWORKS
Number of The strong presence of eClinicalWorks in the ambulatory EMR market has given them a Live HIEs solid base to help carry them over into the private HIE market. KLAS validated seven live Claimed by private HIEs using the eClinicalWorks HIE solution, Electronic Health eXchange (eEHX), to Vendor exchange data. Of the HIE clients KLAS spoke with, 100% have eClinicalWorks as part of their long-term plans and would buy them again.
NA Because eClinicalWorks is newer to HIE, their clients report experiencing some pains as the product matures, with early success hampered by a couple of rough, delayed Number of implementations with poor training. Once live, clients describe the exchange as working Live Public well for data exchange between eClinicalWorks clients, with good interoperability and HIEs Validated built-in alerts. One customer commented, “As poorly as the implementation went, eEHX does what it is supposed to do. I am hopeful that we will be better off as we are live longer.”
Though commentary on eEHX’s functionality was generally positive, only 44% of 0 respondents said the system has all the functionality they need, a lower percentage than any other HIE vendor rated in this study. Public HIEs Overall Score In addition to sharing data between providers using the eClinicalWorks EMR, some customers reported connecting to other EMRs through the cloud, although they mentioned that eClinicalWorks has not yet created a direct bidirectional exchange with NA other EMR vendors. Providers also like the secure messaging piece and note that it is a fairly efficient solution once it is up and running. Number of Live Private HIEs Validated
7
Private HIEs Note: eClinicalWorks had insufficient specialty data to chart 2011 results. Overall Score
78.9*
HIE Study 2011 I 29
. EPIC CARE EVERYWHERE
Number of Epic’s HIE solution, Care Everywhere, offers clients the ability to exchange data with any Live HIEs Epic sites but does not yet allow most of them to exchange data with non-Epic sites. As a Claimed by result, Epic’s solution is currently only used in private HIEs. KLAS has validated 26 private Vendor HIEs exchanging data using Epic’s solution.
Clients using Care Everywhere report that it is a simple, easy-to-implement, and easy-to- 39 use solution with high adoption. In addition, it is seen as a low-cost option since the application is typically already included in the price of the Epic EMR and there are no Number of hosting fees. One executive commented, “To get Care Everywhere up and running, it was Live Public essentially a free service from a contract standpoint. . . .It ended up taking us about two HIEs Validated weeks to implement Care Everywhere in the middle of a go live.”
According to Epic’s estimates, once all pending Epic implementations are complete, over 0 30% of U.S. patient records will be available for exchange through Care Everywhere. In addition, Epic has announced that the ability to connect non-epic sites with Care Everywhere is in development. KLAS was able to validate one site in the early stages of Public HIEs using Care Everywhere to connect with non-Epic systems. Customers look forward to the Overall Score expanded capabilities that this solution will bring in exchanging data with non-Epic organizations.
NA
Number of Live Private HIEs Validated
26
Private HIEs Overall Score 84.3
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. Vendor Briefs
Figure 12: Epic: What information is currently being exchanged? (n=14)
100% 93% 93%
79% 79% 80% 71%
60% Average HIE Vendor
43% 43% 40%
20% 14%
0%
Figure 13: Epic: Which vendors provide the various components of your HIE? 100% 1 1 1 Homegrown 90% Covisint 80% Same as HIE 70% 9
60%
50% 8 11 5 12 10 40%
30%
20% 10% 0%
HIE Study 2011 I 31
Figure 14: Epic: In which areas is your HIE providing reports to Regulatory Agencies? (n=14) 100%
90%
80%
70%
60%
50% 43%
40%
30% 29%
20% 14% 10%
0% Immunization Registry Disease Registry/Population Health Bio Surveillance
32 I HIE Study 2011 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.
. Vendor Briefs
. GE HEALTHCARE EHEALTH INFORMATION EXCHANGE
Number of GE Healthcare reportedly offers a vendor-agnostic, standards-based HIE solution. KLAS Live HIEs validated five live public HIE clients and three live private HIE clients using GE. GE is one Claimed by of only five vendors with more than three live public HIEs. Vendor GE clients have so far given the product mixed reviews. The public HIEs have generally been pleased with GE’s engagement and service, while the private HIEs have noted more 8 problems with GE not living up to expectations. Some clients from both groups feel the GE HIE solution is not as mature as GE led them to believe. One CIO mentioned, “We are Number of disappointed that GE has not delivered the functionality that was promised. Every time we Live Public bring the matter up to the GE management, they push back and say they have met their HIEs Validated contractual commitments. Apparently, the functionality we believe to be spelled out in the contract and what GE thinks the contract means are two different things.” However, GE is currently a market leader in CCD exchange, with clients reporting an average of 42% of 5 their data being exchanged in CCD format.
Public HIEs Overall Score
NA
Number of Live Private HIEs Validated 3
Private HIEs Overall Score NA
HIE Study 2011 I 33
Figure 15: GE Healthcare: What information is currently being exchanged? (n=6)
100%
83% Average HIE Vendor 80% 67%
60% 50% 50% 50%
33% 40% 33%
17% 20%
0%
Figure 16: GE Healthcare: Which vendors provide the various components of your HIE? 100%
90% 1 1 1 1 NextGate 80% 3 Homegrown 70% Same as HIE 60%
50%
40% 5 5 4 2 30%
20%
10% 0%
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. Vendor Briefs
Figure 17: GE Healthcare: In which areas is your HIE providing reports to Regulatory Agencies? (n=6) 100%
90%
80%
70%
60%
50%
40% 33%
30%
20%
10%
0% 0% 0% Immunization Registry Disease Registry/Population Health Bio Surveillance
HIE Study 2011 I 35
. MEDICITY NOVO GRID & MEDICITY PROACCESS
Number of Medicity is one of the best-known names in the HIE market and has deep penetration in Live HIEs private HIEs, with 33 live clients validated by KLAS. In addition, KLAS validated 5 live Claimed by public HIEs using Medicity’s solutions, and Medicity is one of the few HIE vendors actively Vendor pursuing public HIE customers. Medicity currently offers two HIE solutions to the market: Novo Grid, which they completed a merger with in January 2009, and ProAccess. Providers indicate that Medicity is working to eventually merge the two products, but in 111 the meantime some customers are using one of them and some are using both. KLAS currently monitors Novo Grid and ProAccess as two separate products. Novo Grid/ ProAccess Novo Grid is being used by the bulk of Medicity’s private HIE clients. Providers report the solution is both easy to implement and easy to use. It is primarily used as a tool to push Number of results out to participating clinics, and it can be delivered either through a type of Live Public portal/dropbox or directly through a clinic’s EMR, although most customers report using HIEs Validated the dropbox. One challenge remaining for many Novo Grid customers is implementing bidirectional exchange of data as they look to go beyond simple results sharing. In 0/ addition, some customers feel that support for Novo Grid has dropped off since Medicity acquired the solution, and they express uncertainty about the future development road 5 map. Public HIEs Overall Score ProAccess is being used by all five of Medicity’s live public HIE clients and seven of their live private HIE clients. Customers note that ProAccess has more sophisticated functionality than Novo Grid, including the capability for bidirectional interfaces, NA/ although some mention that those interfaces can be a challenge. Many ProAccess customers describe a strong relationship with Medicity and strong implementations and NA training, but others feel that Medicity is struggling to keep up with customer needs for Number of service and development. Live Private HIEs Validated In 2010, Medicity was acquired by Aetna, a payer organization. As with the Ingenix/Axolotl acquisition, the move has so far provoked mixed responses from 26/ Medicity’s client base and providers in general, with some seeing it as an opportunity for a powerful combination of resources and data and others wary of how Aetna will use 7 patient data. Private HIEs Overall Score
84.3/ 78.8*
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. Vendor Briefs
Figure 18: Medicity: What information is currently being exchanged? (Novo Grid n=15; ProAccess n=9) 100% 100% Medicity Novo Grid 89% Medicity ProAccess 80% 80% 78% 80% Average HIE Vendor 67%
60% 56% 53%
40% 40% 33% 33% 27% 27%
20% 13% 11% 11% 7% 7%
0%
Figure 19: Medicity: Which vendors provide the various components of your HIE? 100% 1 1 1 90% 1 1
80% 1 4 70% 1 Multiple Vendors 60% MEDITECH 50% 1 14 6 4 5 eClinicalWorks 8 7 8 Cintex 40% 5 Cerner Same as HIE 30%
20% 2 10% 0%
Medicity Novo Grid Novo Medicity Grid Novo Medicity Grid Novo Medicity Grid Novo Medicity Grid Novo Medicity Medicity Novo Grid Novo Medicity Grid Novo Medicity
Medicity ProAccess Medicity ProAccess Medicity ProAccess Medicity ProAccess Medicity Medicity ProAccess Medicity ProAccess Medicity ProAccess Medicity EMPI/ CDR Electronic Patient Clinical Viewer Personal Lite EMR Patient Record Data Exchange Consent/ and Data Health Record Privacy Config. Tools
HIE Study 2011 I 37
Figure 20: Medicity: In which areas is your HIE providing reports to Regulatory Agencies? (Novo Grid n=17; ProAccess n=8) 100%
90% Medicity Novo Grid Medicity ProAccess 80%
70%
60%
50%
40%
30%
20% 18% 12% 13% 13% 12% 13% 10%
0% Immunization Registry Disease Registry/Population Health Bio Surveillance
38 I HIE Study 2011 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.
. Vendor Briefs
. MOBILEMD
Number of MobileMD has established itself as a mainstream player in the HIE market, with seven live Live HIEs private HIEs validated by KLAS—the second-highest private HIE total among vendors not Claimed by associated with a CIS vendor. MobileMD’s recent growth is fairly remarkable given that Vendor KLAS validated only one live HIE using MobileMD in last year’s study.
Customers consistently describe MobileMD as a vendor that is a pleasure to work with, 30 noting professionalism and good communication from MobileMD’s support staff. Clients also note that MobileMD is very proactive in working to help them improve the solution Number of and how it is being used. One provider commented, “Our relationship and interaction with Live Public MobileMD and their product are the best of any vendor we are working with. MobileMD has HIEs Validated been exceptionally responsive to our needs to evolve as the needs of our community evolve.” Other customers echoed this sentiment.
0 Providers also feel that MobileMD is particularly skilled at building interfaces into provider EMRs and that the system is very physician friendly. One CMIO remarked, “We use MobileMD for our connectivity to our physician practices, and we interface to practically Public HIEs all EMR vendors. . . . It takes literally one email from me to the MobileMD team to get Overall Score another practice hooked up, and they take it from there to get it live.”
NA
Number of Live Private HIEs Validated 7
Private HIEs Overall Score 94.5*
HIE Study 2011 I 39
Figure 21: MobileMD: What information is currently being exchanged? (n=6)
100% 100% 100%
83% 83% 80% 67% 67%
60% Average HIE Vendor 50%
40% 33% 33%
20% 17%
0%
Figure 22: MobileMD: Which vendors provide the various components of your HIE? 100%
90% 1 1 Siemens 1 1 MEDITECH 80% McKesson 1 70% Homegrown Same as HIE 60% 3
50% 5 40% 4 3 4 30%
20% 10% 0%
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. Vendor Briefs
Figure 23: MobileMD: In which areas is your HIE providing reports to Regulatory Agencies? (n=6) 100%
90%
80%
70%
60%
50%
40% 33% 33% 33%
30%
20%
10%
0% Immunization Registry Disease Registry/Population Health Bio Surveillance
HIE Study 2011 I 41
. NEXTGEN
Number of NextGen’s Health Information Exchange solution began as a portal solution that they are Live HIEs working to leverage into a full HIE. KLAS validated six live private HIEs that are using the Claimed by NextGen solution. Vendor Clients describe using “template triggers” to select data from one EMR, including medications, allergies, diagnoses, and demographic data, and populating that data onto NA CCDs that they then send out to other NextGen sites.
Number of The solution itself is reported as fairly simple to use with good data exchange between Live Public NextGen sites. Although clients report struggles in exchanging data with providers not HIEs Validated using the NextGen EMR, they note enthusiasm and high collaboration from NextGen as they try to make that happen. Some providers mention NextGen is building a CCD interface to try to reach non-NextGen providers, and others say that NextGen is working 0 on a case-by-case basis.
A number of respondents note struggles with physician adoption, saying their physicians Public HIEs dislike the NextGen portal and wish the documents flowed directly into the EMR. Some Overall Score also mention slow implementations, while others describe NextGen as very proactive in trying to customize the solution according to customer needs.
NA
Number of Live Private Note: NextGen had insufficient specialty data to chart 2011 results. HIEs Validated
6
Private HIEs Overall Score 83.0*
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. Vendor Briefs
. ORION HEALTH
Number of Orion Health’s origins lie in the international market, where they have pioneered their Live HIEs HIE technology in a number of different countries. However, Orion Health has a large Claimed by U.S. client base using their Rhapsody Integration Engine solution, and they now have a Vendor substantial footprint in the U.S. HIE market, with seven live public HIEs. Orion Health now trails only Axolotl in terms of live clients in the public HIE space. KLAS also validated one live private HIE using Orion Health’s solution. 12 Customers report that the solution is easy to use and that Orion Health goes above and Number of beyond to ensure that client needs are met. One CIO commented, “We had an issue, and Live Public they rolled right into action. Orion doesn’t get into finger-pointing debates. It is a very HIEs Validated different dialogue with them, which makes Orion more productive to work with.” Orion Health’s solution delivers data to physicians primarily through a portal, but customers report that the portal retains patient context and can easily be accessed from within the 7 EMR, which aids with physician adoption.
Moving forward, Orion Health will likely continue to leverage their existing integration Public HIEs engine client base to expand their presence in the U.S. HIE market. Overall Score
85.5*
Number of Live Private HIEs Validated 1
Private HIEs Overall Score NA
HIE Study 2011 I 43
Figure 24: Orion Health: What information is currently being exchanged? (n=7)
100% 100% 100%
86% 86%
80% 71% 71%
60% Average HIE Vendor
40% 29%
20%
0%
Figure 25: Orion Health: Which vendors provide the various components of your HIE? 100%
1 1 90% Multiple Vendors 80% 3 Initiate 4 Homegrown 70% Same as HIE 60%
50% 7 6 40% 5
30% 4
20% 10% 0%
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. Vendor Briefs
Figure 26: Orion Health: In which areas is your HIE providing reports to Regulatory Agencies? (n=7)
Insufficient data to chart.
HIE Study 2011 I 45
. RELAYHEALTH
Number of With 23 live private HIEs, RelayHealth is second only to Medicity in the number of live Live HIEs private HIEs validated by KLAS. Their growth from 8 live private HIEs validated in 2009 to Claimed by 23 in 2010 is one of the largest increases in this study. In addition, KLAS validated one live Vendor public HIE using RelayHealth’s solution, although RelayHealth has indicated that their primary focus will remain on private HIEs. RelayHealth’s HIE solution is closely tied to their PHR and patient portal solutions, so much so that it is difficult for some providers to 73 differentiate between where one ends and the other begins. They are one of the only HIE vendors that has a substantial portion of their customer base using their PHR and Lite Number of EMR components. Live Public HIEs Validated Providers report that RelayHealth is a proactive vendor partner that listens to customers and solicits feedback on how to improve the product. Clients are also generally pleased with the functionality of the RelayHealth solution as well as its look and feel, but some 1 complain that RelayHealth’s level of support for the product is not where it should be.
Several customers report that RelayHealth struggles to implement interfaces into Public HIEs provider EMRs, which can make physician adoption difficult. Some clients are particularly Overall Score frustrated that RelayHealth does not interface well with McKesson solutions, since RelayHealth is owned by McKesson. One customer commented, “There are still some things I think the vendor is struggling with; [one of which] is just the integration with NA [McKesson] Practice Partner. [RelayHealth and Practice Partner] are both McKesson applications, but they don’t always connect well together.” A few customers also complain Number of that RelayHealth oversold them on the capabilities of the product. Live Private HIEs Validated
23
Private HIEs Overall Score 79.0
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. Vendor Briefs
Figure 27: RelayHealth: What information is currently being exchanged? (n=18)
100% 100%
83% 80%
61% 60% 56% Average HIE Vendor 50%
39% 39% 40%
20% 11% 11% 6%
0%
Figure 28: RelayHealth: Which vendors provide the various components of your HIE?
100% 2 90% 3 80% 12 70% 1 60%
50% 15 15 13 6 14 40%
30% 6 McKesson 20% Cerner 10% Same as HIE 0%
HIE Study 2011 I 47
Figure 29: RelayHealth: In which areas is your HIE providing reports to Regulatory Agencies? (n=18) 100%
90%
80%
70%
60%
50%
40%
30%
20%
11% 10% 6% 6% 0% Immunization Registry Disease Registry/Population Health Bio Surveillance
48 I HIE Study 2011 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.