CPOE - PBworks CPOE Final 6-8-10.pdfCPOE: TRAFFIC JAMS ON THE ROAD TO MEANINGFUL USE Healthcare organizations that have not yet adopted computerized physician order entry (CPOE) have

Non-Provider Price: $14,850

Traffi c Jams on the Road to Meaningful Use

CPOE:

May 2010

CPOE Digest 2010 I 1

Executive Overview

PAGE SECTION

4 EXECUTIVE OVERVIEW

How do the vendors stack up?

Worth knowing

The bottom line on vendors

CPOE: Traffic jams on the road to meaningful use

Going the distance

Community hospital CPOE—entering the on-ramp or just

turning the key

McKesson and MEDITECH—stalled by upgrades and

functionality

Siemens—refueled and back on the road

GE and QuadraMed—stranded on the shoulder

Cerner, Eclipsys, Epic—life in the fast lane

Conclusion: Life after meaningful use

Vendor performance overviews

17 VENDOR BRIEFS

Cerner HMS

CPSI McKesson

Eclipsys MEDITECH

Epic QuadraMed

GE Siemens

Healthland

69 EXPANDED RESULTS (75+ PAGES)

T A B L E O F C O N T E N T S

CPOE: Traffic Jams on the Road to Meaningful Use

http://www.klasresearch.com/klas/site/briefs/514f349er2.aspx











2 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the retail price.

Figure 1

HOW DO THE VENDORS STACK UP?

Figure 1: Inpatient CPOE Hospital Growth – 2008 to 2010

WORTH KNOWING CERNER, EPIC, ECLIPSYS CONTINUE TO LEAD. With the most hospitals live on CPOE, the highest client satisfaction, and the deepest physician adoption, these three vendors have become more successful with CPOE than has any other vendor. While Cerner has the most hospitals live, Eclipsys and Epic boast the highest percentage of their own clients live. Cerner and Epic clients are happier the more deeply they adopt CPOE. However, even these leading vendors will need to run faster than historical trends for their installation base to receive the earliest possible payments for achieving meaningful use. MEDITECH AND MCKESSON BEHIND THE EIGHT BALL. Currently, both MEDITECH and McKesson customer bases are significantly upgrading versions to improve physician adoption. However, these vendors have large customer bases and slow CPOE rollout to date. Their clients need to roll out CPOE over 31 times faster than they have in the past year if all are to achieve CPOE adoption before July 1, 2011. COMMUNITY HOSPITALS ARE CONCERNED, AND RIGHTLY SO. Of the more than 4,000 U.S. hospitals with fewer than 200 beds, 89 percent are not live on CPOE. Only MEDITECH and CPSI are making real headway. Providers commonly report difficultly using available products on a deep level. SIEMENS SOARIAN GAINING SPEED. Stuck at three since 2005, Siemens grew to ten Soarian hospitals live with CPOE this year. Providers say Soarian CPOE works but is still maturing.

0 20 40 60 80 100 120 140 160 180 200

Other

Siemens Soarian

Siemens Invision

QuadraMed CPR

MEDITECH MAGIC

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GE LastWord

GE Centricity

Epic

Eclipsys TDS

Eclipsys SCM

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Cerner

2008 CPOE Hospitals Verified




Executive Overview

THE BOTTOM LINE ON VENDORS

CERNER: Among CPOE market leaders. Two-thirds of customers still need to adopt; but at Cerner’s pace, adoption traffic jams are less likely. Overall product satisfaction increases with depth of CPOE usage. CPSI: One of top-two CPOE solutions in community space, but with low physician satisfaction. CPSI has shown strength in facilitating light to medium adoption, but customers working towards full CPOE are generally struggling. ECLIPSYS: Eclipsys has significant CPOE experience and the highest percentage of their own customer base live. While some customers have worries about Eclipsys’ ability to deliver in other areas, customers do not report worries about making CPOE adoption in time for ARRA. EPIC: Given current adoption speed, Epic is the best on track to deliver CPOE to all, or nearly all, customers by 2011. Supports widely with deep adoption; more physicians use this system than any other system. Medication administration is strong. GE: No net growth in three years. Some movement from LastWord to Centricity. Improved usability could bolster adoption. HEALTHLAND: Making some progress in community hospitals. Like most in this space, product is not yet mature. Improvements are ongoing. Many customers left to adopt a newly maturing solution. HMS: Product only out for a year, but users see progress. Functionality not conducive to physician workflow. Many customers left to adopt a relatively immature solution. MCKESSON: Huge percentage of client base still not live. Implementation of v.10.3 could increase CPOE go lives. Overall satisfaction with this product trending slightly downward. MEDITECH: Added more new CPOE-live organizations than any other vendor in 2009. Less than 10 percent of its extensive customer base live with CPOE. Customer anxiety in reaching CPOE in time for ARRA remains high. Older versions of CPOE are generally poorly adopted by physicians. QUADRAMED: CPOE base has not grown significantly in years. Difficult to retain customers; some are looking to other solutions. SIEMENS: New platform is more mature and compelling for providers, with technology now broadly adoptable. Jump from 3 to 10 CPOE-live hospitals in 2009. Of CPOE hospitals, 80 percent still entering less than half of their orders electronically.


Figure 1

Figure 2

CPOE: TRAFFIC JAMS ON THE ROAD TO MEANINGFUL USE Healthcare organizat ion s that have not yet adopted computerized

physician order entry (CPOE) have plenty of company. Only 14 percent of

U.S. hospitals have achieved the expected 10% CPOE level required for

Stage 1 of meaningful use (MU).

The other 86 percent of hospitals have just over a year until July 1, 2011, the latest date for early MU payments. (While full reimbursement is expected to be possible by as late as July 3, 2013, this research will focus on the initial July 1, 2011 date for MU payments.) Clearly, it is rush hour for hospitals trying to meet MU. For hospitals trying to maneuver through, where are the traffic jams? What is causing them? What is the likelihood that resources are available and the software mature enough to achieve sufficient CPOE use by mid-2011 with deep adoption thereafter? To answer these and other questions, KLAS gathered

CPOE data from many Canadian hospitals and virtually every U.S. hospital (excluding military or VA) that were live with a commercial CPOE product through 2009. These 481 interviews represent the 804 hospitals included in this 2010 CPOE report.

GOING THE DISTANCE While the introduction to this report emphasizes urgency in reaching 10 percent CPOE usage by July 1, 2011, achieving that goal represents only the beginning of a hospital’s CPOE journey. Of

Figure 2: Estimated Percent of Total Client Base Doing CPOE Currently Marketed Product Only Based on estimated market share (all hospital sizes)

1%

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8%

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9%

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52%

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Eclipsys


Executive Overview

Figure 3

the hospitals in this study reporting CPOE usage, over 90 percent have already passed the 10-percent mile marker. The next—and perhaps more difficult—question is when each organization will be able to make CPOE an integral part of the workflow. For example, only two-thirds of organizations with CPOE are doing more than half of orders via CPOE, with notable variation between different vendor solutions. For perspective, this report represents the depth of adoption as the percentage of orders done via CPOE—pilot (0–15 percent), moderate (16–50 percent), significant (51–85 percent), and deep (over 86 percent).

COMMUNITY HOSPITAL CPOE—ENTERING THE ON-RAMP OR JUST TURNING

THE KEY Less than 12 percent of community hospitals have adopted CPOE, and those who have show generally shallow adoption. If all community hospitals were to implement CPOE in time for the earliest possible payment, more than eight community hospitals would need to go live on CPOE every day from June 1, 2010, to July 1, 2011. This statistic is even more startling considering that, of community-hospital focused CIS vendors, only CPSI and MEDITECH have more than six hospitals live. Providers in this space using HMS, Siemens MS4, McKesson Paragon, Healthland, and Keane seem restless and concerned, as their vendors have been slow to demonstrate the ability to deliver CPOE: “I went to one of [my vendor’s] user conferences and waited to hear that

they are getting their customers to meaningful use levels. I would have liked to hear about facilities that are already successful, but instead, all I heard was

their promise that their customers won't get penalized.” It should be noted that more than 200 community hospitals are using Cerner Millennium, Eclipsys SCM, Epic EpicCare, or McKesson Horizon for CPOE. However, with the exception of Cerner, none of these vendors are actively selling these products to the smallest community hospitals. Entering the on-ramp. When it comes to CPOE, most vendors serving community hospitals are just ramping up: CPSI—This vendor has by far the broadest reach in the community hospital space, with 59 hospitals, or up to 10 percent of its

While government set meaningful use dates and requirements are still subject to change, KLAS is

referencing the proposed requirements and dates made

public by CMS on January 13, 2010 for the analysis of this report.

While a provider organization is expected to be able to receive full ARRA reimbursement if Stage 1 is

met as late as July 3, 2013, the date of July 1, 2011 allows hospitals the

greatest flexibility in meeting Stage 2 and 3 deadlines.


Figure 3

own client base, live on CPOE (an increase of more than one-third since 2008). Adoption at these facilities is generally shallow. Only 41 percent of CPSI hospitals are using CPOE for more than half of orders, but almost 70 percent have achieved the minimum depth required by ARRA for 2011. This success suggests that CPSI can help clients meet initial ARRA standards; however, deeper use may be hindered by missing functionality and usability. Physician satisfaction with CPSI’s CPOE is significantly below the market-average satisfaction. Users’ frustration increases with depth of use, raising questions about whether CPSI represents a viable long-term strategy or will only satisfy Stage 1 or Stage 2 MU objectives for CPOE. Hospitals that take the time to pre-build order sets generally have more adoption success.

Healthland—Their CPOE has rolled out slowly and is now live at five hospitals, or less than 3 percent of their clients. Adoption at these facilities is moderate to deep, with 80 percent of physicians doing at least some CPOE and three of their five organizations using CPOE for the majority of orders. With Healthland redesigning their CPOE software, some clients are interested in improved functionality but are wary of possible complications. One provider commented, “Healthland is aware that their CPOE functionality has not been well received by physicians. I know Healthland is working to redesign their CPOE under a .NET framework. There are a lot of possibilities for failure when keeping up with MU and CCHIT along with switching out a current platform.”

Figure 3: Percent of Community Hospitals Live on CPOE vs. Percent of Community Market Share Estimated market share

HealthlandHMS

CPSIMEDITECH

Siemens MS4

Cerner

Eclipsys

Epic

GE

McKesson Horizon

McKesson Paragon

Quadramed

Siemens Invision

Siemens Soarian

0%

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rce

nt

of U

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osp

ital

s U

nd

er

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ds

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CP

OE

Percent of U.S. Market Share (Under 200 Beds)

Average


Executive Overview

Figure 4

Figure 4 HMS—This vendor’s CPOE only appeared on the scene last year and is now live at five hospitals, or less than 1 percent of HMS facilities. Providers view HMS CPOE as one more feature in a fully integrated system, but comment that usability is lacking at this point. In fact, problems with CPOE functionality have earned HMS the lowest physician satisfaction in this study. One provider commented, “The medication ordering process is pretty tedious for physicians to sit down and work through. I wish we could do something to streamline the medication ordering process. The process is workable, but for a busy physician, there won’t be a lot of affinity for the medication ordering.”

Despite these challenges, many HMS sites report interest in adopting CPOE as functionality improves. Cerner—Unlike competitors who use different products to reach the smallest community hospitals (such as McKesson with Paragon and Siemens with MS4), Cerner has recently begun bringing hospitals live as part of their CommunityWorks system, a completely hosted, less customizable version of PowerChart and other Cerner applications. There are not yet enough live hospitals to measure CPOE performance. However, many customers hope Cerner will be able to leverage their clinical and CPOE strength to help struggling community hospitals come live with advanced clinicals and CPOE. In the meantime, PowerChart CPOE is live at more than 80 community hospitals in the 50 to 200 bed range.

Figure 4: Depth of Use at Average CPOE Site Maximum of 25 for each category. Average depth of use for each category was divided by 4 to give it a 100 pt scale.

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% MDs Entering Notes Electronically

% of All Patient Orders MDs Enter

% MDs Doing CPOE


Figure 5 Starting the ignition. Several vendors that serve community hospitals don’t yet have their solutions all the way out the door: Keane—KLAS was unable to verify CPOE-live providers on any Keane platform. Many customers are worried about Keane’s ability to support CPOE and meaningful use, and more than two-thirds of Keane customers interviewed are currently planning to leave this vendor. McKesson Paragon—At the time research for this study concluded, McKesson Paragon had no hospitals live with CPOE. Since then, CPOE has become generally available. Four hospitals have come live and more are expressing interest in the release. One provider said, “We are excited that the McKesson Paragon CPOE software has been scheduled for general

release this year. McKesson understands the heightened need for this software. We must roll out CPOE soon or risk losing the stimulus money.” Siemens MS4—CPOE functionality is still in development, with a few of Siemens’ 120 hospitals as test sites. “We are already starting testing CPOE with Siemens, even though it is just in beta form right now. We are already building the scripts for it. We are also doing bedside medication administration as we speak. We will have Siemens pharmacy, lab, radiology, EHR, and bedside medication administration shortly. As a MedSeries4 client, we see this as a big win.”

Figure 5: Percent of all Patient Orders

9562 15

11 17 73

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Executive Overview

Figure 6

MCKESSON AND MEDITECH—STALLED

BY UPGRADES AND FUNCTIONALITY For McKesson and MEDITECH, having all their customers come live with CPOE by mid-2011 is simply a numbers game. Hampered by historically immature CPOE products, both vendors have been comparatively slow in rolling out CPOE. They have recently released significant upgrades that many customers see as essential for adopting CPOE. Despite increasing CPOE adoption over the past year, some doubt that McKesson’s and MEDITECH’s clients will all reach MU-level CPOE before Stage 1 deadlines, since these vendors have historically slow adoption, significant upgrades, and very large customer bases. In fact, if all MEDITECH’s customers were to come live by July 1, 2011, the number of go lives per year would need to be roughly

36 times higher than in 2009, or nearly 100 hospitals per month. McKesson’s numbers are slightly better, but they would still need to bring customers live at least 31 times faster than last year, or about 40 per month. MEDITECH—Combining MAGIC and C/S, MEDITECH has seen significant CPOE growth, almost doubling its number of CPOE hospitals since 2008. Most new adopters have been C/S rather than MAGIC users, though many MAGIC clients would like to continue with MAGIC for the time being. CPOE adoption has been moderate in both systems, with more than half of C/S and MAGIC physicians doing at least some CPOE and more than half of C/S organizations using CPOE for the majority of orders (see figure 5). MEDITECH clients report two major roadblocks. First, many clients have not

Figure 6: Percent of Total Orders Entered by MD, Recently Live Hospitals Hospitals live in last year only. Currently marketed products. Must have at least 6 new hospitals.

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Eclipsys SCM Cerner Epic CPSI MEDITECH MAGIC

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McKesson Siemens Soarian

Pilot

Moderate

Significant

Deep


reached versions 5.6 or 6, though they view the upgraded features as critical to CPOE success as MEDITECH has publically released plans to certify both MAGIC and C/S versions 5.6.4 and 6 for MU. Second, MEDITECH has only 12 percent of their large CIS hospitals and 8 percent of their massive community-hospital base live on CPOE. Together, vendor and provider may be challenged to marshal sufficient resources to meet the 2011 deadline. One client commented, “[MEDITECH is] scrambling because so many hospitals have to get CPOE in place. Their resources are stretched thin. . . We are still on v.5.5, and we will not move to v.5.6 until next summer. We have been on that list to move for over a year.” McKesson Horizon—This vendor has achieved a modest number of hospitals live, increasing with an impressive jump from 37 to 53 hospitals in the last year. However, only a third of CPOE-live organizations are using CPOE for more than half of orders. Even hospitals that mandate CPOE use are often unable to move past moderate (51–85 percent) CPOE usage. Some clients are reluctant to adopt CPOE before implementing v.10.3, McKesson’s MU-certified version, since implementing CPOE and such a substantial upgrade at the same time could be very difficult. As one provider already live on version 10.1 said, “I am pretty nervous about MU. Based on McKesson's ability to deliver the v.10 platform, I am worried about making it to v.10.3. . . I cannot move forward and

implement CPOE and v.10.3 simultaneously. We thought we were in a good place before, but now we are not feeling so confident.”

SIEMENS—REFUELED AND BACK ON THE

ROAD After struggling to boost stagnating CPOE adoption for years, Siemens Soarian grew from three to ten CPOE-live hospitals this year, largely fueled by rolling out Soarian C6. CPOE organizations report that the product is usable but not fully mature. One organization noted, “It was a bumpy ride to get CPOE up and live with medication orders, and there are still some feature-function challenges with regard to integration between Soarian and Siemens Pharmacy. There are some things we want Siemens to add, but we will continue rolling out CPOE.” At this point, the greatest concern for current and prospective Soarian customers is whether Siemens has enough consultants to help clients come live with the product within MU timelines.

GE AND QUADRAMED—STRANDED ON

THE SHOULDER GE Centricity and QuadraMed CPR have small CPOE installation bases, and neither is growing fast. GE has seen no net gain or loss in the number of live CPOE hospitals in the last three years. QuadraMed has achieved only one net addition since 2008. Clients’ of both vendors have achieved adoption depth close to the market average.

91% Percent of live CPOE hospitals that meet

the minimum

requirement for

meaningful use


Executive Overview

Figure 7 CERNER, ECLIPSYS, EPIC—LIFE IN THE

FAST LANE Teamed up with the most MU-ready vendors in the market, Cerner, Eclipsys, and Epic customers express the least concern and the most confidence in meeting MU standards. Most hospitals live: Cerner—Cerner boasts the most-installed CPOE solution, with continuing, rapid growth keeping this vendor in first place. Adoption is wide and deep, with 81 percent of physicians doing at least some CPOE and 85 percent of CPOE organizations using CPOE for at least half of orders. Interestingly, clients rate Cerner higher the more deeply they adopt CPOE and full closed-loop medication delivery.

Around two-thirds of Cerner’s client base has yet to come live on CPOE. If all of their clients were to do so by mid-2011, customers would need to go live at about 30 per month. This is an intimidating task for Cerner’s customer base, though Cerner has shown strength in allocating resources and expertise to bring customers live with CPOE. Highest client satisfaction: Eclipsys — At 52 percent, Eclipsys has a higher percentage of their over 200-bed customer base live on CPOE than does any other vendor. In addition to widespread adoption, Eclipsys Sunrise Clinical Manager CPOE maintains the highest physician satisfaction rating of currently marketed products in this study. One provider illustrated the appeal of this product with the following comment, “Our physicians do not have to go to

Figure 7: Organizations Doing Both BPOC and CPOE (BPOC and CPOE must be with the same vendor)

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multiple places in the chart to do their work. They can do it from their document and fire off orders from their document. It really streamlines the workflow and the efficiency of the clinicians using the system.” Despite their strong track record, Eclipsys has slowed in their CPOE rollout, with only nine new CPOE go lives over the past year. Several factors have contributed to slower CPOE rollouts, including a smaller candidate pool with so many customers already live on CPOE, customer preoccupation with other components such as pharmacy, and few new SCM sales year over year. Deepest physician adoption: Epic—This vendor has achieved some of the most dramatic growth seen in the CPOE market, jumping from 37 to 140 hospitals live in only three years. Epic now boasts the most physicians using CPOE, including the most widespread ambulatory usage. Epic hospitals also average the deepest adoption in this study, with 92 percent of organizations using CPOE for at least half of orders. Given Epic’s pace, they are on track to bring all or the majority of their customers live on CPOE before mid-2011. This would require CPOE go lives to quadruple in speed over last year, increasing to about 14 per month. As one Epic client put it, “when we turned on CPOE, it was a big-bang implementation and everything went live. We came out of the chute on day one at 87 percent CPOE, and now we have this thing humming.” Like Cerner’s clients, Epic

hospitals are happier with their EMR the more deeply they adopt CPOE.

CONCLUSION: LIFE AFTER MEANINGFUL

USE CPOE breadth and depth are increasing across most vendors; however, despite a government push to speed things up, the road to meaningful CPOE adoption will likely be challenging and slower for many providers. Most community hospitals are currently without a viable CPOE vehicle, with MEDITECH and CPSI as the only vendors with significant success in this space. In larger hospitals, many MEDITECH and McKesson clients are awaiting version upgrades before implementing CPOE. Neither GE nor QuadraMed has made significant progress in recent years, but Siemens Soarian is finally gaining speed after years of stagnation. Cerner, Eclipsys, and Epic are giving clients the greatest reason for confidence as MU deadlines approach. With so much on providers’ plates just to meet the Stage 1 deadlines, it is difficult to look even further down the road. However, what happens after the first MU deadline passes, and providers want to move beyond the minimum 10 percent CPOE adoption? Most vendors are capable of meeting this initial standard with at least some clients, but some products, including CPSI, MEDITECH, and McKesson, can be so challenging that clients question their ability to achieve long-term adoption that satisfies physicians. The demands on the healthcare IT market for both providers and vendors have never


Executive Overview

been higher. While increased pressure can mean increased finger-pointing, the need for strong collaboration among vendors, consultants, and providers has never been greater. CPOE is only one of the estimated 23 objectives to meet Stage 1 of MU, but it is a very visible and difficult-to-achieve measurement, even though the final

criteria have not yet been published. The next two years will show which products upgrade to an acceptable level, which vendors can truly partner with customers, and which vendors are simply going through the motions.

Vendor Performance Overviews Download additional vendor information by clicking on a vendor name.

Vendor Provider Feedback

Cerner

BRAVO: Has experience, with more hospitals live on CPOE than other vendors. Holding lead with strong, continuous growth. Very deep adoption. Sites newly live with CPOE report strong CPOE go-live support and focus from Cerner. OUCH: Oncology ordering usage is still lagging. Low percentage of CPOE organizations doing BPOC, despite offering a functional BPOC solution. BOTTOM LINE: Among CPOE market leaders. Two-thirds of customers still need to adopt; but at Cerner’s pace, adoption traffic jams are less likely. Overall product satisfaction increases with depth of CPOE usage.

CPSI

BRAVO: By far the most widespread vendor for CPOE among community hospitals. Shallow and initial CPOE adopters rate CPSI high. Strides in physician documentation and BPOC are impressive for the community-hospital space. OUCH: Low CPOE physician satisfaction. Some sites have lost ground, finding it difficult to keep physicians using CPOE. Difficult to persuade physicians to adopt deeply; overall customer satisfaction decreases with depth of CPOE adoption. BOTTOM LINE: One of top-two CPOE solutions in community space, but with low physician satisfaction. CPSI has shown strength in facilitating light to medium adoption, but customers working towards full CPOE are generally struggling.

Eclipsys

BRAVO: Has highest percentage among vendors of its own customer base live and highest customer satisfaction among currently marketed products. Relatively high adoption levels. A leader in complex ordering, especially for oncology. OUCH: BPOC rollouts playing catch up due to late product introduction. Three organizations doing both BPOC and CPOE reporting early success. BOTTOM LINE: Eclipsys has significant CPOE experience and the highest percentage of their own customer base live, due in part to high physician satisfaction with the product. While some customers have worries about Eclipsys’ ability to deliver in other areas, customers do not report worries about making CPOE adoption in time for ARRA.

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Epic

BRAVO: Fastest growth in this study. Second-most CPOE hospitals of any vendor. Deepest CPOE adoption. By far the widest and deepest ambulatory adoption. Strong inpatient and outpatient integration. OUCH: Not all hospitals see Epic in their price range, nor will Epic consider all hospitals as potential customers. BOTTOM LINE: Given current adoption speed, Epic is the best on track to deliver CPOE to all, or nearly all, customers by 2011. Supports widely with deep adoption; more physicians use this system than any other system. Medication administration is strong.

GE

BRAVO: Deep adoption at some facilities. Good system reliability and uptime. Some organizations using both BPOC and CPOE. OUCH: Not expanding small client base. Slower system response time. Fewer doctors using CPOE at some facilities. Low overall satisfaction with GE’s development and support. BOTTOM LINE: No net growth in three years. Some movement from LastWord to Centricity. Improved usability could bolster adoption.

Healthland

BRAVO: More than doubled the number of CPOE-live organizations this year to a total of five. Deep physician adoption at some facilities. Some physician documentation adoption. Early data suggests good system reliability and uptime. OUCH: No organizations closing the medication administration loop. Early data suggests slower system response time. Support sometimes frustrating for clients. BOTTOM LINE: Making some progress in community hospitals. Like most in this space, product is not yet mature. Improvements are ongoing. Many customers left to adopt a newly maturing solution.

HMS

BRAVO: Doing CPOE and barcoding at a few organizations. Physician documentation progressing. Labs, pharmacy, order entry, documentation, charting can be integrated. OUCH: Lowest satisfaction in this study due to immature functionality. Early data suggests very slow response time. Generally, adoption does not hit 50 percent. BOTTOM LINE: Product only out for a year, but users see progress. Functionality not conducive to physician workflow. Many customers left to adopt a relatively immature solution.

McKesson

BRAVO: Biggest one-year jump yet recorded for McKesson. Over 80 percent of CPOE hospitals doing both CPOE and BPOC. Executive involvement satisfies some customers. OUCH: Few hospitals doing electronic physician documentation. Significant worry among customer base concerning installing v.10.3 and coming live with CPOE in time. BOTTOM LINE: Huge percentage of client base still not live. Implementation of v.10.3 could increase CPOE go lives. Overall satisfaction with this product trending slightly downward.












Executive Overview



MEDITECH

BRAVO: Added more CPOE hospitals this year than ever before. Added more new organizations than any other vendor. For first time in years, majority of growth with C/S clients. Stable product. Widely deployed medication-administration system. OUCH: While adoption is growing, it continues to be shallow overall, with about 1500 U.S. clients and only 130 live on CPOE. MEDITECH offers more limited clinical CPOE go-live support than the other major players. BOTTOM LINE: Added more new CPOE-live organizations than any other vendor in 2009. Less than 10 percent of its extensive customer base live with CPOE. Customer anxiety in reaching CPOE in time for ARRA remains high. Older versions of CPOE are generally poorly adopted by physicians.

QuadraMed

BRAVO: Above-average depth-of-use among clients. BPOC increasing, although still relatively rare. OUCH: Smallest CPOE installation base of all large-hospital vendors. One net addition since 2008. Barcoding used by few clients. BOTTOM LINE: CPOE base has not grown significantly in years. Difficult to retain customers; some are looking to other solutions.

Siemens

BRAVO: Number of CPOE-live hospitals increased from 3 to 10 this year. Release of C6 has increased provider interest and adoption. Very strong BPOC adoption boosts closed-loop efforts. OUCH: Weakest adoption among major vendors in this study. Difficult to find experienced support; some look to third-party consulting firms. Pharmacy interfaces have caused some to struggle. Physician documentation rare. BOTTOM LINE: New platform is more mature and compelling for providers, with technology now broadly adoptable. Jump from 3 to 10 CPOE-live hospitals in 2009. Of CPOE hospitals, 80 percent still entering less than half of their orders electronically.







16 I CPOE Digest 2010 This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price.

CPOE REPORTING TEAM

Jason Hess REPORT AUTHOR Karen Ondo CHIEF EDITOR Clinical Team Reporting Team Steve Van Wagenen Sam Eaquinto Taylor Davis Dan Czech Coray Tate Trina Hsieh

Mark Allphin Evan Thomas

Colin Buckley Celeste Zsembery

Louise Cliche

FOR QUESTIONS OR COMMENTS ON THIS REPORT, CONTACT:

KLAS 630 E Technology Ave. Orem, UT 84097

Ph: 800-920-4109 Fax: 801-377-6345 Web: www.KLASresearch.com

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READER RESPONSIBILITY: This report is a compilation of data gathered from websites, healthcare industry reports, interviews with healthcare

provider executives and managers, and interviews with vendor and consultant organizations. Data gathered from these

sources includes strong opinions (which should not be interpreted as actual facts) reflecting the emotion of exceptional

success and, at times, failure. The information is intended solely as a catalyst for a more meaningful and effective

investigation on your organization’s part and is not intended, nor should it be used, to replace your organization’s due

diligence.

KLAS data and reports represent the combined opinions of actual people from provider organizations comparing how

their vendors, products, and/or services performed when measured against participants' objectives and expectations.

KLAS findings are a unique compilation of candid opinions and are real measurements representing those individuals

interviewed. The findings presented are not meant to be conclusive data for an entire client base. Significant variables

including organization/hospital type (rural, teaching, specialty, etc.), organization size, depth/breadth of software use,

software version, role in the organization, provider objectives, and system infrastructure/network impact participants’

opinions, precluding an exact apples-to-apples vendor/product comparison or a finely tuned statistical analysis.

We encourage our clients, friends and partners using KLAS research data to take into account these variables as they

include KLAS data in their other due diligence. For frequently asked questions about KLAS methodology, please refer to

the KLAS FAQs.

COPYRIGHT INFRINGEMENT WARNING: This report, and its contents, are copyright protected works and are intended solely for your organization. Any other

organization, consultant, investment company, or vendor enabling or obtaining unauthorized access to this report will be

liable for all damages associated with copyright infringement, which may include the full price of the report and/or

attorney’s fees. For information regarding your specific obligations, please refer to the KLAS Data Use Policy.

ABOUT KLAS: For more information about KLAS, please visit our website.

OUR MISSION: KLAS’ mission is to improve the delivery of healthcare technology by independently measuring and reporting on vendor

performance.

Jason Hess [email protected]

http://www.klasresearch.com/

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http://www.klasresearch.com/Klas/Site/About/FAQ.aspx

http://www.klasresearch.com/policy

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mailto:[email protected]


Vendor Briefs


CERNER MILLENNIUM POWERCHART Will I be successful with Cerner CPOE?

Cerner continues to lead in having the most hospitals live with CPOE. Customers coming live with CPOE generally report a strong vendor/customer partnership. As one CMIO reported, “We recently brought up a hospital with CPOE. It was our first CPOE activation, and it went very smoothly; it surpassed all our expectations and was well received by the physicians. This partly reflects on Cerner and the effort that we made in building this system for the hospital. It genuinely astonished all of us how immediately CPOE was adopted by the physicians. This reflects a good tool, a good build, and a good fit for our workflow.” Can Cerner help me meet Stage 1 CPOE requirements for MU?

While Cerner still has two-thirds of their customer base to bring live with CPOE, they have sustained an over 30-percent growth rate in their CPOE base for three years running. With a proven product and significant experience, Cerner is as well positioned as almost any vendor to help customers come live successfully. Beyond CPOE, can Cerner get me to BPOC and physician documentation?

Customers who have closed the loop are very satisfied, but more than three-quarters of CPOE organizations have not yet adopted Cerner’s barcoding solution. Those who have report good success. What is the future for Cerner?

Cerner’s strong CPOE performance thus far suggests that these hospitals have a fighting chance of meeting CPOE deadlines for MU. Additionally, Cerner clients become more satisfied with both the vendor and product as they adopt CPOE more deeply, highlighting that Cerner adoption benefits go beyond meeting MU requirements. Cerner has made significant improvements to the quality of their code over the past year, and customers are reporting overall higher satisfaction. Physician documentation is one area where providers report immaturity. Cerner is also expanding into the community arena with Cerner CommunityWorks. KLAS has not yet validated any of the hospitals live with this product.

Millennium CPOE Non-CPOE Overall Score 73.8 70.2

Product Quality 7.2 6.8 Ease of Use 6.7 6.5

Product Works as Promoted 6.9 6.5 Proactive Service 6.5 5.8

Percent of U.S. Customer Base Doing CPOE

31%

# of Orgs. Doing Both Barcoding and CPOE

18


Vendor Briefs

Figure 8: Cerner: Raw Hospital Count 2003 – 2010

Figure 9: Cerner: In addition to CPOE, what else are you doing?

One organization doing barcoding is using a vendor other than Cerner.

5

15

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Physician Documentation Barcoding

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Yes

Overall % Yes


Figure 10: Cerner: Breakdown of CPOE Use (inpatient n=181, ambulatory n=24)

Figure 11: Cerner: Physician Satisfaction, Response Time, System Reliability 2003 – 2010

4

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2003 2004 2005 2006 2007 2008 2009 2010

Physician Satisfaction Response Time Reliability/Uptime

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Inpatient Ambulatory Inpatient Ambulatory Inpatient Ambulatory

% MDs Doing CPOE % of All Patient Orders MDs Enter % MDs Entering Notes Electronically

Pilot/None

Moderate

Significant

Deep

% Deep Overall


Vendor Briefs

Figure 12: Cerner: Ratings vs. CPOE Vendor Average

6.9

7.37.7

1

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9

Physician Satisfaction with CPOE System Response Time System Reliability & Uptime

Average


CPSI CLINICALS

Will I be successful with CPSI CPOE?

While most community-focused vendors are just coming live with their first hospitals, CPSI has been doing CPOE at some of its hospitals for well over five years. With more than 50 hospitals live with CPOE today, CPSI is holding its lead in the community CPOE game.

Despite this experience, many CPSI clients report frustration reaching and maintaining deep CPOE adoption with CPSI. Only six hospitals, or just over 10 percent of CPSI hospitals with CPOE, have achieved deep adoption. Some hospitals have gone backwards since last year, doing fewer orders via CPOE, or stopping CPOE altogether, often complaining that the system is difficult to use. CPSI customers also report frustration with buggy code, as CPSI works to update their platform from the older COBOL code to a Web-based product. Even with CPSI’s CPOE experience, not all customers are confident that they will be able to meet all the other MU requirements.

Can CPSI help me meet Stage 1 CPOE requirements for MU?

Seventy percent of CPSI CPOE hospitals have achieved the 10 percent depth required for Stage 1 MU. Interestingly, a higher percentage of ambulatory than inpatient sites have accomplished deep CPOE use. While CPSI has 42 percent of their CPOE hospitals entering the majority of their orders via CPOE, many others report that they will be stuck at shallow adoption until CPSI delivers better CPOE physician functionality.

Beyond CPOE, can CPSI get me to BPOC and physician documentation?

Only a small group (about 20 percent) of CPOE hospitals are doing physician documentation, while about 80 percent are live with barcoding. This represents a significant achievement as many community-focused vendors still struggle to offer this functionality.

What is the future for CPSI?

While most CPSI customers for CPOE can reach 10 percent adoption, many report increased frustration as they attempt deeper adoption, suggesting that CPSI can satisfy the Stage 1 MU gap but may not represent a viable long-term strategy without significant product enhancements.

Clinicals CPOE Non-CPOE Overall Score 70.7 65.0




9%


44


Vendor Briefs

Figure 13: CPSI: Raw Hospital Count 2003 – 2010

Figure 14: CPSI: In addition to CPOE, what else are you doing?

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2003 2004 2005 2006 2007 2008 2009 2010


Figure 15: CPSI: Breakdown of CPOE Use (inpatient n=59, ambulatory n=7)

Figure 16: CPSI: Physician Satisfaction, Response Time, System Reliability 2003 – 2010

3

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2003 2004 2005 2006 2007 2008 2009 2010


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Pilot/None

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% Deep Overall


Vendor Briefs

Figure 17: CPSI: Ratings vs. CPOE Vendor Average

5.2

8.0 7.9

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Average


ECLIPSYS SCM Will I be successful with Eclipsys CPOE? Of vendors, Eclipsys is able to boast the highest percentage of their own customer base live on CPOE. Eclipsys has experienced steady growth with Sunrise Clinical Manager since 2003, bringing nine new clients live over the last year. Though they were the 2007 market leader in hospitals live with CPOE, Eclipsys has since been surpassed by Cerner, Epic, and MEDITECH. Physicians continue to report high satisfaction with Eclipsys CPOE. This system is also one of the most advanced on the market when it comes to complex ordering and alerting. Can Eclipsys help me meet Stage 1 CPOE requirements for MU? Adoption levels for current customers using Eclipsys are generally high, with 79 percent of physicians across all Eclipsys CPOE hospitals doing at least some CPOE and 83 percent of organizations entering the majority of orders electronically. One provider illustrated their depth of adoption with this comment, “The product is very solid. We have close to 80 percent CPOE usage. The only place we don’t use CPOE is in the ICU, and that should be coming live in the next few months. The doctors have been big advocates.” Beyond CPOE, can Eclipsys get me to BPOC and physician documentation? Eclipsys has made some definite strides toward closing the loop at their CPOE sites. Eclipsys boasts the third-highest number of organizations doing physician documentation, and KBMA, their BPOC offering, has rolled out to several more sites this year. Despite this growth, BPOC adoption is still lagging far behind the industry average. What is the future for Eclipsys? Eclipsys has proven that they are able to deliver when it comes to CPOE. However, many of Eclipsys’ more advanced customers are struggling in some areas beyond CPOE, such as vendor support or Eclipsys’ ambulatory offerings. The majority of Eclipsys’ installation base has seen great progress toward the delivery of Sunrise Emergency Care and Sunrise Pharmacy, moving the Eclipsys offering towards a more complete enterprise solution.

SCM CPOE Non-CPOE Overall Score 71.2 76.6




52%


9


Vendor Briefs

Figure 18: Eclipsys: Raw Hospital Count 2003 – 2010

Figure 19: Eclipsys SCM: In addition to CPOE, what else are you doing?

Six organizations doing barcoding are using vendors other than Eclipsys.

1321

3948

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8493

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2621

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2003 2004 2005 2006 2007 2008 2009 2010

Eclipsys TDS

Eclipsys SCM

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No

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Figure 20: Eclipsys SCM: Breakdown of CPOE Use (inpatient n=102, ambulatory n=15)

Figure 21: Eclipsys SCM: Physician Satisfaction, Response Time, System Reliability 2003 – 2010

4

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2003 2004 2005 2006 2007 2008 2009 2010


71%

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Pilot/None

Moderate

Significant

Deep

% Deep Overall


Vendor Briefs

Figure 22: Eclipsys SCM: Ratings vs. CPOE Vendor Average

7.17.4

7.6

1

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9


Average


Figure 23: Eclipsys TDS Summary Table

In addition to CPOE, what else are you doing? Breakdown of CPOE Use (n=16)

Physician Satisfaction, Response Time, System Reliability 2003 – 2010

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31% 31%

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% Deep Overall


Vendor Briefs

EPIC EPICCARE INPATIENT Will I be successful with Epic CPOE? Epic is bringing CPOE clients live faster than any other vendor, more than tripling their number of CPOE-live hospitals since 2008. Epic currently has the second-largest CPOE client base, having passed up Eclipsys this year. Throughout their explosive growth, Epic has delivered what is perceived to be a high-quality experience and a quickly maturing product. Echoing many others’ sentiments, one provider commented, “The physicians are delighted with Epic's CPOE. The system is much easier to navigate than our old CIS was. EpicCare Inpatient EMR is very robust and gives the physicians a multitude of ways to do their work. The physicians loved breaking away from an old system that forced them to follow a screen-by-screen workflow.” Can Epic help me meet Stage 1 CPOE requirements for MU? Epic delivers CPOE more deeply than anyone else, with 90 percent of physicians doing at least some CPOE and 92 percent of live organizations using CPOE for the majority of orders. One provider commented, “We have 100 percent CPOE. We are an academic medical center, so our EpicCare Inpatient EMR had full adoption all at once. Over 90 percent of all orders are entered by the doctors. They began entering them on day one, while we were still going live with Epic. The ER doctors think it is fine to use too.” Epic has also deepened adoption in their ambulatory facilities; 93 percent of ambulatory clinics report deep CPOE with 93 percent entering notes electronically. This accomplishment reflects the strong integration between Epic’s inpatient and outpatient systems. Beyond CPOE, can Epic get me to BPOC and physician documentation? In November, 2007, Epic had only seven organizations live with barcoded medication administration. That number has since grown to 24 organizations (84 hospitals—the highest number of closed-loop hospitals in this study), or just under half of Epic’s live organizations, doing both medication administration barcoding and CPOE. Ninety-six percent of live organizations are also doing physician documentation—far above the industry average. Feedback from the sites using Epic’s medication-administration system has been very positive. While Epic’s product is still maturing, it is very functional. What is the future for Epic? Epic CPOE users are satisfied, deep adopters, and the more deeply they use this system, the higher they rate the product overall. In addition, Epic has more ambulatory sites using CPOE and closing the medication-administration loop than any other vendor. While


44%


24


a number of Epic hospitals still need to come live with CPOE, they have reason to be confident, given Epic’s track record to date.

EpicCare Inpatient CPOE Non-CPOE Overall Score 87.0 87.4




Vendor Briefs

Figure 24: Epic: Raw Hospital Count 2003 – 2010

Figure 25: Epic: In addition to CPOE, what else are you doing?

One organization doing barcoding is using a vendor other than Epic.

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Figure 26: Epic: Breakdown of CPOE Use (inpatient n=140, ambulatory n=40)

Figure 27: Epic: Physician Satisfaction, Response Time, System Reliability 2003 – 2010

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2003 2004 2005 2006 2007 2008 2009 2010


94% 93%

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Vendor Briefs

Figure 28: Epic: Ratings vs. CPOE Vendor Average

6.9

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GE CENTRICITY ENTERPRISE & LASTWORD CLINICALS Will I be successful with GE CPOE? With the second-smallest CPOE installation base among hospitals with fewer than 200 beds in this study, GE has seen no net gain or loss in the number of CPOE hospitals in three years, though there has been a slight shift to Centricity as LastWord has been replaced. Can GE help me meet Stage 1 CPOE requirements for MU? In general, Centricity hospitals have achieved moderate to deep CPOE adoption. On average, two-thirds of physicians do at least some CPOE, and just over half of organizations use CPOE for a majority of orders. Adoption depth is slightly shallower than last year, which provider commentary suggests could be due to lack of functionality. One provider said, “The ordering is missing functionality in the system. Physicians still would not want to do online text documentation if it were available. However, we could be at 100 percent CPOE if the system were a bit easier to manipulate.” Beyond CPOE, can GE get me to BPOC and physician documentation? About half of both Centricity and LastWord clients—less than the market average—are doing physician documentation. Just over 60 percent of Centricity CPOE organizations are also doing BPOC. What is the future for GE? One current GE CPOE customer reported, “Several years ago, our hospital invested tens of millions of dollars in GE. Every year since then, it costs another two to three million dollars to upgrade. The problem is that we do not get two or three million dollars' worth of value, and we certainly have not seen the value of our original sum.” Of currently marketed acute EMR products that KLAS tracks, GE continues to be lowest-rated overall. A number of non-CPOE GE customers and at least one GE CPOE site plan to leave GE.

Centricity Enterprise CPOE Non-CPOE Overall Score 56.6 57.8




26%


9


Vendor Briefs

Figure 29: GE: Raw Hospital Count 2003 – 2010

Figure 30: GE Centricity: In addition to CPOE, what else are you doing?

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GE LastWord

GE Centricity

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Figure 31: GE Centricity: Breakdown of CPOE Use (inpatient n=24)

Figure 32: GE Centricity: Physician Satisfaction, Response Time, System Reliability 2003 – 2010

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9

2003 2004 2005 2006 2007 2008 2009 2010


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Vendor Briefs

Figure 33: GE Centricity: Ratings vs. CPOE Vendor Average

6.6

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Figure 34: GE LastWord/Legacy Summary Table



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Vendor Briefs

HEALTHLAND CLINICALS Will I be successful with Healthland CPOE? After six years of developing CPOE, Healthland has finally achieved a substantive step forward for CPOE adoption, jumping from two to five hospitals doing CPOE. However, this represents less than 2 percent of the current Healthland customer base. Customers live with Healthland CPOE report that some significant functionality gaps have yet to be filled. One director of nursing reported, “Doing CPOE with Healthland has been interesting. It is like doing half CPOE, in reality. Their pharmacy system works well, so medication orders can be done electronically. However, the Healthland lab module is a real mess, so we don't do CPOE lab orders.” Can Healthland help me meet Stage 1 CPOE requirements for MU? Customers report a high level of anxiety as they work with Healthland to reach MU requirements. One CIO, not live with CPOE, recently reported to KLAS, “I believe it is going to be tight for Healthland to come through with all of the clinical requirements for meaningful use. Healthland has acknowledged they have been weak on getting physicians to adopt their physician order entry.” Beyond CPOE, can Healthland get me to BPOC and physician documentation? While three Healthland CPOE customers also report doing some physician documentation, no CPOE sites are doing full closed-loop medication administration. What is the future for Healthland? More than 98 percent of Healthland hospitals have yet to go live on CPOE. One CFO recently reported, “I think Healthland is going to have to achieve MU or they won’t be in business, but the Healthland platform is just not intuitive. It doesn’t take the users where they need to go. Achieving MU is one consideration, but getting the nurses and physicians to actually embrace the technology is another issue.”

Clinicals CPOE Non-CPOE Overall Score NA NA

Product Quality NA NA Ease of Use NA NA

Product Works as Promoted NA NA Proactive Service NA NA


2%


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Figure 35: Healthland: Raw Hospital Count 2003 – 2010

Figure 36: Healthland: In addition to CPOE, what else are you doing?

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Vendor Briefs

Figure 37: Healthland: Breakdown of CPOE Use (n=5)

Figure 38: Healthland: Physician Satisfaction, Response Time, System Reliability 2003 – 2010

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Figure 39: Healthland: Ratings vs. CPOE Vendor Average

6.8* 6.8*

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Vendor Briefs

HMS CLINICALS

Will I be successful with HMS CPOE?

Appearing on the CPOE scene only a year ago, HMS CPOE has grown from three to five hospitals since 2009. Two of the five hospitals are still using CPOE for less than 10 percent of orders, blaming immature CPOE functionality for some of their problems. One CPOE hospital recently reported, “There are some improvements HMS could make for CPOE. The medication-ordering process is pretty tedious for physicians to sit down and work through. I wish we could do something to streamline the medication-ordering process. The process is workable, but for a busy physician, there won’t be a lot of affinity for the medication ordering. “

Can HMS help me meet Stage 1 CPOE requirements for MU?

Providers report that Healthland’s CPOE functionality isn’t conducive to an easy, natural workflow. One provider related this experience, “We are on a major initiative to encourage our physicians to document electronically as opposed to dictating. The majority of our physicians are now entering their notes electronically, but when it comes to entering their orders electronically, they are not very pleased with the technology.”

Despite HMS’ still-developing CPOE functionality, many HMS clients are cautiously optimistic that they will reach Stage 1 MU in time. One CIO recently reported, “HMS talks a good talk regarding meaningful use, but we have not seen the end product yet. However, HMS does guarantee that they will be able to meet all of the requirements. They actually did a little presentation recently where they walked through the 23 measures and outlined how they are going to meet all of them. It all sounds good.”

Beyond CPOE, can HMS get me to BPOC and physician documentation?

Within its very small CPOE installation base, HMS is achieving decent success closing the medication administration loop; three of their five sites are using CPOE and BPOC. Three hospitals are also documenting physician notes electronically.

What is the future for HMS?

While less than 1 percent of current HMS customers are doing CPOE, many non-CPOE customers report plans to adopt in the near future. Customers perceive HMS as focusing strongly on overcoming current gaps to help customers meet MU requirements.

Clinicals CPOE Non-CPOE Overall Score NA NA

Product Quality NA NA Ease of Use NA NA

Product Works as Promoted NA NA Proactive Service NA NA


1%


3


Figure 40: HMS: Raw Hospital Count 2003 – 2010

Figure 41: HMS: In addition to CPOE, what else are you doing?

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Vendor Briefs

Figure 42: HMS: Breakdown of CPOE Use (n=5)

Figure 43: HMS: Physician Satisfaction, Response Time, System Reliability 2003 – 2010

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2003 2004 2005 2006 2007 2008 2009 2010



Figure 44: HMS: Ratings vs. CPOE Vendor Average

4.6*

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Average


Vendor Briefs

MCKESSON HORIZON EXPERT ORDERS Will I be successful with McKesson CPOE? This year, McKesson saw its most significant gains yet recorded by KLAS, adding 16 new CPOE hospitals over the past year. However, McKesson still needs to bring about 90 percent of its Horizon clients live on CPOE. System response and reliability scores are lower than average, and the ability to handle complex oncology ordering can be a weakness. Only a few v.10 customers are live with CPOE, but early reports are that CPOE functionality is significantly improved on this version. However, customers currently live with v.10 report that the upgrade took longer and required more effort than originally anticipated. Can McKesson help me meet Stage 1 CPOE requirements for MU? Physicians generally use Horizon CPOE shallowly, even when adoption is mandated. Only a third of CPOE-live organizations are using CPOE for a majority of orders. The more satisfied, successful McKesson clients report a high rate of involvement with McKesson executives. These high-touch clients report that it took significant investments of time and effort to make Horizon CPOE successful, due especially to the complexity of building iForms. Customers who cannot or have not made this investment relate their frustration in being left behind. One IT Director recently commented: “[McKesson’s] product is up there with the other market leaders. Unfortunately, there is a huge disconnect between what McKesson sells and what they deliver. McKesson sells iForms to CIOs and clinicians as the answer to CPOE, but McKesson doesn't deliver these things as advertised. We are left to build our own iForms.” Beyond CPOE, can McKesson get me to BPOC and physician documentation? With the highest percentage of organizations doing BPOC (the second-highest number of organizations after CPSI), McKesson is closing the loop at a majority of their Horizon CPOE organizations. Horizon clients are behind in physician documentation, with just over 20 percent of organizations adopting. What is the future for McKesson? Horizon customers report a high degree of anxiety about their ability to reach Stage 1 CPOE for MU by mid-2011. Many potential customers say they are specifically avoiding McKesson Horizon in their CIS selection. McKesson is further expanding into the community space with the introduction of its CPOE module for Paragon, where four sites have come live since KLAS closed research


8%


33


for this report. Customers waiting for Paragon’s CPOE rollout are anxious, but encouraged by a strong history of on-time delivery from Paragon.

Horizon CPOE Non-CPOE Overall Score 69.8 69.9




Vendor Briefs

Figure 45: McKesson: Raw Hospital Count 2003 – 2010

Figure 46: McKesson: In addition to CPOE, what else are you doing?

8

33

27

3

0%

10%

20%

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40%

50%

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No

Yes

Overall % Yes

2

5

12

18

28

37

53

0

10

20

30

40

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60

2003 2004 2005 2006 2007 2008 2009 2010


Figure 47: McKesson: Breakdown of CPOE Use (inpatient n=53, ambulatory n=3)

Figure 48: McKesson: Physician Satisfaction, Response Time, System Reliability 2003 – 2010

4

5

6

7

8

9

2003 2004 2005 2006 2007 2008 2009 2010


23%

67%

11%

33%

2%

33%

11%26%

33%28%

26%

4%

38%33% 36% 33%

94%

67%

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70%

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Pilot/None

Moderate

Significant

Deep

% Deep Overall


Vendor Briefs

Figure 49: McKesson: Ratings vs. CPOE Vendor Average

6.4

6.8

7.2

1

2

3

4

5

6

7

8

9


Average


MEDITECH C/S ENTERPRISE MEDICAL RECORD & MAGIC PATIENT CARE INQUIRY Will I be successful with MEDITECH CPOE? For the first time in six years, MEDITECH has brought more C/S than Magic sites live. These new gains have brought MEDITECH’s CPOE hospital count up to around 130 hospitals, but with MEDITECH’s massive client base, this represents only 12 percent of their large hospitals and 8 percent of community hospitals. Many clients are reluctant to employ CPOE until they have either v.5.6 or v.6, both of which will be MU-certified. Although recent strides give providers cause for hope, the enormity of moving MEDITECH’s customer base to CPOE worries some current customers. Can MEDITECH help me meet Stage 1 CPOE requirements for MU? Adoption has been shallow to moderate, with C/S slightly exceeding Magic in the depth of adoption; 57 percent of C/S physicians over 52 percent of Magic physicians doing at least some CPOE. Fifty-three percent of C/S organizations are inputting the majority of orders electronically. If newer versions are more conducive to physician workflows, adoption could increase; for now, MEDITECH lags behind competitors. Beyond CPOE, can MEDITECH get me to BPOC and physician documentation? MEDITECH’s medication administration system, BMV, remains the most widely deployed barcoding system on the market. Due to its long-standing functionality, hospitals are significantly more likely to adopt this product than MEDITECH’s CPOE solution. Both Magic and C/S CPOE clients report widespread but shallow physician documentation, with around 70 percent of customers using this functionality at least sometimes. What is the future for MEDITECH? Between ARRA and the v.6 upgrade, the MEDITECH installation base is currently in a state of significant transition. The first v.6 CPOE hospital is newly live, so it is too early to measure what benefits this new upgrade will bring. While a number of hospitals (primarily MAGIC users) are currently getting off the MEDITECH bus, the majority of customers are sticking with this vendor and pushing forward to advanced clinicals, including CPOE. Getting even the majority of the MEDITECH customer base to CPOE will require previously unseen effort and focus from MEDITECH hospitals, the vendor, and consultants.

C/S CPOE Non-CPOE Overall Score 74.8 75.2




9%


55


Vendor Briefs

Figure 50: MEDITECH: Raw Hospital Count 2003 – 2010

Figure 51: MEDITECH C/S: In addition to CPOE, what else are you doing?

33

28

14

21

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Overall % Yes

5 816

27 2632 35

59

59

15

28 31

42

60

69

0

20

40

60

80

100

120

140

2003 2004 2005 2006 2007 2008 2009 2010

MEDITECH MAGIC

MEDITECH C/S

10

17

31

55 57

74

95

128


Figure 52: MEDITECH C/S: Breakdown of CPOE Use (inpatient n=59, ambulatory n=5)

Figure 53: MEDITECH C/S: Physician Satisfaction, Response Time, System Reliability 2003 – 2010

4

5

6

7

8

9

2003 2004 2005 2006 2007 2008 2009 2010


37%

60%

20%

9%

20%

19%

20%

34%

60%

11%

20%

22%

20%

20%

20%

35%

22% 25%20%

45%

60%

0%

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90%

100%



Pilot/None

Moderate

Significant

Deep

% Deep Overall


Vendor Briefs

Figure 54: MEDITECH C/S: Ratings vs. CPOE Vendor Average

6.3

7.37.8

1

2

3

4

5

6

7

8

9


Average


Figure 55: MEDITECH MAGIC Summary Table

In addition to CPOE, what else are you doing? Breakdown of CPOE Use (inpatient n=69, ambulatory n=5)


35

27

11

19

0%

10%

20%

30%

40%

50%

60%

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No

Yes

Overall % Yes

4

5

6

7

8

9

2003 2004 2005 2006 2007 2008 2009 2010


29%

40%

28%

40%

10%

40%

19%

40%

16%

40%

10%

40%29%

20%

38%

20%

20%

23%19%

60%

20%

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Pilot/None

Moderate

Significant

Deep

% Deep Overall


Vendor Briefs

QUADRAMED CPR Will I be successful with QuadraMed CPOE? Of all large hospital vendors, QuadraMed CPR has the smallest CPOE installation base, with 26 hospitals and only 1 net addition since 2008. Almost two-thirds of QuadraMed’s hospitals with more than 200 beds still need CPOE. Can QuadraMed help me meet Stage 1 CPOE requirements for MU? The average depth of use for CPOE at QuadraMed remains above the market average. Sixty-nine percent of physicians are doing some CPOE, and 60 percent of organizations are placing the majority of orders via CPOE. Beyond CPOE, can QuadraMed get me to BPOC and physician documentation? BPOC has progressed since last year, when no CPOE sites were using a QuadraMed or a third-party medication-administration system. Since then, QuadraMed has made progress rolling out a BPOC solution to 20 percent of their CPOE organizations. Of hospitals, 70 percent are entering documentation electronically. What is the future for QuadraMed? QuadraMed is holding steady, but it seems unlikely to see significant CPOE growth in the near future, given its small installation base. Many customers are frustrated by QuadraMed’s overall lack of delivery and development. QuadraMed’s most satisfied CIO recently commented to KLAS, “QuadraMed is challenged by product delivery, timeline commitments, integration advancements, and overall strategy execution. They have missed so many deadlines and commitments that their credibility is nonexistent.”

CPR CPOE Non-CPOE Overall Score 71.7 58.9




43%


3


Figure 56: QuadraMed: Raw Hospital Count 2003 – 2010

Figure 57: QuadraMed CPR: In addition to CPOE, what else are you doing?

7

2

3

8

0%

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No

Yes

Overall % Yes

16

2123 23

26 25 25 26

2

2 4 4 2

0

5

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20

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35

2003 2004 2005 2006 2007 2008 2009 2010

QuadraMed Affinity

QuadraMed CPR

16

21

23

25

2829 29

28


Vendor Briefs

Figure 58: QuadraMed CPR: Breakdown of CPOE Use (inpatient n=26)

Figure 59: QuadraMed CPR: Physician Satisfaction, Response Time, System Reliability 2003 – 2010

4

5

6

7

8

9

2003 2004 2005 2006 2007 2008 2009 2010


65%58%

12%

12%

4%15%

42%

19%15%

58%

0%

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30%

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70%

80%

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100%



Pilot/None

Moderate

Significant

Deep

% Deep Overall


Figure 60: QuadraMed CPR: Ratings vs. CPOE Vendor Average

6.4

7.4

8.4

1

2

3

4

5

6

7

8

9


Average


Vendor Briefs

SIEMENS INVISION & SOARIAN Will I be successful with Siemens CPOE? Soarian is picking up some speed after years of hovering at three hospitals live. Increased adoption is mainly due to the release of C6, a heavily anticipated upgrade. As one provider said, “We came live with the first phase of our Siemens Soarian Clinicals project this past year, and we are looking forward to upgrading to C6. The quality of this version looks strong, and it will give us the underlying foundation to be able to move forward with CPOE and other initiatives.” Functionality is improving but still immature in some areas, including these specified by one Soarian user, “The system is missing a transfer to the level of care, which gives doctors a way to place orders when someone moves from unit to unit. We expect to get this functionality in the next couple of months.” Can Siemens help me meet Stage 1 CPOE requirements for MU? Soarian has the weakest adoption in this study, with less than a third of physicians at CPOE hospitals using CPOE for at least some orders. Some sites that have recently come live say that completing the go-live process with Siemens is painful, especially noting that Siemens has not been meeting demand for experienced resources. “Siemens has so many installations going on, so getting resources from them is always a challenge. . . It has been hard finding the right person who really understands CPOE or who has been involved in the CPOE installation. We actually hired somebody from IBM to work with us on that.” Beyond CPOE, can Siemens get me to BPOC and physician documentation? BPOC is one of Soarian’s brightest spots, live in nine out of ten CPOE-live hospitals. Physician documentation remains immature. Interfaces with the pharmacy have been a struggle for some sites, which could pose problems for hospitals trying to complete the closed loop. “The pharmacy build [for CPOE] was huge. It was 70 percent of the build of the whole system. We had to build a second formulary for our clinical information system over and above what we had on the pharmacy information side. It had to be designed around the way the physicians order, and that was huge. It took us two and half, almost three months to do. Now I see why people say that pharmacy information systems should be integrated with hospital systems instead of interfaced.” What is the future for Siemens? Soarian’s development has been a bumpy road for many Siemens customers, and while the future looks promising, Siemens is not out of the woods yet. Siemens has only one


13%


24


Soarian hospital currently doing nearly 100 percent of their orders via CPOE. While this is a significant achievement over last year, Siemens needs to show that they can consistently help customers reach high adoption.

Soarian CPOE Non-CPOE Overall Score 78.7 71.0




Vendor Briefs

Figure 61: Siemens: Raw Hospital Count 2003 – 2010

Figure 62: Siemens Invision: In addition to CPOE, what else are you doing?

One organization doing barcoding is using a vendor other than Siemens.

9

16

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Yes

Overall % Yes

1 13 3 3

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19

30

3532

4240 39

39

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2003 2004 2005 2006 2007 2008 2009 2010

Siemens Invision

Siemens Soarian

19

30

36

33

4543

42

49


Figure 63: Siemens Invision: Breakdown of CPOE Use (inpatient n=39)

Figure 64: Siemens Invision: Physician Satisfaction, Response Time, System Reliability 2003 – 2010

4

5

6

7

8

9

2003 2004 2005 2006 2007 2008 2009 2010


59%

44%

3%

33%

44%

8%

8%

15%

8% 5%

74%

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Pilot/None

Moderate

Significant

Deep

% Deep Overall


Vendor Briefs

Figure 65: Siemens Invision: Ratings vs. CPOE Vendor Average

7.1

7.7

7.3

1

2

3

4

5

6

7

8

9


Average


Figure 66: Siemens Soarian Summary Table



1

8

8

1

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


No

Yes

Overall % Yes

4

5

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9

2003 2004 2005 2006 2007 2008 2009 2010


10% 10%

10% 10%

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50%30%

100%

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Pilot/None

Moderate

Significant

Deep

% Deep Overall


PAGE SECTION

70 TABLE OF FIGURES

74 MARKET DETAIL

122 KLAS PERFORMANCE DATA

126 VENDOR DETAIL (COMMENTARY, OVERVIEWS, AND TECHNICAL ASSESSMENTS)

Cerner

CPSI

Eclipsys

Epic

GE

Healthland

HMS

McKesson

MEDITECH

QuadraMed

Siemens

139 KLAS SURVEY DOCUMENTS

142 KLAS FAQS SUMMARY

T A B L E O F C O N T E N T S

CPOE: Traffic Jams on the Road to Meaningful Use

Expanded Results (75+ pages) for


TABLE OF FIGURES Figure 1: Inpatient CPOE Hospital Growth – 2008 to 2010 ......................................................................... 2 Figure 2: Estimated Percent of Total Client Base Doing CPOE .................................................................. 4 Figure 3: Percent of Community Hospitals Live on CPOE vs. Percent of Community Market Share ...... 6 Figure 4: Depth of Use at Average CPOE Site ............................................................................................ 7 Figure 5: Percent of all Patient Orders ....................................................................................................... 8 Figure 6: Percent of Total Orders Entered by MD, Recently Live Hospitals ............................................. 9 Figure 7: Organizations Doing Both BPOC and CPOE ............................................................................... 11 Figure 8: Cerner: Raw Hospital Count 2003 – 2010 .................................................................................. 19 Figure 9: Cerner: In addition to CPOE, what else are you doing? ............................................................ 19 Figure 10: Cerner: Breakdown of CPOE Use (inpatient n=181, ambulatory n=24) .................................. 20 Figure 11: Cerner: Physician Satisfaction, Response Time, System Reliability 2003 – 2010 .................... 20 Figure 12: Cerner: Ratings vs. CPOE Vendor Average ................................................................................ 21 Figure 13: CPSI: Raw Hospital Count 2003 – 2010 ..................................................................................... 23 Figure 14: CPSI: In addition to CPOE, what else are you doing? .............................................................. 23 Figure 15: CPSI: Breakdown of CPOE Use (inpatient n=59, ambulatory n=7) ......................................... 24 Figure 16: CPSI: Physician Satisfaction, Response Time, System Reliability 2003 – 2010 ....................... 24 Figure 17: CPSI: Ratings vs. CPOE Vendor Average .................................................................................. 25 Figure 18: Eclipsys: Raw Hospital Count 2003 – 2010 ............................................................................... 27 Figure 19: Eclipsys SCM: In addition to CPOE, what else are you doing? ................................................ 27 Figure 20: Eclipsys SCM: Breakdown of CPOE Use (inpatient n=102, ambulatory n=15) ........................ 28 Figure 21: Eclipsys SCM: Physician Satisfaction, Response Time, System Reliability 2003 – 2010 ......... 28 Figure 22: Eclipsys SCM: Ratings vs. CPOE Vendor Average .................................................................... 29 Figure 23: Eclipsys TDS Summary Table .................................................................................................... 30 Figure 24: Epic: Raw Hospital Count 2003 – 2010 ..................................................................................... 33 Figure 25: Epic: In addition to CPOE, what else are you doing? ............................................................... 33 Figure 26: Epic: Breakdown of CPOE Use (inpatient n=140, ambulatory n=40) ..................................... 34 Figure 27: Epic: Physician Satisfaction, Response Time, System Reliability 2003 – 2010 ....................... 34 Figure 28: Epic: Ratings vs. CPOE Vendor Average .................................................................................. 35 Figure 29: GE: Raw Hospital Count 2003 – 2010 ....................................................................................... 37 Figure 30: GE Centricity: In addition to CPOE, what else are you doing? ................................................ 37 Figure 31: GE Centricity: Breakdown of CPOE Use (inpatient n=24)........................................................ 38 Figure 32: GE Centricity: Physician Satisfaction, Response Time, System Reliability 2003 – 2010 ......... 38 Figure 33: GE Centricity: Ratings vs. CPOE Vendor Average .................................................................... 39 Figure 34: GE LastWord/Legacy Summary Table ...................................................................................... 40 Figure 35: Healthland: Raw Hospital Count 2003 – 2010.......................................................................... 42 Figure 36: Healthland: In addition to CPOE, what else are you doing? ................................................... 42 Figure 37: Healthland: Breakdown of CPOE Use (n=5) ............................................................................ 43 Figure 38: Healthland: Physician Satisfaction, Response Time, System Reliability 2003 – 2010............ 43 Figure 39: Healthland: Ratings vs. CPOE Vendor Average ....................................................................... 44 Figure 40: HMS: Raw Hospital Count 2003 – 2010 ................................................................................... 46 Figure 41: HMS: In addition to CPOE, what else are you doing? .............................................................. 46 Figure 42: HMS: Breakdown of CPOE Use (n=5) ...................................................................................... 47 Figure 43: HMS: Physician Satisfaction, Response Time, System Reliability 2003 – 2010 ...................... 47


Table of Figures

Figure 44: HMS: Ratings vs. CPOE Vendor Average ................................................................................. 48 Figure 45: McKesson: Raw Hospital Count 2003 – 2010 ........................................................................... 51 Figure 46: McKesson: In addition to CPOE, what else are you doing? ..................................................... 51 Figure 47: McKesson: Breakdown of CPOE Use (inpatient n=53, ambulatory n=3) ............................... 52 Figure 48: McKesson: Physician Satisfaction, Response Time, System Reliability 2003 – 2010 ............ 52 Figure 49: McKesson: Ratings vs. CPOE Vendor Average ....................................................................... 53 Figure 50: MEDITECH: Raw Hospital Count 2003 – 2010 .......................................................................... 55 Figure 51: MEDITECH C/S: In addition to CPOE, what else are you doing? .............................................. 55 Figure 52: MEDITECH C/S: Breakdown of CPOE Use (inpatient n=59, ambulatory n=5) ........................ 56 Figure 53: MEDITECH C/S: Physician Satisfaction, Response Time, System Reliability 2003 – 2010 ...... 56 Figure 54: MEDITECH C/S: Ratings vs. CPOE Vendor Average ................................................................. 57 Figure 55: MEDITECH MAGIC Summary Table .......................................................................................... 58 Figure 56: QuadraMed: Raw Hospital Count 2003 – 2010........................................................................ 60 Figure 57: QuadraMed CPR: In addition to CPOE, what else are you doing? .......................................... 60 Figure 58: QuadraMed CPR: Breakdown of CPOE Use (inpatient n=26) ................................................ 61 Figure 59: QuadraMed CPR: Physician Satisfaction, Response Time, System Reliability 2003 – 2010 .. 61 Figure 60: QuadraMed CPR: Ratings vs. CPOE Vendor Average ............................................................. 62 Figure 61: Siemens: Raw Hospital Count 2003 – 2010 .............................................................................. 65 Figure 62: Siemens Invision: In addition to CPOE, what else are you doing? ......................................... 65 Figure 63: Siemens Invision: Breakdown of CPOE Use (inpatient n=39) ................................................ 66 Figure 64: Siemens Invision: Physician Satisfaction, Response Time, System Reliability 2003 – 2010 .. 66 Figure 65: Siemens Invision: Ratings vs. CPOE Vendor Average ............................................................. 67 Figure 66: Siemens Soarian Summary Table ............................................................................................ 68 Figure 67: Survey Participants by Title (n=481) ........................................................................................ 75 Figure 68: Overall: Size of Provider Organizations (n=481) ..................................................................... 75 Figure 69: Summary CPOE Survey Pool .................................................................................................... 76 Figure 70: CPOE Summary Over Time ....................................................................................................... 76 Figure 71: Most Current vs. Previous Products, Total Inpatient Organizations (IP Only + IP/Amb

Combos)............................................................................................................................................. 77 Figure 72: Inpatient and Ambulatory Products ........................................................................................ 78 Figure 73: Inpatient and Ambulatory Organizations ................................................................................ 79 Figure 74: Number of CPOE Inpatient Hospitals Verified Live – 2008 – 2010 Comparison .................... 80 Figure 75: Number of CPOE Hospitals and Organizations ....................................................................... 81 Figure 76: Percent of Vendor’s Own Client Base Doing CPOE (U.S., >200 Beds Only) .......................... 82 Figure 77: Client Base Penetration vs. Percent of U.S. Market Share (<200 Beds Only)........................ 83 Figure 78: Inpatient CPOE Deployment – Number of Live Organizations 2009 vs. 2010 ....................... 84 Figure 79: Ambulatory CPOE Deployment – Number of Live Organizations 2009 vs. 2010 .................. 85 Figure 80: Pharmacy Vendor vs. Inpatient CPOE Vendor (n=787) .......................................................... 86 Figure 81: Positive Patient/Med ID Software Vendor vs. Inpatient CPOE Vendor (n=428) .................... 87 Figure 82: Raw Hospital Count CPOE Hospitals Cumulative 2003 – 2010 ............................................... 88 Figure 83: Raw Hospital Count CPOE Hospitals Overall 2003 – 2010 ...................................................... 88 Figure 84: Number of CPOE Inpatient Hospitals Verified Live by Year ................................................... 89 Figure 85: Number of Live Organizations – Inpatient .............................................................................. 90 Figure 86: Number of Live Organizations – Ambulatory ......................................................................... 90 Figure 87: Total Number of Physicians Doing CPOE ................................................................................ 91


Figure 88: Number of Physicians Doing CPOE – Employed vs. Non-Employed (n=481) ........................ 92 Figure 89: Number of Physicians Doing Inpatient CPOE – Employed vs. Non-Employed by Vendor

(n=481) ............................................................................................................................................... 92 Figure 90: Is inpatient CPOE usage mandated for non-employed physicians? (n=481) ......................... 93 Figure 91: Is inpatient CPOE usage mandated for non-employed physicians? 2009 vs. 2010 (n=481)... 93 Figure 92: Is inpatient CPOE usage mandated for non-employed physicians? – by Vendor (n=481) .... 94 Figure 93: CPOE Adoption Comparing Mandated vs. Not Mandated CPOE Use (n=481) ...................... 95 Figure 94: Market Share: CPOE Live vs. Contracted CIS Clients – Hospitals Over 200 Beds ................. 96 Figure 95: Overall Percent Teaching and Associated Teaching Hospitals versus Non-teaching

Hospitals Live with CPOE (n=804) .................................................................................................... 97 Figure 96: Inpatient Teaching and Associated Teaching Hospitals vs. Non-Teaching Hospitals Live on

CPOE by Vendor/Product .................................................................................................................. 98 Figure 97: Inpatient Teaching and Associated Teaching Hospitals vs. Non-Teaching Hospitals Live on

CPOE by Vendor/Product .................................................................................................................. 99 Figure 98: Raw Count – Inpatient Teaching and Associated Teaching Hospitals vs. Non-Teaching

Hospital CPOE Growth ...................................................................................................................... 99 Figure 99: Percent of Physicians Doing Some Inpatient CPOE at live CPOE sites by Vendor .............. 100 Figure 100: Number of Inpatient Hospitals at the 100% Level ................................................................ 101 Figure 101: CPOE Use by Physicians (Inpatient) by Number of Hospitals .............................................. 101 Figure 102: CPOE Use by Physicians (Ambulatory) by Number of Organizations ................................. 102 Figure 103: Orders Entered by Physicians (Inpatient) by Number of Hospitals .................................... 102 Figure 104: Orders Entered by Physicians (Ambulatory) by Number of Organizations ....................... 103 Figure 105: Percent of All Orders Physicians Enter – Inpatient Organizations (n=481)........................ 103 Figure 106: Percent of Organizations Not at 50% CPOE Use (n=481) .................................................... 104 Figure 107: Number of Years Doing CPOE if Not at 50% of All Orders Entered – Inpatient Organizations

(n=474) ............................................................................................................................................. 105 Figure 108: Average Number of Years Doing CPOE – Inpatient (n=481) ............................................... 106 Figure 109: Overall: In addition to CPOE, what else are you doing? .......................................................107 Figure 110: Overall: Percent of Organizations Doing any Physician Documentation (n=457).............. 108 Figure 111: Overall: Percent of Organizations Doing Barcode Scanning at the Bedside (n=457) ......... 108 Figure 112: Summary Chart CPOE Usage Inpatient and Ambulatory (n=804) ....................................... 109 Figure 113: Physician Satisfaction, Response Time, System Reliability 2003 – 2010 .............................. 110 Figure 114: Physician Satisfaction with CPOE – Inpatient (n=448) .......................................................... 111 Figure 115: Physician Satisfaction Ratings – Ambulatory (n=106)............................................................ 111 Figure 116: Specialty Ordering: Oncology Drugs - Inpatient ................................................................... 112 Figure 117: Specialty Ordering: Oncology Drugs - Ambulatory ............................................................... 112 Figure 118: Overall % of Hospitals Barcode Scanning at the Bedside (n=778) ........................................ 113 Figure 119: Hospitals/Organizations Doing Both BPOC and CPOE (with same vendor) ........................ 114 Figure 120: Percent of CPOE Hospitals doing Bedside Barcode Scanning by Inpatient CPOE Vendor

(n=778) .............................................................................................................................................. 115 Figure 121: Adoption (% Beds) by those Doing Bedside Barcode Scanning by Inpatient CPOE Vendor

(n=403).............................................................................................................................................. 116 Figure 122: System Response Time – Inpatient (n=453) ......................................................................... 117 Figure 123: System Response Time – Ambulatory (n=108) ..................................................................... 117 Figure 124: System Reliability and Uptime – Inpatient (n=455) .............................................................. 118


Table of Figures

Figure 125: System Reliability and Uptime – Ambulatory (n=106) .......................................................... 118 Figure 126: Response Time Ratings Legend ............................................................................................ 119 Figure 127: Response Time Satisfaction Ratings (inpatient n=453, ambulatory n=108)........................ 119 Figure 128: Reliability & Uptime Ratings Legend .................................................................................... 120 Figure 129: Reliability & Uptime Satisfaction Ratings (inpatient n=455, ambulatory n=106) ............... 120 Figure 130: Response Times vs. Number of Physicians Doing CPOE per Organization (n=481) ........... 121 Figure 131: Side-by-Side Comparison – CPOE Sites: ................................................................................. 123 Figure 132: Side-by-Side Comparison – Non-CPOE Sites: ......................................................................... 124 Figure 133: CPOE vs. Non-CPOE Vendor Performance Scoring (100-point scale) .................................. 125


Market Detail


Market Detail

SPECIFIC RESEARCH DATA Figure 67: Survey Participants by Title (n=481)

Figure 68: Overall: Size of Provider Organizations (n=481)

1-200 Beds33%

201-500 Beds34%

501-1,000 Beds17%

Over 1,000 Beds16%

Administrative Director/ Manager

2%CEO/COO/CNO

2%

CIO45%

CMO/CNO7%

IT Director/ Manager

30%

Medical Director/ Manager

8%

Pharmacy Director/ Manager

6%


The report hones in on the experiences of a wide variety of care delivery organizations (U.S. and Canada) and their CPOE experiences using various products from 13 different vendors, Cerner, CPSI, Eclipsys, Epic, GE, Healthland, HMS, Keane, McKesson, MEDITECH, Medsphere, QuadraMed, and Siemens. Figure 69: Summary CPOE Survey Pool

Figure 70: CPOE Summary Over Time

Year #

Vendors #

Products #

Custom Remarkable Comments

2003 11 11 3 CPOE more theoretical than proven; biggest surprise, 48% of all pharmacy orders entered via CPOE are reentered in pharmacy.

2004 10 14 2 Per-Se Patient1 acquired by Misys renamed Misys CPR.

2005 10 13 2

First real evidence outside of teaching (employed) physicians live on CPOE; virtually all sites had at least some customers that had to reenter pharmacy orders; Siemens first Soarian site; Eclipsys first XA site.

2006 12 15 2 Eclipsys reworks XA into a new Eclipsys SCM strategy.

2007 12 16 2 GE acquires IDX; inpatient & ambulatory environments no longer delimiters for some vendors; first time more growth observed with non-employed physicians.

2008 9 14 1

Cerner first vendor to reach 100 hospitals; Consolidation is occurring w/fewer vendors, fewer products, fewer custom; Pharmacy integration still a work in progress only four vendor products report no reentry; Misys CPR acquired by QuadraMed renamed QuadraMed CPR.

2009 15 20 0

Good growth year, non-teaching growth doubled. More providers with more vendor products live on CPOE. Dairyland, now Healthland, acquired by Francisco Partners, a private equity firm.

2010 13 19 1 Siemens, HMS, and Healthland getting off the ground with multiple customer go lives. CPOE growth heating up as ARRA deadlines draw near.

481 Interviews370 IP Org.

111 IP + Amb. Org.

481 Org.

469 US

12 Canadian

804 Hospital Sites

785 US

19 Canadian


Market Detail

Figure 71: Most Current vs. Previous Products, Total Inpatient Organizations (IP Only + IP/Amb Combos)

Current vs. Legacy Product Description

Cerner Millennium is the only product reported doing CPOE, the currently marketed product from Cerner.

CPSI All sites report being on CPSI Clinicals, CPSI’s currently marketed product.

Eclipsys

Sites reported two products: Sunrise Clinical Manager and TDS, although the number of TDS sites is declining. The customers previously reported on XA are included in with the SCM customers as the product is a single go-forward product.

Epic All sites reported being on EpicCare, the currently marketed product from Epic.

GE

Sites report using three distinct products from GE, GE Centricity Enterprise, formerly Carecast, is the go forward product. GE LastWord and GE Centricity Acute Care are no longer being sold and are combined with LastWord for statistical purposes.

McKesson The inpatient sites are doing CPOE with Horizon Expert Orders, the currently marketed product from McKesson.

MEDITECH Sites reported using two distinct products from MEDITECH. The older product, MAGIC, is clearly differentiated from the newer Client/Server product.

QuadraMed Sites report using two distinct products, CPR (which they acquired from Misys and is their announced go forward product) and Affinity, and provider responses have been recorded accordingly.

Siemens The Siemens sites report using two distinct products from Siemens, Invision and Soarian and their responses have been recorded accordingly.

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Figure 72: Inpatient and Ambulatory Products

Vendor Inpatient Ambulatory Cerner Millennium PowerChart Millennium PowerWorks EMR CPSI Clinicals --

Eclipsys Sunrise Clinical Manager

Sunrise Clinical Manager/ Ambulatory Care

TDS Epic EpicCare Inpatient EMR EpicCare Ambulatory EMR

GE Centricity Enterprise Centricity Enterprise LastWord/Legacy --

Healthland Clinicals HMS Clinicals Keane InSight Clinicals McKesson Horizon Expert Orders --

MEDITECH C/S Enterprise Medical Record C/S Enterprise Medical Record MAGIC Patient Care Inquiry LSS-

Medsphere OpenVista EHR

QuadraMed Affinity Clinicals -- CPR --

Siemens Invision Invision Soarian --


Market Detail

Figure 73: Inpatient and Ambulatory Organizations

“Other” includes Custom, Keane, Medsphere, QuadraMed Affinity, and Siemens MedSeries4

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GE Centricity

Epic

Eclipsys TDS

Eclipsys SCM

CPSI

Cerner

Inpatient

Inpatient & Ambulatory


Today’s verifiable live hospitals were 804 versus last year’s 623, an overall increase of 29 percent. The bottom line on U.S. hospital-based CPOE on commercial software products as validated by KLAS is:

15.7 percent of hospitals are doing some CPOE.

11.3 percent are actively using CPOE (active defined as physicians entering greater than 50 percent of patient orders).

19.9 percent is an absolute maximum of current CPOE usage if you count the 785 U.S. KLAS validated commercial sites and the AHA reported 213 Federal Government Hospitals as all doing some CPOE. KLAS statistics do not typically include the Federal Government Hospitals (213 hospitals) as KLAS only surveys sites using commercially available products.

Figure 74: Number of CPOE Inpatient Hospitals Verified Live – 2008 – 2010 Comparison

“Other” includes Keane, Medsphere, QuadraMed Affinity, Siemens MedSeries4, and one custom site.

0 20 40 60 80 100 120 140 160 180 200

Other

Siemens Soarian

Siemens Invision

QuadraMed CPR

MEDITECH MAGIC

MEDITECH C/S

McKesson

HMS

Healthland

GE LastWord

GE Centricity

Epic

Eclipsys TDS

Eclipsys SCM

CPSI

Cerner





Market Detail

Figure 75: Number of CPOE Hospitals and Organizations

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Figure 76: Percent of Vendor’s Own Client Base Doing CPOE (U.S., >200 Beds Only)

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70%Legacy

Currently Marketed

52%

35%

43%

34%

11% 12%

37%

26%25%


Market Detail

Figure 77: Client Base Penetration vs. Percent of U.S. Market Share (<200 Beds Only)

Healthland

HMS

CPSIMEDITECH

Siemens MS4

Cerner

Eclipsys

Epic

GE

McKesson Horizon

McKesson Paragon

Quadramed

Siemens Invision

Siemens Soarian

0%

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CP

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Percent of U.S. Market Share (Under 200 Beds)

Average


Of all the organizations surveyed, 481 (up from 376 last year) are now live with CPOE. These 481 organizations represent 804 hospitals (up from 623 last year). Figure 78: Inpatient CPOE Deployment – Number of Live Organizations 2009 vs. 2010


0 10 20 30 40 50 60 70 80 90

Other

Siemens Soarian

Siemens Invision

QuadraMed CPR

MEDITECH MAGIC

MEDITECH C/S

McKesson

HMS

Healthland

GE LastWord

GE Centricity

Epic

Eclipsys TDS

Eclipsys SCM

CPSI

Cerner

2009

2010


Market Detail

Figure 79: Ambulatory CPOE Deployment – Number of Live Organizations 2009 vs. 2010


0 5 10 15 20 25 30 35 40 45

Other

Siemens Soarian

Siemens Invision

QuadraMed CPR

MEDITECH MAGIC

MEDITECH C/S

McKesson

HMS

Healthland

GE LastWord

GE Centricity

Epic

Eclipsys TDS

Eclipsys SCM

CPSI

Cerner

2009

2010


Figure 80: Pharmacy Vendor vs. Inpatient CPOE Vendor (n=787)

“Other” CPOE vendors include Keane, Medsphere, QuadraMed Affinity, Siemens MedSeries4, and one custom site. “Other” pharmacy vendors include Crown and CPSI.

0%

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100%P

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CPOE Vendor

Other

Siemens

QuadraMed

Mediware

Meditech

McKesson

HCS

GE

Custom

Cerner

Same as CPOE Vendor

Pharmacy Vendor


Market Detail

Figure 81: Positive Patient/Med ID Software Vendor vs. Inpatient CPOE Vendor (n=428)

“Other” CPOE vendors include Keane, Medsphere, QuadraMed Affinity, Siemens MedSeries4, and one custom site. No Healthland CPOE hospital currently has positive patient/med ID software in place.

0%

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CPOE Vendor

Custom

Mediware

McKesson

IntelliDOT

Initiate

Hospira (Sculptor)

GE

Same as CPOE Vendor

Positive Patient/Med ID Vendor


Figure 82: Raw Hospital Count CPOE Hospitals Cumulative 2003 – 2010

Figure 83: Raw Hospital Count CPOE Hospitals Overall 2003 – 2010

0

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2003 2004 2005 2006 2007 2008 2009 2010

Cerner [Millennium PowerChart]

CPSI [Clinicals]

Eclipsys [SCM & TDS]

Epic [EpicCare Inpatient]

GE [Centricity & LastWord]

Healthland

HMS

McKesson [HEO]

MEDITECH [C/S & MAGIC]

QuadraMed [Affinity & CPR]

Siemens [Invision & Soarian]

99

155

241

335

404

486

623

804

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2003 2004 2005 2006 2007 2008 2009 2010

Nu

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Market Detail

Figure 84: Number of CPOE Inpatient Hospitals Verified Live by Year

2003 2004 2005 2006 2007 2008 2009 2010 Cerner 5 15 42 62 76 102 137 181 CPSI -- -- -- 7 7 9 37 59 Eclipsys SCM 13 21 39 48 67 84 93 102 Eclipsys TDS 26 21 28 31 28 22 16 16 Epic 2 4 7 15 24 37 93 140 GE Centricity -- 1 4 6 14 20 23 24 GE LastWord 7 9 15 17 17 13 10 9 Healthland -- -- 1 1 1 2 2 5 HMS -- -- -- -- -- -- 3 5 McKesson Horizon -- 2 5 12 18 28 37 53 MEDITECH C/S 5 8 16 27 26 32 35 59 MEDITECH MAGIC 5 9 15 28 31 42 60 69 QuadraMed CPR 16 21 23 23 26 25 25 26 Siemens Invision 19 30 35 32 42 40 39 39 Siemens Soarian -- -- 1 1 3 3 3 10 Other 26 14 10 23 22 23 6 7 Overall 124 155 241 335 404 486 623 804


Figure 85: Number of Live Organizations – Inpatient

2003 2004 2005 2006 2007 2008 2009 2010 Cerner 5 13 22 31 41 47 64 81 CPSI -- -- -- 7 7 9 37 55 Eclipsys SCM 11 18 26 33 42 54 57 63 Eclipsys TDS 10 15 22 22 19 17 10 9 Epic 1 3 5 7 11 17 33 51 GE Centricity -- 1 2 4 8 10 10 11 GE LastWord 6 8 10 9 9 10 8 7 Healthland -- -- 1 1 1 2 2 5 HMS -- -- -- -- -- -- 3 5 McKesson Horizon -- 1 5 12 16 23 29 36 MEDITECH C/S 3 7 15 25 24 27 29 51 MEDITECH MAGIC 3 7 13 23 26 35 46 55 QuadraMed CPR 6 7 9 9 11 10 9 10 Siemens Invision 8 18 23 25 31 29 27 27 Siemens Soarian -- -- 1 1 3 3 3 9 Other 4 3 6 6 6 8 10 6 Overall 57 101 160 216 256 303 376 481

Note: “Other” includes (for 2010) Custom, Keane, Medsphere, QuadraMed Affinity, and Siemens MedSeries4.

Figure 86: Number of Live Organizations – Ambulatory

2003 2004 2005 2006 2007 2008 2009 2010 Cerner 1 2 7 11 17 17 22 24 CPSI -- -- -- 1 -- -- 4 7 Eclipsys SCM 2 3 5 6 10 12 13 15 Eclipsys TDS 3 4 4 5 3 3 2 2 Epic 1 2 4 6 8 12 25 40 GE Centricity -- -- 1 1 2 3 3 2 GE LastWord -- -- 1 2 1 1 2 1 Healthland -- -- -- -- -- 1 1 2 HMS -- -- -- -- -- -- -- 1 McKesson Horizon -- -- -- -- -- -- 1 3 MEDITECH C/S 1 3 6 6 2 2 3 5 MEDITECH MAGIC 3 -- -- -- -- -- 2 5 QuadraMed CPR 3 3 3 2 4 -- -- 2 Siemens Invision 1 2 4 3 3 3 3 2 Siemens Soarian -- -- -- -- -- -- -- -- Other -- 1 2 2 2 2 2 -- Overall 15 20 37 45 52 55 82 111


Market Detail

Figure 87: Total Number of Physicians Doing CPOE

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2010 # of Physicians Doing CPOE (Inpatient)

2010 # of Physicians Doing CPOE (Ambulatory)


Figure 88: Number of Physicians Doing CPOE – Employed vs. Non-Employed (n=481)

Figure 89: Number of Physicians Doing Inpatient CPOE – Employed vs. Non-Employed by Vendor (n=481)

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Market Detail

Figure 90: Is inpatient CPOE usage mandated for non-employed physicians? (n=481)

Figure 91: Is inpatient CPOE usage mandated for non-employed physicians? 2009 vs. 2010 (n=481)

Yes40%

No60%

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2009 % Mandated


Figure 92: Is inpatient CPOE usage mandated for non-employed physicians? – by Vendor (n=481)

181

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No

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2009 Average % Mandating


Market Detail

This chart represents the percent of physicians doing CPOE split by whether or not CPOE use was mandated. Figure 93: CPOE Adoption Comparing Mandated vs. Not Mandated CPOE Use (n=481)

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Mandated CPOE Use Not Mandated CPOE Use


Figure 94: Market Share: CPOE Live vs. Contracted CIS Clients – Hospitals Over 200 Beds

0%

5%

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15%

20%

25%Market Share: CPOE Live vs. Contracted CIS Clients

Percent of the Total Number of MDs Doing CPOE

Percent of Live CPOE Hospitals

Percent of CIS Market Share (Over 200 Beds) Through 2009


Market Detail

Figure 95: Overall Percent Teaching and Associated Teaching Hospitals versus Non-teaching Hospitals Live with CPOE (n=804)

61% 58%

39% 42%

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2009 2010

Non-Teaching Hospitals Live

Teaching Hospitals Live


Figure 96: Inpatient Teaching and Associated Teaching Hospitals vs. Non-Teaching Hospitals Live on CPOE by Vendor/Product

0 20 40 60 80 100 120

Other

Siemens Soarian

Siemens Invision

QuadraMed CPR

MEDITECH MAGIC

MEDITECH C/S

McKesson

HMS

Healthland

GE LastWord

GE Centricity

Epic

Eclipsys TDS

Eclipsys SCM

CPSI

Cerner

Teaching Hospitals Live

Non-Teaching Hospitals Live


Market Detail

Figure 97: Inpatient Teaching and Associated Teaching Hospitals vs. Non-Teaching Hospitals Live on CPOE by Vendor/Product

Vendor/Product Teaching Hospitals Live Non-Teaching Hospitals Live Total Hospitals Live

2010 2009 2010 2009 2010 2009 Cerner 106 86 75 51 181 137 CPSI 3 56 37 59 37 Eclipsys SCM 77 73 25 20 102 93 Eclipsys TDS 8 9 8 7 16 16 Epic 94 73 46 20 140 93 GE Centricity 18 17 6 6 24 23 GE LastWord 7 7 2 3 9 10 Healthland 2 1 3 2 5 3 HMS 1 -- 4 2 5 2 McKesson 35 28 18 9 53 37 MEDITECH C/S 25 12 34 23 59 35 MEDITECH MAGIC 29 20 40 40 69 60 QuadraMed CPR 22 3 4 1 26 4 Siemens Invision 29 21 10 4 39 25 Siemens Soarian 6 30 4 9 10 39 Other 3 1 4 2 7 3 Total 465 383 339 240 804 623

Figure 98: Raw Count – Inpatient Teaching and Associated Teaching Hospitals vs. Non-Teaching Hospital CPOE Growth

-5

0

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Non-Teaching Hospitals


Figure 99: Percent of Physicians Doing Some Inpatient CPOE at live CPOE sites by Vendor

90%

82% 81% 81% 80% 79%75%

69% 67% 66%

57%

52%48% 46% 44%

29%

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2010 Average = 67%


Market Detail

Figure 100: Number of Inpatient Hospitals at the 100% Level

Number of Inpatient Hospitals at the 100% level for:

2010 2009 2008 2007 2006 2005 2004 2003

Physicians Doing CPOE 291 209 144 98 79 59 25 12 Orders Entered 128 120 77 62 45 34 13 5

There is more aggressive CPOE use. Of the 785 US hospitals live with CPOE, 565 had over 50 percent of potential orders entered by physicians and KLAS considers this group as aggressive CPOE users. Based on the AHA’s count of 5,010 U.S. hospitals this translates into 11.3 percent of U.S. hospitals aggressively doing CPOE. Actual physician usage is described in this chart as deep (86-100 percent), significant (51-85 percent), moderate (16-50 percent) or pilot (1-15 percent).

Pilot Moderate Significant Deep

Overall 111 106 138 449

Figure 101: CPOE Use by Physicians (Inpatient) by Number of Hospitals

0 20 40 60 80 100 120 140

Other

Siemens Soarian

Siemens Invision

QuadraMed CPR

MEDITECH MAGIC

MEDITECH C/S

McKesson

HMS

Healthland

GE LastWord

GE Centricity

Epic

Eclipsys TDS

Eclipsys SCM

CPSI

Cerner

Deep

Significant

Moderate

Pilot


Figure 102: CPOE Use by Physicians (Ambulatory) by Number of Organizations

Figure 103: Orders Entered by Physicians (Inpatient) by Number of Hospitals

0 5 10 15 20 25 30 35 40

Siemens Invision

QuadraMed CPR

MEDITECH MAGIC

MEDITECH C/S

McKesson

HMS

Healthland

GE LastWord

GE Centricity

Epic

Eclipsys TDS

Eclipsys SCM

CPSI

Cerner

Number of Organizations

Deep

Significant

Moderate

Pilot

0 10 20 30 40 50 60 70 80 90 100

Other

Siemens Soarian

Siemens Invision

QuadraMed CPR

MEDITECH MAGIC

MEDITECH C/S

McKesson

HMS

Healthland

GE LastWord

GE Centricity

Epic

Eclipsys TDS

Eclipsys SCM

CPSI

Cerner

Deep

Significant

Moderate

Pilot


Market Detail

Figure 104: Orders Entered by Physicians (Ambulatory) by Number of Organizations

Figure 105: Percent of All Orders Physicians Enter – Inpatient Organizations (n=481)

0 5 10 15 20 25 30 35

Siemens Invision

QuadraMed CPR

MEDITECH MAGIC

MEDITECH C/S

McKesson

HMS

Healthland

GE LastWord

GE Centricity

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Eclipsys TDS

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Number of Organizations

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2009


Figure 106: Percent of Organizations Not at 50% CPOE Use (n=481)

8%

15%17%

40% 40%

45% 47%

58% 60%

66%

78%

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Market Detail

Figure 107: Number of Years Doing CPOE if Not at 50% of All Orders Entered – Inpatient Organizations (n=474)

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Figure 108: Average Number of Years Doing CPOE – Inpatient (n=481)

3.12.7

5.0

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4.9 5.0

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Market Detail

Figure 109: Overall: In addition to CPOE, what else are you doing?

268

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Figure 110: Overall: Percent of Organizations Doing any Physician Documentation (n=457)

Figure 111: Overall: Percent of Organizations Doing Barcode Scanning at the Bedside (n=457)

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CPOE Vendor Average = 59%

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Market Detail

Figure 112: Summary Chart CPOE Usage Inpatient and Ambulatory (n=804)

449

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Figure 113: Physician Satisfaction, Response Time, System Reliability 2003 – 2010

4

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9

2003 2004 2005 2006 2007 2008 2009 2010



Market Detail

Figure 114: Physician Satisfaction with CPOE – Inpatient (n=448)

Figure 115: Physician Satisfaction Ratings – Ambulatory (n=106)

6.9

5.2

7.1

5.4

6.96.6

5.3

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4.6*

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Cerner CPSI Eclipsys SCM Epic McKesson MEDITECH C/S MEDITECH MAGIC

Average = 6.7


Figure 116: Specialty Ordering: Oncology Drugs - Inpatient

Figure 117: Specialty Ordering: Oncology Drugs - Ambulatory

16

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545 78 13

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Market Detail

Figure 118: Overall % of Hospitals Barcode Scanning at the Bedside (n=778)

38%

52%

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2009 2010


Figure 119: Hospitals/Organizations Doing Both BPOC and CPOE (with same vendor)

Note: Data displayed assumes all hospitals are doing BPOC in each closed loop organization.

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90

Number of Organizations doing CPOE

Number of Organizations doing Closed Loop

Number of Hospitals doing Closed Loop


Market Detail

Figure 120: Percent of CPOE Hospitals doing Bedside Barcode Scanning by Inpatient CPOE Vendor (n=778)


Hospitals using a different vendor for BPOC: Cerner – 3 Eclipsys SCM – 11 Eclipsys TDS – 6 Siemens Invision – 4

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This chart displays the percent of beds with barcode scanning capability for only the 403 hospitals that are doing barcode scanning at the bedside. Figure 121: Adoption (% Beds) by those Doing Bedside Barcode Scanning by Inpatient CPOE Vendor (n=403)


No Healthland hospitals are doing BPOC. Hospitals using a different vendor for BPOC: Cerner – 3 Eclipsys SCM – 11 Eclipsys TDS – 6 Siemens Invision – 4

0%

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Market Detail

Figure 122: System Response Time – Inpatient (n=453)

Figure 123: System Response Time – Ambulatory (n=108)

7.3

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Figure 124: System Reliability and Uptime – Inpatient (n=455)

Figure 125: System Reliability and Uptime – Ambulatory (n=106)

7.77.9

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Market Detail

Figure 126: Response Time Ratings Legend

Score Definition Score Definition

9 Always immediate (< 1 second) 4 Delays common with complaints (> 5 seconds)

8 Very slight delays at times (1–2 seconds) 3 Continuous complaints, still livable

7 Slight delay routine, no inconvenience (2–3 seconds) 2 Very difficult, impacts everyone

6 Slight delay, inconvenient (3–4 seconds) 1 Unacceptable, must be fixed

5 Okay with busy time delay, inconvenient (4–5 seconds)

Figure 127: Response Time Satisfaction Ratings (inpatient n=453, ambulatory n=108)

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Ambulatory Average = 7.3

InpatientAverage = 7.5


Figure 128: Reliability & Uptime Ratings Legend

Score Definition

9 Never down (99.9% uptime or less than ½ hour per month)

7 Rarely down + short scheduled down time (99% uptime or less than 7 hours per month)

5 Unscheduled down time four or more times per year plus some scheduled down time

3 Unscheduled down time almost monthly and/or significant scheduled down time

1 Unscheduled or scheduled down time almost weekly

Figure 129: Reliability & Uptime Satisfaction Ratings (inpatient n=455, ambulatory n=106)

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InpatientAverage = 7.8


Market Detail

Figure 130: Response Times vs. Number of Physicians Doing CPOE per Organization (n=481)

Cerner

CPSI

Eclipsys SCM

Eclipsys TDS

Epic

GE Centricity

GE LastWord

Healthland

HMS

McKesson

MEDITECH C/S

MEDITECH MAGIC

QuadraMed CPR

Siemens Invision

Siemens Soarian

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KLAS Performance Data



KLAS PERFORMANCE DATA Figure 131: Side-by-Side Comparison – CPOE Sites:

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Sales & Contracting Contracting Experience 6.7 6.8 6.5 7.6 5.9 6.6 6.9 6.9 7.4 6.7 Product Works as Promoted 6.9 6.7 6.6 7.9 5.4 6.5 7.1 7.3 7.0 6.9 Money’s Worth 6.8 6.9 6.8 7.9 5.7 6.8 7.5 7.3 7.8 6.8 Avoids Nickel-and-Diming 57% 62% 68% 90% 61% 59% 84% 88% 93% 63%

Implementation & Training Quality of Implementation 6.7 6.9 6.4 7.8 5.7 6.7 6.4 6.8 7.3 6.7 Implementation On Time 7.0 7.9 6.3 8.1 4.7 6.9 7.3 6.5 6.3 7.0 Quality of Training 6.8 6.9 6.8 7.9 5.8 6.9 6.4 6.2 6.9 6.8

Functionality & Upgrades Overall Product Quality 7.2 6.5 6.9 7.8 5.9 6.5 7.0 7.1 7.2 7.2 Delivery of New Technology 7.2 6.3 6.7 7.8 5.1 6.6 6.7 6.4 7.1 7.2 Ease of Use 6.7 6.4 6.9 7.3 5.2 6.7 6.5 6.8 7.6 6.7 Product Response Time 6.9 7.1 6.7 7.9 6.2 6.6 7.0 7.2 7.4 6.9 Supports Integration Goals 7.3 6.9 6.6 8.1 4.8 6.5 7.5 6.4 7.8 7.3 Product Has Needed Functionality 44% 23% 35% 57% 5% 21% 34% 39% 33% 22%

Service & Support Quality of Phone/Web Support 6.9 6.9 6.7 7.9 6.1 6.5 6.8 6.6 7.6 6.9 Proactive Service 6.5 6.4 5.9 7.7 4.6 6.0 6.0 6.1 6.6 6.5 Executive Involvement 7.2 6.5 6.5 8.0 6.7 7.4 7.0 6.5 8.0 7.2 Lives Up to Expectations 6.9 6.5 6.7 7.9 5.4 6.5 7.0 6.5 7.1 6.9 Keeps Promises 56% 68% 63% 94% 24% 56% 76% 69% 73% 68%

General Overall Communication 7.1 7.3 6.7 8.4 5.3 7.0 7.4 6.3 7.7 7.1 Recommend to a Peer/Friend 7.1 6.8 6.8 8.3 4.6 6.7 7.7 6.9 7.2 7.1 Overall Satisfaction 7.1 6.6 6.9 8.0 5.6 6.7 7.0 6.9 7.3 7.1 Forecasted Overall Satisfaction 7.4 7.2 7.2 7.8 4.9 7.4 7.5 6.6 7.9 7.4 Part of Long-Term Plans 96% 86% 92% 100% 94% 100% 96% 81% 100% 85% Would You Buy this Again 88% 74% 86% 99% 58% 83% 92% 82% 87% 74% Ranked Client’s Best Vendor 33% 23% 26% 73% 11% 15% 20% 28% 44% 22%


Figure 132: Side-by-Side Comparison – Non-CPOE Sites:

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Sales & Contracting Contracting Experience 6.5 6.2 6.4 7.2 6.0 6.1 6.9 5.6 6.8 6.5 Product Works as Promoted 6.5 6.2 7.4 8.0 5.6 7.0 7.3 6.1 6.4 6.5 Money’s Worth 6.4 6.1 7.2 7.8 5.3 6.8 7.5 6.1 6.5 6.4 Avoids Nickel-and-Diming 51% 47% 61% 90% 67% 65% 80% 70% 73% 49%

Implementation & Training Quality of Implementation 6.4 6.7 6.7 7.5 5.3 6.5 6.7 5.5 6.8 6.4 Implementation On Time 6.6 7.2 6.3 7.9 6.1 6.2 7.4 5.4 6.1 6.6 Quality of Training 6.2 6.8 7.0 7.8 6.1 6.9 6.8 5.6 6.4 6.2

Functionality & Upgrades Overall Product Quality 6.8 6.1 7.5 7.9 5.9 6.6 7.2 6.3 6.8 6.8 Delivery of New Technology 7.0 5.9 7.8 8.0 5.6 6.7 6.8 5.6 7.0 7.0 Ease of Use 6.5 5.9 7.7 7.4 5.7 6.5 6.8 5.7 6.9 6.5 Product Response Time 6.6 6.7 7.7 7.6 6.4 6.7 7.1 5.9 6.6 6.6 Supports Integration Goals 7.1 6.3 7.4 8.0 5.3 6.4 7.5 6.1 7.2 7.1 Product Has Needed Functionality 42% 32% 50% 75% 6% 37% 42% 9% 33% 35%

Service & Support Quality of Phone/Web Support 6.7 6.7 6.8 7.9 6.1 6.6 7.2 6.2 7.0 6.7 Proactive Service 5.8 6.3 6.8 7.7 4.9 5.8 6.2 5.1 6.1 5.8 Executive Involvement 6.9 6.4 7.2 7.9 6.5 6.9 6.7 5.8 7.3 6.9 Lives Up to Expectations 6.7 6.1 7.0 7.9 5.6 6.5 6.9 5.0 6.4 6.7 Keeps Promises 55% 54% 60% 95% 50% 53% 75% 30% 52% 55%

General Overall Communication 6.7 6.4 7.0 8.1 4.7 7.2 6.8 5.7 7.1 6.7 Recommend to a Peer/Friend 6.6 6.2 7.3 8.4 3.4 7.0 7.2 5.9 7.5 6.6 Overall Satisfaction 6.7 6.1 7.6 7.8 5.6 6.4 7.1 6.0 6.7 6.7 Forecasted Overall Satisfaction 7.1 6.4 7.9 8.1 4.7 7.2 7.6 6.2 7.5 7.1 Part of Long-Term Plans 98% 82% 95% 100% 82% 91% 95% 82% 96% 83% Would You Buy this Again 85% 58% 95% 100% 36% 76% 82% 45% 78% 59% Ranked Client’s Best Vendor 26% 15% 33% 74% 6% 24% 25% 20% 17% 14%



Figure 133: CPOE vs. Non-CPOE Vendor Performance Scoring (100-point scale)

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Vendor Detail Special Questions Commentary


Cerner

CERNER

SPECIAL QUESTIONS COMMENTARY The only way I could ever get to 100 percent CPOE would be if we were to get closed-loop medication administration, which we do not currently have. We are just now starting to enter our chemo orders through CPOE. CPOE has become a stable and integral part of the clinical management of our organization. Order sets are used to address both our clinical and regulatory needs. The CPOE product is being enhanced by Cerner. We utilize Cerner RHO, and this is extremely reliable and responsive. The response-time issue is primarily with our network connectivity to primary care centers. As funds become available, this will improve. We have been very successful with CPOE in our inpatient environments. Our big push for this next year will be getting our ambulatory practices up on CPOE. We are seeing about half of our ambulatory orders entered electronically now. We do chemotherapy orders at the hospital, but we do not do any chemotherapy orders through CPOE. We do not even have it set up. We are currently implementing barcoding at the bedside, and that is one of our major initiatives. We are also implementing Cerner out in the physician offices as well. We use IntelliDose for chemotherapy. We have had psyche up on notes for three years, and we have saved about $50,000 a year. We are very happy with the CPOE project. There have been a few frustrations, but that is to be expected. We have a target date this summer to have all of the inpatient on CPOE. 100 percent of the CPOE chemo ordering is done using a custom-developed system and not our main CPOE system. The barcoding is increasing weekly, and we are rolling it out now. Our grade of success was the fact that no individual physician called our CEO to say that this was baloney. That is a big thing. Our OB and psyche departments are not very happy with Millennium PowerChart, but that could be a problem with how we implemented the system. Overall, the surgeons and the people in the ED are quite happy with the system.


We hope to be live on Millennium PowerChart Office sometime in the next two years. We anticipate approval of and funding for BPOC systems next year. All physician clinics are doing CPOE, but only one single-physician clinic is using Cerner PowerWorks. The other 27 physicians use GE Centricity. We had CPOE technology in the inpatient space over the past three years, but the orders were not being ordered by physicians. Two months ago, physicians started doing CPOE.


CPSI

CPSI

SPECIAL QUESTIONS COMMENTARY We need improvements in the workflow and in the system's response time before moving forward. We have two hospitalists leading this charge now, as opposed to just one, so this will help move things along. Also, MU will have an impact in forcing adoption.. We are still going through some challenges in getting our order entry to work properly. The physicians are frustrated because the screens are freezing and there are so many hoops to jump through to get it to work. Six doctors in the ED don't do any CPOE because they are on a separate system. We have had the systems for two years and just began mandatory use this year for the four hospitalists. Our outpatient physicians only come in a few times a month, so it is quite difficult for them to use CPOE. For those physicians, our nurses typically do the orders. There are only two doctors that will do CPOE. All of the others refused. Someone from IT has to be there with the two doctors every time they do CPOE in order to help them through the process. We feel that we are where we need to be now in terms of what needs to be done for CPOE for meaningful use. I can’t imagine the requirements being any harder than they currently are.


ECLIPSYS

SPECIAL QUESTIONS COMMENTARY Eclipsys SCM The implementation of the integrated Eclipsys system at two hospitals has streamlined the ordering process, improved communication between physicians and pharmacists, and enhanced overall patient care. We do very few oncology orders in Eclipsys Sunrise Manager at this point. We have had some real system reliability issues with SCM and Eclipsys. A lot of our reports have been getting hung up, and we can't get a good explanation from Eclipsys as to why this is happening. Virtually all orders are currently entered electronically, although it is not always by physicians. Residents and students tend to comply to CPOE. Some faculty members comply, and some don't. The doctors have liked SCM pretty well. There were only a few doctors who complained at first, but CPOE is mandated, so they just do it now. Although the system has a great depth in its capabilities, the configuration is a time-consuming process. The end result requires many hours to maintain and must be accepted by the end user. We are doing orders and results only in SCM. At this point, none of the doctors or nurses are doing documentation. We have 14 physicians out of 1,200 physicians doing CPOE. We are on one of the final legs of our CPOE project, and we are working on the chemotherapy order sets. We do have a couple, but the order sets do not get into the detail of all of the individual research regimens and the more complex medication orders. CPOE went up house-wide this year to the entire hospital. Our physician adoption rate varies between 95 and 97 percent. Less than 1 percent of our orders are handwritten, and about 2–3 percent are verbal. We are having great success with our CPOE initiative. CPOE is part of our culture now. The physicians call for system improvements instead of calling with complaints about the software. Our projected go-live date for Collection Manager is early next year.


Eclipsys

The barcodes are coming next year, and then we will address physician notes and charting.


EPIC

SPECIAL QUESTIONS COMMENTARY We continue to feel that the Epic system was the best system of choice. Epic commits to our partnership, and they are responsive to working through issues. None of our OP notes are being dictated. All of them are being entered in the EpicCare Inpatient EMR. About 80 percent of the notes are being entered using templates, and about 20 percent are done with free text. We only have a few physicians with disabilities that are using Dragon for actual software navigation within EpicCare, and we have radiologists and pathologists who are using voice recognition to interact with the system on occasion. We are going to Epic's minimum downtime this fall. The scheduled downtime is six hours once a year right now. The system is typically very fast, but the more advanced screens take a little longer. The doctors like the system. We do eMAR at the bedside, but we don't do barcode at the bedside yet for medication administration, so I think that is one of the last mountains for us to climb. Hopefully next year we will have that implemented.


GE

GE

SPECIAL QUESTIONS COMMENTARY GE Centricity We are currently rolling out barcode medication charting, which is an integrated product with GE Centricity. We have it implemented at a pilot unit in one of our hospitals, and we plan to push it out to all of our hospitals this next year. I would say we are currently doing alerting as we can write drug-drug and drug-allergy alerts ourselves and insert them. Our solution gives us the knowledge-based scripting ability to insert alerts. We are looking to move from GE to Epic so we can finally get deep adoption of CPOE by nurses and doctors. GE LastWord We plan to add electronic physician documentation and notes in a couple of years. The system is clunky and the physicians hate it. In reality, we are probably doing things with LastWord that it was not designed to do. We are talking about changing vendors. Everyone is talking about Epic, but we have not made that decision yet.


HMS

SPECIAL QUESTIONS COMMENTARY We just recently did an upgrade of the software and the hardware, and we have the system response time down to about three seconds. Before that it was slower, and the physicians were about to revolt. Some physicians still do not think it is fast enough. One of the biggest challenges we have is system speed. The physicians indicate that the slowness of the system makes it very difficult to try and place orders.


McKesson

MCKESSON

SPECIAL QUESTIONS COMMENTARY We only use Care Alerts on the nursing side, and it caused many unexpected workflow issues. We are slowly restarting it on the nursing side, and we want to evaluate it from a workflow perspective before we introduce it to the physicians. About 85 percent of all the medication orders and 75 percent of all organizational orders are backed by physicians using CPOE. The implementation of CPOE continues to go well, and the product really sells itself. McKesson does not support complex orders such as TPN, banana bags, and so on. Of our hospital physicians who actively manage inpatients, about 85 percent are using CPOE.


MEDITECH

SPECIAL QUESTIONS COMMENTARY MEDITECH C/S We are only doing non-medication orders for CPOE at this time. CPOE is used heavily in our facility. The physicians that are using CPOE put pretty much all of their medications through it. However, we still have a percentage of physicians that is not using CPOE at all. We are hopeful that we can get physician documentation running with v.5.6. I am hopeful that we will hit 10 percent of medications ordered via CPOE by the last quarter of this year in order to meet meaningful use requirements. We are taking the final steps that will allow us to capture the last remaining medications via CPOE. At that point, we will be at 100 percent with the CPOE initiative. MEDITECH MAGIC We are going to Epic in the summer of 2010. We have some doctors doing CPOE with MAGIC Patient Care Inquiry right now. We haven't purchased barcoded med admin from Epic yet, so in some ways, we may be taking a step backward in the move to Epic. My biggest suggestion for others looking at doing CPOE is to get physician adoption as early as possible. CPOE is not just an IT project. Everyone has to be involved or progress will be very slow. We are planning to convert to MEDITECH v.6. We completed the CPOE rollout last year, and we are now at 100 percent CPOE for all inpatient and ED patients. CPOE is now mandated in our facility. We are at 100 percent for our physician orders online. Our handwritten orders are entered into our Pyxis Connect system on the floors, and then they are verified in our pharmacy. All of this information is incorporated into the online medical record.


QuadraMed

QUADRAMED

SPECIAL QUESTIONS COMMENTARY Our hospital is replacing QuadraMed CPR with Paragon Clinicals next year. Although our software allows us multiple levels of alerting, we have chosen to set the system to a low sensitivity. Now we only have critical alerts activated in an effort to avoid alert fatigue. We are not doing any medication ordering via CPOE; that is still all done on paper and entered into the system by the pharmacy. We are doing almost all other orders via CPOE.


SIEMENS

SPECIAL QUESTIONS COMMENTARY Siemens Invision We have seen little change with Siemens as we are in the process of installing Epic. We are planning on replacing Invision Clinicals with Sunrise Clinical Manager in one of our hospitals within the next two years. Invision Clinicals is great when it comes to CPOE. We don't have to make many changes in the system to get what the doctors need. We are happy with it right now. We will see what happens in the next few years. Siemens Soarian The physicians are complaining because CPOE slows down their workflow. However, a lot of the residents and hospitalists who have been using it for a while don’t complain quite as much because they have acclimated and adjusted to it, and they have designed their workflows around it. As a tool, CPOE isn’t bad.


KLAS Survey Documents

REPORT SPECIFIC QUESTIONNAIRE Respondent: Title:

Organization: Phone:

Date: Email:

Provider Organization Details: Software Vendors

CPOE Software Vendor:

Pharmacy Software Vendor:

Positive Patient/Med ID Software Vendor:

Ambulatory Vendor:

Provider Organization Details: Usage Information

Total number of hospitals LIVE with CPOE:

List hospitals LIVE with CPOE:

Number of credentialed physicians and residents at LIVE site(s):

Is CPOE done ONLY in the Emergency Department? (Y/N)

Is CPOE usage mandated for community (non-owned) physicians? (Y/N)

Total number of physicians at outpatient sites where CPOE is LIVE:

Physician Interaction Inpatient Outpatient

% of physicians doing CPOE at all hospital/clinics where CPOE is live: Example: If one hospital out of five is doing CPOE and that hospital has 10 out of 100 physicians doing CPOE, the response should be 10%

Of the physicians doing CPOE, what percent are community (non-employed) physicians?

% of ALL patient orders physicians enter at only those hospitals/clinics where CPOE is live: Example: If one physician doing CPOE, enters 100% of his/her orders and accounts for 100 of the hospital’s 1,000 orders per year, the response should be 10%

Number of years you have been doing CPOE: (from first live)

% of physicians entering their notes electronically at CPOE sites (instead of dictating):

Use the rating scale of 1 to 9 for the following question (9=Incredible thru 1=Couldn’t be worse) Inpatient Outpatient

Rate the physician satisfaction with the CPOE system, including physicians notes if applicable

Use the scale of Nearly all/Some/None/NA for the following question Inpatient Outpatient

Specialty ordering: If you do chemotherapy, are you able to order all of your chemotherapy drugs through your CPOE System?

Medication Administration Inpatient Outpatient

Are barcodes (patient and med) scanned at the bedside at the time of medication administration? (Y/N)

If yes, what percent of beds at sites live with CPOE have this capability?

Technology Inpatient Outpatient

Response time for end-user rating: 9 = Always immediate (<1 sec) 8 = Very slight delay at times (1-2 seconds)


7 = Slight delay, no inconvenience (2-3 seconds) 6 = Slight delay, inconvenient (3-4 seconds) 5 = OK with busy time delay - inconvenient (4-5 seconds) 4 = Delays common with complaints (>5 seconds) 3 = Continuous complaints, still livable 2 = Very difficult, impacts everyone 1 = Unacceptable & must be fixed

System reliability and uptime rating: 9 = Never down (99.9% uptime or less than1/2 hour/month) 7 = Rarely down + short scheduled downs (99% uptime or less than 7 hours/month) 5 = Unscheduled down 4+ times/year plus some scheduled down 3 = Unscheduled down almost monthly and/or significant scheduled down 1 = Unscheduled or scheduled down almost weekly

Please use the space below for all comments or clarifications:


KLAS Survey Documents

KLAS VENDOR PERFORMANCE EVALUATION

Ratings Scale: 1 (Low) through 9 (High) 9 = Extremely Satisfied: Flawless, could not be better. 4 = Somewhat Dissatisfied: Some good things happen. 8 = Very Satisfied: Little if any negative, almost perfect. 3 = Dissatisfied: Significant numbers of unresolved issues. 7 = Satisfied: Insignificant number of unresolved issues. 2 = Very Dissatisfied: Little if any positive. 6 = Somewhat Satisfied: Some bad things happen. 1 = Extremely Dissatisfied: Nothing ever goes right. 5 = Acceptable/OK: Most issues resolved over time.

Answer should

be:

Sales & Contracting

Contract process, terms and administration 1–9

Product functions as sold in the demonstration and contract 1–9

Received your money’s worth 1–9

Avoids charging for every little thing; doesn't nickel-and-dime Yes/No

Implementation & Training

Quality and effectiveness of implementation services 1–9

Implementation met the contracted time frame 1–9

Quality and effectiveness of training 1–9

Functionality & Upgrades

Overall product quality, including upgrades 1–9

Delivers new technology that meets your needs 1–9

Ease of use for end users 1–9

Response time for end users 1–9

Product supports your organization’s integration (interoperability) goals 1–9

Current product functionality meets all your needs today Yes/No

Service & Support

Quality and effectiveness of post implementation phone/web support 1–9

Service is genuinely proactive 1–9

Executive involvement at your organization 1–9

Lives up to expectations 1–9

Keeps promises Yes/No

General

Product is part of your long-term plans Yes/No

Overall communication with your organization 1–9

Likely to recommend to a peer or friend 1–9

Overall satisfaction 1–9

Forecasted overall satisfaction in 12 months 1–9

Would you buy this again? Yes/No

Rank this solution compared to others you are familiar with

(1=the best, 2=one of the best, 3=NOT one of the best) 1, 2, or 3


FAQS REGARDING KLAS DATA Summary KLAS data and reports represent the combined opinions of actual people from provider organizations comparing how their vendors, products and/or services performed when measured against the participant’s objectives and expectations. KLAS findings are a unique compilation of candid opinions and are real measurements representing those individuals interviewed. Findings are not meant to be conclusive data for an entire client base. KLAS provides the findings as valuable data points to be used with other data points in the reader’s overall analysis. We encourage our clients, friends, and partners using KLAS research data to take into account the following statements as they include KLAS data in their other due diligence. Why are we writing this? Often, there are questions regarding the KLAS data that is published in industry reports or online databases. Where does the data come from? What does the data mean? How should the data be viewed? KLAS strives for transparency in all aspects of research. For this reason the following statements are given in response to common questions regarding KLAS data. Why does KLAS make the research public? First and foremost, the data must be public in order for it to benefit the healthcare provider community by providing access to client feedback. Second, data that is public will hold the vendors accountable for their performance as reported by their own customers. Third, public data provides an independent point of reality that allows healthcare professionals to separate marketing myth from reality.

PLANNING THE RESEARCH Do vendors pay to be measured?

No. KLAS partners with and answers only to the provider community. All KLAS performance research is directed and generated by healthcare professionals. KLAS’ mandate is to collect data that benefits the providers. To fulfill that mandate, KLAS must maintain complete vendor neutrality and remain independent of any outside influence other than that of the provider community. Money plays no part in that decision. In fact, KLAS will research a vendor whether or not that vendor desires to be included in the KLAS database. KLAS measures many vendors who pay nothing to KLAS.

However, vendors may pay for a subscription to see the data. KLAS also provides a limited amount of custom projects to vendors, where the data is typically, but not always, available to the public.

Occasionally, a vendor will request that KLAS pursue research within a certain time frame or that KLAS dedicate more research time than presently allocated for pursuing a particular piece of information. In those circumstances, KLAS may consider receiving payment for expedited research, but payment for this expedited research in no way reflects in the scores for that particular product.

To further illustrate this point, in April 2008 KLAS ran an analysis of scores by vendor comparing the average of those that subscribe to Platinum KLAS to those that do not. The comparison was broken into the three standard KLAS buckets: Software, Professional Services, and Medical Equipment. Each bucket had a slight variation to one side or the other. Two of the three showed that vendors that did not subscribe scored slightly higher than


KLAS FAQs Summary

those that did. In summary, buying KLAS data did not appear to influence the vendor score. KLAS maintains a rigorous anti-bias program that is geared to avoid scoring bias of any kind.

How does a vendor qualify for inclusion? The minimum standard that qualifies a vendor/product for inclusion in KLAS data is for at least 15 unique provider organizations to be interviewed and validated by KLAS that utilize that vendor/product, except in cases where the initial qualification threshold is lowered to three and six organizations in cases with small numbers of clients as in Professional Services. So what is a unique provider organization? What is a unique provider organization? A unique provider organization is a single IDN (integrated healthcare delivery network), independent hospital, or free standing clinic. KLAS uses the American Hospital Association Guide, as well as other resources, to categorize provider organizations. For example, Kaiser Permanente is a very large hospital system. KLAS may speak with a dozen individuals throughout Kaiser about a particular software vendor/product, yet those interviews are counted as a single organization (representing Kaiser as a single organization). At least 15 unique provider organizations must rate a product before it is ranked.

OBTAINING THE RESEARCH Where does the data come from? KLAS speaks with hospital and clinic executives, administrators, physicians, nurses and other directors and managers with business responsibilities regarding the experiences they are having with their vendors and products. Routinely, KLAS speaks with approximately 5,000 hospitals and nearly 3,000 ambulatory organizations annually in order to gather direct client feedback on vendor performance. How does KLAS obtain and verify data?

Evaluations are received online, via fax, email, or directly from one-on-one interviews with professionals from provider organizations. Below are some examples of how KLAS receives evaluations: o Providers who have given feedback to KLAS are sent an evaluation update email each

subsequent year. o Some providers who are aware of KLAS visit the KLASresearch.com website and fill out

an online evaluation. o Vendors can invite clients to participate with KLAS, and those providers visit the

KLASresearch.com website and fill out an online evaluation.

Each research participant responds to a standard set of questions that require a numeric answer (one-to-nine scale) or a yes/no answer. These answers, once they are aggregated and averaged, determine a vendor’s overall score and rank as reflected in KLAS reports and online databases.

All completed evaluations are followed up with a confidential interview by a KLAS research analyst. Each phone call includes a candid conversation regarding the experience with the participant’s vendor(s). Appropriate comments from that conversation are included anonymously in the research.

KLAS confirms the role and responsibility of the participant and assesses any conflict of interest. If an evaluation cannot be confirmed or corroborated as valid, it is discarded. Where


the providers participate at the invitation of the vendor, KLAS more heavily scrutinizes the data for evidences of bias.

The results are posted to the KLAS Database and subsequently made available for public use. Please note that: o KLAS reserves the right to quarantine any incomplete or suspect evaluation. o A dedicated KLAS researcher is assigned to resolve data issues from quarantined

evaluations. o KLAS reserves the right to discard evaluations that cannot be confirmed.

What does KLAS do with client contact information?

KLAS keeps all contacts and participating organizations strictly confidential, and any information shared is made anonymous so as to not allow any reader to identify the person or organization that gave the information.

A list of participants is never shared with any outside organization.

KLAS does not share or sell information about a participant's needs or future plans to any outside organization.

Evaluations and commentary submitted are not linked to a participant or organization in any public use of the data (online query, published reports, articles, presentations, etc.).

What level of healthcare professional can submit data to KLAS?

The data collected represents input from individuals who have direct product and/or service responsibility and/or evaluate and manage vendor decisions and relationships. Participants are at the manager/supervisor level or above and are frequently a CIO, Director, Chairman, Administrator, or other business manager at the organization.

At times KLAS is referred to another person within the organization that may have a relevant perspective on a particular vendor or product or service. When an evaluation is submitted from someone below a manager/supervisor level, KLAS must receive approval from a manager (or other key decision maker) before the data is accepted.

Evaluations that cannot be verified, do not meet submission requirements, or are for products or services not in productive use by the participant (unless they are rating applicable indicators such as selling and contracting) are discarded.

UNDERSTANDING THE RESEARCH What are the statistics behind the KLAS research methodology? Our provider partners have asked KLAS to compare the vendors/products once KLAS has measured at least 15 appropriate clients for a given vendor and to report early data with at least six measured clients. (The numbers are six and three respectively for certain cases with small numbers of clients in Professional Services areas). These standards were set in conjunction with our provider partners themselves. They wanted a standard minimum threshold set so that when they viewed KLAS data, they could be confident that they were comparing commercially viable products, not products that have very few installations and are actually unique to a particular organization. Every comparison represents the scores from the actual participants, allowing KLAS to stratify the vendors and products based upon the scores. KLAS utilizes commonly accepted statistical practices. It is important to recognize that the margin of error varies significantly due to the sample size, actual number of possible participants, time live with product, version of the product, size of the organization, role of participant, different participant objectives, previous experience with other vendors, etc. KLAS does not claim to publish scientific research. Rather, the data represents measurements and comments from real people drawn from their actual vendor


KLAS FAQs Summary

experiences. KLAS findings are intended to be a source of peer experiences to be added to other reader research and due diligence. When comparing vendor scores, does a decimal point mean anything? For the actual sample taken, the decimal point allows stratification of vendors/products. From an overall statistical analysis when two (or more) vendors receive very close scores, that means that their customers gave them similar ratings and, if a different group of customers were sampled, the position could be different. If the overall scores are within a decimal point of each other, this can be viewed as a dead heat or close race where one vendor may score somewhat better than another in particular areas, but one managed to edge out the other in overall scoring. What factors can cause a vendor’s score to change over time? A positive or negative movement in scoring trends can be explained in many different ways, and each case is unique. A few examples include:

A new software upgrade that resolves provider issues

Buggy software releases

Renewed focus on proactive account management

Rapid growth without scaling to new support demands

Implementation expectations exceeded

Omissions in the contract What does an asterisk denote? KLAS has established standards to ensure that published data falls within an acceptable level of KLAS Konfidence. A minimum number of unique organizations must be live on the product in question and validated before data on that product is published. Since KLAS was founded, our provider partners have worked with KLAS to help establish levels for early data and comparable data. An asterisk signifies to the reader that the information about the product was taken from less than fifteen provider organizations for software and equipment products and less than six organizations for professional services. An asterisk means that product will not be compared to other products due to the early data nature of the measurement, and readers should only consider the measurement as an early indicator of performance from a small sample of clients. Sometimes the Top 20 scores do not match those seen online in Platinum KLAS or in individual reports, why is this? How should providers interpret a change in a vendor’s (or product’s) positional rating when that vendor appears in two reports published close together? (e.g. Top 20 and a Specialty Report)

KLAS’ research efforts are ongoing. The performance ratings are regularly refreshed as new data is gathered. A rating given for a vendor in a report can be viewed as a snapshot in time. If that same vendor is included in a subsequent report, then the position of that vendor’s rating is subject to change depending on the most recent data provided by that vendor’s clients, even if the reports are published within a short time of each other. It should be noted that scoring trends over long periods of time (i.e. on an annual basis) are likely of more value than scoring trends over short periods of time.

Due to production requirements and in an effort to be fair and provide for "expiring" 12-month data scores, the Top 20 incorporates 13 months of data while Platinum KLAS and other reports include a rolling 12 months of performance data.

As daily performance scores come in and others roll off the active 12-month window, the actual score in a report can be different from a Platinum KLAS score a few days later and a Top 20 score covering 13 months.


What are the variables that can influence the research? Significant variables including organization/hospital type (rural, teaching, specialty, etc.), size of the organization, depth/breadth of software use, software version, role in the organization, provider objectives, and system infrastructure/network, impact participants’ opinions and thus preclude an exact apples-to-apples vendor/product comparison or a finely tuned statistical analysis. How should the reader (research consumer) use KLAS data? KLAS research displays direct client feedback on healthcare technology vendors. In essence, the data provides an anecdotal view into the lives of those healthcare professionals who utilize the solutions in question. It is KLAS’ hope that the data presented can aid a healthcare organization in their due diligence in evaluating prospective vendors. KLAS data is not meant as a replacement for such due diligence; rather, the research can be part of the organization’s evaluation process. In this way KLAS data may also be compared to the following in some degree:

Consumer reports

Movie reviews

Book reviews

Online opinion polls When using KLAS data, among other things, remember to factor in the following:

The sample size

Overall number of potential clients

Early data designations (*)

Types of adopting facilities

Gap between highest- and lowest-scoring participants

Possible variations in software versions in use

Length of time clients have been live, if known

General trend

Comment trends and common threads