trends in cardiovascular information systems 1 · 5.7 5.4 5.3 4.6 4.0 cardiologist cardiovascular...

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Trends in CardiovascularInformation Systems

Research and report by

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TABLE OF CONTENTSExecutive Summary

Vendors Covered in This Report

Demographics

Two-Year Expected Change in Procedures

Provider Recommendation Scores

Organization’s EHR

CVIS Replacement Market (a.k.a. Blood Sport)

Damage Control... “Huston, we have a problem”

Conclusion

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5

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EXECUTIVE SUMMARY Let’s start with the bad news. The most recent data from the National Center for Health Statistics declared heart disease to be the #1 cause of death-- a staggering 27.6 million adults (11.5%) diagnosed with heart disease. We’re not trying to depress you, but it makes sense-- the baby-boomer population is aging, and we’re well aware of the prominence of obesity in our society. Negative health effects shouldn’t entirely be a surprise. The good news is that healthcare provider organizations are expanding and improving their services and facilities to accommodate and treat this increase in cardiovascular disease. Patient care is more important than ever-- and rightfully so. A patient with heart disease in particular typically requires extended care, making it critical for their data to be accessible every step of the way. With demand going up, more physicians are being hired; more Cath Lab, Echo Lab, and Nuclear Medicine modalities are being purchased; and of course more information technology is being utilized, yet at the same time the healthcare industry is trying to reduce costs while actually improving quality of care. This puts caregivers and their organizations between a rock and a hard place: how do you reduce cost AND improve quality? That is quite literally the trillion dollar question. Here’s where technology might be able to save the day: A reliable, easy-to-use, and robust cardiovascular information system (CVIS) can collect all applicable patient data (including images/video) and help physicians and other care providers with detailed, personalized outcome analysis. At its best, a CVIS does what it’s meant to do: it mines and reports critical cardiovascular related data, and it’s easy to use. At its worst, a CVIS produces headaches, increases costs, and generally gets in the way. It doesn’t take a brain surgeon--or in this case, a heart surgeon-- to draw this conclusion: If it’s hard to use, it’s practically useless. Yet many providers are still working with sub-par solutions, usually opting to go with a one-size-fits-all vendor, while keeping one eye open for a CVIS that can satisfy basic needs such as reporting capabilities and ease-of-use. Which vendors are leaving the door open to being replaced and which vendors are providers looking at to help them move cardiovascular medicine into the future? This report goes straight to the source by asking chiefs of cardiology, CV department directors, and other leaders what CVIS solution can get the job done-- and whether or not that solution is currently being used.

Report Author: Chris JensenJunior Author: Jordyn Crowley

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VENDORS COVERED IN THIS REPORT

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DEMOGRAPHICS

5%12%

31%

23%

19%

10%

1-25 beds26-100 beds101-250 beds251-500 beds501-1000 beds1001+ beds

Participants by Title

Participants by Facility Size

Thanks to our participants, who represent a broad spectrum of opinions and concerns in their varying roles. Each provides a different perspective that vendors need to consider when offering and servicing their solutions.

48%

32%

14%

4%

2%

Cardiovascular Director

Cardiologist

Cardiovascular Manager

Chief of Cardiology

Imaging Director


Cardiologist


Chief of Cardiology

Imaging Director

1-25 beds

26-100 beds

101-250 beds

251-500 beds

501-1000 beds

1001+ beds

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23%

15%

14%12%

11%

9%

4%3%

9%GE HealthcareMcKessonPhilips HealthcareEpicSiemensMerge (IBM)LUMEDXMeditechOther

DEMOGRAPHICS CONT.

Organization’s CVIS Vendor

Not pictured: Agfa, Digisonics, Evident, Fuji, INFINITT, Meditech, Verity

GE Healthcare

McKesson

Philips Healthcare

Epic

Siemens

Merge (IBM)

LUMEDX

Meditech

Other

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TWO-YEAR EXPECTED CHANGE IN PROCEDURES

5%

13%

29%

26%

8%8%7%

2%

3%

21%+ increase

11-20% increase

6-10% increase

0-5% increase

No Change0-5% decrease

6-10% decrease

11-20% decrease

21%+ decrease

Expected Change in Procedures Over the Next Two Years

What can we say that isn’t plain to see in this graph? CV procedures are going up in the neighborhood of 5-10%, which is not surprising.

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TWO-YEAR CHANGE CONT.

5%

5%

8%

7%

9%

17%

8%

4%

23%

16%

4%

33%

21%

22%

30%

27%

42%

33%

64%

19%

26%

27%

42%

14%

16%

26%

9%

17%

5%

4%

17%

1-25 beds

26-100 beds

101-250 beds

251-500 beds

501-1000 beds

1001+ beds

Expected Change in Procedures by Organization Size

21%+ decrease

11-20% decrease

6-10% decrease

0-5% decrease

No Change

0-5% increase

6-10% increase

11-20% increase

21%+ increase

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38%

25%

15%12% 11%

6% 6% 6%

Reasons for Predicted Increase in Procedures Over Next Two Years

Reasons for Predicted Increase

This data breaks down the specific reasons providers gave when predicting an increase in procedures– but isn’t everyone saying the same thing? It’s a bit of a chicken-egg situation, where it’s more likely the chicken (aging populations, less healthy populations, population growth) driving the increase within organizations than the egg (expansion for the sake of capturing more of the existing market). Take the majority of providers who say expanding their facilities or services is what will drive procedures up over the next two years: they aren’t just expanding for the fun of it– they are growing because the demand for CV procedures is growing. And why is that? It’s because the population is aging, and big surprise, becoming a more...well...doughy (read: obese), sedentary people

in general. An increase in CV disease leads to an increase in procedures which means organizations are having to hire more staff, increase their service lines, build more labs, etc... and so the dominos go. Another piece of data that sticks out is providers’ expectation of expanded insurance coverage. As much as physicians are there to provide care to those in acute situations– it’s cheaper and more efficient to get an important procedure done earlier instead of allowing the risk to materialize–unfortunately, sometimes a care plan really comes down to someone other than the provider (we’re looking at you, insurers). As payers expand their definitions and requirements based on evidence, more patients will hopefully be eligible for care.

*Other: Market share, increased market competition, referrals, accreditation

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Very few providers actually predict a decrease in CV procedures in the near future, but it’s still worth hearing them out. Some attribute the belief that there will be a decrease because of technology, which will reduce return visits. Can improved technology really stem growth or slow it down? As long as the masses continue to live less healthy lives, up-and-coming technology won’t likely be enough to cause a decrease in cardiovascular procedures, but it can help providers manage

more procedures without sacrificing quality of care. We’d count that as a major win in what is currently a losing battle. While a large percentage of providers think expanded insurance will increase the number of CV procedures done in their hospitals, there’s a group who believe insurance will actually decrease visits. The reasons behind this faith in expanded coverage isn’t readily clear and warrants additional research.

Reasons for Predicted Decrease

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PROVIDER RECOMMENDATION SCORES

#1 MOST RECOMMENDEDC V I S S o l u t i o n

EPIC

PHILIPSHighly RECOMMENDED

C V I S S o l u t i o nHighly RECOMMENDED

C V I S S o l u t i o n

IBM

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RECOMMENDATION SCORES CONT.

6.6 6.5

5.65.4 5.3

5.0

4.6 4.5

Epic Philips Healthcare

Merge (IBM) Siemens GE Healthcare

Meditech LUMEDX McKesson

Average Recommendation by Current CVIS

Looking at provider recommendation scores by vendor, we see some of the lowest scores in any health IT segment. Interestingly, enterprise and standalone solutions are rated as number one and two with Epic and Philips, respectively. While all scores are low, these two vendors have enough separation from other prominent competitors in the space to have a little breathing room.

Not pictured: Agfa, Digisonics, Evident, INFINITT, Meditech, Verity

Vendors covered in this chart include Siemens, GE Healthcare, Merge (IBM), Meditech, Philips Healthcare, LUMEDX, Epic, and McKesson.

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REACTIONDATA CLIENTS

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5.75.4

5.3

4.6

4.0

Cardiologist Cardiovascular Director


Chief of Cardiology Imaging Director

Average Recommendation by Title

Among CV providers, cardiologists are the happiest with their current vendors by a slight margin. However, any time the frontline user of a solution is happier than the decision-making leadership, it’s worth taking note. In comparison, are caregivers happier with their EHR than CIOs and other IT leadership? Not a chance. Not to put a damper on what is an interesting data point, but with scores across all titles in the sub 6’s, no one is ecstatic about the overall CVIS experience. Where is the most critical miss for suppliers? Chiefs of cardiology. Sure, an even lower score is given

by imaging directors, but given the subject matter, they are not as relevant inthis study (and no slight intended toward ourimaging directors). Anyway, if this group (chiefs of cardiology) is even just lukewarm on a solution, it’s going to be an uphill battle and may cause some vendors to “get the boot.” At an average score of 4.6, don’t let the door hit you on the way out (as the expression goes)– unless there isn’t a suitable alternative. In that case, chiefs will simply have to manage their expectations.

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7.0

5.0

5.0

1.0

5.1

4.2

8.0

6.0

4.1

6.7

4.5

6.0

5.7

5.5

7.0

6.0

3.5

8.0

5.4

4.3

5.6

6.7

6.8

8.0

5.0

4.0

8.0

GE Healthcare

McKesson

Philips Healthcare

Epic

Siemens

Merge (IBM)

LUMEDX

Meditech

Vendor Ratings by Title

Looking at provider recommendation scores by participant title shows that most vendors have a sweet spot in terms of who the biggest supporter is among their install bases. As usual, GE’s top-down marketing approach is displayed by the rating among chiefs of cardiology. On the other hand, Philips appears to be winning the war among both CV directors and managers. Score well with these two groups and you’re more than likely to have staying power. Meditech scores well among CV managers. Epic is propped up by imaging directors, but doesn’t fare nearly as well among leadership and cardiologists.

One of the most interesting data points in this breakout is IBM’s rating among cardiologists. These frontline users are so often an afterthought when in reality they should be viewed as an extremely important group (second only to the patient experience). Can focusing more attention on end users create a bubble up effect that equates to the capture of market share? Only if the end users (caregivers) are vocal enough.

Chief of Cardiology



Cardiologist

Imaging Director

Vendors covered in this chart include Siemens, GE Healthcare, Merge (IBM), Meditech, Philips Healthcare, Philips Healthcare, LUMEDX, Epic, and McKesson.

PR

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3.0

4.0

8.0

5.0

6.6

6.0

8.0

5.0

6.4

3.6

5.8

7.0

5.0

6.0

5.0

5.0

3.1

6.3

9.5

6.0

6.8

5.0

7.0

3.5

7.7

6.0

6.0

4.6

4.0

8.5

5.7

7.0

5.5

3.0

5.0

GE Healthcare

McKesson

Philips Healthcare

Epic

Siemens

Merge (IBM)

LUMEDX

Meditech

Vendor Ratings by Bed Count

1-25 beds

26-100 beds

101-250 beds

251-500 beds

501-1000 beds

1001+ beds

Vendors covered in this chart include Siemens, GE Healthcare, Merge (IBM), Meditech, Philips Healthcare, LUMEDX, Epic, and McKesson.

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ORGANIZATION’S EHR

33%

28%

19%

10%

7%

3%

Epic

Cerner

Meditech

Allscripts

McKesson

Evident

Organization’s EHR Vendor

A care organization’s EHR is an important reference point in analyzing trends in specific departments as enterprise EHR vendors continue to improve and push their modules out to their customers.

Not pictured: Centricity, eCare, GEMMS, HMS, Medhost

Epic

Cerner

Meditech

Allscripts

McKesson

Evident

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ORGANIZATION’S EHR CONT.

14%

25%

32%

14%

4%

12%

29%

18%

12%

6%

30%

30%

5%

5%

20%

42%

42%

8%

20%

60%

7%

7%

7%

88%

6%

6%

20%

20%

20%

40%

Epic

Cerner

Meditech

Allscripts

McKesson

Current EHR vs. Current CVIS Whether it’s healthcare IT or a trip to Costco, people seem to want the “whole package.” It’s not a revelation that many provider organizations seem to prefer an integrated clinical platform compared to having each department manage solutions from individual vendors. This means best of breed vendors will continue to face a bit of an uphill battle to maintain market share. It can be done, but these vendors have to be vigilant in the management of their businesses.

In contrast to the narrative of care organizations standardizing on enterprise platforms (where it makes reasonable sense), providers rank integration much lower than important issues such as customer service and features such as robust reporting capabilities. How do vendors like Epic contractually entice providers to switch to its one-size-fits-all system even though providers rank other CVIS features as more important? It’s because no vendor in the space is consistently doing an amazing job at making providers stand up and take notice or take a stand against encroachment by big enterprise players. Only Epic seems to be seeing real success with the enterprise approach as it relates to a CVIS add-on. It remains to be seen how Cerner will approach this market with its CVIS module.

At the end of the day, people are willing to give up marginally better solutions in favor of a vendor that provides all solutions under its umbrella– especially when IT leadership has an unspoken goal to reduce the number of different solutions to manage, support, and sometimes even babysit. This should be the last wake-up call CVIS vendors need before they see additional business slip through their fingers.

We can see in this data set where relationships lie. With Cerner’s acquisition of much of Siemens’ health IT assets (excluding radiology and cardiology), it makes sense that a strong relationship exists between these two suppliers. This is displayed in the data by Siemens accounting for the majority of CVIS solutions among Cerner’s EHR install base. Meditech customers lean towards GE’s CVIS, while Allscripts customers have a more pronounced pull for LUMEDX.

GE Healthcare

Philips Healthcare

McKesson

Merge (IBM)

Siemens

Epic

LUMEDXVendors covered in this chart include Siemens, GE Healthcare, Merge (IBM), Philips Healthcare, LUMEDX, Epic, Allscripts, Cerner, Meditech, and McKesson.

PR

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CVIS REPLACEMENT MARKET(A.K.A. BLOOD SPORT)

#1 in CVIS REPLACEMENT BUSINESS

EPIC

PHILIPSCVIS Business Replacement Leader

GE HEALTHCARE

CVIS Business Replacement Leader

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REPLACEMENT MARKET CONT.

46%54%

Switching

Not Switching

CVIS Replacement Market

Say it with us: C-H-U-R-N. Close to half of our nearly 200 participants state that they are seriously considering replacing their current CVIS in the near future. However, without any highly rated supplier solutions in this department, the post-honeymoon relationship is likely to be underwhelming.

Switching

Not Switching

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48%

33%

29%

19%17% 17%

14%

5% 5%3% 3% 3%

This data supports the idea of one-size-fits-all enterprise platforms making significant inroads in the CVIS market with Epic far and away capturing the greatest mindshare for replacement business. As was stated, the value of moving to a simpler health IT strategy will eventually win the day among provider leadership (for obvious reasons), unless major innovation or markedly

higher customer service occurs outside of the enterprise vendors. Interestingly, the emerging trend we’re seeing is pressure not only from the enterprise EHR side, but enterprise imaging vendors like IBM, McKesson, and Agfa squeezing the market from the other side. Can we use the word “enterprise” any more frequently in this report? Stay tuned.

Vendors Most Considered for Replacement Business

Vendors covered in this chart include McKesson, Siemens, Fuji, LUMEDEX, Agfa, Merge (IBM), Walters Kluwer, Philips Healthcare, Digisonics, GE Healthcare, INFINITT, and Epic.

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100%100%

14%

43%

43%

29%

14%

14%

14%

14%

14%

14%

14%

42%

42%

26%

11%

5%

21%

11%

11%

5%

5%

5%

5%

31%

23%

15%

31%

31%

31%

23%

38%

25%

50%

25%

13%

25%

13%

50%

50%

33%

33%

17%

Epic

GE Healthcare

Philips Healthcare

LUMEDX

Siemens

Merge (IBM)

McKesson

Fuji

Agfa

Wolters Kluwer

Digisonics

INFINITT

Considered Vendors by Bed Count

What hope can 1-100 bed hospitals have of grabbing Epic’s attention for their solutions, let alone coming up with the budget to cut the checks? These obstacles don’t seem to stop them from stating decisively that Epic is the frontrunner in what appears to be a one horse race. It should be noted that several of these smaller hospitals, that are looking at Epic, are part of IDNs and are reaping the perceived benefits of the decisions by the larger, supremely influential hospitals in the overall organizations.

On the other end of the scale, GE is keeping up on the mindshare front with Epic among the mega hospital organizations (1001+ beds), while Philips is garnering the most attention among hospitals with 501-1000 beds.

1-25 beds

26-100 beds

101-250 beds

251-500 beds

501-1000 beds

1001+ beds

Vendors covered in this chart include Siemens, Merge (IBM), McKesson, LUMEDX, Fuji, Philips Healthcare, Agfa, GE Healthcare, Epic, Walters Kluwer, Digisonics, and INFINITT.

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REPLACEMENT MARKET CONT.Considered Vendors by Title

In mindshare for replacement business, IBM once again scores well among cardiologists. Word seems to be out among this group that its solutions have the most to offer to those who are the “boots on the ground.” It would be interesting to get the perspective from the other side of the caregiver coin (nurses) to see if the narrative carries through. One would think IBM could make some serious hay by having the solution practicing cardiologists prefer to use. Execution will never go out of style.

Let’s address the elephant(s) in the room (as if there could be more than one). Both Epic and Siemens’ mindshare percentage among chiefs of cardiology is a bit anecdotal as a limited number of chiefs suggested their departments are in the market. So, while not bad news, we probably won’t bet the farm on this data.



Chief of Cardiology

Cardiologist

Imaging Director

Vendors covered in this chart include Siemens, Merge (IBM), McKesson, LUMEDX, Fuji, Philips Healthcare, Agfa, GE Healthcare, Epic, Walters Kluwer, Digisonics, and INFINITT.

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DAMAGE CONTROL... “HOUSTON, WE HAVE A PROBLEM”

52%

38%

33%30% 29%

20%

17%

McKesson Siemens LUMEDX GE Healthcare Epic Philips Healthcare

Merge (IBM)

Who’s Losing Business(As Percentage of Total Installations)

Among participants who said they are seriously considering a move to a competing CVIS solution, we discovered why certain vendors are most vulnerable to being replaced. Perhaps McKesson should consider taking an “all hands on deck” approach as its customers are saying it has a lot of work to do. It’s worth noting that the n here is not insignificant.

On the opposite end of the spectrum, IBM is shedding the fewest customers among the major CVIS vendors. Does this have anything to do with its favorability among cardiologists? The answer is almost assuredly “yes.”

Vendors covered in this chart include Siemens, GE Healthcare, Merge (IBM), Philips Healthcare, LUMEDX, Epic, and McKesson.

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REACTIONDATA CLIENTS

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DAMAGE CONTROL CONT.Vendors at Greatest Risk of

Losing CVIS Business

A couple of juicy insights cropped up in this data. First, intentionally or not, war has apparently been waged by Epic against McKesson’s CVIS customers–McKesson customers who state their relationship is on the rocks consider Epic as the most viable replacement by a massive margin. Siemens is also in a bit of trouble as it appears it is being outflanked on both sides by both Epic (enterprise) and Philips (best-of-breed), with GE (another best-of-breed player) coming up from behind.

Epic

GE Healthcare

Philips Healthcare

LUMEDX

Siemens

Merge (IBM)

McKesson

Fuji

Agfa

Walters Kluwer

Digisonics

INFINITT

Vendors covered in this chart include GE Healthcare, LUMEDX, Epic, Philips Healthcare, Siemens, Merge (IBM), McKesson, Fuji, Agfa, Walters Kluwer, Digisonics, and INFINITT

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DAMAGE CONTROL CONT.

21%

17% 17%

15%

11%

7%

4%3%

Make it much easier

to use

Customer service

Reporting capabilities

More robust platform

Reduce the cost

Nothing, we're being forced to

switch

Integration Other

How to Save “At Risk” Installations

This data supports the notion that cardiologists have more influence on whether the CV department keeps its CVIS or not; the majority of this group suggest lack of usability as the main reason for going back out to the market. This point, plus the fact that very few participants mentioned they were being forced to adopt CVIS from an enterprise

firm, should give all best-of-breed players real hope to not only retain a much greater percentage of customers, but also to succeed when going head-to-head with an enterprise vendor for net new business. The key is to build better, easier-to-use products and to do a much better job servicing customers.

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DAMAGE CONTROL CONT.

10%

40%

20%

33%

11%

9%

33%

30%

20%

7%

33%

9%

33%

25%

20%

27%

22%

27%

33%

15%

10%

13%

11%

22%

18%

15%

10%

7%

11%

22%

5%

11%

7%

11%

18%

11%

GE Healthcare

Philips Healthcare

McKesson

Merge (IBM)

Siemens

Epic

LUMEDX

How to Save “At Risk” Installations by Vendor

Breaking down the “How to Save ‘At Risk’ Installs” graph, we find the most prominent solutions in this space each have specific areas in which improvement is critical to retaining customers. But how many of these vendors are zeroing in on these pain points? You just have to ask nicely and say please. (Ok, well, there’s a little more to it than that, but that’s a discussion for another day.)

Customer service

Reporting capabilities

Make it much easier to use

More robust platform

Reduce the cost

Integration

Nothing, we’re being forced to switch

Other

Vendors covered in this chart include Siemens, GE Healthcare, Merge (IBM), Philips Healthcare, LUMEDX, Epic, and McKesson.

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DAMAGE CONTROL CONT.How to Save “At Risk” Installations by Title



Chief of Cardiology

Cardiologist

Imaging Director

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DAMAGE CONTROL CONT.How to Save “At Risk” Installations

by Bed Count

1-25 beds

26-100 beds

101-250 beds

251-500 beds

501-1000 beds

1001+ beds

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CONCLUSION Well, its plain that most CVIS suppliers have their work cut out for themselves if any want to decisively break away from the pack. Frankly, many have their work cut out if they simply want to survive. As of right now, Epic is making the most headway in winning replacement business, which is the biggest indicator of what’s important to providers now. With the continued discussion about all things “enterprise” in health IT, standalone vendors either need (1) strong partnerships, (2) distinguishable benefits (think unique selling proposition), or (3) a legitimate and swift exit strategy. For those finding themselves without any one of these, the outlook is not positive.

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APPENDIX A

AgfaDigisonicsEvidentFujiINFINITTVerity

Additional vendors covered in this report:

trends in cardiovascular information systems 1 · 5.7 5.4 5.3 4.6 4.0 cardiologist cardiovascular...

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