3. 2017 other md vendors 5 5 b

1. 2017 Physician Practice “Other” Vendors
• Recap of physician practice market:
- Top 10 vs. the next 40, vs. the rest
- Details of the next 10 vendors:
• Founding, M&As and HQ
• Product lines & targets
• Annual revenue & # of FTEs
• How to select a system from so many
vendors & products?
- Not through 632 RFPs!
(“Request For Prevarication”)
- But through your own users’ scores
(phone calls, site visits, etc.)
© 2017 HIS Professionals, LLC
Vince Ciotti
&
Elise Ames
HIS Professionals, L.L.C.

2. © 2017 HIS Professionals, LLC
Remaining 622 Physician Practice Vendors
• In this episode we recap the 622 “other” vendors with under 5K
attestations each; here’s a visual comparison of how these three
slices of vendors share the total of 366,765 ONC attestations:

3. © 2017 HIS Professionals, LLC
The Next 40 Vendors
• Following the “Top 10” we
reviewed last week are these
“Next 40” physician vendors,
• With 20% of the 366,765 total
EHR attestations reported.
• Some notable developments:
– eMDs - who just bought
McKesson’s MD products, so
will enter the top 10 next year
– Sunquest – a leading LIS
vendor, with 2K+ clients
attesting with them as a
“modular” EMR
– Meditech – who Release 6
integrated Ambulatory EMR
should increase their share
rapidly next year

4. © 2017 HIS Professionals, LLC
Review of Vendors 11 to 20
• Behind the “Top 10” are these
“Next 10” physician vendors,
• Which according to the ONC’s
data set comprise just over 8% of
2016’s EMR attestations.
• Characteristics of these firms:
– All are privately held
– They target small to medium size
independent practices
– Many target specific specialties,
for example: Ophthalmologists,
Chiropractors, & Radiologists.
– Their estimated annual revenue
is between $10M and $100M
– All have less than 300 employees
Note: These companies are all private or
subsidiaries of larger companies, so where
possible we estimated their revenue and number
of employees based on data from a variety of
sources. We only included commercially
available EHRs that have been certified as
“complete”, removing those that are self-
developed or have modular certification.

5. © 2017 HIS Professionals, LLC
Next 10 Vendor Company Snapshots
11. Eyefinity/Office Mate - Based in Rancho
Cordova, CA, Eyefinity was founded in 2000. In
2008, they merged with Office Mate who offered a
PM solution for eye care offices. In addition to
software, Eyefinity offers services such as RCM,
supply ordering, and other business solutions.
Eyefinity/Office Mate, Inc. operates as a subsidiary
of Vision Service Plan.
12. MEDENT (Community Computer Service, Inc.)
– Founded in 1968 and headquartered in Auburn
NY, the company claims that 7,000+ providers use
their system. According to their web site,
MEDENT’s ”All in One” PM/EHR is sold to
practices mainly in the Northeast corridor of the
US. Annual revenue is ≈$40M, from 185 FTEs.

6. © 2017 HIS Professionals, LLC
Next 10 Vendor Company Snapshots
13. Integrated Practice Solutions (dba ChiroTouch) –
Established in 1999 and headquartered in San Diego,
CA, Integrated Practice Solutions, Inc. offers
“ChiroTouch EHR” practice management and
SmartCloud Chiropractic EHR software. IPS has
annual revenue of ≈$13.6M with 198 employees.
14. eMDs – Founded in1996 by David Winn, MD, and
based in Austin TX, eMDs targets its “Solutions
Series” EHR/PM towards specialty practices. In 2015
eMDs was acquired by Marlin Equity, and merged
with RCM firm MDeverywhere. In 2016, eMDs
acquired Medisoft, Lytec, Practice Partner, and
Practice Choice from McKesson. eMDs claims 55K
providers are now using its software, including the
McKesson systems. Before the acquisition, revenue
was ≈$20M with ≈220 FTEs.

7. © 2017 HIS Professionals, LLC
Next 10 Vendor Company Snapshots
15. Compulink Business Systems, Inc. -
Founded in1985 and based in Westlake Village
CA, Compulink sells the “Advantage” PM/HER
used in ≈6K practices. Advantage targets
specialties like ophthalmology, dermatology,
ENT, and mental health. Annual revenue is
about $15M, and Compulink has 75+
employees.
16. SRS Health (formerly SRSsoft, changed to
SRS Health in Jan 2017) is also targeted to
specialty practices. SRS was founded in 1997
and is based in Montvale, NJ. The company has
annual revenue of approximately $36M, and
has 208 employees.

8. © 2017 HIS Professionals, LLC
Next 10 Vendor Company Snapshots
17. Modernizing Medicine – Founded in 2010 and
based in Boca Raton, FL, Modernizing Medicine
sells its “EMA” PM/EHR to specialty practices
including: dermatology, ophthalmology,
orthopedic surgery, gastroenterology, ENT,
neurology and rheumatology. Annual revenue is
≈$46M from 280 employees.
18. Amazing Charts, LLC - Founded in 2001 by
Jonathan Bertman, MD, the company is
headquartered in North Kingstown, RI and
provides both EHR/PM systems and billing
services. Amazing Charts was purchased by
medical education vendor Pri-Med in 2012 and
operates as an independent subsidiary. Its 120
employees generate ≈$35M in revenue.

9. © 2017 HIS Professionals, LLC
Next 10 Vendor Company Snapshots
19. DR Systems – Headquartered in San Diego,
DR Systems was founded as an imaging solutions
company in 1992, and was acquired by Merge in
2015. DR Systems’ “eHR for Meaningful Use” is
targeted for anesthesiologists, radiologists and other
specialist Eligible Providers to help them qualify for
the EHR Incentive Program.
20. Aprima Medical Software Located in
Richardson TX, Aprima (formerly iMedica) was
founded in 1998. Aprima sells PM/EHR software for
both primary care and specialties, and also offers
services such as RCM and credentialing for
physician practices. Aprima is growing rapidly - we
estimate their annual revenue at $100M+, generated
by ≈250 employees.

10. © 2017 HIS Professionals, LLC
Sifting Through the Pile
• If your practice is buying a new PM/EMR system, how can you go
about evaluating this enormous number of vendors & products?
• First, here are two selection techniques not to overly rely on:
1. “Feature checklists” – issued in an RFP (Request For
Prevarication) that lists thousands of features desired.
Why not trust RFP responses? Because they are answered by
vendor sales mavens, not programmers, whose job is to say
“yes” to as many features as possible through answers like:
• “Coming in release 7.A-3” (some day…)
• “Needs further discussion” (over lunch or dinner?)
• “Set-up via Work Flow Engine” (by whom, for how much?)
• “Handled through screen painter or report writer” (really?)
After all, how would you answer a questionnaire about your
practice’s capabilities – wouldn’t you tend to interpret every
question in a way that let’s you say “yes” the most often?

11. © 2017 HIS Professionals, LLC
Sifting Through the Pile, cont’d
The second thing not to overly rely on when evaluating vendors is:
2. Demos – The most popular way practices evaluate systems and
vendors sell them, but there are several crucial issues:
• The person giving the demo can be more important than the
system: veteran vs. rookie, pleasant vs. nerd, funny vs. dull,
physically attractive vs. not quite, young vs old, etc.
• Screen images don’t reveal much about system navigation:
number of clicks, multiple keys (shift/command), consistency
• Releases – are you seeing the actual version you will buy, or
some radically new release that is still in development?
• Fees – is every screen included in the base version, or are
they extra-cost apps or modules you have to pay more for?
Demos can be very helpful in educating users in modern systems
if you’re on a legacy one, but they tell you very little about crucial
issues like ongoing service levels, implementation, etc…

12. © 2017 HIS Professionals, LLC
System Selection Techniques
The following steps take far more time than just watching demos, but
they give you a far better idea of a vendor/system’s capabilities:
• Phone reference calls - by the end users in your selection
committee (registrars, billers, MDs, RNs…) to counterparts in:
- Your state (for regulatory compliance, HIE/RHIOs, etc.)
- Your practice size (# of MDs) and specialty
- Your product/release being proposed – not an older version
- Converting from your system for the archival EMR & AR.
Request such a diverse user list from vendors in an early RFI.
It is important not to call just the contact person the vendor
provides (CFO or IT Director), but have each user call the
switchboard and ask for their counterparts so they can talk shop
about what the system is like in the real world, including gaps &
issues. Yes, it takes time, but you get to learn the truth about
service and support, initial implementation, bug-fixes, etc.

13. © 2017 HIS Professionals, LLC
System Selection Techniques, cont’d
Other techniques that help work around vendor sales & marketing tactics:
• User Manuals – easily available on-line today, they tell you a lot more
than a “yes” answer in an RFP feature checklist:
- How hard to search for a given item/topic?
- Are they written in simple English or “Geek?”
- Lots of illustrations (flows, screens, reports)?
- Features “not available” when searched for?
And these manuals are how vendors define their products in contracts!
• Site Visits – when you’re down to 2-3 finalist vendors,
have a small team of key users (IT, nursing, physicians,
BO, Access, HIM, etc.) physically travel to a client
practice and meet with their peers. NO CHAPERONES
from the vendor, but just private, 1-hour, person-to-
person meetings where end users hear what it’s like
using the system in real life – both the good and the bad.

14. © 2017 HIS Professionals, LLC
System Selection Techniques, cont’d
Two other techniques that can greatly help you pick the right vendor:
• Implementation Team – insist on meeting the folks you will be working
with after signing the contract and the sales reps depart:
- How many will be on-site, versus remote?
- For how many days will they be present?
- How experienced are they with this release?
- What do they actually do versus your users?
Most practices never meet them in advance, yet implementation
fees can equal or exceed vendors’ software license fees!
• MD Fair – since the owners and most critical users of
practices are the medical staff, when you’re down to 2
finalist vendors have them set up PCs in adjacent rooms
and invite your entire medical staff to come in for a 5-10
minute for a one-on-one, hands-on use of CPOE & the
EMR. Not screen shots, but hands-on the actual device
to see how hard or easy the system is to use.

15. © 2017 HIS Professionals, LLC
Document the Results
• Checklists – best to
score the results of
each of these steps
in checklists scored
numerically so you
can create a
summary of the
results like the table
on the right:
• Vote - key to get a
final vote from your
selection committee
on their decision,
creating an
invaluable “buy-in” by
users for the
inevitable issues
during the system
implementation...
• Note how no vendor is “Perfect” – they all have
their gaps and weaknesses. The purpose is to
select the “least of the evils” and insure users are
prepared for the challenges of the conversion.

16. © 2017 HIS Professionals, LLC
The End
 There you have it - our overview of physician practice vendors:
- Details on the top 10, and an overview of the rest
- Key info on products, origins, M&As, revenue, & FTEs
- Product positioning by practice sizes & specialties
- Suggestions for sorting through so many alternatives
 Please send any compliments or thanks to:
- Elise Ames
- 413.329.6925
- eames@hispros.com
• And direct any complaints or criticisms to:
- Vince Ciotti
- 505.466.4958
- vciotti@hispros.com