CONFIDENTIAL
Electronic Records
Matthew Kim
Research Intern | Healthcare
+1 512-651-3495 Austin Office
mkim@glgroup.com
November 2015

Contents
I. Overview of Industry
II. Medical v. Electronic
III. Ambulatory v. Hospital
IV. Selection Criteria
V. Implementation
VI. Market Share
VII. Conclusion

Contributors
John D’Amore
President and Chief Technology Officer
Diameter Health
•Former President and Founder at Clinfometrics
•Has over a decade of experience in health IT and medical informatics
•CM since 2013 and has done three GLG events
Mike Mytych
Founder and Owner
Health Information Consulting, LLC
•Has conducted over 100 EHR vendor selections for physicians and hospitals
•Has been in the healthcare IT space for over 30 years
•CM since 2002 and has done six GLG events
Michael Sills, MD, FACC
Vice President
Informatics and Technology at Baylor Quality Alliance
•Former Medical Director of Non-Invasive Department at BUMC
•Spent 12 years serving as President of Cardiology Consultants of Texas
•CM since 2013 and has done one GLG event
Richard Wong, MD
Cardiologist
Kaiser Permanente Medical Group
•Involved in hospital’s information system on local and regional levels
•Has extensive research experience with various EHR vendors
•CM since 2006

History and Transition
1960-2000
• Larry Weed and Problem Oriented Medical Problem
• First Electronic Medical Record at The Regenstrief Institute
• Emergence of World Wide Web
2000-2009
• The Era of George W. Bush
• George W. Bush Creates Office of National Coordinator of Health IT
• Doubles Funding for Healthcare IT Projects to $100 Million
2009-
Present
• American Recovery and Reinvestment Act (ARRA) of 2009
• Health IT for Economic and Clinical Health (HITECH) Act
• Promote Adoption and Meaningful Use of Health IT
4

Three Components of Meaningful Use
5
The use of certified EHR in a meaningful way.
The use of certified EHR technology for
electronic exchange of health information to
improve quality of health care.
The use of certified EHR technology to
submit clinical quality and other measures.

Three Stages of Meaningful Use
6

Three Stages of Meaningful Use
• Electronically capturing health information in a standardized format
• Reporting clinical quality measures and public health information
• Using information to engage patients and their families in their care
Stage 1:2011
• More rigorous health information exchange (HIE)
• Increased requirements for e-prescribing and incorporating lab results
• More patient-controlled data
Stage 2:2014
• Improving overall quality, safety, and efficiency
• Access to comprehensive patient data through patient-centered HIE
• Improving population health
Stage 3:2016
7

8
Medical Records v. Health Records
ElectronicMedicalRecords(EMR)
• Digital version of paper charts in the clinician’s office
• Contains medical and treatment history of patients in one practice
• Information in EMRs does NOT travel easily out of practice
EMR’s do not follow the patients: stay with the associated provider
ElectronicHealthRecords(EHR)
• Built to share information with other healthcare providers
• Contains information from all the clinicians involved in a patient’s care
• Designed to be accessed by all people involved in a patient’s care
EHR’s follow the patients:specialist, hospital, nursing home, laboratories, etc.

But really…
EMR EHR SYNONYMOUS
9

10
Ambulatory v. Hospital Electronic Health Records
AmbulatoryElectronicHealthRecords
• Outpatient care – medical care provided on outpatient basis
• Physician practice – single system
• Less expensive
• Integration is less challenging and complex
• Clinical documentation is less complex and detailed
HospitalElectronicHealthRecords
• Inpatient care – patients who requires admission to a hospital
• Larger practices – collection of disparate systems in various departments
• More expensive
• Integration is more challenging and complex
• Clinical documentation is more complex and detailed

Top Factor in Selection Criteria
11
Sizeof
Institution

Implementation Process
Assess Your
EHR Needs
Set “SMART”
EHR Goals
Make Key
Decisions
Narrow the Field
Design and Issue
a Request for
Information (RFI)
Compare
Vendors
Schedule Site
Visits
Conduct
Demonstrations
Contact
References
12

A Look at The Top Hospital EHR Vendors
KeyCharacteristics MajorPlayers
13
Relentless Improvement
High Quality
Good Customer Service
Reliability

Hospital EHRs: Top Vendors
14
• Private American company
• Consistently the #1 EHR vendor for market share
• Clients have won the most Davies Awards
• Public American company
• Consistently in Top 5 for market share
• Clients have won many Davies Awards
• Private American company
• Consistently in Top 5 for market share
• Clients have won many Davies Awards

Hospital EHRs: 2015 Market Share
15
Epic
20.3%
Cerner
19.1%
MEDITECH
16.3%
CPSI
7.1%
McKesson
6.9%
Rest of Market
30.3%
InpatientEHRMarketin theU.S.
AllInpatientHospitals
EHRVendorMarketShares
No Vendor Share Cum %
1 Epic 20% 20%
2 Cerner 17% 37%
3 MEDITECH 17% 54%
4 Other 14% 68%
5 McKesson 8% 76%
6 CPSI 7% 83%
7 Siemens 5% 88%
8 HMS 5% 93%
9 Healthland 4% 97%
10 Allscripts 4% 100%

Hospital EHRs: 2015 Market Share
16
AllInpatientHospitalSystems
EHR VendorMarketShare

Epic: Relentless Dominance
> Current market leader
• Most commonly selected EHR by eligible professionals participating in meaningful use
> Founded in 1979 by computer scientist and current CEO, Judy Faulkner
> Clients:
• Kaiser Permanente in Oakland, CA
• Cleveland Clinic in Cleveland, OH
• Johns Hopkins Medicine in Baltimore, MD
• Massachusetts General Hospital in Boston, MA
• Mount Sinai Health System in New York, NY
EPIC HAS BEEN NAMED THE BEST OVERALL SOFTWARE SUIT
AND OVERALL PHYSICIAN PRACTICE VENDOR FOR
FIVEYEARS INA ROW.
17

Epic: Physician & Industry Perspectives
• Does an incredible job on implementation process
• Just follow the advice from start to finish
Implementation
• Provides integration necessary to reach MU
• Makes it more feasible to reach MU requirements
Integration
18

Cerner: Don’t Count Us Out
> Second greatest market share
> Founded in 1979 by current Chairman and CEO, Neal Patterson
> Largest independent health information technology company in the world
> Consistently receives high marks in independent user satisfaction surveys
> Clients:
• University of Pittsburgh Medical Center in Pittsburgh, PA
• Indiana University Health in Indianapolis, IN
• Banner Health in Phoenix, AZ
• Memorial Hermann Health System in Houston, TX
• Adventist Health System in Winter Park, FL
19

MEDITECH: We’re Still Here
> Third greatest market share
> Founded in 1969 by current Chairman, Neil Pappalardo
> Committed to being environmentally friendly
> Supports more than 43 unaffiliated nonprofit organizations
> Clients:
• CHRISTUS Health in Austin, TX
• Swedish Covenant Hospital in Chicago, IL
• Henry Mayo Newhall Hospital in Valencia, CA
• Citizens Memorial Healthcare in Bolivar, MO
• St. Agnes Healthcare in Baltimore, MD
20

A Look at The Top Ambulatory EHR Vendors
KeyCharacteristics MajorPlayers
21
Relentless Improvement
Good Customer Service
Reliability
High Quality

Ambulatory EHRs: Top Vendors
22
• Private American company
• Consistently the #1 EHR vendor for market share
• Expensive
• Private American company
• #1 EHR for Customer Satisfaction
• Cost effective: No Implementation Fee
• Public American company
• Consistently in Top 3 for market share
• Expensive

Ambulatory EHRs: 2015 Market Share
23
AmbulatoryEHRMarketWith>100Beds
AllAmbulatoryHospitals
EHRVendorMarketShares
No Vendor Share Cum %
1 Epic 23% 23%
2 Practice Fusion 22% 45%
3 Cerner 14% 58%
4 Allscripts 10% 68%
5 MEDITECH 9% 77%
6 CPSI 7% 83%
7 McKesson 5% 88%
8 NextGen 4% 92%
9 eClinicalWorks 4% 96%
10 Healthland 4% 100%
Epic
28%
Practice
Fusion
14%
Cerner
13%
Allscripts
12%
MEDITECH
10%
Rest of
Market
23%
AmbulatoryEHRMarketWith<100Beds
Practice
Fusion
21%
Epic
16%
Cerner
14%
CPSI
13%
MEDITECH
8%
Rest of
Market
28%

Practice Fusion: Rising Up the Ranks
> Commonly selected EHR by eligible professionals participating in meaningful use
> Founded in 2005 by former CEO, Ryan Howard
> Free support and training
> Designed for individual and solo practice
> Clients:
• Carolina Complete Medical in High Point, NC
• Health Aim Inc. in Walnut Creek, CA
• Oak Tree Osteopathy in San Diego, CA
• Concierge Family Practice in Austin, TX
PRACTICE FUSION HAS NO IMPLEMENTATION FEE,
CONTRACTS OR TERMINATION PENALTIES.
25

What does this mean for
GLG clients?
26
Key Questions:
What are the common pitfalls with EHR systems on the market?
What is the competitive landscape like?
How is the market for EHR evolving?
Are you familiar with the implementation of various EHR systems?
Council Members of Interest:
John D’Amore
Mike Mytych
Michael Sills, MD
Richard Wong, MD
Companies of Interest:
Epic Systems
Cerner Corporation
MEDITECH
Practice Fusion

Takeaways
> Transition to electronic records is contingent on how fast the world is evolving
> EMRs and EHRs are essentially synonymous
• Mainly use “EHR” term because its stated as that in Meaningful Use
> Issues and workflows are different between ambulatory and hospital EHR’s
• EHR system for an outpatient setting is not suitable for an inpatient setting
• EHR system for an inpatient setting is not suitable for an outpatient setting
> Epic is dominant and shows no signs of slowing down
> GLG must be knowledgeable about clients’ interest in this industry
• Recruit CMs who have expertise with the selection and implementation process of various EHR systems
• Recruit CMs who are familiar with market share of various EHR vendors
27

Questions?
28

CONFIDENTIAL
Thank You