Research and Report by Healthcare IT Trends in the UK Who's Winning & Losing 1
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Premium Content Not Included In this Report EPR Net Promoter Scores Identified by Supplier EPR suppliers most considered or new and replacement business EPR supplier most at risk of being replaced PAS Net Promoter Scores identified by supplier PAS suppliers most considered for replacement business PAS suppliers most at risk of being replaced HIT suppliers mentioned as making the biggest impact 3
Table of Contents Executive Summary... Demographics... Top Issues... EPR Use... EPR Installs Among Participants... EPR Net Promoter Scores... EPR Replacement Market... PAS Installs Among Participants... PAS Net Promoter Scores... PAS Replacement Market... Vanguard Sites... Conclusion... 6 7 9 16 18 20 27 28 30 35 36 42 4
Vendors Covered in this Report 5
Executive Summary As we revisited the topic of clinical IT from a year ago, a simple question keeps resurfacing: are electronic patient records (EPR) having a meaningful impact in healthcare? And if so, does this positive impact outweigh the expense and added complexity to providers efforts of delivering care? If we boil down the NHS Five Year Forward View plan, it s not a stretch to suggest it has two primary goals in establishing new models of care: 1) improve patient care and 2) reduce costs. Few would argue that in order to transform healthcare, patient information had to go digital. But what s done is done Did we focus so much on the push for EPRs that there is a feeling of mission accomplished with the fairly high adoption rates? It doesn t feel like a stretch to compare the advent of EPRs to a home team merely moving the ball across the halfway line and hearing the crowd chant GOAL! while the players put on a premature and excessive celebration. Clearly EPRs have laid the groundwork for a revolution of healthcare. Yet there is still a long road ahead (half the field and across the goal line, if you will) before the general population will look back and say, I can t believe the practice of medicine was so limited back then. So, now what? In walks analytics. Yes, basic analytics in healthcare have been around for a while, incubating, marinating, or going through any other iteration of growing up as a technology. Until EPRs and analytics solutions are sufficiently mature and integrated effectively, we are all going to continue to wait for better care outcomes for both individuals and populations. We digress In our latest research on the EPR market, we take a close look at the following: Top issues facing NHS trust leaders (Hint: Brexit s crashing the party) Net Promoter Score ratings for EPR suppliers EPR replacement rates and suppliers poised to win or lose as a result Net Promoter Score ratings for patient administration system (PAS) suppliers PAS replacement rates and suppliers poised to win or lose as a result Perceptions of which HIT suppliers making having the greatest impact Prominent EPR and PAS suppliers among Vanguard sites Data from this year (2016) trended against 2015 research, where appropriate Breakout data by participants titles, organisation sizes, and NHS regions For healthcare suppliers and trust leaders, this data gives a current lay of the land of clinical IT. Some of the findings confirm commonly held beliefs and other data points highlight progression on the supplier side that may not yet be obvious to stakeholders. 6
Demographics A big thanks to the 110 participants from 72 trusts across all NHS regions. As you can see, they are a diverse group, from various leadership categories and organisation sizes, which gives this study a rich perspective of the state of UK healthcare. Participants by Title 12% 24% Chief Executives 17% Operations Leadership Finance Leadership 7% IT Leadership Other* 4 *Other: Professors, Associate Director of Pharmacy, Fellow, Medicine Information, Cardiology Consultant, and Antimicrobial Pharmacist 7
Demographics Cont. Participants by Organisation Size 37% 25% 17% 1 8% 2% 1-100 Beds 101-250 Beds 251-500 Beds 501-1000 Beds 1000+ Beds GP organisation **Note: Given that some trusts operate in more than one region, we have selected the primary region of the trust. As a result of these occurrences, some specific data points have been omitted regarding suppliers presence by region. Participants by NHS Region 34% 2 21% 18% 4% 3% Midlands and East London North South Northern Ireland Wales 8
Top Issues When asked what issues need to be addressed within the organisation, we see the shortage of physicians and nurses as the top concern of trust leadership by an unprecedented margin of 23%. What s more interesting is this concern takes priority across all regions (see further down). In our Aug. 2016 report on the perceived impact of Brexit on the NHS, which you can download here, we found out that provider leadership believe the UK s exit from the EU will significantly add to staffing pressures and rightly so. As one participant of that study aptly stated: We depend heavily on migrants - from Europe and further afield. We do not pay our nurses, AHPs and doctors enough. They want to emigrate, and we are importing cheaper (and often less well adapted or trained) replacements. Brexit will worsen the situation. This fear is further manifested in the data from this study. How the NHS attracts more individuals into these roles, once the transition occurs, will determine the long term stability of the health system. The bottom of this list includes improvements to information security. In light of the continued news coverage regarding the value of patient information and the increased assault by identity thieves, hackers, and others with malicious intent, we find it interesting that improved security is not more of a priority. It appears either NHS leaders feel their security solutions and strategies are sound or they don t feel the threat applies to them. One thing is certain: all it takes is one major breach to snap everyone s attention back to this issue. 9
Top Issues Cont. Top Issues Organisations Need to Address 71% 48% 47% 43% 4 4 39% 29% 21% Shortages of physicians and nurses Improving Coordinating Financial care Management Managing patient populations Managing and analysing data (patient, clinical, financial, etc) Creating an accountable care organisation Patient engagement Getting a meaningful return on investment on major healthcare IT purchases Improving healthcare information security 10
Top Issues Cont. Brexit s Perceived Impact on Staffing (Aug. 2016) 4% 2 Positive Neutral Negative 76% 11
Top Issues Cont. The priority of caregiver shortages has not budged from last year showing the continued pressure facing the NHS in filling these most critical of roles. This year, however, the lower priority items appear to be increasing in priority from last year, including the push for accountable care models, improvements to patient engagement with the largest increase of 17%, getting meaningful returns on IT purchases, and improvements to information security. We re not surprised to see these topics moving closer to the forefront as steam picks up for alternative care models. Top Issues Organisations Need to Address (Year Over Year) 71% 71% 54% 48% 47% 44% 43% 39% 4 4 39% 38% 3 29% 23% 2 21% 13% Shortages of physicians and nurses Improving Financial Management Coordinating care Managing patient populations Managing and analysing data (patient, clinical, financial, etc) Creating an accountable care organisation Patient engagement Getting a meaningful return on investment on major healthcare IT purchases Improving healthcare information security 2016 2015 12
Top Issues Cont. If we set aside the undisputed top issue (physician and nurse shortages), what are the other hot buttons for each leadership group among participants? Chief executives views place a high priority on improving financial management (not surprising given their role) followed closely by care coordination. Operations leadership tend to side with chief executives. Next, finance leadership obviously has improving financial management as a top priority, but it is interesting to see creating accountable care organisations as their second biggest issue that needs to be addressed. With so many unknowns still surrounding the creation of accountable care models that improve outcomes while juggling the moving target of costs, it appears finance leaders within the NHS are looking at the long game and truly want to get out ahead of this complicated topic. Lastly, IT leaders place equal importance on both coordinating care and addressing caregiver shortages. At the end of the day, many of the top concerns among NHS leaders are interconnected, leaving NHS leaders to assess which areas they feel have the greatest impact on patient care and reducing costs. Top Issues Your Organisation Needs to Address (by Title) 15% 14% 13% 9% 4% 8% 1 1 1 9% 7% 8% 16% 12% 11% 1 5% 8% 12% 11% 13% 11% 5% 11% 1 9% 13% 13% 13% 5% 17% 17% 18% 21% 17% Chief Executives Operations Leadership Finance Leadership IT leadership Improving Financial Management Improving healthcare information security Creating an accountable organisation Getting a meaningful return on investment on major healthcare IT purchases Managing patient populations Managing and analysing data (patient, clinical, financial, etc.) Coordinating Care Shortages of physicians and nurses Patient Engagement 13
Top Issues Cont. It appears smaller trusts are feeling the biggest pinch from caregiver shortages. Top Issues Your Organisation Needs to Address (by Organisation Size) 11% 1 13% 12% 4% 5% 16% 11% 15% 1 1 11% 1 7% 1 7% 11% 1 1 14% 16% 12% 9% 5% 1 12% 1 5% 1 15% 13% 26% 15% 17% 21% 101-250 251-500 501-1000 1001+ Improving Financial Management Improving healthcare information security Creating an accountable organisation Getting a meaningful return on investment on major healthcare IT purchases Managing patient populations Managing and analysing data (patient, clinical, financial, etc.) Coordinating Care Shortages of physicians and nurses Patient Engagement 14
Top Issues Cont. The south region seems to have different fish to fry than other NHS regions, registering a zero on improving financial management. Is this a result of financial genius in this region or a different approach to managing precious financial resources? One could argue without difficulty that managing populations and coordinating care are the most effective ways to manage costs (and thus finances by extension). It certainly takes a more deliberate and concerted effort to make this a reality and frankly there is still a long road ahead in reaching efficiency in these two areas but unless those efforts are made now, the dividends won t follow anytime soon. Top Issues Your Organisation Needs to Address (by NHS Region) 16% 13% 13% 6% 9% 13% 7% 9% 6% 4% 1 4% 11% 1 1 14% 1 12% 7% 12% 1 7% 1 17% 21% 18% 19% 5% 8% 8% 1 8% 13% 23% 25% North Midlands and East London South Improving Financial Management Improving healthcare information security Creating an accountable organisation Getting a meaningful return on investment on major healthcare IT purchases Patient Engagement Managing patient populations Managing and analysing data (patient, clinical, financial, etc.) Coordinating Care Shortages of physicians and nurses 15
EPR Use The EPR market still has some moderate growth opportunities with nearly one-third of organisations stubbornly holding out (at least in the near term). Watch for new data to be published at a later date analysing why these trusts have avoided what has become the norm in healthcare. Do you have and EPR Solution? 29% Yes No - Not currently 71% 16
EPR Use Cont. From 2015 to 2016 we see adoption rates have not changed outside a reasonable margin of error. This reinforces the data that a large number of trusts have no intentions of even sitting on the fence let alone hopping over to the other side. What could incentivise these holdouts? Major improvements to current solutions? Clearer benefits for patients and trusts? Better solutions that make meaningful use of EPR data to better manage populations? Look for new research in coming months that will dig to the bottom of why adoption has stagnated and what needs to happen to move the needle. EPR Adoption (Year Over Year) 71.4% 70.6% 28.6% 29.4% Yes No - Not currently 2016 2015 17
EPR Use Cont. EPR Installs Among Participants We share this information not to infer market share among EPR suppliers, but to show the demographic makeup of participants. EPR Installs Among Participants 11% 1 7% 7% 5% 4% 4% 2% 2% 2% 2% 18
EPR Use Cont. EPR Installs (by Organisation Size) Cerner 11% 2 24% Allscripts 24% 4 Servelec 27% CSC 5% 33% 101-250 beds InterSystems EMIS 7% 1 5% 251-500 beds 500-1000 beds 1000+ beds TPP Homegrown 11% Advanced 7% System C 1 Epic 5% 11% 19
EPR Net Promoter Scores The suppliers outlined in this report are rated based on the Net Promoter Score (NPS) methodology, which measures customer satisfaction by asking one simple question: How likely are you to recommend your supplier to a peer or colleague? and yields results that major academic research suggests is the most accurate measure of overall satisfaction. Participants are given a scale of 0-10 to define their overall willingness to refer a supplier to a colleague. Those who choose between 0-6 are tagged as detractors. 7-8 respondents are passives and those who select a 9-10 are the company s promoters. A Net Promoter Score is displayed as a single number, ranging from 100 (a perfect score) to -100 (say goodbye to the business), by subtracting the percent of detractors (those most likely to speak out negatively about the business) from the percent of promoters (those who sing praises). Passives are tossed out of the equation as they contribute no detriment or benefit to the overall equation. This simple formula looks like this: % Promoters - % Detractors = Net Promoter Score (NPS) Scores of 30 and above are considered good to great. Score ranging from 0-29 should be a cause for alarm. Negative scores are often a sign of a sinking ship -- and we all know what happens to captains in those cases. The exception to this is when all suppliers in a space have scores that range from anemic to worse as displayed below. In the defense of EPR suppliers, it is easier said than done to create order and simplicity in this incredibly complicated environment. The fact is, if you have a flat NPS score in the EPR market things could be worse. However, the two suppliers with positive scores should chalk this up as a big win for their perception in the market. Note: Since NPS and customer satisfaction data can be a very sensitive issue, we have deidentified supplier names from their respective scores. Participants of this study, NHS officials and employees of trusts, and peer60 clients can email us directly to discuss scores associated with specific suppliers by emailing Chris Jensen at chris@peer60.com. 20
EPR Net Promoter Scores Cont. EPR Supplier Net Promoter Scores 50 20 0 0 0-33 -44-50 -67-100 -100 Suppliers in this graph include (not in respective order): Advanced, Allscripts, Cerner, CSC, EMIS, Epic, InterSystems, Servelec, System C, Homegrown 21
EPR Net Promoter Scores Cont. EPR Net Promoter Score Breakout 4 5 5 6 We see a very mixed bag of promoters, passives, and detractors for most EPR suppliers covered in this report. 33% 33% 33% 14% 14% 71% 10 Promoters 33% 67% Passives Detractors 11% 33% 56% 5 5 33% 67% 10 10 Suppliers in this graph include (not in respective order): Advanced, Allscripts, Cerner, CSC, EMIS, Epic, InterSystems, Servelec, System C, Homegrown 22
EPR Net Promoter Scores Cont. Year over year (2015 to 2016) we see some common themes more suppliers who were in the negative last year have made progress over the past twelve months in the eyes of their customers. Only one supplier is in positive territory both years. While we generally avoid displaying NPS scores publicly, we can let one cat out of the bag the homegrown EPR solution scored a -100 last year and zero this year, giving it the widest swing. The only limitation to this data is the fact that it does not have widespread adoption outside its primary trust, and is therefore limited in the number of participants who can rate satisfaction. We ll reiterate that once other trusts begin to catch wind that there are a handful of suppliers that are rated significantly higher than their competitors, we wouldn t be surprised in the slightest to see a market share shift begin to occur. EPR Net Promoter Scores (Year Over Year) 100 50 20 33 0 0 0 0 0-33 -33-44 -50-50 -50-80 -67-100 -100-100 -100-100 Suppliers in this graph include (not in respective order): Advanced, Allscripts, Cerner, CSC, EMIS, Epic, InterSystems, Servelec, System C, Homegrown 2016 NPS 2015 NPS 23
EPR Net Promoter Scores Cont. EPR Net Promoter Scores (by Title) 50 Chief Executives -6 Operations Leadership Finance Leadership IT Leadership -11 Other -70-67 Suppliers in this graph include (not in respective order): Advanced, Allscripts, Cerner, CSC, EMIS, Epic, InterSystems, Servelec, System C, Homegrown 24
EPR Net Promoter Scores Cont. While no region is happy with its EPR suppliers as a whole, trusts in Wales are consistently the most displeased with their EPR suppliers as evidenced by the lowest score possible of -100. EPR Net Promoter Scores (by NHS Region) North Midlands and East London South Wales Northern Ireland -38-29 -36-54 -50-100 Suppliers in this graph include (not in respective order): Advanced, Allscripts, Cerner, CSC, EMIS, Epic, InterSystems, Servelec, System C, Homegrown 25
EPR Net Promoter Scores Cont. We see an interesting trend with NPS data by organisation size; The smaller the organisation, the more unhappy it is with its EPR supplier. EPR Net Promoter Scores (by Organisation Size) 1-100 beds 101-250 251-500 501-1000 1001+ GP organisation -32-29 -50-44 -50-100 Suppliers in this graph include (not in respective order): Advanced, Allscripts, Cerner, CSC, EMIS, Epic, InterSystems, Servelec, System C, Homegrown 26
EPR Replacement Market We re seeing a little cooling of the EPR replacement market from last year with an approximate shift of 1 in replacement intentions. EPR Replacement Market (Year Over Year) 86% 76% 14% 24% Yes No 2016 2015 EPR Replacement Market (by Organisation Size) 10 75% 8 9 7 10 25% 2 1 3 1-100 beds 101-250 251-500 501-1000 1000+ GP organisation No Yes 27
PAS Installs Among Participants Here is the PAS supplier lay of the land among our participants. PAS Installs Among Partcipants 21% 15% 11% 8% 5% 5% 5% 3% 3% 3% 3% 28
PAS Installs Cont. PAS Installs (by Organisation Size) CSC 8% 28% 38% Cerner 13% 25% 28% InterSystems 17% 11% 13% Sema Helix 8% 6% 1-100 Beds EMIS 6% 10 101-250 Beds 251-500 Beds System C 11% 501-1000 Beds 1000 + Beds IMS Maxims 8% Allscripts 6% 33% Epic 6% 13% 29
PAS Net Promoter Scores If we thought the EPR scores were unsightly, the PAS scores are an outright eyesore among the worst we ve seen in any health IT segment anywhere (not just in the UK, but in the Western Hemisphere). Despite this, there are two suppliers worth the attention of NHS trusts. A score of 50 is unprecedented in this market and a flat score is respectable in light of all other scores. To reiterate, -100 is the lowest possible NPS score and four of our covered suppliers received it. *For an explanation of the Net Promoter Score methodology, see page 20. Note: Since NPS and customer satisfaction data can be a very sensitive issue, we have de-identified supplier names from their respective scores. Participants of this study, NHS officials and employees of trusts, and peer60 clients can email us directly to discuss scores associated with specific suppliers by emailing Chris Jensen at chris@peer60.com. 50 PAS Supplier Net Promoter Scores 0-50 -67-67 -75-100 -100-100 -100 Suppliers in this graph include (not in respective order): Allscripts, EMIS, Epic, Cerner, CSC, IMS Maxims, InterSystems, Sema Helix, System C and TPP. 30
PAS Net Promoter Scores Cont. Suppliers in this graph include (in no respective order): Allscripts, Cerner, CSC, EMIS, Epic, IMS Maxims, InterSystems, Sema Helix, System C and TPP. Looking at the this data year-over-year, we see confirmation of providers general displeasure with their PAS suppliers. PAS Net Promoter Scores (Year Over Year) 50 0 0 0-50 No 2015 Data No 2015 Data -50-67 -67-67 -75-81 -100-100 -100-100 -100-100 -100 Suppliers in this graph include (not in respective order): Allscripts, EMIS, Epic, Cerner, CSC, IMS Maxims, InterSystems, Sema Helix, System C and TPP. 2016 NPS 2015 NPS 31
PAS Net Promoter Scores Cont. PAS Net Promoter Scores (by Promoters and Detractors) 5 5 5 5 10 In a sea of detractors, one thing is clear: There is pent-up demand for improvements to current PAS solutions (and there haven t been any in the recent history of this technology). However, as word continues to get out about the couple of suppliers that have more favorable perceptions among their customers, we expect to see a shift in the PAS market. 11% 11% 78% Promoters 33% 67% Passives 25% 75% Detractors 10 10 10 10 Suppliers in this graph include (not in respective order): Allscripts, EMIS, Epic, Cerner, CSC, IMS Maxims, InterSystems, Sema Helix, System C and TPP. 32
PAS Net Promoter Scores Cont. IT leaders are the most tolerant of their PAS suppliers. While further research would be needed to determine why, perhaps suppliers have focused more on integration than usability. Average PAS Net Promoter Scores (by Title) Chief Executives Operations Leadership Finance Leadership IT Leadership Other -26-32 -43-40 The next two breakouts by region and organisation size show the consistent unhappiness providers have with the bulk of PAS suppliers. Wales is the most dissatisfied, which seems to be consistent with IT suppliers in other healthcare segments in this region (such as EPR). Average PAS Net Promoter Scores (by NHS Region) -50 North Midlands and East London South Wales Northern Ireland -32-35 -33-33 -43-50 Suppliers in this graph include (not in respective order): Advanced, EMIS, Epic, Cerner, CSC, IMS Maxims, InterSystems, Sema Helix, System C and TPP. 33
PAS Net Promoter Scores Cont. While the trend of smaller organisations being more unhappy with their PAS suppliers than their larger counterparts is less pronounced than a similar breakout for EPR, the data still supports the idea that either smaller organisations are harder to please or the more prominent suppliers among smaller trusts are not meeting the needs of their customers as well as their competitors. Average PAS Net Promoter Scores (by Organisation Size) 1-100 beds 101-250 251-500 501-1000 1001+ GP organisation -17-31 -43-42 -41-50 Suppliers in this graph include (not in respective order): Advanced, EMIS, Epic, Cerner, CSC, IMS Maxims, InterSystems, Sema Helix, System C and TPP. 34
PAS Replacement Market With so much discontent among customers, it s interesting to find that the PAS replacement market is somewhat stagnant. This would seem to support the possibility that trusts believe the whole basket is full of bad apples and that it s just easier to make due with what they already have than to go through the hassle of a lateral move. The good news is it appears there are a couple of suppliers doing right by their customers and we re waiting eagerly to see how long it takes for word to spread. PAS Replacement (by Organisation Size) 10 75% 8 9 8 10 25% 2 1 2 1-100 beds 101-250 251-500 501-1000 1000+ GP organisation No Yes 35
Vanguard Sites The purpose of the NHS in evaluating and approving trusts as Vanguard sites is to achieve the goal of developing new care models as part of the Five Year Forward View. One of the nine areas the NHS will be aiding these trusts in is harnessing technology. Specifically mentioned in this supporting point is the need to find more effective ways of using digital technology. Following this progression, EPR and PAS suppliers have both an increased opportunity and a shortened leash to walk in lockstep with the NHS to improve their technology and the support and training offered to maximise the intended benefits. We were curious to see if there were trends within the Vanguard Sites in terms of preferred suppliers, which will be displayed in the following pages of this report. Has your organisation been selected as a Vanguard site? 8% 19% No Yes Not yet 73% 36
Vanguard Sites Cont. Vanguard Selection (Year Over Year) 73% 73% 19% 2 8% 7% No Yes Not yet 2016 2015 37
Vanguard Sites Cont. Vanguard Selection (by Organisation Size) 14% 1 15% 11% 25% 5 10 86% 75% 89% 75% 5 1-100 beds 101-250 251-500 501-1000 1000+ GP organisation Not yet Yes No 38
Vanguard Sites Cont. Vanguard Selection (by NHS Region) 13% 4% 13% 25% 15% 33% 25% 83% 85% 10 10 53% 5 North Midlands and East London South Wales Northern Ireland Not yet Yes No 39
Vanguard Sites Cont. There are four primary suppliers that account for EPR installs among all Vangard sites in this report. Epic s numbers are misleading considering the limited presence in the UK market. Most notable is the high percent of Allscripts customers that are Vanguard sites. Is this supplier better suited to supporting care organisations that are pushing the quality of care boundaries than their competitors or is it just a coincidence? Vanguard Selection (by EPR Supplier) 13% 17% 25% 33% 5 5 88% 75% 10 67% 10 10 10 10 10 5 33% Not yet Yes No 40
Vanguard Sites Cont. While interesting data, Allscripts, IMS Maxims and Epic did not have as many PAS installs among participants as CSC and InterSystems who also showed up among Vanguard sites. However, considering Allscripts shows up prominently among Vanguard sites in both EPR and PAS it s worth mentioning. Intersystems also has a relatively strong showing among Vanguard sites for both EPR and PAS. Vanguard Selection (by PAS Supplier) 1 12.5% 1 2 5 5 8 87.5% 8 10 10 10 10 10 5 5 Not yet Yes No 41
Conclusion It s clear that the Health IT markets for EPR and PAS have an interesting and uncommon correlation. The primary suppliers in these spaces have some of the lowest (we re talking basement level) Net Promoter Scores we ve seen and yet these markets are experiencing low turnover rates even in light of the tender process slowing down trust decisions. This seems to suggest a level of acceptance on the part of NHS and trust leadership that there are no good alternatives to current solutions. Given the bulk of data, these trends seem to be justified. Why go through the hassle and expense of making a lateral move? However, there are a couple of suppliers that are viewed significantly more favorably than the rest of the competition and it s only a matter of time before word spreads. When asked which health IT suppliers are making an impact in healthcare, very few were highlighted and none were mentioned more than once. In fact, more participants went out of their way to state that no suppliers are having a positive impact which is troubling considering the amount of money that is committed each year to support these solutions. As if dissatisfaction with current IT solutions isn t enough, add the pressure NHS trusts are facing with current staffing shortages that are strongly believed will only get worse in the face of Brexit (making it more difficult to continue attracting caregivers from other countries). Again, see our report on that topic here. NHS leadership is undoubtedly working on how to address this looming problem. All in all, we don t envy the NHS. Adding pressures to an already difficult, widely publicised job is not a challenge to be tackled by average people. 42