Tag Archives: Allscripts

SPI Digital Health: Epic and the Art of Keeping things Simple

And so, the Epic juggernaut rolls on. This time, by securing a ‘next generation’ EHR contract at Northwell Health, a sizable health system in New York state. Behind the headline confirming Epic’s relentless march across US health systems is an arguably more pertinent narrative: how, when or indeed if other vendors will ever compete. It will take something special, or wholly unexpected, to tilt the power balance. 

The Signify View 

As much as the Northwell Health deal is another feather in Epic’s well-adorned cap, it is another blow for the slew of vendors clinging to its coat tails. 

None more so than Altera Digital Health (formerly part of Allscripts), whose legacy system Epic will replace on the Northwell Health deal. The contract, whose value is undisclosed, will see Epic create a single patient record across ambulatory, emergency, inpatient and post-acute care in 21 hospitals and roughly 900 outpatient facilities across New York state in a phased rollout. Norwell expects the first go-live in 2025.  

Losing out to Epic (and there is no great surprise in that given recent trends) nonetheless represents a setback for Altera in the US. At least it is not alone in this: aside from Epic, only MEDITECH is growing its share in the acute hospital market. Given the yawning gulf between them and Epic, the chasing pack might do well to focus on MEDITECH’s methods.  

Box of Tricks 

The acute/health system hospital market in the US, for both Integrated Delivery Networks (IDNs) and standalone hospitals, is a tough place for most vendors right now given Epic’s continued dominance.  In 2021, Epic gained 72 hospitals and 12,000 beds, a trend that has continued in 2022. Success for other vendors is a rare commodity: Oracle Cerner lost hospitals and thousands of beds in 2021 and 2022, as did Altera and CPSI. Medhost has managed to just about keep its head above water.  

MEDITECH is the only vendor bucking the trend, and is the only vendor offering Epic ‘serious’ competition at present. 

Could peering into MEDITECH’s box of tricks offer hope for other vendors? Possibly. Only four years ago, MEDITECH was also treading water, its revenues flatlining. Around the same time it launched its Expanse EHR solution. That proved well received by its customers, many of whom migrated to the new solution. Expanse has subsequently established an excellent reputation in the market, and steadily gaining market share.  

Unlike Epic, MEDITECH’s sweet spot is smaller health systems and individual hospital. Partnerships are key too: great examples being those with Innovaccer for value-based care (VBC) which we explore in this Insight; and with Google to improve search capabilities within its EHR. Having a strong product and partnerships that import innovation go a long way.  

Altera’s Challenge  

MEDITECH’s relatively simple model and sharp product focus contrasts starkly to that of Allscripts. The latter has two EHR products: Sunrise (for large hospital IDNs) and Paragon (for independent community hospitals), with a roughly 50:50 split in terms of business across the two.  

Allscripts acquired Paragon (as well as two revenue cycle management solutions (Star and HealthQuest), a lab information system and a content management system) in 2017 from McKesson. Allscripts (which then became Altera) then had to devote time (and money) giving Paragon some much-needed TLC. Furthermore, Paragon’s focus on independent hospitals is a challenge – as IDNs snap up smaller facilities, this is an ever-diminishing market, while Sunrise, which is aimed at IDNs and larger hospitals, has struggled to compete. 

Allscripts’ insatiable appetite for acquisitions from several years ago has come back to haunt it, and remains saddled with a disconnected portfolio, and solutions with very different DNA. Very different to Epic, whose principle remains to build its portfolios exclusively in-house rather than acquire. 

Even the mid-2022 sale of Allscripts’ inpatient business to Harris (and subsequent rebranding to Altera Digital Health) has failed materially to address legacy problems with a fragmented portfolio. On paper, Altera has some great solutions. Its TouchWorks ambulatory EHR for larger practices is a case in point, and Sunrise has both inpatient and primary/ambulatory care functionality. Alongside its value-based care offerings built around dbMotion it ticks the boxes in terms of the general building blocks that IDNs are looking for from a network-wide EHR vendor.  But the fragmented portfolio continues to hamper the vendor, especially when bidding for larger IDN contracts. 

There is another strategic complication for Altera. Its owner, Harris Computer Corporation, does not integrate at a business or strategic level the many (good) vendors it acquires. Some of these companies compete with each other, and Harris has an inpatient EHR solution directly up against Altera. Harris owns iMDsoft that has lots of well respected, departmental IT solutions for ICU and anaesthesia, and owns many small, ambulatory EHR vendors, such as Amazing Charts. Harris’ stable may be large, its solutions prized and its global footprint wide, but it is a disparate and disconnected business. And that is a problem when competing with Epic. 

Side-Tracked Cerner 

For different reasons to Altera, Oracle Cerner’s strategic and product woes are well documented. Globally, it has many issues on its plate that suck up considerable money and brainpower. Rarely a week goes by without reference to its painful, long-delayed, much-blighted multi-billion dollar Millennium EHR contract for the US Veteran’s Association. We have also written (see the Insight here) about long-term doubts over the future of its i.s.h.med solution in Europe. And, like Altera, Oracle Cerner’s portfolio is also fragmented, having bought in much of the technology over the years. Unlike Altera, the big hope for Oracle Cerner is that it has Oracle’s financial heft to bring its solutions (Millennium being the obvious example) up to scratch. However, although there are signs that the benefits of the acquisition are kicking in in some areas, the gap with Epic continues to widen. 

Smart Branding  

In plotting a viable path forward, vendors will do well to consider that IDNs increasingly seek those with a strong VBC IT portfolio element. Epic, Oracle Cerner (HealtheIntent) and Allscripts (dbMotion) all score well on that front, but HealtheIntent and dbMotion are positioned as standalone ‘brand’ solutions divorced from the EHR offering. On the other hand, Epic’s VBC product is simply positioned as an extension of epicCare, making it far easier for customers to engage with. 

MEDITECH, which was quite late to the game in terms of VBC solutions, is again well positioned in this respect. Its tie-up with Innovaccer, a best-of-breed VBC vendor, is a prime example of the power of partnerships for MEDITECH. 

When Less is More 

In many respects, Epic’s rampant success is a salutary lesson to other vendors of the power of keeping things simple. Where others have chosen to acquire technology and expertise, Epic’s single-minded philosophy of developing in-house is clearly paying dividends, such that much of its growth is self-perpetuating. This is especially true as health systems gradually consolidate IT procurement through one vendor. That vendor is increasingly Epic. 

This is very attractive to hospitals and IDNs, and those that Signify Research talks to – many of whom have migrated out from the likes of Oracle Cerner – acknowledge that Epic is now the safest (and simplest) pair of hands in the market. 

Signify Premium Insight: Veradigm’s Shift as it Seeks to Capture New RWD Opportunities

In mid-February, healthcare tech and analytics company Veradigm and HealthVerity, a leading real world data (RWD) marketplace, announced they would be teaming up to ‘advance research and improve patient care for cardiovascular disease and diabetes patients’.  

Veradigm says the collaboration will see full interoperability between Veradigm’s Cardiovascular and Metabolic Registries data and de-identified patient data on HealthVerity’s IPGE platform.  

The Signify View 

The tie-up reinforces Veradigm’s strategic focus on RWD and life sciences (the company was the RWD and life sciences arm of EHR vendor Allscripts until the end of 2022, when Allscripts rebranded as Veradigm). It is also Veradigm’s first partnership free of the Allscripts name. 

The company’s journey to RWD began in earnest in March 2022 when Allscripts (of which Veradigm was a small but growing unit at the time) was split in two after struggling for several years to grow revenues and inpatient/health system market share. The bulk of pre-split incarnation of Allscripts’ EHR portfolio – inpatient solutions Sunrise, Paragon and Opal, TouchWorks ambulatory EHR for large practices and its population health management tools – was sold to IT monolith Harris Computer Corporation for $526M. This business now operates under the Harris umbrella as Altera Health, and accounted for $927.6M of Allscripts’ total revenues in 2021). 

The split left Allscripts with two EHR products for small practices: Allscripts Professional, and Practice Fusion (a suite of originally free EHR products that Allscripts acquired in early 2018), as well as Veradigm. Combined, these businesses generated $552.2M in revenue in 2021. Veradigm was established with the aim of using Practice Fusion’s EHR data to provide research tools for payers, providers and life science companies for research, drug discovery, clinical trials and RWD-type applications. On 1 January 2023, the remaining Allscripts business were rebranded as Veradigm. 

Veradigm’s decision to gradually distance itself from pure-play EHR is a positive step. Its RWD business (particularly that to payers/lifescience) is growing faster (15% for payer/lifescience in 1-3Q22). While its provider revenues, largely driven by Allscripts Professional and Practice Fusion EHRs, while still the bulk of the business, are growing at a much slower rate (4% 1-3Q22). 


By selling much of its EHR portfolio to Harris, Veradigm is now free from Allscripts’ shackles and, should it choose, can team up with other EHR vendors who offer greater value (as well as develop partnerships with RWD vendors like HealthVerity). As Veradigm focuses on growing its RWD and life sciences focus for the business. 

Growth Goals  

On the face of it, the collaboration brings together two heavyweights which, in theory, should accelerate Veradigm’s RWD and life sciences business growth. HealthVerity is one of the largest platform RWD marketplaces, offering as a repository of healthcare and consumer data, and through the partnership it will act as a conduit for Veradigm to sell its ‘regulatory quality’ cardiology and metabolic registry data to pharmaceutical firms and other researchers.  

Veradigm’s Cardiology Registry is the largest US outpatient cardiovascular quality improvement registry, with more than 102M records and 13,000 providers. Its Metabolic Registry has 79M records and 11,100 providers. Veradigm’s EHR data of more than 176M patients from the past five years is also incorporated in both registries, as well as data from 300M medical claims made over two years. This ancillary claims and registry data is much more structured and usable than healthcare data (see diagram below). Based on population health data, it is already growing quickly and should continue to do so. 

Beyond the HealthVerity tie-up, Veradigm will also be keen to capitalise on a concept known as ‘data gravity’, a kind of snowball effect where the more data a company has, the more data it attracts (essentially because it is regarded as a good host in which to commercialise it). However, if it wishes to take advantage of this concept, Veradigm will need to partner with, or have access to, larger volumes of clinical data. Clinical RWD (cRWD) comprises just a small percentage of RWD projects today, but is growing quickly, particularly multi-modality projects which combine types of cRWD and cRWD/RWD. 

cRWD is also the hardest type of data from which to profit, because curating data is hard – for example, in the anonymisation of unstructured data, as well as GDPR and HIPAA compliance. There are hundreds of ways to de-identify data, but the process of de-identification ironically risks losing some original value in that data.  

So while ancillary RWD is an easy, low value path to growth for Veradigm, the real potential riches lie in also accessing cRWD. 

The cRWD Challenge 

We discuss the challenges of exploiting cRWD in this recent Insight. cRWD remains firmly in its formative stages, and is difficult to work with, limiting mass utilisation. While the potential of cRWD is undoubtedly vast (and Veradigm already has an advantage over other cRWD vendors like GE and Philips given that it has more immediate, and broader, access to EHR data and social determinants of health), data curation is time- and labour-intensive. Despite the upside potential, companies like Veradigm would be advised to tread carefully, and avoid betting too heavily on the potential of curated data until NLP technology enables the curation process to become more automised. A more logical approach will be to grow its registry and claims RWD businesses (which are already the bigger part of the company) and, instead of participating directly in cRWD, it may choose to circumvent the issue of clinical data curation and partner out with more vendors like HealthVerity instead. 

A more immediate problem for Veradigm as it tries to accelerate growth in its clinical RWD business is that it lost many resources in the portfolio sale to Harris. Notably, Allscripts’ dbMotion data integration solution. This would have been a valuable weapon for Veradigm in harmonising Oncology Information System (OIS), Laboratory Information System (LIS) and clinical data across its PHM portfolio, but it is now in Altera’s hands. Veradigm also lost some Allscripts inpatient information in the company break-up. 

That said, dbMotion was quite an old technology. An aggregation engine is truly useful only if it can curate data and make it automatically usable. Maybe there is an opportunity here, therefore, for Veradigm to develop a new data aggregation solution which will better serve its own strategic ambitions. 

Race Against Time 

As a public company, Veradigm does not necessarily have the luxury of time to achieve growth. It will need to satisfy its shareholders that its decision to shift focus to RWD is the right one. 

In a 2023 Financial Guidance report, the company says it expects revenues of between $640M and $660M in 2023 (from $552.2M in 2021), and to achieve this it will need to maintain some growth via cash cows (its EHR product lines). In a 2020 Life Sciences Briefing, Veradigm highlighted life sciences and payer solutions as high growth areas for the business, and it really needs to start performing.  

Clinical RWD promises much, but with the challenges of curating data it will take time to unlock the obvious potential. In any case Veradigm will also be up against other EHR vendors which are predicted to continue to dominate the clinical RWD market for the foreseeable future. Wider partnerships between Clinical RWD vendors and generalist RWD providers will be increasingly required as requests for combined clinical and non-clinical datasets increase. Again, this may be a strategic direction option for Veradigm, a company with plenty going for it as it moves into new territory.